Biomedical subjects
Publications and source records attributed to M G Titler.
Critical care nurses have a responsibility to provide care from a family-systems perspective in which illness is not an isolated, time-limited event, but instead a highly stressful situation that evolves from the family's history and contributes dynamically toward its future. This article discusses nurse-family relationships, strategies to promote family-focused care, and mechanisms to make family-focused care a reality.
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The authors describe the process and outcome of implementing a research-based pain management protocol in four adult critical care units at a large, Midwestern tertiary care center. The project was initiated and directed by members of the divisional research committee. Strategies used to change practice included determining if pain management was a problem via quality assessment monitors, surveying nurses regarding their knowledge and attitude toward pain management, educating staff members about the research base for the practice change, using change champions in each unit, and developing a core group of nurses in each unit to facilitate the change. Outcomes of this research utilization project include a 41% decline in the number of patients in pain, a 44% decline in pain intensity, and improvement in nurses knowledge about pain.
Pain management in the critically ill is a challenge and a problem of great concern for critical care nurses. The authors review research on pain in the areas of pain assessment, nurses' knowledge and attitudes, pharmacologic interventions, and nonpharmacologic interventions for the management of pain. Although the research base is not completely developed in the critically ill population, implications for practice are provided, based upon the findings in populations akin to the critically ill. Strategies are outlined for achieving improved pain control in critical care units through education, adoption of standards on pain management, and quality improvement activities.
Although nurses contribute significantly to patient outcomes, there are few data documenting the nature or magnitude of that impact and how it may vary in different practice settings or geographic regions (Lang & Marek, 1992). Only when we move beyond the theoretical into the practical application of outcome evaluation and management will we be able to have a data-driven system to articulate nursing's contribution to patient outcomes. Making this application a reality requires the vision and talents of nurses in all roles from staff nurses to administrators.
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How much blood must be discarded from a heparinized arterial line to obtain accurate coagulation studies, specifically activated partial thromboplastin time? The published literature provides insight into the question and guidelines for practice in adult critical care. This article reviews and integrates findings from 14 research studies published from 1971 to 1993 on discarding blood from arterial lines for coagulation studies. Investigators compared activated partial thromboplastin time values from arterial and venous blood samples using various discard volumes, sites and sizes of catheters, and heparin flush concentrations. Similarities and differences in arterial and venous activated partial thromboplastin time were reported. Studies have demonstrated that adequate discard volume for activated partial thromboplastin time is 6 times the catheter dead space. These results should not be generalized to systemically heparinized patients, pediatric patients, or other types of heparinized lines such as pulmonary artery, central venous, or Hickman catheters.
Collaborative research teams are an attractive means of conducting nursing research in the clinical setting because of the many opportunities that collaboration can supply. These opportunities include a chance to: (1) network with other nurses who have similar interests, (2) share knowledge and expertise for designing clinical studies that directly affect daily practice, (3) develop instruments, (4) write grant proposals, (5) collect and analyze data, and (6) prepare manuscripts for publication. The effectiveness of research teams, however, is strongly influenced by group functioning. This article describes the functioning of a collaborative family interventions research team of nursing faculty members and CNSs at a large Midwestern university setting. The formation of the group and membership characteristics are described, along with strategies used to identify the research focus and individual and group goals. Aspects related to the influence of the group on members and the internal operations of the group are also addressed. Future strategies to be explored will focus on the size of the group and joint authorship issues. The authors also set forth a number of recommendations for development of collaborative research groups.
This articles describes the behavioral responses of adult family members to critical illness and how these responses change over the course of the hospitalization. A convenience sample of 52 family members of patients in intensive units completed the Iowa ICU Family Scale, a self-report tool measuring sleep, eating, activity, family role, and support behaviors. Scales were completed by family members each day during the first week and then weekly throughout the patient's ICU stay. Family members reported sleeping less with a poorer quality of sleep, less nutritional intake, an increased use of cigarettes, alcohol, and over-the-counter and prescription medications, and spending more time talking, visiting the patient, and waiting. Stress was highest at the time of the ICU admission, began to plateau at Day 6, and then dropped considerably by Day 28. These findings suggest that crisis intervention is important during the early phase of caring for critically ill patients and their family members.
Research on iatrogenic injuries and technology dependency is sparse in light of the expansive use of technology in health care today. Many of the publications are single case reports of an iatrogenic injury related to a specific type of device. Little has been done to analyze these reports in a collective fashion. Nursing research is especially limited, and most studies were located in the medical literature. The majority of research has been done in pediatric populations with major emphasis on respiratory and nutritional technology. In contrast, little research has been done with adults who are ventilator dependent. Perhaps the paucity of research in this area is related to the Food and Drug Administration (FDA) requirements for technology safety before placement of a device on the health care market with the subsequent assumption by health care personnel that the technology is safe and effective. The challenge for the future is to build programs of nursing research that (1) describe the incidence and nature of iatrogenic injuries associated with technologies that are of high volume and for which many patients are dependent and (2) to tests ways to prevent iatrogenic injuries associated with technologies often used in nursing practice.
This article reviews the other articles in this issue that provide evidence of recent progress in clinical nursing research. The authors, guest editors of this issue, issue a call for further research to develop improvements in clinical nursing practice.
Visitation and proximity needs are consistently rated as very important by families of critically ill patients. This article reviews the literature on the proximity needs of families, presents nursing interventions to meet them, and suggests a plan for future research in this area.
This study defined 10 nursing interventions that focus on purposeful acquisition, interpretation, and synthesis of patient data for clinical decision making. Critical and supporting activities used to carry out these interventions were delineated. Organizing and naming of monitoring activities are essential first steps to legitimizing, documenting, and investigating this area of professional nursing practice.
This phenomenologic study describes the effects of adult hospitalization in a critical care setting on the family as perceived by patients, spouses, children in the family, and nurses. Tape-recorded interviews were completed with 12 spouses, 9 patients (2 mothers and 7 fathers), 11 children, and 12 nurses. Responses were analyzed by using systematic thematic content analysis. Themes that emerged with regard to how this event affected the family unit and individuals in the family included (1) lack of communication among family members; (2) protecting children from anxiety-provoking information; (3) overriding threat, exemplified by feelings of vulnerability, uncertainty, intense emotions, and physical illness in children; (4) disruption of normal home routines; (5) changes in relationships; and (6) role conflict. Nurses' perceptions of the impact of this event on parents, spouses, and children demonstrated some incongruences with perceptions of patients and family members. Practice implications from this study include the following nursing actions: (1) eliciting more comprehensive information about relationships among family members and the impact on the family; (2) developing mechanisms to promote communication among family members; (3) making referrals to community resources such as school nurses, counselors, and chaplains; and (4) teaching nurses and parents ways to help children cope with this event.
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Successful implementation of nursing diagnosis in nursing education begins with assessment of the program's philosophy, terminal objectives, faculty, and organizational framework. The outcome of successful implementation is a graduate that uses nursing diagnosis as the pivotal point in nursing practice. If nurses of today and tomorrow are to become competent diagnosticians in nursing, teaching diagnostic reasoning and nursing diagnosis formulation must be an integral part of the nursing educational process.
The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).