248 resultados para Adult Deaths


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This paper explores the reasons for the author’s reluctance to bring examples of her own poetry into her practice as teacher educator on a program for adult literacy tutors. The paper begins with the author’s poem, “The Place of Poetry”, which is used as a tool for reflection on the author’s assumptions about her identities as poet and as educator. The paper ends with poems written by the author’s students, which demonstrate that the use of poetry in education has the potential to facilitate transformative learning.

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There is significant public and professional interest in the non-accidental death of children where abuse and neglect are suspected of being contributory factors. Systems for reviewing these deaths have been developed in each of the four jurisdictions within the UK. The main aims are to ensure that individuals and professionals are held to account if practice falls below the expected standard, whilst also seeking to strengthen the systems for protecting children through reflecting on what lessons, if any, can be learnt from the death of a child through abuse or neglect. Recently, the benefit of such inquiries and the quality of serious case reviews have come under scrutiny. In this paper, the authors report the findings of a Delphi study that sought to explore how the process of conducting reviews following the death of a child could be improved through seeking the views of experienced professionals responsible for child protection in Northern Ireland. The authors conclude that the system does command professional support, but could be improved through greater attention to process issues and a stronger emphasis on translating learning into action. In common with research looking at other recent practice developments, there is a need to focus on process indicators as a means to ensuring that well intentioned policies are translated into workable and functioning practices.

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Aims: This paper is a report of a three round Delphi study of intensive care nursing research priorities in Europe (October 2006–April 2009).

Background: Internationally, priorities for research in intensive care nursing have received some attention focusing on healthcare interventions and patient needs. Studies as early as the 1980s identified priorities in the United States, United Kingdom, Hong Kong and Australia. Research priorities of intensive care nurses across the European Union are unknown.

Methods: The participants, invited in 2006, included 110 intensive care nurses, managers, educators and researchers from 20 European Critical Care Nursing Associations. Delphi round one was an emailed questionnaire inviting participants to list important areas for research. The list was content analysed and developed into an online questionnaire for rounds two and three. In round two, participants ranked the topics on a scale of 1–6 (not important to extremely important). Mean scores of round two were added to the questionnaire of round three and participants ranked the topics again.

Results: There were 52 research topics in 12 domains. There was a dominance of priorities in five main areas: patient safety; impact of evidence based practice on outcomes; impact of workforce on outcomes; well being of patients and relatives; and impact of end-of-life care on staff and practice.

Conclusions: The results reflect worldwide healthcare concerns and objectives and highlight topics that nurses view as fundamental to the care of critically ill patients. These topics provide a platform for future research efforts to improve clinical practice and care of patients in intensive care.

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Objective To investigate the effects of weaning protocols on the total duration of mechanical ventilation, mortality, adverse events, quality of life, weaning duration, and length of stay in the intensive care unit and hospital.

Design Systematic review.

Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, LILACS, ISI Web of Science, ISI Conference Proceedings, Cambridge Scientific Abstracts, and reference lists of articles. We did not apply language restrictions.

Review methods We included randomised and quasi-randomised controlled trials of weaning from mechanical ventilation with and without protocols in critically ill adults.

Data selection Three authors independently assessed trial quality and extracted data. A priori subgroup and sensitivity analyses were performed. We contacted study authors for additional information.

Results Eleven trials that included 1971 patients met the inclusion criteria. Compared with usual care, the geometric mean duration of mechanical ventilation in the weaning protocol group was reduced by 25% (95% confidence interval 9% to 39%, P=0.006; 10 trials); the duration of weaning was reduced by 78% (31% to 93%, P=0.009; six trials); and stay in the intensive care unit length by 10% (2% to 19%, P=0.02; eight trials). There was significant heterogeneity among studies for total duration of mechanical ventilation (I(2)=76%, P

Conclusion There is evidence of a reduction in the duration of mechanical ventilation, weaning, and stay in the intensive care unit when standardised weaning protocols are used, but there is significant heterogeneity among studies and an insufficient number of studies to investigate the source of this heterogeneity. Some studies suggest that organisational context could influence outcomes, but this could not be evaluated as it was outside the scope of this review.

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