Nursing care of the mechanically ventilated patient: what does the evidence say? Part one.

The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.

Nursing care of the mechanically ventilated patient: What does the evidence say?: Part two

The care of the mechanically ventilated patient is a fundamental component of a nurse's clinical practice in the intensive care unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly, yet is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient was explored with specific focus on patient safety: particularly patient and equipment assessment. This article, part two, examines the evidence related to the mechanically ventilated patient's comfort: patient position, hygiene, management of stressors (such as communication, sleep disturbance and isolation), pain management and sedation.

Therapeutic relationships in specialist palliative care nursing practice.

There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked.

Turning Around Talipes: Nursing Considerations

The management of congenital talipes equinovarus (TEV) has received much clinical and research attention within the disciplines of medicine and physiotherapy. However, few articles have been published about the role of the registered nurse in contributing to the optimum health and wellbeing of the child and family presenting for assessment and treatment of the condition. Much of the most intense treatment for TEV occurs in the first few weeks of the child’s life; a time of critical growth and development when the infant is both sensitive and vulnerable to the environment within which it is nurtured. This is also a crucial time for developing a secure attachment to the caregiver and nurses can assist parents in optimising their infant’s opportunities for a secure attachment relationship. This paper thus provides an overview of the medical and physiotherapy management of TEV and highlights the role nurses have in providing nursing care and psycho-social support to parents of infants with TEV, in areas such as the maintenance of skin integrity and circulation, providing effective pain relief, and optimising growth, development, and a secure attachment relationship. Congenital TEV or 'club foot' is one of the most common congenital orthopaedic anomalies of infants. In Queensland in 2000, in approximately 50,000 births, 244 infants were born with talipes; almost five infants per 1000 births. National statistics are not as specific, with coding providing only 'other lower limb' as the category that would encompass talipes; the 1997 national incidence of such lower limb congenital malformations is reported as 1.7 per 10,000 births 1.

Advancing the meaning of nursing and technology

Technology and Nursing Practice explains and critically engages with the practice implications of technology for nursing. It takes a broad view of technology, covering not only health informatics, but also 'tele-nursing' and the use of equipment in clinical practice.

Technological Change and Nursing: A Labour Process Theory Approach to the Shaping of Nursing Work

Technology and Nursing Practice explains and critically engages with the practice implications of technology for nursing. It takes a broad view of technology, covering not only health informatics, but also 'tele-nursing' and the use of equipment in clinical practice.

Nursing resource implications of the unoccupied bed

Objective: To explore the specific factors that impact on nursing resources in relation to the ‘unoccupied bed’. Design: Descriptive observational Setting: Multiple wards in single site, tertiary referral hospital Main outcome measure: Identification and classification of tasks related to the unoccupied bed. Results: Our study identified three main areas of nursing work, which centre on the ‘unoccupied bed’: 1) bed preparation for admission; 2) temporary transfer; 3) bed preparation post patient discharge. Conclusion: The unoccupied bed is not resource neutral and may involve considerable nursing time. The time associated with each of the reasons for the bed being unoccupied remains to be quantified.

Economics of maritime disasters : essays on the Titanic and Lusitania

This work seeks to fill some of the gap existing in the economics and behavioural economics literature pertaining to the decision making process of individuals under extreme environmental situations (life and death events). These essays specifically examine the sinking’s of the R.M.S. Titanic, on 14th April of 1912, and the R.M.S. Lusitania, on 7th May 1915, using econometric (multivariate) analysis techniques. The results show that even under extreme life and death conditions, social norms matter and are reflected in the survival probabilities of individuals onboard the Titanic. However, results from the comparative analysis of the Titanic and Lusitania show that social norms take time to organise and be effective. In the presence of such time constraints, the traditional “homo economicus” model of individual behaviour becomes evident as a survival of the fittest competition.

Re-thinking home economics : from modern to postmodern accounts of pedagogical bodies

Two perceptions of the marginality of home economics are widespread across educational and other contexts. One is that home economics and those who engage in its pedagogy are inevitably marginalised within patriarchal relations in education and culture. This is because home economics is characterised as women's knowledge, for the private domain of the home. The other perception is that only orthodox epistemological frameworks of inquiry should be used to interrogate this state of affairs. These perceptions have prompted leading theorists in the field to call for non-essentialist approaches to research in order to re-think the thinking that has produced this cul-de-sac positioning of home economics as a body of knowledge and a site of teacher practice. This thesis takes up the challenge of working to locate a space outside the frame of modernist research theory and methods, recognising that this shift in epistemology is necessary to unsettle the idea that home economics is inevitably marginalised. The purpose of the study is to reconfigure how we have come to think about home economics teachers and the profession of home economics as a site of cultural practice, in order to think it otherwise (Lather, 1991). This is done by exploring how the culture of home economics is being contested from within. To do so, the thesis uses a 'posthumanist' approach, which rejects the conception of the individual as a unitary and fixed entity, but instead as a subject in process, shaped by desires and language which are not necessarily consciously determined. This posthumanist project focuses attention on pedagogical body subjects as the 'unsaid' of home economics research. It works to transcend the modernist dualism of mind/body, and other binaries central to modernist work, including private/public, male/female,paid/unpaid, and valued/unvalued. In so doing, it refuses the simple margin/centre geometry so characteristic of current perceptions of home economics itself. Three studies make up this work. Studies one and two serve to document the disciplined body of home economics knowledge, the governance of which works towards normalisation of the 'proper' home economics teacher. The analysis of these accounts of home economics teachers by home economics teachers, reveals that home economics teachers are 'skilled' yet they 'suffer' for their profession. Further,home economics knowledge is seen to be complicit in reinforcing the traditional roles of masculinity and femininity, thereby reinforcing heterosexual normativity which is central to patriarchal society. The third study looks to four 'atypical'subjects who defy the category of 'proper' and 'normal' home economics teacher. These 'atypical' bodies are 'skilled' but fiercely reject the label of 'suffering'. The discussion of the studies is a feminist poststructural account, using Russo's (1994) notion of the grotesque body, which is emergent from Bakhtin's (1968) theory of the carnivalesque. It draws on the 'shreds' of home economics pedagogy,scrutinising them for their subversive, transformative potential. In this analysis, the giving and taking of pleasure and fun in the home economics classroom presents moments of surprise and of carnival. Foucault's notion of the construction of the ethical individual shows these 'atypical' bodies to be 'immoderate' yet striving hard to be 'continent' body subjects. This research captures moments of transgression which suggest that transformative moments are already embodied in the pedagogical practices of home economics teachers, and these can be 'seen' when re-looking through postmodemist lenses. Hence, the cultural practices ofhome economics as inevitably marginalised are being contested from within. Until now, home economics as a lived culture has failed to recognise possibilities for reconstructing its own field beyond the confines of modernity. This research is an example of how to think about home economics teachers and the profession as a reconfigured cultural practice. Future research about home economics as a body of knowledge and a site of teacher practice need not retell a simple story of oppression. Using postmodemist epistemologies is one way to provide opportunities for new ways of looking.