The Clinics: Nursing – serie

Intensive care units (ICUs) provide comprehensive, advanced care to patients with serious or life-threatening conditions and consequently, a significant amount of end-of-life care (EOLC). Indeed, approximately 20% of deaths in the U.S. are associated with an ICU stay, and nearly half of U.S. patients who die in hospitals experience an ICU stay during the last 3 days of life. Despite the commonality of the ICU experience, ICU patients typically suffer from a range of distressing symptoms such as pain, fatigue, anxiety, and dyspnea, causing families significant distress on their behalf. Thus, there is a growing imperative for better provision of palliative care (PC) in the ICU, which may prevent and relieve suffering for patients with life threatening illnesses. Effective palliative care is accomplished through aggressive symptom management, communication about the patient and family's physical, psychosocial and spiritual concerns, and aligning treatments with each patient's goals, values, and preferences. PC is also patient-centered and uses a multidisciplinary, team-based approach that can be provided in conjunction with other life-sustaining treatments, or as a primary treatment approach. Failure to align treatment goals with individual and family preferences can create distress for patients, families, and providers. If implemented appropriately, palliative care may significantly reduce the health care costs associated with intensive hospital care, and help patients avoid the common, non-person centered treatment that is wasteful, distressing, and potentially harmful. Due to the success of many PC programs, administrators, providers, and accrediting bodies are beginning to understand that palliative care in the ICU is vital to optimal patient outcomes.

Neuromonitoring is a broad term that essentially accounts for the essence of neuroscience nursing. Nurses working with critically ill, neurologically impaired patients should have a foundation in not only in invasive neuromonitoring, but the more subtle aspects of care. Nurses must understand that they are the most important tool in monitoring patients and interpreting the data. This issue of Critical Care Nursing Clinics will bring together the critical aspects of neuromonitoring in the intensive care units that can be used as a resource for nurses. Some articles included are devoted to Temperature Targeted Management; Refractory Intracranial Pressure Management; Blood pressure monitoring controversies; Invasive Neuromonitoring; Neuroradiology Review; Nursing Monitoring of Critically Ill Neurological Patients; Case Studies in EEG monitoring; and Neuromonitoring in the Operating Room.

Sedation is a necessary component of care for critically ill and injured individuals. Sedatives assist in coping with mechanical ventilation and other invasive devices, and help patients tolerate procedures and noxious stimuli in the intensive care unit. Sedatives are also useful in the control of agitation and delirium. In addition to fundamental humane reasons, calming patients with sedatives provides physiologic benefits, such as reducing oxygen consumption expended during restlessness, and prevents dislodgement of life-preserving tubes and catheters. When administering sedatives to manage critically ill patients, clinicians must be cognizant of the many complex issues surrounding their use. This issue, edited by Consulting Editor, Dr. Jan Foster, provides current updates in this area, including new guidelines and a focus on delirium.

Nurses are challenged to understand the scientific bases of psychiatric disorders and treatment implications that modify behavior and improve functional status and quality of life for clients and their significant others. This challenge extends to integration of scientific knowledge into the biological, functional, and psychosocial distress experienced by persons with mental disorders. The primary strength of this issue is its broad focus and synthesis of scientific knowledge into psychiatric mental health practice. The initial section centers on technological advances and the art of psychiatric mental health nursing and legal considerations when caring for persons with mental disorders. The following section provides discussions of various psychiatric disorders, including anxiety and mood disorders, acute psychosis, attention deficit disorders, substance-related disorders, eating disorders, and borderline personality disorder. The remaining section focuses on special populations and treatment concerning children and adolescents and families in crisis, geriatric emergencies, adverse drug reactions, and suicide. Each article integrates innovative treatment modalities, including pharmacotherapy and psychotherapeutic interventions such as psychoeducation, family involvement, and psychosocial rehabilitation. This issue will provide timely updates in these areas and be a go-to source for mental health and psychiatric nurses.