Canadian Journal of Critical Care Nursing

In early 2010, the Royal Alexandra Hospital (RAH) was the only tertiary hospital in Edmonton, Alberta, without a rapid response team (RRT). Once funding was obtained, the RAH RRT was developed with the mission of "Helping you make it happen" with the underlying philosophy that any call is a good call and the team is there to support care on the wards. The RAH RRT is unique, as it uses a registered nurse/respiratory therapist model rather than the physician model used by most tertiary centres. The RAH RRT provides consistent and efficient response to deteriorating patients and visitors to the hospital...

ICU care has traditionally focused on curative treatment, but making the decision to withdraw life-sustaining therapies, the there is an increasing awareness of the key role palliative and barriers to providing good end-of-life care, factors that support comfort care play. Through a review of recent literature on end- good end-of-life care, and specific guidelinesfor the withdrawal of-life care and withdrawal of life-sustaining therapies in the of life-sustaining therapies. Using this information, a checklist to intensive care unit, four themes have emerged: the challenges of support end-of-life care by critical care nurses was created...

BACKGROUND: Death is a common occurrence in intensive care units (IC Us) and the complexity of care makes it difficult for nurses to find a balance between the patient's physical needs and the family's emotional needs, especially in circumstances of unexpected death. Cumulative or unresolved grief for families can have lasting negative repercussions. Nurses, therefore, need access to bereavement education in order to provide optimal- bereavement support. PURPOSE: The purpose of this review is to identify challenges and facilitators that nurses experience in delivering bereavement support during and after sudden or unexpected death in ICUs...

BACKGROUND: Pain is a common experience among patients in intensive care units (ICUs). Many patients in ICUs have difficulty communicating their pain because of mechanical ventilation, and issues can arise when the nurse attempts to interpret the severity of pain,and work towards effective pain management. PURPOSE: The aim of this study was to determine the suitability of the Critical-Care Pain Observation Tool (CPOT) as an assessment tool to be used by ICU nursing staff to assess pain in adult...

In February 2015, the Supreme Court of Canada released its decision in the Carter v. Canada (Attorney General) case, declaring section 241(b) and section 14 of the Criminal Code invalid, and granting a one-year suspension on that declaration to enable the Parliament of Canada to respond. In June 2016, Bill C-14: An Act to Amend the Criminal Code and Make Related Amendments to Other Acts (Medical Assistance in Dying) was passed after much debate in the House of Commons and Senate of Canada. Brief summaries of the Carter v...

BACKGROUND: There is growing knowledge specif c to remote, rural and northern nursing practice in Canada's north. However, there is limited research that specifically addresses the experiences of critical care nurses working in Canada's northern communities. PURPOSE: The purpose of this pilot study was to begin to explore and better understand the experiences of Canadian nurses providing critical care to patients and families in intensive care units north of the 60th parallel...

BACKGROUND: The intensive care unit (IGU) is a busy, high stress, complex environment in which health care professionals routinely provide numerous forms of advanced life support and life sustaining measures to a wide mix of critically ill patients. Frontline ICU professionals directly involved in patient care may be subjected to considerable psychosocial stressors and be susceptible to moral distress and burnout. PURPOSE: To describe and compare the prevalence and contributing factors to moral distress and burnout among ICUprofessionals in a large quaternary cardiovascular surgery ICU (CVICU)...

Debriefing is the active reflection, conceptualization and basis for reinforced or changed behaviour in response to new learning experiences. It has been acknowledged as a valuable tool towards achieving learning outcomes informal teaching or training ven- ues. However, there is limited recognition of the importance of informal debriefing in the clinical setting, especially in critical care settings. Additional specialized training is received by registered nurses to be able to care for clinically unstable patients in critical care units...

Shift work is a common practice in the health care field to maintain 24-hour patient care. The purpose of this article is to recognize the negative impact of shift work on critical care nurses, and identify strategies to mitigate these effects. A review of the literature was completed, using the search terms: 'shift work, 'critical care', impact, and health. The literature revealed that shift work has an adverse effect on the health of a nurse. Some of the health implications include stress, sleep deprivation, cardiovascular disease, gastrointestinal symptoms, and mental health illnesses...

No abstract text is available yet for this article.

BACKGROUND: In situ simulation (ISS) is an emerging teaching strategy aimed to improve professionals' competencies and collaborative practice to increase patient safety The impact of ISS is still to be demonstrated before expanding the use of this method in our critical care settings. PURPOSE: The objective of this paper is to explore the literature regarding ISS training and present advantages and challenges. DESIGN AND METHOD: An integrative review was conducted, based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement...

BACKGROUND: Acute kidney injury (AKI) is a common complication in critically ill patients. Renal replacement therapy is prescribed for as many as 70% of critically ill patients in AKI and may be provided in the form of intermittent or continuous dialysis including intermittent hemodialysis, sustained low-efficiency dialysis, and continuous renal replacement therapy (CR RT). CRRT is commonly used for unstable critically ill patients, as it involves a slow continuous process. The nursing work involved with CR RT is highly complex and the learning requirements are challenging; therefore, it is important to identify nursing practices...

Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals...

BACKGROUND: Most intravenous medication errors occur during administration. Smart pumps can reduce the incidence of dose or rate errors using soft and hard limits. However, industry standard dose error reduction software misses errors that occur during titration. The dose change alert was developed to detect errors during titration. PURPOSE: To evaluate the safety implications of the dose change alert in the SIGMA Spectrum Infusion System on the administration of high-alert medications at The Ottawa Hospital...

BACKGROUND: Legislation, guidelines and accreditation standards cal for the minimization of physical restraints, yet their use remains common in intensive care units (ICUs) both in Canada and internationally. In Canada, physical restraints are prescribed by physicians. However, assessment of their need, application, and removal are primarily the responsibility of ICU nurses. OBJECTIVES: We sought to describe Canadian ICU nurses' decision-making and practices of physical restraint application and discontinuation, as well as alternative measures attempted prior to their use for critically ill adults...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

UNLABELLED: An unplanned extubation is defined as an extubation that occurs at a time other than that planned for the procedure. It may result in life-threatening complications such as laryngospasm, pulmonary or cardiac failure. Quality improvement initiatives have targeted an unplanned extubation rate of 0% in pediatric intensive care units. OBJECTIVE: To determine if a targeted approach specific to local practices and unit culture could decrease the incidence of and, ultimately, eliminate unplanned extubations in our tertiary care PICU...

Ethical or legal errors related to the consent pathway for incapable patients are an everyday reality. Quality improvements in communication or palliative care have been attempted, but little attention has been given to meeting basic legal and ethical obligations. In this paper, the authors share lessons learned during two years of implementing the Checklist for meeting Ethical and Legal Obligations (ChELO) in the intensive care unit of a large community hospital in Ontario. We use a case-based approach to demonstrate the need for our intervention, our use of positive deviance in a change strategy, and the effectiveness of the checklist itself...