a bit disappointed about this book, really superficial, recommended only for internship or 4th year medical students, if your older than that, you will be. ICU Recall (Recall Series): Medicine & Health Science Books @ deotertuachartpep.ga ICU Recall (Recall Series) [Curtis G. Tribble] on deotertuachartpep.ga *FREE* shipping on qualifying offers.
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Feb 28, Next. Our Latest B&N Book Club Pick! . ICU Recall (Recall Series) / Edition 1 with concise information concerning intensive care unit issues. The one minor omission is the deletion of central nervous system anatomy in this edition that I believe is important in a book of basic facts like ICU Recall. Nov 1, The updated Third Edition of ICU Recall facilitates rapid review and memorization with a concise question and answer format. Topics include.
Dialysis cannot kick-start the kidneys to function again. ICU measures like ventilators, vasopressor medications, and dialysis are supportive, not curative.
They support failing organs until we can achieve a cure through other means—with antibiotics for pneumonia, a stent for a heart attack, or kidney transplantation for end-stage renal disease. Our ability to return a patient home depends upon our power to achieve cure; ICU measures only support organ function in the meantime. If we cannot treat the inciting illness, ICU measures will only prolong death. They may prod our hearts to beat a while longer, but they will never return us home.
Furthermore, patients and families will inevitably be disappointed if they are not told whether the treatment they or their loved ones are receiving will do is designed to cure the underlying problem or is merely keeping one of their major organs functioning while working towards a cure. In cases where cure is impossible or one of those major organ systems cannot recover, difficult decisions have to be made.
Butler recounts numerous interactions with families of patients struggling with what to do—or not do—when these situations arise and stopping life-sustaining measures is discussed.
Unfortunately, she does not talk much about what sort of life can be preserved so much as she emphasizes how miserable, undignified, and dishonoring the prolongation of death with its invasive procedures, pain, risk of bedsores, and unconscious or semi-conscious experience is. Still, simply articulating the idea that death is not a singular event to be avoided but a process to be recognized and not prolonged is a valuable gift to the church in and of itself.
Butler also does not mention organ transplantation in cases of brain death, a complex topic that probably did not necessarily need a complex discussion of the history of brain death but should have gotten at least a chapter subheading. Particular when it comes to otherwise healthy people who have suffered from a catastrophic trauma, the question of donating organs will inevitably arise and family members should be equipped to think through this topic. At the very least, I would liked to hear Butler ruminate on resurrection bodies containing mismatched organs.
Patients admitted to intensive care are a heterogeneous group admitted for very different reasons. But these patients share a high degree of dependency on others as their ability to perform self-care is reduced.
The subject has been investigated through qualitative in-depth interviews of lived experience with three former patients admitted to an intensive care unit at a Danish university hospital. The in-depth interviews have been characterized as narratives.
Theoretical and empirical background Dependency in an ontological and cultural perspective According to Henriksen and Vetlesen , dependency determines what it means to be a human being. Dependency is linked to a resulting vulnerability, meaning that the human being who is referred to the care of others as a human being is not a self-sufficient self but is always in relationships to other human beings.
In this referral, there is an inherent risk of not being seen and a risk that the caring needs of the individual are not met. Dependency on others is constant throughout life, and it is permanent, but it is often in connection with severe illness that we become conscious of this dependency on others. Dependency on others is often associated with negative feelings and powerlessness, and that is a value-laden concept.
This can be understood from a cultural—historical perspective, as autonomy in the Western culture is considered an overall value. Autonomy means to be self-governing and self-determining. This interpretation of the concept of autonomy comes from the moral philosopher Kant — and still dominates today. To be self-sufficient financially and in relation to work as a cultural ideal can create a basis for the thought that we as human beings are independent.
To be independent becomes an ideal demonstrating freedom that can be won by the human being. Dependency is considered something you can grow out of or detach yourself from.
Experienced dependency in different health science contexts There are several research studies on dependency on care in different contexts.
Five studies explored how it is experienced to be dependent on help in one's own home. Dependency on others is described as a burden associated with insecurity, low self-esteem, and lack of opportunity to negotiate the care. Monrad found that the help is a strain to some as it makes it difficult for the elderly person to maintain the life historical narrative of him or herself. The self is threatened, especially when the help takes over an activity that has defined the elderly person or when the help makes the limitations of the person clear.
Dependency on others is also associated with powerlessness. The experiences of dying patients have also been explored. Eriksson and Andershed have explored how it is experienced to be dependent on care in one's own home or at a hospice when death is imminent. They found that dependency is associated with experiences of bodily alienation, being a burden, and gratitude in relation to the professional caregiver.
Dependency is described as a journey with difficult moments but also with periods of relief when the dying person receives the necessary help and experiences closeness with the caring staff. Dependency has also been explored in the hospital sector. In a study of medical and surgical patients, Strandberg, Norberg, and Jansson found that dependency on care involves a struggle to receive the help needed, and the context, degree, and type of dependency may influence how dependency is experienced.
They preferred when nurses took the initiative.
These articles thus investigate dependency from an organizational perspective. Three articles discuss different aspects of dependency on care from a patient perspective. In an older article, Griffin discussed how the self of critically ill patients is threatened when they are forced to be dependent on others.
Perception of self is described as an important part of perceiving oneself as whole, and it is important to the perception of security and self-esteem. Griffin described how nursing and doctor activities force patients to realize how seriously ill they are, and this changes their perception of the self.
There is an experience of loss in this, and the perception of wholeness is disturbed. Intensive care patients are forced into this dependency, which is passively related to losing control of daily activities and having their privacy invaded by others.
Forced dependency and loss of control are described as significant stressors in the intensive care patient; some patients describe the feeling of lack of control and helplessness as more threatening than the threat of death. The article is rather old, and it is uncertain whether it is based on actual research as it has not been possible to procure the sources on which it is based.
Two newer studies from the intensive care setting describe dependency, but none of the studies have particularly focused on dependency. McKinley, Nagy, Stein-Parbury, Bramwell, and Hudson studied the experience of being a critically ill patient at an intensive care unit. The study was based on focus group interviews with 14 former patients 3—6 months after discharge.
The study found that vulnerability is the concept that best characterizes the intensive care patient. Vulnerability is related to the patient's extreme dependency during critical illness and lack of ability to meet one's own needs. The vulnerability is aggravated when, for example, these needs are not met by the staff.
When needs are met and the care is individualized, patients experience a sense of security despite their vulnerability. It seems to be important to the patients that nurses can anticipate their needs. Almerud, Alapack, Fridlund, and Ekebergh corroborated these findings where they explored how it is perceived to be critically ill or injured in a high-technology intensive care unit. The study was based on interviews with nine patients during their admission or shortly after discharge.
Dependency is one of the elements that defined the experience of being an intensive care patient. Control, influence, and freedom disappear, and patients leave themselves to others; this leads to contradictory feelings of security and vulnerability. Dependency on others and technology are described as a form of suffering where the patients have no other choice but to surrender to machines and routines. The study showed that patients try to be good patients by adapting to the expectations of the system and that technology comes between the patient and the nurse.
The literature review on intensive care patients and dependency has shown that existing studies primarily focus on dependency from an organizational perspective. A few studies have described how dependency is part of the experience of being an intensive care patient. Dependency is in these studies described as being associated with major vulnerability and suffering.
However, there are no empirical studies focusing on experienced dependency. As patients are increasingly awake during their stay at the intensive care unit as a consequence of altered sedation practices, it can be assumed that patients are more conscious of dependency on others compared to previously. The reviewed literature from nonintensive settings show that dependency leads to many different experiences for patients but that dependency often is experienced negatively.
This could indicate that the context plays an important role for how dependency is experienced. Dependency on care will presumably not be experienced in the same way at an intensive care unit compared to receiving help in the home or in another hospital context. Care seems to be more easily accessible in an intensive care unit as it is not planned in the same way as in the primary care field, and the staffing is higher compared to in ordinary bed wards.
Patients on respirator treatment are special because they can have difficulties communicating their own needs. The studies reviewed from nonintensive settings show that dependency is associated with insecurity, powerlessness, lack of control, limited autonomy, bodily alienation, and threatening of integrity and self as a consequence of one's dependency on others.
Dependency is described as being linked to suffering, violation, and fighting where the patients are subjected to the treatment of others. Research also shows that patients use different strategies to cope with dependency.
There are moments of relief, too. It thus seems relevant to focus on the meaning that intensive care patients attach to being dependent on care. Their method has been used in several studies and is applied in healthcare research and human studies when it is important to obtain knowledge of the meaning of lived experience. The main inspiration for developing their method is Ricoeur's phenomenological hermeneutical interpretation theory of moving through three methodological steps in the analysis and interpretation of the text, which is carried out on three levels: a naive reading, a structural analysis, and a comprehensive understanding interpreted whole.
The intention with the method is to improve understanding of a phenomenon. Selection of participants Participants were recruited from a high-technology intensive care unit of a larger Danish university hospital receiving medical and surgical patients. To minimize some of the recall problems, criteria are saying that patients must have been discharged from the intensive care unit within the last 6—12 months and have received respirator treatment for 1 week or longer.
Because of the recall problems, it is very difficult to recruit participants.
Only adults older than 18 years interested in telling their experiences were selected. We assume that there will be other experiences of dependency among children and adolescents. Moreover, only rarely are patients younger than 18 years admitted to the intensive care unit where participants from this study were selected. As patients in all age groups are admitted to an intensive care unit, it was in addition to methodological considerations deemed relevant with an age span.
Only persons who could speak and understand Danish and have a Danish cultural background participated. Patients with signs of posttraumatic stress or patients who had been mentally unstable during the admission to the intensive care unit did not participate in the purposeful selection.
The head nurse knew of two potential participants with signs of posttraumatic stress and one patient who was admitted due to attempted suicide. These patients were not asked to participate.
Through the head nurse at the intensive care unit, contact was established to the participating patients. The nurse was in telephone contact with former patients who complied with the purposeful criteria. The participants were briefly informed about the study by the head nurse, and if they were interested in more information, a letter was sent providing it.
Subsequently, participants were contacted by telephone for confirmation of participation and to make an appointment for the time and place of the interview. The written material suggested that the interview take place in the participant's home, but each participant made his or her own decision. It was difficult to find participants for the study. Eight persons were contacted by the head nurse at first; three agreed to participate. The remaining five were all males; two had no recollection of the stay at the intensive care unit, one declined due to lack of time, one never replied, and one was in such a poor state that participation was not possible according to his spouse.
Several of the patients who, according to the department nurse, were candidates for the study had died after discharge from the intensive care unit. Thus, the criteria for discharge were changed to between 3 and 12 months. The three participants were: Participant 1: year-old female admitted to the intensive care unit due to surgical complications.
The admission lasted 3 weeks. The woman subsequently stayed for a prolonged period of time at a surgical bed ward and has needed help from her family after discharge from the hospital.
She was interviewed 1 year after admission to the intensive care unit, and at this time she had resumed her job. Participant 2: year-old woman admitted to the intensive care unit due to a complicated postoperative course. Moreover, the woman had a known medical problem, which had made the treatment difficult.
She was admitted for 3 months and, subsequently, she participated in prolonged rehabilitation; the total length of hospital admission was approximately 6 months. She was interviewed 3 months after discharge from the intensive care unit, when she had just come home.
She still needs help in the home; the help is provided by family and the professional system. During the stay at the intensive care unit, the woman had been transferred to a smaller hospital with a smaller intensive care unit, and her recollections are primarily from the latter unit. The woman is a pensioner. Participant 3: year-old male admitted to the intensive care unit due to a medical problem.
The stay lasted 3 weeks, and subsequently he was admitted to a medical ward. He was interviewed approximately 3 months after discharge from the intensive care unit. At this time, he is temporarily staying at a nursing home. He has been an early retirement pensioner for 15 years. The participants had been used to managing on their own before the admission to hospital. The participants had difficulties recalling the time at the intensive care unit and to make coherent narratives; especially participant 3 had difficulties distinguishing dreams from reality and episodes from the bed ward and the intensive care unit.
It has been possible to exclude parts of the interview due to knowledge of the special characteristics of the intensive care unit. Materials and analysis The interview guide contained the following themes: dependency in relation to understanding of self, dependency in relation to time, bodily experiences linked to dependency, and experiences in relation to the nurse. Themes and questions were based on the literature review.
The guide has functioned only as an indicator.
Transcriptions have been made after each interview to provide a clear recollection of the interview; to increase the reliability, parts of the interviews have been heard many times. The transcription process has been long and has demanded carefulness. The findings appear through an analysis and interpretation of the text, which is carried out on three levels: a naive reading, a structural analysis, and an interpreted whole that can increase, change, or broaden the understanding.
This means that it is a continuous process from what is said to what is talked about.
This demands a phenomenological approach where the researcher is open to what the text says and becomes influenced and moved by it. The structural analysis searches for themes, threads of meaning penetrating the whole text or parts of it.
These meaning units are read and reflected upon in relation to the naive reading. You'll find complete coverage of multi-system pathologic processes such as malnutrition, immunosuppression, neoplasia, and manifestations of infection, as well as patient-specific issues such as trauma, burns, transplants, and pediatric problems.
This edition includes new techniques for cardiac support, renal support, and immunosuppression and thoroughly updated information on pharmacology, radiology, and monitoring. The enclosed bookmark helps readers self-test by covering the answers.
ICU Recall lives up to the detailed, well organized and easy to learn information expected from the Recall series of books. If you are new to critical care medicine, this is a must have.
ICU Recall. Nelson L. Thaemert , Charles E.Cardiac Arrest. While Branen could not move - and couldn ;t speak, thanks to feeding and breathing tubes - she could hear everything than transpired in the room next to hers.
He finishes by saying that in the end you give up or postpone your needs. The nurse was in telephone contact with former patients who complied with the purposeful criteria. A finding confirmed by Strandberg et al.
Book Review: Between Life and Death by Kathryn Butler
However, its use is increasing and an expanded section including modes, settings, troubleshooting, and evidence-based indications would be useful. Your Email:.
Establishing a revised story makes it possible to move on Horsdal, , pp.
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