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Biomedical subjects

C Coulton

Publications and source records attributed to C Coulton.

8 recordsLinked to original sources
PubMed1985

'Do not resuscitate' orders. Incidence and implications in a medical-intensive care unit.

"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. The DNR patients consumed more resources, both before and after DNR orders. Interventions started before DNR designation were continued in at least 76% of patients. Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.

Aged↗
PubMed1985

Research agenda for discharge planning.

With increased competition over diminishing resources in health care today, discharge planning has become a key element for hospital survival. The sudden high status now attached to this traditional social work function has caused major power struggles for control over discharge planning. Social workers have up to now succeeded in being undisputed leaders in this area because of tradition and demonstrations of clinical competence. Continued success and status in the future will require arguments and organizational design based on scientific research and hard data. This paper describes the main questions that need to be examined and proposes manageable approaches for conducting practice field studies.

Aftercare↗
PubMed1984

ICU visiting policies.

Head nurses from 78 ICUs in 37 northeast Ohio hospitals were interviewed about visiting policies. There was tremendous variation with regard to frequency and length of visits; 25% of these ICUs allowed only 2 visits/day, and 42% restricted visits to under 20 min. Most units rarely or never allowed children under 12 yr old to visit. Traditional rationales for restricted visiting are not supported by studies in the literature, nor are they consistent with current concepts of patients' rights. In an era where high technology and medicine by-the-numbers threaten to dehumanize patients, open visiting is an important part of the humanization process.

Adult↗
PubMed1983

A national survey of hospital ethics committees.

A telephone survey of 602 randomly selected hospitals was conducted to identify existing ethics committees, i.e., those with the potential to become involved in the decision-making process in specific cases. Using the number of acute care beds as the criterion, hospitals were divided into 2 groups: (1) over 200 beds; n = 400; (2) 200 or fewer beds; n = 202. Chairpersons of identified committees completed detailed questionnaires. Seventeen committees were found--approximately 1% of all U.S. hospitals. A typical committee included physicians, clergymen, and other professionals. Almost all committees were advisory, not decision-making bodies, and considered very effective by their chairpersons. Ethics committees have not, however, solved current medical ethical problems; nor have they allayed the concerns of patients' rights advocates about patient representation and control. Further study is warranted.

Ethical Review↗
PubMed1980

Planning for posthospital care: a follow-up study.

Ongoing services to patients who are about to be discharged from the hospital appear to be critically needed. Whether the need for such services should be met by hospitals or community agencies requires examination. This article reports on a study that describes the posthospital needs of patients and the extent to which these needs are met subsequent to discharge.

Aftercare↗