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Biomedical subjects

K T Kirchhoff

Publications and source records attributed to K T Kirchhoff.

At least 19 recordsLinked to original sources
PubMed2000

Intensive care nurses' experiences with end-of-life care.

BACKGROUND: With much attention being focused on how patients die and whether or not they are provided appropriate care, the care of dying patients in intensive care units must be described and improved. OBJECTIVES: To describe end-of-life care in intensive care units as perceived by critical care nurses who have taken care of dying patients. METHODS: A semistructured interview guide was developed and revised after pretesting in a focus group of faculty clinicians with extensive, recent experience in intensive care. Four focus groups were held with randomly selected nurses from 4 intensive care units in 2 hospitals; participants had 2 years or more of experience and were working half-time or more. Tapes from each focus group were transcribed and reviewed by the investigators before the subsequent group met. Category labels were developed, and topics and themes were determined. RESULTS: "Good" end-of-life care in the intensive care unit was described as ensuring that the patient is as pain-free as possible and that the patient's comfort and dignity are maintained. Involvement of the patient's family is crucial. A clear, accurate prognosis and continuity of care also are important. Switching from curative care to comfort care is awkward. CONCLUSIONS: Disagreement among patients' family members or among caregivers, uncertainty about prognosis, and communication problems further complicate end-of-life care in intensive care units. Changes in the physical environment, education about end-of-life care, staff support, and better communication would improve care of dying patients and their families.

Adult↗
PubMed2000

Critical care nurses' perceptions of obstacles and helpful behaviors in providing end-of-life care to dying patients.

BACKGROUND: Little is known about nurses' perceptions of obstacles or helpful behaviors ("helps") in providing end-of-life care in the intensive care setting. OBJECTIVE: To determine the importance of various obstacles and helps in providing end-of-life care as perceived by critical care nurses. METHODS: A questionnaire was mailed to 300 members of the American Association of Critical-Care Nurses. Nurses were asked to rate obstacles and helps in giving end-of-life care, and additional obstacles and/or helps, and answer demographic questions. RESULTS: Six of the top 10 obstacles were related to issues with patients' families that make care at the end of life more difficult, such as the family's not fully understanding the meaning of life support, not accepting the patient's poor prognosis, requesting more technical treatment than the patient wished, and being angry. Added obstacles related mostly to problems with physicians' behavior. Most helps were ways to make dying easier for patients and patients' families, such as agreement among physicians about care, dying with dignity, and families' acceptance of the prognosis. Added helps included allowing music, pets, and so forth into the patient's room. CONCLUSIONS: Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering. Nurses do not acknowledge having difficulty providing care to dying patients aside from conflicts that arise because of patients' families and physicians.

Adult↗
PubMed1996

Evaluation of scheduled J-pouch irrigations on decreasing stool frequency after ileoanal pull-through and ileostomy closure.

This study was intended to determine whether J-pouch irrigations through the efferent limb of the protective ileostomy stoma after ileoanal pull-through are effective in decreasing high stool frequency after ileostomy closure. Patients undergoing ileoanal pull-through may have high stool frequency after ileostomy closure. J-pouch irrigations through the efferent ileostomy stoma may decrease stool frequency by increasing J-pouch volume, improving storage capacity. The study used a randomized, prospective design in a university hospital outpatient setting. Participants (N = 58) were randomly assigned to control and experimental groups. Effectiveness of irrigation was determined by stool frequency. Both groups were taught Kegel exercises (anal muscle strengthening exercises). The experimental group was taught how and when to irrigate the J-pouch daily; the control group was not. Forty-seven subjects, 25 men and 22 women ranging in age from 15 to 65 years, completed the study. Results of MANOVA indicated no significant between-group difference in the average number of times that subjects performed Kegel exercises; however, there was a significant decrease during the 4-week study period (p < 0.001). There was no significant difference between groups in stool frequency, which decreased with time. There also was no significant effect on nocturnal leakage or satisfaction with surgical outcome. Additional clinical variables that were measured but had no significant effect included eating late, pouch size, and intake of sugar, fiber, bulk-forming products, and antidiarrheal agents. The study did not support the effectiveness of J-pouch irrigation in decreasing stool frequency after ileostomy closure. The cost, time commitment, and burden of performing daily irrigations are not warranted in this patient group.

Adult↗
PubMed1995

Productivity of nurse researchers employed in clinical settings.

With limited resources, there is increased scrutiny of the contributions of leadership staff, such as nurse researchers employed in the clinical setting (NRECS). The authors describe activities that pertain to research, presentations, publications, and procurement of funds for studies. Major obstacles that impede NRECS from achieving their goals, job performance evaluation and indices (staff, organization, and personal) that NRECS use to determine success in enacting their role also are presented.

Clinical Nursing Research↗
PubMed1995

Ensuring accurate references.

About one-third of published nursing articles have some type of error in the references. Authors need to ensure that references are accurate before submitting the manuscript to the journal or book publisher. This author who has conducted research on reference errors and is an experienced author gives you practical steps to prevent errors in your manuscript.

Bibliographies as Topic↗
PubMed1995

Chest tube removal practices in critical care units in the United States.

BACKGROUND: Pain assessment and management are recognized as major problems in critical care settings. However, little is known about pain management practices related to medical procedures performed in the ICU, particularly removal of chest tubes. OBJECTIVES: To describe practices related to chest tube removal in the United States, with an emphasis on pain assessment and management. METHODS: A survey instrument was developed and mailed to 995 members of the American Association of Critical-Care Nurses who cared for patients with chest tubes. They were asked about chest tube removal practices in their institutions. RESULTS: Chest tubes are removed primarily by physicians and house staff, although 11% of respondents reported that specially trained nurses removed the tubes. Only 16% indicated that a prescription for pain medication was routinely available before chest tube removal. The drug administered most frequently was intravenous morphine sulfate, but the dose varied considerably. Nurses were generally satisfied (65.6%) with practices related to chest tube removal in their unit; nurses who were not satisfied (34.4%) wished to see better pain management practices (45%), removal of tubes by the patient's assigned nurse (17.8%), a protocol for tube removal (13.9%), notification of the nurse before removal (12.2%), and other changes (10%). CONCLUSIONS: Practices associated with chest tube removal, especially pharmacologic management of procedure-related pain, vary in critical care units. Caregivers are advised to develop practice policies to guide decisions about management of acute pain in this patient population.

Adult↗
PubMed1993

Nurses' beliefs and attitudes toward visiting in adult critical care settings.

OBJECTIVE: To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. DESIGN: Both interviews and questionnaires were used to gather data on nurses' attitudes and beliefs about visiting and open visiting according to the format of Ajzen and Fishbein's Theory of Reasoned Action. SETTING: Five Utah intensive care units and three Ohio intensive care units. SAMPLE: Critical care nurses in Utah (N = 29) and Ohio (N = 41) were interviewed to assess their beliefs about the effects of visiting on patients, families, nurses and nursing care delivery. RESULTS: Nurses believed the consequence of visiting was more positive for the patient from a psychological perspective than from a physiological perspective but that the effects might differ depending on the patient, the visitor and the circumstances. They believed that visiting had negative consequences for families, because they became exhausted, and that visiting was disruptive for nursing care delivery. Their attitudes about effects of visiting on nursing staff were consistently more negative than were attitudes about the effects on the patient and the family. CONCLUSION: To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.

Adult↗
PubMed1993

Increasing the wearing time of vinyl urinary drainage bags by decontamination with bleach.

The purpose of this study was to determine the safety of 4 week re-use of vinyl urinary leg and bed bags in the acute rehabilitation setting when decontaminated daily with a dilute bleach (sodium hypochlorite) rinse. Patients requiring urinary bags (n = 54) were randomly assigned to Control (C) and Experimental (E) groups. C's bags were replaced weekly; E's only after four weeks. Both groups received identical daily bag decontamination and weekly urine and bag cultures. No significant differences were found between groups with ANCOVA, controlling for baseline urine cultures, age, number of days catheterized, and use of antibiotics. Thirty different organisms were cultured in urine and bags; when the procedure was done daily, all bag cultures showed only minimal contamination (0-100CFU/mL). Bacterial growth (4.4% of leg bags) > 100CFU/mL was found only when the daily decontamination procedure had been omitted. In fact, 57% of leg bags and 76.5% of bed bags returned with no growth. We conclude that it is safe and cost effective to reuse vinyl urinary leg and bed bags for four weeks.

Adult↗
PubMed1993

Issues and challenges in clinical nursing research.

In this article, issues encountered that are problematic in conducting research in clinical settings are discussed along with potential solutions. Subject accrual, compatibility of the research protocol with day-to-day operation of the clinical site, gaining cooperation from groups of health professionals, and obtaining required approvals are the most common problems encountered. Overcoming these problems does not mean the elimination of them; awareness and acknowledgement of these problems in the planning process will minimize the negative influence they may have on the study.

Clinical Nursing Research↗
PubMed1992

Development of a program for neonatal intensive care units managed by neonatal nurse practitioners.

Because of reduced medical coverage and changing educational experiences of the pediatric residents, the Department of Nursing Practice at the University of Utah Hospital in collaboration with the Department of Patient Care Services at Primary Children's Medical Center seized the opportunity to develop a nurse-managed patient care service within two tertiary-level nurseries in the State of Utah. Collaboration with nursing administrators and practitioners in both sites yielded joint plans for a successful NNP program. Initial efforts were to fund jointly and support the College of Nursing to develop an educational program, whereas the clinical program was developed before the reduction in medical coverage. Many issues were addressed because of the multidisciplinary and multi-institutional nature of the program. Work is ongoing in the recruitment of students and NNPs, development and review of clinical practice, and endorsement and privileging considerations.

Hospitals, Pediatric↗
PubMed1992

Positional oxygenation changes in air-transported neonates.

The effect of position on oxygenation was compared in 24 critically ill, premature neonates during pressurized, fixed-wing transport. The purpose of the study was to assess if there is a significant change in the arterial oxygen tension in the supine, prone, or prone-free positions during air transport. Neonates with endotracheal tubes in place who (1) had radiologic evidence of hyaline membrane disease, (2) had an umbilical artery catheter in place, and (3) required at least 1 hour of air transport to a level III intensive care center were admitted into the study after parental consent. There was an average 8% increase in oxygenation in the prone and prone-free positions when compared with the supine position. Although this difference might be considered clinically significant for the critically ill premature neonate, there was no statistically significant difference in arterial oxygen tension among the three positions tested in this study.

Aircraft↗
PubMed1991

Analysis of the research about heparinized versus nonheparinized intravascular lines.

This article is a review and analysis of published and unpublished research on the efficacy of both dilute heparin solutions and normal saline solutions in flushing and maintaining the patency of vascular catheters. Twenty studies involving both intravenous and intraarterial catheters in pediatric and adult patients are summarized and analyzed both quantitatively and qualitatively. Thirteen studies that were conceptually similar were subjected to a meta-analysis; no significant difference in duration of patency was found between intravascular catheters flushed with saline solution and those flushed with a heparinized solution. Implications for changing practice based on research findings are discussed.

Adult↗
PubMed1991

Who is responsible for research utilization?

In summary, difficulties exist when critical care staff nurses attempt to use research or, perhaps, do not even think about using research. However, the responsibility for facilitating research utilization is shared by nurses in various settings. We all need to make major changes to assist in that process before we ask why staff nurses are not using research.

Critical Care↗