PubMed · 8539134
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M Lehane, T Bennett. Dealing with difficult client behaviour.. https://pubmed.ncbi.nlm.nih.gov/8539134/
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This article describes the development of a psychiatric 'intensive care' service for men and women with serious or enduring forms of psychotic disorder. The authors suggest that such a residential therapeutic service may be an essential part of the development of community care for the most vulnerable people served by mental health services.
BACKGROUND AND OBJECTIVE: Percutaneous dilatational tracheostomy (PDT) is a recently developed method to obtain endotracheal access, also at the bed-side, in ventilated patients. The procedure is described and results are presented. PATIENTS AND METHODS: PDT was performed in 112 patients (82 men, 30 women, average age 50.7 years) between 1.5. 1994 and 31.5. 1996, in all cases expected to require more than 10 days of assisted ventilation. All complications, late sequelae and cosmetic results after decannulation were analysed. RESULTS: No serious complications were noted during the procedure. Erroneous puncture occurred in nine patients, but were corrected without problem. Complications necessitating temporary interruption of the tracheostomy consisted of accidental extubation and ventilatory problems (two patients each). There were no late sequelae and the cosmetic results were judged to be very good. CONCLUSION: PDT is a simple and relatively easily learned procedure. It has a low complication rate, late sequelae are very rare and cosmetic results after closure of the tracheostomy are excellent.
This article challenges nurses to examine their practice and procedure when establishing enteral feeding. The author suggests that discontinuation for 'complications' such as diarrhoea may not be appropriate, and recommends that nurses take more responsibility for patient nutrition.