Providing high-quality end-of-life (EoL) care within UK healthcare settings is a high priority identified in national and local guideline and policy documents. The Department of Health (DH) (2016) published a document of commitment following a review of choice at EoL, recognising the need for high-quality personalised care. This echoes many of the priorities put forward by The National Palliative and End of Life Care Partnership (2015) who published ambitions for EOL provision. These ambitions emphasised the need for individualised care, equality of access, maintaining comfort, coordination across service providers and the need for staff education and training. The National Institute of Health and Care Excellence (NICE) (2011 (updated in 2013)) quality standard for End of Life care for Adults lists several quality statements. Quality statement 3 considers the need for assessment and formation of individualised care plans for dying patients:'People approaching the end of life are offered comprehensive holistic assessments in response to their changing needs and preferences, with the opportunity to discuss, develop and review End-of-life care guidelines and care plans in the intensive care unit Alison Luckett ABSTRACTThe aim of this literature review was to examine end of life (EoL) care practice within the Intensive care unit (ICU). By exploring the literature, it is hoped to suggest how national guidance can be integrated into the ICU setting. Delivering high-quality, patient-centred EoL care is high priority on the UK health agenda. The highly technological environment within ICU can create barriers to recognising death and initiating EoL care planning. Despite recommendations in the literature for the integration of standardised guidance, implementation, compliance and evaluation are yet to be widely reported. This literature review highlights the need for ICU health professionals to embrace EoL guideline recommendations. Development of robust processes is vital to inform future practice.
Nursing Standard cardiorespiratory / CPD Why you should read this article:• To improve your knowledge of the various equipment and procedures required when caring for a patient with a tracheostomy • To understand the role of the nurse in tracheostomy insertion and maintenance • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) CitationBillington J, Luckett A (2018) Care of the critically ill patient with a tracheostomy. Nursing Standard. AbstractTracheostomy management is increasingly necessary in critical care units and general wards. Therefore, it is important that nurses are equipped with the appropriate knowledge and skills to meet the individual needs of patients with a tracheostomy safely and competently. This article aims to enhance nurses' understanding of the potential challenges that patients with a tracheostomy may experience, and to guide nurses in providing effective care and support to these patients. It outlines the care that should be provided for patients with a tracheostomy who are critically ill, including methods of humidification and endotracheal suctioning. This article also discusses the effects that a tracheostomy may have on a patient's communication and psychological well-being, and explains the actions that nurses should take in an emergency and if complications occur. Author details John Billington, senior lecturer, School of Health Sciences, University of Central Lancashire, Preston, England; Alison Luckett, senior lecturer, School of Nursing, University of Central Lancashire, Preston, England Keywords critical care, emergency care, intensive care, respiratory, temporary tracheostomy, tracheostomy, tracheostomy tube Key points • Nurses must understand the immediate post-insertion and long-term management required in patients with a tracheostomy if they are to provide safe and effective care • Critical care units in the UK use tracheostomy tubes from a variety of manufacturers, so it is important that nurses are familiar with the type and size of tube inserted (Intensive Care Society 2014). • The nurse's role in tracheostomy insertion is usually to gather the necessary equipment and to ensure the correct checklists are completed (Plowright 2014) • The psychological well-being of patients with a tracheostomy should be considered as important as the physical interventions, because patients without a speaking valve will be unable to speak, and this can cause them anxiety and frustrationAims and intended learning outcomes This article aims to explore the evidence related to the nursing care required for a patient with a tracheostomy. It also considers the types of tracheostomy tubes used in patients who are critically ill and discusses the essential nursing care and psychological support that they may require. The article also describes the considerations necessary when discharging a patient with a tracheo...
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