Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.
Environmental and biotic pressures impose homeostatic costs on all organisms. The energetic costs of maintaining high body temperatures (Tb) render endotherms sensitive to pressures that increase foraging costs. In response, some mammals become more heterothermic to conserve energy. We measured Tb in banner-tailed kangaroo rats (Dipodomys spectabilis) to test and disentangle the effects of air temperature and moonlight (a proxy for predation risk) on thermoregulatory homeostasis. We further perturbed homeostasis in some animals with chronic corticosterone (CORT) via silastic implants. Heterothermy increased across summer, consistent with the predicted effect of lunar illumination (and predation), and in the direction opposite to the predicted effect of environmental temperatures. The effect of lunar illumination was also evident within nights as animals maintained low Tb when the moon was above the horizon. The pattern was accentuated in CORT-treated animals, suggesting they adopted an even further heightened risk-avoidance strategy that might impose reduced foraging and energy intake. Still, CORT-treatment did not affect body condition over the entire study, indicating kangaroo rats offset decreases in energy intake through energy savings associated with heterothermy. Environmental conditions receive the most attention in studies of thermoregulatory homeostasis, but we demonstrated here that biotic factors can be more important and should be considered in future studies.
Background/Aims: To explore the experiences and perceptions of physiotherapists involved in the care of people with Parkinson's disease and respiratory compromise. Methods: This exploratory qualitative study recruited four physiotherapists who participated in a focus group and completed reflective diaries over a 3-month period. Experiences were explored using Interpretative Phenomenological Analysis. Findings: The study highlights three key themes: application of professional knowledge, application of clinical decision making and challenges to application of care. Conclusions: The results demonstrate sensitive awareness in caring for a dependent and vulnerable population whose key motor signs, compounded by ageing are perceived as influencing the presentation of respiratory compromise. There are descriptions of a reactive response to illness, alongside reflections on the challenges faced when asserting autonomy and recognising where the role of physiotherapy fits within the multidisciplinary team. Sputum clearance is perceived as being a key aspect of this role, although there is uncertainty with regard to the effectiveness and appropriateness of treatment options. Multiple perceived challenges to care provision are highlighted, with key concerns surrounding clinician and patient 2 knowledge levels, maintenance of patient mobility, person centred care and clarity in the direction of care.
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