By I. Frillock. Bluffton University.

In the experiences of transcendence characterized by the human system the informational capacity includes fifth stage buy generic precose 25 mg on-line. It is in the moving through the choice not only all the things we normally associate with point and the stages of decentering and unbinding consciousness buy 50 mg precose fast delivery, such as thinking and feeling discount 25 mg precose with visa, but also that a person moves on to higher levels of con- all the information embedded in the nervous system, sciousness (Newman, 1999). The information of these and other systems reveals the corollary between her theory of Health as complexity of the human system and how the infor- Expanding Consciousness and Young’s theory of mation of the system interacts with the information the Evolution of Consciousness in that we “come of the environmental system. Newman sees fers the image of a smooth lake into which two death as a transformation point, with a person’s stones are thrown. As the stones hit the water, con- consciousness continuing to develop beyond the centric waves circle out until the two patterns reach physical life, becoming a part of a universal con- one another and interpenetrate. Nurses are changed been an expansion of consciousness when there is a by their interactions with their patients, just as pa- richer, more meaningful quality to their relation- tients are changed by their interactions with nurses. Relationships that are more open, loving, This mutual transformation extends to the sur- caring, connected, and peaceful are a manifestation rounding environment and relationships of the of expanding consciousness. The nurse and client may also see movement Newman states: “We have come to see nursing as a through Young’s spectrum of evolving conscious- process of relationship that co-evolves as a func- ness, where people transcend their own egos, dedi- tion of the interpenetration of the evolving fields of cate their energy to something greater than the the nurse, client, and the environment in a self- individual self, and learn to build order against organizing, unpredictable way. It is important the pattern from the outside, but by entering into the that the nurse be able to practice from the center of evolving pattern as it unfolds. It involves being with rather demands that nurses develop tolerance for uncer- than doing for. It is caring in its state of disequilibrium that the potential for deepest, most respectful sense. She states, “The rhythmic relating of process of attending to that which is meaningful. The Somali nurse will have to ask Margaret Newman’s Theory of Health as Expand- more clarifying questions and seek to understand ing Consciousness is being used throughout the that which has not been her experience. No matter world, but it has been more quickly embraced and what the background of the nurse and patient, the understood by nurses from indigenous and Eastern clarifying process, if done in an open, caring, and cultures, who are less bound by linear, three- nonjudging manner, provides great insight for both dimensional thought and physical concepts of participants in the pattern-recognition process as health and who are more immersed in the meta- the nurse and the patient realize their interconnect- physical, mystical aspect of human existence. When the nurse-patient interaction is fo- Increasingly, however, the theory is being enthusi- cused on attending to meaning, it transcends astically embraced by nurses in industrialized na- barriers of culture, gender, age, class, race, educa- tions who are finding it increasingly difficult to tion, and ethnicity. The pilot study informed the methodology unless one has fully comprehended sorrow, and used by Newman and Moch (1991) in their re- vice versa. Although they seem to be opposites, search with people with cardiovascular disease. If you want to see a dark view 20 women diagnosed with breast cancer, cen- pattern more clearly, you would put it against a tering the nurse-patient dialogue on the pattern of light background. Moch asked the women in her study to methodology permits a nurse to be present to a describe what was meaningful to them and found client whose life circumstances are very different that in talking about meaningful people and events, from those of the nurse. For example, the pattern- the sequential patterns of interaction between peo- recognition interaction for a homeless 16-year-old ple and their environment become apparent. After completion of the The interview: After the study has been explained interviews, the data are analyzed more intensely and informed consent obtained, the data collec- in light of the theory of health as expanding tion process begins with the nurse asking the consciousness. Young’s spectrum of conscious- participant a simple, open-ended question such ness is applied, and the quality and complexity as, “Tell me about the most meaningful people of the sequential patterns of interaction are eval- and events in your life. If the intent of the research is to look at a simply about meaningful events, the meaning- group of people or at a community, similarities ful relationships usually arise as the stories are of pattern among participants are identified. Follow-up: At the second interview, the diagram (or Newman states: “Not only is our science a human other visual portrayal) is shared with the partic- science, but, within the context of a practice disci- ipant without any causal interpretation. This kind of theory is participant is given the opportunity to comment embodied in the investigator-nurse. This dialectic situation being addressed by making a difference in process is repeated in subsequent interviews, the situation, as well as being informed by the data with data added to the narrative and the dia- of the situation” (Newman, 1994b, p. In ad- medical disease diagnosis or with similar life cir- dressing long-term implications of this study, cumstances (Newman, 1994). She characterized the perspectives about health as expanding conscious- overall pattern to be one of isolation and being ness. In discussing the implications her research closed in because participants isolated themselves holds for nursing practice, Moch stressed that in- from situations they were unable to deal with and corporating a “health-within-illness experience” avoided any stimuli that could threaten their pul- view has the potential to drastically change the way monary status. They found three common themes: the activity restrictions, and in their inability to pur- need to excel, the need to please others, and feelings of sue what they need and want” (p. These findings were consistent with the Rosenthal (1996) conducted a similar study in the literature on coronary artery disease and personal- United States and found a relationship between ity type. When applying Young’s (1976) theory to pattern recognition and evolving consciousness to the participants, they found that most participants be related to a sense of connectedness, with the par- were caught in a repetitive cycle characteristic of ticipants who manifested a sense of connectedness the centering stage. Blocks to movement along the being able to utilize pattern recognition to tran- spectrum were seen as being mirrored by the blocks scend their illness. If they had She (Yamashita, 1999) described a process whereby reached the limits of their resources, death was the caregivers moved through struggling alone and feel- ‘transformative door’ to higher consciousness” ing alienated from those around them as the schiz- (Moss, 1981, p.

Heat Moisture Exchangers) should be changed according to manufacturers’ instructions (normally daily); catheter mounts should be changed at the same time as humidifiers Infection control 135 ■ invasive techniques and disconnection of intravenous lines should trusted 50mg precose, when possible purchase 50mg precose free shipping, avoid times of dust disturbance (e purchase 50 mg precose with visa. Antibiotics and other medical treatments can reduce morbidity and mortality, but preventing infection is humanly (and usually financially) preferable. Hygiene is helped by adequate and appropriate facilities, including sufficient washbasins, aprons and unit guidelines and protocols. All multidisciplinary team members should be actively involved in making decisions, but nurses have an especially valuable role in coordinating and controlling each patient’s environment. Problems from infection are likely to escalate; continuing vigilance and care can minimise infection risks and the spread of microorganisms. Further reading Articles on infection control frequently appear in specialist and general journals. Taylor’s (1978) classic article on handwashing is recommended; issues for nursing practice regularly appear in many general nursing journals. She was transferred from elderly care facilities with rapidly deteriorating respiratory function, copious mucopurulent sputum and atelectasis. Catherine’s previous respiratory tract infections had been treated with oral Amoxycillin (beta lactam class of antibiotics). Issues related to infection control are included in end-of-chapter scenarios in chapters 39 and 40. Chapter 16 Ethics Introduction The value of ethics for healthcare has been increasingly recognised: critical care often adds greater focus and poignancy to ethical dilemmas. Ethics raises questions rather than provides answers; dilemmas have more than one solution. Each person has values; some are formed or shared with peer groups, others are individual. Different values may cause conflict (for example, the care versus cure debate of Chapter 1). Active questioning enables evaluation of beliefs underpinning practice, helping nurses to understand others’ perspectives, but solutions necessarily remain individual. Increasing public expectations (and litigation) of healthcare, and changes within nursing (increased autonomy, responsibility and accountability) are reflected by greater emphasis on ethics in nursing education. A high public and media profile makes intensive care nursing a much-scrutinized area. This chapter provides a basis both for practice and for the remainder of this book; professional development can usefully be extended through discussion with colleagues and further study. This chapter describes the four main ethical principles identified by Beauchamp and Childress (1994): ■ autonomy ■ non-maleficence ■ beneficence ■ justice and the three main ethical theories identified by Rumbold (1993): ■ duty-based ■ goal-based ■ rights-based Other authors may give different arrangements, wording or additional theories and principles. Ethical principles provide a framework with which to work through dilemmas, identifying what is harmful, what is good and what is just. Decisions may differ between individuals because individual morals (values and beliefs) influence decision-making Intensive care nursing 138 processes. Ethical theories identify different sets of beliefs; understanding our own and others’ sets of beliefs (values) helps towards the understanding of differences. Some examples presented in this chapter include legal and professional perspectives; unlike ethics, these expectations can be enforced, and so nurses should consider their individual professional (and legal) accountability. Ethics are guides to decision-making, and decisions are influenced by sources such as ■ religion ■ law ■ society (and social values) ■ peers ■ individual values If growth from novice to expert entails moving from following rules to initiation (Benner 1984), understanding sources of ‘intuitive’ decisions can substantiate accountable evidence-based practice. The literal translation of both is ‘norm’ (Greek ethos, Latin mores), but they have different connotations. Many staff are uncomfortable with applying economics to healthcare, but while decisions should never be made solely on economic grounds, finance cannot be ignored where resources remain finite. Intensive care nursing relies on technology to support and monitor physiological function. Breathing and heartbeat can be replaced by technology (causing redefinition of death as absence of brainstem function), but intervention may prolong dying rather than prolong life: Rachels (1986) draws a distinction between living and the physical process of being alive. Technology may be used inappropriately; no treatment, intervention or observation should become ‘routine’. This much-used term is value-laden: what one person considers acceptable quality, another may not (e. Values vary between the extremes of preserving life at all costs, and always letting ‘nature’ take its course. Ethical principles Autonomy Beauchamp and Childress (1994) suggest that each ethical principle is part of a continuum. Autonomy, the first principle, is usually interpreted as ‘self-rule’—that is, making an informed free choice. Consent by relatives for mentally competent adults has no legal validity (Brazier 1992; Dimond 1995; Braithwaite 1996). Parents or guardians have the right to consent to treatment for children under 18 (Dimond 1995), but the 1989 Children’s Act and civil law precedent of ‘Gillick competence’ emphasise rights of children to make their own informed decisions provided they have achieved sufficient maturity to fully understand what is proposed (Brazier 1992). So one relatively young child may (legally) make more profound decisions than an older child. If in doubt, nurses should seek help to clarify the rights and duties of all concerned (most hospitals have legal advisors).

Judicious use is imperative if we are to preserve our arsenal of antimicrobial agents into the next decade order 25 mg precose. Bacteria that inevitably develop antibiotic resistance in animals comprise food- borne pathogens buy generic precose 50 mg on line, opportunistic pathogens and commensal bacteria buy discount precose 50mg on-line. The same antibiotic resistance genes and gene transfer mechanisms can be found in the 92 microfloras of animals and humans. They can be easily accumulated in the organism to levels that can potentially injure human health as well as the environment. Bloom of resident antibiotic-resistant bacteria in soil following manure fertilization. Emergence of multidrug-resistant, extensively drug-resistant and untreatable gonorrhea. An era of untreatable gonorrhea may be approaching, which represents an exceedingly serious public health problem. Herein, we review the evolution, origin and spread of antimicrobial resistance and resistance determinants (with a focus on extended-spectrum cephalosporins) in N. Essential actions include: implementing action/response plans globally and nationally; enhancing surveillance of gonococcal antimicrobial resistance, treatment failures and antimicrobial use/misuse; and improving prevention, early diagnosis and treatment of gonorrhea. Novel treatment strategies, antimicrobials (or other compounds) and, ideally, a vaccine must be developed. In the vast majority of cases where antimicrobials are used, the microorganisms have found a way to evade or resist the antimicrobial agent. Resistance occurs whenever antimicrobials are used – in the community, on the farm, and in healthcare. Antimicrobial resistance is a global problem, and some of our most significant global threats are multi-drug resistant tuberculosis and drug-resistant malaria. Particularly concerning are the carbapenemase- producing bacteria, such as bacteria of the Klebsiella species, among others. Among the antimicrobial agents in use today are antibiotic drugs (which kill bacteria), antiviral agents (which kill viruses), antifungal agents (which kill fungi), and antiparisitic drugs (which kill parasites). An antibiotic is a type of antimicrobial agent made from a mold or a bacterium that kills, or slows the growth of other microbes, specifically bacteria. Predicting the extinction of Ebola spreading in Liberia due to mitigation strategies. VsigQfkrLmg • “Cycling of homogeneous antibiotic exposure is unlikely to control the emergence of gram-negative antimicrobial resistance in intensive care units. Moving beyond too little, too late: Managing emerging infectious diseases in wild populations requires international policy and partnerships. Detection and reporting of such rare pathogens in transplant recipients is critical to patient care and improving our understanding of posttransplant infections. Food commensal microbes as a potentially important avenue in transmitting antibiotic resistance genes. Food commensal microbes as a potentially important avenue in transmitting antibiotic resistance genes. This reappearance, coupled with its potential for aerosol dissemination and associated high mortality rate, also makes Y. The role of the natural environment in the emergence of antibiotic resistance in Gram-negative bacteria. Unless the rise in antibiotic resistance can be reversed, we can expect to see a substantial rise in incurable infection and fatality in both developed and developing regions. Anthropogenic activity might be causing evolution of antibiotic resistance in the environment. Eighty-four percent of the isolates were resistant to at least one antibiotic, and 53 percent were resistant to at least three antibiotics. Sixteen percent of the isolates were resistant to ceftriaxone, the drug of choice for treating salmonellosis in children. These findings provide support for the adoption of guidelines for the prudent use of antibiotics in food animals and for a reduction in the number of pathogens present on farms and in slaughterhouses. National surveillance for antimicrobial- resistant salmonella should be extended to include retail meats. Multiresistant Gram-negative bacteria: The role of high-risk clones in the dissemination of antibiotic resistance. With a dearth of new antibiotics coming to market, the need for action to avert a developing global crisis in health care is increasingly urgent. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. Global incidence and prevalence of selected curable sexually transmitted infections – 2008. Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating. Owing to limited access to diagnosis, only 35,000 (47%) of them were diagnosed in 2013.

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