Dynamics : the Official Journal of the Canadian Association of Critical Care Nurses

The Registered Nurses Professional Development Centre's Critical Care Nursing Program situated in Halifax, Nova Scotia, aspires to provide evidence-based critical care nursing education. Using a didactic traditional lecture-based teaching method, the faculty noted that some learners were not prepared for class, preferred memorization of content and were not engaged in their learning. In 2008, faculty acknowledged the need to change their principal teaching method in the full-time program to a method that would foster student engagement and active learning while inspiring registered nurses to become life-long critical thinkers...

Journal club has been used for decades to incorporate reading clinical and research articles into professional practice of numerous health care providers to disseminate knowledge and to bridge the gap between research and clinical practice. In this article, the authors describe how such activity was implemented by and for the nursing team of an intensive care unit. This journal club was designed to trigger dialogue among the nurses related to cardiac surgery topics, while providing an organizational support for them aimed to facilitate the incorporation of reading in their professional habits...

Critical care nurses complete tasks during patient care to promote the recovery or maintain the health of their patients. These tasks can be routine or non-routine to the nurse. Non-routine tasks are characterized by unfamiliarity, requiring nurses to seek additional information from a variety of sources to effectively complete the tasks. Critical care units are dynamic environments where decisions are often made by nurses under stress and time pressure because patient status changes rapidly. A non-routine task (e...

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BACKGROUND: Withdrawal of life-sustaining treatment is a process in which active treatment and the accompanying technology are removed, ending in the death of the patient. PURPOSE: To understand the lived experience of critical care nurses who care for patients during the process of withdrawal of life-sustaining treatment. METHODS: A phenomenological study was undertaken and interviews were conducted with six critical care nurses. RESULTS: The essence of this experience was described by these nurses as "trying to do the right thing"...

Discontinuing life-sustaining interventions requires an artful skill perhaps even more challenging than providing life-sustaining treatments. Critical care nurses require advanced skills to provide comfort care and, ultimately, a "good death" that encompasses the family and patient. Educational focus has been placed on maintaining the living, but with increasing palliation in critical care, education must include comfort care. This article focuses on the art of discontinuing life-sustaining treatment and providing a seamless, comfortable transition for patient and family...

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Clinicians frequently encounter and grapple with complex ethical issues and perplexing moral dilemmas in critical care settings. Intensive care unit (ICU) clinicians often experience moral distress in situations in which the ethically right course of action is intuitively known, but cannot be acted on. Most challenging cases pertain to end-of-life issues. Researchers have shown that moral distress and moral residue are common among critical care nurses. It is, therefore, essential that all ICU clinicians (and nurses, in particular) have an ongoing opportunity to work safely through these ethical dilemmas and conflicts...

The experience of critical care nurses caring for patients and families during the withdrawal of life support has recently been explored (Vanderspank-Wright, Fothergill Bourbonnais, Brajtman, & Gagnon, 2011). In that study, the nurses were able to find, using their developing knowledge and experience, their own way, over time, through the process of withdrawing life support. Challenges in caring for patients and families were described by the participants in themes such as "the runaway train of technology," which explored nurses' experience of caring in a technologically complex environment...

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In this article, the authors highlight an incident that involved a mix-up between the oral anticoagulant medication Pradax (dabigatran etexilate) and the antiplatelet medication Plavix (clopidogrel). Because critical care nurses may admit or care for patients who are receiving (or have received) one of these medications, it is important that they be aware of the potential for confusion between these two drug names throughout the medication-use process.

BACKGROUND: Intracranial pressure monitoring using an external ventricular drainage (EVD) system is the most commonly used technology to monitor intracranial pressure or drain cerebrospinal fluid (CSF) in neurological and neurosurgical patients. CSF samples are collected routinely from the EVD system for laboratory tests. No study has been conducted to identify where the most appropriate site for CSF collection is in order to reduce the disruption of the closed EVD system and reduce the risk of infection...

Critical illness and injury have no concept of time and do not always occur within regular business hours or at times conducive to optimal hospital function. In fact, it is a global trend that critically ill patients admitted to hospitals on weekends suffer higher mortality rates than those admitted during the week. Using a Canadian nursing lens, it is clear that there are some obvious differences in hospital function on weekends that include decreased hospital staffing, access to diagnostic services, intensivist coverage and the reluctance of patients to seek care on weekends...

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In this column, the authors review Amphotericin B incidents reported Although amphotericin B may be less commonly used today because to ISMP Canada. In particular, we focus on incidents reported to have of alternative antifungal agents available, incident reports suggest resulted in patient harm due to mix-ups between the conventional there continues to be a need to alert practitioners to the different (non-lipid)formulation and lipid formulations of amphotericin B. formulations, and to implement system safety strategies...

The nursing student's clinical experience serves to form a bridge between the theoretical knowledge of the classroom and its application to patient care. The intensive care unit (ICU) has not traditionally been considered an ideal placement for undergraduate nursing students (Ballard & Trowbridge, 2004). However, in the fall of 2008, with a rise in enrolment, the school was faced with finding more clinical sites to accommodate our placement needs. Twelve of our students in the first semester of their second year of the baccalaureate program were challenged with meeting the objectives of our curriculum in four of the ICUs located in our partnering hospitals at the McGill University Health Centre...