Family Care Rituals in the ICU to Reduce Symptoms of Post-Traumatic Stress Disorder in Family Members-A Multicenter, Multinational, Before-and-After Intervention Trial.

Objectives: To assess the feasibility and efficacy of implementing "Family Care Rituals" as a means of engaging family members in the care of patients admitted to the ICU with a high risk of ICU mortality on outcomes including stress-related symptoms in family members.

Design: Prospective, before-and-after intervention evaluation.

Setting: Two U.

To Continue or to Withhold Opioid Analgesics? An Ethical Dilemma Involving a 63-year-old Cancer Patient Who 'Broke the Pain Contract'.

[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].

Reevaluation of the critical-care pain observation tool in intubated adults after cardiac surgery.

Background: Pain assessment in critically ill patients who are intubated, sedated, and unable to verbalize their needs remains a challenge. No universally accepted pain assessment tool is used in all intensive care units.

Objectives: To examine concurrent validation of scores on the Critical-Care Pain Observation Tool for a painful and a non-painful procedure and to examine interrater reliability of the scores between 2 nurse raters.

The hospitalized prisoner with a life-threatening illness: criminal first and patient second?

It is generally accepted that the Patient's Bill of Rights applies to all patients including prisoners. Yet, a prisoners' incarcerated status generally prohibits inmates from making any decision that may shorten his/her life, and as such, the de facto medical decision maker becomes the medical director of the state correctional facility. This case study highlights the challenges that arise when the ethically appropriate response to a hospitalized prisoner's terminal medical condition warrants decisions that are in conflict with that advocated by the correctional facility.

Conflicting voices: Withhold treatment or not for a patient with chronic self-destructive behavior?

Patients with a history of chronic self-destructive and self-injurious behavior present many difficulties to healthcare providers. These patients often have related substance abuse and personality disorders that complicate their medical care. Treatment encounters initially may be related to medical treatment of episodic substance intoxicated states with or without self-inflicted injuries.

Respecting patient autonomy versus protecting the patient's health: a dilemma for healthcare providers.

A 74-year-old man with multiple chronic medical problems was hospitalized for respiratory distress. He experienced recurrent aspiration and required frequent suctioning and endotracheal intubation on several occasions. The patient was deemed competent and steadfastly refused feeding tube placement.

Critical Care Nurse Intern program: addressing psychological reactions related to critical care nursing.

Rhode Island Hospital Critical Care Nurse Internship program prepares recent graduates to work in critical care specialty units. Despite best efforts to prepare nurse interns for immersion into the critical care arena, significant clinical challenges await, and it is unknown how individual nurse interns will react under stressful clinical encounters. With this concern in mind, it was decided to add a new lecture to the critical care curriculum to address psychological reactions related to critical care nursing.

Moral discord, cognitive coping strategies, and medical intensive care unit nurses: insights from a focus group study.

Moral discord occurs when contextual factors prevent nurses from implementing felt moral mandates. Medical intensive care unit (MICU) nurses frequently confront moral issues and hold themselves personally responsible for their moral actions. They use a variety of cognitive coping strategies to deal with moral discord.

Factors that enable or complicate end-of-life transitions in critical care.

Background: Nurses in medical intensive care units are routinely involved in negotiations to maintain or withdraw life support. How nurses move from aggressively attempting to extend life to letting life end is not well understood.

Objective: To explore nurses' experiences of moving from cure- to comfort-oriented care and to describe factors that inhibit or facilitate such transitions.

A descriptive study of coping strategies used by Medical Intensive Care Unit nurses during transitions from cure- to comfort-oriented care.

Objective: The aim of this study was to describe Medical Intensive Care Unit (MICU) nurses' coping behaviors while caring for a patient whose medical treatment transitioned from cure- to comfort-oriented care.

Methods: The use of a descriptive qualitative research design with brief selective participant observation and focus group interviews was used to explore the coping experiences of MICU nurses. The study took place in an 18-bed MICU that was part of a 719-bed acute care hospital located in the northeastern United States.