Search

The intensive care unit (ICU) is a complex amalgam of physical and cognitive workflows of its various personnel. The ICU team is compiled of persons with widely varying scopes of practice, levels of experience, roles, and responsibilities. Basic categories of personnel include bedside nurse, charge nurse, resident, advanced practice provider, pharmacist, nutritionist, fellow, attending, and consultant. Together, team members must collaborate to learn about and stabilize the critically ill patient, diagnose clinical states, plan and execute treatment, and monitor illness and recovery. The disparate geography and workflow of each individual guarantees that communication between team members will be complex. Issues of collaboration, teamwork, communication, and workflow are therefore paramount.

Serial, consistent, and well-documented neurological assessments are the most important aspect of nursing care for the pediatric neurosurgical patient. Subtle changes in the neurological assessment may first be noted by a bedside nurse. Keen observation skills and the ability to extract information about a patient’s baseline level of neurological function from the parents or primary caregivers are essential. The nurse’s response to assessment changes is essential to the prevention of secondary neurological sequelae and other complications associated with neurological disorders [11]. These potential complications include, among others, inability to protect the airway, immobility, endocrine disorders related to central hormonal dysregulation, impaired communication, and behavioral issues [20].

Nurses in an eighteen bed multi-disciplinary Paediatric Intensive Care Unit (PICU) have helped to develop a bedside computer system which automatically records the patient’s physiological variables such as heart rate, blood pressure, and respiratory rate from the bedside monitor on a minute to minute basis and graphically displays this information on a bedside microcomputer. The graphic display of this detailed information facilitates the astute observation of patterns and trends in the patient’s physiological status (Figure 1).

The nursing staff of a Coronary Care Unit (CCU) are not only concerned with the day to day data on individual patients, they also need to know longer term characteristics of the case group they care for- Both bedside and administrative staff want to know such things as the average age of the patients admitted to the unit, the average stay in the unit, the workload at any time, the mortality rate and much more. Such information is not only time-consuming and tedious to collect but the analyses of the results are normally only available at a much later date and are seldom easiliy accessible to the bedside nurse. In addition, using personnel without critical care training to collect and evaluate the data does not often improve the reliability of results. We now feel that we have found a solution to a number of these problems which puts a very powerful tool in the hands of bedside and administrative staff alike. Both can now obtain immediate answers to many of the questions about our unit which have previously too often remained unanswered due to lack of relevant information.

Intracranial pressure (ICP) monitoring is used as an early sign of neurological deterioration in the management of patients with a variety of neurosurgical conditions. Mean ICP is the most commonly used for this purpose; however, mean ICP is a relatively late indicator of many secondary injury processes, and neurological deterioration may occur in the presence of normal ICP.