RESUMEN
The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. This article addresses the medical community's resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.
Asunto(s)
Cuidados Críticos/normas , Enfermedad Crítica/rehabilitación , Delirio/rehabilitación , Ambulación Precoz , Modelos Psicológicos , Evaluación de Necesidades/organización & administración , Seguridad del Paciente , Logro , Enfermedad Crítica/psicología , Delirio/psicología , Humanos , Unidades de Cuidados Intensivos/organización & administración , Autoimagen , Apoyo Social , Estados UnidosRESUMEN
Any technique that conserves classroom instructional time without sacrificing the amount learned is of great educational value. This research compared a laboratory analogue of the clicker technique to analogues of other classroom pedagogical methods that all involve repeated testing during teaching. The clicker analogue mimics the classroom practice of dropping material that is understood by the majority of the class, as revealed by testing with clicker questions, from further lecture. A fact learning and retrieval paradigm was used, in which college students learned facts about unfamiliar countries. Compressing instruction time based on group-level performance produced as much learning as no compression and as compression based on individual-level performance. Results suggest that the clicker technique is an efficient and cost-effective method of conserving instructional time without loss of amount learned.