cheryl crocker | University of Nottingham (original) (raw)
Papers by cheryl crocker
Nursing in Critical Care, 2007
Many patients have physiological deterioration prior to cardiac arrest, death and intensive care ... more Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests and unanticipated ICU admissions) in 90 hospitals [69 UK, 19 Australia and two New Zealand (ANZ)]. Sixty-eight hospitals reported primary events during the 3-day study period (50 UK, 16 Australia and two ANZ). Data on the availability of ICU/high-dependency unit (HDU) beds and cardiac arrest teams and medical emergency teams (METs) were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty per cent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and METs were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.
Intensive and Critical Care Nursing, 2008
There has been renewed interest in weaning from mechanical ventilation in critical care since the... more There has been renewed interest in weaning from mechanical ventilation in critical care since the publication of the Modernisation Agency paper in 2002. There have been many papers reporting ways of improving the weaning process but these are specific to single elements and neglect the contextual issues that influence the weaning process. Care bundles have been introduced nationally to standardise patient care and improve patient outcome. Examples in critical care are the ventilator care bundle and sepsis care bundle. However, since care bundles have become linked with targets and part of the 10 High Impact Changes there is a tendency to want to call everything a care bundle. A care bundle is a small but critical set of processes that when implemented together improve outcome. One critical care network has written a weaning care bundle. This is an example of a service improvement initiative the aim of which was to improve weaning from mechanical ventilation. This paper reviews this approach and presents results from a pilot in one teaching hospital.
Journal of Advanced Nursing, 2009
Title. The role of technology in critical care nursing. Aim. This paper is a report of a study to... more Title. The role of technology in critical care nursing. Aim. This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice. Background. The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres.
British Journal of Nursing, 2003
Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hosp... more Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts &amp;#39;review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit&amp;#39;. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic&amp;#39;s work and case studies are utilized in order to illustrate key points.
Intensive and Critical Care Nursing, 2006
Intensive and Critical Care Nursing, 2005
Intensive and Critical Care Nursing, 2004
Nursing in Critical Care, 2009
Weaning from mechanical ventilation has attracted a growing interest recently in the medical and ... more Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols. Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses. Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient-centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning. Weaning in the context of critical care can be challenging. To wean the difficult-to-wean or the long-term-weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.
Nursing in Critical Care, 2007
Nursing in Critical Care, 2010
Recovery from critical illness can be prolonged and can result in a number of significant short- ... more Recovery from critical illness can be prolonged and can result in a number of significant short- and long-term psychological consequences. These may be associated with the patient&amp;amp;amp;amp;amp;amp;amp;#39;s perception of the intensive care experience. The aims of the study were to assess patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care unit (ICU) experience and the effect of these on anxiety, depression and post-traumatic stress up to 6 months after discharge. One hundred and three participants were recruited from six ICUs from one Critical Care Network in the United Kingdom. A prospective, longitudinal study was designed to assess anxiety, depression, post-traumatic stress symptomatology and patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care experience. Data were collected on three occasions: after intensive care discharge and before hospital discharge, and 2 months and 6 months later. Measures included the impact of events scale, hospital anxiety and depression scale and intensive care experience questionnaire. Anxiety, depression, avoidance and intrusion scores did not significantly reduce over time. At hospital discharge there was a significant association between patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care experience and anxiety, depression, avoidance and intrusion scores at hospital discharge. Standardised assessment of an intensive care experience is important. It provides information about the patient experience which can inform care practice within ICU, following discharge to the ward and, in the longer term, rehabilitation.
Nursing in Critical Care, 2009
Aim: The aim of the research was to understand how nurses used technology to wean patients from m... more Aim: The aim of the research was to understand how nurses used technology to wean patients from mechanical ventilation. Background: The literature concerned with the development of critical care centres on the role of technology with little emphasis on the nursing contribution. Design: An ethnographic approach was used to understand how nurses used technology to wean patients from mechanical ventilation. Methods: Data were gathered by participant observation and interviewing over a 6-month period. In total, 250 h of field notes were recorded. Results: Data were analysed by the content analysis method. Knowing the patient was a central theme identified. Three sub-themes were identified: ways of knowing, continuity of care and the role of the patient in the weaning trajectory. Conclusion: 'Knowing the patient' was implied during the interviews as essential to the delivery of patient-centred care. There were two main factors that needed to be present in order for nurses to know their patients: continuity of care and expertise. 'Ways of knowing' was reliant on gaining information about the patient. The role of the patient was a passive recipient of treatment. Implications for practice: Knowing the patient has been defined as a characteristic of expert nursing. To be truly patient-centred nursing needs to address the barriers that prevent nurses from getting to 'know' their patients.
Intensive and Critical Care Nursing, 2007
The paper offers a view of the development of critical care from the position of nursing. The nur... more The paper offers a view of the development of critical care from the position of nursing. The nursing contribution is not fully acknowledged in the historical and professional literature. This paper offers an alternative history of the development of intensive care (ICU), which takes account of the nursing profession's contribution, rather than the commonly held view that ICU developed predominately as a result of new and innovative technology. The technology was not new but rather it was transferred, usually from the operating theatre, and applied to new conditions. There were many contributing factors that shaped the development of intensive care. One was the grouping together of sick patients so that they could be cared for by skilled nurses who 'watched over' them, by providing detailed observation. This paper outlines the development of intensive care in England from 1952 to the new millennium. It begins with an analysis of the changing definitions reflected in policy and professional documents before moving on to examine the factors that influenced its development and concludes with a discussion of the nursing contribution and future direction.
Intensive and Critical Care Nursing, 2002
Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weani... more Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weaning can be defined as the process of assisting patients to breathe spontaneously without mechanical ventilatory support [Am. J. Crit. Care 7 (1998) 149].
Nursing in Critical Care, 2007
Many patients have physiological deterioration prior to cardiac arrest, death and intensive care ... more Many patients have physiological deterioration prior to cardiac arrest, death and intensive care unit (ICU) admission that are detected and documented by medical and nursing staff. Appropriate early response to detected deterioration is likely to benefit patients. In a multi-centre, prospective, observational study over three consecutive days, we studied the incidence of antecedents (serious physiological abnormalities) preceding primary events (defined as in-hospital deaths, cardiac arrests and unanticipated ICU admissions) in 90 hospitals [69 UK, 19 Australia and two New Zealand (ANZ)]. Sixty-eight hospitals reported primary events during the 3-day study period (50 UK, 16 Australia and two ANZ). Data on the availability of ICU/high-dependency unit (HDU) beds and cardiac arrest teams and medical emergency teams (METs) were also collected. Of 638 primary events, there were 308 (48.3%) deaths, 141 (22.1%) cardiac arrests and 189 (29.6%) unplanned ICU admissions. There were differences in the pattern of primary events between the UK and ANZ (P < 0.001). There were proportionally more deaths in the UK (52.3% versus 35.3%) and a higher number of unplanned ICU admissions in ANZ (47.3% versus 24.2%). Sixty per cent (383) of primary events had a total of 1032 documented antecedents. The most common antecedents were hypotension and a fall in Glasgow Coma Scale. The proportion of ICU/HDU to general hospital beds was greater in ANZ (0.034 versus 0.016, P < 0.001) and METs were more common in ANZ (70.0% versus 27.5%, P = 0.001). The data confirm antecedents are common before death, cardiac arrest and unanticipated ICU admission. The study also shows differences in patterns of primary events, the provision of ICU/HDU beds and resuscitation teams, between the UK and ANZ. Future research, focusing upon the relationship between service provision and the pattern of primary events, is suggested.
Intensive and Critical Care Nursing, 2008
There has been renewed interest in weaning from mechanical ventilation in critical care since the... more There has been renewed interest in weaning from mechanical ventilation in critical care since the publication of the Modernisation Agency paper in 2002. There have been many papers reporting ways of improving the weaning process but these are specific to single elements and neglect the contextual issues that influence the weaning process. Care bundles have been introduced nationally to standardise patient care and improve patient outcome. Examples in critical care are the ventilator care bundle and sepsis care bundle. However, since care bundles have become linked with targets and part of the 10 High Impact Changes there is a tendency to want to call everything a care bundle. A care bundle is a small but critical set of processes that when implemented together improve outcome. One critical care network has written a weaning care bundle. This is an example of a service improvement initiative the aim of which was to improve weaning from mechanical ventilation. This paper reviews this approach and presents results from a pilot in one teaching hospital.
Journal of Advanced Nursing, 2009
Title. The role of technology in critical care nursing. Aim. This paper is a report of a study to... more Title. The role of technology in critical care nursing. Aim. This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice. Background. The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres.
British Journal of Nursing, 2003
Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hosp... more Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts &amp;#39;review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit&amp;#39;. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic&amp;#39;s work and case studies are utilized in order to illustrate key points.
Intensive and Critical Care Nursing, 2006
Intensive and Critical Care Nursing, 2005
Intensive and Critical Care Nursing, 2004
Nursing in Critical Care, 2009
Weaning from mechanical ventilation has attracted a growing interest recently in the medical and ... more Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols. Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses. Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient-centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning. Weaning in the context of critical care can be challenging. To wean the difficult-to-wean or the long-term-weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care.
Nursing in Critical Care, 2007
Nursing in Critical Care, 2010
Recovery from critical illness can be prolonged and can result in a number of significant short- ... more Recovery from critical illness can be prolonged and can result in a number of significant short- and long-term psychological consequences. These may be associated with the patient&amp;amp;amp;amp;amp;amp;amp;#39;s perception of the intensive care experience. The aims of the study were to assess patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care unit (ICU) experience and the effect of these on anxiety, depression and post-traumatic stress up to 6 months after discharge. One hundred and three participants were recruited from six ICUs from one Critical Care Network in the United Kingdom. A prospective, longitudinal study was designed to assess anxiety, depression, post-traumatic stress symptomatology and patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care experience. Data were collected on three occasions: after intensive care discharge and before hospital discharge, and 2 months and 6 months later. Measures included the impact of events scale, hospital anxiety and depression scale and intensive care experience questionnaire. Anxiety, depression, avoidance and intrusion scores did not significantly reduce over time. At hospital discharge there was a significant association between patients&amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their intensive care experience and anxiety, depression, avoidance and intrusion scores at hospital discharge. Standardised assessment of an intensive care experience is important. It provides information about the patient experience which can inform care practice within ICU, following discharge to the ward and, in the longer term, rehabilitation.
Nursing in Critical Care, 2009
Aim: The aim of the research was to understand how nurses used technology to wean patients from m... more Aim: The aim of the research was to understand how nurses used technology to wean patients from mechanical ventilation. Background: The literature concerned with the development of critical care centres on the role of technology with little emphasis on the nursing contribution. Design: An ethnographic approach was used to understand how nurses used technology to wean patients from mechanical ventilation. Methods: Data were gathered by participant observation and interviewing over a 6-month period. In total, 250 h of field notes were recorded. Results: Data were analysed by the content analysis method. Knowing the patient was a central theme identified. Three sub-themes were identified: ways of knowing, continuity of care and the role of the patient in the weaning trajectory. Conclusion: 'Knowing the patient' was implied during the interviews as essential to the delivery of patient-centred care. There were two main factors that needed to be present in order for nurses to know their patients: continuity of care and expertise. 'Ways of knowing' was reliant on gaining information about the patient. The role of the patient was a passive recipient of treatment. Implications for practice: Knowing the patient has been defined as a characteristic of expert nursing. To be truly patient-centred nursing needs to address the barriers that prevent nurses from getting to 'know' their patients.
Intensive and Critical Care Nursing, 2007
The paper offers a view of the development of critical care from the position of nursing. The nur... more The paper offers a view of the development of critical care from the position of nursing. The nursing contribution is not fully acknowledged in the historical and professional literature. This paper offers an alternative history of the development of intensive care (ICU), which takes account of the nursing profession's contribution, rather than the commonly held view that ICU developed predominately as a result of new and innovative technology. The technology was not new but rather it was transferred, usually from the operating theatre, and applied to new conditions. There were many contributing factors that shaped the development of intensive care. One was the grouping together of sick patients so that they could be cared for by skilled nurses who 'watched over' them, by providing detailed observation. This paper outlines the development of intensive care in England from 1952 to the new millennium. It begins with an analysis of the changing definitions reflected in policy and professional documents before moving on to examine the factors that influenced its development and concludes with a discussion of the nursing contribution and future direction.
Intensive and Critical Care Nursing, 2002
Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weani... more Weaning from mechanical ventilation is challenging and requires expert knowledge and skill. Weaning can be defined as the process of assisting patients to breathe spontaneously without mechanical ventilatory support [Am. J. Crit. Care 7 (1998) 149].