INTENSIVE AND CRITICAL CARE NURSING 303

The experience of adult trained intensive therapy numes caring for children in a general intensive therapyunit Deborah Atldnson Senior Staff Nurse, St. Mary’s Hospital, Portsmouth, UK

A quantitative study using the phenomenological approach to data collection and analysis was carried out. The study examined the experiences of adult inten- sive therapy (ITU) nurses who had recently provided nursing care to critically ill children. Respondents con- sisted of 6 qualified ITU nurses who worked full time on the general ITUs of 2 district general hospitals. None of the respondents were paediatric trained.

Data was collected through semi-strutted interviews. Analysis of data was conducted using Collaizi’s six pro- cedural steps of analysis. 22 significant statements were extracted from the interviews and arranged into five themes.

The respondents unanimously described feelings of anxiety, lack of support and a desire for more self-confi- dence. All these emotions being attributable to lack of familiarity and inexperience. However, they expressed some positive experiences of caring for the critically ill child, and felt it was an interesting aspect of intensive care nursing which they wished to develop.

The study analyses how ITU nurses circumvent the dilemma of administering critical care (which they are qualified to do) to paediatrics (which none were trained for).

Challenging e&&dished ritual concerning bereave- ment se&ces in a combined intensive and coronary caremlit Helen Rayes

The issues surrounding dying and bereavement in intensive care of the critically ill have been comprehen- sively studied (Manley 1986, Dotter et al 1988, Farrell 1989, Eastham 1990) and many initiatives have led to a more focused approach to the care of family and loved ones.

The author will give an overview of the process and outcome of a project by learning contract undertaken as part of the Dip HE (Prof. Practice) with the University of Greenwich.

The brief was to refine and revise the existing unit protocol for the care of bereaved relatives. The out- come included the formation of a bereavement interest group, complete revision of an information booklet for loved ones (Wright 1991)) and the design of a sympathy cared as part of a formal follow-up facility by a named nurse (The Patient’s Charter, DOH). Evaluation of this new strategy will take place in Spring 1995 using ques- tionnaire and semi-structured interviews.

References

Brown 1987 Meeting the needs of relatives Part I. Care of the Critically ill 3; 5

Brown 1987 Meeting the needs of relatives Part II. Care of the critically ill 3; 6

Doctor B et al 1988 Families and intensive care nurses. Comparison of perception. Patient Education Council 12: 29-31

Eastham K 1990 Dealing with bereavement in Critical Care. Intensive Care Nursing 6: 185-191

Farrell M F 1989 Dying and bereavement. The role of the critical care nurse. Intensive Care Nursing 2: 114-122

Manley K 1988 The needs and support of relatives. Nursing 3; 52: 19-21

Wright B 1991 Sudden death: intervention skills for the caring professions. Edinburgh, Churchill Livingstone.

Calculating the cost of individual patient care on the intensive care unit, using the therapeutic interven- tion scoring system Amanda J Rowlatt StafF Nurse, Intensive Care Unit, Southampton University Hospitals, Southampton General Hospital, Southampton, UK

Aim The aim of the study was to carry out an audit on a group of patients admitted to the general intensive care unit, to calculate their individual cost of care, using the TISS system. This was promoted by an increasing need to be able to produce more accurate costing infor- mation regarding ICU practice as part of the internal market mechanism of health care financing.

Methodology 50 patients, totalling 197 bed days, admitted to the ICU over a 5-month-period were studied. For each patient, two groups of costs were calculated - specific costs per patient and overhead costs. Records were kept of drugs, consumables, investigations, fluid and blood products used, to enable the specific costs per patient to be calcu- lated. A record of all overhead costs was also main- tained, i.e. staffing costs, capital costs, hotel services, estate management costs, miscellaneous pharmacy and miscellaneous stores - to facilitate the calculated of a fixed cost per patient bed day. The amount of thera- peutic intervention performed for each patient was recorded daily using the TISS system.

By dividing the total cost of care for the 50 patients, by their aggregated TISS points, a value per TISS point was calculated. In this way a formula (i.e. value per TISS point x daily TISS score) could be used to calculate the daily cost per day for an individual patient.

Results The total specific costs incurred amounted to 248 552. There was a mean specific cost of 5246. The total fixed costs incurred amounted to Xl57070 (f797 per bed