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Background: 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's perception of the intensive care experience., Aim: The aims of the study were to assess patients' 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., Method: 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' 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., Results: Anxiety, depression, avoidance and intrusion scores did not significantly reduce over time. At hospital discharge there was a significant association between patients' perceptions of their intensive care experience and anxiety, depression, avoidance and intrusion scores at hospital discharge., Conclusion: 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.

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., Method: An ethnographic study was conducted and data were collected on one critical care unit in a large teaching hospital over a 6-month period in 2004. The methods included participant observation, interviews and the collection of field notes., Findings: The overall theme 'The nursing-technology relation' was identified. This comprised three sub-themes: definition of technology, technology transferred and technology transformed. Novice nurses took a task-focussed approach to weaning, treating it as a 'medical' technology transferred to them from doctors. Expert nurses used technology differently and saw its potential to become a 'nursing technology'., Conclusion: Nurses need to examine how they can adapt and to 'reconfigure' technology so that it can be transformed into a nursing technology. Those technologies that do not fit with nursing may have no place there. Rather than simply extending and expanding their roles through technology transfer, nurses should transform those technologies that preserve the essence of nursing and can contribute to a positive outcome for patients.

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.

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.

Nurse-led discharge from the High Dependency Unit (HDU) was introduced in 2002 with the aim of improving access to level 2 beds (beds offering higher level of support and observation; ). The project has yet to be formally evaluated but there have been perceived benefits for both patients and staff.

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 'review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit'. 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's work and case studies are utilized in order to illustrate key points.

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) 1491. Weaning from mechanical ventilation is not about the method used but more about how that method is employed [Crit. Care Med. 27 (1999) 2331]. A review of the literature revealed that there was no one method of weaning that was superior, furthermore evidence suggests that the use of a protocol was more effective in reducing the duration of weaning [Dimensions Crit. Care Nurs. 2 (1991) 398; Respir. Care Clin. North Am. 2 (1996) 105; AACN Clin. Issues Crit. Care 7 (1996) 550; Crit. Care Med. 25 (1997) 567; Arch. Surg. 133 (1998) 483; Chest 118 (2000) 459]. A retrospective audit of all patients who were ventilated for 7 or more days in one intensive care over a 1-year period, revealed 94 (of 500) patients were ventilated for an average of 16.8 days. There were no weaning guidelines or protocols in place at this time and weaning from mechanical ventilation was inconsistent and uncoordinated. A process mapping exercise revealed there was a delay in initiating the decision to wean of 96 h. Weaning protocols were put in place and nurse led weaning was initiated and supported by the nurse consultant. Monthly statistics were collated and this revealed the average ventilator time had reduced. Protocol led weaning has been effective in reducing the duration of ventilation. Problems still occur in initiating the decision to wean early. An audit of patient notes has revealed many reasons for this. These reasons include, over sedation, the use of morphine and midazolam, particularly in the elderly and those with renal impairment, is delaying weaning. Other reasons include, delay in tracheostomy placement. Staff are not initiating weaning guidelines early this may be due to lack of knowledge, lack of support or failure of the guidelines. Mechanisms are in place to support nurses at the bedside.

Patients requiring treatments previously only undertaken in critical care units are now being nursed in other ward areas. A study was carried out to determine the difficulties that are faced by ward nurses caring for this highly dependent patient group. Staff and patient stress were problems experienced and there was a call for closer liaison between ICU and ward staff.