Critical care nurse最新文献

Early Mobility After Cardiac Surgery: A Quality Improvement Project.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024509

Ansley Cook, Faith Grill, Cole Taylor, Lauren Toles, Natalie Baker

{"title":"Early Mobility After Cardiac Surgery: A Quality Improvement Project.","authors":"Ansley Cook, Faith Grill, Cole Taylor, Lauren Toles, Natalie Baker","doi":"10.4037/ccn2024509","DOIUrl":"https://doi.org/10.4037/ccn2024509","url":null,"abstract":"Background: Coronary artery bypass graft surgery is one of the most common cardiac procedures performed worldwide. The longer these patients remain in bed, the greater their risk of postoperative complications and prolonged length of stay.Local problem: At the authors' institution, the average length of stay after coronary artery bypass graft surgery was 7.27 days, longer than the national average of 6.9 days. This quality improvement project was undertaken to increase these patients' postoperative mobility and thereby reduce their length of stay.Methods: Data on mobility and length of stay of patients with isolated coronary artery bypass graft surgery during an 8-week period were collected retrospectively to establish preintervention values. These values were compared with postintervention values for an equivalent period. An evidence-based nurse-driven early mobility protocol was used to mobilize appropriate patients from bed to chair on postoperative day 0. This level of mobility was documented as a score of 4 on the Johns Hopkins Highest Level of Mobility Scale.Results: From before to after protocol implementation, the postoperative length of stay decreased by 1.04 days. None of the 103 patients in the preintervention group scored a 4 on the Johns Hopkins Highest Level of Mobility Scale, compared with 36 of 134 patients in the intervention group. The difference in postoperative length of stay was clinically but not statistically significant (2-sided P = 1.95).Conclusion: Early mobility may help improve patient outcomes by reducing hospital length of stay and minimizing complications associated with prolonged immobility.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"15-23"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assistive Communication Device Used During Pediatric Noninvasive Ventilation.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024960

Emily Otto, Ashley Kaspar, Keith Kerr, Gayle Droemer, Allison Waddle

{"title":"Assistive Communication Device Used During Pediatric Noninvasive Ventilation.","authors":"Emily Otto, Ashley Kaspar, Keith Kerr, Gayle Droemer, Allison Waddle","doi":"10.4037/ccn2024960","DOIUrl":"https://doi.org/10.4037/ccn2024960","url":null,"abstract":"Introduction: Noninvasive ventilation therapy is a common approach in acute respiratory failure as an alternative to invasive mechanical ventilation. Assistive communication strategies are necessary to overcome communication impairments and anxiety caused by oronasal obstruction in pediatric intensive care unit patients undergoing noninvasive ventilation.Clinical findings and diagnosis: A 7-year-old girl was admitted with a history of pulmonary arterial hypertension and recurrent respiratory failure requiring bilevel positive airway pressure intervention. The patient experienced initial lack of bilevel positive airway pressure mask compliance due to oronasal mask discomfort.Interventions: The trial of a novel communication device (SPEAX, Ataia Medical) involving a microphone that attaches to the patient's bilevel positive airway pressure mask for enhanced communication.Outcomes: Use of the assistive communication device was associated with increased intelligibility to familiar listeners, mask compliance, enhanced mobility, and reduced patient anxiety levels throughout hospitalization and in later episodes of readmission.Conclusion: The implementation of assistive communication devices can alleviate communication barriers in pediatric bilevel positive airway pressure users, contributing to increased compliance and diminished anxiety for patients and caregivers. Providing a pathway for effective communication may reduce sedation use, minimizing risks of sedation-related delirium and improving overall quality of life in these patients.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"31-34"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024259

Suzanne Krais, Jenelle Sheasby, Jasjit Banwait, Natalie Lewis, Zhaoli Liu

{"title":"Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation.","authors":"Suzanne Krais, Jenelle Sheasby, Jasjit Banwait, Natalie Lewis, Zhaoli Liu","doi":"10.4037/ccn2024259","DOIUrl":"https://doi.org/10.4037/ccn2024259","url":null,"abstract":"Background: Patients with cardiogenic shock have a 25% to 50% mortality rate despite the introduction of mechanical circulatory devices and coordinated medical treatment. The use of shock teams has improved outcomes for these patients.Local problem: A cardiovascular hospital with a multidisciplinary shock team had inconsistency and delays in recognition and diagnosis of patients with cardiogenic shock.Methods: A nurse-led, preintervention-postintervention quality improvement project was performed in April and May 2021 and in April and May 2022 within a cardiovascular hospital in north Texas. The 2 nursing staff interventions regarding shock team activation were education and shock alert implementation. Time from first signs to diagnosis (for inpatients) and time from initial transfer request to acceptance (for transferring patients) were measured. Descriptive and statistical analyses were conducted using R, version 4.0.0 (R Foundation for Statistical Computing).Results: The mean (SD) time to diagnosis of cardiogenic shock decreased significantly from 17.98 (28.39) hours in the preintervention group (n = 25) to 8.15 (12.26) hours in the postintervention group (n = 45; P = .045). For patients with cardiogenic shock transferring from referring hospitals, the median (IQR) time to acceptance was 1.55 (0.08-3.18) hours in the preintervention group and 0.35 (0.00-0.72) hours in the postintervention group (P < .001).Conclusions: Nursing staff interventions regarding shock team activation significantly improved the time of diagnosis and acceptance of patients with cardiogenic shock in a cardiovascular hospital, enhancing the overall quality of care provided to these patients.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"24-30"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Addressing Workplace Violence in Critical Care: A Call for Comprehensive Training and Support.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024434

Melissa Cortez

引用次数: 0

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024513

Brian C Peach, Caitlin L Cox

{"title":"Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report.","authors":"Brian C Peach, Caitlin L Cox","doi":"10.4037/ccn2024513","DOIUrl":"10.4037/ccn2024513","url":null,"abstract":"Introduction: Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation.Clinical findings and diagnosis: A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated.Interventions: The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100).Outcomes: The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83.Conclusion: This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"35-40"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evidence-Based Approach to Appropriate Staffing.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024614

Sarah D Delgado

引用次数: 0

Dental Hygienist Intervention to Prevent Ventilator-Associated Pneumonia in an Intensive Care Unit.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024868

Sarah B Hoerler, Benjamin C Hickox

引用次数: 0

Resilience in Intensive Care Unit Nurses: An Integrative Review.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024753

Teenu Xavier, Beverly M Hittle, Liliana Rojas-Guyler, Rebecca C Lee

{"title":"Resilience in Intensive Care Unit Nurses: An Integrative Review.","authors":"Teenu Xavier, Beverly M Hittle, Liliana Rojas-Guyler, Rebecca C Lee","doi":"10.4037/ccn2024753","DOIUrl":"https://doi.org/10.4037/ccn2024753","url":null,"abstract":"Background: The intensive care unit environment exposes nurses to high-stress situations that potentially affect their mental and physical health. Resilience is a protective factor that can enhance the well-being of intensive care unit nurses.Objective: To investigate the current evidence regarding resilience in intensive care unit nurses and identify factors that promote resilience.Methods: A comprehensive literature search was undertaken for primary research conducted between January 1990 and December 2022. The updated framework of Whittemore and Knafl was used as a guide. Studies were critically appraised for methodological quality by using the Johns Hopkins Nursing evidence-based practice appraisal tool.Results: Twelve studies were included; most used quantitative methods to measure resilience. The findings indicate that intensive care unit nurses exhibit various levels of resilience, the literature contains inconsistencies about factors affecting resilience, and resilience protects nurses against negative psychological outcomes.Discussion: Nurses' resilience levels should be regularly assessed to identify areas for improvement and gauge the impact of resilience interventions. By continuously monitoring and adapting support strategies on the basis of resilience changes over time, organizations can meet the needs of intensive care unit nurses.Conclusion: More research is needed to comprehend the factors that impact resilience and devise interventions to boost resilience in intensive care nurses.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"52-63"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medication Transitions of Care in Trauma and Acute Care Surgery Patients.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024401

Bethany R Shoulders, Kelly L Maguigan, Dironada K Strange, Stephen J Lemon

{"title":"Medication Transitions of Care in Trauma and Acute Care Surgery Patients.","authors":"Bethany R Shoulders, Kelly L Maguigan, Dironada K Strange, Stephen J Lemon","doi":"10.4037/ccn2024401","DOIUrl":"https://doi.org/10.4037/ccn2024401","url":null,"abstract":"Background: Although the benefits of improved transitions of care regarding medications are widely known, implementation is variable among inpatient settings and populations and requires an interprofessional effort. This article reviews the body of published research on challenges with medication history taking and reconciliation for inpatients requiring treatment of traumatic injuries or surgical intervention.Review of evidence: A comprehensive search of PubMed and MEDLINE databases from inception to February 2021, the reference lists of qualifying articles, and PubMed's \"similar article\" suggestions were used to identify publications based on the following key terms: patient transfer, transitional care, medication reconciliation, general surgery, and surgical procedures. Publications relevant to trauma and surgical patient populations were selected. Only 11 articles met the full criteria.Implementation: The general challenges of accurate medication reconciliation at admission are also often barriers in the trauma and general surgery population. Discerning trends in the literature and evidence-based practice may be helpful.Evaluation: The publications revealed many barriers to medication reconciliation at admission, in the intensive care unit, and at intensive care unit and hospital discharge.Sustainability: Practices that can overcome these challenges include persistence in obtaining accurate information, paying close attention to changes in dosage or dosage forms and resumption of home medications at intensive care unit discharge, and having a follow-up plan for prescribing and deprescribing at hospital discharge.Conclusion: Clear guidelines are needed for performing medication assessments at the bedside, including the role of each health care professional who conducts them and how the process is coordinated.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 6","pages":"41-51"},"PeriodicalIF":2.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Workplace Violence: An Uncomfortable, Yet Important Topic.

IF 2 4区医学

Critical care nurse Pub Date : 2024-12-01 DOI: 10.4037/ccn2024502

Annette M Bourgault

引用次数: 0