Critical care nurse最新文献

{"title":"What Do Technology, Social Media, and Critical Care Nursing Have in Common?","authors":"Linda Harrington","doi":"10.4037/ccn2026480","DOIUrl":"https://doi.org/10.4037/ccn2026480","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"78-79"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105375","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}

{"title":"Acute Motor and Sensory Axonal Neuropathy Variant of Guillain-Barré Syndrome: A Nurse-Led Intensive Care Case Report.","authors":"Noor Hasmee, Bhupendra Singh, Hema Joshi","doi":"10.4037/ccn2026159","DOIUrl":"https://doi.org/10.4037/ccn2026159","url":null,"abstract":"<p><strong>Background: </strong>Acute motor and sensory axonal neuropathy is a rare, severe variant of Guillain-Barré syndrome marked by rapid progression, autonomic dysfunction, and delayed recovery. The patient in this report was treated in a resource-limited intensive care unit and had coexisting tropical infections that complicated diagnosis and treatment.</p><p><strong>Clinical findings: </strong>A 40-year-old man presented with acute quadriparesis, respiratory distress, and autonomic instability following a febrile illness. Laboratory tests revealed anemia, electrolyte imbalance, and methicillin-resistant Staphylococcus aureus bacteremia. Serology test results were weakly positive for dengue virus, typhoid, and scrub typhus. Nerve conduction studies confirmed acute motor and sensory axonal neuropathy.</p><p><strong>Diagnosis: </strong>Acute motor and sensory axonal neuropathy was complicated by polyinfection and tuberculous pleuritis, confirmed via cartridge-based nucleic acid amplification testing. Imaging showed bilateral pleural effusion and right lung collapse and consolidation.</p><p><strong>Interventions: </strong>Despite 5 cycles of intravenous immunoglobulin therapy, the patient showed no initial improvement and received 7 plasmapheresis cycles. Additional interventions included tracheostomy, vasopressors, bromocriptine for central fever, and antitubercular therapy. Nursing care grounded in the Roy Adaptation Model emphasized airway management, prevention of secondary complications, emotional reassurance, caregiver communication, and coordination of interprofessional care.</p><p><strong>Outcomes: </strong>The patient demonstrated steady neurological improvement, was successfully weaned from ventilation, and transitioned to rehabilitation. Nurse-led, theory-informed interventions were key to patient stabilization and long-term recovery.</p><p><strong>Conclusion: </strong>This case illustrates the complexity of acute motor and sensory axonal neuropathy with multiple infections and the role of structured nursing care for positive outcomes in intensive care units.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"28-35"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105243","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}

{"title":"Palliative Care Trigger Process in the Pediatric Intensive Care Unit: A Quality Improvement Project.","authors":"Cynthia Myo, Beth Nachtsheim Bolick, Julie Reed, Kimberly A Pyke-Grimm","doi":"10.4037/ccn2026109","DOIUrl":"https://doi.org/10.4037/ccn2026109","url":null,"abstract":"<p><strong>Background: </strong>Early integration of palliative care for pediatric intensive care unit patients and their families is beneficial for establishing goals of care and complex decision-making.</p><p><strong>Objective: </strong>To implement the use of a trigger criteria process to deliver palliative care to a specific population of pediatric intensive care unit patients who would most benefit from receiving such care.</p><p><strong>Methods: </strong>Trigger criteria were developed through a literature review and interprofessional work group discussions. Medical records were reviewed to compare the frequency of pediatric palliative care consultation 1 year before project implementation and during the 6-month project period.</p><p><strong>Intervention: </strong>The pediatric palliative care trigger criteria process was integrated into 3 areas of the pediatric intensive care unit workflow. Staff members identified patients meeting the trigger criteria and initiated team discussion on the appropriateness of palliative care. A pediatric palliative care consultation was requested if the team agreed that it would be beneficial.</p><p><strong>Results: </strong>Twelve of 18 patients (67%) had pediatric palliative care consultations during the 6-month project period using the trigger process, compared with 7 of 27 patients (26%) before process implementation.</p><p><strong>Conclusion: </strong>Implementation of a trigger criteria process to identify patients with high needs for palliative care was successful and effective in the pediatric intensive care unit in the setting of limited palliative care availability. Reassessment of trigger criteria, integration of the trigger process into the electronic health record, and ongoing staff education will be required for long-term sustainability of the project.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"46-52"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105253","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}

{"title":"Decompression Huddles.","authors":"Rachael Alexis Jividen, Christine Humphrey","doi":"10.4037/ccn2026906","DOIUrl":"https://doi.org/10.4037/ccn2026906","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"76-77"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105310","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}

{"title":"Regional Anesthesia for Patients Undergoing Cardiac Surgery: An Overview for the Bedside Nurse.","authors":"Zachary Feldt, John McNeil, Neal Parikh, Janelle Georgiana, Paul D Gallo","doi":"10.4037/ccn2026152","DOIUrl":"https://doi.org/10.4037/ccn2026152","url":null,"abstract":"<p><strong>Background: </strong>Regional anesthesia techniques are becoming increasingly used to reduce postoperative pain, reduce opioid use, and improve other outcomes in patients undergoing cardiac surgery.</p><p><strong>Objective: </strong>To provide critical care nurses with an overview of regional anesthesia techniques for cardiac surgery patients and to discuss considerations for bedside nurses to ensure safe, effective, and patient-centered care.</p><p><strong>Methods: </strong>A review of current literature was performed to provide a summary of fascial plane block techniques and the benefits, risks, and implications of their use for patients undergoing cardiac surgery. The role of bedside critical care nurses was examined.</p><p><strong>Results: </strong>Regional anesthesia has been shown to improve postoperative pain scores, shorten intensive care unit and hospital stays, reduce several postoperative complications, and improve other patient-centered outcomes for cardiac surgery patients. Critical care nurses perform crucial roles during placement of the blocks, when monitoring patients for adverse effects of local anesthesia, and by providing patient education and managing patients' expectations.</p><p><strong>Discussion: </strong>Regional anesthesia is an important tool in the care of patients undergoing cardiac surgery, and studies support its benefits for patient outcomes. However, further research is needed to develop and optimize evidence-based protocols for clinicians and perioperative care teams.</p><p><strong>Conclusion: </strong>As regional anesthesia becomes a routine component of post-cardiac surgery care, critical care nurses must be familiar with block techniques (administration and implication), monitoring protocols, and management of potential adverse events to optimize patient outcomes.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"21-27"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105365","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}

{"title":"Pediatric Clinical Practice Guidelines: Evidence, Expertise, and the Nursing Voice.","authors":"Annette M Bourgault","doi":"10.4037/ccn2026407","DOIUrl":"https://doi.org/10.4037/ccn2026407","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"4-5"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105278","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}

{"title":"Using Stethoscope Hygiene Barriers to Reduce Central Catheter-Associated Bloodstream Infection Rates.","authors":"Naomi Ragsdale, Wendy Simpson, W Frank Peacock","doi":"10.4037/ccn2026637","DOIUrl":"https://doi.org/10.4037/ccn2026637","url":null,"abstract":"<p><strong>Background: </strong>Central line [catheter]-associated bloodstream infections (CLABSIs) represent a significant mortality risk.</p><p><strong>Local problem: </strong>Due to a significant increase in CLABSI rate, a new CLABSI prevention bundle strategy was evaluated to determine whether it changed the CLABSI rate.</p><p><strong>Methods: </strong>A before and after quality improvement project was performed in an 18-bed intensive care unit from March 1, 2021, to March 1, 2025. A CLABSI prevention bundle was implemented; CLABSI rates were compared for 1 year before to 3 years after intervention implementation. Additionally, clinician satisfaction surveys were collected.</p><p><strong>Interventions: </strong>The implemented bundle consisted of (1) replacement of disposable stethoscopes with touch-free, aseptic stethoscope diaphragm cover dispensers (DiskCover System, AseptiScope, Inc) in each intensive care unit room, and (2) requiring a chlorhexidine-impregnated dressing for all central catheters, with standardization and reeducation of bedside staff on central catheter dressing changes.</p><p><strong>Results: </strong>Of 5226 intensive care unit patients, the mean CLABSI rate was 4.42 (95% CI, 2.93-5.91) infections per 1000 patient central catheter days during the year before implementation, which decreased to 0.70 (95% CI, -1.21 to 2.61) in the 3 years after implementation. Clinicians reported the new strategy was easy to use and superior to disposable stethoscopes.</p><p><strong>Conclusion: </strong>A CLABSI bundle that included touch-free, aseptic stethoscope hygiene barriers and chlorhexidine-impregnated dressings was highly effective at decreasing the CLABSI rate.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"61-66"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105381","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}

{"title":"Enhancing Nursing Assessment Through Artificial Intelligence: Bridging Intuition and Innovation.","authors":"Wesley J Stephens","doi":"10.4037/ccn2026319","DOIUrl":"https://doi.org/10.4037/ccn2026319","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"72-75"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105299","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}

{"title":"A New Competence Standard Improves Nurses' Confidence in Readiness to Practice.","authors":"Julie Miller, Mary Stahl, Sara Grieshop, Devin Bowers","doi":"10.4037/ccn2026499","DOIUrl":"https://doi.org/10.4037/ccn2026499","url":null,"abstract":"<p><strong>Background: </strong>An evidence-informed competence framework, with measurable performance outcomes and knowledge, skills, and abilities metrics, and an implementation toolkit were developed and beta tested to determine nurse readiness for transitioning from orientation to autonomous practice.</p><p><strong>Objective: </strong>To evaluate satisfaction and toolkit implementation and impact, and to identify opportunities for improvement.</p><p><strong>Methods: </strong>Sites replaced their orientation methods with the competence framework, and beta testing took place over a 1-year period. Surveys before and after implementation measured orientee and nurse leader confidence in orientees' ability to recognize a change in stability, intervene for a change in stability, advocate on behalf of the patient, and provide safe patient care. Comparisons of length of orientation, satisfaction, and opportunities for improvement were assessed. Nurse retention at 1 year was determined.</p><p><strong>Results: </strong>Thirteen progressive care and critical care units with 49 orientees completed the beta test; 24 orientees completed the before and after surveys. After beta testing, orientees reported increased confidence levels in all polled performance outcomes compared with before orientation. Most (92%) orientees reported the framework performance outcomes and knowledge, skills, and abilities metrics were moderately to completely effective in preparing them to work with minimal supervision. Most (88%) nurse leaders, educators, and preceptors rated these same outcomes and metrics as moderately to completely effective. Nurse retention at 1 year was 90%.</p><p><strong>Conclusion: </strong>The beta test demonstrated improvement in confidence in all polled areas, and 1-year retention outperformed the national average. The competence framework is effective in answering the question, How do leaders know when the nurse is ready to transition from orientation to more independent practice?</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"36-45"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105264","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}

{"title":"Pediatric Measles Resurgence: Implications for Acute and Critical Care Nursing Practice.","authors":"Janakiram Rameswaran, Jessica Strohm Farber, Kristin Atlas, Kerry Shields","doi":"10.4037/ccn2026877","DOIUrl":"10.4037/ccn2026877","url":null,"abstract":"<p><strong>Background: </strong>The United States declared endemic measles eliminated in 2000. However, outbreaks continued, with resurgences in 2019 and 2025. In 2025, more than 2200 cases across 48 outbreaks, the most since 1992, were reported. In the first half of 2026, 2073 cases were reported. Declining measles, mumps, and rubella vaccination rates have increased susceptibility among children. Acute and critical care nurses are central to early recognition and management of measles for optimal outcomes.</p><p><strong>Objective: </strong>To summarize current evidence on measles epidemiology, pathophysiology, clinical presentation, complications, treatment strategies, and acute and critical care nursing implications, emphasizing preparedness amid rising case numbers.</p><p><strong>Methods: </strong>A literature review was conducted using PubMed and CINAHL databases and websites of Centers for Disease Control and Prevention, World Health Organization, professional organizations, and pediatric hospitals. English-language sources published from 2015 to August 2025 were prioritized; relevant earlier studies were included. Reference lists were searched for additional articles.</p><p><strong>Data synthesis: </strong>Measles is among the most contagious human diseases. Typical features include fever, cough, coryza, conjunctivitis, and morbilliform rash. Severe respiratory and neurological complications may require critical care hospitalization. Complications like encephalitis may present weeks to years after acute infection. Management remains supportive, with vitamin A supplementation recommended. Acute and critical care nursing priorities include early recognition, isolation precautions, specimen collection, respiratory and hemodynamic support, neurological monitoring, serial assessments, hydration, nutrition, and caregiver education.</p><p><strong>Conclusion: </strong>Measles is resurging in the United States despite being vaccine preventable. Nurse preparedness, including knowledge of clinical features, complications, and infection control, is essential to mitigate morbidity and mortality and to support outbreak prevention.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":" ","pages":"10-20"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469407","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}