Critical care nurse最新文献

{"title":"2025 National Teaching Institute Evidence-Based Solutions Abstracts.","authors":"","doi":"10.4037/ccn2025791","DOIUrl":"https://doi.org/10.4037/ccn2025791","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"e1-e37"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751514","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":"From Reactive to Proactive: A Novel Rapid Response System.","authors":"Fiona A Winterbottom","doi":"10.4037/ccn2025623","DOIUrl":"https://doi.org/10.4037/ccn2025623","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"74-76"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751519","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":"Have Nursing Work Conditions Improved?","authors":"Annette M Bourgault","doi":"10.4037/ccn2025541","DOIUrl":"https://doi.org/10.4037/ccn2025541","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"8-10"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751520","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":"The Full Scope of Nurses' Work in Hospitals.","authors":"Devin Carr, Kathleen M Vollman","doi":"10.4037/ccn2025732","DOIUrl":"https://doi.org/10.4037/ccn2025732","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"11-12"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751529","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":"Impact of a Sleep-Promoting Schedule on Sleep Quality in the Intensive Care Unit.","authors":"Kristin Long, Beth Hundt, Clareen Wiencek, Jeanel Little","doi":"10.4037/ccn2025288","DOIUrl":"10.4037/ccn2025288","url":null,"abstract":"<p><strong>Background: </strong>Hospitalized patients often experience sleep disruption that fragments their sleep and disturbs their circadian rhythms, putting them at risk for sleep deprivation. The risk increases with greater severity of illness and is especially high in intensive care unit patients. Sleep deprivation can prolong the intensive care unit stay, contribute to emotional and physiological distress, and even increase the patient's risk of death.</p><p><strong>Local problem: </strong>Critical care nurses in a 28-bed medical intensive care unit reported that patients often complained of sleep disruption or exhibited emotional and physical distress resulting from sleep deprivation. An analysis of the gap between recommended evidence-based best practice and current practices in the unit revealed numerous opportunities to improve patients' sleep. The aim of this evidence-based quality improvement project was to increase interprofessional adherence to an existing sleep-promoting schedule to reduce avoidable interruptions and improve patient sleep quality.</p><p><strong>Methods: </strong>To promote sleep, staff member interactions with patients between midnight and 4 am were minimized, if appropriate. Documented patient encounters and call bell initiation were evaluated as process measures. Patients' self-perceived sleep quality, an outcome measure, was evaluated using the Richards-Campbell Sleep Questionnaire.</p><p><strong>Results: </strong>Adherence to a sleep-promoting schedule reduced patient sleep interruptions between midnight and 4 am by as much as two-thirds while increasing patients' overall self-perceived sleep quality by 6.7 percentage points.</p><p><strong>Conclusion: </strong>An interprofessional effort to minimize patient interruptions at night in an intensive care unit setting led to improved patient sleep quality and sustainable practice changes.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"33-40"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751523","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":"Tele-Intensive Care Unit Collaboration to Decrease Pressure Injuries: A Quality Improvement Project.","authors":"Kelly Small, Jason White, Christopher Palmer, Cassandra Arroyo, Jennifer Licare, Gretchen Lucas, Rebecca Rojek, Beth Taylor, Lisa Wright, Marilyn Schallom","doi":"10.4037/ccn2025404","DOIUrl":"10.4037/ccn2025404","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources.</p><p><strong>Local problem: </strong>An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention.</p><p><strong>Methods: </strong>A quality improvement initiative incorporating tele-intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used.</p><p><strong>Results: </strong>For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after implementation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02).</p><p><strong>Conclusion: </strong>Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"50-59"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751528","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":"Decreasing Sternal Wound Infections After Cardiac Surgery: A Nurse-Driven Bundle Approach.","authors":"Tilu Chacko, Kayla Dunn, Alexandra Taylor Berger, Michael Spicer, Darshani Singh","doi":"10.4037/ccn2025230","DOIUrl":"https://doi.org/10.4037/ccn2025230","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"80-86"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751515","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":"Physiological and Psychological Changes in Patients Undergoing Percutaneous Coronary Intervention: An Integrative Review.","authors":"Isadora Braga Calegari, Laissa Borges E Silva, Fernanda Fernandes Silva, Márcia Marques Dos Santos Felix, Maria Beatriz Guimarães Raponi, Maria Helena Barbosa","doi":"10.4037/ccn2025959","DOIUrl":"10.4037/ccn2025959","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous coronary intervention has been the main percutaneous method of myocardial revascularization used in all clinical scenarios, but patients undergoing these procedures may experience negative physiological and psychological changes.</p><p><strong>Objective: </strong>To identify the physiological and psychological changes experienced by patients undergoing percutaneous coronary intervention.</p><p><strong>Methods: </strong>This integrative review was carried out through a search for primary studies included in the PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin America and the Caribbean Literature on Health Sciences), and Embase databases in February 2023. No publication time frame was delimited, and articles in English, Portuguese, and Spanish were considered.</p><p><strong>Results: </strong>Of the 889 studies initially identified in the search, 20 made up the final sample. The majority (n = 13) of the included studies predominantly assessed psychological changes after percutaneous coronary intervention, with follow-up periods ranging from 6 months to 1 year. A few studies (n = 6) explored physiological changes among patients undergoing percutaneous coronary intervention, and 1 study investigated the prevalence of depression and anxiety in patients with coronary heart disease in 24 European countries. The main psychological changes found after percutaneous coronary intervention were increased anxiety and depression. Anxiety and depression levels were reduced at long-term follow-up. Physiological changes included fatigue, shortness of breath, and chest discomfort.</p><p><strong>Conclusion: </strong>The results of this review show an urgent need for health care professionals to better assess patients' psychological state and employ strategies aimed at providing comprehensive care.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"13-24"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751527","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":"Diagnostic Precision: Exchanging Urinary Catheters Before Urine Specimen Collection to Reduce Catheter-Associated Urinary Tract Infection.","authors":"Kathleen Romano, Jessica Leone, Nora Love, Amy Caramore","doi":"10.4037/ccn2025857","DOIUrl":"10.4037/ccn2025857","url":null,"abstract":"<p><strong>Background: </strong>Catheter-associated urinary tract infections are among the most prevalent and costly types of hospital-acquired infections. During the COVID-19 pandemic, growing numbers of critical care patients required indwelling urinary catheters, leading to higher infection rates.</p><p><strong>Local problem: </strong>A critical care unit saw a 7-fold increase in the rate of catheter-associated urinary tract infection during the COVID-19 pandemic. A review of procedures showed that the current standard of care for preventing such infections was inadequate. In particular, patients who could not have indwelling urinary catheters promptly removed risked a potential false-positive diagnosis of catheter-associated urinary tract infection due to clinicians' use of long-term catheters to obtain urine specimens for microbiological evaluation.</p><p><strong>Methods: </strong>A literature review was performed to gather evidence on best practices for urine specimen collection in the critical care unit. An interprofessional task force including frontline nurses advocated implementation of a pilot project in 2 critical care units involving exchange of catheters before obtaining urine specimens for microbiological evaluation in any patient who had an indwelling catheter in place for more than 24 hours.</p><p><strong>Results: </strong>Implementation of the new protocol resulted in a major reduction in the diagnosis of catheter-associated urinary tract infection, with no incidents occurring for 2 consecutive quarters. Based on these results, the new evidence-based workflow was incorporated as the standard of care for all adult inpatients.</p><p><strong>Conclusion: </strong>Catheter exchange before collection of urine specimens in patients requiring urine culture evaluation can improve accuracy of diagnosis of catheter-associated urinary tract infection and promote antibiotic stewardship.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"25-32"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751517","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":"Intravenous Fluid Therapy Choice in Trauma Patients in the Intensive Care Unit: A Scoping Review.","authors":"Aaron McKee, Nancy Moriber, Joni Tornwall","doi":"10.4037/ccn2025318","DOIUrl":"10.4037/ccn2025318","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, intravenous fluid resuscitation is contentious. Although research has explored intravenous fluids for patients with sepsis or septic shock, evidence guiding fluid choices for trauma patients in intensive care units remains scarce.</p><p><strong>Objective: </strong>To summarize current recommendations for intravenous fluid choices for resuscitation and their impact on outcomes in trauma patients in intensive care units.</p><p><strong>Methods: </strong>The literature was appraised with a scoping review using the Joanna Briggs Institute framework.</p><p><strong>Results: </strong>A search of databases (CINAHL Plus, MEDLINE, Health Source: Nursing/Academic Edition, PubMed, and Scopus) yielded 10 articles examining crystalloid and colloid solutions. In trauma patients, major adverse outcomes (mortality, acute kidney injury, hospital/intensive care unit length of stay) did not significantly differ according to crystalloid solution type except in patients with traumatic brain injury, for whom normal saline was beneficial. Albumin and hypertonic saline as adjuncts to fluid therapy were generally safe except for patients with traumatic brain injury.</p><p><strong>Discussion: </strong>Balanced crystalloid solutions and normal saline can be used interchangeably in trauma patients except those with traumatic brain injury. The use of albumin for first-line resuscitation is questionable due to cost and lack of benefit over other fluids. Hypertonic saline may benefit patients with delayed abdominal closure after exploratory laparotomy.</p><p><strong>Conclusion: </strong>In trauma patients, outcomes are not influenced by intravenous fluid type except for those with traumatic brain injury, for whom normal saline is preferred over balanced crystalloid solutions. Hypertonic saline and albumin may be adjunct therapies after considering cost, availability, and individual patient characteristics.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 2","pages":"41-49"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751526","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}