Critical care nurse最新文献

{"title":"Beyond the Guidelines: Nursing Leadership in Pediatric End-of-Life Care.","authors":"Kathryn E Roberts, Tiffany Mullen","doi":"10.4037/ccn2026516","DOIUrl":"https://doi.org/10.4037/ccn2026516","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"6-8"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105226","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":"Standardizing Intensive Care Unit Discharge Through Use of the National Early Warning Score.","authors":"Abigail Weilbacher, Marilyn A Prasun, Heather Cook","doi":"10.4037/ccn2026340","DOIUrl":"https://doi.org/10.4037/ccn2026340","url":null,"abstract":"<p><strong>Background: </strong>No standardized process for determining intensive care unit discharge readiness is available. Intensive care unit readmission is associated with adverse patient outcomes.</p><p><strong>Objective: </strong>To evaluate whether implementation of an intensive care unit discharge protocol based on the National Early Warning Score impacts intensive care unit readmission rates, intensive care unit length of stay, and rapid response team activations.</p><p><strong>Methods: </strong>This quality improvement initiative was implemented in the medical intensive care unit at a 671-bed urban, academic medical center. De-identified electronic medical record data (vital signs, length of intensive care unit stay, and readmission risk factors) were obtained before and during the intervention.</p><p><strong>Results: </strong>Two hundred ten patients during the preintervention phase and 211 patients during the intervention phase met inclusion criteria. A nonsignificant 1.5% reduction in intensive care unit readmission rate was found (P = .54). Mean National Early Warning Score at intensive care unit discharge for patients who required readmission was significantly higher in the preintervention group (P = .004), and significantly more patients in the preintervention group were discharged with a National Early Warning Score indicating high risk (P = .04). Length of stay and rapid response team activations did not significantly differ between groups. All readmitted patients had readmission risk factors, most commonly respiratory reasons and vital sign abnormalities.</p><p><strong>Conclusion: </strong>An intensive care unit discharge protocol provides standardization to the discharge process and promotes collaboration between nurses and physicians. Future research on a National Early Warning Score-driven intensive care unit discharge protocol is needed.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"e1-e8"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105370","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":"Digitalizing Ventilator Safety: Enhancing Workflow Efficiency and Competency in Critical Care.","authors":"Wei Jun Dan Ong, Eleanor Dela Peña, Faheem A Khan, Woon Hean Keenan Chong, Lawrence Ace Azul","doi":"10.4037/ccn2026554","DOIUrl":"https://doi.org/10.4037/ccn2026554","url":null,"abstract":"<p><strong>Background: </strong>Noninvasive ventilation is increasingly delivered outside intensive care units; however, ventilator alarm management, documentation, and competency validation remain inconsistent when paper-based processes are used. Delayed or inconsistent responses to actionable alarms may contribute to clinical deterioration and escalation of care.</p><p><strong>Local problem: </strong>Nurses and respiratory therapists reported fragmented documentation, limited access to standardized troubleshooting guides, and time-consuming competency tracking for noninvasive ventilation devices in acute medical units that provide intermediate-level care.</p><p><strong>Methods: </strong>This quality improvement project, which used a pre-post design, involved implementation of a digital ventilator safety workflow using QR code-linked alarm guidance and a secure online checklist. Data were collected during a 6-month baseline period and a 6-month postimplementation period. Clinical content, workflow mapping, and alarm-guidance pathways were developed in-house by the respiratory therapy department and deployed through AskVijay, a digital clinical guidance platform. Competency validation was conducted during onboarding and annual assessment.</p><p><strong>Results: </strong>Digital implementation was associated with an increase in checklist completion compliance from 80% to 100% and a reduction in checklist completion time from a median of 8.5 minutes to 3.9 minutes. Use of required digital fields supported more complete documentation. Centralized electronic records enabled consolidated competency documentation and facilitated tracking of checklist and competency completion.</p><p><strong>Conclusion: </strong>A digital ventilator safety workflow supported standardized documentation, point-of-care access to alarm guidance, and competency tracking for unit-based noninvasive ventilation care. In-house clinical development enabled iterative refinement to align with local practice needs and workflows.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 5","pages":"53-60"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105305","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 Extracorporeal Membrane Oxygenation Decannulation: An Ethical, Evidence-Based Approach.","authors":"Richard Arbour, Mackenzie Abate, Orion Garcia, Sheriff Gbadamosi, Sean M Baskin","doi":"10.4037/ccn2026166","DOIUrl":"10.4037/ccn2026166","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation, although lifesaving, is invasive. Complications affecting all body systems mandate reevaluation of goals of care. When extracorporeal membrane oxygenation is nonbeneficial, planning for de-escalation/decannulation to allow natural death must occur.</p><p><strong>Local problem: </strong>In a tertiary care facility with 64 beds using extracorporeal membrane oxygenation, practices varied regarding extracorporeal membrane oxygenation initiation, patient/family communication, futility determination, and symptom management during de-escalation. Symptom management during transition to comfort-directed care was suboptimal, increasing patient, family, and team discomfort. The goals of this quality improvement project were to mitigate practice variability and improve patient experience and communication, allowing for comfortable, natural death.</p><p><strong>Methods: </strong>Palliative care integration, literature review of best practices, and creation of an interprofessional task force were process improvements during extracorporeal membrane oxygenation de-escalation. New clinical guidelines provided structure, consistency, and evidence-based care processes mitigating practice variability during de-escalation/decannulation.</p><p><strong>Results: </strong>Successful guideline implementation decreased practice variability, lessening patient/family stress and discomfort. After implementation, team member self-reports of secondary trauma and moral distress symptoms during extracorporeal membrane oxygenation de-escalation/decannulation decreased. Team members reported improved end-of-life care delivery with family education and support, patient advocacy, and symptom management. Family members appreciated attention to the patient's and their own well-being during end-of-life care. Structured debriefings helped staff members process feelings toward end-of-life care and identified opportunities for improvement.</p><p><strong>Conclusion: </strong>Guideline application decreased practice variability in extracorporeal membrane oxygenation de-escalation/decannulation, incorporating patient and family preferences. Death became more comfortable and dignified. Decreased practice variability and proactive symptom management improved patient/family experience.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"17-28"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648265","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":"Point-of-Care Ultrasonography by Advanced Practice Providers for Patients With Undifferentiated Shock.","authors":"Nicholas Fatolitis, Anthony W McGuire","doi":"10.4037/ccn2026613","DOIUrl":"https://doi.org/10.4037/ccn2026613","url":null,"abstract":"<p><strong>Background: </strong>In this evidence-based practice project, point-of-care ultrasonography by advanced practice providers was implemented in a central Florida intensive care unit. The project was guided by the following question: Does implementation of point-of-care ultrasonography by critical care advanced practice providers over 3 months decrease time to intravenous fluid, vasopressor, or inotrope administration or modify the treatment plan for patients with undifferentiated shock, as compared with current practice without point-of-care ultrasonography?</p><p><strong>Review of evidence: </strong>A strong body of evidence supports using advanced practice provider-performed point-of-care ultrasonography to enhance care for critically ill patients.</p><p><strong>Implementation: </strong>Baseline data on treatment of patients with undifferentiated shock, including intravenous fluid volume and time to intervention, were collected over 60 days. Advanced practice providers then completed in-person point-of-care ultrasonography training focused on clinical application and integration into decision-making. A second 60-day data collection period tracked evaluation and treatment by advanced practice providers.</p><p><strong>Evaluation: </strong>Time to intervention did not significantly differ between preintervention and postintervention groups. However, point-of-care ultrasonography findings consistently changed or refined patient care.</p><p><strong>Sustainability: </strong>The project site will continue advanced practice provider-led point-of-care ultrasonography across all intensive care units.</p><p><strong>Conclusions: </strong>Implementation of point-of-care ultrasonography by critical care advanced practice providers does not delay intervention, helps confirm clinical diagnoses, and refines treatment delivery for patients with undifferentiated shock. Point-of-care ultrasonography provides a structured approach to assessment and management and should continue to be used in intensive care units.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"44-51"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648444","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 Patient Safety During Awake Tracheal Intubation.","authors":"Nicole Trainer","doi":"10.4037/ccn2026314","DOIUrl":"https://doi.org/10.4037/ccn2026314","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"76-79"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648287","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":"Policy Bites: Why Policy Belongs in Critical Care Practice.","authors":"Annette M Bourgault","doi":"10.4037/ccn2026229","DOIUrl":"https://doi.org/10.4037/ccn2026229","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"4-5"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648414","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":"Evidence-Based Practice Implementation, Part 2: Embedding Evidence-Based Innovations in Practice.","authors":"Margo A Halm","doi":"10.4037/ccn2026330","DOIUrl":"https://doi.org/10.4037/ccn2026330","url":null,"abstract":"<p><p>Part 1 of this series, \"Selecting Interventions,\" explored how to choose interventions for evidence-based practice implementation that fit the patient population, practice setting, and clinician workforce. Part 1 also introduced the Consolidated Framework for Implementation Research as a roadmap. Using Critical Care Nurse publication exemplars on hospital-acquired pressure injury prevention, part 1 illustrated how innovations can be single, bundled, or blended. Part 2 of the series shifts the focus from what to implement to how to make it stick. This article unpacks 9 elements of the implementation process domain of the Consolidated Framework for Implementation Research: teaming, assessing the context, assessing needs of innovation recipients and deliverers, planning, tailoring strategies, engaging, doing, reflecting and evaluating, and adapting. These elements provide practical, evidence-informed guidance for teams ready to not only embed innovations but sustain them in everyday practice.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"53-61"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648262","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":"Corrections.","authors":"","doi":"10.4037/ccn2026915","DOIUrl":"https://doi.org/10.4037/ccn2026915","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"7"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648338","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 Role of Technology in Nursing Practice.","authors":"Jenny G Alderden, Carl Goforth","doi":"10.4037/ccn2026899","DOIUrl":"https://doi.org/10.4037/ccn2026899","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"6-7"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648363","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}