Critical care nurse最新文献

{"title":"Violence in the Workplace: Preparedness, Prevention, Response, and Recovery Strategies for Acute and Critical Care Nurses.","authors":"Dawn Carpenter, Alexander Menard, Johnny Isenberger, Gregg A Stevens, Lisa LaRock","doi":"10.4037/ccn2025799","DOIUrl":"https://doi.org/10.4037/ccn2025799","url":null,"abstract":"<p><strong>Background: </strong>Workplace violence has been increasing in hospitals and has been associated with employee turnover and decreased productivity and quality of care.</p><p><strong>Objective: </strong>To identify interventions acute and critical care nurses can employ to address workplace violence among patients and visitors.</p><p><strong>Methods: </strong>The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for publications related to hospital workplace violence.</p><p><strong>Results: </strong>Of 951 articles retrieved, 47 were included. Only 2 articles (4%) were specific to critical care, 5 (11%) were generic to hospital settings, and 40 (85%) focused on emergency departments. The highest level of evidence was in 1 randomized controlled trial; 46 articles (98%) had level 6 or 7 evidence. The evidence revealed 3 themes: preparedness/prevention, response to violence, and recovery. Preparedness/ prevention was the most prevalent theme. Assessment and screening, communication, education, leadership, and infrastructure were subthemes.</p><p><strong>Discussion: </strong>Nurses can engage in efforts to promote a safe and healthy work environment. With increasing prevalence of workplace violence in health care, acute and critical care nurses must be prepared to prevent and manage violence. Focused education, including simulations and drills, are essential.</p><p><strong>Conclusion: </strong>Bedside nurses and leadership teams should collaborate to reduce workplace violence in their environments. Further research focusing on workplace violence in acute and critical care areas is needed to define the most effective interventions.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"28-45"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198582","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":"Risks Associated With Peripheral Vasopressor Administration.","authors":"Todd Heslep","doi":"10.4037/ccn2025632","DOIUrl":"https://doi.org/10.4037/ccn2025632","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"12-13"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198483","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":"Strategies to Identify and Navigate Misinformation.","authors":"Annette M Bourgault","doi":"10.4037/ccn2025588","DOIUrl":"https://doi.org/10.4037/ccn2025588","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"4-6"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198473","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":"Sepsis Identification Tools: A Narrative Review.","authors":"Maureen A Seckel, Joanna D Lejnieks","doi":"10.4037/ccn2025240","DOIUrl":"https://doi.org/10.4037/ccn2025240","url":null,"abstract":"<p><strong>Background: </strong>Although sepsis remains a medical emergency, there is no standard test for diagnosing it. Current sepsis management guidelines strongly recommend screening for sepsis but do not identify a specific tool to use.</p><p><strong>Objective: </strong>To summarize the evidence for sepsis screening tools and triggers, identify the current tools used, and describe their effectiveness.</p><p><strong>Methods: </strong>A review of the literature from January 2019 through June 2024 was performed. Studies were included if they described sepsis screening tools used for adults in the emergency department or adult inpatients, including intensive care unit patients. Studies were excluded if they described tools specific to machine learning with artificial intelligence or biomarkers and biologics.</p><p><strong>Results: </strong>A total of 300 articles were screened. The final set of 26 studies included articles on computerized clinical decision support systems (8 studies), existing early warning systems (14 studies), and new or novel tools (4 studies). Sepsis definitions were heterogeneous and generally based on disease classification codes, criteria from the Sepsis-2 or Sepsis-3 definitions, or combinations thereof. The most commonly used early warning system tools used that had superior evidence were the National Early Warning Score versions 1 and 2. Little evidence supported the use of the quick Sequential [Sepsis-related] Organ Failure Assessment alone for sepsis identification. The use of computerized clinical decision support systems is varied; both proprietary and individual system-developed tools are available, with little consensus on standards for reporting accuracy.</p><p><strong>Conclusion: </strong>It is clear that all currently available tools function only as adjuncts to clinical acumen.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"63-79"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198514","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":"Nursing Care of Critical Care Patients Without Sedation.","authors":"Kali Dayton","doi":"10.4037/ccn2025439","DOIUrl":"https://doi.org/10.4037/ccn2025439","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"85-87"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198523","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":"Vascular Access and Complications in Critical Illness.","authors":"Tammy L Monter","doi":"10.4037/ccn2025483","DOIUrl":"https://doi.org/10.4037/ccn2025483","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 5","pages":"8-10"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198649","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 Misaligned Solution: The Challenges of Deploying Intensive Care Unit Nurses to Unfamiliar Practice Environments.","authors":"Angela Morris","doi":"10.4037/ccn2025270","DOIUrl":"https://doi.org/10.4037/ccn2025270","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"10-11"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764698","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":"Animal-Assisted Interventions for Psychological Distress During Prolonged Intensive Care Unit Stay: A Case Report.","authors":"Taryn Kellogg, Camille Brockett-Walker","doi":"10.4037/ccn2025759","DOIUrl":"https://doi.org/10.4037/ccn2025759","url":null,"abstract":"<p><strong>Introduction: </strong>Lung transplant is a critical treatment for patients with end-stage lung disease, but recovery is often complicated by physiological and psychological challenges. This case report describes a 61-year-old female bilateral orthotopic lung transplant recipient who experienced significant psychological decline during an extended intensive care unit stay and the use of animal-assisted interventions to address these challenges.</p><p><strong>Clinical findings: </strong>The patient experienced multiple postoperative complications, including coagulopathy, venovenous extracorporeal membrane oxygenation for hypoxia, delayed chest closure, right ventricular dysfunction, acute kidney injury, adrenal insufficiency, hypogammaglobulinemia, diaphragmatic paralysis, antibody-mediated rejection, bacteremia, and severe deconditioning.</p><p><strong>Diagnosis: </strong>The patient's psychological decline manifested through increased somnolence, reduced engagement in physical therapy, and minimal interaction with family and health care professionals.</p><p><strong>Interventions: </strong>Weekly animal-assisted interventions were introduced to improve mood and increase motivation. These sessions involved therapy animals with the goal of enhancing the patient's psychological well-being.</p><p><strong>Outcomes: </strong>The patient responded positively to animal-assisted interventions, showing improved mood, increased engagement, and participation in rehabilitation. The theoretical framework of acceptability was used to assess the intervention's success, with results indicating high acceptability and effectiveness.</p><p><strong>Conclusion: </strong>Animal-assisted interventions addressed the patient's psychological challenges during prolonged intensive care unit stays following lung transplant. The intervention improved both psychological well-being and patient engagement. Theoretical framework of acceptability scores supported the acceptability of animal-assisted interventions, suggesting that these should be considered as part of an interprofessional approach to managing prolonged hospitalizations in transplant recipients.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"12-20"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764699","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":"Entering a No Diaper Zone: Rethinking Prevention of Catheter-Associated Urinary Tract Infection.","authors":"Kathryn Cabral, Victoria Anderson, Isabel Allen, Dorian Hoskins, Kristen Byers, Margaret Gettis","doi":"10.4037/ccn2025843","DOIUrl":"https://doi.org/10.4037/ccn2025843","url":null,"abstract":"<p><strong>Background: </strong>Catheter-associated urinary tract infections are a leading hospital-acquired infection and are a major cause of increased morbidity, mortality, and health care costs, with 83% of pediatric cases occurring in pediatric intensive care units. Indwelling urinary catheters are widely used in adult and pediatric patients to accurately monitor urine output and manage fluid balance.</p><p><strong>Local problem: </strong>Staffing challenges and high nurse turnover in a 56-bed pediatric intensive care unit led to inconsistencies in practices to prevent catheter-associated urinary tract infection. Stool contamination from diapers used alongside indwelling urinary catheters increased the risk of infection.</p><p><strong>Methods: </strong>An interprofessional team designed a comprehensive catheter-associated urinary tract infection prevention strategy through plan-do-study-act cycles. Compliance was tracked through electronic surveys during catheter-associated urinary tract infection huddles, bedside infection prevention rounds, and bundle audits, with statistical process control charts used to measure infection rates before and after implementation of interventions. Interventions consisted of introduction of an exploratory no-diapering protocol, use of an advanced indwelling urinary catheter drainage system, and consistent staff reeducation.</p><p><strong>Results: </strong>The rate of catheter-associated urinary tract infection decreased from 3.13 to 0 per 1000 catheter days, with 527 event-free days (about 1.5 years).</p><p><strong>Conclusion: </strong>The combination of an advanced indwelling urinary catheter drainage system, elimination of diapers, and structured staff reeducation reduced the rate of catheter-associated urinary tract infection in the pediatric intensive care unit. This approach has potential for application in both pediatric and adult critical care settings to reduce infection rates and improve patient outcomes.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"21-28"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764701","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":"Integration of Rapid Response Teams and Early Warning Systems to Reduce Cardiac Arrests and Intensive Care Unit Readmissions.","authors":"Laura Weigand, Tracy Viers, Eydie Tipton","doi":"10.4037/ccn2025131","DOIUrl":"https://doi.org/10.4037/ccn2025131","url":null,"abstract":"<p><strong>Background: </strong>Early identification and treatment of clinical deterioration is crucial for improving outcomes among hospital patients. A high-acuity response team (HART) program can integrate early warning systems and proactive rounding by critical care nurses to prevent unplanned escalations in care.</p><p><strong>Local problem: </strong>During the COVID-19 pandemic, a HART program was inconsistently implemented because of intensive care unit staffing shortages. Barriers to optimizing the HART nurse role included inconsistent practices, lack of clear role expectations, and frequent reassignment of HART nurses to compensate for staffing shortages.</p><p><strong>Methods: </strong>Postpilot implementation of the HART program began in October 2019. Critical care nurses were designated as HART nurses, responsible for monitoring the Rothman Index, and assisted bedside nurses with high-acuity patients. Data were collected from 2019 to 2023 and were analyzed using IBM SPSS Statistics, version 29, with statistical significance defined as P ≤ .05.</p><p><strong>Results: </strong>The HART program significantly reduced 24-hour intensive care unit readmissions by 33.9% and 72-hour readmissions by 32.7%. HART nurse consultations increased by 35.7%. There were clinically significant decreases in code blue emergencies outside the intensive care unit (22.2%) and overall (16.7%), although no statistically significant differences were found for rapid response team activations or unplanned intensive care unit transfers.</p><p><strong>Conclusion: </strong>The HART nurse program effectively integrates early warning systems and rapid response teams, significantly reducing intensive care unit readmissions and improving patient care. Clear role expectations and dedicated staffing are needed, and continuous stakeholder engagement and resource allocation are essential for sustaining the program's success.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"49-56"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764702","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}