Critical care nurse最新文献

{"title":"Decreasing Unplanned Extubation Rates on an Adult Medical Intensive Care Unit.","authors":"Alyson Triolo, Jennifer R Ricker","doi":"10.4037/ccn2026904","DOIUrl":"https://doi.org/10.4037/ccn2026904","url":null,"abstract":"<p><strong>Background: </strong>Decreasing unplanned extubation rates in critically ill patients is an important element of care in the intensive care unit. However, most available literature on unplanned extubation addresses its prevalence, risk factors, and patient outcomes; few articles offer specific, reproducible interventions for preventing unplanned extubation.</p><p><strong>Local problem: </strong>In the adult medical intensive care unit of a large academic tertiary care hospital, the unplanned extubation rate in the last quarter of 2018 was 2.0 per 100 ventilator days, higher than the internal benchmark of 1.06 per 100 ventilator days.</p><p><strong>Methods: </strong>A quality improvement project was initiated to identify patients' risk for unplanned extubation and implement interventions according to risk level. The risk categories and associated bundled nursing interventions were created by an expert work group using available literature and data collected on the unit. The effectiveness of the interventions was tested by continually monitoring unplanned extubation rates.</p><p><strong>Results: </strong>After the project's initiation in 2019, the rate of unplanned extubations in the intensive care unit decreased from 1.307 per 100 ventilator days in 2018 to 0.344 in 2023. A 2-proportion z test revealed a significant difference in unplanned extubation rates between 2018 and 2023 (P < .001), indicating that the project implemented in 2019 effectively reduced unplanned extubation events over time.</p><p><strong>Conclusion: </strong>By integrating evidence-based interventions, fostering a culture of safety, and emphasizing proper patient assessment and communication, substantial progress was made in decreasing unplanned extubation rates.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"8-16"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648304","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":"Reflection Activity After Patient Death to Reduce Anxiety in Intensive Care Nurses.","authors":"Rachael Bruce, Cassandra Cobb, Kristy Everett, Alandra Love, Megan Shelton, Melanie Baucom, Andres Azuero","doi":"10.4037/ccn2026689","DOIUrl":"10.4037/ccn2026689","url":null,"abstract":"<p><strong>Background: </strong>Many nurses, particularly those working in intensive care units, experience anxiety and burnout as a result of caring for patients with complex conditions and high mortality rates. This situation often leads to employee dissatisfaction and high turnover.</p><p><strong>Local problem: </strong>The purpose of this project was to reduce anxiety related to patient death among nurses in a 17-bed medical intensive care unit through the implementation of a previously developed evidence-based postdeath reflection activity called \"The Pause.\"</p><p><strong>Methods: </strong>Unit leaders received training in the Pause. Staff nurses anonymously and voluntarily completed preintervention and postintervention surveys collecting self-reported demographic data and scores on the revised Collett-Lester Fear of Death Scale, which measures fear and anxiety about death. The intervention was performed by a trained staff member when a patient died. Quantitative data were evaluated using descriptive statistics and measures of effect size.</p><p><strong>Results: </strong>A total of 38 nurses (54% of nursing staff members) completed the preintervention survey, and 22 nurses (31% of nursing staff members) completed the postintervention survey. The mean total score on the revised Collett-Lester Fear of Death Scale decreased by 15% (Cohen d = 0.53) from before to after the intervention, indicating reduced overall anxiety related to patient death among participating nurses.</p><p><strong>Conclusion: </strong>Implementation of the Pause was associated with a decrease in anxiety among bedside nurses. Given the minimal cost and workload for staff members, along with the positive outcome, continuation of this intervention is recommended.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"29-35"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648411","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 Comprehension: Is There a Checkbox for That?","authors":"Katie Thompson","doi":"10.4037/ccn2026929","DOIUrl":"https://doi.org/10.4037/ccn2026929","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"6"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648268","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 and Professional Organizations.","authors":"Yvette Conyers, Sarah Miner","doi":"10.4037/ccn2026173","DOIUrl":"https://doi.org/10.4037/ccn2026173","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"82-83"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648373","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":"Use of pH Testing to Confirm Feeding Tube Placement: A Quality Improvement Project.","authors":"Emily Castro, Lovelyn Joy Aguila, Ann Langan, Melissa Shuriah-Graham, Diane Grassi, Lavern Brown, Shalesha Hernandez, Soon Yong Yun, Ani Jacob","doi":"10.4037/ccn2026129","DOIUrl":"https://doi.org/10.4037/ccn2026129","url":null,"abstract":"<p><strong>Background: </strong>Chest radiography confirms initial nasogastric tube placement but is impractical for repeated verification during feeding and medication administration.</p><p><strong>Local problem: </strong>Nasogastric tube placement verification practices on the neuroscience unit delayed feedings and medication administration due to radiograph interpretation and physician order wait times. The aim of this quality improvement project was to assess feasibility, usability, and adoption of gastric aspirate pH testing and tube length measurement for ongoing nasogastric tube placement verification after initial chest radiography confirmation.</p><p><strong>Methods: </strong>The Stevens Star Model of Knowledge Transformation guided this project and involved assessing relevance and feasibility of the practice change, developing an action plan, implementing the intervention, and evaluating the results. The quality improvement intervention was to use gastric aspirate pH testing along with distal tube length measurement at the nostril exit site, rather than gastric auscultation, for ongoing nasogastric tube placement verification.</p><p><strong>Results: </strong>With 100% staff compliance with workflow and process measures, the project was feasible and usable. A total of 141 gastric aspirate samples were tested over 6 months. Gastric placement was confirmed (pH ≤5.5) in 131 samples. Ten of the 141 samples had a pH of greater than 5.5, indicating placement not confirmed. Postimplementation surveys indicated that staff nurses accepted the practice change.</p><p><strong>Conclusion: </strong>Gastric aspirate pH testing along with tube length measurement is feasible and effective for ongoing nasogastric tube placement verification in patients with stroke and other neurological conditions. The next step is to incorporate suggested process improvements into the next practice change cycle.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"36-43"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648417","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 the Triple D Method on Conflict Management and Workplace Engagement.","authors":"Tanizia Sims, Melvin Bacchus, Shannon Johnson, Bertha Adigler, Laura Howard, Stan Thomas, Maryann Maldonado, Ngozi Ayabazu-Okoye, Mahamed Ali, Yeshimebet Linscheid, Kourtney Spikes","doi":"10.4037/ccn2026391","DOIUrl":"https://doi.org/10.4037/ccn2026391","url":null,"abstract":"<p><strong>Background: </strong>Although nurses' attitudes toward teamwork and work-related well-being have been explored, evidence is limited on the impact of a team-based method to manage interpersonal conflicts among nursing staff members.</p><p><strong>Local problem: </strong>Nursing leaders on a 20-bed critical care service unit at a large teaching hospital in the southwestern United States received increasing reports of interpersonal conflicts between direct care staff members. They chose to address this problem by acknowledging the incivility and implementing improvement initiatives.</p><p><strong>Methods: </strong>This project, which followed a plan-do-study-act cycle, compared perceptions of interpersonal communication and workplace engagement initiatives before and after implementation of the Triple D Method: Discuss, Decide, Deliver and compared the presence of self-care behaviors before and after the promotion of well-being practices. Data were collected through voluntary and anonymous questionnaires. Responses were assessed 1 month before and 6 months after implementation of the interventions.</p><p><strong>Interventions: </strong>Each month, nurses and nursing assistants met with the unit's nurse leaders to discuss teamwork barriers, decide on strategies to limit these barriers, and implement the chosen solutions. Well-being practices were promoted.</p><p><strong>Results: </strong>Staff perceptions of interpersonal conflict management and engagement initiatives improved after implementation of the Triple D Method. The promotion of well-being practices was effective in increasing reported self-care behaviors.</p><p><strong>Conclusion: </strong>The results demonstrated that the Triple D Method was useful in supporting interpersonal conflict management. The promotion of well-being practices was effective in increasing reported well-being behaviors and fostering a healthy work environment. These strategies should be replicated in direct care settings with larger sample sizes.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 4","pages":"62-70"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648295","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":"Titration Parameters as a Foundation for Clinical Judgment, Not a Replacement.","authors":"Justin R Wilkerson","doi":"10.4037/ccn2026153","DOIUrl":"https://doi.org/10.4037/ccn2026153","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 3","pages":"7-8"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136862","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":"Quantitative Pupillometry Obtained During Cardiac Arrest: A Case Report.","authors":"Kathrina Siaron, Lilian Otieno, Lindsay M Riskey, Sharla Houston, DaiWai M Olson, Emerson B Nairon","doi":"10.4037/ccn2026662","DOIUrl":"10.4037/ccn2026662","url":null,"abstract":"<p><strong>Introduction: </strong>Quantitative pupillometry is increasingly used to assess patients' neurologic function quickly and accurately. This case report discusses the feasibility of collecting quantitative pupillometry data for patients experiencing cardiac arrest, the potential value of these data, and limitations of quantitative pupillometry.</p><p><strong>Clinical findings: </strong>An 83-year-old woman was admitted to the cardiac catheterization laboratory for coronary angiography and percutaneous coronary intervention. She experienced cardiac arrest during the procedure, and the rapid response team was deployed.</p><p><strong>Diagnosis: </strong>Coronary artery disease with angina was present upon admission. The patient was admitted with the intent to perform percutaneous coronary intervention of the left anterior descending coronary artery.</p><p><strong>Interventions: </strong>During the cardiac arrest and while staff members were performing chest compressions, rapid response team nurses obtained quantitative pupillometry readings to assess pupil function.</p><p><strong>Outcomes: </strong>The quantitative pupillometry readings obtained from the left and right eyes suggested that neurologic function was abnormal but still present. The main challenges associated with performing quantitative pupillometry during a cardiac arrest are overcrowding of essential personnel at the head of bed and finding an appropriate time to obtain readings without compromising life-sustaining interventions.</p><p><strong>Conclusion: </strong>Using quantitative pupillometry to assess pupil function during cardiac arrest is feasible when performed by nurses. This report may facilitate pupil assessment during cardiac arrest and provide new insights into cerebral perfusion as a biomarker of recovery.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 3","pages":"11-15"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136796","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":"Reducing Respiratory Device-Related Pressure Injuries in High-Acuity Patients: A Quality Improvement Project.","authors":"Julie A Gray, Katie R Brooks, Amanda Eltz, Staci S Reynolds, Tracey L Yap","doi":"10.4037/ccn2026303","DOIUrl":"10.4037/ccn2026303","url":null,"abstract":"<p><strong>Background: </strong>Respiratory medical device-related pressure injuries are a persistent challenge in acute care, particularly among high-acuity patients requiring continuous respiratory support.</p><p><strong>Local problem: </strong>At a 186-bed community hospital, respiratory medical device-related pressure injury rates rose significantly in the intensive care and progressive care units following the COVID-19 pandemic.</p><p><strong>Methods: </strong>Plan-do-study-act cycles guided implementation of this quality improvement project. Baseline data were collected from January 2019 through June 2023, followed by intervention implementation from July 2023 through January 2025 and outcome monitoring through March 2025. The project was conducted in a 19-bed intensive care unit and a 30-bed progressive care unit and involved 121 registered nurses and 28 respiratory therapists. During the intervention phase, 123 eligible patients requiring continuous respiratory support for more than 24 consecutive hours were audited for intervention and documentation compliance. Statistical process control chart analysis was used to track monthly respiratory device-related pressure injury rates over time, identifying trends according to visual interpretation.</p><p><strong>Results: </strong>Respiratory medical device-related pressure injury rates declined by 52%, from 0.56 to 0.27 per 1000 patient days. Intervention compliance with placement of barrier dressings improved from 41 of 56 (71.7%) audit observations to 71 of 73 (97.8%) audit observations. Documentation compliance increased from 25 of 56 (43.4%) audit observations to 63 of 73 (89.7%) audit observations.</p><p><strong>Conclusion: </strong>Standardizing preventive barrier use and strengthening interprofessional collaboration substantially reduced respiratory medical device-related pressure injuries.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 3","pages":"35-42"},"PeriodicalIF":2.3,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136852","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 Joint Commission Titration Guidelines and the Death of Nursing Clinical Judgment in the Intensive Care Unit.","authors":"Caleb Armstrong","doi":"10.4037/ccn2026618","DOIUrl":"https://doi.org/10.4037/ccn2026618","url":null,"abstract":"","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"46 3","pages":"6-7"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136895","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}