Critical care nurse最新文献_第3页

Integration of Rapid Response Teams and Early Warning Systems to Reduce Cardiac Arrests and Intensive Care Unit Readmissions. 整合快速反应小组和早期预警系统以减少心脏骤停和重症监护病房再入院。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025131

Laura Weigand, Tracy Viers, Eydie Tipton

{"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":"Background: 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.Local problem: 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.Methods: 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.Results: 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.Conclusion: 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.","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}

引用次数: 0

Pediatric Bronchiolitis Obliterans and Bronchiolitis Obliterans Syndrome: Nursing Considerations. 小儿闭塞性细支气管炎和闭塞性细支气管炎综合征：护理注意事项。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025696

Jared Deffler

{"title":"Pediatric Bronchiolitis Obliterans and Bronchiolitis Obliterans Syndrome: Nursing Considerations.","authors":"Jared Deffler","doi":"10.4037/ccn2025696","DOIUrl":"https://doi.org/10.4037/ccn2025696","url":null,"abstract":"Background: Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring.Objective: To provide acute care, transplant, and critical care nurses a summary of the disease process, causes, and treatment options for bronchiolitis obliterans in pediatric patients to promote early recognition of signs in at-risk patients.Methods: This descriptive literature review was limited to articles published in 2013 or later. Searches of the PubMed and CINAHL databases using the terms bronchiolitis obliterans and pediatric yielded 432 articles. Of these articles, 22 were used for this review. The Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used to assess levels of evidence and methodologic quality of the articles.Results: Patients in 3 main groups are at risk for bronchiolitis obliterans: those who have had respiratory infection, those who have received lung transplant, and those who have received stem cell transplant.Discussion: A diagnosis of bronchiolitis obliterans requires lung biopsy and histopathology. For patients who are unable to undergo biopsy or whose biopsy results are inconclusive, bronchiolitis obliterans syndrome can be clinically identified with spirometry (forced expiratory volume in first second of expiration and forced expiratory flow at 25% to 75% of forced vital capacity) and high-resolution computed tomography. Systemic corticosteroids are often the first-line treatment; second-line strategies are under investigation.Conclusion: Knowledge of risk factors, signs, and current treatments for bronchiolitis obliterans/bronchiolitis obliterans syndrome can help acute care and critical care nurses decelerate progression of the disease.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"29-37"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764735","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}

引用次数: 0

Palliative Care Specialty Nursing in Medical Intensive Care Units. 医学重症监护病房的姑息治疗专业护理。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025739

Amy Newman, Joshua Lasseigne, Suzanne Goldhirsch, Emily Chai, Samuel Acquah, Camille Davis, Karen Stanley, Ankita Mehta

{"title":"Palliative Care Specialty Nursing in Medical Intensive Care Units.","authors":"Amy Newman, Joshua Lasseigne, Suzanne Goldhirsch, Emily Chai, Samuel Acquah, Camille Davis, Karen Stanley, Ankita Mehta","doi":"10.4037/ccn2025739","DOIUrl":"https://doi.org/10.4037/ccn2025739","url":null,"abstract":"Introduction: Given the serious illness burden of patients in medical intensive care units, palliative care is a key element of their care. This case discussion highlights the role of the palliative care specialty registered nurse in an embedded palliative care model in medical intensive care units.Clinical findings: A 44-year-old female patient with decompensated cirrhosis was transferred to the study hospital for liver transplant evaluation. Her hospital stay involved multiple complications.Diagnosis: The patient was determined to have palliative care needs. Multiple areas of intervention were identified.Interventions: A model including a palliative care specialty registered nurse was initiated in the medical intensive care unit.Outcomes: The palliative care specialty registered nurse had 2 roles: (1) optimizing patient care by partnering with medical intensive care unit colleagues to develop a plan of care aligned with patient and family values and preferences and (2) supporting and enhancing critical care nursing excellence by helping bedside nurses advocate for the patient's palliative care needs. Nurses were also empowered with communication skills to engage with patients, family members, and primary team colleagues.Conclusion: The palliative care specialty registered nurse model can be used in various intensive care unit settings. However, the complex care needs of critically ill patients, the unique nature and structural variations across critical care settings, and the resources required to implement this model are potential challenges.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"43-48"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764734","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}

引用次数: 0

Standardization of Nursing Journal Clubs. 护理期刊俱乐部规范化。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025335

Shirley Visperas, Eileen Wong, Katie Azama

引用次数: 0

Missed Nursing Care in Acute and Critical Care Settings: Implications and Interventions. 急性和危重症护理环境中的护理缺失：影响和干预措施。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025560

Debra Siela

引用次数: 0

Mitigating Skin Failure in Critically Ill Patients at the End of Life: A Case Report. 减轻危重病人临终时皮肤衰竭：一例报告。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025450

Lynn Kordasiewicz, Katie Fik, Christy Petry, Janice Sturtz

{"title":"Mitigating Skin Failure in Critically Ill Patients at the End of Life: A Case Report.","authors":"Lynn Kordasiewicz, Katie Fik, Christy Petry, Janice Sturtz","doi":"10.4037/ccn2025450","DOIUrl":"https://doi.org/10.4037/ccn2025450","url":null,"abstract":"Introduction: Limited research on preventing and managing skin failure events such as deep tissue injuries and Kennedy terminal ulcers is available. These skin failure events often appear among patients experiencing multiple organ failure with hypoperfusion to the skin despite evidence-based nursing interventions to enhance skin integrity.Clinical findings: A 68-year-old White man presented at a trauma hospital after several recent falls at home. He immediately required hospitalization. Several medical complications, including a deep tissue pressure injury, evolved. The pressure injury remained clinically stable throughout his hospitalization.Diagnosis: The patient received a diagnosis of deep tissue pressure injury.Interventions: Aggressive medical management, implementation of a turning schedule on a low-air-loss surface, foam dressings, and offloading boots were used to prevent skin damage and preserve skin integrity.Outcomes: The patient's condition declined and he developed a deep tissue pressure injury on the sacrum that did not advance or become infected. The family agreed to comfort measures and he soon died.Conclusion: Skin failure events such as deep tissue pressure injuries and Kennedy terminal ulcers often occur among critically ill patients, older patients, those approaching end of life, and other patients with prolonged pressure upon body surfaces. The Centers for Medicare & Medicaid Services holds hospitals financially accountable for sequelae of events associated with hospital-acquired full-thickness pressure injuries. Additional research to categorize skin failure events as secondary to hypoperfusion and not medical mismanagement can optimize patient safety and positively impact the finances and credibility of medical organizations.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"38-42"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764733","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}

引用次数: 0

Respiratory Distress Observation Scale and Medication Administration. 呼吸窘迫观察量表及给药。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025268

Erin C Hare

引用次数: 0

Corrections. 修正。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025780

引用次数: 0

Reframing the Term Missed Care to Avoid Misplaced Blame. 重新定义“遗漏医疗”一词，避免错误的指责。

IF 2 4区医学

Critical care nurse Pub Date : 2025-08-01 DOI: 10.4037/ccn2025206

Annette M Bourgault

引用次数: 0

Reducing Postpyloric Feeding Start Times in Patients With Large Hemispheric Infarction Receiving Therapeutic Hypothermia. 治疗性低温降低大半球梗死患者幽门后进食起始时间

IF 2 4区医学

Critical care nurse Pub Date : 2025-06-01 DOI: 10.4037/ccn2025413

Wenya Cao, Hong Chang, Miao Li, Linlin Fan, Fei Tian, Gang Liu, Yan Zhang

{"title":"Reducing Postpyloric Feeding Start Times in Patients With Large Hemispheric Infarction Receiving Therapeutic Hypothermia.","authors":"Wenya Cao, Hong Chang, Miao Li, Linlin Fan, Fei Tian, Gang Liu, Yan Zhang","doi":"10.4037/ccn2025413","DOIUrl":"https://doi.org/10.4037/ccn2025413","url":null,"abstract":"Background: Early postpyloric feeding provides effective and safe enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.Local problem: Patients with large hemispheric infarction undergoing therapeutic hypothermia often have gastrointestinal dysfunction and undergo repeated bedside attempts at blind postpyloric feeding tube placement. Confirming tube position via radiography can delay nutrient intake, increase costs, and expose patients to unnecessary radiation.Methods: In this quality improvement study, specialist nurses were trained to use ultrasonography instead of radiography to confirm postpyloric feeding tube position, reducing reliance on ancillary services. Preimplementation and postimplementation data included time from tube placement to first feeding and the frequency of radiography use. Surveys were conducted to assess the health care team's satisfaction with the new process.Results: Sixty-seven placements (30 before implementation, 37 after implementation) were evaluated. Feeding start times significantly decreased by 34.85% (mean [SD], 741.20 [192.73] minutes before implementation vs 482.86 [166.15] minutes after implementation; P < .001). The addition of ultrasound guidance for postpyloric feeding tube placement significantly decreased the number of abdominal radiographs per patient by 56.0% (mean [SD], 2.5 [0.9] before implementation vs 1.1 [0.4] after implementation; P < .001). Most health care team members indicated that this practice change reduced the time to initiation of enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.Conclusions: By improving processes, we reduced feeding start times, minimized radiography use, and enhanced the health care team's satisfaction with postpyloric feeding tube placement for patients receiving therapeutic hypothermia.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 3","pages":"33-40"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191601","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}

引用次数: 0