Critical care nurse最新文献_第6页

2024 National Teaching Institute Evidence-Based Solutions Abstracts. 2024 国家教学研究所循证解决方案摘要。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-04-01 DOI: 10.4037/ccn2024578

引用次数: 0

Critical Care Alarm Fatigue and Monitor Customization: Alarm Frequencies and Context Factors. 重症监护警报疲劳与监护仪定制：警报频率和环境因素。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-04-01 DOI: 10.4037/ccn2024797

Layla Z Arkilic, Elizabeth Hundt, Beth Quatrara

{"title":"Critical Care Alarm Fatigue and Monitor Customization: Alarm Frequencies and Context Factors.","authors":"Layla Z Arkilic, Elizabeth Hundt, Beth Quatrara","doi":"10.4037/ccn2024797","DOIUrl":"10.4037/ccn2024797","url":null,"abstract":"Background: Alarm fatigue among nurses working in the intensive care unit has garnered considerable attention as a national patient safety priority. A viable solution for reducing the frequency of alarms and unnecessary noise is intensive care unit alarm monitor customization.Local problem: A 24-bed cardiovascular and thoracic surgery intensive care unit in a large academic medical center identified a high rate of alarms and associated noise as a problem contributing to nurse alarm fatigue.Methods: An alarm monitor quality improvement project used both alarm frequency and nurse surveys before and after implementation to determine the effectiveness of interventions. Multimodal interventions included nurse training sessions, informational flyers, organizational policies, and an alarm monitor training video. Unexpected results inspired an extensive investigation and secondary analysis, which included examining the data-capturing capabilities of the alarm monitors and the impact of context factors.Results: Alarm frequencies unexpectedly increased after the intervention. The software data-capturing features of the alarm monitors for determining frequency did not accurately measure nurse interactions with monitors. Measured increases in patient census, nurse staffing, and data input from medical devices from before to after the intervention substantially affected project results.Conclusions: Alarm frequencies proved an unreliable measure of nurse skills and practices in alarm customization. Documented changes in context factors provided strong anecdotal evidence of changed circumstances that clarified project results and underscored the critical importance of contemporaneous collection of context data. Designs and methods used in quality improvement projects must include reliable outcome measures to achieve meaningful results.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 2","pages":"21-30"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140331584","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

Enabling Registered Nurses, Licensed Practical and Vocational Nurses, and Assistive Personnel to Practice to Their Fullest Extent. 使注册护士、执业护士和职业护士以及辅助人员能够充分发挥其作用。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-04-01 DOI: 10.4037/ccn2024809

Rebecca L Johnson

引用次数: 0

Nursing Care of a Child With Delirium Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Case Report. 接受静脉体外膜氧合治疗的谵妄患儿的护理：病例报告。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-04-01 DOI: 10.4037/ccn2024150

Cong-Hui Fu, Yan Li, Yu-Cai Zhang, Xiao-Ya Yang, Ji Liu, Min-Jie Ju, Ting-Ting Xu

{"title":"Nursing Care of a Child With Delirium Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Case Report.","authors":"Cong-Hui Fu, Yan Li, Yu-Cai Zhang, Xiao-Ya Yang, Ji Liu, Min-Jie Ju, Ting-Ting Xu","doi":"10.4037/ccn2024150","DOIUrl":"10.4037/ccn2024150","url":null,"abstract":"Introduction: Children receiving extracorporeal membrane oxygenation are prone to delirium. This case report describes the nursing care of a child with delirium who received venoarterial extracorporeal membrane oxygenation. Relevant interventions and precautions are also discussed.Clinical findings: A 6-year-old girl was admitted to the pediatric intensive care unit with a 2-day history of vomiting and fever. The child underwent cannulation for venoarterial extracorporeal membrane oxygenation.Diagnosis: The child was diagnosed with acute fulminant myocarditis, cardiac shock, and ventricular arrhythmia.Interventions: On the third day of extracorporeal membrane oxygenation, bedside nurses began using the Cornell Assessment of Pediatric Delirium to assess the child for delirium symptoms. The team of physicians and nurses incorporated a nonpharmacologic delirium management bundle into pediatric daily care. Delirium screening, analgesia and sedation management, sleep promotion, and family participation were implemented.Outcomes: During the 18 days of pediatric intensive care unit hospitalization, the child had 6 days of delirium: 1.5 days of hypoactive delirium, 1.5 days of hyperactive delirium, and 3 days of mixed delirium. The child was successfully discharged home on hospital day 22.Conclusion: Caring for a child with delirium receiving venoarterial extracorporeal membrane oxygenation required multidimensional nursing capabilities to prevent and reduce delirium while ensuring safe extracorporeal membrane oxygenation. This report may assist critical care nurses caring for children under similar circumstances.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 2","pages":"13-20"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140331591","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

Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review. 使用查房清单改善成人重症监护病房的沟通与协作：综合评述。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-04-01 DOI: 10.4037/ccn2024942

Marshall S Gunnels, Susan L Thompson, Yvette Jenifer

{"title":"Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review.","authors":"Marshall S Gunnels, Susan L Thompson, Yvette Jenifer","doi":"10.4037/ccn2024942","DOIUrl":"10.4037/ccn2024942","url":null,"abstract":"Background: Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes.Objective: To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication?Methods: An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both.Results: Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention.Conclusions: Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 2","pages":"31-40"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140331593","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

Use of Biomarkers to Objectively Evaluate Pain in Critically Ill Children: A Scoping Review. 使用生物标记物客观评估重症儿童的疼痛：范围综述。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-02-01 DOI: 10.4037/ccn2024257

Eleni Tamvaki, Margarita Giannakopoulou, Evangelos Bozas, Danai Zachpoulou

{"title":"Use of Biomarkers to Objectively Evaluate Pain in Critically Ill Children: A Scoping Review.","authors":"Eleni Tamvaki, Margarita Giannakopoulou, Evangelos Bozas, Danai Zachpoulou","doi":"10.4037/ccn2024257","DOIUrl":"10.4037/ccn2024257","url":null,"abstract":"Background: Many studies have been conducted recently to identify biomarkers that could potentially be used to objectively evaluate pain.Objective: To synthesize and critically analyze primary studies of endogenous biomarkers and their associations with pain to identify suitable biomarkers for the objective evaluation of pain in critically ill children.Methods: PubMed, Scopus, and Ovid databases were searched; searches were restricted by publication date, language, species, and participant age. Critical appraisal tools and the Strengthening the Reporting of Observational Studies in Epidemiology checklist were used to evaluate quality of evidence.Results: All included articles were coded according to methods and findings. Saliva, blood, cerebrospinal fluid, and gingival crevicular fluid were used to detect biomarkers. Enzyme-linked immunosorbent assays were used in most studies (64%). Appropriate statistical analyses were performed at a significance level of P < .05 in included studies. Cytokines, peptides, and hormones were associated with pain, stress, and inflammatory response, suggesting that they can be used to screen for pain in children during painful conditions. Only 1 study in neonates did not show any correlation between saliva biomarkers and pain.Conclusion: According to this literature review, various biomarkers that are easily obtained and measured in a clinical setting are associated with pain in children. Further investigation of these biomarkers through observational studies is suggested to evaluate their suitability for pain assessment in critically ill children.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 1","pages":"55-66"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697089","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

Nurse-Driven Fluid Responsiveness Evaluation in Patients With Septic Shock: A Quality Improvement Initiative. 由护士主导的脓毒性休克患者输液反应性评估：一项质量改进计划。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-02-01 DOI: 10.4037/ccn2024984

Yana Dilman, Claire Bethel, Navitha Ramesh, Charlene Myers

{"title":"Nurse-Driven Fluid Responsiveness Evaluation in Patients With Septic Shock: A Quality Improvement Initiative.","authors":"Yana Dilman, Claire Bethel, Navitha Ramesh, Charlene Myers","doi":"10.4037/ccn2024984","DOIUrl":"10.4037/ccn2024984","url":null,"abstract":"Background: Fluid responsiveness should be assessed in patients with septic shock because only 50% of patients are fluid responsive. Dynamic measures of fluid responsiveness, like pulse pressure variation measured after a passive leg raise maneuver, are recommended to guide fluid administration in patients with sepsis after initial fluid resuscitation.Local problem: The purpose of the project was to evaluate outcomes after implementing a nurse-driven fluid responsiveness evaluation using passive leg raise and pulse pressure variation measurement in patients with septic shock.Methods: The project included 30 adult patients with septic shock in a 24-bed medical-surgical intensive care unit at a community hospital. A new nursing process was initiated for bedside fluid responsiveness evaluation (pulse pressure variation measurement after passive leg raise). Staff members received in-person individual training sessions. Preintervention and 20-week postintervention patient outcomes data were collected to estimate the project's impact on incidence of fluid overload and acute kidney injury, duration of mechanical ventilation, and intensive care unit length of stay. Preintervention and postintervention staff satisfaction surveys assessed nurses' perception of the project's value.Results: Before intervention, 24 of 37 patients (65%) met criteria of fluid overload. The project resulted in a 28% decrease in the incidence of fluid overload. Staff satisfaction surveys revealed a significant increase in nurses' feelings of empowerment to positively affect patient outcomes; all nurses agreed that the new process was efficient.Conclusion: The results indicate that the project had a positive impact on patient outcomes and nurse autonomy.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 1","pages":"13-20"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139721978","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

Screening for Alcohol Use Disorder and Management of Alcohol Withdrawal Syndrome in Critical Care Patients. 重症监护患者酒精使用障碍筛查和酒精戒断综合征管理。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-02-01 DOI: 10.4037/ccn2024423

Lindsay Mezzadri

{"title":"Screening for Alcohol Use Disorder and Management of Alcohol Withdrawal Syndrome in Critical Care Patients.","authors":"Lindsay Mezzadri","doi":"10.4037/ccn2024423","DOIUrl":"10.4037/ccn2024423","url":null,"abstract":"Background: Evidence-based research indicates that subjective questionnaires should be eliminated in screening for alcohol use disorder and management of alcohol withdrawal syndrome in critical care patients. However, transitioning clinicians away from these screening tools remains challenging.Objective: To improve screening for alcohol use disorder and management of alcohol withdrawal syndrome in the critical care setting by implementing an evidence-based alcohol use disorder screening tool and alcohol withdrawal syndrome protocol for critical care patients.Methods: The project site was a 17-bed adult medical intensive care unit in a large, southeastern US teaching hospital. Interventions consisted of the elimination of previously used tools such as the Clinical Institute Withdrawal Assessment for Alcohol-Revised and implementation of the Prediction of Alcohol Withdrawal Severity Scale for alcohol use disorder screening and the Richmond Agitation-Sedation Scale and symptom-triggered benzodiazepine administration for alcohol withdrawal syndrome management.Results: Alcohol use disorder screening among the critical care patient population increased by 49% from before to after the intervention. Of the patients at risk for withdrawal, 79% had an order for monitoring with the new intensive care unit alcohol withdrawal protocol in the postintervention group, compared with 35% who had an order for monitoring with the Clinical Institute Withdrawal Assessment for Alcohol-Revised in the preintervention group.Conclusion: The elimination of previously used tools and the implementation of the Prediction of Alcohol Withdrawal Severity Scale and the new intensive care unit alcohol withdrawal protocol improved alcohol use disorder screening and alcohol withdrawal syndrome management among critical care patients.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 1","pages":"46-54"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139680815","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

Strategies to Achieve Evidence-Based Practice in Nursing. 实现循证护理实践的策略。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-02-01 DOI: 10.4037/ccn2024359

Steven Cuzmenco

引用次数: 0

Insulin Infusion Protocols for Blood Glucose Management in Critically Ill Patients: A Scoping Review. 用于重症患者血糖管理的胰岛素输注方案：范围综述。

IF 1.6 4区医学

Critical care nurse Pub Date : 2024-02-01 DOI: 10.4037/ccn2024427

Miao Huang, Ruiqi Yang, Dong Pang, Xiuni Gan

{"title":"Insulin Infusion Protocols for Blood Glucose Management in Critically Ill Patients: A Scoping Review.","authors":"Miao Huang, Ruiqi Yang, Dong Pang, Xiuni Gan","doi":"10.4037/ccn2024427","DOIUrl":"10.4037/ccn2024427","url":null,"abstract":"Background: Continuous insulin infusion is a method for maintaining blood glucose stability in critically ill patients with hyperglycemia. Many insulin infusion protocols have been applied in intensive care units. Understanding the content of these protocols can help clinical staff choose the most appropriate and convenient protocol and promote best practices in managing glucose levels in critically ill adult patients.Objective: To examine the types of insulin infusion therapies performed for blood glucose management in critically ill patients.Methods: For this scoping review, 3 Chinese-language and 8 English-language databases were searched for articles published from May 25, 2016, to October 25, 2022.Results: Twenty-one articles met the inclusion criteria. Twenty-one insulin infusion protocols were examined. Most of the insulin infusion protocols were paper protocols. Fourteen glucose management indicators were included in the 21 protocols. The glucose target range for all 21 protocols ranged from 70 to 180 mg/dL (3.9-10.0 mmol/L). Nurses were primarily responsible for protocol implementation in most protocol development processes. The roles of nurses differed in nurse-led insulin infusion protocols and non-nurse-led insulin infusion protocols.Discussion: This scoping review indicates an urgent need for more comprehensive glycemic control guidelines for patients receiving critical care. Because insulin infusion protocols are core aspects of blood glucose management guidelines, different population subgroups should also be considered.Conclusions: Nurse-led guidelines must be based on the best available evidence and should include other variables related to glucose management (eg, patient disease type, medication, and nutrition) in addition to insulin infusion.","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"44 1","pages":"21-32"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697085","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