Critical Care Nursing Quarterly最新文献

{"title":"The Impact of Universal Screening for Substance Use Disorders During Emergency Services Within an Integrated Health Care System.","authors":"Serene Carruthers,&nbsp;Elliot Sutton-Inocencio","doi":"10.1097/CNQ.0000000000000463","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000463","url":null,"abstract":"<p><p>Each day, across America, people come to emergency service providers in need of care and support. Although not ideal, emergency departments have become the de facto outpatient treatment center in many communities. This positions emergency department providers to be ideal partners in the treatment of substance use disorders. Substance use and deaths by overdose have been of great concern for many years, and since the start of the pandemic, the trends have caused further concern. Drug overdoses have claimed the lives of more than 932 000 Americans over the past 21 years. Excessive alcohol use is a leading cause of premature death in the United States. In 2020, of people identified as needing substance use treatment in the past year, only 1.4% received any treatment. As we watch the death tolls and cost of care continue to trend upward, emergency service providers have the unique opportunity to quickly screen, intervene, and refer to help get these complex and sometimes challenging patients better care, while also avoiding the worsening of the crisis in which we find ourselves.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"282-298"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine: A Sedation Alternative in the Intensive Care Setting.","authors":"Amy Thomas,&nbsp;Marie Ullrich","doi":"10.1097/CNQ.0000000000000458","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000458","url":null,"abstract":"<p><p>In the last 20 years, the occurrences of drug shortages have increased in frequency as well as duration before returning to the mainstream market. This has prompted intensive care unit nurses and medical staff to seek alternate medication infusion options that provide safe yet effective sedation for patients admitted to intensive care units across the country. Dexmedetomidine (PRECEDEX) emerged in 1999 after the Federal Drug Administration approved it for intensive care use but was quickly embraced by anesthesia providers as it rendered patients undergoing procedures or surgery with adequate analgesia and sedation. Dexmedetomidine (PRECEDEX) continued to maintain patients who required short-term intubation and mechanical ventilation with adequate sedation throughout the entire perioperative period. With patients remaining hemodynamically stable in the initial postoperative period, critical care nurses embraced the use of dexmedetomidine (PRECEDEX) in the intensive care unit setting. As dexmedetomidine (PRECEDEX) gained popularity, it has been used to help manage multiple disease processes such as delirium, agitation, alcoholic withdrawal, and anxiety. Dexmedetomidine (PRECEDEX) has been indicated to be a safer alternative to benzodiazepines, narcotics, or propofol (Diprivan), while providing adequate sedation and allowing patients to maintain hemodynamic stability.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"271-276"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Effective Interventions Against Workplace Violence.","authors":"Jennifer Shane Escue,&nbsp;Felipe Gutierrez,&nbsp;Jenny Rebecca Batts,&nbsp;Melvin Lumagui,&nbsp;Virtud Oloan","doi":"10.1097/CNQ.0000000000000457","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000457","url":null,"abstract":"<p><p>Workplace violence (WPV) is widespread and increasing in health care organizations. The purpose of this performance improvement (PI) project was to understand what measures could effectively be implemented to decrease the incidence of WPV events in an acute inpatient health care facility. The A3 problem-solving methodology was utilized. The current state and countermeasures to decrease gaps in the current processes were examined. The methodology engaged all stakeholders in problem-solving and continuous improvement. PI members implemented the house-wide interventions in January 2019 and in financial year 2019 assault with injuries decreased to 39. Further research is needed to support effective interventions against WPV.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"255-270"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Electronic Rounding Board on Falls and Self-harm Among Psychiatric Inpatients: Quality Improvement Project.","authors":"Mary Kay Shibley,&nbsp;Son Chae Kim,&nbsp;Laurie Ecoff","doi":"10.1097/CNQ.0000000000000468","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000468","url":null,"abstract":"<p><p>More than 1 million falls are reported in US hospitals each year. Psychiatric inpatients are at high risk for self-harm behaviors with reported suicide rate of 6.5 per 1000 patients. Patient observation is the primary risk management intervention in preventing adverse patient safety incidents. This project aimed to examine the effectiveness of handheld electronic rounding board (ObservSMART) implementation on falls and self-harm incidents among psychiatric inpatients. A retrospective review of adverse patient safety incidents was conducted to compare the 6-month preimplementation period versus the 6-month postimplementation period with staff training and implementation in July 2019. The monthly fall rates per 1000 patient-days were 3.53 versus 3.80 during the pre- and postimplementation periods, respectively. About one-third of the falls resulted in mild or moderate injuries for both periods. The incidence of self-harm was 3 versus 7 during the pre- and postimplementation periods, with incidence of 1 versus 6, respectively, among adult patients, who are more likely to hide self-harm. Although there were no changes in falls, the implementation of ObservSMART markedly increased the detection of patient self-harm, including self-injury and suicide attempts. It also ensures staff accountability and provides an easy-to-use tool to perform timely, proximity-based patient observations.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"310-318"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recognizing and Reducing Delirium in the Intensive Care Unit.","authors":"Thomas Dechant,&nbsp;Lauren Smith,&nbsp;Jose Chavez","doi":"10.1097/CNQ.0000000000000465","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000465","url":null,"abstract":"<p><p>This article discusses a quality improvement study conducted on intensive care unit (ICU) staff nurses that assessed their ability to utilize the CAM-ICU tool for delirium detection properly. Staff members' expertise in identifying and managing delirious patients directly correlates with reducing the long-term sequelae associated with ICU delirium. The cohort of ICU nurses participating in this research study took a questionnaire on 4 separate occasions. The survey ascertained quantitative and qualitative data, reflecting personal knowledge about the CAM-ICU tool and delirium. After each round of assessment, group and one-on-one educational sessions were provided by the researchers. The study culminated with providing each staff member a delirium reference card (badge buddy) containing relevant and easily accessible clinical information that supported the ICU staff nurses in correctly implementing the CAM-ICU tool.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"277-281"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a Nurse-Driven Fluid Management Protocol to Improve Outcomes in Critically Ill Patients.","authors":"Loraine Barstow,&nbsp;Denise H Tola,&nbsp;Benjamin Smallheer","doi":"10.1097/CNQ.0000000000000467","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000467","url":null,"abstract":"<p><p>This article reports results of a nurse-driven fluid management protocol in a medical-surgical intensive care unit (ICU). Use of static measures such as central venous pressure monitoring, heart rate, blood pressure, and urine output is poor predictors of fluid responsiveness and can result in inappropriate fluid administration. Indiscriminate administration of fluid can result in prolonged mechanical ventilation time, increased vasopressor requirements, increased length of stay, and greater costs. Use of dynamic preload parameters such as stroke volume variation (SVV), pulse pressure variation, or changes in stroke volume with a passive leg raise has been shown to be more accurate predictors of fluid responsiveness. Improved patient outcomes including decreased length of hospital stay, reduction in kidney injury, decreased mechanical ventilation time and requirements, and reduced vasopressor requirements have been demonstrated by using dynamic preload parameters. ICU nurses were educated on cardiac output and dynamic preload parameters and a nurse-driven fluid replacement protocol was established. Knowledge scores, confidence scores, and patient outcomes were measured pre- and post-implementation. The results indicated that there was no change in knowledge scores between pre- and postimplementation groups (mean = 80%). There was a statistically significant increase in nurse confidence in using SVV (P = .003); however, this change is not clinically significant. There was no statistically significant difference in other confidence categories. The study indicated that ICU nurses were resistant to adoption of a nurse-driven fluid management protocol. While anesthesia clinicians are familiar with technologies to evaluate fluid responsiveness in the perioperative setting, the new technology posed challenges to ICU confidence. This project demonstrates that traditional methods of nursing education did not provide the support needed for implementation of a novel approach to fluid management, and that there is a need for further improvement in educational strategies.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 3","pages":"319-326"},"PeriodicalIF":1.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-Term Outcomes of Neuromuscular Electrical Stimulation in Critically Ill Patients.","authors":"Ghada S K Mahran,&nbsp;Mogeda M Mehany,&nbsp;Mostafa S Abbas,&nbsp;Abd-ElRady Shehata,&nbsp;Azza S AbdElhafeez,&nbsp;Ahmed A Obiedallah,&nbsp;Sherif A Mohamed","doi":"10.1097/CNQ.0000000000000445","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000445","url":null,"abstract":"<p><p>Muscle weakness acquired in the intensive care unit (ICU) adversely affects outcomes of ICU patients. This article reports the short-term respiratory effects of neuromuscular electrical stimulation (NMES) in critically ill patients. Patients were randomly assigned to an intervention group (NMES + conventional physiotherapy) and a control group (sham NMES + conventional physiotherapy). The application of NMES in the intervention group resulted in a significant decrease in the duration of mechanical ventilation and reduced the number of weaning trial failures. Other positive outcomes included reductions in the length of ICU stays and decreased mortality when compared with the control group.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 2","pages":"126-135"},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10133988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foreword.","authors":"Carmen G Warner","doi":"10.1097/CNQ.0000000000000441","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000441","url":null,"abstract":"","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 2","pages":"115"},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10826158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Discharge Criteria Checklist for COVID-19 Patients From the Intensive Care Unit.","authors":"Ghada S K Mahran,&nbsp;Marzoka A Gadallah,&nbsp;Awatef E Ahmed,&nbsp;Warda R Abouzied,&nbsp;Ahmed A Obiedallah,&nbsp;Magdy M M Sayed,&nbsp;Mostafa S Abbas,&nbsp;Sherif A A Mohamed","doi":"10.1097/CNQ.0000000000000455","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000455","url":null,"abstract":"<p><p>This study aims to develop and validate a checklist of discharge readiness criteria for COVID-19 patients from the intensive care unit (ICU). We conducted a Delphi design study. The degree of agreement among 7 experts had been evaluated using the content validity index (CVI) through a 4-point Likert scale. The instrument was validated with 17 items. All the experts rated all items as very relevant which scored the item-CVI 1, which validates all checklist items. Using the mean of all items, the scale-CVI was calculated, and it was 1. This meant validation of the checklist as a whole. With regard to the overall checklist evaluation, the mean expert proportion of the instrument was 1, and the S-CVI/UA was 1. This discharge criteria checklist improves transition of care for COVID-19 patients and can help nurses, doctors, and academics to discharge COVID-19 patients from the ICU safely.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 2","pages":"227-238"},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10507211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Approach to Increase Compliance With Spontaneous Awakening Trials and Spontaneous Breathing Trials in the Medical Intensive Care Unit.","authors":"Nicole Jones,&nbsp;Rozmeen Shivji","doi":"10.1097/CNQ.0000000000000448","DOIUrl":"https://doi.org/10.1097/CNQ.0000000000000448","url":null,"abstract":"<p><p>Prolonged mechanical ventilation can lead to undesirable outcomes, including reduced 6-month survival, increased hospital mortality, intensive care unit (ICU) length of stay, and physiological stress. A large academic medical center currently has a Spontaneous Awakening Trials/Spontaneous Breathing Trials (SAT/SBT) protocol with an SAT/SBT compliance goal of 80%; however, the medical intensive care unit's (MICU) SAT/SBT compliance rate was only 33% for FY2020. The Define-Measure-Analyze-Improve-Control (DMAIC) framework was used to guide this quality improvement project. Current processes and root causes for noncompliance were analyzed through chart reviews, a preimplementation staff survey, and meetings with stakeholders. Compliance rates were compared before and after implementation. Interventions included education, reminder fliers, weekly chart audits, and individualized weekly emails to noncompliant RNs and RTs. To achieve project sustainability, 2 unit champions were selected to continue the weekly emails and chart audits. Data were collected from 216 patients and 1063 patient ventilator days from October 2020 to October 2021. The SAT/SBT compliance steadily increased throughout the 13-month implementation period, except for 3 months. The preimplementation monthly SAT/SBT compliance rate was 26% in September 2020. After 13 months of project implementation, the SAT/SBT compliance rate was 64% in October 2021. There was no significant change in patient ventilator days pre- and post-quality improvement project. A multi-intervention implementation strategy consisting of education in-services, weekly chart audits, weekly emails to staff with current compliance rates, and reminder fliers can successfully increase SAT/SBT compliance rates. Utilizing unit champions provides sustainability.</p>","PeriodicalId":10789,"journal":{"name":"Critical Care Nursing Quarterly","volume":"46 2","pages":"157-164"},"PeriodicalIF":1.4,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10124918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}