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Beyond Monitors: Intravenous Smart Pump Alarm Fatigue As a Safety Concern. 超越监视器：静脉注射智能泵报警疲劳作为安全问题。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025136
Brenda Abena Nyarko, Karen K Giuliano
{"title":"Beyond Monitors: Intravenous Smart Pump Alarm Fatigue As a Safety Concern.","authors":"Brenda Abena Nyarko, Karen K Giuliano","doi":"10.4037/aacnacc2025136","DOIUrl":"10.4037/aacnacc2025136","url":null,"abstract":"<p><p>Intravenous smart pump alarm fatigue remains a persistent and underrecognized patient safety concern in acute and critical care settings. Although alarm fatigue has been traditionally associated with physiological monitors, intravenous smart pumps are also a frequent source of alarms for hospitalized patients that contribute substantially to alarm fatigue. This article synthesizes current evidence on intravenous smart pumps and related alarm fatigue, identifies knowledge gaps, and proposes short-term and long-term interventions. Inconsistencies in alarm design and inadequate human-centered design have led to the development of intravenous smart pump systems that create an unacceptably high number of technical alarms that are unrelated to changes in patient status. Data-driven strategies are discussed as mechanisms to reduce burden and enhance alarm effectiveness. A systems-level approach combining human factors engineering, intelligent algorithm development, and clinical partnerships with manufacturers is essential for reducing alarm-related risk, decreasing nursing workload, and improving patient outcomes.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"252-257"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001638","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}
引用次数: 0
Secondary Infusion Underdelivery: Risks and Rewards of Common Workarounds. 二次输液输送不足：常见解决方案的风险和回报。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-09-15 DOI: 10.4037/aacnacc2025893
Jeannine W C Blake, Robert Butterfield, Tiffany Hopper, Nathaniel M Sims
{"title":"Secondary Infusion Underdelivery: Risks and Rewards of Common Workarounds.","authors":"Jeannine W C Blake, Robert Butterfield, Tiffany Hopper, Nathaniel M Sims","doi":"10.4037/aacnacc2025893","DOIUrl":"10.4037/aacnacc2025893","url":null,"abstract":"<p><p>Secondary medication delivery using large-volume smart pumps offers important workflow and safety benefits. However, the widely used linear peristaltic large-volume smart pumps rely on sufficient head-height differential for accurate secondary infusion, leading to underdelivery risks. This article outlines common clinician workarounds used to mitigate these risks, including delivering secondary medications via primary mode, programming excess volume to be infused, clamping primary lines, and using short-set primary delivery. Although intended to ensure full medication delivery, these strategies introduce safety risks, increase alert burden, and heighten cognitive load. In contrast, cassette-based large-volume smart pumps use valve-controlled fluid delivery, eliminating the need for head-height differential and reducing the potential for human error. This review evaluates the risks and rewards of these workarounds and offers guidance to support informed decision-making while advocating for long-term technology solutions that improve safety, reduce clinician burden, and align with best practices in infusion therapy.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 3","pages":"240-251"},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001603","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}
引用次数: 0
Diagnostic Error: An Overview. 诊断错误：概述。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025978
Mary Mescher Benbenek
{"title":"Diagnostic Error: An Overview.","authors":"Mary Mescher Benbenek","doi":"10.4037/aacnacc2025978","DOIUrl":"10.4037/aacnacc2025978","url":null,"abstract":"<p><p>Diagnostic error is increasingly identified as a concern in health care. The purposes of this article are to provide an understanding of diagnostic error and its contributing factors and to briefly review strategies to reduce errors. A literature review provided a definition of diagnostic error, a synopsis of diagnostic error prevalence and settings, systemic and individual factors contributing to diagnostic error, and cognitive biases and errors in diagnostic reasoning. Strategies to address diagnostic error are discussed. Diagnostic errors are prevalent across clinical settings, may result in harm, and are preventable. Enhancing the education of health care professionals related to diagnostic reasoning and metacognition, using clinical decision-making tools, and advocating for strong communication practices may reduce diagnostic errors in practice settings.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"123-130"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188242","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}
引用次数: 0
Diagnostic Reasoning for APRN Learners: Overview of Teaching Strategies. APRN学习者的诊断推理：教学策略概述。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025341
Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy
{"title":"Diagnostic Reasoning for APRN Learners: Overview of Teaching Strategies.","authors":"Lauren A Petersen, Stephanie Delkoski, Sarah McCarthy","doi":"10.4037/aacnacc2025341","DOIUrl":"10.4037/aacnacc2025341","url":null,"abstract":"<p><p>Diagnostic error is a critical issue in health care. To reduce diagnostic error and enhance practice safety of new graduates, advanced practice registered nurse (APRN) learners need intentional preparation in diagnostic reasoning. It is imperative that APRN programs integrate diagnostic reasoning into all program curricula. This article provides an overview of teaching strategies aimed at promoting skill development in diagnostic reasoning, specifically related to knowledge development, differential diagnosis, and reflective practices. The article reviews foundational information related to dual-process thinking and teaching strategies for APRN primary and acute care curricula. Knowledge development is supported by illness scripting and problem representation activities. Skills in differential diagnosis and diagnosis prioritization are supported by the use of grids and lists. Cognitive debiasing and reflective practice are supported through self-explanation and structured reflection. Implementation of tailored teaching strategies can effectively prepare learners for clinical practice as diagnosticians.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"131-142"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188245","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}
引用次数: 0
Diagnostic Reasoning as a Component of Clinical Reasoning in Nurse Practitioner Education: Extension of a Scoping Review. 诊断推理作为临床推理在护士执业教育的一个组成部分：范围审查的延伸。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025518
Sheila Smith, Mary Mescher Benbenek, Sarah Meyer, Jenna Herman, Elizabeth Weinfurter
{"title":"Diagnostic Reasoning as a Component of Clinical Reasoning in Nurse Practitioner Education: Extension of a Scoping Review.","authors":"Sheila Smith, Mary Mescher Benbenek, Sarah Meyer, Jenna Herman, Elizabeth Weinfurter","doi":"10.4037/aacnacc2025518","DOIUrl":"10.4037/aacnacc2025518","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic reasoning (DR) is a critical skill for nurse practitioners (NPs). This article provides an update of a 2022 scoping review of DR content in NP education, highlighting advances in curriculum integration.</p><p><strong>Objective: </strong>To assess the degree that scholarly literature about clinical reasoning in NP education includes DR; identify how DR is defined in NP education; and describe the teaching methodologies used to support DR-related knowledge, skills, and/or attitudes.</p><p><strong>Methods: </strong>We examined and categorized the literature from the past 2.5 years, assessing the scope, current status, and impact of DR-related content in NP education programs.</p><p><strong>Results: </strong>Literature reviews emphasized meta-cognitive strategies and competency assessment. Case reports described innovative teaching interventions and objective measures of student competency. Primary research articles explored a variety of DR topics, including survey research, diagnostic accuracy, structured reflection, and tool validation studies. New contributions included model and tool development articles for teaching and evaluating DR.</p><p><strong>Conclusions: </strong>Substantial progress was seen in the integration of DR components, theory, evidence-based teaching, and evaluation approaches in NP education, demonstrating increased awareness of the importance of DR competencies for NP students. Extending these advances to faculty, preceptor, and NP research development will provide important foundations for NP education and scholarship.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"158-173"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188243","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}
引用次数: 0
Diagnostic Reasoning Competency Assessment Tools: An Integrative Review. 诊断推理能力评估工具：综合回顾。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025683
Leah Burt, Patricia B Griffith, Margaret Bavis, Rebecca Raszewski
{"title":"Diagnostic Reasoning Competency Assessment Tools: An Integrative Review.","authors":"Leah Burt, Patricia B Griffith, Margaret Bavis, Rebecca Raszewski","doi":"10.4037/aacnacc2025683","DOIUrl":"10.4037/aacnacc2025683","url":null,"abstract":"<p><p>Diagnostic errors are the most common cause of medical mistakes in the United States. Nurse practitioners (NPs) are critical in reducing the incidence of diagnostic errors, because diagnosis is a common competency for NPs. Although strategies for teaching diagnostic reasoning in NP education have been studied, little research has been conducted on evaluating diagnostic reasoning competencies among NP students. This integrative literature review was performed to identify and synthesize diagnostic reasoning competency assessment strategies in NP education. Data were evaluated for quality and synthesized to provide a comprehensive, actionable overview for NP educators. Although most assessments have been implemented among medical learners, most are also based on processes common to interprofessional diagnostic reasoning competencies. A small number were developed or implemented with NP learners. Current assessment methods may be used in NP education in various settings (eg, simulation education, clinical rotations) with varying reliability and validity.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"174-186"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188244","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}
引用次数: 0
Secondary Headache: Learning Diagnostic Reasoning in Complex Cases. 继发性头痛：学习复杂病例的诊断推理。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025295
Sarah McCarthy, Sheila Smith
{"title":"Secondary Headache: Learning Diagnostic Reasoning in Complex Cases.","authors":"Sarah McCarthy, Sheila Smith","doi":"10.4037/aacnacc2025295","DOIUrl":"10.4037/aacnacc2025295","url":null,"abstract":"<p><p>Acute care nurse practitioners (ACNPs) provide care in a variety of settings and for a wide range of patient acuities. Flexible use of both analytic and nonanalytic thinking is necessary for safer and efficient diagnostic reasoning (DR). The purpose of this article is to review the diagnostic thought process required of ACNPs, provide a case-based example of DR in a complex secondary headache scenario, and identify key tools to help ACNP learners develop strong DR skills. Multiple strategies for developing or advancing DR competencies can be used by ACNP learners at all levels using learner-driven approaches. Statistically significant improvement in DR performance can be achieved with intentional, learner-driven activities and metacognitive exercises. ACNP learners have the opportunity to master DR using various system 1, system 2, and metacognitive processes to ensure safe and effective DR, even in the most complex of cases.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"143-157"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188252","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}
引用次数: 0
Diagnostic Reasoning Foundations: Theoretical and Scientific Background With Suggested Competencies for Nurse Practitioner Education. 诊断推理基础：理论和科学背景与建议的护士执业教育能力。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-06-15 DOI: 10.4037/aacnacc2025354
Sheila Smith, Mary Mescher Benbenek, Lauren A Petersen
{"title":"Diagnostic Reasoning Foundations: Theoretical and Scientific Background With Suggested Competencies for Nurse Practitioner Education.","authors":"Sheila Smith, Mary Mescher Benbenek, Lauren A Petersen","doi":"10.4037/aacnacc2025354","DOIUrl":"10.4037/aacnacc2025354","url":null,"abstract":"<p><p>This article provides a comprehensive narrative review and explanation of the theory, science, and component processes of diagnostic reasoning, based on over 30 years of diagnostic reasoning literature. Building on this background information and the authors' nurse practitioner education and practice expertise, foundational diagnostic reasoning concepts and processes are applied to nurse practitioner education and practice. Foci are suggested for nurse practitioner education competencies in the diagnostic reasoning components of illness scripts and script activation, interaction and encounter management, hypothesis-directed patient evaluation, problem representation and differential diagnosis, value-based testing, identifying and communicating the working diagnosis, developing the management plan, and metacognition and documentation. The desired goals include highest quality practice, diagnostic safety, and improved health outcomes.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 2","pages":"109-122"},"PeriodicalIF":1.5,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188246","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}
引用次数: 0
Growth in Nurse Practitioner Fellowship Programs: Implications for Scope of Practice. 执业护士奖学金项目的增长：对执业范围的影响。
IF 1.5
AACN Advanced Critical Care Pub Date : 2025-03-15 DOI: 10.4037/aacnacc2025678
John D Gonzalez, Kristin H Gigli
{"title":"Growth in Nurse Practitioner Fellowship Programs: Implications for Scope of Practice.","authors":"John D Gonzalez, Kristin H Gigli","doi":"10.4037/aacnacc2025678","DOIUrl":"10.4037/aacnacc2025678","url":null,"abstract":"<p><p>Postgraduate fellowship programs for nurse practitioners have proliferated since 2007. These programs facilitate the transition to practice for new nurse practitioners as well as those who are experienced and choose to move to a new specialty. Outcome data demonstrate the effectiveness of these programs in promoting the development of novice nurse practitioners. Fellowship programs offer education outside the framework of the Consensus Model for regulation of the licensure, accreditation, certification, and education of advanced practice registered nurses and have limited implications for nurse practitioners' scope of practice. Greater understanding of the limits of fellowship programs is needed to ensure that nurse practitioners work within their scope of practice.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"36 1","pages":"14-19"},"PeriodicalIF":1.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143504783","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}
引用次数: 0
Climate Change: Time for Hospitals to Respond. 气候变化：医院应对的时间。
IF 1.5
AACN Advanced Critical Care Pub Date : 2024-12-15 DOI: 10.4037/aacnacc2024134
Mary Frances D Pate
{"title":"Climate Change: Time for Hospitals to Respond.","authors":"Mary Frances D Pate","doi":"10.4037/aacnacc2024134","DOIUrl":"10.4037/aacnacc2024134","url":null,"abstract":"<p><p>Alarm bells are sounding internationally as climate change impacts planet Earth and its inhabitants. Health care organizations must consider the role they play in working toward environmental sustainability in terms of mitigation, resilience, leadership, and equity. Institutions need to address the effects of climate change on the physical health and mental well-being of patients and their families as well as employees. Awareness of the complexities of sustainability initiatives and disaster management related to inclement weather and weather-related events is critical for health care organizations to avoid precipitating the illnesses and diseases they endeavor to prevent and heal.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"35 4","pages":"320-324"},"PeriodicalIF":1.5,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789719","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}
引用次数: 0
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