Dimensions of Critical Care Nursing最新文献

{"title":"The Value of Risk Rounding: Transforming Nursing Intuition Into Recognition Through Identifying Foreseeable Risk.","authors":"Kristen Dagley","doi":"10.1097/DCC.0000000000000559","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000559","url":null,"abstract":"<p><p>The practice of risk rounding serves as a routine contribution to a highly reliable organization, a culture of curiosity empowering all team members to speak up in real time, and provides insight into areas of uncertainty. Highly reliable organizations protect the time and the team member who disrupts the routine service delivery when a risk is identified. In a 16-week pilot study, staff nurses in a Manhattan cardiothoracic intensive care unit participated in risk rounding wherein the staff identified foreseeable risks in a neighboring patient room. The objective of the pilot study was to foster a culture of safety and improve preparedness for urgent or emergent clinical scenarios. The postsurvey demonstrated improvement in both objectives with potential secondary benefits such as improved patient experience scores and nursing-sensitive indicators.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"42-45"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701802","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":"Book and Media Review.","authors":"K. Gould","doi":"10.1097/DCC.0000000000000562","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000562","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"21 1","pages":"49"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83859350","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":"The Circle of Life: A Senior Nursing Student Summative Capstone Simulation.","authors":"Julie Lindsay,&nbsp;Mary Pautler,&nbsp;James Thomas Papesca","doi":"10.1097/DCC.0000000000000558","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000558","url":null,"abstract":"<p><strong>Background: </strong>During the course of a baccalaureate education, nursing students may encounter patient situations that are unexpected and emergent, including death. The use of simulation can offer students the opportunity to practice their communication skills with family centered-care and their teamwork in a safe environment with these emotionally charged patient situations.</p><p><strong>Objectives: </strong>The aim of this study was to provide students with a final summative simulation that could encompass as much of the curriculum as possible.</p><p><strong>Methods: </strong>We developed a simulation experience involving a 32-week pregnant woman diagnosed with H1N1, who deteriorated and needed intubation and an emergency C-section. Students were required to care not only for the pregnant patient who was decompensating but also for the premature infant while working with two providers, a chaplain, and the \"husband/father\" in an intensive care environment.</p><p><strong>Results: </strong>Around 94% of the students thought the simulation was beneficial and helped them improve clinical judgments, assessments, and interprofessional and patient/family communication. Students felt this simulation was challenging and recommended it to continue for other senior classes. Students found the debriefing and open discussion with all participants beneficial.</p><p><strong>Discussion: </strong>The use of a summative simulation encompassing as much of the nursing curriculum as possible can be an effective tool to assess student learning and engagement.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"12-14"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701796","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":"Moving Forward From a New Place in 2023.","authors":"Kathleen Ahern Gould","doi":"10.1097/DCC.0000000000000563","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000563","url":null,"abstract":"The author discusses the need to stay alert to public health needs, the complexities of disparities, and the value of attentive leadership in 2023. Topics covered include lessons learned from the COVID-19 pandemic, the culture shift after the pandemic, and a framework for organizational introspection.","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"1-2"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700360","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":"Communicating With Unconscious Patients: An Overview.","authors":"Madelaine M Lawrence,&nbsp;Rebecca P Ramirez,&nbsp;Paul J Bauer","doi":"10.1097/DCC.0000000000000561","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000561","url":null,"abstract":"<p><strong>Background: </strong>Nurses are told to speak to their unconscious patients because hearing is said to be the last sense to depart. There was little reliable evidence before the 1990s that patients in an unconscious state could hear and understand what was being said. That led to reluctance on the part of health professionals to communicate with these unresponsive patients.</p><p><strong>Objective: </strong>This historical overview aims to present researched evidence from the 1990s to the present detailing awareness that occurs in unconscious patients, when that awareness increases, and how to detect that awareness. It also includes research about the benefits of communicating with unconscious patients and descriptions of how registered nurses and other health care professionals, from a postsurvey after a continuing education course on experiences of unconscious patients, plan to communicate with unconscious patients.</p><p><strong>Methods: </strong>A literature search was conducted, which included more than 150 articles and books about experiences of unconscious patients in several electronic databases, including PubMed, CINAHL, and the British Nursing Index. In addition, an analysis of 105 postcourse responses by registered nurses (89%) and other health professionals (11%), licensed practical nurses, emergency medical technicians, and cardiac technicians after taking a continuing education course on experiences of previously unconscious patients were analyzed.</p><p><strong>Results: </strong>The Glasgow Coma Scale and the Full Outline of Unresponsiveness scale are helpful behavioral tools to identify levels of coma but miss detecting awareness in patients who can hear and understand but cannot move. The estimates are that 25% to 40% (J Trauma. 1975;15:94-98; J Neurosci Nurs. 1988;20:223-228; J Neurosci Nurs. 1990;22(1):52-53; Am J Crit Care. 1995;3:227-232) of patients diagnosed with a disorder of consciousness can hear and understand what is being said in their environment. Substantial evidence supports that isolation and loneliness, such as experienced by some patients perceived to be unaware, can be physically and psychologically harmful.</p><p><strong>Conclusions: </strong>Strong evidence shows that some patients diagnosed as being in a vegetative state can hear and understand what is being said in their environment. Interviews with previously unconscious patients and electrophysiological methods show that awareness can be detected in patients perceived to be unconscious. There is documented evidence that patients experience awareness when going into unconsciousness, even when they appear unaware and when moved. To our knowledge, these times have not been researched using electrophysiological devices but established from interviews.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"3-11"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701720","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":"Thank You-2020-2022 Peer Reviewers.","authors":"","doi":"10.1097/DCC.0000000000000564","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000564","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"1 1","pages":"46-48"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79584863","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":"Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention.","authors":"Ala Ashour,&nbsp;Sami Al-Rawashdeh,&nbsp;Mu'ath Tanash,&nbsp;Ahmed Al-Smadi,&nbsp;Ali Alshraifeen,&nbsp;Abedalmajeed Shajrawi","doi":"10.1097/DCC.0000000000000560","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000560","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is a predictor of a bad prognosis in patients with coronary heart disease. Patients with coronary heart disease undergoing percutaneous coronary intervention (PCI) reported high levels of anxiety, yet little is known about changes in anxiety levels after this procedure.</p><p><strong>Objective: </strong>The aim of this study was to examine changes in anxiety levels of patients undergoing PCI and identify differences in anxiety levels based on patients' demographics and clinical details.</p><p><strong>Methods: </strong>A convenience sample of patients undergoing first-time elective PCI (N = 165) completed the Generalized Anxiety Disorder Scale at baseline (discharge time) and 6 months later. Paired samples t test was used to assess the changes in anxiety levels. The χ2 test was used to examine the pattern of changes between the 2 time points. Patients did not have access to cardiac rehabilitation.</p><p><strong>Results: </strong>Six months after PCI, the anxiety level scores decreased significantly; mean scores for the baseline versus follow-up were 10.84 ± 5.98 versus 4.29 ± 6.02, respectively (P = .001). Only 18.2% of the patients had normal levels of anxiety at the baseline compared with 71.5% 6 months later. History of hospitalization after PCI, being a smoker, younger age, and low level of education were associated with higher levels of anxiety at follow-up.</p><p><strong>Conclusions: </strong>Although anxiety levels were reduced 6 months after PCI, assessing patients' anxiety levels and implementing psychoeducational interventions at follow-up should be incorporated to optimize the care of PCI patients, particularly for those who are younger, who are smokers, or with a low educational level.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"15-21"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701797","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":"Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice.","authors":"Staci S Reynolds,&nbsp;Bradi B Granger","doi":"10.1097/DCC.0000000000000556","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000556","url":null,"abstract":"<p><strong>Background: </strong>Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence.</p><p><strong>Objective: </strong>Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects.</p><p><strong>Methods: </strong>We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice.</p><p><strong>Conclusions: </strong>Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"33-41"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701800","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":"Cardiac Surgery Unit Advanced Life Support Training: A 10-Year Retrospective Study Examining Patient Mortality Outcomes After Implementation.","authors":"John P Whitlock","doi":"10.1097/DCC.0000000000000557","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000557","url":null,"abstract":"<p><strong>Background: </strong>Although the body of knowledge related to Cardiac Surgery Unit Advanced Life Support (CSU-ALS) guideline has grown over the last 10 years, there is no existing literature examining the impact of this training on patient mortality outcomes.</p><p><strong>Objectives: </strong>This article describes one institution's experience related to patient mortality outcomes following a rigorous training program following the CSU-ALS guideline. Because of the small numbers associated with cardiac arrests after cardiac surgery (0.7%-8%), statistical significance was not a goal.</p><p><strong>Methods: </strong>A quasi-experimental design was used to compare mortality outcomes before and after CSU-ALS training. One hundred percent of the staff were trained in the initial year, and 85% to 90% of the staff maintained competency in the following years. The author used 10 years of retrospective data to compare mortality rates 4 years before and 6 years after the intervention.</p><p><strong>Results: </strong>The retrospective data showed a decrease in the percentage of failure-to-rescue rate in the intervention group (control 16% vs intervention 2%). Fisher exact testing implies that the observed frequencies were not significantly different from the expected frequencies (P = .072 and P = .135). Because of the small sample size, statistical significance could not be established.</p><p><strong>Discussion: </strong>This institution experienced an extremely positive track record in outcomes despite its inability to prove a statistically significant correlation to the CSU-ALS training. The overall observed and self-reported confidence level of the staff during the study period was outside the project scope but deserves mention and further research.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 1","pages":"22-32"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40701798","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":"Self-Care for New and Student Nurses Companion Instructor's Guide and Workbook.","authors":"K. Gould","doi":"10.1097/dcc.0000000000000555","DOIUrl":"https://doi.org/10.1097/dcc.0000000000000555","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"70 1","pages":"357-359"},"PeriodicalIF":1.7,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91377422","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}