Dimensions of Critical Care Nursing最新文献

{"title":"Surgical Intensive Care Unit Nurses' Coping With Moral Distress and Moral Residue: A Descriptive Qualitative Approach.","authors":"Adam T Booth, Becky J Christian","doi":"10.1097/DCC.0000000000000665","DOIUrl":"10.1097/DCC.0000000000000665","url":null,"abstract":"<p><strong>Background: </strong>Moral distress is defined as knowing the right course of action to take but being hindered by institutional constraints.</p><p><strong>Objective: </strong>The purpose of this study was to explore surgical intensive care unit (SICU) nurses' experiences of moral distress, moral residue, coping, and perceived quality of patient care.</p><p><strong>Method: </strong>A descriptive qualitative approach used in-depth, semistructured individual interviews of SICU nurses in a metropolitan, academic medical center until theoretical saturation occurred.</p><p><strong>Results: </strong>Five themes were identified from 21 interviews. Root causes of moral distress were identified including end-of-life care, conflicts with management, staffing, inadequate resources, communication problems, power differentials between physicians and nurses, and working with incompetent providers. Interviews highlighted the torment experienced by participants, which demonstrated that unacknowledged moral distress impacted their quality of patient care and well-being. Accounts provided insight into patient care that was perceived to be wrong. Well-being was affected as 2 participants sought inpatient psychiatric treatment for moral distress, whereas others were looking for new nursing careers, and many were in school to leave the SICU.</p><p><strong>Discussion: </strong>This study is unique because it corroborated Epstein and Hamric's Crescendo Effect framework by providing in-depth analyses of moral distress, moral residue, and the crescendo effect and how these concepts developed within SICU nurses when left unaddressed. Interviews revealed that unacknowledged moral distress created moral residue, which subsequently impacted the quality of patient care and the nurses' well-being.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"298-305"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769440","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 Relationship Between Ethical Attitudes and Compassion Fatigue in Nurses Working in Surgical Intensive Care Units.","authors":"Melek Üçüncüoğlu, Yasemin Güner, Dilek Çilingir, Erdem Taşdemir, Selçuk Akturan","doi":"10.1097/DCC.0000000000000661","DOIUrl":"10.1097/DCC.0000000000000661","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the relationship between ethical attitudes and compassion fatigue experienced by nurses in surgical intensive care units.</p><p><strong>Methods: </strong>It is mixed-design research. The study was conducted with 38 nurses working in the surgical intensive care units of a university hospital who agreed to participate in the study. Quantitative data were collected using the Nurse Information Form, the Ethical Attitude Scale for Nursing Care, and the Compassion Fatigue-Short Scale. Qualitative data were collected using a semistructured questionnaire, through individual interviews with 9 volunteer nurses in surgical intensive care units.</p><p><strong>Results: </strong>The study revealed that nurses exhibited high levels of ethical attitudes in nursing care along with high levels of compassion fatigue. During the qualitative data analysis, 4 key themes emerged: ethical approaches in surgical intensive care units, professional quality of life in nurses, the reflections of compassion fatigue on ethical behavior, and nurses' well-being.</p><p><strong>Conclusions: </strong>It was concluded that when compassion fatigue increased in nurses in surgical intensive care units, ethical attitudes in nursing care decreased. Therefore, compassion fatigue can be addressed by programs that support nurses' well-being, such as meditation, deep breathing, self-compassion exercises, and so on. It can be reduced.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"306-312"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769508","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":"Pediatric Resuscitation, Parental Presence, and Provider Perspective.","authors":"Julie Lindsay, Abbey Hudgins, Stephine Patel","doi":"10.1097/DCC.0000000000000666","DOIUrl":"10.1097/DCC.0000000000000666","url":null,"abstract":"<p><strong>Background: </strong>Varying opinions and practices exist about parental presence during a pediatric resuscitation. In addition, there is a paucity of literature that investigates the perspectives of health care providers about the efficacy of parental presence in these situations.</p><p><strong>Objectives: </strong>The aim of this study was to gain an understanding of the perspectives of emergency health care providers about parental presence during pediatric resuscitation.</p><p><strong>Methods: </strong>This pilot study surveyed emergency health care providers about their opinions of parental presence during pediatric resuscitation. All participants were given a survey with closed- and open-ended questions. Data analysis included descriptive statistics for the demographic data and qualitative analysis for the open-ended responses.</p><p><strong>Results: </strong>A total of 52 emergency services personnel completed the survey. Of the physician respondents, 78.2% (n = 18) were opposed to parental presence during pediatric resuscitation. Common reasons for opposition included the lack of education, interpersonal team communication skills or experience, and discussion concerning end-of-life issues.</p><p><strong>Discussion: </strong>Utilization of formal education and simulation for parental presence during resuscitation could be helpful for increasing providers' comfort levels with parental presence.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"328-332"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769490","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":"Improving Interprofessional Provider Perceptions About Opioid Use Disorder in the Acute Care Setting Through a Blended Educational Simulation Intervention.","authors":"Christine A Murphy, Barbara E Lakatos, Colleen E Shelly, Maria Bentain-Melanson, Genina F Salvio, Mary Maggie Ryan, Scott G Weiner","doi":"10.1097/DCC.0000000000000664","DOIUrl":"10.1097/DCC.0000000000000664","url":null,"abstract":"<p><strong>Background: </strong>The influx of patients in the acute care setting with opioid use disorder (OUD) has outpaced many hospitals' ability to educate interprofessional staff. This creates distressing experiences for interprofessional staff and patients, leading to moral distress and burnout in staff and poor patient outcomes.</p><p><strong>Objective: </strong>The purpose of this study was to improve interprofessional staff knowledge, attitudes, and perceptions toward working with patients who have OUD using a blended classroom-simulation-based curriculum.</p><p><strong>Methods: </strong>A preintervention and postintervention design was selected. Interprofessional staff (n = 46) participated in a blended classroom-simulation educational intervention focused on the neurobiology of OUD, stigma reduction, pain management, and harm reduction principles, followed by 3 high-fidelity simulation scenarios. Participants completed the Drug and Drug Problems Perceptions Questionnaire to measure staff self-perceived knowledge, skills, and attitudes when working with patients who use drugs before, immediately after, and again 3 and 6 months postintervention.</p><p><strong>Results: </strong>Most respondents were nurses with an average of 7.6 (SD, 9.6) years of experience. The majority did not have prior training in substance use disorder before (75.6%). There was a statistically significant decrease in mean Drug and Drug Problems Perceptions Questionnaire scores across the total score mean: 55.2 (95% confidence interval, 52.2-58.3) versus 45.5 (95% confidence interval, 43.9-47.1), P < .001. Decreased score indicates improved attitude and perception.</p><p><strong>Discussion: </strong>A curriculum consisting of a blended classroom-simulation intervention was successful at improving several domains regarding perceptions of caring for patients with OUD. This educational intervention can serve as a model for health care systems with goal of improving patient outcomes and staff well-being.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"320-327"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769448","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 AMA Insider: A Digital Reference for Timely Updates to AMA Style and Format.","authors":"Kathleen Ahern Gould","doi":"10.1097/DCC.0000000000000669","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000669","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"334"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769517","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":"Embracing Artificial Intelligence: A Challenge for 2025.","authors":"Kathleen Ahern Gould","doi":"10.1097/DCC.0000000000000670","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000670","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 6","pages":"277-278"},"PeriodicalIF":1.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769487","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":"Critical Care Nurses' Perspectives of Caring for Patients With Cancer.","authors":"Elizabeth Mitchell, Ilana R Azulay Chertok","doi":"10.1097/DCC.0000000000000652","DOIUrl":"10.1097/DCC.0000000000000652","url":null,"abstract":"<p><strong>Background: </strong>Critical care nurses are expected to work with patients who present with a wide range of health problems, but may lack sufficient education, skill development, and resources needed for providing psychosocial cancer care.</p><p><strong>Objective: </strong>The purpose of this study was to gain a deeper understanding of nononcologic critical care nurses' experience working with patients and their families affected by cancer.</p><p><strong>Method: </strong>A phenomenological qualitative study using semistructured interviews was conducted with 15 nononcologic critical care nurses. Colaizzi's 7-step methodology was followed for data analysis and interpretation of findings. Audio recordings were transcribed verbatim, the narrative data were analyzed and coded, and themes were identified that were confirmed by participants.</p><p><strong>Results: </strong>Four themes emerged from the nurses' narratives: lack of professional preparation refers to the perceived lack of education, skill development, and resources; collaboration and teamwork pertain to the importance of communication and moral support; being present expresses their perceived role in providing compassionate care; and nurtured empathy reflects the impact of cancer care on the nurses.</p><p><strong>Discussion: </strong>The narratives provide insight into the experience and perceptions of the nononcologic critical care nurses caring for patients with cancer. Information from the themes and narratives can be used to inform the development of knowledge and skills for nononcologic nurses who provide care to patients with cancer.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"239-245"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793755","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":"Efficacy of a Standardized Process in Optimizing Appropriate Use of Progressive Care Unit Beds in a Tertiary Care Facility.","authors":"Susan B Stempek, Michael S Rosenblatt, Nelson Repenning, John Sterman, Janice R Morrissette, Susan E Flanagan, Lindsey Sallese, Yuxiu Lei, Timothy N Liesching","doi":"10.1097/DCC.0000000000000657","DOIUrl":"10.1097/DCC.0000000000000657","url":null,"abstract":"<p><strong>Background: </strong>Poor patient progression from the progressive care unit (PCU) beds has been recognized as a bottleneck, limiting the hospital's ability to optimize capacity for the sickest patients. Improving nurse management on PCU admission and discharge criteria could avoid PCU bottlenecks.</p><p><strong>Local problem: </strong>Our institution lacked a standard process to identify clinically appropriate patients ready for transfer out of the PCU, causing delays in vacating PCU beds.</p><p><strong>Objectives: </strong>The aim of this study was to determine if creating a standard process to empower bedside nurses and unit nursing leaders to push readiness information to the provider team improves the appropriateness of PCU stay and transfers patients out of the PCU earlier.</p><p><strong>Methods: </strong>The most common causes of delayed transfer out of the PCU were discussed among stakeholders. A process was designed to empower the bedside nurses to partner with a physician leader to send information to the provider team requesting evaluation of the patient's readiness to leave the unit. The improvement of meeting the criteria for PCU was evaluated by comparing 60 patients prior to the intervention phase with 139 patients during the intervention.</p><p><strong>Results: </strong>The primary outcome, percentage of patients meeting PCU criteria, was 53% during the audit phase and 68% during the intervention phase (P = .05). The PCU transfer time was pushed 1 hour earlier in the day.</p><p><strong>Conclusions: </strong>The standard process of empowering bedside nurses to partner with physician leaders to push readiness for transferring patients out of the PCU resulted in a significant improvement in the percentage of patients meeting PCU criteria and earlier discharge of appropriate patients.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"259-265"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793715","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":"Educational Interventions for Rapid Response Team Members: A Narrative Literature Review.","authors":"Alexander Birch, Maureen Varty","doi":"10.1097/DCC.0000000000000655","DOIUrl":"10.1097/DCC.0000000000000655","url":null,"abstract":"<p><strong>Background: </strong>Research continues to be conducted on rapid response systems as patient outcomes associated with rapid response team activations are still not consistently showing benefit. One particular area of focus that is a growing area is the literature regarding training and education for individual team members of the rapid response team.</p><p><strong>Objective: </strong>The purpose of this narrative review was to describe the current literature regarding educational interventions for rapid response team members.</p><p><strong>Methods: </strong>This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To be included in the narrative review, studies needed to be reporting on educational interventional research for rapid response team members of the efferent limb. No studies were excluded based upon study design or publication years.</p><p><strong>Results: </strong>This narrative review included 6 studies. Four studies assessed outcomes associated with rapid response team members, and 2 of the studies assessed patient outcomes associated with implementing education routinely for rapid response teams. All studies found a positive impact of implementing educational interventions.</p><p><strong>Discussion: </strong>Our narrative review found that limited research has been conducted in the area of educational interventions for rapid response team members, and of the articles identified, most did not assess patient-associated outcomes. The findings demonstrate that this area of research is in its early stages, and further work is needed to identify what content should be provided in the education and what educational methodologies should be employed, and to continue to assess patient health outcomes associated with educational interventions for rapid response team members.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"266-271"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793714","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":"End-Tidal Carbon Dioxide Measurement in Out-of-Hospital Cardiac Arrest as a Predictor of Return of Spontaneous Circulation: A Literature Review.","authors":"Andrea Bruni, Alessandro Fagorzi, Stefania Mirri, Marta Machetti, Stefano Trapassi, Moris Rosati, Francesco D'Ambrosio, Matteo Laprocina, Lorenzo Righi","doi":"10.1097/DCC.0000000000000658","DOIUrl":"10.1097/DCC.0000000000000658","url":null,"abstract":"<p><strong>Introduction: </strong>One of the leading causes of morbidity and mortality worldwide is out-of-hospital cardiac arrest. Early defibrillation and high-quality cardiopulmonary resuscitation (CPR) have improved survival. The main goal of CPR is to achieve return of spontaneous circulation (ROSC), which is assessed by looking for a pulse, analyzing the heart rhythm, and assessing carbon dioxide levels. The use of cartography during CPR to confirm the correct position of the endotracheal tube during intubation or to assess the effectiveness of chest compressions has increased significantly in the last years. The aim of this review was to identify correlations between end-tidal carbon dioxide levels and the likelihood of ROSC in patients with out-of-hospital cardiac arrest.</p><p><strong>Methods: </strong>A literature search was performed in MEDLINE (via Pubmed), Scopus, Web of Science, and Google Scholar databases from September to November 2022. Keywords combined with the Boolean operators (AND/OR) were used in both free text and Medical Subject Headings. Studies on adult patients published between 01/01/2016 and 28/09/2022 were searched, with no geographical restrictions.</p><p><strong>Results: </strong>At the end of the selection process, 14 studies were included that investigated capnography in out-of-hospital CPR and reported at least 1 outcome between end-tidal carbon dioxide and ROSC or survival.</p><p><strong>Discussion: </strong>Capnography is an advantageous tool due to its noninvasive characteristics, ease of use, and immediacy of data. In out-of-hospital cardiac arrest, the use of the end-tidal carbon dioxide appears to be an appropriate complementary tool to support clinical decisions, such as correct positioning of the endotracheal tube, optimizing ventilation in CPR, and as a predictor of ROSC.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"253-258"},"PeriodicalIF":1.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793716","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}