Dimensions of Critical Care Nursing最新文献

{"title":"DCCN on the Web.","authors":"","doi":"10.1097/01.DCC.0000947296.51189.dc","DOIUrl":"https://doi.org/10.1097/01.DCC.0000947296.51189.dc","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 5","pages":"254"},"PeriodicalIF":1.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154980","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":"Calibration of the PREdiction of DELIRium in ICu Patients (PRE-DELIRIC) Score in a Cohort of Critically Ill Patients: A Retrospective Cohort Study.","authors":"Francesco Gravante,&nbsp;Diana Giannarelli,&nbsp;Antonello Pucci,&nbsp;Luigi Pisani,&nbsp;Roberto Latina","doi":"10.1097/DCC.0000000000000586","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000586","url":null,"abstract":"<p><strong>Background: </strong>To predict delirium in intensive care unit (ICU) patients, the Prediction of Delirium in ICU Patients (PRE-DELIRIC) score may be used. This model may help nurses to predict delirium in high-risk ICU patients.</p><p><strong>Objectives: </strong>The aims of this study were to externally validate the PRE-DELIRIC model and to identify predictive factors and outcomes for ICU delirium.</p><p><strong>Method: </strong>All patients underwent delirium risk assessment by the PRE-DELIRIC model at admission. We used the Intensive Care Delirium Screening Check List to identify patients with delirium. The receiver operating characteristic curve measured discrimination capacity among patients with or without ICU delirium. Calibration ability was determined by slope and intercept.</p><p><strong>Results: </strong>The prevalence of ICU delirium was 55.8%. Discrimination capacity (Intensive Care Delirium Screening Check List score ≥4) expressed by the area under the receiver operating characteristic curve was 0.81 (95% confidence interval, 0.75-0.88), whereas sensitivity was 91.3% and specificity was 64.4%. The best cut-off was 27%, obtained by the max Youden index. Calibration of the model was adequate, with a slope of 1.03 and intercept of 8.14. The onset of ICU delirium was associated with an increase in ICU length of stay (P < .0001), higher ICU mortality (P = .008), increased duration of mechanical ventilation (P < .0001), and more prolonged respiratory weaning (P < .0001) compared with patients without delirium.</p><p><strong>Discussion: </strong>The PRE-DELIRIC score is a sensitive measure that may be useful in early detection of patients at high risk for developing delirium. The baseline PRE-DELIRIC score could be useful to trigger use of standardized protocols, including nonpharmacologic interventions.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"187-195"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9569456","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":"DCCN on the Web.","authors":"","doi":"10.1097/01.DCC.0000937140.86952.5f","DOIUrl":"https://doi.org/10.1097/01.DCC.0000937140.86952.5f","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"239"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9558367","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":"What Are the Barriers and Facilitators for Critical Care Nurse Participation in a Patient Blood Management Program?","authors":"Danita Wabeke,&nbsp;Deborah Tolich","doi":"10.1097/DCC.0000000000000585","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000585","url":null,"abstract":"<p><strong>Background: </strong>Patient blood management (PBM) programs strive to implement best practices, mitigating blood loss through procedures to decrease anemia and the need for transfusion. Critical care nurses may have the greatest impact on blood preservation and anemia prevention for the most critically ill patients. Nurse perceptions of barriers and facilitators in PBM are not fully understood.</p><p><strong>Objectives: </strong>The primary aim was to determine critical care nurses' perceptions of barriers and facilitators to participation in PBM. The secondary aim was to understand ways in which they believe the barriers can be addressed.</p><p><strong>Methods: </strong>A qualitative descriptive method was used following Colaizzi's process. Critical care nurses (n = 110) were recruited from 10 critical care units in 1 quaternary care hospital to participate in focus groups. Data were analyzed using qualitative methodology and NVivo software. Communication interactions were categorized into codes and themes.</p><p><strong>Results: </strong>Study findings were gathered under 5 categories: assessing need for blood transfusions, laboratory challenges, availability and appropriateness of supplies, minimizing need for laboratory draws, and communication. Three prominent themes indicated that (a) critical care nurses have a limited awareness of PBM, (b) critical nurses must be empowered to engage in interprofessional collaboration, and (c) addressing barriers is not complex.</p><p><strong>Conclusion: </strong>The data provide insight into the challenges of critical care nurse participation in PBM, driving next step efforts in building on the institution's strengths and improving engagement. It is imperative that the recommendations derived from critical care nurses' experiences be further developed.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"196-201"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9568953","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":"Corrigendum: The Impact of Type of Acute Myocardial Infarction on Cardiac Patient Self-efficacy After Hospitalization.","authors":"","doi":"10.1097/01.DCC.0000938656.92104.bc","DOIUrl":"https://doi.org/10.1097/01.DCC.0000938656.92104.bc","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"233"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886999","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":"Frequency and Magnitude of Obstacles and Helpful Behavior Items in End-of-Life Care as Perceived by Nurses Working in Critical-Access Hospitals.","authors":"Renea L Beckstrand,&nbsp;Shalyn Larsen,&nbsp;Janelle L B Macintosh,&nbsp;Ryan Rasmussen,&nbsp;Karlen E Luthy,&nbsp;Trissa M Lyman","doi":"10.1097/DCC.0000000000000589","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000589","url":null,"abstract":"<p><strong>Background: </strong>Twenty percent of Americans live in rural areas where most of their health care is provided in critical-access hospitals (CAHs). It is unknown how frequently obstacle and helpful behavior items occur in end-of-life (EOL) care in CAHs.</p><p><strong>Objectives: </strong>The aims of this study were to determine the frequency of occurrence scores of obstacle and helpful behavior items in providing EOL care in CAHs and to also determine which obstacles and helpful behaviors have the greatest or least impact on EOL care based on the magnitude scores.</p><p><strong>Methods: </strong>A questionnaire was sent to nurses working in 39 CAHs in the United States. Nurse participants were asked to rate obstacle and helpful behavior items by size and frequency of occurrence. Data were analyzed to quantify the impact of obstacle and helpful behavior items on EOL care in CAHs by multiplying the mean size by the mean frequency of items to determine mean magnitude scores.</p><p><strong>Results: </strong>Items with the highest and lowest frequency were determined. In addition, obstacle and helpful behavior item magnitude scores were calculated. Seven of the top 10 obstacles were related to patients' families. Seven of the top 10 helpful behaviors involved nurses ensuring families had positive experiences.</p><p><strong>Conclusion: </strong>Nurses in CAHs perceived issues around patient family members as significant obstacles to EOL care. Nurses work to ensure that families have positive experiences. Visiting hour issues seemed to be irrelevant. The use of technology, such as telehealth, seemed to provide little benefit in EOL care in CAHs.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"211-222"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887004","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":"Chagas Disease Cardiomyopathy.","authors":"Ariana Jimenez,&nbsp;Elizabeth J Winokur","doi":"10.1097/DCC.0000000000000590","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000590","url":null,"abstract":"<p><p>Chagas disease is a prominent neglected tropical disease endemic to many countries in Latin America. Cardiomyopathy is the most serious manifestation due to the severity and complications of heart failure. As a result of expanded immigration and globalization, there is an increased number of patients with Chagas cardiomyopathy who are being admitted to hospitals in the United States. It is imperative as a critical care nurse to be educated on the nature of Chagas cardiomyopathy as it differs from the more commonly seen ischemic and nonischemic forms. This article provides an overview of the clinical course, management, and treatment options of Chagas cardiomyopathy.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"202-210"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887002","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":"Exploring the Interprofessional Contributions of Spiritual Health Practitioners to Prevent Compassion Fatigue in Nurses.","authors":"Amy Hildebrand,&nbsp;Sheryl Reimer-Kirkham,&nbsp;Barry Quinn","doi":"10.1097/DCC.0000000000000587","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000587","url":null,"abstract":"<p><strong>Background: </strong>Few studies in academic literature involve the application of a spiritual health intervention for the purpose of mitigating compassion fatigue in nurses.</p><p><strong>Objectives: </strong>The purpose of this qualitative study was to explore the perspectives of Canadian spiritual health practitioners (SHPs) in their support for nurses to prevent compassion fatigue.</p><p><strong>Method: </strong>Interpretive description was utilized for this research study. Sixty-minute interviews with 7 individual SHPs were conducted. Data were analyzed with NVivo 12 software (QSR International, Burlington, Massachusetts). Thematic analysis identified common themes that allowed data from interviews, a pilot project on psychological debriefing, and a literature search to be compared, contrasted, and compiled.</p><p><strong>Results: </strong>The 3 main themes were found. The first theme highlighted the underlying issue of how spirituality is ranked or viewed within health care and the impact of leadership integrating spirituality in their practice. The second theme related to SHPs' perception of nurses' compassion fatigue and lack of connection to spirituality. The final theme explored the nature of SHP support to mitigate compassion fatigue before and during the COVID-19 pandemic.</p><p><strong>Discussion: </strong>Spiritual health practitioners are positioned in a unique role to be facilitators of connectedness. They are professionally trained to provide a type of in situ nurturing for patients and health care staff through spiritual assessments, pastoral counseling, and psychotherapy. The COVID-19 pandemic has revealed an underlying desire for in situ nurturing and connectedness in nurses due to an increase in existential questioning, unusual patient circumstances, and social isolation leading to disconnectedness. Organizational spiritual values are recommended to be exemplified by those in leadership to create holistic, sustainable work environments.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"223-233"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887001","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":"Authorship: \"Begin With the End in Mind\".","authors":"Helene Bowen Brady","doi":"10.1097/DCC.0000000000000594","DOIUrl":"https://doi.org/10.1097/DCC.0000000000000594","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"242-243"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9545417","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":"Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study.","authors":"Carleigh M Rittel, Bryan A Borg, Anelis V Hanessian, Angela Kuhar, Mindy J Fain, Christian Bime","doi":"10.1097/DCC.0000000000000588","DOIUrl":"10.1097/DCC.0000000000000588","url":null,"abstract":"<p><strong>Background: </strong>Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options.</p><p><strong>Objectives: </strong>Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population.</p><p><strong>Method: </strong>This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed.</p><p><strong>Results: </strong>There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, -2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate.</p><p><strong>Conclusions: </strong>In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"42 4","pages":"234-239"},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10208591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}