American Journal of Critical Care最新文献_第6页

Cardiac Arrhythmias After Coronary Artery Bypass Graft Surgery. 冠状动脉旁路移植手术后的心律失常。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-05-01 DOI: 10.4037/ajcc2024870

Dillon J Dzikowicz, Sukardi Suba, Mary G Carey

引用次数: 0

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19. 重症监护护士在 COVID-19 之后的道德复原力、道德伤害、制度背叛和创伤压力。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024481

Guy M Weissinger, Deborah Swavely, Heidi Holtz, Katherine C Brewer, Mary Alderfer, Lisa Lynn, Angela Yoder, Thomas Adil, Tom Wasser, Danielle Cifra, Cynda Rushton

{"title":"Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19.","authors":"Guy M Weissinger, Deborah Swavely, Heidi Holtz, Katherine C Brewer, Mary Alderfer, Lisa Lynn, Angela Yoder, Thomas Adil, Tom Wasser, Danielle Cifra, Cynda Rushton","doi":"10.4037/ajcc2024481","DOIUrl":"10.4037/ajcc2024481","url":null,"abstract":"Background: Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied.Objectives: To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout.Methods: This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables.Results: Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms.Conclusions: Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"105-114"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress. 虚拟现实模拟对新护士评估儿科呼吸窘迫的影响。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024878

Dana L Raab, Kelly Ely, Keith Israel, Li Lin, Amy Donnellan, Jennifer Saupe, Melissa Klein, Matthew W Zackoff

{"title":"Impact of Virtual Reality Simulation on New Nurses' Assessment of Pediatric Respiratory Distress.","authors":"Dana L Raab, Kelly Ely, Keith Israel, Li Lin, Amy Donnellan, Jennifer Saupe, Melissa Klein, Matthew W Zackoff","doi":"10.4037/ajcc2024878","DOIUrl":"10.4037/ajcc2024878","url":null,"abstract":"Background: Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses.Objective: To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care.Methods: New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined.Results: Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P < .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P = .006).Conclusions: Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics-specific assessment skills.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"115-124"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical Pearls. 临床珍珠

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024539

Rhonda Board

引用次数: 0

Discussion Guide for the Amorim Article. 阿莫林文章讨论指南。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024993

Grant A Pignatiello

引用次数: 0

Understanding and Improving Bereavement Support in the Intensive Care Unit. 了解并改进重症监护病房的丧亲支持。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024438

Aluko A Hope, Cindy L Munro

引用次数: 0

Assessing Discomfort in American Adult Intensive Care Patients. 评估美国成人重症监护患者的不适感。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024362

Marshall S Gunnels, Emily M Reisdorf, Jay Mandrekar, Linda L Chlan

{"title":"Assessing Discomfort in American Adult Intensive Care Patients.","authors":"Marshall S Gunnels, Emily M Reisdorf, Jay Mandrekar, Linda L Chlan","doi":"10.4037/ajcc2024362","DOIUrl":"10.4037/ajcc2024362","url":null,"abstract":"Background: While in the intensive care unit, critically ill patients experience a myriad of distressing symptoms and stimuli leading to discomfort, a negative emotional and/ or physical state that arises in response to noxious stimuli. Appropriate management of these symptoms requires a distinct assessment of discomfort-causing experiences.Objectives: To assess patient-reported discomfort among critically ill patients with the English-language version of the Inconforts des Patients de REAnimation questionnaire, and to explore relationships between demographic and clinical characteristics and overall discomfort score on this instrument.Methods: This study had a cross-sectional, descriptive, single-cohort design. The convenience sample consisted of alert and oriented patients aged 18 years or older who had been admitted to intensive care units at a Midwestern tertiary referral hospital and were invited to participate. An 18-item questionnaire on physiological and psychological stimuli inducing discomfort was administered once. Each item was scored from 0 to 10, with the total possible discomfort score ranging from 0 to 100. Descriptive statistics were used to analyze participants' demographic and clinical characteristics and questionnaire responses.Results: A total of 180 patients were enrolled. The mean (SD) overall discomfort score was 32.9 (23.6). The greatest sources of discomfort were sleep deprivation (mean [SD] score, 4.0 [3.4]), presence of perfusion catheters and tubing (3.4 [2.9]), thirst (3.0 [3.3]), and pain (3.0 [3.0]).Conclusions: Intensive care unit patients in this study reported mild to moderate discomfort. Additional research is needed to design and test interventions based on assessment of specific discomfort-promoting stimuli to provide effective symptom management.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"126-132"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Transitioning to Palliative Care in an Italian Cardiac Intensive Care Unit Network. 意大利心脏重症监护病房网络向姑息治疗过渡。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024535

Alice Sacco, Matteo Pagnesi, Simone Frea, Martina Briani, Carlotta Sorini Dini, Maurizio Bertaina, Marco Marini, Filippo Trombara, Luca Villanova, Amelia Ravera, Guido Tavazzi, Federico Pappalardo, Nuccia Morici, Luciano Potena

{"title":"Transitioning to Palliative Care in an Italian Cardiac Intensive Care Unit Network.","authors":"Alice Sacco, Matteo Pagnesi, Simone Frea, Martina Briani, Carlotta Sorini Dini, Maurizio Bertaina, Marco Marini, Filippo Trombara, Luca Villanova, Amelia Ravera, Guido Tavazzi, Federico Pappalardo, Nuccia Morici, Luciano Potena","doi":"10.4037/ajcc2024535","DOIUrl":"10.4037/ajcc2024535","url":null,"abstract":"Background: Recent data indicate that end-of-life management for patients affected by acute decompensated heart failure in cardiac intensive care units is aggressive, with late or no engagement of palliative care teams.Objective: To assess current palliative care and end-of-life practices in a contemporary Italian multicenter registry of patients with cardiogenic shock due to acute decompensated heart failure.Methods: A survey-based approach was used to collect data on palliative care and end-of-life management practices. The AltShock-2 registry enrolled patients with cardiogenic shock from 12 participating centers. A subset of 153 patients with cardiogenic shock due to acute decompensated heart failure enrolled between March 2020 and March 2023 was analyzed, with a focus on early engagement of palliative care teams and deactivation of implantable cardioverter-defibrillators (ICDs).Results: \"Do not resuscitate\" orders were documented in patient records in only 5 of 12 centers (42%). Palliative care teams were engaged for 21 of 153 enrolled patients (13.7%). Among the 51 patients with ICDs, 6 of 17 patients who died (35%) had defibrillator deactivation. Of the 17 patients who died, 13 died in the hospital and 4 died within 6 months after discharge; 1 patient had ICD deactivation supported by palliative care services at home.Conclusions: Therapy-limiting practices, including ICD deactivation, are not routine in the Italian centers participating in this study. The results emphasize the importance of integrating palliative care as a simultaneous process with intensive care to address the unmet needs of these patients and their families.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"145-148"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inactivity May Identify Older Intensive Care Unit Survivors at Risk for Post-Intensive Care Syndrome. 不活动可识别出有重症监护后综合症风险的老年重症监护室幸存者。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024785

Maya N Elias, Emily A Ahrens, Chi-Shan Tsai, Zhan Liang, Cindy L Munro

{"title":"Inactivity May Identify Older Intensive Care Unit Survivors at Risk for Post-Intensive Care Syndrome.","authors":"Maya N Elias, Emily A Ahrens, Chi-Shan Tsai, Zhan Liang, Cindy L Munro","doi":"10.4037/ajcc2024785","DOIUrl":"10.4037/ajcc2024785","url":null,"abstract":"Background: Older adults (≥age 65) admitted to an intensive care unit (ICU) are profoundly inactive during hospitalization. Older ICU survivors often experience life-changing symptoms, including cognitive dysfunction, physical impairment, and/or psychological distress, which are components of post-intensive care syndrome (PICS).Objectives: To explore trends between inactivity and symptoms of PICS in older ICU survivors.Methods: This study was a secondary analysis of pooled data obtained from 2 primary, prospective, cross-sectional studies of older ICU survivors. After ICU discharge, 49 English- and Spanish-speaking participants who were functionally independent before admission and who had received mechanical ventilation while in the ICU were enrolled. Actigraphy was used to measure post-ICU hourly activity counts (12:00 AM to 11:59 PM). Selected instruments from the National Institutes of Health Toolbox and Patient-Reported Outcomes Measurement Information System were used to assess symptoms of PICS: cognitive dysfunction, physical impairment, and psychological distress.Results: Graphs illustrated trends between inactivity and greater symptom severity of PICS: participants who were less active tended to score worse than one standard deviation of the mean on each outcome. Greater daytime activity was concurrently observed with higher performances on cognitive and physical assessments and better scores on psychological measures.Conclusions: Post-ICU inactivity may identify older ICU survivors who may be at risk for PICS and may guide future research interventions to mitigate symptom burden.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"33 2","pages":"95-104"},"PeriodicalIF":2.7,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11098449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139995271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Enhancing New Nurses' Pediatric Respiratory Assessment Skills. 提高新护士的儿科呼吸评估技能。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2024-03-01 DOI: 10.4037/ajcc2024199

Sarah K Wells

引用次数: 0