The Canadian journal of critical care nursing最新文献

{"title":"A call for standardized national guidelines on QT/QTc monitoring in Canada","authors":"Kathleen Hutton, D. Hutton","doi":"10.5737/23688653-3221419","DOIUrl":"https://doi.org/10.5737/23688653-3221419","url":null,"abstract":"Background: With QT-prolonging drugs being trialed for the treatment of COVID-19, national health associations allude to the importance of proficient QT interval assessment. However, in Canada there is no policy in place that clearly identifies a single method for routine QT monitoring. Aim: To demonstrate the need for a clear Canadian guideline for the measurement of the QT/QTc interval and to advocate for a standardized approach to education. Methods: This paper uses a medical anthropological approach to scale this practice gap from the individual provider to the institutions that govern practice and education. Nurses and emergency medical personnel from hospitals across Canada were polled with questionnaires on their confidence and knowledge of assessing the QT/QTc interval. We seek to identify causes for the widespread lack of confidence that goes beyond the context of nursing and is interdisciplinary in nature. Findings: Of the 292 participants who were polled, roughly 75% report measuring the QT interval. However, more than 50% of participants are not confident in their measurement. Although critical care nurses report the highest levels of confidence, the rate of correct answers amongst the whole of participants on knowledge-based questions is shockingly low (only nine percent attempted to provide a value for the QTc; 34% of those who were unsure of the normal QTc say they were not taught). Ninety percent of participants report they do not analyze the QTc, with critical care nurses accounting for 34% of participants. Conclusion: The lack of consensus on a QTc formula and the absence of clear guidelines on this well-documented issue exacerbate the continued gap in practice observed in our findings. We urge leading organizations to create a national guideline that supports a standardized approach to QT/QTc measurement that can be taught to and used by not only critical care nurses, but everyone in healthcare who provides cardiac monitoring.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42522912","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 influence of simulation in predicting intent to stay, among critical care nurses","authors":"S. Goldsworthy","doi":"10.5737/23688653-322513","DOIUrl":"https://doi.org/10.5737/23688653-322513","url":null,"abstract":"Aim: This paper will present a study, which tested a theoretical Critical Care Nurse Retention model and mechanisms that may influence intent to stay in the organization, unit and nursing profession.  Background: The current international nursing shortage is worsening and is particularly acute in critical care settings. There is a rapidly aging nursing workforce and at the same time a significant shortfall in the number of new graduates to replace the large numbers of retiring nurses. Intensive care units have been shown to have the highest turnover rates and there is limited scientific evidence on how to retain critical care nurses. One of the most commonly listed incentives for nurses is organizational support in the form of access to educational opportunities and career development.  Design: A quasi-experimental longitudinal design was used in a random sample of 363 critical care nurses from multiple hospital sites in Ontario.  Method: The 374-hour intervention included an online component, high-fidelity simulation, and a preceptored clinical component.  Data Analysis: ANCOVA and hierarchical regression were used to analyze the hypothesized model.  Results: Findings showed the professional development intervention had a direct effect on intent to stay in the unit and intent to stay in the profession. Final analysis revealed that the model explained 23% of the variance in intent to stay in the profession.  Conclusion: This research provides new evidence supporting the relevance and importance of investing in professional development opportunities and its subsequent impact on intent to stay.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42680368","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":"Rôle de l’infirmière lors de la prise en charge d’une personne ventilée aux soins intensifs : une revue narrative","authors":"Mylène Suzie Michaud, Marilou Gagnon, J. Jacob, Krystina B. Lewis","doi":"10.5737/23688653-3222029","DOIUrl":"https://doi.org/10.5737/23688653-3222029","url":null,"abstract":"En pratique clinique, l’infirmière joue un rôle essentiel dans la prise en charge de la personne ventilée aux soins intensifs. Afin de mieux comprendre ce rôle, une revue narrative de la littérature a été effectuée en sciences infirmières et plus précisément, la littérature qui porte sur la prise en charge des personnes ventilées aux soins intensifs. Une recherche des bases de données MEDLINE, Nursing & Allied Health Database, CINAHL et PsycINFO a généré 1107 écrits. Après avoir appliqué nos critères de sélection, un total de 45 écrits ont été sélectionnés et analysés. Nos résultats suggèrent que la gestion de l’anxiété, l’agitation, la douleur, la dyspnée, l’hygiène, le sommeil et l’environnement font partie intégrante du rôle de l’infirmière vis-à-vis de la prise en charge d’une personne ventilée aux soins intensifs. L’infirmière est également le lien de communication entre la personne ventilée, les membres de sa famille et l’équipe de soins. Toutefois, l’infirmière rencontre plusieurs obstacles lorsqu’elle prend en charge une personne ventilée, notamment le manque de connaissances, de ressources, de temps, de collaboration et d’autonomie. D’autres recherches sont nécessaires afin de relever les nombreux obstacles auxquels les infirmières sont confrontées et d’identifier des pistes de solutions au plan clinique.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47941881","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":"Supporting ethical ICU nursing practice in organ donation: An analysis of personhood","authors":"Stephanie Sorensen, Marianne Sofronas, Helen Hudson, D. Wright","doi":"10.5737/23688653-3211826","DOIUrl":"https://doi.org/10.5737/23688653-3211826","url":null,"abstract":"Organ donation is critical to the survival of thousands of people waiting for an organ transplant. While nurses take responsibility for patient and family comfort and quality of dying whenever patients die in the intensive care unit (ICU), organ donation presents unique challenges to these ideals. Critical care settings are essential for organ donation, where candidates for donation are identified, referred, stabilized, and maintained until organs can be retrieved. Nurses may feel challenged in completing organ donation-related tasks without forsaking values and practices that are typically associated with a palliative nursing approach and the achievement of a ‘good death’ in the ICU. Further, the moral uncertainty in this context could be increasing, given the advent of a new pathway for organ donation in ICU: medical assistance in dying (MAiD). In this paper, we reflect on the ethical meanings, challenges and possibilities of a good death in the context of organ donation in ICU nursing. We argue that personhood—as a conceptual frame to guide nursing practice—offers one way of reconciling seemingly disparate values and practices. To illustrate the importance of integrating this concept, we draw on real-life case studies from clinical ICU nursing. These examples showcase the emotional engagement and moral tension that nurses could experience when caring for people who occupy a liminal space between life and death. Ultimately, we hope this paper will inspire and support ethical reflection and action among ICU nurses caring for organ donors.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"364 1","pages":"18-26"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78117175","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":"Explicit recall related to mechanical ventilation: An evolutionary concept analysis","authors":"M. Michaud, M. Gagnon","doi":"10.5737/23688653-321917","DOIUrl":"https://doi.org/10.5737/23688653-321917","url":null,"abstract":"Mechanical ventilation combined with sedation is widely used in the intensive care unit (ICU). However, this intervention is not without consequence on the patient. ICU patients can, in fact, remember perceptions that occurred during their mechanical ventilation—a phenomenon known as explicit recall. This phenomenon is not well defined, and no common terminology exists in the medical and nursing literature, where a variety of concepts are used interchangeably to describe the same experience. The goal of this concept analysis was to address the conceptual vagueness that surrounds explicit recall. Using Rodgers’ evolutionary approach, a total of 68 articles were analyzed to identify the concept’s antecedents, attributes, and consequences. The findings revealed that the explicit recall concept is perceptive, interpretative, subjective, dynamic, and temporal. It occurs following treatment that requires general anesthesia or sedation. It is also shaped by the modalities of anesthesia and sedation, as well as individual characteristics. Consequences of explicit recall can include anxiety, flashbacks, and post-traumatic stress disorder.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"52 1","pages":"9-17"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87850577","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":"Diagnosis of chronic post-hypoxic myoclonus in near hanging survivor: Case report","authors":"D. Hersey","doi":"10.5737/23688653-32158","DOIUrl":"https://doi.org/10.5737/23688653-32158","url":null,"abstract":"A 39-year-old male, who attempted suicide by hanging, developed chronic myoclonus with intact cognitive function. Chronic post-hypoxic myoclonus is a rare syndrome that may develop after a respiratory arrest and it presents as late onset and persistent purposeful myoclonus with preserved or slightly impaired cognitive function. Increasing critical care nurses’ awareness of chronic post-hypoxic myoclonus will lead to earlier diagnosis of this rare syndrome.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"364 1","pages":"5-8"},"PeriodicalIF":0.0,"publicationDate":"2020-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74010334","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":"Investigating the Success Rate of Cardiopulmonary Resuscitation, Survival Rate in Patients,and their Related Factor","authors":"Athare Nazri Panjaki, Narges Salari, M. Khoshfetrat","doi":"10.5812/CCN.64856","DOIUrl":"https://doi.org/10.5812/CCN.64856","url":null,"abstract":"Background: Cardiopulmonary resuscitation (CPR) procedure consists of measures taken to restore the acts of the heart and the brain in a person who has lost their own consciousness. Thus, the purpose of the present study was to investigate the success rate of Cardiopulmonary Resuscitation, survival rate in patients, and their related factors in order to assist in improving effective conditions and measures within hospitals to increase the success rate of CPR. Methods: This cross-sectional analytic study was conducted in 2016. To this end, a total number of 199 patients affected with cardiopulmonary arrest and undergoing the CPR procedure in the emergency wards and other hospitals units in Iran were recruited using a convenience sampling method. Then, patient information was collected through a researcher-designed checklist as well as a review of clinical records. The data were also analyzed via the SPSS.16 software. Data analysis was similarly performed using descriptive statistics and Chi-square and t-test. Results: The mean age of patients was 44 years. The result of 36.7% of CPR procedures conducted was reported successful, however, only 4% of patients finally survived. In general, the findings revealed that factors such as age, gender, hospital, history of prior diseases, checked initial rhythm, work shift, time of work shift change, pre-resuscitation intubation status, and underlying cause of cardiopulmonary arrest had no effects on the success rate of CPR procedure. However, location of the occurrence of cardiopulmonary arrest (P = 0.03) and specialty of physicians in charge of resuscitation teams (P = 0.01) were among the factors affecting the success rate of CPR procedure. Furthermore, checked initial cardiac rhythm (P < 0.0001) and a history of prior heart diseases (P = 0.05) in patients had impacts on their survival rate. Conclusions: Given the simplicity and teachability of the principles of basic life support (BLS), health status, and survival rate in patients can be easily and significantly promoted through the public education of the initial resuscitation measures. Moreover, according to the investigations made in this respect, post-resuscitation measures can dramatically affect the survival rate of individuals. Therefore, it is suggested to investigate post-resuscitation measures in other studies of prospective type in order to propose strategies to improve the survival rate of patients.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"PP 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84335407","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":"Clinical Manifestation of Acute Myocardial Infarction: Classified by Age and Gender","authors":"B. Taghipour, E. Froelicher, A. Goudarzian, Y. Chan, H. Nia, Ameneh Yaghoobzadeh, A. Haghdoost","doi":"10.5812/ccn.68676","DOIUrl":"https://doi.org/10.5812/ccn.68676","url":null,"abstract":"Background: The purpose of the study was to evaluate clinical manifestations of acute myocardial infarction as classified by age and gender. Methods: This cross sectional study was conducted in a coronary care unit of a regional urban medical center in northern Iran (Amol). A total of 366 patients diagnosed with acute myocardial infarction were recruited from January to June 2013. Patient demographic information, past medical history, and current symptom data were collected. Results: Multivariatelogisticanalyseswereperformedtoidentifyriskpredictorsof myocardialinfarctionpatientsclassifiedbyage andgender. Riskpredictorsforolderpatientsweredyspnea,OR=1.76(95% CI1.01,3.06),weaknessoddsratio=2.35(95% CI1.31,4.21), nausea odds ratio = 1.83 (95% CI 1.04, 3.20), vomiting odds ratio = 2.48 (95% CI 1.34, 4.57), fatigue odds ratio=1.87 (95% CI 1.02, 3.39), belching, odds ratio = 2.13 (95% CI 1.08, 4.20), and hiccups odds ratio = 2.81 (95% CI 1.25, 6.30). Sub group analysis in older women patients identified weakness odds ratio = 3.13 (95% CI 1.11, 8.85), and belching odds ratio = 34.70 (95% CI 3.86, 312.2) as risk predictors. Among older men patients, the predominant symptoms were sweating odds ratio = 3.74 (95% CI 1.06, 13.2) and vomiting odds ratio = 2.54 (95% CI 1.10, 5.91). Conclusions: Thisstudyconcludesthatolderacutemyocardialinfractionpatientsweremorelikelytohavenon-specificsymptoms. Initial assessment for acute myocardial infarction should consider the possibility of non-specific clinical manifestations, such as weakness and belching in older women, and sweating and vomiting in older men. with statistical significance set at P < 0.05. Differences between the 2 age-groups on demographical and clinical details were assessed using Chi-square tests with odds ratios (95% Confidence Interval) presented. A logistic regression was performed on the clinical symptoms and pain sites comparing the age groups adjusting for demographics and type of myocardial infraction.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"4 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83270150","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 of Discomforting Factors with Coping StrategiesAmong Patients in Cardiac Surgery Intensive Care Units","authors":"M. Rahimi, S. Kolagari, K. Yazdi, M. Aryaie","doi":"10.5812/ccn.63763","DOIUrl":"https://doi.org/10.5812/ccn.63763","url":null,"abstract":"Background: Patientsincardiacsurgeryintensivecareunitsareaffectedbydifferentdiscomfortingfactorsandusedifferentstrate-gies for their management. Objective: The aim of this study was to examine the relationship of discomforting factors with coping strategies among patients hospitalized in cardiac surgery intensive care units. Methods: This descriptive - correlational study was done in 2016. A convenience sample of 110 patients was drawn from the cardiac surgery intensive care unit of Amir - al - momenin heart surgery center, Kordkuy, Iran. Data were collected using a demographic questionnaire,theDiscomfortingFactorsinCardiacSurgeryIntensiveCareUnitQuestionnaire,andJalowiecCopingScale. Pearson correlation analysis, the one - way analysis of variance, the paired - sample t - test and the Tukey’s post hoc test were used to analyze the data. Data analysis was performed via the SPSS software (v. 16.0) and at a significance level of less than 0.05. Results: The mean score of discomforting factors was greater than the moderate level (74.08 ± 16.93). Participants used emotion -focusedcopingstrategiesmorethanproblem-focusedones. Discomfortingfactorswereinverselycorrelatedwithproblem-focused strategies (r = - 0.266; P = 0.005) and directly correlated with emotion-focused strategies (r = 0.247; P = 0.009). Conclusions: Patientsincardiacsurgeryintensivecareunitssufferfromthenegativeeffectsof differentdiscomfortingfactorsand use emotion - focused coping strategies more than problem - focused strategies for the management of the factors.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"18 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2018-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79101784","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":"Patient Compliance to Non-Invasive Ventilation in Sub-Intensive Care Unit: An Observational Study","authors":"A. D'orazio, A. Dragonetti, Giorgio Campagnola, C. Garza, F. Bert, S. Frigerio","doi":"10.5812/CCN.65300","DOIUrl":"https://doi.org/10.5812/CCN.65300","url":null,"abstract":"Background: Thesuccessof noninvasiveventilationdependsonmanyfactorsandeffectivedeliveryrequiresteamwork. Information on the therapeutic program must be sustained by healthcare staff and family. Objectives: Investigate the clinical and care factors that affect the level of patient compliance to non invasive ventilation. Methods: A prospective, observational and multicentre study was conducted between November 1, 2015 and February 15, 2016 in three sub-intensive wards. A data collection tool was created with the working definition of “Patient intolerant to non invasive ventilation” and a structured interview was conducted to investigate patient experience of NIV. Statistical analysis was conducted with the STATA MP13 software. Results: Coordination of patient-ventilator interaction prevents intolerance (OR = 0.68, 95% IC 0.46 - 0.98; P = 0.04). Overweight andobesepatientsshowedahigherprobabilityof intolerancetononinvasiveventilationwithrespecttounderweightandnormal weight patients (OR = 0.53, 95% IC 0.34 - 0.82; P = 0.005). Patients with a higher probability of intolerance experienced a NRS level of 4/5 (OR = 1.76, 95% IC 1.30 - 2.41; P ≤ 0.001) while receiving continuous treatment (OR = 1.26, 95% IC 1.04 - 1.53; P = 0.019). Patients in open-space settings experienced less intolerance (4.7 SD ± 1.2) with respect to patients in single rooms (2.5 SD ± 0.9). Anxious patients developed more intolerance than calm and informed patients (OR = 7.39, 95% IC 3.19 - 17.13; P ≤ 0.001) Conclusions: Compliance to non invasive ventilation depends on multiple factors, including relational aspects that affect treatment success. Attention to patient comfort, pain control, and collaboration with the caregiver appear to have the most influence on patient compliance.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"52 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2018-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84925505","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}