The Canadian journal of critical care nursing最新文献

{"title":"Investigation of the Effects of Stepwise Sodium and Ultrafiltration Profile on Dialysis Adequacy","authors":"S. Azam, Shahgholian Nahid, Mortazavi Mojgan","doi":"10.17795/CCN-5105","DOIUrl":"https://doi.org/10.17795/CCN-5105","url":null,"abstract":"Background: One of the leading causes of disability and mortality among patients receiving hemodialysis (HD) is HD inadequacy. Enhancing HD adequacy can improve the prognosis for these patients. Objectives: This study sought to investigate the effects of stepwise sodium and ultrafiltration profile on HD adequacy. Patients and Methods: This crossover clinical trial was conducted on 30 patients, who were receiving HD in two HD centers, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Each participant received HD in four routine HD sessions and four stepwise sodium and ultrafiltration profile sessions. Hemodialysis adequacy was calculated online by a software installed on the HD machines. The data were analyzed by conducting the paired-samples t test. Results: The mean of dialyzer urea clearance multiplied by time, divided by volume of distribution of urea (Kt/V) ratio in the routine HD and the stepwise sodium and ultrafiltration profile groups were 1.237 and 1.395, respectively. This difference was statistically significant (P < 0.05). Conclusions: Sodium and ultrafiltration profile maintain hemodynamic stability through adjusting sodium concentration and ultrafiltration and, therefore, they improve HD adequacy, as well as patients’ tolerance to HD. Consequently, replacing routine HD techniques with this technique is recommended.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"16 1","pages":"0-0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73406478","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":"Practical Strategies for Decreasing and Controlling Permi-Cath Infection in Patients on Hemodialysis","authors":"Shahrzad Khojandi, Safoura Dorri, Meisam Rahimipour-Anaraki, A. Irajpour","doi":"10.17795/CCN-5097","DOIUrl":"https://doi.org/10.17795/CCN-5097","url":null,"abstract":"Background: One of the methods for achieving vascular access in hemodialysis patients is using cuffed hemodialysis catheters (permicath), which has some risks such as infection. Staphylococcus is the most common microorganism that causes permi-cath infection, and has contaminated 90% of clinical staff. Objectives: This study aimed to determine some strategies to reduce the level of permi-cath infection in hemodialysis patients. Patients and Methods: This was an action research, conducted on 32 patients with permi-cath, 21 of whom had acquired this infection in the past six months. The subjects were selected through convenient sampling. The required data were collected by observations, interviews and using the data documented in the patients’ medical files as well as a questionnaire. The etiological factors of permi-cath infection were investigated; the strategies were determined through staffs’ participation and using a standard guideline. Economical strategies were administrated based on their priority and applicability. Results: Twenty-five (65 %) patients received antibiotics (vancomycin); this number decreased to one (4.6%) after the intervention. Fourteen (44 %) were hospitalized before the intervention; this also decreased to zero after the intervention. Therefore, there was a statistically significant difference between the number of patients taking antibiotics before and after the intervention. Conclusions: Action research is an appropriate method for changing and improving nurses’ practice. Since staffs’ viewpoints are considered in this method, it makes them accept the required changes more rapidly. In addition, the decisions that are made will be more stable.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"153 1","pages":"0-0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78694475","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 Effect of Chronic Disease Self-Management Program on Health Status of Patients Undergoing Coronary Artery Bypass Graft Surgery","authors":"Javad Miri, Arsalan Naderipour, Hosain Ashtarian, A. Hashemian","doi":"10.17795/CCN-5103","DOIUrl":"https://doi.org/10.17795/CCN-5103","url":null,"abstract":"Background: The chronic disease self-management program is among the most important methods for promoting self-care. Objectives: This study was done to evaluate the effects of this program on patients’ health status after undergoing coronary artery bypass graft surgery. Patients and Methods: This one-group pretest-posttest clinical trial was conducted in 2013 on 46 patients, who had recently undergone a coronary artery bypass graft surgery and had been referred to the cardiac rehabilitation center of Imam Ali (PBUH) Hospital, Kermanshah, Iran. The participants were recruited conveniently and were educated based on the chronic disease self-management program. The data were collected using a demographic questionnaire and the health status questionnaire and were analyzed through conducting the Chisquare test using the SPSS software (v.21.0). Results: The chronic disease self-management program had significant effects on the participants’ general health, daily activities and pain (P < 0.001) but did not significantly affect their overall health status, energy or fatigue, feeling of well-being and social functioning. Conclusions: The chronic disease self-management program significantly affects various health-related parameters. It is an inexpensive non-invasive intervention, which complements conventional medical treatments and thus, can be used by rehabilitation centers.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"2 1","pages":"0-0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89700361","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 OF RECOVERED ORDERS AT THE CARDIAC CARE UNIT","authors":"R. Esmaeili, M. Nesami, A. Nadighara, Aghdas Taghizadeh","doi":"10.17795/CCN-5100","DOIUrl":"https://doi.org/10.17795/CCN-5100","url":null,"abstract":"Background: Patients' safety is one of the basic concepts in health care systems and one of the major concerns of patient care. Medical errors are amongst the main factors that could threat patients' safety. At intensive care units, there is always the possibility of errors during various stages such as the ordering stage. Objectives: The aim of this study was to determine the frequency of pharmacological and non-pharmacological recovered orders at intensive care units and its associated issues. Patients and Methods: This study was a cross-sectional study based on pharmacological and non-pharmacological orders obtained from patients' records and daily record sheets at the intensive care units of Mazandaran heart center during year 2015. All orders from patients' records (n = 1046), which included 29214 orders, were reviewed during a three-month period. Data was collected using a researcher-made checklist and included patients' demographic information and a medical checklist on the patients' conditions, name of the person who had recorded the order and the person who had discovered the recovered order, type of recovered pharmacological and non pharmacological orders and related factors. To analyze the data, statistical tests such as mean and relative frequency, contin- gency parts and chi-square test were applied using the SPSS 19 software. Results: A total of 29214 pharmacological and non pharmacological orders, written in 1046 patients' records of six coronary care units were investigated. We found that 150 (0.5%) recovered orders were documented. The results showed a significant relationship between the academic year of medical assistants and the recovered orders (K2 = 88.619, P < 0.05); most orders were recovered by second-year assistants. Conclusions: According to this study, it is necessary to define a procedure for careful review of pharmacological and non pharmaco- logical orders. In addition, it is recommended to use clinical pharmacologists and expert critical care nurses to allow the possibility of discovering wrong orders before putting them into practice.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"41 1","pages":"0-0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84115127","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":"Nurse Burnout and Patient Satisfaction With Nursing Care at Dialysis and Cardiac Care Units","authors":"A. Shorofi, H. Jafari, H. A. Lolaty, J. Cherati, M. Karimzadeh","doi":"10.17795/CCN-5102","DOIUrl":"https://doi.org/10.17795/CCN-5102","url":null,"abstract":"Background: Since the quality of services provided in hospitals is often based on the patients’ understanding of nursing care, it can be expected that job burnout in nurses adversely affects patient satisfaction. Objectives: The present study aimed to investigate nurse burnout and its relationship with patient satisfaction with nursing care at dialysis and cardiac care units (CCU). Patients and Methods: This descriptive-correlational study was conducted on 89 CCU and dialysis nurses using a convenience sampling method. In addition, 313 patients were randomly selected from the same hospital units as the nurses. Maslach burnout inventory and patient satisfaction instrument were used for data collection. Results: The results showed an inverse correlation between patient satisfaction and nursing care, and burnout experienced by CCU and dialysis nurses (r = -0.633). Conclusions: There was an inverse and significant relationship between nurse burnout and its dimensions, and patient satisfaction in cardiac care units and dialysis wards. In other words, patient satisfaction decreases by an increase in each dimension of burnout in nurses.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76307928","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":"Head Nurses’ Perception of Educational Needs for Acquiring Managerial Competence at Intensive Care Units: A Qualitative Study","authors":"Nazari Roghieh, Vanaki Zohreh, Mohammadkhan Kermanshahi Sima, H. Ebrahim","doi":"10.17795/CCN-5104","DOIUrl":"https://doi.org/10.17795/CCN-5104","url":null,"abstract":"Background: In dealing with the new challenges of the health system, the head nurses of intensive care units need continuing educational programs, and investigating the learning requirements is the infrastructure of developing human resources. Objectives: This study aimed to assess the educational needs of the head nurses of intensive care units. Materials and Methods: This qualitative study was conducted during year 2014. Data collection was done through semi-structured and in-depth face-to-face interviews with ten head nurses of the intensive care units of hospitals located in Mazandaran province. Data analysis was carried out with the conventional method of qualitative content analysis. Results: After data analysis and extraction of 300 primary codes, 21 categories and four main themes were identified. The themes included “scientific needs”, “artistic needs”, “technical needs” and “organizational needs”, which partially overlapped. Conclusions: The data of this study showed that for obtaining managerial competence in these units, the head nurses of intensive care units need some instructions to satisfy their scientific, artistic, technical and organizational needs. Proper planning and implementation of continuous in-service education based on these training requirements paves the way for providing hospitals with nurses competent for managing the intensive care units.","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"44 1","pages":"0-0"},"PeriodicalIF":0.0,"publicationDate":"2016-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84814529","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":"Impact of shift work on critical care nurses.","authors":"Cheryl Pryce","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Shift work is a common practice in the health care field to maintain 24-hour patient care. The purpose of this article is to recognize the negative impact of shift work on critical care nurses, and identify strategies to mitigate these effects. A review of the literature was completed, using the search terms: 'shift work, 'critical care', impact, and health. The literature revealed that shift work has an adverse effect on the health of a nurse. Some of the health implications include stress, sleep deprivation, cardiovascular disease, gastrointestinal symptoms, and mental health illnesses. Furthermore, shift work impacts a nurse's social life and may result in patient harm. Strategies to reduce the negative impact of shift work will be focused on educating critical care nurses and managers. These strategies include frontline staff maintaining a moderate amount of exercise, sustaining a well-balanced diet, using relaxation techniques, reducing the use of cigarettes, working an eight-hour work day, and napping during scheduled breaks. Recommendations for managers include implementing quiet time at the workplace, providing a safe space for staff to nap during breaks, facilitating an eight-hour work day, and encouraging a multidisciplinary team approach when managing workload.</p>","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"27 4","pages":"17-21"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36119532","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 Reflections.","authors":"Renée Chauvin","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"27 2","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34707865","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":"Informal debriefing: Underutilization in critical care settings.","authors":"Julie Werry","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Debriefing is the active reflection, conceptualization and basis for reinforced or changed behaviour in response to new learning experiences. It has been acknowledged as a valuable tool towards achieving learning outcomes informal teaching or training ven- ues. However, there is limited recognition of the importance of informal debriefing in the clinical setting, especially in critical care settings. Additional specialized training is received by registered nurses to be able to care for clinically unstable patients in critical care units. Informal debriefing can allow critical care nurses to learn from the experience of exposure to different clinical situations and progress towards becoming competent, expert clinicians. The purpose of this article is to present a discussion highlighting informal debriefing and the importance of providing feedback to novice and experienced nurses in critical care areas. The underutilization of informal debriefing will be explored together with possible barriers and challenges to its use. Solutions to overcoming such barriers will be proposed, as a means of ensuring that valuable reflection and learning opportunities are not lost. These suggestions will emphasize the importance of how informal debriefing promotes professional and personal development, and safer patient care.</p>","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"27 4","pages":"22-26"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36119510","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":"Moral distress and burnout among cardiovascular surgery intensive care unit healthcare professionals: A prospective cross-sectional survey.","authors":"Leah Johnson-Coyle,&nbsp;Dawn Opgenorth,&nbsp;Mandy Bellows,&nbsp;Jasdip Dhaliwal,&nbsp;Sydney Richardson-Carr,&nbsp;Sean M Bagshaw","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The intensive care unit (IGU) is a busy, high stress, complex environment in which health care professionals routinely provide numerous forms of advanced life support and life sustaining measures to a wide mix of critically ill patients. Frontline ICU professionals directly involved in patient care may be subjected to considerable psychosocial stressors and be susceptible to moral distress and burnout.</p><p><strong>Purpose: </strong>To describe and compare the prevalence and contributing factors to moral distress and burnout among ICUprofessionals in a large quaternary cardiovascular surgery ICU (CVICU).</p><p><strong>Methods: </strong>Web-based survey of ICU professionals (registered nurses [RN]/nurse practitioners [NP]; registered respiratory therapists [RRT]; allied health [AH] and physicians [MD]) working in a 24-bed CVICU at the Mazankowski Alberta Heart Institute, between June 15-29, 2015. The survey captured sociodemographic data and integrated the Moral Distress Scale-Revised, the Maslach Burnout Inventory', and a validated job satisfaction questionnaire.</p><p><strong>Findings: </strong>One hundred sixty-nine providers completed the sur- vey (response rate 88%). The majority of respondents were aged 26-34 years old (45%), female (79%), married or common law (50%), full-time employed (78%) and had been working in the CVICU for >5 years (46%). Moral distress scores were highest among RN/NP (med [IQR] 80 [57-110]) and RRT (85 [61-104]) compared to AH (54 [39-66]) and physicians (66 [43-82], p=0.05). The highest-ranked sources of moral distress were related to controversies on end-of-life care (\"Continue to participate in the care for a hopelessly ill person who is being sustained on a ventilator, when no one will make a decision to withdrawal support\") and poor communication (\"witness healthcare providers giving false hope' to a patient or family\"). High, moderate and low levels of burnout syndrome were found in 64.0%, 22.7% and 13.3% of respondents with significantly greater levels among non-physician professionals (p<0.001). Job satisfaction was highest for physicians compared with other professionals (p<0.001). The item \"the recognition you get for good work\" was consistently rated as poor across all groups. Moral distress and burnout scores were positively correlated (p<0. 001), whereas both were neg- atively correlated with job satisfaction (p<0.001 for both). This was primarily driven by RN/NP scores.</p><p><strong>Conclusion: </strong>Moral distress and burnout are common in health- care professionals in a large academic cardiovascular surgery ICU, in particular among nurses and respiratory therapists. Both moral distress and burnout have a negative perception on job satisfaction. These findings will direct strategies to mitigate moral distress and burnout along with enhancing patient care and improving the workplace environment.</p>","PeriodicalId":91413,"journal":{"name":"The Canadian journal of critical care nursing","volume":"27 4","pages":"27-36"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36119512","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}