Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838419
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Substance use disorders are increasing in the growing older adult population in the U.S. and abroad. Most interventions fail to account for the unique physical and psychosocial risk factors associated with substance use...Substance use disorders are increasing in the growing older adult population in the U.S. and abroad. Most interventions fail to account for the unique physical and psychosocial risk factors associated with substance use disorder. The older adult makes up a large portion of ICU admits and it is imperative to identify appropriate methods of prevention and treatment in this patient population. Important components of substance use disorder assessment and treatment in the older ICU patient were identified from the literature. Increased morbidity related to age-related conditions, pharmacologic concerns, withdrawals, and stigma were identified as essential items to consider when caring for the older ICU patient with substance use disorder.
Persaud E, Nissley C, Piasecki E
… +1 more, Quinn C
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838418
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The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the...The demand for surgical intervention and hospitalization is expected to increase with the growth of the older adult population. Despite advances in technology and minimally invasive surgical procedures, the needs of the older adult in the perioperative period are unique. Transitions of care from the decision to support surgery through surgical intervention, subsequent hospitalization, and postacute discharge must be supported to achieve optimal patient outcomes. The clinical nurse specialist is well suited to address care delivery and assure implementation of best practices across the continuum.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838417
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Elderly critical care patients are one of the largest growing patient population groups according to Medicare data. More than 51% of elderly patients are discharged on inappropriate medications that have the potential to...Elderly critical care patients are one of the largest growing patient population groups according to Medicare data. More than 51% of elderly patients are discharged on inappropriate medications that have the potential to cause harm or interact adversely with other medications. Precision health has the potential to prevent adverse drug events and prescription of inappropriate medications. The purpose of this literature review was to define the concept of precision health and determine the state of science regarding interprofessional models of precision health for assessment of caregiver impact on polypharmacy in elderly intensive care unit patients.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838416
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A dedicated sepsis coordinator role at Penn Medicine Lancaster General Hospital led initiatives to improve sepsis core measure compliance by 40% during the course of 4 years with submission of all sepsis cases. Chart abs...A dedicated sepsis coordinator role at Penn Medicine Lancaster General Hospital led initiatives to improve sepsis core measure compliance by 40% during the course of 4 years with submission of all sepsis cases. Chart abstraction and analysis of noncompliant cases identified areas for improvement: early recognition education, order set revisions, documentation support, and the implementation of a nurse-driven 24/7 sepsis monitoring process. The cooperative work with Penn Medicine affiliates, sharing best practices, improves overall sepsis bundle compliance and transitions of care. Ongoing achievements acknowledge the value of building relationships and leading improvements through the collaborative efforts of interprofessional teams.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838415
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All patients within critical care units are vulnerable and many of them are unable to communicate their wishes and needs to the caregivers treating their acute critical illness. This inability to communicate is why inter...All patients within critical care units are vulnerable and many of them are unable to communicate their wishes and needs to the caregivers treating their acute critical illness. This inability to communicate is why interdisciplinary intensive care teams across the country heavily rely on spouses, children, siblings, parents, other next of kin, or other designated medical durable power of attorneys to advocate for those who cannot advocate for themselves. Unfortunately, there is a growing population of elder orphans who lack this support system when they need it the most.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838414
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Progressive supranuclear palsy (PSP) is a fatal neurodegenerative disorder. Care requires a patient-centered approach encompassing compassion, communication, and empathy. Despite concerted actions to streamline PSP patie...Progressive supranuclear palsy (PSP) is a fatal neurodegenerative disorder. Care requires a patient-centered approach encompassing compassion, communication, and empathy. Despite concerted actions to streamline PSP patient transitions, the care is multifaceted and cause of concern. Patients with PSP undergoing transitional care are at an increased risk of undesirable outcomes, frequently endure poor communication, and encounter inconsistent care. Therefore, patients with PSP and families worry about the uncertainty in care, including who is accountable for the care and available resources. Through the three spheres of impact, Clinical Nurse Specialists can educate and assist intensive care unit nurses caring for patients with PSP /families, aiding in the successful care transition.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838413
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Biofilm infections are a serious threat to public health, resistant to traditional treatments and host immune defenses. Biofilm infections are often polymicrobial, related to chronic wounds, medical devices (eg, knee rep...Biofilm infections are a serious threat to public health, resistant to traditional treatments and host immune defenses. Biofilm infections are often polymicrobial, related to chronic wounds, medical devices (eg, knee replacements, catheters, tubes, contact lenses, or prosthetic valves) and chronic recurring diseases. Biofilms are more complex than nonadhered planktonic bacteria and produce a structure that prevents damage to the bacteria within the biofilm structure. The structure provides a hidden route to feed and nurture the bacteria allowing for ongoing spread of the bacteria.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838412
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Engaging the health care team, including older adults and their caregivers, with the Institute for Healthcare Improvement 4M Model can help ensure every older adult receives (1) optimal health care, (2) is not harmed by...Engaging the health care team, including older adults and their caregivers, with the Institute for Healthcare Improvement 4M Model can help ensure every older adult receives (1) optimal health care, (2) is not harmed by health care, and (3) is satisfied with their health care. The evidence-based 4 Ms Model includes 4 significant concepts specific to older adult care: What matters, Mentation, Mobility, and Medication. Unfortunately, clinicians do not consistently apply the 4 Ms Model when caring for older adults. Personalized, age-friendly care based on the 4 Ms Model can improve outcomes for older adult patients.
Crit Care Nurs Clin North Am
· 2023 Dec · PMID 37838411
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Having end-of-life (EOL) conversations is often difficult for even seasoned clinicians. There are many well-developed conversation guidelines used in the specialty of palliative medicine. There is no one ultimate guide t...Having end-of-life (EOL) conversations is often difficult for even seasoned clinicians. There are many well-developed conversation guidelines used in the specialty of palliative medicine. There is no one ultimate guide that makes having an emotion-filled conversation easy. However, using the tenets of medical ethics, cloaked with experience, compassion, empathy, and respect makes EOL conversations less traumatic for the patient-family system and for the provider. Palliative specialists have the training and experience in effectively having EOL conversations, especially when death is unavoidable. Utilizing shared decision making, palliative specialists ensure there is mutual respect and communication between providers and the family system.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532388
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Pediatric intensive care unit nurses can be exposed to hundreds of alarms per patient they care for each shift. The exposure to so many alarms can cause nurses to be desensitized to future alarms and thus increase the ti...Pediatric intensive care unit nurses can be exposed to hundreds of alarms per patient they care for each shift. The exposure to so many alarms can cause nurses to be desensitized to future alarms and thus increase the time to respond to alarms. This is one of the largest patient safety concerns within health care today. Steps should be taken to mitigate the number of alarms nurses experience so that they can properly respond to actionable alarms.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532387
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Asthma is a complex chronic disease characterized by inflammatory disorder causing airflow obstruction due to inflammation, bronchospasms, and mucus plugging. Children who fail to respond to initial first-line therapies...Asthma is a complex chronic disease characterized by inflammatory disorder causing airflow obstruction due to inflammation, bronchospasms, and mucus plugging. Children who fail to respond to initial first-line therapies often require hospitalization, and many with severe exacerbations and near-fatal asthma require admission to the pediatric intensive care unit (PICU). Nursing care of these PICU patients requires close monitoring and excellent assessment of their respiratory status. Administration of medications, such as albuterol, methylprednisolone, magnesium sulfate, and sedatives, is needed. Close communication with the care team is vital, including providers and respiratory therapy, to coordinate care and to communicate assessment findings.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532386
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Pediatric intensive care units (PICUs) rely on interprofessional communication and collaboration to mitigate the risk for medical error. To operationalize these tenets, many PICUs use multidisciplinary bedside rounds as...Pediatric intensive care units (PICUs) rely on interprofessional communication and collaboration to mitigate the risk for medical error. To operationalize these tenets, many PICUs use multidisciplinary bedside rounds as the foundation of their workflow. Bedside nurse participation in rounds is inconsistent, diminishing the return on team investment in patient safety. Given this dilemma, some institutions have shifted from provider-led to nurse-led rounds. Here, the authors explore the rationale, experiences, and outcomes of implementation of nurse-led rounds within 4 PICU service lines.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532385
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Delirium is a fluctuating level of awareness based on a physiologic disease process. Within pediatrics, delirium affects approximately 30% of patients admitted to critical care units and is associated with increased mort...Delirium is a fluctuating level of awareness based on a physiologic disease process. Within pediatrics, delirium affects approximately 30% of patients admitted to critical care units and is associated with increased mortality, morbidity, length of stay, and care costs. Multiple pediatric critical care societies recommend the implementation of screening practices using validated delirium tools. Delirium remains underrecognized because of suboptimal screening and protocol implementation in pediatric critical care units nationally and internationally. The mainstay of delirium prevention and management is nonpharmacologic, focusing on normalizing a patient's environment, sleep/wake cycles, nutritional status, and activity levels.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532384
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Most children admitted to the pediatric intensive care unit with a new or reoccurring hematology or oncology diagnosis are at high risk for developing a hematologic or oncologic emergency. Although these children represe...Most children admitted to the pediatric intensive care unit with a new or reoccurring hematology or oncology diagnosis are at high risk for developing a hematologic or oncologic emergency. Although these children represent a low percentage of pediatric critical care admissions, their acuity is high, and their care is complicated and challenging. Nurses are an essential part of the interprofessional team of providers who care for these critically ill patients. Experience recognizing acute decompensation and excellent assessment and communication skills significantly improve patient outcomes.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532383
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Unplanned extubations (UEs) are common, potentially avoidable complications of endotracheal intubation among pediatric patients. UE can be associated with adverse patient outcomes including increased length of stay, hosp...Unplanned extubations (UEs) are common, potentially avoidable complications of endotracheal intubation among pediatric patients. UE can be associated with adverse patient outcomes including increased length of stay, hospitalization cost, and cardiorespiratory decompensation. Inconsistency in the definition of UE has led to underreporting. Staff must be able to recognize and intervene appropriately when an UE occurs. Risk factors have been identified and quality improvement initiatives aimed at reducing UE have shown to be effective in reducing the incidence. The lack of consistent definition may lead to underreporting and may not lead to effective quality improvement initiatives.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532382
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Communication is a central aspect of nursing care and is especially important when pertaining to progressive illnesses and end of life. This article reviews basic palliative care terminology and outlines a variety of com...Communication is a central aspect of nursing care and is especially important when pertaining to progressive illnesses and end of life. This article reviews basic palliative care terminology and outlines a variety of communication frameworks from the "dos" to the "don'ts." These communication strategies are meant to be added to the nurse's "toolbox" so that nurses may use them in various scenarios. These communication tools are meant to help mitigate the stress and discomfort nurses often feel when using palliative communication or delivering bad news.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532381
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Health care providers caring for patients at the end of life (EOL) are faced with a multitude of emotions such as guilt, anger, sadness, and helplessness. Because of the negative impact of initiating EOL care (EOLC) to t...Health care providers caring for patients at the end of life (EOL) are faced with a multitude of emotions such as guilt, anger, sadness, and helplessness. Because of the negative impact of initiating EOL care (EOLC) to the pediatric population, organizations must be proactive in instituting education and resources on EOLC. They must also provide advanced skills to nurses who take care of patients at their EOL. Understanding the consequences of providing EOL care to patients in the pediatric intensive care unit allows for better allocation of resources and support services for nurses. This improves patient outcomes and nurse retention.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532380
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Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overvi...Pediatric critical care nursing is a key pillar in patient care and outcomes for children who are ill and injured. Tremendous advances have occurred in pediatric critical care and nursing. This article provides an overview of the key advances in pediatric critical care nursing through the decades.
Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532379
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With supporting the best neurodevelopmental outcomes possible, the doctor of nursing practice project was constructed. An educational program was created for nursing staff discussing the importance of kangaroo care and h...With supporting the best neurodevelopmental outcomes possible, the doctor of nursing practice project was constructed. An educational program was created for nursing staff discussing the importance of kangaroo care and how to safely facilitate it in the intensive care setting. Following the education completion, kangaroo care was implemented. Data were collected exploring barriers to implementation, discharge on maternal breast milk, and parental feedback.