Robinson S, Green K, Depew A
… +2 more, Dedeo M, Gallegos C
Crit Care Nurse
· 2026 Feb · PMID 41620100
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BACKGROUND: The increased complexity of critical care nursing has resulted in nurses performing more high-risk, low-volume (HRLV) procedures, which may increase patient risk. LOCAL PROBLEM: The purpose of this project wa...BACKGROUND: The increased complexity of critical care nursing has resulted in nurses performing more high-risk, low-volume (HRLV) procedures, which may increase patient risk. LOCAL PROBLEM: The purpose of this project was to develop a resource for critical care nurses to more effectively manage HRLV scenarios at intensive care units at a large urban hospital to improve nurses' practice. METHODS: CINAHL and Medline databases were searched using the keywords high-risk low-volume, HRLV, badge buddy, just in time, and nurse competency. Twenty articles were identified, and 4 were included in this project. An accessible printed resource packet was created as a form of education and reference in HRLV scenarios. Each packet was laminated and kept at nurses' stations and included summaries, "pearls" (highlights), diagrams, checklists, and QR codes that linked directly to facility policies. Nurses were invited to complete an 8-question survey 8 weeks after implementation. RESULTS: Forty-three nurses completed the survey: 63% worked day shift, and 100% found the resource relevant. On average, the nurses agreed the packet increased knowledge, saved time, helped access policies, and influenced practice. On a scale of 1 to 10, the nurses rated the packet "very helpful" (mean, 9.09). When asked what was useful, participants indicated "easily accessible" and "finding information." CONCLUSION: The resource packet has been used in HRLV scenarios and with new nurses during downtime. It was easy to implement and can be individualized for many units and patient populations. It serves as a bridge to easily bring best practice information to the bedside.
Bourgault AM, Simmons JC, Powers J
… +2 more, Aguirre L, Sole ML
Crit Care Nurse
· 2026 Feb · PMID 41620098
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BACKGROUND: Enteral feeding intolerance, a type of gastrointestinal dysfunction, is common in adults receiving mechanical ventilation, yet its definition and clinical assessment remain variable. If untreated, this syndro...BACKGROUND: Enteral feeding intolerance, a type of gastrointestinal dysfunction, is common in adults receiving mechanical ventilation, yet its definition and clinical assessment remain variable. If untreated, this syndrome may lead to underfeeding, which is associated with worse patient outcomes. OBJECTIVE: To describe what is known about enteral feeding intolerance, including who is at risk, clinical symptoms, identifying measures used, treatment, and clinical implications for nursing practice. RESULTS: Enteral feeding intolerance is identified by (1) changes in gastrointestinal function, (2) high gastric residual volume, and/or (3) inadequate delivery of enteral nutrition. A combination of gastrointestinal symptoms and high gastric residual volume is generally used to diagnose the condition. The most common symptoms are vomiting, abdominal distention, absence of bowel sounds or flatus, and diarrhea. Administration of promotility agents and reduction of the enteral formula rate are most often used to reduce the effects of enteral feeding intolerance until it resolves. DISCUSSION: Many gastrointestinal assessment findings are subjective and lack precision. Although the routine measurement of gastric residual volume is no longer standard practice, it is indicated in patients at risk for enteral feeding intolerance. CONCLUSION: Nurses should become familiar with how to assess for and treat enteral feeding intolerance, as well as rule out other common gastrointestinal complications. Clinical biomarkers are needed to objectively identify enteral feeding intolerance in critically ill patients.
Crit Care Nurse
· 2026 Feb · PMID 41620096
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Evidence-based practice is a critical skill for nurses and health care professionals. Because interprofessional teams are based in a culture of clinical inquiry, they must ask important practice questions, search for and...Evidence-based practice is a critical skill for nurses and health care professionals. Because interprofessional teams are based in a culture of clinical inquiry, they must ask important practice questions, search for and appraise relevant evidence, and, based on the best available evidence, design single, bundle, or blended interventions to improve targeted outcomes. The Consolidated Framework for Implementation Research is an implementation science model that teams can use to not only plan these interventions but also implement and evaluate selected interventions in the local practice setting. This article, as part 1 of a series, will review considerations for designing interventions using a collection of Critical Care Nurse articles on hospital-acquired pressure injury prevention initiatives as exemplars. In part 2, I will explore the process of planning and executing the most effective strategies to embed the evidence-based intervention into practice in a sustainable way.
Crit Care Nurse
· 2025 Dec · PMID 41319997
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INTRODUCTION: Mastoiditis is a major complication of acute otitis media that, if left undiagnosed or untreated, can lead to meningitis. This case report shares the clinical course of a child with acute mastoiditis. The r...INTRODUCTION: Mastoiditis is a major complication of acute otitis media that, if left undiagnosed or untreated, can lead to meningitis. This case report shares the clinical course of a child with acute mastoiditis. The related discussion provides an overview of acute mastoiditis, including its presenting signs and symptoms, diagnostic testing, treatment, and outcome and prognosis. CLINICAL FINDINGS AND DIAGNOSIS: A 9-year-old male patient presented with fever, symptoms of a viral upper respiratory infection, and tachycardia. His physical examination was remarkable for muscle hypotonia, asymmetrical pupils, and incomprehensible speech. Laboratory testing and imaging confirmed Streptococcus pneumoniae meningitis, acute mastoiditis, and hydrocephalus. INTERVENTIONS: Within hours of admission, the patient's neurologic status deteriorated, requiring intubation and emergent ventriculostomy with external ventricular drain placement. Once he was stabilized, a right mastoidectomy with myringotomy tube placement was performed. PATIENT OUTCOME: Ultimately, the patient underwent ventriculoperitoneal shunt placement and, after a 5-month hospitalization, had significant neurologic delays for which he received aggressive inpatient rehabilitation. CONCLUSION: This case report and condition review highlight the importance of assessing for acute otitis media and recognizing early signs and symptoms of mastoiditis in all children to minimize disease progression and associated morbidity and mortality.
Crit Care Nurse
· 2025 Dec · PMID 41319996
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BACKGROUND: Spontaneous awakening and breathing trials are evidence based; however, adoption has been inconsistent. LOCAL PROBLEM: An academic medical center demonstrated a need for investigating and quantifying practice...BACKGROUND: Spontaneous awakening and breathing trials are evidence based; however, adoption has been inconsistent. LOCAL PROBLEM: An academic medical center demonstrated a need for investigating and quantifying practice patterns regarding spontaneous awakening and breathing trials. METHODS: This quality improvement project used champion-based education and electronic health record data to quantify practice patterns. RESULTS: Two hundred and seventy-four of 308 medical intensive care unit staff members (88.9%) completed education regarding spontaneous awakening and breathing trials. Compliance with spontaneous awakening trials increased significantly by 30.1% (from 42.9% to 55.8%, P < .001). Compliance with spontaneous breathing trials increased nonsignificantly by 12.4% (from 66.7% to 75%, P = .10). Before and after the intervention, time intervals from trial pass to extubation (262 minutes vs 277 minutes), from trial pass to extubation order entry (193 minutes vs 266 minutes), and from extubation order entry to extubation (14 minutes vs 18.5 minutes) did not significantly change. Duration of mechanical ventilation, rates of reintubation and unplanned extubation were unchanged. CONCLUSION: Defining compliance with spontaneous awakening and breathing trials and quantifying practice patterns are feasible and may enhance discipline-specific accountability and implementation strategies. Interprofessional education, as a sole approach, may increase compliance only modestly.
Crit Care Nurse
· 2025 Dec · PMID 41319995
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BACKGROUND: In many intensive care units, inconsistent early goals-of-care discussions contribute to interventions that may not align with patient or family preferences. A standardized approach to identify and reduce non...BACKGROUND: In many intensive care units, inconsistent early goals-of-care discussions contribute to interventions that may not align with patient or family preferences. A standardized approach to identify and reduce nonbeneficial interventions and ensure that treatment aligns with patient-centered goals is lacking. LOCAL PROBLEM: In a 12-bed medical intensive care unit, nurses observed frequent discrepancies between provided care and patient prognosis, with no standardized process to guide early goals-of-care discussions. METHODS: This quality improvement project included a 1-month baseline and a 1-month intervention period. The primary measure was the daily count of patients flagged by nursing staff in collaboration with the care team as receiving potentially nonbeneficial or futile care, defined as interventions unlikely to achieve meaningful recovery or inconsistent with patient values. During the intervention, clinicians used the BRIDGE-ICU worksheet-an admissions workflow with key prognostic indicators, patient values, and decision-making steps-to guide early goals-of-care discussions. Baseline and intervention data were compared using an independent t test. Compliance was the percentage of intensive care unit admissions with BRIDGE-ICU document completion within 24 hours. RESULTS: The average daily count of flagged nonbeneficial interventions decreased from 4.10 before to 3.17 after the intervention, a 22.7% reduction (t = 2.05, P = .045). Compliance reached 67.3% across 110 admissions. CONCLUSION: Use of the BRIDGE-ICU workflow was associated with a significant reduction in nurse-flagged instances of nonbeneficial or futile care. By providing a structured approach to early goals-of-care discussions, the intervention supported consistent identification and prevention of interventions not aligned with patient-centered goals.
Poole W, Reimert D, Paul K
… +3 more, Healey K, Hagel D, Whalen M
Crit Care Nurse
· 2025 Dec · PMID 41319988
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INTRODUCTION: One way to address the projected shortfalls in the quality and quantity of the nursing workforce is by implementing a virtual nursing role in the intensive care unit. Although virtual nursing is an establis...INTRODUCTION: One way to address the projected shortfalls in the quality and quantity of the nursing workforce is by implementing a virtual nursing role in the intensive care unit. Although virtual nursing is an established model of care for advanced practice providers, there are no well-established best practices for operationalizing virtual nursing to support bedside nurses. OBJECTIVES: To evaluate the literature related to implementing virtual nursing in the intensive care unit. METHODS: The Johns Hopkins evidence-based practice model was used to formulate the practice question and review and appraise the literature. RESULTS: The search yielded 17 reports with primarily anecdotal evidence. Although the evidence provided low levels of support for recommendations, 3 major themes emerged: operational considerations, attitudes of staff members and associated leadership solutions, and education for patients and staff members. CONCLUSION: Virtual nursing is an emerging technology. Some guidance on implementing these programs is available, but more rigorous implementation science research is needed.
Crit Care Nurse
· 2025 Dec · PMID 41319986
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BACKGROUND: Frontline intensive care unit nurses are essential in caring for critically ill patients. However, they often encounter emotionally draining situations. The COVID-19 pandemic, administrative burdens, and unfa...BACKGROUND: Frontline intensive care unit nurses are essential in caring for critically ill patients. However, they often encounter emotionally draining situations. The COVID-19 pandemic, administrative burdens, and unfavorable working conditions exacerbate these challenges, increasing nurses' risk of chronic stress and burnout. LOCAL PROBLEM: A needs assessment at our academic hospital found that more than 60% of intensive care unit nurses experienced burnout, although 71% demonstrated resilience, highlighting the need for meaningful support and resilience-building strategies. This project assessed the impact of mindfulness-based clinical aromatherapy on intensive care unit nurses' stress experience. METHODS: This quality improvement project implemented an online mindful clinical aromatherapy wellness program with peer support champions. Participants engaged in daily mini-mindfulness sessions using Ascents aromatherapy and the Smiling Mind app for 4 weeks. Stress and well-being were measured using the 10-item Perceived Stress Scale and the World Health Organization-Five Well-Being Index before and after the intervention. Additional questions were administered after the intervention to evaluate program satisfaction. Outcomes were evaluated using t tests and Cohen d. RESULTS: The participation rate was 81%. The mean Perceived Stress Scale-10 score decreased by 9.36% and the World Health Organization-Five score increased by 10.98%. Most participants (82%) enjoyed the program, and 68% intended to continue mindfulness or aromatherapy. Feedback showed an overall favorable response and the benefits of integrative health practices during stressful shifts. CONCLUSION: Incorporating evidence-based integrative health practices into daily routines may meaningfully ameliorate nurses' stress experience. Health care leaders are encouraged to support initiatives aimed at cultivating nurses' mental health, thereby optimizing capacity to provide exceptional patient care.
Horabik D, Serrano-Smith M, Wood R
… +2 more, Sobeck S, Siegmund LA
Crit Care Nurse
· 2025 Dec · PMID 41319984
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BACKGROUND: Open chest emergencies are high-risk, low-frequency events. Resternotomy procedures should be performed within 5 minutes of a suspected complication. The inability to recognize a complication can delay meetin...BACKGROUND: Open chest emergencies are high-risk, low-frequency events. Resternotomy procedures should be performed within 5 minutes of a suspected complication. The inability to recognize a complication can delay meeting the 5-minute metric. OBJECTIVES: To improve nurses' recognition of cardiac tamponade and awareness of equipment needed for resternotomy and to decrease response time from start of cardiac arrest to resternotomy. METHODS: In coordination with key stakeholders, the nursing professional development specialist created a 4-hour multimodal education program that included classroom engagement, deliberate practice, and a high-fidelity simulation with detailed prebriefing and debriefing. In 2023 the course was increased to 8 hours to allow for a repeat of the simulation. RESULTS: A total of 444 nurses participated. The mean (SD) setup time in preparation for sternotomy in 2021 was 311.2 (101.7) seconds, or 5.2 minutes; in 2022 was 323.8 (183.7) seconds, or 5.4 minutes; and in 2023 (after the repeated simulation was added to the course) was 254.8 (170.4) seconds, or 4.2 minutes, which was less than the 5-minute metric. CONCLUSIONS: After attending the course, nurses' response time during simulation of an open chest emergency improved.
Gallegos C, Robinson M, Ayola B
… +2 more, Kovar L, Roehrig N
Crit Care Nurse
· 2025 Dec · PMID 41101776
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INTRODUCTION: Measles is a highly contagious respiratory illness spread through droplets. Signs range from mild to severe, and some patients need hospitalization. Vaccines to prevent measles have been accessible since th...INTRODUCTION: Measles is a highly contagious respiratory illness spread through droplets. Signs range from mild to severe, and some patients need hospitalization. Vaccines to prevent measles have been accessible since the late 1960s, and the disease was declared eliminated in the United States in 2000. CLINICAL FINDINGS: A measles outbreak in 2025 provided an opportunity to examine the perspectives of 3 pediatric intensive care unit nurses who cared for critically ill children with measles. Interviews revealed strengths and stressors they encountered during their care of these patients. OUTCOMES: The nurses demonstrated resilience and adaptation while managing an infectious disease outbreak. They used organizational support, teamwork, and lessons learned from the COVID-19 pandemic to navigate the complexities of patient care. Strengths included enhanced preparedness, responsiveness facilitated by organizational leaders, and infection prevention measures. Stressors included media impact, community trust issues, and communication barriers. Despite these challenges, the nurses were committed to overcoming misinformation, building trust, and effectively communicating with families to ensure comprehensive disease prevention education. CONCLUSION: Recommendations for health care institutions include enhancing media literacy, addressing vaccine hesitancy, and promoting disaster preparedness to equip nurses for future challenges.