Carpenter D, Menard A, Isenberger J
… +2 more, Stevens GA, LaRock L
Crit Care Nurse
· 2025 Oct · PMID 41027646
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BACKGROUND: Workplace violence has been increasing in hospitals and has been associated with employee turnover and decreased productivity and quality of care. OBJECTIVE: To identify interventions acute and critical care...BACKGROUND: Workplace violence has been increasing in hospitals and has been associated with employee turnover and decreased productivity and quality of care. OBJECTIVE: To identify interventions acute and critical care nurses can employ to address workplace violence among patients and visitors. METHODS: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were searched for publications related to hospital workplace violence. RESULTS: Of 951 articles retrieved, 47 were included. Only 2 articles (4%) were specific to critical care, 5 (11%) were generic to hospital settings, and 40 (85%) focused on emergency departments. The highest level of evidence was in 1 randomized controlled trial; 46 articles (98%) had level 6 or 7 evidence. The evidence revealed 3 themes: preparedness/prevention, response to violence, and recovery. Preparedness/ prevention was the most prevalent theme. Assessment and screening, communication, education, leadership, and infrastructure were subthemes. DISCUSSION: Nurses can engage in efforts to promote a safe and healthy work environment. With increasing prevalence of workplace violence in health care, acute and critical care nurses must be prepared to prevent and manage violence. Focused education, including simulations and drills, are essential. CONCLUSION: Bedside nurses and leadership teams should collaborate to reduce workplace violence in their environments. Further research focusing on workplace violence in acute and critical care areas is needed to define the most effective interventions.
Smallegan KR, Smith SJ, Wilder HL
… +3 more, Payne GE, Raiciulescu S, Capps CM
Crit Care Nurse
· 2025 Oct · PMID 41027645
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BACKGROUND: Team communication is essential to delivering health care safely. Nurses in the adult intensive care unit at a large military treatment facility were not consistently present in daily patient rounds and state...BACKGROUND: Team communication is essential to delivering health care safely. Nurses in the adult intensive care unit at a large military treatment facility were not consistently present in daily patient rounds and stated that team communication could be improved. This clinical question was developed: among critical care staff members, how does a standardized daily rounding script, compared with current practice, impact interdisciplinary communication over a 36-week period? REVIEW OF EVIDENCE: Current literature includes 3 themes: rounds should be interdisciplinary; include the ABCDEF bundle (pain assessment, spontaneous awakening and breathing trials, analgesia and sedation choice, delirium assessment, early mobility, and family engagement); and use a standardized script. These elements can improve perceptions of collaboration in rounds. IMPLEMENTATION: An interdisciplinary rounding script was introduced across 2 adult intensive care units at a military hospital over 36 weeks. Before and after the intervention, the Collaboration and Satisfaction About Care Decisions survey was used to assess nurses' perceptions of collaboration; rounds were observed for key elements. EVALUATION: After implementation, the mean survey score (both units combined) rose by 1.5 units, nurse presence at rounds increased by 21.6% (P = .01), nurse contributions to rounds increased by 31.1% (P = .001), all bundle elements were reviewed 18.9% more often (P = .07), a summary of care was given 53.6% more often (P < .001), and order read back was completed 69.8% more often (P < .001). SUSTAINABILITY: Continued use of the script in the military treatment facility will require adapting it to practice changes and training new staff members on its use.
Crit Care Nurse
· 2025 Oct · PMID 41027644
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BACKGROUND: Organizational culture and work environment are important factors in retaining staff members and achieving good patient outcomes. The COVID-19 pandemic exacerbated existing challenges for nurses and the healt...BACKGROUND: Organizational culture and work environment are important factors in retaining staff members and achieving good patient outcomes. The COVID-19 pandemic exacerbated existing challenges for nurses and the health care organizations employing them. LOCAL PROBLEM: Following the COVID-19 pandemic, the nursing staff turnover rate at Los Angeles General Medical Center in Los Angeles, California, reached 20.62%, an all-time high. A quality improvement project was initiated to improve the organization's culture in order to increase retention and improve other nurse-sensitive indicators. METHODS: The quality improvement project was intended to implement as many as possible of the 6 healthy work environment standards established by the American Association of Critical-Care Nurses (AACN): Effective Communication, True Collaboration, Appropriate Staffing, Authentic Leadership, Meaningful Recognition, and Shared Decision-Making. Key elements of the project were the implementation of professional shared governance, a new graduate transition to practice program, a mobile application to improve communication, a grant-funded project to decrease burnout, the AACN Clinical Scene Investigator Academy, a leadership development program, and a new staffing and scheduling system. RESULTS: The quality improvement program resulted in improved patient outcomes, reduced nurse turnover, an increased rate of nurse certification, a higher proportion of nurses educated at the bachelor of science in nursing level or higher, and decreased overall costs. CONCLUSION: Implementation of a quality improvement program focusing on the 6 AACN healthy work environment standards can improve the nursing work environment.
Crit Care Nurse
· 2025 Oct · PMID 41027636
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BACKGROUND: Although sepsis remains a medical emergency, there is no standard test for diagnosing it. Current sepsis management guidelines strongly recommend screening for sepsis but do not identify a specific tool to us...BACKGROUND: Although sepsis remains a medical emergency, there is no standard test for diagnosing it. Current sepsis management guidelines strongly recommend screening for sepsis but do not identify a specific tool to use. OBJECTIVE: To summarize the evidence for sepsis screening tools and triggers, identify the current tools used, and describe their effectiveness. METHODS: A review of the literature from January 2019 through June 2024 was performed. Studies were included if they described sepsis screening tools used for adults in the emergency department or adult inpatients, including intensive care unit patients. Studies were excluded if they described tools specific to machine learning with artificial intelligence or biomarkers and biologics. RESULTS: A total of 300 articles were screened. The final set of 26 studies included articles on computerized clinical decision support systems (8 studies), existing early warning systems (14 studies), and new or novel tools (4 studies). Sepsis definitions were heterogeneous and generally based on disease classification codes, criteria from the Sepsis-2 or Sepsis-3 definitions, or combinations thereof. The most commonly used early warning system tools used that had superior evidence were the National Early Warning Score versions 1 and 2. Little evidence supported the use of the quick Sequential [Sepsis-related] Organ Failure Assessment alone for sepsis identification. The use of computerized clinical decision support systems is varied; both proprietary and individual system-developed tools are available, with little consensus on standards for reporting accuracy. CONCLUSION: It is clear that all currently available tools function only as adjuncts to clinical acumen.
Olivier R, Skinner C, Bloom T
… +1 more, Rutledge D
Crit Care Nurse
· 2025 Oct · PMID 41027634
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BACKGROUND: Many patients with end-stage kidney disease begin dialysis therapy with central venous dialysis catheters, significantly increasing the risk of dialysis catheter-related bloodstream infection. Bloodstream inf...BACKGROUND: Many patients with end-stage kidney disease begin dialysis therapy with central venous dialysis catheters, significantly increasing the risk of dialysis catheter-related bloodstream infection. Bloodstream infections are among the most severe harm events affecting patients receiving dialysis. LOCAL PROBLEM: In 2023, the dialysis catheter-related central line [catheter]-associated bloodstream infection (CLABSI) rate at an acute care medical center in southern California was thrice the national benchmark. This quality improvement project aimed to decrease this rate by adding chlorhexidine-coated dialysis catheter caps to standard care. METHODS: Using the Knowledge to Action model, the medical center made a dialysis catheter-related CLABSI reduction practice change. Preimplementation and postimplementation monthly aggregate data were collected for dialysis catheter-related CLABSIs, central venous dialysis catheter days, and dialysis catheter-related infection rates. One-on-one dialysis staff simulation training and process compliance audits ensured intervention fidelity. The intervention was replacement of nonchlorhexidine dialysis catheter caps with chlorhexidine-coated dialysis catheter caps for patients with central venous dialysis catheters. RESULTS: An 8-week preimplementation period included 119 patients, 561 dialysis therapies, 934 central dialysis catheter days, and 2 dialysis catheter-related CLABSIs (2.14 infections per 1000 catheter days). An 8-week postimplementation period included 128 patients, 583 dialysis therapies, 897 central dialysis catheter days, and 0 dialysis catheter-related CLABSIs; no dialysis catheter-related CLABSIs occurred during postimplementation sustainability assessment (24 weeks total). CONCLUSIONS: Use of chlorhexidine-coated dialysis catheter caps led to clinically significant results among patients receiving dialysis with central catheters at an acute care medical center.
Crit Care Nurse
· 2025 Oct · PMID 41027633
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BACKGROUND: The rapid evolution of artificial intelligence technologies, particularly in critical care nursing, presents opportunities and ethical challenges. Artificial intelligence has potential to enhance patient care...BACKGROUND: The rapid evolution of artificial intelligence technologies, particularly in critical care nursing, presents opportunities and ethical challenges. Artificial intelligence has potential to enhance patient care and clinical decision-making, yet concerns regarding privacy, consent, bias, discrimination, and the dehumanization of care persist. OBJECTIVE: To explore the intersection of artificial intelligence and ethics in nursing, with a focus on ethical implications for patient care and clinical decision-making. METHODS: A comprehensive literature search was done for this narrative review to synthesize knowledge on artificial intelligence in nursing, incorporating insights from nursing, information technology, legal studies, and medicine. RESULTS AND DISCUSSION: Artificial intelligence technologies are reshaping nursing workflows and can improve health care outcomes. However, these technologies introduce complex ethical concerns, including the risk for bias, data privacy issues, and the potential for reduced human interaction in patient care. Critical care nurses are uniquely positioned to leverage artificial intelligence effectively while identifying and mitigating risks related to its use. The involvement of critical care nurses in the development and application of artificial intelligence technologies is essential to ensure the accuracy, safety, and fairness of these tools. CONCLUSION: Critical care nurses must advocate for the ethical integration of artificial intelligence in health care, ensuring alignment with core nursing values such as autonomy, beneficence, nonmaleficence, justice, and veracity. By actively participating in discussions, monitoring artificial intelligence tools, and providing feedback, nurses can help to ensure that artificial intelligence technologies enhance patient care while upholding the ethical principles fundamental to nursing practice.
Crit Care Nurse
· 2025 Aug · PMID 40748933
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INTRODUCTION: Lung transplant is a critical treatment for patients with end-stage lung disease, but recovery is often complicated by physiological and psychological challenges. This case report describes a 61-year-old fe...INTRODUCTION: Lung transplant is a critical treatment for patients with end-stage lung disease, but recovery is often complicated by physiological and psychological challenges. This case report describes a 61-year-old female bilateral orthotopic lung transplant recipient who experienced significant psychological decline during an extended intensive care unit stay and the use of animal-assisted interventions to address these challenges. CLINICAL FINDINGS: The patient experienced multiple postoperative complications, including coagulopathy, venovenous extracorporeal membrane oxygenation for hypoxia, delayed chest closure, right ventricular dysfunction, acute kidney injury, adrenal insufficiency, hypogammaglobulinemia, diaphragmatic paralysis, antibody-mediated rejection, bacteremia, and severe deconditioning. DIAGNOSIS: The patient's psychological decline manifested through increased somnolence, reduced engagement in physical therapy, and minimal interaction with family and health care professionals. INTERVENTIONS: Weekly animal-assisted interventions were introduced to improve mood and increase motivation. These sessions involved therapy animals with the goal of enhancing the patient's psychological well-being. OUTCOMES: The patient responded positively to animal-assisted interventions, showing improved mood, increased engagement, and participation in rehabilitation. The theoretical framework of acceptability was used to assess the intervention's success, with results indicating high acceptability and effectiveness. CONCLUSION: Animal-assisted interventions addressed the patient's psychological challenges during prolonged intensive care unit stays following lung transplant. The intervention improved both psychological well-being and patient engagement. Theoretical framework of acceptability scores supported the acceptability of animal-assisted interventions, suggesting that these should be considered as part of an interprofessional approach to managing prolonged hospitalizations in transplant recipients.
Cabral K, Anderson V, Allen I
… +3 more, Hoskins D, Byers K, Gettis M
Crit Care Nurse
· 2025 Aug · PMID 40748932
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BACKGROUND: Catheter-associated urinary tract infections are a leading hospital-acquired infection and are a major cause of increased morbidity, mortality, and health care costs, with 83% of pediatric cases occurring in...BACKGROUND: Catheter-associated urinary tract infections are a leading hospital-acquired infection and are a major cause of increased morbidity, mortality, and health care costs, with 83% of pediatric cases occurring in pediatric intensive care units. Indwelling urinary catheters are widely used in adult and pediatric patients to accurately monitor urine output and manage fluid balance. LOCAL PROBLEM: Staffing challenges and high nurse turnover in a 56-bed pediatric intensive care unit led to inconsistencies in practices to prevent catheter-associated urinary tract infection. Stool contamination from diapers used alongside indwelling urinary catheters increased the risk of infection. METHODS: An interprofessional team designed a comprehensive catheter-associated urinary tract infection prevention strategy through plan-do-study-act cycles. Compliance was tracked through electronic surveys during catheter-associated urinary tract infection huddles, bedside infection prevention rounds, and bundle audits, with statistical process control charts used to measure infection rates before and after implementation of interventions. Interventions consisted of introduction of an exploratory no-diapering protocol, use of an advanced indwelling urinary catheter drainage system, and consistent staff reeducation. RESULTS: The rate of catheter-associated urinary tract infection decreased from 3.13 to 0 per 1000 catheter days, with 527 event-free days (about 1.5 years). CONCLUSION: The combination of an advanced indwelling urinary catheter drainage system, elimination of diapers, and structured staff reeducation reduced the rate of catheter-associated urinary tract infection in the pediatric intensive care unit. This approach has potential for application in both pediatric and adult critical care settings to reduce infection rates and improve patient outcomes.
Crit Care Nurse
· 2025 Aug · PMID 40748931
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BACKGROUND: Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring. OBJECTIVE: T...BACKGROUND: Bronchiolitis obliterans/bronchiolitis obliterans syndrome is an irreversible, obstructive lung disease characterized by the narrowing of bronchioles by lung fibrosis, inflammation, and scarring. OBJECTIVE: To provide acute care, transplant, and critical care nurses a summary of the disease process, causes, and treatment options for bronchiolitis obliterans in pediatric patients to promote early recognition of signs in at-risk patients. METHODS: This descriptive literature review was limited to articles published in 2013 or later. Searches of the PubMed and CINAHL databases using the terms bronchiolitis obliterans and pediatric yielded 432 articles. Of these articles, 22 were used for this review. The Johns Hopkins Nursing Evidence-Based Practice appraisal tool was used to assess levels of evidence and methodologic quality of the articles. RESULTS: Patients in 3 main groups are at risk for bronchiolitis obliterans: those who have had respiratory infection, those who have received lung transplant, and those who have received stem cell transplant. DISCUSSION: A diagnosis of bronchiolitis obliterans requires lung biopsy and histopathology. For patients who are unable to undergo biopsy or whose biopsy results are inconclusive, bronchiolitis obliterans syndrome can be clinically identified with spirometry (forced expiratory volume in first second of expiration and forced expiratory flow at 25% to 75% of forced vital capacity) and high-resolution computed tomography. Systemic corticosteroids are often the first-line treatment; second-line strategies are under investigation. CONCLUSION: Knowledge of risk factors, signs, and current treatments for bronchiolitis obliterans/bronchiolitis obliterans syndrome can help acute care and critical care nurses decelerate progression of the disease.