Pena H, Stokes J, Zulueta L
… +10 more, Awuku M, Bergamesca K, Do J, Espersen T, Fleetwood R, Knors J, Thomas T, Tobey A, Thompson JA, Granger BB
Crit Care Nurse
· 2025 Feb · PMID 39889791
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BACKGROUND: Patient and family satisfaction with care in intensive care units is not reflected in Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Gaps may be unknown. LOCAL PROBLEM: In a cardiot...BACKGROUND: Patient and family satisfaction with care in intensive care units is not reflected in Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Gaps may be unknown. LOCAL PROBLEM: In a cardiothoracic intensive care unit, patient satisfaction scores were not assessed and gaps could not be addressed. The primary aim was to obtain baseline data on patient and family satisfaction. The secondary aim was to improve identified gaps in satisfaction. METHODS: A preintervention-postintervention, 2-cycle quality improvement project and a 12-month sustainability assessment were conducted to evaluate patient and family satisfaction in a cardiothoracic intensive care unit in a large academic health system from August 2022 to August 2023. The Nursing Intensive Care Satisfaction Scale was used to measure patients' satisfaction and the European Quality Questionnaire was used to measure family members' satisfaction with intensive care unit nursing care. Standardized scripting, processes for patient and family engagement during rounds, and structured communication were used to enhance patient and family engagement. RESULTS: At baseline (47 patients, 35 family members), overall patient and family satisfaction was high (mean [SD] satisfaction scores: patients, 87.6 [19.3]; family members, 94.6 [9.7]; P = .06). After intervention cycle 2, family members (n = 50) had high mean satisfaction scores on the Information Needs sub-scale of the European Quality Questionnaire. Family participation in rounds improved from 18.5% of rounds at baseline to 76.5% after intervention cycle 2 and was 61.5% at 12 months. CONCLUSION: Strategies that engage family members in rounds improve communication and satisfaction.
Xavier T, Hittle BM, Rojas-Guyler L
… +1 more, Lee RC
Crit Care Nurse
· 2024 Dec · PMID 39615542
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BACKGROUND: The intensive care unit environment exposes nurses to high-stress situations that potentially affect their mental and physical health. Resilience is a protective factor that can enhance the well-being of inte...BACKGROUND: The intensive care unit environment exposes nurses to high-stress situations that potentially affect their mental and physical health. Resilience is a protective factor that can enhance the well-being of intensive care unit nurses. OBJECTIVE: To investigate the current evidence regarding resilience in intensive care unit nurses and identify factors that promote resilience. METHODS: A comprehensive literature search was undertaken for primary research conducted between January 1990 and December 2022. The updated framework of Whittemore and Knafl was used as a guide. Studies were critically appraised for methodological quality by using the Johns Hopkins Nursing evidence-based practice appraisal tool. RESULTS: Twelve studies were included; most used quantitative methods to measure resilience. The findings indicate that intensive care unit nurses exhibit various levels of resilience, the literature contains inconsistencies about factors affecting resilience, and resilience protects nurses against negative psychological outcomes. DISCUSSION: Nurses' resilience levels should be regularly assessed to identify areas for improvement and gauge the impact of resilience interventions. By continuously monitoring and adapting support strategies on the basis of resilience changes over time, organizations can meet the needs of intensive care unit nurses. CONCLUSION: More research is needed to comprehend the factors that impact resilience and devise interventions to boost resilience in intensive care nurses.
Crit Care Nurse
· 2024 Dec · PMID 39615541
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BACKGROUND: Although the benefits of improved transitions of care regarding medications are widely known, implementation is variable among inpatient settings and populations and requires an interprofessional effort. This...BACKGROUND: Although the benefits of improved transitions of care regarding medications are widely known, implementation is variable among inpatient settings and populations and requires an interprofessional effort. This article reviews the body of published research on challenges with medication history taking and reconciliation for inpatients requiring treatment of traumatic injuries or surgical intervention. REVIEW OF EVIDENCE: A comprehensive search of PubMed and MEDLINE databases from inception to February 2021, the reference lists of qualifying articles, and PubMed's "similar article" suggestions were used to identify publications based on the following key terms: patient transfer, transitional care, medication reconciliation, general surgery, and surgical procedures. Publications relevant to trauma and surgical patient populations were selected. Only 11 articles met the full criteria. IMPLEMENTATION: The general challenges of accurate medication reconciliation at admission are also often barriers in the trauma and general surgery population. Discerning trends in the literature and evidence-based practice may be helpful. EVALUATION: The publications revealed many barriers to medication reconciliation at admission, in the intensive care unit, and at intensive care unit and hospital discharge. SUSTAINABILITY: Practices that can overcome these challenges include persistence in obtaining accurate information, paying close attention to changes in dosage or dosage forms and resumption of home medications at intensive care unit discharge, and having a follow-up plan for prescribing and deprescribing at hospital discharge. CONCLUSION: Clear guidelines are needed for performing medication assessments at the bedside, including the role of each health care professional who conducts them and how the process is coordinated.
Krais S, Sheasby J, Banwait J
… +2 more, Lewis N, Liu Z
Crit Care Nurse
· 2024 Dec · PMID 39615540
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BACKGROUND: Patients with cardiogenic shock have a 25% to 50% mortality rate despite the introduction of mechanical circulatory devices and coordinated medical treatment. The use of shock teams has improved outcomes for...BACKGROUND: Patients with cardiogenic shock have a 25% to 50% mortality rate despite the introduction of mechanical circulatory devices and coordinated medical treatment. The use of shock teams has improved outcomes for these patients. LOCAL PROBLEM: A cardiovascular hospital with a multidisciplinary shock team had inconsistency and delays in recognition and diagnosis of patients with cardiogenic shock. METHODS: A nurse-led, preintervention-postintervention quality improvement project was performed in April and May 2021 and in April and May 2022 within a cardiovascular hospital in north Texas. The 2 nursing staff interventions regarding shock team activation were education and shock alert implementation. Time from first signs to diagnosis (for inpatients) and time from initial transfer request to acceptance (for transferring patients) were measured. Descriptive and statistical analyses were conducted using R, version 4.0.0 (R Foundation for Statistical Computing). RESULTS: The mean (SD) time to diagnosis of cardiogenic shock decreased significantly from 17.98 (28.39) hours in the preintervention group (n = 25) to 8.15 (12.26) hours in the postintervention group (n = 45; P = .045). For patients with cardiogenic shock transferring from referring hospitals, the median (IQR) time to acceptance was 1.55 (0.08-3.18) hours in the preintervention group and 0.35 (0.00-0.72) hours in the postintervention group (P < .001). CONCLUSIONS: Nursing staff interventions regarding shock team activation significantly improved the time of diagnosis and acceptance of patients with cardiogenic shock in a cardiovascular hospital, enhancing the overall quality of care provided to these patients.
Cook A, Grill F, Taylor C
… +2 more, Toles L, Baker N
Crit Care Nurse
· 2024 Dec · PMID 39615539
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BACKGROUND: Coronary artery bypass graft surgery is one of the most common cardiac procedures performed worldwide. The longer these patients remain in bed, the greater their risk of postoperative complications and prolon...BACKGROUND: Coronary artery bypass graft surgery is one of the most common cardiac procedures performed worldwide. The longer these patients remain in bed, the greater their risk of postoperative complications and prolonged length of stay. LOCAL PROBLEM: At the authors' institution, the average length of stay after coronary artery bypass graft surgery was 7.27 days, longer than the national average of 6.9 days. This quality improvement project was undertaken to increase these patients' postoperative mobility and thereby reduce their length of stay. METHODS: Data on mobility and length of stay of patients with isolated coronary artery bypass graft surgery during an 8-week period were collected retrospectively to establish preintervention values. These values were compared with postintervention values for an equivalent period. An evidence-based nurse-driven early mobility protocol was used to mobilize appropriate patients from bed to chair on postoperative day 0. This level of mobility was documented as a score of 4 on the Johns Hopkins Highest Level of Mobility Scale. RESULTS: From before to after protocol implementation, the postoperative length of stay decreased by 1.04 days. None of the 103 patients in the preintervention group scored a 4 on the Johns Hopkins Highest Level of Mobility Scale, compared with 36 of 134 patients in the intervention group. The difference in postoperative length of stay was clinically but not statistically significant (2-sided P = 1.95). CONCLUSION: Early mobility may help improve patient outcomes by reducing hospital length of stay and minimizing complications associated with prolonged immobility.
Otto E, Kaspar A, Kerr K
… +2 more, Droemer G, Waddle A
Crit Care Nurse
· 2024 Dec · PMID 39615538
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INTRODUCTION: Noninvasive ventilation therapy is a common approach in acute respiratory failure as an alternative to invasive mechanical ventilation. Assistive communication strategies are necessary to overcome communica...INTRODUCTION: Noninvasive ventilation therapy is a common approach in acute respiratory failure as an alternative to invasive mechanical ventilation. Assistive communication strategies are necessary to overcome communication impairments and anxiety caused by oronasal obstruction in pediatric intensive care unit patients undergoing noninvasive ventilation. CLINICAL FINDINGS AND DIAGNOSIS: A 7-year-old girl was admitted with a history of pulmonary arterial hypertension and recurrent respiratory failure requiring bilevel positive airway pressure intervention. The patient experienced initial lack of bilevel positive airway pressure mask compliance due to oronasal mask discomfort. INTERVENTIONS: The trial of a novel communication device (SPEAX, Ataia Medical) involving a microphone that attaches to the patient's bilevel positive airway pressure mask for enhanced communication. OUTCOMES: Use of the assistive communication device was associated with increased intelligibility to familiar listeners, mask compliance, enhanced mobility, and reduced patient anxiety levels throughout hospitalization and in later episodes of readmission. CONCLUSION: The implementation of assistive communication devices can alleviate communication barriers in pediatric bilevel positive airway pressure users, contributing to increased compliance and diminished anxiety for patients and caregivers. Providing a pathway for effective communication may reduce sedation use, minimizing risks of sedation-related delirium and improving overall quality of life in these patients.
Crit Care Nurse
· 2024 Dec · PMID 39615537
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INTRODUCTION: Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk...INTRODUCTION: Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation. CLINICAL FINDINGS AND DIAGNOSIS: A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated. INTERVENTIONS: The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100). OUTCOMES: The participant's posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83. CONCLUSION: This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.
Carpenter D, Menard A, Isenberger J
… +2 more, Stevens GA, LaRock L
Crit Care Nurse
· 2024 Oct · PMID 39348931
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BACKGROUND: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care-associated shootings also increased. The role of acute and critical care nurses during shootings is not well def...BACKGROUND: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care-associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature. OBJECTIVE: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital. METHODS: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting. RESULTS: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience. DISCUSSION: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures. CONCLUSIONS: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients.
Crit Care Nurse
· 2024 Oct · PMID 39348930
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BACKGROUND: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring f...BACKGROUND: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them. OBJECTIVE: To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting. METHODS: The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review. RESULTS: Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis. CONCLUSION: Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice.
Crit Care Nurse
· 2024 Oct · PMID 39348929
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BACKGROUND: Decreases in size, capability, clinical volumes, case mixes, and complex care opportunities in military treatment facilities contribute to the atrophy of clinical skills among medical professionals in these f...BACKGROUND: Decreases in size, capability, clinical volumes, case mixes, and complex care opportunities in military treatment facilities contribute to the atrophy of clinical skills among medical professionals in these facilities. LOCAL PROBLEM: The COVID-19 pandemic resulted in a 39% decline in admissions to a military critical care unit. The decrease in patient census contributed to skill sustainment challenges. METHODS: To identify methods to combat skill atrophy, the CINAHL and PubMed databases were searched using the terms peacetime effect, military-civilian partnership, and skill sustainment. Active-duty critical care nurses stationed at a military treatment facility implemented a military-civilian partnership with a civilian medical facility for clinical skill sustainment. RESULTS: One year after implementation, 39 critical care nurses had completed 511 shifts, gaining clinical experiences seldom achieved at the military facility. A survey of these nurses demonstrated that 8 of 17 (47%) gained experience treating patients requiring intra-aortic balloon pumps or continuous renal replacement therapy, 6 of 17 (36%) gained experience with patients requiring a ventricular assist device, 12 of 17 (71%) acquired hands-on experience with intracranial pressure monitoring, and 14 of 17 (82%) reported vasoactive intravenous infusion manipulation. CONCLUSIONS: This article highlights the importance of evaluating clinical practice within the military health system, developing military-civilian partnerships, and removing military-civilian partnership barriers for nurses and other health care professionals. Failure to implement military-civilian partnerships may adversely affect the clinical competency of the military nurse force.
O'Hollearn S, Schaefer R, DuBose C
… +2 more, Smith D, Goforth C
Crit Care Nurse
· 2024 Oct · PMID 39348928
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Publisher ↗
Low-titer O-positive whole blood was used extensively by the military during operations in Iraq and Afghanistan. Studies have consistently shown that this therapy is feasible, safe, and effective in the management of hem...Low-titer O-positive whole blood was used extensively by the military during operations in Iraq and Afghanistan. Studies have consistently shown that this therapy is feasible, safe, and effective in the management of hemorrhagic shock in trauma patients, and it is now the standard of care across the US military Joint Trauma System. The military's success in using low-titer O-positive whole blood has renewed the practice in the civilian setting, with recent research confirming its safety and efficacy. In a few short years, use of this treatment for hemorrhagic shock has expanded to more than 80 US level I and level II trauma centers. However, its use is still relatively rare in the rural hospital setting. This article describes the benefits for patients, staff members, and the overall trauma system of using low-titer O-positive whole blood in rural hospitals.
Bhatta EAM, DeCarli NJ, Duffy JR
… +1 more, McAdams B
Crit Care Nurse
· 2024 Oct · PMID 39348927
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Operation Allies Refuge started in July 2021 with implications for critical care nurses, both military and civilian, serving at the US Army's Landstuhl Regional Medical Center in Landstuhl, Germany. Cultural and logistic...Operation Allies Refuge started in July 2021 with implications for critical care nurses, both military and civilian, serving at the US Army's Landstuhl Regional Medical Center in Landstuhl, Germany. Cultural and logistical concerns and complications were at the forefront of care provided to Afghan evacuees during the operation and were exacerbated by a mass casualty event on August 26, 2021, when a suicide bomber attacked the Abbey Gate of Hamid Karzai International Airport in Kabul, Afghanistan. This article discusses the issues that affected care, including language barriers, supply shortages, cultural differences, mass evacuation during a pandemic, and management of the mass casualty event by the critical care team. The information is compiled into a summary of lessons learned to assist in future management of emergency evacuee care within our military and civilian health care systems.
Crit Care Nurse
· 2024 Oct · PMID 39348926
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Publisher ↗
Critical care nursing is a highly dynamic and demanding field, and critical care nurses play a vital role in the US military health care system. Although many critical care nurses are resilient to myriad occupational exp...Critical care nursing is a highly dynamic and demanding field, and critical care nurses play a vital role in the US military health care system. Although many critical care nurses are resilient to myriad occupational exposures, for some nurses the job leads to adverse psychological effects, including compassion fatigue and burnout. This article describes the evidence used to develop a psychoeducation program designed to mitigate burnout among health care professionals, particularly critical care nurses. Implementation considerations (including those in the context of disaster response) and future battlefield are discussed. Ultimately, supporting the psychological health of the US military's critical care nurse force is vital to ensure their well-being, the readiness of our armed forces, and the security of our nation.
Agyenim-Boateng G, Ridkodim N, Leitch E
… +3 more, Hafer K, Ng N, Arbour R
Crit Care Nurse
· 2024 Oct · PMID 39348925
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Publisher ↗
BACKGROUND: Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care...BACKGROUND: Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. LOCAL PROBLEM: On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. METHODS: Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. RESULTS: Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. CONCLUSIONS: Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity.