Saltzman B, Fayram L, Houston M
… +1 more, Laures E
Crit Care Nurse
· 2026 Jun · PMID 42219210
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BACKGROUND: Medical devices are common causes of health care-associated pressure injuries in pediatric patients. Noninvasive ventilation masks are among the most frequently used medical devices that result in injury. Uni...BACKGROUND: Medical devices are common causes of health care-associated pressure injuries in pediatric patients. Noninvasive ventilation masks are among the most frequently used medical devices that result in injury. Unique pediatric facial anatomy, limited noninvasive ventilation mask sizes, and lack of pediatric-specific guidelines all contribute to injury. LOCAL PROBLEM: In 2021, the local pediatric intensive care unit reported that 66% of stage 2 or greater health care-associated pressure injuries were facial injuries related to noninvasive ventilation masks. An evidence-based practice project was conducted to prevent noninvasive ventilation mask-related pressure injuries in the pediatric intensive care unit. METHODS: An evidence-based bundle specific to the local pediatric intensive care unit was developed in accordance with the Iowa Model-Revised through interprofessional collaboration. Process and outcome data were collected to evaluate bundle implementation. Data included knowledge, attitude, and behavior indicators and health care-associated pressure injury outcome data. RESULTS: The number of health care-associated pressure injuries related to noninvasive ventilation masks decreased from 6 in 2021 to 0 in 2022 after bundle implementation in October 2022. Postimplementation survey data showed that unit staff members' knowledge improved and behaviors to prevent health care-associated pressure injuries increased after implementation of the practice change. CONCLUSION: An evidence-based practice approach guided development of a localized practice change. Bundle use and interprofessional team collaboration reduced pressure injuries related to noninvasive ventilation masks in the pediatric intensive care unit.
McDermott C, Haun PJ, Robinson E
… +1 more, Russo L
Crit Care Nurse
· 2026 Jun · PMID 42219209
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BACKGROUND: Hospitals and health systems experienced unprecedented levels of nurse turnover during the COVID-19 pandemic, increasing the need for new graduate nurses in the postpandemic workforce. LOCAL PROBLEM: With a g...BACKGROUND: Hospitals and health systems experienced unprecedented levels of nurse turnover during the COVID-19 pandemic, increasing the need for new graduate nurses in the postpandemic workforce. LOCAL PROBLEM: With a growing shortage of qualified preceptors, a redesign of the preceptor role was proposed. Clustering new graduate nurses into small groups of 2 to 5 allows for increasing the number of new graduate nurses onboarded with a limited number of preceptors. METHODS: A group-orientation model was used to assign a preceptor dedicated to orientation and unburdened with patient assignment to a small group of new graduate nurses. New graduate nurses stayed within the group for the first phase of onboarding, from 4 to 8 weeks, then transitioned to 1:1 supervision with a preceptor for the last phase of orientation. RESULTS: Preceptor and new graduate nurse satisfaction increased. New graduate nurse retention also increased by 3 percentage points compared with new graduate nurses oriented with the traditional model over the same period. The cost of preceptor salaries in the first 15 months of the group-orientation program was approximately $10 000 per new graduate nurse. DISCUSSION: The group-orientation model appears to be financially viable, with favorable impact on new graduate nurse retention. CONCLUSION: A group-orientation model for onboarding new graduate nurses may be a useful approach to accelerate onboarding, enhance satisfaction, and decrease turnover. The cost of providing group orientation may be offset by cost savings seen when new graduate nurse retention increases.
Crit Care Nurse
· 2026 Jun · PMID 42219208
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BACKGROUND: As a result of the COVID-19 pandemic, health care systems nationally are adopting innovative strategies to streamline nursing care while optimizing outcomes. Concurrently, registered dietitian nutritionists a...BACKGROUND: As a result of the COVID-19 pandemic, health care systems nationally are adopting innovative strategies to streamline nursing care while optimizing outcomes. Concurrently, registered dietitian nutritionists are seeking opportunities to maximize their professional contribution and underscore their value as part of the interprofessional health care team. Implementing a feeding tube placement program led by registered dietitian nutritionists, rather than nurses, might enhance patient safety and enable dietitians to practice at an expert level while affording nurses more time for other patient care responsibilities. LOCAL PROBLEM: In a 5-hospital health system, the COVID-19 pandemic worsened nursing shortages and increased nurse workloads and burnout. High volumes of patients with respiratory compromise increased the demand for postpyloric feeding tube placement. Challenges included unreliable placement methods and the need for bedside procedures due to transport restrictions. This situation prompted the creation of a registered dietitian nutritionist-led program for bedside feeding tube placement. METHODS: An electromagnetic sensor-guided feeding tube placement program was implemented in phases across the health system after a successful pilot. This process included development of a feeding tube placement practice guideline, electronic health record updates, superuser training, competency development, and system-wide education. RESULTS: One year after implementation, the program has saved more than 350 nursing hours. The number of radiographs has been reduced by 20% and the incidence of ventilator-associated pneumonia has been reduced by 67%, with no lung placements. CONCLUSION: Enabling registered dietitian nutritionists to lead feeding tube placement is an effective strategy for optimizing patient care and safety while reducing nursing workload.
Crit Care Nurse
· 2026 Jun · PMID 42219207
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BACKGROUND: Respiratory medical device-related pressure injuries are a persistent challenge in acute care, particularly among high-acuity patients requiring continuous respiratory support. LOCAL PROBLEM: At a 186-bed com...BACKGROUND: Respiratory medical device-related pressure injuries are a persistent challenge in acute care, particularly among high-acuity patients requiring continuous respiratory support. LOCAL PROBLEM: At a 186-bed community hospital, respiratory medical device-related pressure injury rates rose significantly in the intensive care and progressive care units following the COVID-19 pandemic. METHODS: Plan-do-study-act cycles guided implementation of this quality improvement project. Baseline data were collected from January 2019 through June 2023, followed by intervention implementation from July 2023 through January 2025 and outcome monitoring through March 2025. The project was conducted in a 19-bed intensive care unit and a 30-bed progressive care unit and involved 121 registered nurses and 28 respiratory therapists. During the intervention phase, 123 eligible patients requiring continuous respiratory support for more than 24 consecutive hours were audited for intervention and documentation compliance. Statistical process control chart analysis was used to track monthly respiratory device-related pressure injury rates over time, identifying trends according to visual interpretation. RESULTS: Respiratory medical device-related pressure injury rates declined by 52%, from 0.56 to 0.27 per 1000 patient days. Intervention compliance with placement of barrier dressings improved from 41 of 56 (71.7%) audit observations to 71 of 73 (97.8%) audit observations. Documentation compliance increased from 25 of 56 (43.4%) audit observations to 63 of 73 (89.7%) audit observations. CONCLUSION: Standardizing preventive barrier use and strengthening interprofessional collaboration substantially reduced respiratory medical device-related pressure injuries.
Crit Care Nurse
· 2026 Jun · PMID 42219206
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INTRODUCTION: Quantitative pupillometry is increasingly used to assess patients' neurologic function quickly and accurately. This case report discusses the feasibility of collecting quantitative pupillometry data for pat...INTRODUCTION: Quantitative pupillometry is increasingly used to assess patients' neurologic function quickly and accurately. This case report discusses the feasibility of collecting quantitative pupillometry data for patients experiencing cardiac arrest, the potential value of these data, and limitations of quantitative pupillometry. CLINICAL FINDINGS: An 83-year-old woman was admitted to the cardiac catheterization laboratory for coronary angiography and percutaneous coronary intervention. She experienced cardiac arrest during the procedure, and the rapid response team was deployed. DIAGNOSIS: Coronary artery disease with angina was present upon admission. The patient was admitted with the intent to perform percutaneous coronary intervention of the left anterior descending coronary artery. INTERVENTIONS: During the cardiac arrest and while staff members were performing chest compressions, rapid response team nurses obtained quantitative pupillometry readings to assess pupil function. OUTCOMES: The quantitative pupillometry readings obtained from the left and right eyes suggested that neurologic function was abnormal but still present. The main challenges associated with performing quantitative pupillometry during a cardiac arrest are overcrowding of essential personnel at the head of bed and finding an appropriate time to obtain readings without compromising life-sustaining interventions. CONCLUSION: Using quantitative pupillometry to assess pupil function during cardiac arrest is feasible when performed by nurses. This report may facilitate pupil assessment during cardiac arrest and provide new insights into cerebral perfusion as a biomarker of recovery.
Crit Care Nurse
· 2026 Jun · PMID 42219205
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BACKGROUND: Mechanical ventilation increases patients' risk for ventilator-associated events. Nursing unit councils can help mitigate these events through shared governance. LOCAL PROBLEM: The medical critical care unit...BACKGROUND: Mechanical ventilation increases patients' risk for ventilator-associated events. Nursing unit councils can help mitigate these events through shared governance. LOCAL PROBLEM: The medical critical care unit at the project site faced challenges in outperforming benchmarks, increasing ventilator days, and consistently adhering the ICU Liberation Bundle. This project aimed to reintroduce effective practices and enhance nurse empowerment to reduce ventilator-associated events and improve patient outcomes. METHODS: Led by a clinical nurse specialist and the medical critical care nursing unit council, the quality improvement project focused on the spontaneous awakening and breathing trials element of the ICU Liberation Bundle. Multifaceted interventions included education, data literacy training, compliance monitoring, and root cause analysis of ventilator-associated events. The Council Health Survey was distributed before and after the intervention to evaluate the nursing unit council's feelings of empowerment. RESULTS: In the preintervention period, 23 patient charts were audited and in the intervention period, 34 patient charts were audited. Before the intervention, 15 nurses completed the Council Health Survey, and after the intervention, 9 nurses completed it. The intervention took place during 8 weeks. Ventilator-associated events decreased by 33.3% and the ventilator-associated event rate per 1000 ventilator days decreased by 29.9%; however, these changes were not significant (P = .70). Spontaneous awakening trial compliance increased from 75.7% to 83.0% (P = .39) and spontaneous breathing trial compliance decreased from 88.4% to 70.4% (P = .10); neither change was significant. Council Health Survey overall scores dropped 9.8%; subscale scores did not significantly change (P values ranged from .10 to .81). CONCLUSION: The ICU Liberation Bundle has been shown to improve patient outcomes. Future initiatives should focus on sustaining a comprehensive approach to reducing ventilator-associated events.
Crit Care Nurse
· 2026 Jun · PMID 42219199
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INTRODUCTION: Extracorporeal membrane oxygenation is an invasive form of mechanical therapy for patients requiring circulatory or respiratory support. Venovenous extracorporeal membrane oxygenation supports patients' lun...INTRODUCTION: Extracorporeal membrane oxygenation is an invasive form of mechanical therapy for patients requiring circulatory or respiratory support. Venovenous extracorporeal membrane oxygenation supports patients' lungs by oxygenating the blood, replacing pulmonary gas exchange function, and allowing a failing lung to recover. This supportive therapy can be used to treat patients with acute rejection following a lung transplant. CLINICAL FINDINGS: A 59-year-old White man was admitted for bilateral orthotopic lung transplant and was nearing the time of discharge home after the procedure. However, acute decompensation on postoperative day 17 prolonged the patient's hospitalization. DIAGNOSIS: The patient received a diagnosis of antibody-mediated rejection. INTERVENTION: The patient completed antibody-mediated rejection treatment and underwent cannulation for venovenous extracorporeal membrane oxygenation. The extracorporeal membrane oxygenation cannulation was later changed to a venovenous-venous configuration to manage ongoing hypoxemia. OUTCOMES: Postoperative complications related to the diagnosis of acute rejection resulted in prolonged hospitalization. The patient was transferred out of the intensive care unit on postoperative day 93. He was discharged home when he was hemodynamically stable. CONCLUSION: Acute rejection occurs in nearly one-third of patients after lung transplant, highlighting the need for accurate patient diagnosis. This case report discusses the treatment of antibody-mediated rejection, demonstrates how venovenous extracorporeal membrane oxygenation can be used to support a patient with acute rejection following a lung transplant, and highlights the crucial role of critical care nurses in treating patients receiving extracorporeal membrane oxygenation.
BACKGROUND: Proton pump inhibitors are widely used to treat gastrointestinal conditions, but prolonged use increases the risk of infections, fractures, kidney disease, and other adverse outcomes, particularly in adults a...BACKGROUND: Proton pump inhibitors are widely used to treat gastrointestinal conditions, but prolonged use increases the risk of infections, fractures, kidney disease, and other adverse outcomes, particularly in adults aged 65 years and older. Despite guideline recommendations for limited duration, inappropriate prescribing remains common, contributing to adverse outcomes and increased health care costs. LOCAL PROBLEM: Baseline audits at a 24-bed telemetry unit in a Texas community hospital revealed that 35.3% of older adults were prescribed proton pump inhibitors without appropriate indication. The purpose of this initiative was to evaluate the effect of a nurse-led proton pump inhibitor medication review using a structured proton pump inhibitor deprescribing algorithm. METHODS: This 16-week quality improvement initiative, guided by the Iowa Model of Evidence-Based Practice, included an 8-week preimplementation phase followed by an 8-week postimplementation assessment phase. Forty-five nurses were trained to apply the deprescribing algorithm in collaboration with physicians and pharmacists at patient admission and discharge. Implementation tools included electronic health record text templates, patient education resources, and interprofessional huddles. RESULTS: Among 186 patient records reviewed, inappropriate proton pump inhibitor use declined from 35% to 5% (P < .001). No adverse gastrointestinal events were reported. Informal feedback showed increased nurse confidence in and knowledge of deprescribing practices. CONCLUSIONS: This nurse-led intervention significantly reduced inappropriate proton pump inhibitor prescriptions and enhanced patient safety. Integration of decision tools, education, and interprofessional collaboration supported sustainability. The model is scalable to other medication stewardship efforts in acute care.
BACKGROUND: Spontaneous intracerebral hemorrhage affects approximately 80 000 people in the United States annually and is associated with significant risk of disability and mortality. As with many acute conditions, proto...BACKGROUND: Spontaneous intracerebral hemorrhage affects approximately 80 000 people in the United States annually and is associated with significant risk of disability and mortality. As with many acute conditions, protocolized care has been shown to benefit patients with intracerebral hemorrhage. The 2024 American Heart Association/American Stroke Association guidance document for intracerebral hemorrhage management recommends bundled care interventions, including timely blood pressure control, anticoagulation reversal, and surgical intervention to improve outcomes. OBJECTIVE: To assess the rationale for and literature pertaining to the recommended bundled care interventions for intracerebral hemorrhage management and offer practical guidance for nurses to optimize patient care. METHODS: The recommendations in the 2024 American Heart Association/American Stroke Association guidance document for intracerebral hemorrhage management were reviewed, the literature supporting bundled care interventions was assessed, and a narrative review of this information was generated. RESULTS: Protocolized care has shown benefit for many devastating conditions, including acute ischemic stroke. Recent guidelines and evidence suggest that this kind of intervention may also improve outcomes for intracerebral hemorrhage patients. The critical care nurse has a significant role to play in facilitating timely interventions for intracerebral hemorrhage patients, particularly regarding neurologic status changes and blood pressure control. Further study is needed to determine the most appropriate timing and targets for the best outcomes. CONCLUSION: Recent evidence and guidance documents support the use of bundled care protocols to improve outcomes for individuals experiencing intracerebral hemorrhage. Early recognition of intracerebral hemorrhage and knowledge of bundled care interventions may benefit these patients and improve outcomes.
INTRODUCTION: The occurrence of giant malignant solitary fibrous tumor of the pleura with severe hypoglycemia as the initial symptom is exceedingly rare. This type of tumor requires extensive surgical resection, and the...INTRODUCTION: The occurrence of giant malignant solitary fibrous tumor of the pleura with severe hypoglycemia as the initial symptom is exceedingly rare. This type of tumor requires extensive surgical resection, and the postoperative mortality rate is high. This article documents the nursing experience in such a case. CLINICAL FINDINGS: A 68-year-old man was admitted to the hospital because of recurrent episodes of severe hypoglycemia. Examination revealed a giant malignant solitary fibrous tumor measuring 16.5 × 12.6 × 18.1 cm in the thoracic cavity. It was suspected that the patient's hypoglycemia resulted from the tumor's secretion of insulin-like growth factor. DIAGNOSIS: Postoperative pathologic examination confirmed the diagnosis of a malignant solitary fibrous tumor originating in the pleura. INTERVENTIONS: The patient underwent resection of a right thoracic mass and right pneumonectomy. The interprofessional team-consisting of the thoracic surgeon, an endocrinologist, a respiratory care nurse, a thrombosis specialist nurse, a nutrition nurse, and a critical care nurse-worked together to provide therapy and nursing care. OUTCOMES: The patient had an uneventful postoperative recovery in the hospital and was discharged on postoperative day 6. He was followed up for 6 months and continued to experience an excellent recovery. CONCLUSION: Interprofessional collaboration can improve postoperative recovery in cases of giant solitary fibrous tumor of the pleura, preventing potential complications.
BACKGROUND: Identifying caregivers with limited health literacy is an organizational care issue. Health care organizations need to prepare nurses to identify low-literacy caregivers and to equip caregivers with tools to...BACKGROUND: Identifying caregivers with limited health literacy is an organizational care issue. Health care organizations need to prepare nurses to identify low-literacy caregivers and to equip caregivers with tools to make informed care decisions. LOCAL PROBLEM: In a pediatric cardiovascular intensive care unit performing biventricular and single-ventricle repairs, caregiver satisfaction with understanding what was taught by nurses during hospitalization was below the national benchmark of 80%. Thirty-day readmission rates following surgical repair were above the national benchmark of 10%. METHODS: A quality improvement project was conducted. Nurses screened caregivers' health literacy within 24 hours of patient admission using a validated literacy screening tool. Nurses provided discharge education in 5 key areas: medication administration, wound care, cardiopulmonary resuscitation, nutrition, and need for additional medical care. Education was provided to the caregiver at the identified literacy level using the teach-back method. Data on project outcomes were collected via anonymous surveys and readmission rates were analyzed for trends in care management. RESULTS: Over a 12-month period, 150 caregivers were screened. Sixty-four percent of caregivers demonstrated adequate literacy, 23% displayed limited literacy, and 13% met criteria for low literacy. Caregiver satisfaction with discharge education during hospitalization increased to 100%, and caregivers indicated that they felt confident performing required posthospitalization tasks. Thirty-day readmission rates following surgical repair decreased by 1.8%. CONCLUSION: Increasing health literacy awareness is essential for improving patient health outcomes and empowering caregivers to make informed care decisions. Literacy tools can help nurses educate caregivers with limited health literacy to improve postdischarge care.
INTRODUCTION: Obesity increases the risk of severe acute respiratory distress syndrome, prolonging mechanical ventilation duration and intensive care unit stays. Factors affected by obesity include diaphragm displacement...INTRODUCTION: Obesity increases the risk of severe acute respiratory distress syndrome, prolonging mechanical ventilation duration and intensive care unit stays. Factors affected by obesity include diaphragm displacement and reduced lung volume. This case report discusses nursing care for a patient who received verticalization therapy, resulting in improved lung volume distribution and oxygenation. CLINICAL FINDINGS AND DIAGNOSIS: A 27-year-old man with obesity was admitted to the intensive care unit and placed on mechanical ventilation due to severe respiratory failure caused by an allergic reaction. Chest radiography revealed lung volume loss, atelectasis, and pulmonary edema. INTERVENTIONS: Within the first 24 hours of admission, the patient required increased ventilator settings, continuous intravenous sedatives, and paralytics. On hospital day 12, the patient was positioned prone to address refractory hypoxemia and acute respiratory distress syndrome. When prone positioning failed to improve oxygenation and ventilation, the patient was placed in a specialty bed to undergo verticalization therapy on hospital day 20. OUTCOMES: Within 24 hours of initiation of verticalization therapy, ventilator settings were decreased. Chest radiographs demonstrated improved lung volumes within 5 days of verticalization therapy initiation. CONCLUSION: This case report enhances the understanding of caring for patients with severe acute respiratory distress syndrome and obesity, emphasizing the critical role of nurse-led verticalization therapy in treating individuals affected by these conditions.