Critical care nurse最新文献

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.

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.

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.

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.

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.