Critical care nurse最新文献

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.

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.

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.