Critical care nurse最新文献

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.

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.

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.