Critical care nurse最新文献

Background: Women with large breasts are at risk for wounds after sternotomy.

Local problem: Over 12 months, 7 of 110 female patients who underwent sternotomy (6.4%) had 274 additional hospital days related to pressure injuries and sternal dehiscence after sternotomy. The financial burden for the longer stays was more than $751 000. The purpose of this quality improvement initiative was to implement a soft, comfortable bra to prevent wounds and sternal dehiscence in female patients after sternotomy.

Methods: Nurses implemented a new bra that reduced wound tension, had stretchable material that could expand for swelling, did not absorb moisture, and was available in a range of sizes to accommodate all women. Staff members measured patients' chest circumference before surgery and dressed patients in the bra in the operating room immediately after surgery. Patients wore the bra for breast support 20 to 24 hours a day for 6 weeks after surgery.

Results: The new bra was used for 82 patients. No patients who wore the bra developed sternal dehiscence or chest pressure wounds. The wound incidence rate decreased from 6.4% to 0%.

Conclusion: Female patients undergoing sternotomy should be dressed in a comfortable and appropriately sized bra immediately after surgery and should wear it for 6 weeks. Such a bra can help prevent sternal dehiscence and pressure injuries.

Background: Hospitalized patients often experience sleep disruption that fragments their sleep and disturbs their circadian rhythms, putting them at risk for sleep deprivation. The risk increases with greater severity of illness and is especially high in intensive care unit patients. Sleep deprivation can prolong the intensive care unit stay, contribute to emotional and physiological distress, and even increase the patient's risk of death.

Local problem: Critical care nurses in a 28-bed medical intensive care unit reported that patients often complained of sleep disruption or exhibited emotional and physical distress resulting from sleep deprivation. An analysis of the gap between recommended evidence-based best practice and current practices in the unit revealed numerous opportunities to improve patients' sleep. The aim of this evidence-based quality improvement project was to increase interprofessional adherence to an existing sleep-promoting schedule to reduce avoidable interruptions and improve patient sleep quality.

Methods: To promote sleep, staff member interactions with patients between midnight and 4 am were minimized, if appropriate. Documented patient encounters and call bell initiation were evaluated as process measures. Patients' self-perceived sleep quality, an outcome measure, was evaluated using the Richards-Campbell Sleep Questionnaire.

Results: Adherence to a sleep-promoting schedule reduced patient sleep interruptions between midnight and 4 am by as much as two-thirds while increasing patients' overall self-perceived sleep quality by 6.7 percentage points.

Conclusion: An interprofessional effort to minimize patient interruptions at night in an intensive care unit setting led to improved patient sleep quality and sustainable practice changes.

Background: Critically ill patients may have pressure injuries upon admission, increasing the need for nursing care and resources.

Local problem: An increase in pressure injuries during the COVID-19 pandemic required implementation of 2-nurse skin assessments for pressure injury identification and prevention.

Methods: A quality improvement initiative incorporating tele-intensive care unit (tele-ICU) nurses and wound, ostomy, and continence nurses using camera technology in collaboration with bedside intensive care unit nurses was conducted in 3 intensive care units within a multi-institutional health care system from 2021 through 2023. Sites included an academic medical center and 2 community hospitals. The team implemented the following bundle: (1) tele-ICU nurses provided second skin assessments, (2) tele-ICU and bedside intensive care unit nurses reviewed pressure injury prevention measures on admission, and (3) tele-ICU nurses documented pressure injuries. Customized daily dashboards and automated reporting were implemented. Crude data descriptive analysis and segmented regression analysis were used.

Results: For 4723 admissions, 2-nurse skin assessment compliance increased from 46.9% during the 9-month preimplementation period to 80.8% during the 18-month postimplementation period, showing that compliance increased by 72.3%. Overall, 1153 pressure injuries were identified on intensive care unit admission or transfer, a mean of 20.6 per month before implementation and 64.1 per month after implementation. In the segmented regression analysis, the number of pressure injuries identified as present on admission significantly increased after implementation (P = .02).

Conclusion: Integrating tele-ICU nurses, bedside intensive care unit nurses, and wound, ostomy, and continence nurses with camera technology increased compliance with 2-nurse assessments, leading to identification of present-on-admission pressure injuries, prompt treatment, and preventive interventions.

Background: Percutaneous coronary intervention has been the main percutaneous method of myocardial revascularization used in all clinical scenarios, but patients undergoing these procedures may experience negative physiological and psychological changes.

Objective: To identify the physiological and psychological changes experienced by patients undergoing percutaneous coronary intervention.

Methods: This integrative review was carried out through a search for primary studies included in the PubMed, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), LILACS (Latin America and the Caribbean Literature on Health Sciences), and Embase databases in February 2023. No publication time frame was delimited, and articles in English, Portuguese, and Spanish were considered.

Results: Of the 889 studies initially identified in the search, 20 made up the final sample. The majority (n = 13) of the included studies predominantly assessed psychological changes after percutaneous coronary intervention, with follow-up periods ranging from 6 months to 1 year. A few studies (n = 6) explored physiological changes among patients undergoing percutaneous coronary intervention, and 1 study investigated the prevalence of depression and anxiety in patients with coronary heart disease in 24 European countries. The main psychological changes found after percutaneous coronary intervention were increased anxiety and depression. Anxiety and depression levels were reduced at long-term follow-up. Physiological changes included fatigue, shortness of breath, and chest discomfort.

Conclusion: The results of this review show an urgent need for health care professionals to better assess patients' psychological state and employ strategies aimed at providing comprehensive care.