Critical Care Nursing Quarterly最新文献

Enteral feeding is a major risk factor for ventilator-associated pneumonia (VAP). Abdominal massage is believed to reduce residual gastric content, potentially decreasing the incidence of VAP. This study aims to evaluate the effect of abdominal massage as a complementary therapy on aspiration risk and physiological parameters in mechanically ventilated patients. An experimental research design was used. A purposive sample of 60 mechanically ventilated adult patients receiving intermittent nasogastric enteral feeding was selected. Data were collected using the Abdominal Massage Assessment tool. Physiological parameters in the study group were lower than those in the control group after receiving abdominal massage. The study concludes that abdominal massage improves patients' physiological parameters and reduces the incidence of aspiration in enterally fed, mechanically ventilated patients.

Sepsis and septic shock are two of the most prevalent disease states in today's medical intensive care units. Sepsis is a multi-system inflammatory response to infection that affects multiple organ systems, with the cardiovascular system being one of the most profoundly affected. Inflammatory mediators cause dilatation of the venous system, local tissue perfusion defects cause vasoconstriction of arterioles, and catecholamines cause increases in heart rate. Thus, nurses play a crucial role in assessing these clinical manifestations in the critically ill patient as noted through blood pressure, heart rate, capillary refill, and mentation. Invasive monitoring, such as arterial lines along with laboratory markers of perfusion also contribute to characterization of this clinical picture. Thus, early recognition and intervention are essential to prevent the progression to cardiovascular collapse and death. This article provides practical guidance for nurses in recognizing cardiovascular instability and implementing treatment strategies to help improve patient outcomes in the critical care setting.

We developed a streamlined approach to improve healthcare quality by enhancing the patient admission process to the intensive care unit (ICU). Guided by the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines, our departmental initiative, "Starting on the Right Foot," was implemented in 3 stages: data collection and problem identification, design and implementation, and regular assessments. To evaluate the impact of this intervention, we compared satisfaction rates before and after implementation. One year following the launch of the initiative, we observed a significant increase in satisfaction among patients' loved ones during ICU admissions. The average satisfaction rating rose from 51.5% prior to the intervention to 81.6% post-implementation (p < .001), underscoring the model's effectiveness in improving the overall critical care experience. This initiative demonstrates the value of a family-centered model that emphasizes communication, empathy, and collaboration, and we advocate for similar approaches to foster a more compassionate, patient-centered environment in healthcare settings.

Critical care nurses experience high levels of burnout compared to other nurses, due to daily exposure to extremely stressful situations, critically ill patients, and high workload. Emotional intelligence (EI) is considered a protective factor against burnout. There is a dearth of literature on the association between these 2 variables among critical care nurses including those in Jordan. To explore the relationship between EI and burnout among critical care nurses in Jordan, a descriptive, cross-sectional, and correlational design was used. A convenience sample of 284 critical care nurses working in Jordanian governmental hospitals was recruited. Data were collected using Maslach burnout inventory to assess burnout level, and Genos Emotional Intelligence Inventory (concise version) to assess EI level. Nurses' burnout level was moderate with respect to emotional exhaustion (44.5%), while high burnout was reported for depersonalization (66.9%) and low personal accomplishment (48.4%). In terms of hierarchical regression analysis, emotional exhaustion was predicted negatively as a function of working hours, other marital status group, and emotional intelligence, with 26.2% of variance explained, and similar results were observed in depersonalization burnout with 15.5% of variance explained. Finally, EI alone had a positive impact on personal accomplishment with 38.8% of variance in personal accomplishment explained by nurses' emotional intelligence. This study showed a negative and significant correlation between EI and burnout levels among nurses in critical care units in Jordan. Starting to prepare nurses to be emotionally competent is highly recommended to reduce their burnout.

Unstable patients in the neurocritical care unit (NCCU) need repeated diagnostic imaging. Intrahospital transports of such patients is hazardous where even small changes in physiology may lead to secondary brain injury. In this study we describe the workflow, safety aspects and reflect on our initial experience of close-to-bedside magnetic resonance (MR) imaging in the NCCU. A descriptive observational study was conducted to assess the safety of the transportation method and potential physiological changes associated with it. Eligible patients referred for MR imaging while in critical care at the NCCU between December 2021 and April 2022 were included. Physiological variables, including mean arterial pressure, heart rate, oxygen saturation, and fraction of inspired oxygen, were documented by critical care nurses before patient transfer, midway through MR scanning, and upon return to the NCCU bed. The suite's setup, including equipment and staffing, is detailed. Patient preparation and transportation procedures are described, emphasizing safety protocols. No main detrimental physiological changes occurred in patients undergoing close-to-bedside MR scanning included in our study (n = 45). No hazardous safety incidents occurred during the conduction of this study using this transportation approach. The concept of close-to-bedside MR imaging in the NCCU appears safe and minimizes numerous risks associated with intrahospital transports of unstable patients in neurocritical care. Safe access to repeated MR scanning of NCCU patients enables us to further advance the field of neurocritical care.

Early basic life support and defibrillation using automated external defibrillators (AEDs) are key for improving survival in those suffering an out-of-hospital sudden cardiac arrest. To improve survival, access to AEDs by lay responders is growing, and use is included in basic cardiac life support training. These devices are considered extremely safe, evidenced by the paucity of medical literature on AED misuse and expert opinion. However, it's crucial to point out that even medical personnel can make errors in their use. This case study of AED misuse during a community event and narrative literature review underscores the potential for errors in using an AED, which could cause considerable patient harm. To prevent errors in AED use, it is important to train on (1) equipment in use or likely to be encountered in the field, (2) how to dump an electric charge, especially when using a fully automated machine, (3) the need to follow specific machine instructions, (4) proper application of the defibrillator pads (including one-piece pads with metronome), (5) the need to assess the patient and not rely entirely on the AED prompts, which can contain false alerts and inappropriate instruction, and (6) the need for closed-loop communication, even when participating in a community event.

Observational studies have explored associations between frailty and delirium, but conclusions have been controversial. We aimed to identify the potential causality effect between these 2 traits using Mendelian randomization (MR). The genetics instrument related with frailty index (FI) was taken from a summary-level genome-wide association study (GWAS), and the GWAS of delirium was obtained from the FinnGen Study. The inverse variance weighted method (IVW) was performed. MR analysis found a causal association between genetically predicted FI and an elevated risk of delirium in IVW (odds ratio [OR]: 2.85; 95% CI: 1.03-7.90; P= .04). This study encouraged early identification of the baseline frailty in intensive care units. Critical care nurses are advised to use multidimensional tools to identify frailty. Then, individualized care plans should be made according to frailty degrees, like nutrition and pre-rehabilitation for pre-frail patients. Nurses can optimize medical resources and apply cluster interventions for delirium high-risk groups.

Cardiac arrest, a condition in which the heart ceases to function and oxygen delivery to the brain and other vital organs is interrupted, affects 700 000 Americans annually. One of the most devastating consequences of cardiac arrest is the lack of oxygen delivery to the brain, resulting in anoxic brain injury and severe neurological dysfunction. The pivotal trial published in 2002 by Dr. Stephen Bernard and his team, touted the positive benefits of therapeutic temperature management on the neurological recovery of post-cardiac arrest patients and changed the way the scientific and medical communities viewed the use of hypothermia. Since then, research has seemingly confirmed the apparent benefits of hypothermia on neurological recovery but the question remains as to what temperature patients should be cooled to, and more recently, if patients should actively be cooled at all or if the medical team should strive to maintain normothermia. A thorough literature review identified 6 studies comparing the neurological benefits of targeted temperature management and targeted normothermia, and concluded that a change in clinical practice cannot be made based on the current literature.

Sepsis is an inflammatory response to severe infection, which can affect any organ system. This inflammatory response can lead to life-threatening end organ dysfunction. In this article, we review pulmonary complications of sepsis including hypoxemia and acute respiratory distress syndrome. We also discuss pulmonary sources of sepsis including the management of community- and hospital-acquired pneumonia and ventilator-associated pneumonia.