Critical Care Nursing Quarterly最新文献

Innovations in oncology have expanded treatment eligibility, leading to a rise in cancer patients requiring critical care. This necessitates that all critical care clinicians possess a fundamental knowledge of prevalent oncological conditions and identify emergent scenarios requiring immediate action. This article will explore key oncological complications and their management approaches.

Moral distress can impact nurses and the care team significantly. A profession dedicated to the principles of caring and compassion is often subjected to patients receiving futile treatment. With the proliferation of extreme life-prolonging measures come the difficulties in the withdrawal of those medical modalities. If a prognosis is poor and care is perceived as curative rather than palliative, providers may often feel conflicted and distressed by their interventions. The American Association of Colleges of Nursing has expressed growing concern about an increase in the use of inappropriate life-support treatments related to futile care. The compelling case of a severely beaten 69-year-old homeless man who had cardiac-arrested and was resuscitated after an unknown amount of down-time, provides the contextual framework for this report. Ethical conflicts can become very challenging, which inevitably increases the suffering of the patient and their caregivers. Research findings suggest that health care organizations can benefit from enacting processes that make ethical considerations an early and routine part of everyday clinical practice. A proactive approach to ethical conflicts may improve patient care outcomes and decrease moral distress.

This is a qualitative phenomenological study that was designed to navigate through nurses' lived experiences, burdens, and coping strategies while working with COVID-19 patients. The sample included 20 nurses who had worked with COVID-19 patients for more than or equal to 6 months. The interviews were conducted between October 1, 2021, and April 15, 2022. At that time, the third COVID wave had elapsed, and we were peaking on a fourth pandemic wave, so included participants had lived through a minimum of 2 to 3 peaks. Six themes emerged, which were: nurses coping with COVID-19 crisis, professional relationship burden, personal burden, environmental burden, physical symptom burden, and emotional burden of the crisis. Nurses' lived experiences during the pandemic were deep, intense, and moderately to highly affecting their ways of thinking, feeling, and behaving. That experience opened nurses' eyes on countless number of challenges that require special attention, care, and preparation on many levels. The minimal preparatory levels are personal, departmental, organizational, and strategic.

Burnout is a state of emotional and physical depletion. Its occurrence among critical care nurses (CCNs) is a concept that has gained traction yet remains an issue with global consequences. Nurses are especially vulnerable to burnout due to the persistent stressors they are exposed to, which include the general work environment, biological factors, and emerging changes caused by COVID-19. This study aims to assess the severity of burnout among CCNs during the COVID-19 pandemic and its associated factors. A descriptive cross-sectional questionnaire was used in this study to measure the estimated burnout rate among CCNs in Palestine and establish associations with potential factors. Maslach Burnout Inventory questionnaire was used for the task. The results showed out of the 173 participants, more than 35% reported severe overall burnout. Per burnout domains, it was found that around 70% of participants suffered from low personal accomplishment, while 59.5% had severe levels of depersonalization, and finally, more than 65% of critical nurses had severe emotional exhaustion. Out of the various variables tested, gender, age, type of hospital, PPE, and fear of transmission were found to be associated with overall burnout. CCNs in Palestine were found to be severely burned out and should be dealt with before getting out of hand. The research found variables related to burnout contributed to burnout. Recommendations for further studies and prioritization should be made.

Cardiogenic shock (CS) is a complex and dreadful condition for which effective treatments remain unclear. The concerningly high mortality rate of CS emphasizes a need for developing effective therapies to reduce its mortality and reverse its detrimental course. This article aims to provide an updated and evidence-based review of the pathophysiology of CS and the related pharmacotherapeutics with a special focus on vasoactive and inotropic agents.

The use of diaries is known to reduce post-intensive care syndrome in the intensive care unit (ICU) for survivors and families. Studies are needed to explore nurses' experience with diaries. Although the diaries are written for the patient, the diary entries may be helpful for the nurse as well. Research has shown that ICU diaries fill in significant memory gaps and aid in the resolution of delusional memories. However, there is a shortage of knowledge about the nurses' experience of writing caring notes in diaries. The purpose of this research was to explore the extracorporeal membrane oxygenation (ECMO) nurses' experience of writing caring notes in diaries during the patients' ICU stay. This is a descriptive phenomenological qualitative research study using semi-structured interviews. A one-on-one interview was performed, audiotaped, and transcribed. Three investigators analyzed the data for themes, subcategories, and indicators. A purposive sample of 15 specialty-trained ECMO nurses participated in the study. Three themes emerged from the study relating to the nurse, family, and patient, including positive and negative aspects of writing in the diary and barriers. The vast majority (88%) of 340 comments answered during the interviews were positive. Overall, nurses found the diaries to be beneficial to the nurse, family, and patient. Diary writing may help nurses get back to the core of why we do what they do. Understanding the nurses' experience may help to improve communication and family satisfaction while optimizing dairy programs.

Air medical transport of critically ill and injured patients began during World War II. Now air transport has become an integral part of health care, nationally and internationally. With the development of portable medical equipment critical care has extended beyond the hospital by bringing critical care to the scene or to rural hospitals. Air medical programs transport critically ill and injured patients by helicopter or airplane while continuously providing critical care enroute. These transports are interfacility from accident scenes, disaster areas, and remote locations where the patient is transported to a tertiary care center so that definitive care will be provided. The 2 modes of air transport are rotor wing (helicopters) and fixed wing (airplanes). Air medical transport is utilized when ground transportation is not conducive to patient criticality or location relative to a tertiary care center. There are many factors to consider when choosing a mode of transport, and each mode has its own unique advantages and disadvantages. Air medical programs place emphasis on clinical care, safety, and quality assurance, with the patient being the focused beneficiary. This article addresses implementation and management of rotor wing air medical transport with a focus on standards of care, safety, and quality.