Pub Date : 2019-07-01DOI: 10.1097/01.CCN.0000565132.49413.54
L. Simko, Alicia L. Culleiton
The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.
{"title":"Cardiogenic shock with resultant multiple organ dysfunction syndrome.","authors":"L. Simko, Alicia L. Culleiton","doi":"10.1097/01.CCN.0000565132.49413.54","DOIUrl":"https://doi.org/10.1097/01.CCN.0000565132.49413.54","url":null,"abstract":"The prognosis for a patient with multiple organ dysfunction syndrome (MODS)-also known as organ dysfunction or organ failure-is grave, and mortality can be high when three or more organ systems fail. This article reviews ongoing abnormalities of organ-specific parameters and a bedside clinical scoring assessment tool to identify the mortality of MODS, focusing on the management of MODS resulting from cardiogenic shock in ICU patients who require support of failing organs to survive.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000565132.49413.54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61632696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1097/01.CCN.0000565040.65898.01
Joseph M. Caristo, P. Clements
Bullying, incivility, and workplace violence are pervasive problems within the nursing profession, resulting in a toxic work environment, a variety of related health issues, increased costs to healthcare organizations, and compromises in patient safety. Bullying, incivility, and workplace violence can occur in all areas of nursing.1 Each of these pervasive challenges can take many forms. Here are a few illustrative scenarios: A new RN is struggling with his patient assignment. When he requests help from his more experienced coworker, she replies that she is “too busy” with her own assignment to assist, even though she knows he has been struggling. Her denial of assistance is accompanied by a comment such as, “I am just as busy as you are. Keep trying, and you will eventually figure it out. That’s how I learned when I was a new nurse.” During shift change, an experienced RN rolls her eyes and mutters under her breath as she reads the assignment board that was created by a lessexperienced, younger RN for her first time. She comments within earshot of the new nurse, “These Millenials have no idea what they are doing.” A newly hired RN who was once unlicensed assistive personnel (UAP) has noticed that other RNs on the unit do not seem to trust her judgment and repeatedly tell her what she is doing is wrong. Instead of providing insight into strategies for improved performance, her nurse colleagues simply turn and walk away when she tries to explain why she selected a certain approach. These examples demonstrate the critical importance for all members of the nursing profession to actively examine and combat the effects of bullying, incivility, and workplace violence in the healthcare environment; establish methods for identification of and disciplinary consequences for bullying behavior; and conduct an examination of the related financial burdens of attrition for hospitals and other healthcare agencies. Nurse manager promotion of zero-tolerance policies for workplace violence, including bullying, and increased education is necessary for a cultural shift within contemporary nursing policy and practice. Bullying, incivility, and workplace violence defined Workplace bullying has been discussed in the nursing literature for almost 20 years. The phenomenon is often referenced by the expression “Nurses eat their young.”2 In spite of the widespread recognition of this damaging behavior toward new, young, or inexperienced nurses, the problem persists. One definition of workplace bullying is repeated, health-harming mistreatment of one or more persons by one or more perpetrators. It is abusive conduct (threats, humiliation, intimidation, or verbal abuse) that causes work interference.3 Bullying may also be referred to as horizontal violence, lateral violence, or relational aggression.4 Bullying, abuse, conflict, incivility, and lateral violence of any form make up the broader phenomenon of workplace incivility.5 All of these terms describe forms of psychologic
{"title":"Let's stop “eating our young”","authors":"Joseph M. Caristo, P. Clements","doi":"10.1097/01.CCN.0000565040.65898.01","DOIUrl":"https://doi.org/10.1097/01.CCN.0000565040.65898.01","url":null,"abstract":"Bullying, incivility, and workplace violence are pervasive problems within the nursing profession, resulting in a toxic work environment, a variety of related health issues, increased costs to healthcare organizations, and compromises in patient safety. Bullying, incivility, and workplace violence can occur in all areas of nursing.1 Each of these pervasive challenges can take many forms. Here are a few illustrative scenarios: A new RN is struggling with his patient assignment. When he requests help from his more experienced coworker, she replies that she is “too busy” with her own assignment to assist, even though she knows he has been struggling. Her denial of assistance is accompanied by a comment such as, “I am just as busy as you are. Keep trying, and you will eventually figure it out. That’s how I learned when I was a new nurse.” During shift change, an experienced RN rolls her eyes and mutters under her breath as she reads the assignment board that was created by a lessexperienced, younger RN for her first time. She comments within earshot of the new nurse, “These Millenials have no idea what they are doing.” A newly hired RN who was once unlicensed assistive personnel (UAP) has noticed that other RNs on the unit do not seem to trust her judgment and repeatedly tell her what she is doing is wrong. Instead of providing insight into strategies for improved performance, her nurse colleagues simply turn and walk away when she tries to explain why she selected a certain approach. These examples demonstrate the critical importance for all members of the nursing profession to actively examine and combat the effects of bullying, incivility, and workplace violence in the healthcare environment; establish methods for identification of and disciplinary consequences for bullying behavior; and conduct an examination of the related financial burdens of attrition for hospitals and other healthcare agencies. Nurse manager promotion of zero-tolerance policies for workplace violence, including bullying, and increased education is necessary for a cultural shift within contemporary nursing policy and practice. Bullying, incivility, and workplace violence defined Workplace bullying has been discussed in the nursing literature for almost 20 years. The phenomenon is often referenced by the expression “Nurses eat their young.”2 In spite of the widespread recognition of this damaging behavior toward new, young, or inexperienced nurses, the problem persists. One definition of workplace bullying is repeated, health-harming mistreatment of one or more persons by one or more perpetrators. It is abusive conduct (threats, humiliation, intimidation, or verbal abuse) that causes work interference.3 Bullying may also be referred to as horizontal violence, lateral violence, or relational aggression.4 Bullying, abuse, conflict, incivility, and lateral violence of any form make up the broader phenomenon of workplace incivility.5 All of these terms describe forms of psychologic","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000565040.65898.01","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44946412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-01DOI: 10.1097/01.CCN.0000560100.86664.9d
J. Crable
Approximately 395,000 patients per year undergo cardiac surgery in the US, with the incidence of postoperative cardiac arrest in adult patients ranging from 0.7% to 2.9%.1-6 Cardiac arrest after cardiac surgery typically is related to one of two types of reversible causes: electrophysiologic disturbances, such as dysrhythmias; or mechanical causes, such as graft malfunction, cardiac tamponade, bleeding, or tension pneumothorax.7 Around the world, outcomes for patients undergoing cardiac surgery who experience cardiac arrest are good but vary, with between 17% and 79% of patients surviving to discharge.8 Of these patients, 25% to 50% involve ventricular fibrillation (VF) and can be treated immediately with defibrillation.8 Additionally, both cardiac tamponade and major bleeding events respond to resuscitation and emergency resternotomy.8 The current American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) guidelines do not specifically address cardiac arrests following cardiac surgery.9 In 2009, the European Association for Cardio-Thoracic Surgery published its Guideline for Resuscitation in Cardiac Arrest after Cardiac Surgery.8 Called CALS-S in the US, this guideline has been adopted in several prominent cardiac programs.10 Because of ACLS limitations, many US cardiac surgery programs, including this study hospital, have established their own cardiac arrest post cardiac surgery protocols that are not necessarily standardized or evidence-based.11 CALS-S provides an evidencebased protocol to improve outcomes for cardiac arrest in patients who have undergone cardiac surgery.8 Failure to rescue (FTR) is the occurrence of death after complications not present at the time of admission.12 In 2015, using modified ACLS guidelines at this study hospital, 1,097 patients underwent cardiac surgery, and 15 of these patients (1.4%) suffered a cardiac arrest after surgery. Of these, eight did not survive, translating to a pre-CALS-S implementation FTR rate of 53%. The nurse experience during cardiac arrest can be stressful and uncomfortable.13 Stress affects nurse performance and patient outcomes in cardiac arrest response.13 Previous nurse stress levels at this study hospital were unknown, but anecdotal evidence suggested some degree of stress and discomfort among cardiac surgery intensive care unit (CSICU) nurses. The purpose of this quality improvement project was to reduce the FTR rate for cardiac arrest in cardiac surgery patients by implementing an educational intervention to improve CSICU nurses’ comfort and confidence in using the CALS-S guideline when responding to such events.
{"title":"Improving patient outcomes with the Cardiac Advanced Life Support-Surgical (CALS-S) guideline","authors":"J. Crable","doi":"10.1097/01.CCN.0000560100.86664.9d","DOIUrl":"https://doi.org/10.1097/01.CCN.0000560100.86664.9d","url":null,"abstract":"Approximately 395,000 patients per year undergo cardiac surgery in the US, with the incidence of postoperative cardiac arrest in adult patients ranging from 0.7% to 2.9%.1-6 Cardiac arrest after cardiac surgery typically is related to one of two types of reversible causes: electrophysiologic disturbances, such as dysrhythmias; or mechanical causes, such as graft malfunction, cardiac tamponade, bleeding, or tension pneumothorax.7 Around the world, outcomes for patients undergoing cardiac surgery who experience cardiac arrest are good but vary, with between 17% and 79% of patients surviving to discharge.8 Of these patients, 25% to 50% involve ventricular fibrillation (VF) and can be treated immediately with defibrillation.8 Additionally, both cardiac tamponade and major bleeding events respond to resuscitation and emergency resternotomy.8 The current American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) guidelines do not specifically address cardiac arrests following cardiac surgery.9 In 2009, the European Association for Cardio-Thoracic Surgery published its Guideline for Resuscitation in Cardiac Arrest after Cardiac Surgery.8 Called CALS-S in the US, this guideline has been adopted in several prominent cardiac programs.10 Because of ACLS limitations, many US cardiac surgery programs, including this study hospital, have established their own cardiac arrest post cardiac surgery protocols that are not necessarily standardized or evidence-based.11 CALS-S provides an evidencebased protocol to improve outcomes for cardiac arrest in patients who have undergone cardiac surgery.8 Failure to rescue (FTR) is the occurrence of death after complications not present at the time of admission.12 In 2015, using modified ACLS guidelines at this study hospital, 1,097 patients underwent cardiac surgery, and 15 of these patients (1.4%) suffered a cardiac arrest after surgery. Of these, eight did not survive, translating to a pre-CALS-S implementation FTR rate of 53%. The nurse experience during cardiac arrest can be stressful and uncomfortable.13 Stress affects nurse performance and patient outcomes in cardiac arrest response.13 Previous nurse stress levels at this study hospital were unknown, but anecdotal evidence suggested some degree of stress and discomfort among cardiac surgery intensive care unit (CSICU) nurses. The purpose of this quality improvement project was to reduce the FTR rate for cardiac arrest in cardiac surgery patients by implementing an educational intervention to improve CSICU nurses’ comfort and confidence in using the CALS-S guideline when responding to such events.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000560100.86664.9d","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48669537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1097/01.CCN.0000554831.89961.bc
C. Macleod
Abstract: This article reviews coronary artery bypass grafting preoperative preparation, operative procedure, and postoperative care. A patient case study frames this article's discussion of clinician action, patient healthcare options, and nursing considerations. Preoperative patient education, postoperative complications, and interventions are reviewed.
{"title":"Emergency coronary artery bypass grafting: An overview","authors":"C. Macleod","doi":"10.1097/01.CCN.0000554831.89961.bc","DOIUrl":"https://doi.org/10.1097/01.CCN.0000554831.89961.bc","url":null,"abstract":"Abstract: This article reviews coronary artery bypass grafting preoperative preparation, operative procedure, and postoperative care. A patient case study frames this article's discussion of clinician action, patient healthcare options, and nursing considerations. Preoperative patient education, postoperative complications, and interventions are reviewed.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"14 1","pages":"8–13"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000554831.89961.bc","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44298314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1097/01.CCN.0000554837.72036.49
C. Foody, Danielle McDonald, L. Lozano
Medication errors are a leading, yet preventable, cause of patient harm. Healthcare providers need to make the medication administration process as safe as possible to reduce adverse drug events (ADEs), which include medication errors as well as near-misses. Medication errors are defined as medication administration at the incorrect time, frequency, strength, or dose; by the incorrect route; or to the incorrect patient.1 A near-miss can be defined as a risk of a medication error that is discovered before the error reaches the patient.2 Challenges arise when healthcare professionals must administer multiple medications to several patients, which can be complicated when confronted with a vast array of outside factors and interruptions. The original five rights of medication administration include the following: Right Patient, Right Medication, Right Dose, Right Route, and Right Time. These rights are often neglected when interruptions occur during a medication pass.3 Evidence reveals that millions of medical errors occur each year; 250,000 of these errors are directly related to medication errors, causing 44,000 to 98,000 deaths per year.4 The authors of the present study endeavored to reduce interruptions during a medication pass to ultimately decrease the number of errors and near-misses on the 31-bed progressive care unit in a community-based hospital. The nurses’ schedules and assignments were random and followed a 4:1 patient-to-nurse ratio. The study began in November 2017 and concluded in August 2018. The purpose of the
{"title":"Reducing medication interruptions on a progressive care unit","authors":"C. Foody, Danielle McDonald, L. Lozano","doi":"10.1097/01.CCN.0000554837.72036.49","DOIUrl":"https://doi.org/10.1097/01.CCN.0000554837.72036.49","url":null,"abstract":"Medication errors are a leading, yet preventable, cause of patient harm. Healthcare providers need to make the medication administration process as safe as possible to reduce adverse drug events (ADEs), which include medication errors as well as near-misses. Medication errors are defined as medication administration at the incorrect time, frequency, strength, or dose; by the incorrect route; or to the incorrect patient.1 A near-miss can be defined as a risk of a medication error that is discovered before the error reaches the patient.2 Challenges arise when healthcare professionals must administer multiple medications to several patients, which can be complicated when confronted with a vast array of outside factors and interruptions. The original five rights of medication administration include the following: Right Patient, Right Medication, Right Dose, Right Route, and Right Time. These rights are often neglected when interruptions occur during a medication pass.3 Evidence reveals that millions of medical errors occur each year; 250,000 of these errors are directly related to medication errors, causing 44,000 to 98,000 deaths per year.4 The authors of the present study endeavored to reduce interruptions during a medication pass to ultimately decrease the number of errors and near-misses on the 31-bed progressive care unit in a community-based hospital. The nurses’ schedules and assignments were random and followed a 4:1 patient-to-nurse ratio. The study began in November 2017 and concluded in August 2018. The purpose of the","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":"14 1","pages":"45–48"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000554837.72036.49","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1097/01.CCN.0000554830.12833.2f
Ellen Fineout-Overholt
www.nursingcriticalcare.com TA M IS C IA O / S H U T T E R S T O C K Critical care nurses can best explain the reasoning for their clinical actions when they understand the worth of the research supporting their practices. In critical appraisal, clinicians assess the worth of research studies to clinical practice. Given that achieving improved patient outcomes is the reason patients enter the healthcare system, nurses must be confident their care techniques will reliably achieve best outcomes. Nurses must verify that the information supporting their clinical care is valid, reliable, and applicable. Validity of research refers to the quality of research methods used, or how good of a job researchers did conducting a study. Reliability of research means similar outcomes can be achieved when the care techniques of a study are replicated by clinicians. Applicability of research means it was conducted in a similar sample to the patients for whom the findings will be applied. These three criteria determine a study’s worth in clinical practice. Appraising the worth of research requires a standardized approach. This approach applies to both quantitative research (research that deals with counting things and comparing those counts) and qualitative research (research that describes experiences and perceptions). The word critique has a negative connotation. In the past, some clinicians were taught that studies with flaws should be discarded. Today, it is important to consider all valid and reliable research informative to what we understand as best practice. Therefore, the author developed the critical appraisal methodology that enables clinicians to determine quickly which evidence is worth Abstract: Critical appraisal is the assessment of research studies’ worth to clinical practice. Critical appraisal— the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis, and recommendation. This article reviews each phase and provides examples, tips, and caveats to help evidence appraisers successfully determine what is known about a clinical issue. Patient outcomes are improved when clinicians apply a body of evidence to daily practice.
{"title":"A guide to critical appraisal of evidence","authors":"Ellen Fineout-Overholt","doi":"10.1097/01.CCN.0000554830.12833.2f","DOIUrl":"https://doi.org/10.1097/01.CCN.0000554830.12833.2f","url":null,"abstract":"www.nursingcriticalcare.com TA M IS C IA O / S H U T T E R S T O C K Critical care nurses can best explain the reasoning for their clinical actions when they understand the worth of the research supporting their practices. In critical appraisal, clinicians assess the worth of research studies to clinical practice. Given that achieving improved patient outcomes is the reason patients enter the healthcare system, nurses must be confident their care techniques will reliably achieve best outcomes. Nurses must verify that the information supporting their clinical care is valid, reliable, and applicable. Validity of research refers to the quality of research methods used, or how good of a job researchers did conducting a study. Reliability of research means similar outcomes can be achieved when the care techniques of a study are replicated by clinicians. Applicability of research means it was conducted in a similar sample to the patients for whom the findings will be applied. These three criteria determine a study’s worth in clinical practice. Appraising the worth of research requires a standardized approach. This approach applies to both quantitative research (research that deals with counting things and comparing those counts) and qualitative research (research that describes experiences and perceptions). The word critique has a negative connotation. In the past, some clinicians were taught that studies with flaws should be discarded. Today, it is important to consider all valid and reliable research informative to what we understand as best practice. Therefore, the author developed the critical appraisal methodology that enables clinicians to determine quickly which evidence is worth Abstract: Critical appraisal is the assessment of research studies’ worth to clinical practice. Critical appraisal— the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis, and recommendation. This article reviews each phase and provides examples, tips, and caveats to help evidence appraisers successfully determine what is known about a clinical issue. Patient outcomes are improved when clinicians apply a body of evidence to daily practice.","PeriodicalId":19344,"journal":{"name":"Nursing Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.CCN.0000554830.12833.2f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44706833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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