AACN Advanced Critical Care最新文献

Background: Diagnostic reasoning (DR) is a critical skill for nurse practitioners (NPs). This article provides an update of a 2022 scoping review of DR content in NP education, highlighting advances in curriculum integration.

Objective: To assess the degree that scholarly literature about clinical reasoning in NP education includes DR; identify how DR is defined in NP education; and describe the teaching methodologies used to support DR-related knowledge, skills, and/or attitudes.

Methods: We examined and categorized the literature from the past 2.5 years, assessing the scope, current status, and impact of DR-related content in NP education programs.

Results: Literature reviews emphasized meta-cognitive strategies and competency assessment. Case reports described innovative teaching interventions and objective measures of student competency. Primary research articles explored a variety of DR topics, including survey research, diagnostic accuracy, structured reflection, and tool validation studies. New contributions included model and tool development articles for teaching and evaluating DR.

Conclusions: Substantial progress was seen in the integration of DR components, theory, evidence-based teaching, and evaluation approaches in NP education, demonstrating increased awareness of the importance of DR competencies for NP students. Extending these advances to faculty, preceptor, and NP research development will provide important foundations for NP education and scholarship.

This article provides a comprehensive narrative review and explanation of the theory, science, and component processes of diagnostic reasoning, based on over 30 years of diagnostic reasoning literature. Building on this background information and the authors' nurse practitioner education and practice expertise, foundational diagnostic reasoning concepts and processes are applied to nurse practitioner education and practice. Foci are suggested for nurse practitioner education competencies in the diagnostic reasoning components of illness scripts and script activation, interaction and encounter management, hypothesis-directed patient evaluation, problem representation and differential diagnosis, value-based testing, identifying and communicating the working diagnosis, developing the management plan, and metacognition and documentation. The desired goals include highest quality practice, diagnostic safety, and improved health outcomes.

Postgraduate fellowship programs for nurse practitioners have proliferated since 2007. These programs facilitate the transition to practice for new nurse practitioners as well as those who are experienced and choose to move to a new specialty. Outcome data demonstrate the effectiveness of these programs in promoting the development of novice nurse practitioners. Fellowship programs offer education outside the framework of the Consensus Model for regulation of the licensure, accreditation, certification, and education of advanced practice registered nurses and have limited implications for nurse practitioners' scope of practice. Greater understanding of the limits of fellowship programs is needed to ensure that nurse practitioners work within their scope of practice.

Alarm bells are sounding internationally as climate change impacts planet Earth and its inhabitants. Health care organizations must consider the role they play in working toward environmental sustainability in terms of mitigation, resilience, leadership, and equity. Institutions need to address the effects of climate change on the physical health and mental well-being of patients and their families as well as employees. Awareness of the complexities of sustainability initiatives and disaster management related to inclement weather and weather-related events is critical for health care organizations to avoid precipitating the illnesses and diseases they endeavor to prevent and heal.

The health care industry accounts for 5% of global greenhouse gas emissions, with hospitals being the largest contributor. Critical care units create 3 times the greenhouse emissions of other hospital patient care units. Health care contributions to environmental harm include medical waste disposal, toxicant exposure, and pollutants. Integrating green practices into hospitals, especially in intensive care units, can seem overwhelming, with barriers including time constraints, lack of leadership and organizational support, and ignorance of green practices. Nursing is a socially responsible discipline committed to improving the health of individuals and communities; values of environmental stewardship and the desire to minimize poor health outcomes caused by climate change do not always align with hospital policies or clinician practices. This article addresses how nurses can confront the complex environmental problems in the workplace, apply sustainability principles to develop a green nursing practice, and collectively influence the future of national and global health.

Climate change affects human health broadly and is leading to poor population health outcomes in a number of areas. Among pregnant people specifically, it can contribute to greater risk of health complications. Certain populations are more likely to be exposed to the adverse environmental impacts of climate change, which further amplifies existing health inequities in the United States, including in maternal health. Nurses who work in emergent, acute, and critical care settings must be prepared to care for individuals who are pregnant and experiencing medical emergencies as a result of exposure to extreme heat, air pollution, natural disasters, and infectious diseases that are direct consequences of climate change. To this end, nurses must be ready to recognize, treat, and manage pregnancy complications arising from climate-related conditions, as well as provide patient education on future mitigation strategies and advocacy to reduce its harms.

Climate change is apparent. Temperatures are rising. Floods are more frequent and devastating. Climate changes can favor the development of emerging infectious diseases. The number of animal reservoirs and vector hosts can increase, further spreading pathogens. Many emerging infectious diseases were not historically considered major threats in US but have become a major concern in US territories and various states. In June 2024, the Centers for Disease Control and Prevention issued a Health Alert Network advisory about an increase in local transmission of dengue fever. Preventing the transmission of emerging infectious diseases has become a focus of regulatory agencies. Nurse education at all levels should include infectious diseases and be coordinated with local, state, and regional institutions. Emerging infectious diseases are now formidable challenges to health care.

Climate change has increased the frequency and severity of natural disasters, including the 2023 wildfires in Maui, Hawai'i. The no-notice disaster affected hospital operations at the sole acute care hospital that serves the community, requiring immediate interventions and reallocation of resources. The purpose of this article is to explore the role that critical care nurses play in responding to wildfires. Literature related to the nursing role in managing wildfire injuries and the events on Maui are explored and a case study presented. Results are organized into themes: environmental limitations, disaster response and code triage activation, no-notice preparation for critical care nurses, preparation to increase patient capacity and maintain patient safety standards, hospital staffing and staff affected by the disaster, management of patient care and hospital system operations, and disaster medical tent. Preparation for no-notice events requires critical care nurse involvement to effectively facilitate care for patients affected by disasters.

Background: The term post-intensive care syndrome refers to a group of symptoms that commonly occur after intensive care unit discharge, leading to worsening physical or mental health. The incidence of this syndrome is increasing. Critical care clinicians can play a pivotal role in improving patient outcomes through knowledge of post-intensive care syndrome risk factors and symptoms.

Objective: To explore critical care clinicians' current knowledge of post-intensive care syndrome as a basis for developing critical care educational interventions.

Methods: This quantitative, cross-sectional, observational pilot study was conducted to survey critical care physicians, nurses, nurse practitioners, and physician assistants at a university hospital on their knowledge of post-intensive care syndrome symptoms and risk factors and their confidence in their ability to recognize the condition.

Results: A total of 51 clinicians completed the survey. The overall levels of knowledge and confidence regarding post-intensive care syndrome risk factors and symptoms were low, with no significant differences found by clinician role.

Conclusions: These findings support the need for interprofessional education on post-intensive care syndrome risk factors and early identification of symptoms in the critical care setting.