Dimensions of Critical Care Nursing最新文献

Background: Determining appropriate extracorporeal membrane oxygenation (ECMO) candidacy ensures appropriate utilization of this costly resource. The current ECMO survival prediction scores do not consider clinician assessment of patient viability. This study compared clinician prediction of survival to hospital discharge versus prediction scores.

Objectives: The aim of this study was to compare clinician prediction of patients' survival to hospital discharge versus prognostic prediction scores (Respiratory ECMO Survival Prediction [RESP] or Survival After Veno-Arterial ECMO [SAVE] score) to actual survival.

Methods: This was an observational descriptive study from January 2020 to November 2021 conducted with interviews of nurses, perfusionists, and physicians who were involved during the initiation of ECMO within the first 24 hours of cannulation. Data were retrieved from the medical record to determine prediction scores and survival outcomes at hospital discharge. Accuracy of clinician prediction of survival was compared to the RESP or SAVE prediction scores and actual survival to hospital discharge.

Results: Accurate prediction of survival to hospital discharge for veno-venous ECMO by nurses was 47%, 64% by perfusionists, 45% by physicians, and 45% by the RESP score. Accurate predictions of patients on veno-arterial ECMO were correct in 54% of nurses, 77% of physicians, and 14% by the SAVE score. Physicians were more accurate than the SAVE score, P = .021, and perfusionists were significantly more accurate than the RESP score, P = .044. There was no relationship between ECMO specialists' years of experience and accuracy of predications.

Conclusion: Extracorporeal membrane oxygenation clinicians may have better predictions of survival to hospital discharge than the prediction scores. Further research is needed to develop accurate prediction tools to help determine ECMO eligibility.

Skin tears are a major problem for patients and the health care professionals who treat them. Although opinions on their prevalence differ, it is estimated that they are encountered more frequently than pressure sores but are overlooked. Recommendations based on strong evidence were presented for the prevention and treatment of skin tears as classified by the International Skin Tear Advisory Panel. This case series includes the clinical status of 3 patients who developed skin tears while receiving care in the hospital, and the corrective and preventive practices related to skin tears. This article will contribute to raising the awareness of health care professionals in predicting, preventing, evaluating, and treating skin tears.

Background: Changes in healthcare delivery were required during the first year of the COVID-19 pandemic.

Objective: The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting.

Method: A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission.

Results: Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001).

Discussion: The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.

Background: Artificial airways are essential in various clinical settings to maintain a patient's airway and provide necessary support for ventilation and oxygenation. These devices are commonly temporary and come in several types, each serving specific purposes. Understanding the indications, types, and proper care of artificial airways is crucial for health care professionals to ensure patients receive optimal care and prevent complications.

Objective: This article aims to review the indications for using artificial airways and discuss the most commonly used types, including supraglottic airway devices, endotracheal tubes, tracheostomy tubes, and laryngectomy tubes. It also provides insights into the procedures involved in intubation and percutaneous tracheostomy and offers guidance on patient management, emphasizing assessment, oral care, suctioning, and humidification for patients with these airway devices.

Conclusion: This article underscores the significance of understanding artificial airways, not just as a set of skills but as a commitment to patient welfare. Health care professionals who master the knowledge and care of these devices can significantly contribute to their patients' well-being and quality of life.

Introduction: Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body.

Background: Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV.

Methods: Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers.

Results: Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies.

Discussion: This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies.

Conclusion: Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.

The term "system well-being" can move forward a new vision, meaning the result coming from the addition of the well-being of persons belonging to different institutions and organizations, which are all parts of the "health care system." Beginning with this "new definition," with the aim of analyzing the multifaceted issues related to nurses' well-being, we could use the "classical nursing metaparadigm" composed of 4 concepts: "health," "nursing," "environment," and "person." We briefly describe this conceptual map and provide some focused suggestions for further reflection on topics such as physical and psychological well-being, economic gain and career opportunities, work climate, burnout, low job satisfaction, moral distress, compassion fatigue, and a joyful work environment. This view may help organizations to focus on interventions to prevent or eliminate stress, which may be more proactive and effective than interventions to manage stress. Moreover, it offers a multidimensional map to analyze the different aspects influencing the well-being issue, keeping in mind that a concrete solution can be obtained only if all the components of health care systems and society do their part. Some solutions proposed by authors and organizations to increase nurses' well-being are mindfulness based, such as meditation, yoga, acupuncture, gratitude, journaling, choirs, coaching, workload reduction, job crafting, and peer networks. Other reflections on work organization, expected professional behaviors, nurses' retention, and education should be added to the discussion on this multidimensional issue.

Introduction: It is important to understand the concept of comfort as a whole to build an assistance intervention plan that meets the person's needs. Therefore, it is necessary to monitor and assess the person's sleep by considering the surrounding environment, to provide a comfortable environment that is quiet and provides privacy, especially in contexts of difficult management of environmental factors in the approach to the person in critical condition.

Objectives: The aims of this study were to map the nursing interventions that promote sleep-promoting environmental comfort in critically ill people and identify the instruments to assess sleep in critically ill people.

Methods: This is a scoping review based on the methodological strategy of the Joanna Briggs Institute for Scoping Reviews. The search was conducted on February 17 and 18, 2022, in the databases CINAHL, Cochrane Library Plus, PubMed, JBI Evidence Synthesis, SciELO, DANS Easy Archive, RCAAP, and DART-Europe using the Boolean phrase search strategy: "Hospital Emergency Service" OR "Critical Care" AND "Sleep" NOT "Children" AND Nurs*. We included all studies, conducted in any contextual setting, in Portuguese, English, or Spanish, on adult patients with acute and/or critical illness in intensive care and/or emergency units, which addressed nursing interventions that contribute to environmental comfort and promote sleep. Studies on pregnant or puerperal women, persons with psychiatric disorders, and those at the end of life or in palliative care were excluded.

Results: Twenty-one articles were included in this scoping review. Three categories of nursing interventions emerged: person centered (14 interventions), environment centered (37 interventions), and nurse role centered (45 interventions). Three categories of instruments for sleep assessment emerged, in particular: quality of sleep (12 instruments), environmental effects on a night's sleep (2 instruments), and influence on sleep practices in the intensive care unit (1 instrument).

Discussion: The use of instruments to monitor comfort and sleep allows for an accurate assessment of the impact of nurses' intervention focusing on sleep-promoting interventions aimed at comfort, for an improvement of sleep in critically ill patients.

Conclusion: The interpretation of the content makes it clear that how critically ill patients in different contexts experience the environmental context positively or negatively conditions their comfort. In this sense, it is essential to reflect on these measures as a team so that everyone can apply them.