American Journal of Nursing最新文献

Background: Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA.

Purpose: The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center.

Methods: The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record.

Results: A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate.

Conclusion: Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA.

Background: In 2018, the U.S. Army Surgeon General created the Army Medical Department Military-Civilian Trauma Team Training (AMCT3) program to enhance the clinical proficiency of medical personnel serving on Army trauma teams called forward resuscitative surgical detachments (FRSDs). FRSDs provide resuscitative and surgical care to wounded patients in the deployed environment until they can be medically evacuated to a higher level of care. Through AMCT3, FRSD personnel work at civilian trauma centers while not deployed in order to maintain their combat casualty care competency.

Purpose: This article describes an innovative nursing-specific AMCT3 program model in which Army nurses serving on an FRSD are embedded within a level 1 trauma center for a 3-year assignment. The goal of the program, which was established at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee, is to improve participants' clinical proficiency and skills in preparation for the next major military conflict, with the aim of reducing preventable battlefield deaths.

Methods: The VUMC Military Affairs Committee, in consultation with Army medical leaders, developed a unique 3-part model for a nursing partnership program at VUMC. This model includes separate tracks for critical care and emergency nurses. The nurses receive training in their specialty, cross-training in the opposite track, and other professional development opportunities. A critical care nurse and an emergency nurse were assigned to the program in January 2022 and September 2022, respectively.

Results: Between January 2022 and June 2023, the critical care nurse completed all the required individual critical task lists-specialty-specific clinical skills Army medical personnel must be competent in before deployment-except for 1, obtaining intra-abdominal pressure.

Conclusion: The VUMC AMCT3 nursing partnership training model ensures that Army nurses are highly prepared to function as part of the FRSD and to provide superior combat casualty care in a resource-limited environment.

Empowering staff nurses.

Building the clinical competency of military personnel during peacetime.

ACCORDING TO THIS STUDY.

Combating all forms of oppression to achieve health equity.

Most of those surveyed said they were satisfied with such care.

Providing expert, person-centered care to older adults across settings.