Background Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep ...sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings. Objective To evaluate the correlation between the clinical assessment of sedation using the Sedation-Agitation Scale (SAS) and the assessment using BIS in ventilated and sedated ICU patients. Methods ICU patients requiring mechanical ventilation and sedation were monitored using the SAS and BIS. Nurses initiated event markers with BIS at the time of SAS assessment but were blinded to BIS scores. Results Data were collected on 40 subjects generating 209 paired readings. Moderate positive correlation between BIS and SAS values was shown with a Spearman Rank coefficient r value of .502 and an r2 of .252 ( P < .0001). Wide ranges of BIS scores were observed, especially in very sedated patients. Strong positive correlation was noted between BIS and electromyography with an r value of .749 ( P < .0001). Age and gender significantly influenced BIS/SAS correlations. Conclusion In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.
When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure.
To ...compare automatic noninvasive measurements of blood pressure in the upper arm and forearm.
A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level.
Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure).
Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.
In August 2008, the American Association of Critical-Care Nurses' (AACN's) Evidence-Based Practice Resource Work Group met to review current AACN Practice Alerts and to identify new Practice Alerts ...to be created. The work group was also tasked with reassessment of the grading system used by AACN that evaluates evidence associated with the Practice Alerts and other AACN resources. This article details the effort of this national volunteer work group, specifically highlighting the development of the new AACN evidence-leveling hierarchy system.
Title. Influence of organizational characteristics and caring attributes of managers on nurses' job enjoyment
Aim. This paper is a report of a study to investigate the effect of organizational ...characteristics and perceived caring attributes of managers on nurses’ job enjoyment.
Background. Job satisfaction was the outcome of several studies about organizational or professional practice environments. Study variables predicted 30–60% of the variance in job satisfaction. Job enjoyment, the affective dimension of job satisfaction and manager caring were not variables in previous studies.
Methods. We recruited a convenience sample of Registered Nurses (n = 731) employed by a large healthcare system in the mid‐Atlantic region of the United States of America. Participants were primarily staff nurses, female, white, full‐time employees and 41 years of age or older. Most had a baccalaureate degree in nursing and 4·5% had an advanced practice license. Participants were surveyed in 2005 using Lake’s Practice Environment Scale of the Nursing Work Index, Nyberg’s Caring Assessment Scale, the Job Enjoyment Subscale of the Atwood and Hinshaw Job Satisfaction Scale and a demographic data form. Descriptive statistics were used to explore the study variables. Data were analysed using multiple regression.
Results. Nursing foundations for quality of care, nurse manager ability, leadership and support of nurses, staffing and resource adequacy and collegial nurse–physician relations explained 30·6% of the variance in job enjoyment. Age, area of practice and job type explained an additional 5·4%.
Conclusion. Quantitative measures did not identify a majority of the variables associated with job enjoyment. Research using a qualitative and quantitative methodology with different practice samples may reveal other variables that influence job enjoyment.
Improving Outcomes With Therapeutic Hypothermia Bucher, Linda; Buruschkin, Rolma; Kenyon, Dina M ...
Dimensions of critical care nursing,
2013-May/June, Letnik:
32, Številka:
3
Journal Article
Recenzirano
Therapeutic hypothermia appears to be effective in limiting the trauma resulting from ischemia as well as reducing reperfusion injury.
AACN levels of evidence: what's new? Armola, Rochelle R; Bourgault, Annette M; Halm, Margo A ...
Critical care nurse
29, Številka:
4
Journal Article
Recenzirano
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
7.
Improving outcomes with therapeutic hypothermia Bucher, Linda; Buruschkin, Rolma; Kenyon, Dina M ...
Nursing,
2013-January, 2013-Jan, 2013-01-00, 20130101, Letnik:
43, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Therapeutic hypothermia, a controlled reduction of core body temperature to 89.6°F to 932°F, is used in patients who don't regain consciousness after return of spontaneous circulation following ...cardiac arrest. Cardiac arrest can result in global ischemia, direct cell damage, and cerebral edema, leading to a high rate of cerebral ischemia. Hypoxic brain injury directly results in neuronal damage and cerebral edema. The earliest rationale for the effects of hypothermia as a neuroprotectant was based on the slowing of cellular metabolism that results from a drop in body temperature. Here, Bucher et al examine the link between the pathophysiology of cardiac arrest and the physiology underlying therapeutic hypothermia.
Bucher et al present a case of Mr. S who experienced a foreign body airway obstruction and subsequent cardiac arrest while eating lunch at work. His coworkers called 911 and began CPR; an automated ...external defibrillator (AED) was not available. He arrived at the ED unresponsive and in a sinus bradycardia. His medical history includes hypertension and type 2 diabetes. Mr. S may be a candidate for therapeutic hypothermia and will need quick intervention to avoid possible or further neurologic decline. Therapeutic hypothermia for patients with ROSC after cardiopulmonary arrest results in positive patient outcomes. In 2010, the American Heart Association (AHA) revised its guidelines to recommend therapeutic hypothermia for any patient who had ROSC after cardiac arrest and was comatose.
Patients with diabetes often have impaired wound healing and an increased rate of postoperative complications with surgery. Most research has focused on the effect of hyperglycemia in the ...postoperative period, but there is limited evidence to guide blood glucose (bG) control throughout the perioperative period. This retrospective study explored the effect of hyperglycemia in the PACU on postoperative complications, length of stay (LOS), and in-hospital mortality in patients with diabetes undergoing spine, colon, or joint surgery. Findings revealed that the total LOS for patients with a PACU bG >200 mg/dL was significantly longer than for patients with a maximum bG of 140 to 200 mg/dL. Further, the rate of total complications increased significantly as bG levels increased. More prospective, controlled studies on the management of perioperative hyperglycemia are recommended for consideration.
In a study exploring the impact of a new physician practice model on staff's perceptions of their work environment, no statistically significant differences were found; however, some interesting ...results were obtained. Nurses should strive to improve working relationships not only with nurses and physicians, but also with members of the entire health care team and system.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
