OBJECTIVE:The debilitating and persistent effects of ICU-acquired delirium and weakness warrant testing of prevention strategies. The purpose of this study was to evaluate the effectiveness and ...safety of implementing the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle into everyday practice.
DESIGN:Eighteen-month, prospective, cohort, before-after study conducted between November 2010 and May 2012.
SETTING:Five adult ICUs, one step-down unit, and one oncology/hematology special care unit located in a 624-bed tertiary medical center.
PATIENTS:Two hundred ninety-six patients (146 prebundle and 150 postbundle implementation), who are 19 years old or older, managed by the institutions’ medical or surgical critical care service.
INTERVENTIONS:Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle.
MEASUREMENTS AND MAIN RESULTS:For mechanically ventilated patients (n = 187), we examined the association between bundle implementation and ventilator-free days. For all patients, we used regression models to quantify the relationship between Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle implementation and the prevalence/duration of delirium and coma, early mobilization, mortality, time to discharge, and change in residence. Safety outcomes and bundle adherence were monitored. Patients in the postimplementation period spent three more days breathing without mechanical assistance than did those in the preimplementation period (median interquartile range, 24 7–26 vs 21 0–25; p = 0.04). After adjusting for age, sex, severity of illness, comorbidity, and mechanical ventilation status, patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle experienced a near halving of the odds of delirium (odds ratio, 0.55; 95% CI, 0.33–0.93; p = 0.03) and increased odds of mobilizing out of bed at least once during an ICU stay (odds ratio, 2.11; 95% CI, 1.29–3.45; p = 0.003). No significant differences were noted in self-extubation or reintubation rates.
CONCLUSIONS:Critically ill patients managed with the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility bundle spent three more days breathing without assistance, experienced less delirium, and were more likely to be mobilized during their ICU stay than patients treated with usual care.
BACKGROUND:Although dying children are often aware of their impending death, parents are reluctant to communicate with their dying child about death.
OBJECTIVE:The objective of this study was to ...examine how parents of children in the advanced stage of a life-threatening disease trajectory communicated about death.
METHODS:Using grounded theory methods, data were collected via interviews with 18 parents of children who had died of an advanced life-threatening disease.
RESULTS:Ways in which parents communicated with their dying child were impacted by the degree of threat to the parental role. From the onset of their child’s life-threatening illness, the sense of parental self was threatened, resulting in “Parental Vulnerability.” To endure parental vulnerability, parents confronted a process of “Redefining Parenthood.” Before the child’s death, parents experienced (1) Protecting From Fears, (2) Protecting Normalcy, (3) Protecting Faith, (4) Experiencing Protection From Their Child, and (5) Bookmarking Memories. After the child’s death, parents experienced (1) Telling the Story, (2) Making Meaning, (3) Protecting the Child’s Memory, (4) Defining a New Normal, and (5) Learning to Live With Regret.
CONCLUSIONS:Results provide new information about the experiences of parents of dying children as they communicated with their child during the dying process and as they found ways to go on with life after their child’s death.
IMPLICATIONS FOR PRACTICE:Findings can be used by healthcare professionals to help support families of dying children. The field of pediatric oncology nursing would benefit from exploration of the dying child’s perspective.
The Power in Coming Together Albert, Debra; Gruebling, Nicole; Nuss, Suzanne L. ...
Nurse leader,
12/2021, Letnik:
19, Številka:
6
Journal Article
Recenzirano
Odprti dostop
The role of the chief nursing officer is multifaceted and complex. These complexities can be exacerbated during times of turbulence, specifically the COVID-19 pandemic. Understanding communication ...and collaboration are core to achieving optimal outcomes, this article outlines the experience of 3 chief nursing officers through the COVID-19 pandemic and the value of a structured platform for peer shared learning and support.
Background Although an emphasis has been placed on protecting patients by improving health care worker compliance with infection control techniques, challenges associated with patient isolation do ...exist. To address these issues, a more consistent mechanism to evaluate specific clinical behaviors safely is needed. Methods The research method described in this study used a high fidelity simulation using a live standardized patient recorded by small cameras. Immediately after the simulation experience, nurses were asked to view and comment on their performance. A demographic survey and a video recorded physical evaluation provided participant description. A questionnaire component 1 month after the simulation experience offered insight into the timing of behavior change in clinical practice. Results Errors in behaviors related to donning and doffing equipment for isolation care were noted among the nurses in the study despite knowing they were being video recorded. This simulation-based approach to clinical behavior analysis provided rich data on patient care delivery. Conclusion Standard educational techniques have not led to ideal compliance, and this study demonstrated the potential for using video feedback to enhance learning and ultimately reduce behaviors, which routinely increase the likelihood of disease transmission. This educational research method could be applied to many complicated clinical skills.
•Evaluated N95 respirator behaviors in nurses providing simulated isolation care.•Video recordings were reviewed and scored.•Detailed scoring will guide improved training for N95 respirator use.
...Video review and scoring was used to evaluate the behaviors of nurses wearing N95 filtering face piece respirators while providing isolation care in a simulated patient care environment. This study yielded a detailed description of behaviors related to N95 respirator use in a health care setting. Developing a more robust and systematic behavior analysis tool for use in demonstration, simulation, and clinical care would allow for improved respiratory protection of health care workers.
This secondary analysis from a larger mixed methods study with a sequential explanatory design investigates the clinical challenges for nurses providing patient care, in an airborne and contact ...isolation room, while using a computer on wheels for medication administration in a simulated setting. Registered nurses, who regularly work in clinical care at the patient bedside, were recruited as study participants in the simulation and debriefing experience. A live volunteer acted as the standardized patient who needed assessment and intravenous pain medication. The simulation was video recorded in a typical hospital room to observe participating nurses conducting patient care in an airborne and contact isolation situation. Participants then reviewed their performance with study personnel in a formal, audio-recorded debriefing. Isolation behaviors were scored by an expert panel, and the debriefing sessions were analyzed. Considerable variation was found in behaviors related to using a computer on wheels while caring for a patient in isolation. Currently, no nursing care guidelines exist on the use of computers on wheels in an airborne and contact isolation room. Specific education is needed on nursing care processes for the proper disinfection of computers on wheels and the reduction of the potential for disease transmission from environmental contamination.
Clinical Challenges in Isolation Care Beam, Elizabeth; Gibbs, Shawn G.; Hewlett, Angela L. ...
The American journal of nursing,
2015-April, Letnik:
115, Številka:
4
Journal Article
Recenzirano
Odprti dostop
OVERVIEWIn 2014, the authors published the results of a study investigating nurses’ use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne ...precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.
The Institute of Medicine recognizes that emergency departments across the United States are routinely overburdened, often exceeding their capacity to safely meet patient needs.1 Barriers to patient ...flow in the emergency department can lead to congestion, delays in treatment, and real or potentially catastrophic patient outcomes.2-5 Negative consequences of crowding in the emergency department include an increase in the following: care delays, numbers of patients who leave without being seen, patient deaths, medical errors, overall ED lengths of stay, ambulance diversions, and negligence claims.3 Research shows that patients admitted to the hospital on days with high ED crowding have a greater likelihood of inpatient death, increased length of hospital stay, and increased cost per admission.6 Furthermore, ED crowding negatively affects the emergency medical services within a community when ambulances are diverted away from crowded emergency departments or paramedics are held up by delays in the emergency department, effectively taking them out of service to respond to additional calls.7 The emergency department at the Nebraska Medical Center experienced an unprecedented surge in patient demand during the H1N1 epidemic occurring in 2009 and 2010. Year 3 Time from patient arrival to triage 9.6 8.7 5.3 7.0 Time from placement in triage to RN evaluation 6.3 5.6 4.3 3.6 Time from patient arrival to being seen by provider 43.9 41.5 39.6 38.8 Time from STEMI patient arrival to ECG 7.5 7.2 6.3 6.4 Time from STEMI patient arrival to cardiac catheterization laboratory 38.3 43.0 35.6 33.8 Table ED performance on time-sensitive metrics before and after greeter nurse role creation in January 2012 ECG, electrocardiography; FY, fiscal year; RN, registered nurse; STEMI, ST-segment elevation myocardial infarction.
To provide clinical insights into dosing and administration of IV busulfan, a conditioning agent for hematopoietic stem cell transplantation (HSCT).
Review of published literature related to busulfan ...pretransplant conditioning using MEDLINE. Meeting abstracts, investigational protocols, and pharmaceutical manufacturers' package inserts also were reviewed.
Busulfan is an effective myeloablative conditioning agent for HSCT. The IV formulation increases dose assurance and the ability to target a therapeutic window. Therapeutic drug monitoring ensures that targeted blood levels are achieved, especially in children, thereby preventing underdosing, which can lead to disease progression or rejection, as well as overdosing, which can cause an increased risk of toxic side effects.
IV busulfan is a convenient, safe, and effective conditioning agent used in HSCT that has a predictable pharmacokinetic profile.
An understanding of the pharmacokinetic principles underlying the relationship between the therapeutic window for busulfan and optimal HSCT outcomes will facilitate proper dosing and administration of IV busulfan.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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