Critical care nurse
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Many novice managers feel unprepared to handle some of the situations that occur as a daily part of their job. It is important to provide an environment through which novice managers can receive training and develop skills in effective communication in complex nursing environments. Simulation-based training can provide a safe, interactive way for new managers to develop their communication and leadership skills. This type of training allows novice managers to increase their confidence and improve their job satisfaction and their management skills.
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Critical care nurse · Oct 2011
Case ReportsCritically ill patients with H1N1 influenza A undergoing extracorporeal membrane oxygenation.
The most common cause of death due to the H1N1 subtype of influenza A virus (swine flu) in the 2009 to 2010 epidemic was severe acute respiratory failure that persisted despite advanced mechanical ventilation strategies. Extracorporeal membrane oxygenation (ECMO) was used as a salvage therapy for patients refractory to traditional treatment. At Legacy Emanuel Hospital, Portland, Oregon, the epidemic resulted in a critical care staffing crisis. ⋯ The role of ECMO in supporting patients with severe respiratory failure due to H1N1 influenza is described, followed by discussions of the nursing care challenges for each body system. Variations from standards of care, operational considerations regarding staff workload, institutional burden, and emotional wear and tear of the therapy on patients, patients' family members, and the entire health care team are also addressed. Areas for improvement for providing care of the critically ill patient requiring ECMO are highlighted in the conclusion.
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Critical care nurses are essential members of the health care team and often assist patients and patients' families who are facing end-of-life concerns. In that role, a nurse needs an understanding of many important factors, including legal implications associated with the end of life. Since the 1970s, courts have decided several cases that have established legal principles in end-of-life care. ⋯ For incompetent adults and children, decisions are made by a surrogate. In the absence of an advance directive or documentation of goals of care, the surrogate, in collaboration with the medical team, determines a plan of care, including decisions about end-of-life care. When issues of medical futility occur, attempts to work with patients and their families should be undertaken, but if the dispute cannot be resolved, a transfer in care may be the only option.
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Critical care nurse · Oct 2011
Aspiration prevention protocol: decreasing postoperative pneumonia in heart surgery patients.
BACKGROUND Postoperative pneumonia contributes to morbidity and mortality in patients who have open heart surgery. OBJECTIVES To determine if measures to reduce aspiration in patients after cardiothoracic surgery would decrease the occurrence of postoperative pneumonia. METHODS All patients undergoing cardiothoracic surgery from April 2008 through October 2008 were prospectively enrolled in the study. ⋯ RESULTS In the 6 months before development and implementation of the protocol, postoperative pneumonia developed in 11% of patients. After implementation of the protocol, no patients had postoperative pneumonia (P < .01). CONCLUSIONS Implementing an aspiration prevention protocol was effective in reducing the occurrence of postoperative pneumonia in patients who had cardiothoracic surgery.
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Critical care nurse · Oct 2011
The going home initiative: getting critical care patients home with hospice.
Although considerable effort is being directed at providing patients and their families with a "good death," most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.