Critical care nurse
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Critical care nurse · Apr 2012
So you want to change practice: recognizing practice issues and channeling those ideas.
Applying the best evidence to support nursing practice and generating new knowledge for use in practice are the hallmarks of excellence and allow practitioners to meet patient care quality and safety priorities. Although identifying a patient care problem comes easily to staff nurses, the process of clarifying the problem and channeling those ideas through to a practice change can be daunting for bedside nurses. This article provides guidance to staff nurses who want to identify a clinical problem and change practice.
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Acute and critical care nurses routinely encounter ethical "quandaries" such as providing perceived futile care. Other everyday ethically important occurrences may go unrecognized, however, thus diminishing their importance to moral nursing practice. ⋯ Patient/provider scenarios are used to illustrate components of Rest's model followed by an approach to distinguish ethical from nonethical situations. Practical strategies to enhance ethical skills such as development of nursing ethics groups and providing continuing ethics education also are presented.
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Critical care nurse · Apr 2012
The journey to zero central catheter-associated bloodstream infections: culture change in an intensive care unit.
A process change with the goal of decreasing and ultimately eliminating bloodstream infections associated with central catheters in critical care patients was implemented at Riverside Methodist Hospital. This process of implementation resulted in a culture change in the hospital's medical surgical intensive care unit. Keys to success included a multidisciplinary team approach, support from persons with a stake in the process, and provision of continuous feedback. The lessons learned in this journey at Riverside Methodist Hospital can help caregivers at other hospitals decrease the occurrence of these life-threatening infections.
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Scientists are only beginning to fully understand the purpose of sleep and its underlying mechanisms. Lack of sleep is associated with many diseases, including infection, and with increased mortality. Lack of proper sleep is an important problem in the intensive care unit, and interventions have been designed to improve it. Sleep is associated with immune function, and this relationship is partially based on the physiological basis of sleep, sleep architecture, the sleep-wake cycle, cytokines and the hypothalamic-pituitary axis.
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Critical care nurse · Apr 2012
Critical care nurses' role in implementing the "ABCDE bundle" into practice.
Imagine working in an environment where all patients undergoing mechanical ventilation are alert, calm, and delirium free. Envision practicing in an environment where nonvocal patients can effectively express their need for better pain control, repositioning, or emotional reassurance. ⋯ A recently proposed bundle of practices for the intensive care unit could advance the current practice environment toward this idealized environment. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle incorporates the best available evidence related to delirium, immobility, sedation/analgesia, and ventilator management in the intensive care unit for adoption into everyday clinical practice.