Critical care nurse
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Critical care nurse · Jun 2012
Engaging families to participate in care of older critical care patients.
Provision of optimal outcomes for older adults can be understood through the use of the American Association for Critical-Care Nurses Synergy Model. These outcomes can be enhanced if strategies are designed to improve the characteristics of patients and families as described in the Synergy Model. When older adults are admitted to critical care units, spouses, children, and friends are in a position to participate in care. This column examines the Synergy Model's patient characteristic of participation in care relative to involvement of the family and significant others of the older patient as a method of enhancing optimal outcomes.
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Evidence-based practice is an expected core competency of all health care clinicians regardless of discipline. Use of evidence-based practice means integrating the best research with clinical expertise and patient values to achieve optimal health outcomes. ⋯ Role modeling and integrating the skills necessary to develop evidence-based practice into clinical and nonclinical courses is an important part in developing positive attitudes toward evidence-based practice, an essential first step to using evidence to guide practice decisions. The step-by-step approach to evidence-based practice proposed by Melnyk and colleagues provides an excellent organizing framework for teaching strategies specifically designed to facilitate nurses' knowledge and skill development in evidence-based practice.
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Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. ⋯ If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.
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Contrast-induced nephropathy is a major adverse event that occurs during studies that require contrast medium. Almost 10% of all hospital-acquired instances of renal insufficiency are directly attributed to contrast material, with significantly higher mortality and morbidity than cases that do not involve contrast material. ⋯ Critical care nurses are pivotal in identifying patients' risk factors and potential nephrotoxic agents in order to avoid contrast-induced nephropathy. This article outlines the pathophysiology and definitions of normal kidney function, nephropathy, and chronic kidney disease.
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Stress is a common phenomenon in the intensive care unit for both patients and nurses. Critical care nurses may experience many forms of stress, including physical, psychological, and moral stress or distress. ⋯ Although commonly associated with adverse outcomes, stress can lead to personal growth. The tend and befriend strategy is an intervention that was developed to help nurses increase their ability to grow from stressful situations, especially those related to moral distress.