Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Mar 2014
Validation of the critical-care pain observation tool in adult critically ill patients.
Effective management of pain begins with accurate assessment of its presence and severity, which is difficult in critically ill patients. The Critical-Care Pain Observation Tool (CPOT) was developed to evaluate behaviors associated with pain and validated primarily with cardiac surgical patients. ⋯ The CPOT is an acceptable behavioral pain assessment scale for use in the general critical care patient population and is more appropriate for use with adults than the FLACC.
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Dimens Crit Care Nurs · Mar 2014
ReviewGlucose management in critically ill medical and surgical patients.
Currently, many providers treat hyperglycemia in the critically ill based on guidelines suggesting target glucose ranges between 140 and 180 mg/dL. However, recent literature has attempted to challenge this by comparing the effect of intensive insulin therapy (IIT) to conventional insulin therapy. ⋯ Factors such as days of mechanical ventilation, infection rates, length of stay in the ICU, and incidence of organ failure were included as secondary end points. The data suggest IIT may improve patient outcomes in some areas, but the data are not statistically significant, and adoption of an IIT protocol is not recommended at this time.
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Dimens Crit Care Nurs · Jan 2014
The effect of intensive care unit environments on nurse perceptions of family presence during resuscitation and invasive procedures.
In a growing number of requests, family members are asking for proximity to their family member during resuscitation and invasive procedures. ⋯ Perceptions of family presence were significantly higher for pediatric and medical intensive care unit nurses. Further education and support may be needed in the surgical and mixed intensive care units. Evidence-based practice guidelines that are family centered can define the procedures and resources for family presence, to ultimately promote professional practice.
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Dimens Crit Care Nurs · Nov 2013
ReviewPrevention of unplanned intensive care unit admissions and hospital mortality by early warning systems.
Researchers have found that patients exhibit physiological changes up to 8 hours prior to an arrest event. Deaths have been attributed to a lack of observation, lack of documentation of observations, inability of a caregiver to recognize early signs of deterioration, and lack of communication between healthcare providers. This integrative review examines early warning scoring systems and their effectiveness in predicting a patient's potential for deterioration and considers whether these scoring systems prevent unplanned intensive care unit admissions and/or death. ⋯ Nine studies fitting the search criteria were included in this review. Early warning scoring systems that interface with electronic medical records and are supplemented with decision aides (algorithms) and clinical support systems produce an effective screening system for early identification of deteriorating patients. This multifaceted approach decreases unplanned intensive care unit admissions and hospital mortality.
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Dimens Crit Care Nurs · Nov 2013
Using the synergy model of patient care in understanding the lived emergency department experiences of patients, family members and their nurses during critical illness: a phenomenological study.
Despite many studies conducted aimed to understand and improve emergency care, research on the triad of nurses, patients, and family members looking at the lived emergency department experiences and their perspective of each from the other is notably absent. In a hermeneutic phenomenological study using van Manen's method, a sample of 10 patients, 5 family members, and 8 nurses of a nonprofit community hospital was recruited and interviewed in 2010 to 2011 to explore, understand, and describe their lived experiences during critical illness in the emergency department. ⋯ The American Association of Critical-Care Nurses' Synergy Model for Patient Care was applied in conceptualizing the findings and served as a framework in recommending practices and interventions geared toward improving competencies required in caring for critically ill patients and their families in the emergency department. The study supports recognizing the patient and family as active participants in the patient's medical care; encouraging family-member presence and creating institutional policies for patient- and family-centered care, as well as encouraging the development of ongoing programs that will recognize, enhance, and support the psychological and emotional well-being of emergency department nurses.