Dimensions of critical care nursing : DCCN
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Dimens Crit Care Nurs · Mar 2017
Comparative StudyCritical Care Nurses' Perceptions of End-of-Life Care Obstacles: Comparative 17-Year Data.
Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years. ⋯ Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time. Obstacles related to families may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has not previously experienced a similar situation. On the basis of the current top 5 obstacles, recommendations for possible areas of focus include (1) improved health literacy assessment of families followed by earlier directed, appropriate, and specific EOL information; (2) improved physician/team communication; and (3) ensuring patients' wishes are followed as written. In general, patient- and family-centered care using clear and open EOL communication regarding wishes and desires between patients and families, their physicians, and nurses will help decrease common obstacles, thus improving the quality of EOL care provided to dying patients and families.
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Dimens Crit Care Nurs · Jan 2017
Nursing Practices and Policies Related to Family Presence During Resuscitation.
Despite its shown benefits, family presence during resuscitation (FPDR) is a controversial topic among critical care nurses and is not routinely implemented. ⋯ Despite the shown benefits of FPDR, it is not a routine component of resuscitation in critical care settings. Nurse managers and educators should focus on policy creation and education to help guide nurses at the bedside. The impact of policy and education on critical care nurses' support for and implementation of FPDR requires further study.
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Dimens Crit Care Nurs · Jan 2017
Assessment of Clinical Alarms Influencing Nurses' Perceptions of Alarm Fatigue.
Excessive clinical alarms have inundated health care for years. Multiple governing bodies, organizations, and facilities have deemed alarm management a priority. Alarm management is a multifaceted problem that affects all health care organizations and clinical staff, especially those in critical care units. Ultimately, the lack of knowledge regarding nurses' perceptions to alarm management and alarm fatigue creates patient safety chiasms. ⋯ Following the survey, themes emerged, and changes were implemented including the following: an alarm management policy was created, tools were provided to staff for easy usage, staff were educated using hands-on practice at an annual training summit, and sustainability was created through continuation of alarm management assessment and improvement.
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Dimens Crit Care Nurs · Nov 2016
Interprofessional Perspectives on ABCDE Bundle Implementation: A Focus Group Study.
The ABCDE bundle is a multifaceted, interprofessional intervention that is associated with reduced ventilator and delirium days as well as increased likelihood of mobility in intensive care. ⋯ The number of disciplines required to perform an activity and individual component complexity was reported to influence ABCDE bundle implementation. Nurses repeatedly described challenges with coordinating care across disciplines. Small tests of change, adequate staffing, interprofessional training and protocol development efforts, and role modeling may be effective methods for successful ABCDE bundle implementation.
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Dimens Crit Care Nurs · Nov 2016
The ABCDE Bundle: A Survey of Nurses Knowledge and Attitudes in the Intensive Care Units of a National Teaching Hospital in Italy.
The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice. ⋯ A substantial need for educational improvement and cultural change is needed. The results of this study may help other facilities to identify contextual and professionals-related factors possibly hindering the bundle's implementation.