Dimensions of critical care nursing : DCCN
-
Dimens Crit Care Nurs · Jan 2016
What Factors Are Associated With the Development of Pressure Ulcers in a Medical Intensive Care Unit?
Instruments used to determine the risk of pressure ulcer development are universally applied to adult patients. These instruments do not differentiate between intensive and acute care patients. ⋯ Vasopressor use and length of stay are not factors that are accounted for in current pressure ulcer risk assessment instruments. The administration of vasopressor support and patient length of stay are potential contributory factors that need to be considered when assessing patients. Instruments specific to intensive care unit pressure ulcer risk stratification are warranted and should include the unique characteristics of a critically ill patient.
-
Dimens Crit Care Nurs · Nov 2015
Review Case ReportsPronation therapy case report: nurse's perspective and lessons learned.
This article describes a brief review of prone therapy and its efficacy and effect on mortality in the treatment of acute respiratory distress syndrome. Furthermore, the situational background and clinical events that transpired prior to, during, and after the institution of pronation therapy for Elkhart General Hospital's Critical Care Center's first pronation patient using the RotoProne Therapy System are described from the nurse's perspective. The lessons learned from this first experience have led to the formation of several practice-based recommendations for future patient care.
-
Dimens Crit Care Nurs · Nov 2015
Case ReportsPromotion of progressive mobility activities with ventricular assist and extracorporeal membrane oxygenation devices in a cardiothoracic intensive care unit.
Progressive mobility (PM) is a clinical intervention that influences complications experienced throughout critical illness. Early PM is a relevant topic in critical care practice literature and was principle to introducing a PM care guideline in an acute cardiothoracic/cardiovascular intensive care unit. ⋯ Development of a PM guideline uses a critical appraisal of practice evidence, highlights multidisciplinary collaboration, and increases progression to ambulation. Mobility for complex patients is attainable, as demonstrated in the postguideline outcomes. The PM guideline provides structure to primary caregivers and promotes safe practices. The PM guideline facilitates an advanced level of care, promotes safe practices, champions holistic recovery, and encourages active patient involvement, goals satisfying to both patients and staff.
-
Dimens Crit Care Nurs · Nov 2015
Facilitating palliative care referrals in the intensive care unit: a pilot project.
Palliative care in intensive care units (ICUs) reduces costs and improves outcomes yet is consistently underused; studies suggest that screening tools increase the use of palliative services. ⋯ Data suggest that the PPSv2 was well received by the bedside nurses and changed practice patterns with regard to facilitating palliative care services.
-
Dimens Crit Care Nurs · Sep 2015
Implementation of an Intensive Care Unit Delirium Protocol: An Interdisciplinary Quality Improvement Project.
Delirium is a commonly observed problem for adult patients in the intensive care unit (ICU) that is associated with increased mortality, increased hospital length of stay, and long-term disability of ICU survivors. This makes prevention and prompt treatment of delirium imperative goals for critical-care providers. Bedside critical-care nurses are uniquely poised to champion efforts to prevent, detect, and treat delirium but oftentimes are not aware of the most recent evidence-based guidelines or the potential long-term implications for the ICU survivor. Nurses have reported higher levels of confidence in detecting delirium, increased knowledge of delirium, and enhancement of patient care skills after receiving formal didactic educational training. ⋯ This quality improvement project demonstrates that a formal didactic training program for ICU nurses can result in increased awareness and knowledge of ICU delirium and adequately prepare them for how to properly screen and treat patients. Although overall compliance with implementing daily ICU delirium screenings and care bundle interventions was relatively low, those patients who did receive screening and interventions demonstrated that the incidence of positive delirium screenings at this facility is low compared with reported figures. In addition, patients who did receive the appropriate care bundle interventions did so in a uniform manner, regardless of the presence or absence of clinical delirium.