Critical care nursing quarterly
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Review Case Reports
Teaching staff nurses the CAM-ICU for delirium screening.
The confusion assessment method for the intensive care unit (CAM-ICU) is a tool for screening for delirium in ventilated patients that with proper training can be administered quickly by staff nurses in the ICU. Unrecognized delirium can have a range of negative consequences, and in the elderly patients, it may be the first sign of an acute illness that, if left untreated, could result in death. ⋯ Preparatory decisions include (1) how the tool will be used, (2) defining the process for identifying and recording baseline mental status, and (3) defining how documentation will occur. On the basis of the experience of teaching this tool to staff nurses, a 6-step process is explicated to facilitate integration: (1) putting it in context, (2) defining the features, (3) talking about tough cases, (4) doing the assessment, (5) documenting the assessment, and (6) continuing to discuss.
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Most patients with heart failure (HF) respond within a matter of hours to days to available medical treatments. Nursing's current challenge in HF inpatient care is their short length of stay and content dense patient education needs. ⋯ Pragmatically viewed, we need to turn the 5 key areas upside down to meet our HF patient's needs during early hospitalization: (1) recognizing symptoms, (2) pacing rest and exercise, (3) daily weights, (4) restricting sodium and fluids, and (5) managing medications. This "organizing" issue is important to our success and costly to all those who accepted the published order as prescriptive for their video, audio, and printed discharge education materials.
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Interdisciplinary healthcare teams have become the new model for patient care delivery in today's complex healthcare environment of increased specialization and disciplinarity of healthcare providers. Research to support the efficacy of this model has been problematic because of poorly conceptualized interdisciplinary teams as well as methodological problems conducting the research. Findings from organizational studies and healthcare interdisciplinary research can be integrated into a theory-based model to design an educational workshop to develop team members. Development of team members is proposed as a means to enhance collaboration among team members and therefore reduce the risk of team failure.
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This article reviews the scientific health and medical literature on accidental falls and fall prevention modalities specifically directed to the hospitalized elderly population over a 15-year period. ⋯ Fall prevention modalities may facilitate achievement of the ninth goal of The Joint Commission namely, to "reduce the risk of patient harm resulting form falls" and achievement of Healthy People 2010 15th goal namely, to "reduce death from falls."
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A growing body of scientific evidence demonstrates negative effects of fatigue on human performance. Nursing practice encompasses many tasks that require optimal performance. Fatigue can be the result of a multitude of contributing causes. Nurses and nursing leaders must be aware of the causes and effects of fatigue and ensure that its impact is considered where staffing and patient safety intersect.