Critical care nursing quarterly
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In addition to improving gas exchange by mechanical ventilation, minimizing iatrogenic lung injury and making the patient comfortable are important goals. This article reviews advanced ventilator modes and techniques that might help to accomplish these goals. Small tidal volumes (VT) and low ventilation pressure minimize ventilator-induced lung injury. ⋯ Certain ventilator modes purport to automate part of the ventilator discontinuance process. The ASV progressively reduces support as the patient's lung condition improves, while SmartCare/pressure support (Dräger, Lübeck, Germany) reduces support and then initiates a spontaneous breathing trial. Further research is required to determine the proper place these new modes have in the intensive care unit.
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To guide family adjustment, an effort was made to facilitate pediatric visitation in an adult intensive care unit (ICU). Goals were to improve customer satisfaction and to raise staff comfort level with child visitation. After implementing an open visitation policy, concerns around pediatric visitation in the ICU remained. ⋯ Nursing interventions were reviewed and resources provided. A survey demonstrated that the book increased staff comfort level with children visiting the unit, was a positive tool for patients and families, and eased fears among children while helping to facilitate coping mechanisms. The article will describe the practice change of pediatric visitation in an ICU and how it could be applied to other critical care settings.
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For more than a decade, research has demonstrated both the widespread prevalence and negative outcomes associated with intensive care unit delirium. Hospitals are, therefore, being called to institute evidence-based protocols to prevent and manage its occurrence. Integrating evidence-based practice into bedside care can be a challenge. ⋯ This approach has been proven successful in reduction of ventilator-associated pneumonias and catheter-related blood stream infections, while in partnership with Johns Hopkins University. The purpose of this article is to describe the creation of evidence-based toolkits used to facilitate successful statewide changes in practice using an interprofessional team including nurses, physicians, and pharmacists. The content reflects a step-wise approach to not only engage and educate staff, but also strategies to execute and evaluate the effectiveness.
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To gain an understanding of and increased knowledge about the effects of open visiting hours on patients, their family members, and nurses within the intensive care unit environment, the author reviewed 10 empirical studies. Much has been debated about the essentials needed to create a healing environment that best promotes harmony of the mind, body, and spirit for the critically ill patient. Research indicates an open visiting policy may improve the quality of care and satisfaction of patients, family members, and nurses in the intensive care unit. The studies reviewed show that although most critical care nurses find that open visiting hours may impede patient care, the benefits to patients and family outweigh any negative impact to the patient.
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Over the past decade, winners of the Society of Critical Care Medicine's critical care unit design award have demonstrated an increase in overall square footage, but this trend has been inconsistent. The following analysis compares the space allocation of 15 recently completed critical care units to document trends in overall space allocation and compare the allocation of space between small, medium, and large units. ⋯ Within the net or usable square footage allocation, all categories of space increased progressively as the overall space increased, with the exception of direct patient care space and patient care support space categories. Overall, averages are provided to be used as preliminary benchmarks for organizations evaluating their existing critical care units or planning replacement units.