Clinical nurse specialist CNS
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The purpose of this quality improvement project was to determine if the use of standardized insulin orders versus the use of nonstandardized insulin orders improved glucose results in a hospital's critical care unit. A clinical nurse specialist-led interdisciplinary team developed standardized insulin orders with the goal of improving glucose control. ⋯ A mean glucose of 175 mg/dL and median glucose of 149 mg/dL were the outcomes when standardized insulin orders were used versus a mean glucose of 206 mg/dL and median glucose of 190 mg/dL when standardized orders were not used. System change efforts to improve glucose control resulted in improved staff nurse empowerment, improved provider knowledge of glucose control methods, and improved patient glucose control in this Midwestern hospital.
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Since Van den Berghe et al published their study on tight glucose control in 2001, intensive insulin therapy (IIT) has been increasingly used for critically ill patients worldwide. However, recent studies reported a significantly increased risk of hypoglycemia without a significant reduction in mortality. ⋯ Intensive insulin therapy was not associated with significant reduction in mortality in adult critically ill patients but was related to a significant increase in the incidence of hypoglycemia. Therefore, it is inappropriate to generalize IIT for all critically ill patients, even though it significantly improved blood glucose control.
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The purpose of this article was to share the experiences and knowledge gained of the clinical nurse specialist's (CNS's) role in the development and implementation of an interdisciplinary geropalliative model of care. ⋯ A geropalliative model of care can be integrated into a variety of healthcare settings. Clinical support and expertise contributed to positive outcomes. Questions for research include the need to identify a symptom assessment tool that is valid, reliable, and easy to use in the chronically ill, geriatric setting, as well as discerning innovative ways to disseminate knowledge to nurses.