Clinical nurse specialist CNS
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The purposes of this study about patients with pressure ulcers were to: (a) examine demographic characteristics, laboratory values, Braden Scale scores, and presence of pressure ulcer prevention methods and (b) examine pressure ulcers in terms of classification, stage, wound care, and documentation. The investigation was a prospective, descriptive study; the methods used were patient observations and data recordings from the medical record. Of the patients followed (n = 694), 71 had pressure ulcers. ⋯ Dressings used for wound care were generally gauze or a hydrocolloid. Nurses' charting about pressure ulcers was complete for only 35% of notations. The results of this study indicate that advanced practice nurses have a critical role in caring for patients with pressure ulcers and educating care providers.
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Effective management of psychiatric emergencies has emerged as an important area in the field of mental illness. Psychiatric clinical nurse specialists (CNSs), with their advanced training in psychodynamics, pathophysiology, physical assessment, pharmacology, crisis intervention, and psychotherapy, are the ideal practitioners to respond to the treatment needs of the individual and family experiencing a psychiatric emergency. This article outlines the practice domain of the psychiatric CNS in such a setting. The psychiatric CNS brings a level of expertise to the emergency department that allows for comprehensive biopsychosocial assessment, effective crisis intervention, medication management, inclusion of family dynamics, and consideration of environmental influences in treatment and follow-up.
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We designed a prospective study of endotracheal intubations and reintubations in our inner city Level 1 Trauma Center, to determine the frequency and causes of reintubation and evaluate the impact of an educational intervention aimed at minimizing unplanned extubations (UEs). After an initial 3-month phase, efforts were instituted to educate healthcare providers to the causes of reintubation noted. An identical 3-month period was then studied to evaluate the efficacy of the interventions. ⋯ Reintubations after UEs decreased from 14% to 5.2% (rate ratio, 0.374; 95% confidence interval = 0.141, 0.990). Multiple reintubation events decreased from 45% to 18.8% (p = 0.07). Increased provider education and protocol changes were associated with lower reintubation rates.
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Reports consistently state that hospitalized patients' pain is undermanaged and is caused by healthcare professional's failure to assess pain adequately and provide relief. The purpose of this study was to explore patients' expectations and perceptions of their acute postoperative pain to improve understanding and management. The sample consisted of 20 patients undergoing coronary artery bypass surgery. ⋯ Results suggest that, although most patients experienced moderate-to-severe pain intensity, they also experienced periods of no pain, used little pain medication, and reported satisfaction with pain relief. Patients reported undesired side effects from pain medication, beliefs that pain served a purpose in recovery, fears of addiction, and expectations that pain would or should be present. The recommendation simply to provide more pain medication may not be appropriate or desirable for all patients.