American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Negotiating Transitions: Involvement of Critical Care Outreach Teams in End-of-Life Decision Making.
Little research has examined the involvement of critical care outreach teams in end-of-life decision making. ⋯ A considerable amount of time is being spent on these emergency referrals, and decisions to limit medical treatment are common. The appropriateness of escalation of levels of care is often not questioned until patients become critically or acutely unwell, and outreach teams subsequently intervene.
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Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. ⋯ A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.
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Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. ⋯ More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia.
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Nurse practitioners and physician assistants are being increasingly integrated into intensive care unit and hospital-based care teams, yet limited information is available on provider to patient ratios. ⋯ Additional information on factors influencing provider to patient ratios and specific components of the roles of nurse practitioners and physician assistants will be important to ensure the best utilization of these providers to enable optimal patient care outcomes.
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Up to 50 000 intensive care unit interhospital transfers occur annually in the United States. ⋯ Interhospital transfers of cancer patients to an intensive care unit at an oncological center are infrequent but are most commonly done for direct interventional care. Most patients received planned interventions soon after transfer.