American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit.
Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. ⋯ When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.
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The Admission Discharge Transfer-Synergy Model Acuity Tool (ADT-SMAT) was developed to quantify patient intervention intensity and patient response variability and to capture nurses' critical thinking. The tool is based on the American Association of Critical-Care Nurses Synergy Model for Patient Care. ⋯ This is the first study attempting to correlate Synergy Model patient characteristics and acuity while integrating nurses' critical decision-making process. With further testing, the ADT-SMAT could be a valuable tool to quantify and standardize patient characteristics in determining the appropriate level of care associated with admission, discharge, and transfer decisions.
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Sepsis is a leading cause of mortality among hospitalized patients and is the most expensive condition affecting the US health care system. Pneumonia is associated with about half of sepsis cases, yet limited research has described the incidence of sepsis in the context of nonventilator hospital-acquired pneumonia (NV-HAP). Persons with NV-HAP who are at risk for sepsis must be identified so that interventions to reduce the burden of NV-HAP and improve outcomes among patients with sepsis can be designed. ⋯ Sepsis in the context of NV-HAP is a key concern. Additional research is needed to identify factors associated with the development of sepsis among patients with NV-HAP.
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Developing a sustainable strategy for prescriber-led review of antimicrobial use in a critical care unit may improve antimicrobial use without the need for additional resources. ⋯ Nurse prompting can lead to significant reductions in antimicrobial use, providing a sustainable mechanism for independent antimicrobial reassessment.
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Multicenter Study
Factors Associated With Nurses' Knowledge of and Perceived Value in Evidence-Based Practices.
Little is known about how the education and specialty certification of intensive care unit nurses influence patients' outcomes. ⋯ Nursing specialty certification was associated with nurses' individual psychosocial beliefs and their perceptions of evidence-based practices in the intensive care unit, whereas education level was not. Supporting nurses in obtaining specialty certification could assist with the adoption of evidence-based practices as a means to improve quality of care in the intensive care unit.