American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Multicenter Study
Intensive Care Nurses' Knowledge About Use of Neuromuscular Blocking Agents in Patients With Respiratory Failure.
The recent increase in use of neuromuscular blocking agents (NMBAs) in patients with acute respiratory distress syndrome is set against a backdrop of concerns about harm associated with use of these high-risk drugs. Bedside nurses play a pivotal role in the safe and effective use of these agents. ⋯ Critical care nurses are knowledgeable about the importance of concurrent analgesia and sedation during use of NMBAs. Routes of elimination, duration of action, and adverse effects were less commonly known and represent areas for focused education and quality improvement surrounding use of NMBAs in the intensive care unit.
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The extent to which gastric acid inhibitors and feedings affect gastric pH in infants is unclear. ⋯ The pH of gastric aspirates from critically ill infants is often 5.5 or less, regardless of the use of acid inhibitors, feedings, or both. Most likely a cut point of 5.5 or less would rule out respiratory placement because tracheal pH is typically 6.0 or higher.
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Prevention of falls during hospitalization depends in part on the behaviors of alert patients to prevent falls. Research on acutely ill patients' intentions to behave in ways that help prevent falls and on the patients' perceptions related to falls is limited. ⋯ Although assessments may indicate a risk for falling, acutely ill inpatients may not perceive they are likely to fall. Patients' intentions to engage in behaviors to prevent falls vary with the patients' fall-related perceptions of confidence, outcomes, and fear related to falling.
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Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. ⋯ Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes.
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Nurses and physicians often describe critical care that is not expected to provide meaningful benefit to a patient as futile, and providing treatments perceived as futile is associated with moral distress. ⋯ Interprofessional concordance on provision of critical care perceived to be futile is low; however, joint predictions between physicians and nurses were most predictive of patients' outcomes, suggesting value in collaborative decision making.