American journal of critical care : an official publication, American Association of Critical-Care Nurses
-
Morbidity and mortality conferences are a tool for evaluating care management, but they lack a precise format for practice in intensive care units. ⋯ In addition to their educational value, regular morbidity and mortality conferences formatted for intensive care units are useful for assessing quality of care and patient safety.
-
Head-of-bed elevation of 30 degrees to 45 degrees is important in preventing ventilator-associated pneumonia, but clinicians' perception and determination of head-of-bed elevation are not widely reported. ⋯ Head-of-bed angle was perceived correctly by 50% to 86% of clinicians. Nurses tended to underestimate the angle, whereas other clinicians tended to overestimate. Nurses, respiratory therapists, and physical/occupational therapists showed the best understanding of the correct angle for minimizing occurrence of ventilator-associated pneumonia. Elevation gauges were most often used to determine the angle.
-
Case Reports
Knotting of nasogastric tube around a nasotracheal tube: An unusual cause of hypercapnia in a 3-month-old infant.
A 3-month-old boy was admitted to the intensive care unit because of septic shock; he required immediate intubation and placement of a nasogastric tube. A confirmatory chest radiograph showed that the nasogastric tube was looping in the hypopharynx and needed to be repositioned. During removal of the nasogastric tube, the infant experienced hypercapnia and respiratory distress. These complications were due to looping and knotting of the nasogastric tube around the nasotracheal tube.
-
Continuous ST-segment monitoring can be used to detect early and transient cardiac ischemia. The American Heart Association and American Association of Critical-Care Nurses recommend its use among specific patients, but such monitoring is routine practice in only about half of US hospitals. ⋯ Respondents (55%) were unaware of published monitoring guidelines. Hospital leaders could raise awareness by multidisciplinary review of evidence and possibly incorporating continuous ST-segment monitoring into hospitals' standards of practice.
-
Limited research has been conducted to assess family needs in neonatal intensive care units. Health care providers often make assumptions about what families need, but these assumptions are unfounded and can lead to inappropriate conclusions. When assessed appropriately, family needs can be incorporated into individualized plans of care, enhancing family-centered care. ⋯ Identifying the needs of parents in neonatal intensive care units can enhance nursing communication and allow nurses to incorporate parents' needs into families' plans of care. The family needs inventory can help identify those needs and allows the integration of individualized nursing care to fulfill those needs, providing a positive family-centered experience in the unit for patients and their families.