American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. ⋯ Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.
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To evaluate the effect of a standardized worksheet on physicians' and nurses' perceptions of their understanding of goals of care and on patients' length of stay in an intensive care unit. ⋯ Nurses' and physicians' perceptions of their understanding of the goals of care and of communication between them were improved and stays in the unit were shortened when the worksheet was used.
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Few studies address predictors for successful weaning of older adults from mechanical ventilation. ⋯ Persistent positive fluid balance in older surgical patients is associated with prolonged mechanical ventilation. Estimates of fluid balance might be useful in weaning older patients from long-term mechanical ventilation.
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The predictive accuracy of scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) for in-hospital mortality among critically ill cancer patients varies. ⋯ APACHE II scores are predictive of hospital mortality in critically ill cancer patients. The presence of metastasis and respiratory failure at admission are also associated with outcome.
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To minimize the occurrence of adverse events among patients, critical care nurses must be alert to subtle changes in patients' conditions, perform accurate clinical assessments, and respond expediently. However, little is known about the effects of the nurses' work hours on vigilance and patients' safety. ⋯ The findings support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses' work hours to no more than 12 consecutive hours during a 24-hour period.