American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Ventilator-associated pneumonia is a common complication of mechanical ventilation. Backrest position and time spent supine are critical risk factors for aspiration, increasing the risk for pneumonia. Empirical evidence of the effect of backrest positions on the incidence of ventilator-associated pneumonia, especially during mechanical ventilation over time, is limited. ⋯ Subjects spent the majority of the time at backrest elevations less than 30 degrees . Only the combination of early, low backrest elevation and severity of illness affected the incidence of ventilator-associated pneumonia.
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Multicenter Study Comparative Study
Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally.
Inadequate nutritional intake in critically ill patients can lead to complications resulting in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. ⋯ Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings.
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The role of acute care nurse practitioners (ACNPs) has developed in capacity. More than 3500 advanced practice nurses have been certified as ACNPs, and the number of practice settings where these professionals work is continually expanding. ⋯ What started as an attempt to gather information on the role of ACNPs evolved into a national 5-year longitudinal survey of ACNP practice. The cumulative results of the project are reported, and how the role of the ACNP was established in advanced practice nursing is discussed.
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Comparative Study
Clinical comparison of automatic, noninvasive measurements of blood pressure in the forearm and upper arm.
When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure. ⋯ Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.
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Families of critical care patients experience high levels of emotional distress. Access to information about patients' medical conditions and quality relationships with healthcare staff are high-priority needs for these families. ⋯ More interpersonal contact with medical staff can help meet the information needs of patients' families. Nurses may aid in families' adjustment by fostering a sense of optimism in family members and encouraging them to participate in the patients' care.