AACN clinical issues
-
AACN clinical issues · Feb 2003
ReviewIdentification and management of delirium in the critically ill patient with cancer.
Rather than a specific entity, delirium is at the midpoint on a spectrum of potential mental status changes that ranges from full consciousness to deep coma. The extremes are relatively easy to recognize, but other points along the spectrum may go unrecognized or be misdiagnosed. ⋯ Although all critically ill patients are at risk for delirium, cancer presents additional assaults to the central nervous system via direct tumor invasion or iatrogenic provocations. This article describes delirium in cancer, and addresses diagnostic and management issues across the course of the disease.
-
AACN clinical issues · Feb 2003
ReviewClinical management of stressors perceived by patients on mechanical ventilation.
Psychological and psychosocial stressors perceived by the mechanically ventilated patient include intensive care unit environmental factors, communication factors, stressful symptoms, and the effectiveness of interventions. The studies reviewed in this article showed four stressors commonly identified by mechanically ventilated patients including dyspnea, anxiety, fear, and pain. ⋯ Four interventions including hypnosis and relaxation, patient education and information sharing, music therapy, and supportive touch have been investigated in the literature and may be helpful in reducing patient stress. The advanced practice nurse is instrumental in the assessment of patient-perceived stressors while on the ventilator, and in the planning and implementation of appropriate interventions to reduce stressors and facilitate optimal ventilation, weaning, or both.
-
Advances in technology and the expansion of the emergency medical system have made emergency care available to large numbers of people experiencing trauma. Assessing the quality of life experienced by trauma survivors may assist in the development of interventions to optimize the outcomes in this patient population. The purpose of this study was to assess the quality of life experienced by severely injured trauma survivors, and to determine if a relation exists between the severity of the injury and the quality of life, the impact on the family of survivors, and the community resources needed by the survivors. ⋯ Although most of the SIP's 12 behavior categories indicated severe disruption, the behavior categories of work, recreation and pastimes, home management, and sleep and rest were the most negatively affected. Patients and families should be prepared for the physical, emotional, and financial disruptions that occur after severe traumatic injury. Support services, including community resources, are needed to optimize outcomes after discharge.
-
AACN clinical issues · Nov 2002
ReviewEvaluating ventilator weaning best practice: a long-term acute care hospital system-wide quality initiative.
Long-term acute care (LTAC) hospitals and units are becoming increasingly important to the management of patients who have serious, complex critical illnesses and require mechanical ventilation for extended periods of time. Kindred Healthcare, Inc., a nation-wide system of LTAC hospitals embarked on a quality initiative to establish a Ventilator Management and Weaning Best Practice. The process steps included: measurement of performance of all hospitals in the system using a risk-adjusted methodology to evaluate clinical outcomes, identification of facilities with superior outcomes; structured evaluation of the characteristics, practices, and protocols of these Best Practice hospitals; and utilization of the information gleaned from these hospitals to establish evidence-based LTAC best practice ventilator management guidelines. Key characteristics of the Best Practice LTAC hospitals were: hospital-wide philosophy that "everybody weans"-that is, all disciplines actively participate and all patients are expected to wean; collaborative multidisciplinary plans of care; a consistent and a 24-hour-a-day approach to ventilator management and weaning; daily communication; mutual respect for the contributions of all disciplines to the weaning process; early, aggressive nutrition support and intervention by rehabilitation services; use of 24-hour in-hospital advance practice nurses, hospitalists, or physician assistants; and intervention by physiatrists.
-
The nursing shortage is seriously challenging hospitals to provide safe, quality care to acute and critically ill patients. Most frequently reported are the registered nurse (RN) shortages in intensive care units (ICUs) and step-down units. Issues surrounding the nursing shortage are multifaceted and require comprehensive solutions. ⋯ Remedies for the acute and critical care nursing shortage will require highly innovative initiatives and multiple long-term strategies focused on forces driving the growing nursing shortage. One solution to workplace issues may lie in the philosophy of the Magnet Hospital program. The advanced practice nurse can play a significant role in providing leadership in addressing factors and designing comprehensive and innovative strategies directed at recruitment and retention of RNs in acute and critical care settings.