AACN clinical issues
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AACN clinical issues · Feb 1997
ReviewAcute-care nurse practitioners: 'strangers in a strange land'.
In 1961, Heinlein described a "stranger" from another planet struggling to comprehend and integrate the cultural idiosyncracies of earthlings in his adopted land. One could compare that situation with what confronts acute-care nurse practitioners (ACNPs) as they embark into the practitioner's world of acute care. Rather than embrace the expensive and fragmented patient-care world through collaboration with its "strangers," ACNPs would benefit from clinging to elements of their own native nursing culture and become "nesters" rather than "perchers" in the quest for improved health care.
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AACN clinical issues · Feb 1997
ReviewCredentialing and privileging: insight into the process for acute-care nurse practitioners.
Acute-care nurse practitioners must be knowledgeable of the mechanisms whereby their scope of practice is defined and regulated, and through which professional competence is ensured. The mechanisms whereby hospitals determine scope and practice parameters is through credentialing and the delineation of clinical privileges. ⋯ Acute-care nurse practitioners are encouraged to negotiate for delineation of clinical privileges that are consistent with their professional and legal scope of practice, educational and individual capabilities, and the safe delivery of quality patient care. It is important that the process not be misused to erect barriers to practice, resulting in underserving of patient and organizational needs.
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AACN clinical issues · Nov 1996
ReviewHigh-level positive end expiratory pressure management in the surgical patient with acute respiratory distress syndrome.
Although the exact incidence of ARDS is not know, it is frequently reported that there are 150,000 cases in the United States each year. Despite major advances in medical and respiratory intensive care, the mortality for patients with ARDS remains exceedingly high and has not changed appreciably from the 50% to 75% reported during the last 25 years. ⋯ Although most practitioners agree that patients with severe ARDS require mechanical ventilation to maintain adequate gas exchange, controversies center on the amount of supplemental oxygen, level of positive end expiratory pressure (PEEP), and mode of ventilation needed to increase patient survival but reduce ventilator-associated complications. This review provides supportive evidence for the use of high-level PEEP (more than 15 cm H20) in the care of the surgical patient with severe ARDS.
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AACN clinical issues · Nov 1996
ReviewVentilator weaning protocols and techniques: getting the job done.
Various protocols and techniques used to facilitate the weaning process are herein summarized. The protocols were derived from the literature, a survey of critical care nurses, and personal communications with individuals who use innovative methods to expedite the weaning process and reduce costs. The protocols provide a guideline for standardizing the weaning process, but they do not negate the importance of having skilled clinicians who provide continuity in implementing the protocols. The nursing profession has the opportunity to provide leadership in reducing health care costs through implementation of standardized approaches to weaning patients from mechanical ventilatory support.
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AACN clinical issues · Nov 1996
ReviewPreventing complications of mechanical ventilation: permissive hypercapnia.
Research suggests that the forces exerted on the lungs by mechanical ventilators may cause as much damage to the lungs as the original pathologic process. In an attempt to limit additional injury to damaged lungs and improve the morbidity and mortality of patients requiring mechanical ventilation, investigators have proposed a controversial method of ventilatory management, permissive hypercapnia. This method attempts to maintain adequate oxygenation while allowing ventilation to decrease; carbon dioxide increases. ⋯ Ventilating pressures and volumes are lowered, with a resultant lower minute ventilation. Few adverse effects have been noted when this process has occurred gradually. By using permissive hypercapnia from the initiation of mechanical ventilation, it is possible to support the body through the resolution of the disease process while preventing additional lung injury.