Comparing Opinions on Meaningful Recognition: Do Views of Trauma Nursing Leaders and Staff Align?

With increased demand for registered nurses (RN), due to increasing shortage and turnover rate, the role of meaningful recognition becomes of paramount importance. We hypothesized that RNs and leaders value forms of recognition differently, due to generational gap and changing health care environment. This study included 46 RN/support staff (RN/SS group) and 10 nurse leaders (leaders group) from a Level 1 trauma center. Mean values from 5-point Likert scale survey on 31 forms of recognition (grouped into 6 categories) and demographics (age, nursing experience, and gender) were compared. All participants were separated into groups: 35 years of age and younger (millennials; n = 29) and older than 35 years (Gen X/boomers; n = 27). Majority of RN/SS were 26-35 years of age (43.5%) and 50.0% had less than 3 years of nursing experience. Half of the leaders were 36-45 years of age (p = .01 vs. RN/SS), and 70.0% had 16 years of experience or greater (p = .001). There was 9:1 female-to-male ratio in both groups (p = .8). The RN/SS rated "salary increase" highest and leaders rated "celebration for years of service" highest (both means: 4.4). When categorized, "monetary rewards" ranked highest both by RN/SS and leaders (means: 4.4 and 4.1). Overall, there was no statistically significant difference between mean values. The Gen X/boomers rated statistically significantly higher 9 forms and 3 categories (written/public acknowledgment and private verbal feedback) than millennials. Mean values for forms/categories of recognition were lower for RN/SS than for leaders, but differences were not statistical. Age drove the most difference in most meaningful forms, as preference for monetary rewards stems from the younger generations' focus on work-life balance.

Intravenous Ibuprofen Reduces Opioid Consumption During the Initial 48 Hours After Injury in Orthopedic Trauma Patients.

OBJECTIVES: To evaluate the efficacy of intravenous (IV) ibuprofen (Caldolor) administration in the management of acute pain in orthopedic trauma patients and to minimize opioid use. DESIGN: Randomized controlled trial, double-blind, parallel, placebo-controlled. SETTING: Level 1 Trauma Center. PATIENTS: A total of 99 consecutive orthopedic trauma patients with fractures of the ribs, face, extremities, and/or pelvis were randomized to receive either 800 mg IV ibuprofen (53 patients) or placebo (44 patients) administered every 6 hours for a total of 8 doses within 48 hours of admission and the same PRN medications along with 20-mg IV/PO Pepcid twice a day. To establish pain reduction efficacy, the analysis was consequently performed in the modified intent-to-treat group that included 74 randomized subjects with a baseline pain score greater than 2. The primary outcomes were reduction in opioid consumption and decrease in pain intensity (PI). INTERVENTION: Administration of study medications. OUTCOME MEASUREMENTS: PI measured by Numerical Rating Scale, opioid consumption adjusted to morphine equivalent dose, and time to first narcotic administration. RESULTS: The 2 groups had comparable baseline characteristics: age, sex distribution, mechanism of injury, type of injury, injury severity score, and PI. IV ibuprofen statistically significantly reduced opioid consumption compared with placebo during the initial 48-hour period (P = 0.017). PI calculated as PI differences was statistically different only at 8-hour interval after Caldolor administration. Time to first narcotic medication was significantly longer in the Caldolor group (hazard ratio: 1.640; 95% confidence interval, 1.009-2.665; P = 0.046). CONCLUSIONS: IV ibuprofen provided adequate analgesia, prolonged time to first narcotic administration, and was opioid-sparing for the treatment of pain in orthopedic trauma patients, which makes Caldolor a recommended candidate for managing acute pain in the diverse orthopaedic trauma population. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Early Versus Late Tracheostomy in Trauma Patients With Rib Fractures.

BACKGROUND: Patients with blunt chest trauma with multiple rib fractures (RF) may require tracheostomy. The goal was to compare early (≤7 d) versus late (>7 d) tracheostomy patients and to analyze clinical outcomes, to determine which timing is more beneficial. METHODS: This retrospective review included 124 patients with RF admitted to trauma ICU at two level 1 trauma centers who underwent tracheostomy. Analyzed variables included age, gender, injury severity score, Glasgow Coma Scale, number of ribs fractured, total fractures of the ribs, prevalence of bilateral RF, flail chest, maxillofacial injuries, cervical vertebrae trauma, traumatic brain injuries (TBI), coinjuries, epidural analgesia, surgical stabilization of RF, failure to extubate, hospital LOS, intensive care unit LOS (ICULOS), duration of mechanical ventilation, mortality, and timing and type of tracheostomy. RESULTS: Mean number of RF in all tracheostomized patients with blunt chest trauma was 5.2 and 85% of patients had pulmonary co-injuries. Mean tracheostomy timing was 9.9 d. Early tracheostomy (ET) was correlated with statistically significant reduction in ICULOS and duration of mechanical ventilation. The dominant cause of mortality in all groups was TBI and it was more pronounced in the ET patients. Most deaths were encountered between 3 and 5 wk after admission. ET was more often performed in the operating room with an open technique, whereas late tracheostomy was more often implemented with percutaneous technique at bedside. CONCLUSIONS: ET could be beneficial in chest trauma patients with multiple RF as it reduces ICULOS and ventilation requirements. Mortality benefits are not correlated with tracheostomy timing.

Text messaging and brief phone calls for weight loss in overweight and obese English- and Spanish-speaking adults: A 1-year, parallel-group, randomized controlled trial.

BACKGROUND: Weight loss interventions based solely on text messaging (short message service [SMS]) have been shown to be modestly effective for short periods of time and in some populations, but limited evidence is available for positive longer-term outcomes and for efficacy in Hispanic populations. Also, little is known about the comparative efficacy of weight loss interventions that use SMS coupled with brief, technology-mediated contact with health coaches, an important issue when considering the scalability and cost of interventions. We examined the efficacy of a 1-year intervention designed to reduce weight among overweight and obese English- and Spanish-speaking adults via SMS alone (ConTxt) or in combination with brief, monthly health-coaching calls. ConTxt offered 2-4 SMS/day that were personalized, tailored, and interactive. Content was theory- and evidence-based and focused on reducing energy intake and increasing energy expenditure. Monthly health-coaching calls (5-10 minutes' duration) focused on goal-setting, identifying barriers to achieving goals, and self-monitoring. METHODS AND FINDINGS: English- and Spanish-speaking adults were recruited from October 2011 to March 2013. A total of 298 overweight (body mass index [BMI] 27.0 to 39.9 kg/m2) adults (aged 21-60 years; 77% female; 41% Hispanic; 21% primarily Spanish speaking; 44% college graduates or higher; 22% unemployed) were randomly assigned (1:1) to receive either ConTxt only (n = 101), ConTxt plus health-coaching calls (n = 96), or standard print materials on weight reduction (control group, n = 101). We used computer-based permuted-block randomization with block sizes of three or six, stratified by sex and Spanish-speaking status. Participants, study staff, and investigators were masked until the intervention was assigned. The primary outcome was objectively measured percent of weight loss from baseline at 12 months. Differences between groups were evaluated using linear mixed-effects regression within an intention-to-treat framework. A total of 261 (87.2%) and 253 (84.9%) participants completed 6- and 12-month visits, respectively. Loss to follow-up did not differ by study group. Mean (95% confidence intervals [CIs]) percent weight loss at 12 months was -0.61 (-1.99 to 0.77) in the control group, -1.68 (-3.08 to -0.27) in ConTxt only, and -3.63 (-5.05 to -2.81) in ConTxt plus health-coaching calls. At 12 months, mean (95% CI) percent weight loss, adjusted for baseline BMI, was significantly different between ConTxt plus health-coaching calls and the control group (-3.0 [-4.99 to -1.04], p = 0.003) but not between the ConTxt-only and the control group (-1.07 [-3.05 to 0.92], p = 0.291). Differences between ConTxt plus health-coaching calls and ConTxt only were not significant (-1.95 [-3.96 to 0.06], p = 0.057). These findings were consistent across other weight-related secondary outcomes, including changes in absolute weight, BMI, and percent body fat at 12 months. Exploratory subgroup analyses suggested that Spanish speakers responded more favorably to ConTxt plus health-coaching calls than English speakers (Spanish contrast: -7.90 [-11.94 to -3.86], p < 0.001; English contrast: -1.82 [-4.03 to 0.39], p = 0.107). Limitations include the unblinded delivery of the intervention and recruitment of a predominantly female sample from a single site. CONCLUSIONS: A 1-year intervention that delivered theory- and evidence-based weight loss content via daily personalized, tailored, and interactive SMS was most effective when combined with brief, monthly phone calls. TRIAL REGISTRATION: ClinicalTrials.gov NCT01171586.

Quantification of rib fractures by different scoring systems.

BACKGROUND: The three known systems for evaluation of patients with rib fractures are rib fracture score (RFS), chest trauma score (CTS), and RibScore (RS). The aim was to establish critical values for these systems in different patient populations. METHODS: Retrospective cohort study included 1089 patients with rib fractures, from level-1 trauma center; divided into two groups: first group included 620 nongeriatric patients, and second group included 469 geriatric patients (≥65 y.o.). Additional variables included mortality, injury severity score (ISS), hospital and intensive care unit lengths of stay (HLOS, ICULOS), duration of mechanical ventilation, rate of pneumonia (PN), tracheostomy, and epidural analgesia. RESULTS: RFS critical values were 10 for nongeriatric and eight for geriatric patients, CTS were four and six respectively, and RS were one for both. Nongeriatric patients with RFS ≥10 versus RFS <10, had higher mortality, ISS, HLOS, ICULOS, and tracheostomy (P <0.03). Geriatric patients with RFS ≥8 versus RFS <8, had higher mortality, ISS, HLOS, ICULOS, and PN (P <0.03). Nongeriatric patients with CTS ≥4 versus CTS <4, had higher mortality, ISS, HLOS, ICULOS, duration of mechanical ventilation, and PN (P < 0.02). Geriatric patients with CTS ≥6 versus CTS <6 had greater values for all variables (P < 0.01). Both groups with RS ≥1 versus RS <1, had greater values for all variables (P < 0.05). In geriatric group, prediction of PN was good by CTS (c = 0.8) and fair by RFS and RS (c = 0.7). CONCLUSIONS: Physicians should choose score to match specific population and collected variables. RFS is simple but sensitive in elderly population. CTS is recommended for geriatric patients as it predicts PN the best. RS is recommended for assessment of severely injured patients with high ISS.

Does unit designation matter? A dedicated trauma intensive care unit is associated with lower postinjury complication rates and death after major complication.

BACKGROUND: Recent data suggest that specialty intensive care units (ICUs) have outcomes better than those of mixed ICUs. The cause for this apparent discrepancy has not been well established. We hypothesized that trauma patients admitted to a dedicated trauma ICU (TICU) would have a lower complication rate as well as death after complication (failure to rescue [FTR]). METHODS: This was a retrospective review of the ICUs of two Level I trauma centers covered by one group of surgical intensivists. One center has a dedicated TICU, while the other has a mixed ICU. Demographic and clinical characteristics were stratified into TICU and ICU groups. The primary outcomes were postinjury complications and FTR. Multivariate regression was used to derive factors associated with complications and FTR. RESULTS: During the 5-year study period, 3,833 patients were analyzed. TICU patients were older (57.8 vs. 47.0 years, p < 0.0001), had higher Charlson score (2 vs. 1, p = 0.001), had more severe head injuries (Head Abbreviated Injury Scale [AIS] score ≥ 3, 50.0% vs. 37.5%, p < 0.0001), and had greater injury burden (Injury Severity Score [ISS] > 16, 49.6% vs. 38.6%, p < 0.0001) than those admitted to the mixed ICU. Need for immediate operative intervention was similar (18.0% vs. 17.6%, p = 0.788). Overall complications were significantly higher in trauma patients admitted to the mixed ICU (27.5% vs. 17.0%, p < 0.0001), as well as FTR (3.7% vs. 1.8%, p < 0.0001). Trauma patients admitted to a dedicated TICU had significantly lower chance of developing a postinjury complication (adjusted odds ratio [AOR], 0.5; p < 0.0001), FTR (AOR, 0.3; p < 0.0001), and overall mortality (AOR, 0.4; p < 0.0001). CONCLUSION: Admission of critically ill trauma patients to a TICU staffed by a surgical intensivist is associated with a lower complication rate and FTR. Factors such as trauma nursing experience, education, and unit management structure should be further explored to elucidate the observed improved outcomes. LEVEL OF EVIDENCE: Prognostic study, level III.

The heart of critical care. Cardiovascular advances continue to pump up cardiac-related outcomes.

Cardiac technology provides quicker assessment and diagnostic techniques. Other devices assist with more effective patient treatments and supportive healing.