ABSTRACT
BACKGROUND: For decades, medication titration has been within nurses' scope and practice. In 2017 The Joint Commission (TJC) revised elements for orders for the titration of continuous intravenous medications. OBJECTIVES: To explore the practice and perceptions of nurses regarding TJC standards for titration of continuous intravenous medications. METHODS: Nurses with experience titrating medications completed an investigator-designed, validated cross-sectional survey. Inductive thematic analysis was conducted in order to analyze the open-ended comments from that quantitative survey. RESULTS: From among 730 completed surveys, 159 comments were received. Analysis of the comments yielded 3 levels of abstraction. Two overarching themes were harm and professionalism. Additional abstraction for the harm theme revealed categories of erosion of workplace wellness, moral dilemma, and patient safety, which were coded as relating to workplace stress, workload, burnout/turnover, physical risk, inefficiency, demeaning/devalued, falsification of records, problematic orders, burden of documentation, suboptimal care, delay in care, individualized care, and provider availability. Within the professionalism theme, categories of autonomy and nurse proficiency were identified, with 7 associated codes: top of scope, critical thinking, overregulation, teamwork, education, registered nurse knowledge, and novice registered nurse guidance. CONCLUSIONS: The standards from TJC impose harm by eroding workplace wellness and introducing moral dilemmas and patient safety concerns. Professionalism is threatened through limits on scope and autonomy. Further advocacy is necessary in order to resolve unanticipated consequences related to the titration standards.
Subject(s)
Clinical Competence , Medication Therapy Management , Nurses , Cross-Sectional Studies , Humans , Medication Therapy Management/ethics , Morals , Occupational Stress , Personnel Turnover , WorkplaceABSTRACT
Telehealth is an acknowledged strategy to meet patient healthcare needs. In critical care settings, Tele-ICU's are expanding to deliver clinical services across a diverse spectrum of critically ill patients. The expansion of telehealth provides increased opportunities for advanced practice providers including advanced practice nurses and physician assistants; however, limited information on roles and models of care for advanced practice providers in telehealth exist. This article reviews current and evolving roles for advanced practice providers in telehealth in acute and critical care settings across 7 healthcare systems in the United States. The health system exemplars described in this article identify the important role of advanced practice providers in providing patient care oversight and in improving outcomes for acute and critically ill patients. As telehealth continues to expand, additional opportunities will lead to novel roles for advanced practice providers in the field of telehealth to assist with patient care management for subacute, acute, and critically ill patients.
Subject(s)
Critical Care , Interdisciplinary Communication , Nurse Practitioners , Patient Care Team , Telemedicine , Advanced Practice Nursing , Delivery of Health Care , Health Services Needs and Demand , Humans , Organizational Case Studies , United StatesABSTRACT
The American Association of Critical-Care Nurses (AACN) is the world's largest specialty nursing organization. The AACN Certification Corporation provides credentialing to validate nursing practice in acute and critical care. The advent of tele-ICU nursing added a challenge to the application of certification in a new specialty area. Nurses working in a tele-ICU have many years of experience in hands-on acute or critical care nursing at the bedside. In their role as tele-ICU nurses, these skills are applied to the assessment, evaluation, and decision support of care for critically ill patients in various acute and critical care units from remote locations connected directly to the ICU through high-speed audio and video technology. This article outlines the journey of the advent of the CCRN-E (registered nurse in critical care) credential and its place in the new specialty of tele-ICU nursing practice.
Subject(s)
Critical Illness/nursing , Intensive Care Units/organization & administration , Professional Competence , Telemedicine/organization & administration , Certification , Critical Care , Education, Nursing, Continuing/methods , Education, Nursing, Graduate/methods , Female , Humans , Male , Nurse's Role , Social Responsibility , Societies, Nursing/organization & administration , United StatesABSTRACT
Evidence-based practice (EBP) has become more than just a trendy buzzword in health care; EBP validates care delivery methods and grants satisfaction to nurses in knowing the care they provide is based on valid, current information. Research-based enhancements are paramount to the advancement of nursing practice and prompt the implementation of creative methods to improve care. The advent of the tele-intensive care unit (ICU) introduces new members of the health care team to assist with implementation of EBP initiatives. This new partnership results in improved length of stay, mortality rates, and ventilator times for critical care patients. Current literature suggests that a clinician-driven, standardized ventilator management protocol is of significant benefit. Tele-ICU clinicians provide an interactive element to coordinate interdisciplinary team efforts. Enhanced communication, data evaluation, and timely intervention expedite the weaning process and reduce ventilator length of stay. Consistent collaboration between tele-ICU and bedside clinicians successfully improves patient outcomes through standardized adherence to best-practice initiatives.
