RESUMO
Incorporation of best clinical practices into the baccalaureate critical care nursing curriculum is important. At The College at Brockport, best clinical practices are introduced early in the semester and are reinforced throughout the semester in both class and clinical settings. Among the best clinical practices included are those recommended by the American Association of Critical-Care Nurses, The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, The Joint Commission, Quality and Safety Education for Nurses, the Surviving Sepsis Campaign, and the Institute for Safe Medication Practices. The culminating assignment of the semester requires students to focus on patient safety. Students describe the use of the National Patient Safety Goals and other best practices in the critical care setting. The role of the nurse leader and exploration of near-miss and work-around events also are described. Nursing students need to provide safe competent nursing care by incorporating best practices into their clinical practice now and in the future when they become registered professional nurses.
Assuntos
Enfermagem de Cuidados Críticos/educação , Bacharelado em Enfermagem/normas , Currículo , New YorkRESUMO
The role of vitamin D in critical illness is under investigation. Recent data indicate declining levels of serum vitamin D in multiple adult populations. Deficiencies have been strongly linked to infectious processes and certain chronic disorders. Vitamin D deficiency that is present at the onset of critical illness may impact the severity of illness and contribute to less-than-optimal outcomes. This article describes the function of vitamin D, the effects that deficiencies have on body systems, and the emerging role of vitamin D deficiency for critically ill patients.
Assuntos
Estado Terminal , Deficiência de Vitamina D/fisiopatologia , Vitamina D/fisiologia , Adulto , Feminino , Humanos , Masculino , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Cuidados Pós-Operatórios/enfermagem , Robótica , Estudos de Coortes , Humanos , Tempo de Internação , Satisfação do Paciente , Resultado do TratamentoRESUMO
Rochester General Hospital developed an exceedingly well received homegrown database, CMReview, for its CMs. The right team comprised of a data analyst, IT programmers, technology-appreciative CMs, and administrative support has created an asset to the functioning of the care management department. Having the people on site with a vested interest in the success of the project has been a win/win for all of us.
Assuntos
Administração de Caso , Sistemas de Gerenciamento de Base de Dados , Competência Profissional , Humanos , Relações Enfermeiro-Paciente , Assistência ao Paciente/normasRESUMO
An empowering clinical nurse advancement system can facilitate institutional behaviors that embrace all of AACN's healthy work environment standards and thus serve as a building block for developing a flourishing health care environment. The results generate positive outcomes that are evident to health care professionals, patients, patients' families, and health care organizations. Patients benefit from highly satisfied employees who work in a culture of caring and excellence.
Assuntos
Cuidados Críticos/normas , Papel do Profissional de Enfermagem , Competência Profissional/normas , Sociedades de Enfermagem/organização & administração , Local de Trabalho/normas , Tomada de Decisões , Eficiência , Humanos , Satisfação no Emprego , Liderança , Seleção de Pessoal/organização & administração , Desenvolvimento de Programas/normas , Qualidade da Assistência à Saúde , Estados UnidosRESUMO
Quality patient care has always been of the highest priority for nurses. With the current government emphasis on reporting, improving care, and reimbursement, nurses and their institutions are more responsible than ever for assuring the delivery and documentation of excellent patient care. Our institution achieved improved compliance reports for the CMS quality indicators through a combined effort of collegial interdisciplinary delivery of care, a more responsive documentation system, real-time quality assurance, and ongoing education.
Assuntos
Centers for Medicare and Medicaid Services, U.S. , Administração Hospitalar , Relações Interinstitucionais , Papel do Profissional de Enfermagem , Indicadores de Qualidade em Assistência à Saúde/organização & administração , United States Dept. of Health and Human Services , Centers for Medicare and Medicaid Services, U.S./organização & administração , Documentação , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Mecanismo de Reembolso , Gestão da Qualidade Total/organização & administração , Estados Unidos , United States Dept. of Health and Human Services/organização & administraçãoRESUMO
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a clinical entity first described in the early 1990s in Japan and now receiving increased attention in the United States. The clinical features include an onset of chest pain mimicking that of an acute myocardial infarction, electrocardiogram changes similar to those of an acute myocardial infarction, normal coronary arteries on cardiac catheterization, and a signature appearance on echocardiogram. Takotsubo cardiomyopathy results in a significantly decreased ejection fraction that, as long as the patient receives appropriate hemodynamic support, typically undergoes spontaneous reversal. This article describes the history, clinical presentation, and management strategies for Takotsubo cardiomyopathy and provides a case study.
Assuntos
Cardiomiopatia de Takotsubo/diagnóstico , Idoso , Estimulação Cardíaca Artificial , Feminino , Humanos , Fatores de Risco , Volume Sistólico , Cardiomiopatia de Takotsubo/etiologia , Cardiomiopatia de Takotsubo/terapiaAssuntos
Amiodarona/efeitos adversos , Antiarrítmicos/efeitos adversos , Cuidados Críticos/métodos , Hipotireoidismo , Tireotoxicose , Idoso , Amiodarona/metabolismo , Amiodarona/farmacocinética , Antiarrítmicos/metabolismo , Antiarrítmicos/farmacocinética , Fibrilação Atrial/tratamento farmacológico , Diagnóstico Diferencial , Interações Medicamentosas , Meia-Vida , Humanos , Hipotireoidismo/induzido quimicamente , Hipotireoidismo/diagnóstico , Hipotireoidismo/terapia , Masculino , Taxa de Depuração Metabólica , Monitorização Fisiológica/enfermagem , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Alta do Paciente , Educação de Pacientes como Assunto , Valores de Referência , Testes de Função Tireóidea/métodos , Hormônios Tireóideos/fisiologia , Tireotoxicose/induzido quimicamente , Tireotoxicose/diagnóstico , Tireotoxicose/terapiaRESUMO
The prevalence of diabetes mellitus makes the occurrence of hyperglycemic emergencies a key component in clinical practice. The expert nurse is well positioned to manage both diabetic ketoacidosis and hyperosmolar hyperglycemic states. Patient care management includes a high index of suspicion for awareness for the possibility of diabetic ketoacidosis or hyperosmolar hyperglycemic states in patients based on a multifactorial etiology, evidence-based treatment of the emergent episode, and tertiary prevention to prevent recurrent episodes.
Assuntos
Cuidados Críticos/métodos , Cetoacidose Diabética/terapia , Emergências/enfermagem , Coma Hiperglicêmico Hiperosmolar não Cetótico/terapia , Glicemia/metabolismo , Causalidade , Cuidados Críticos/normas , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/etiologia , Cetoacidose Diabética/metabolismo , Emergências/epidemiologia , Medicina Baseada em Evidências , Família/psicologia , Hidratação , Humanos , Hiperglicemia , Coma Hiperglicêmico Hiperosmolar não Cetótico/diagnóstico , Coma Hiperglicêmico Hiperosmolar não Cetótico/etiologia , Coma Hiperglicêmico Hiperosmolar não Cetótico/metabolismo , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Monitorização Fisiológica/enfermagem , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Educação de Pacientes como Assunto , Prevalência , Recidiva , Respiração ArtificialRESUMO
Dying is a journey for all involved. We have been fortunate to work in a hospital with both an ICU and a palliative care/hospice unit. We have transferred patients for whom care was withdrawn and who were still alive on the next day to the palliative care unit and have found the transfer to work to maximize comfort in dying. For many patients and families who have developed relationships with the staff in their ICU, the combination of established relationships, traditional therapies, and CAT maximizes the comfort during the dying process.