Successful outcomes for the ventilator-dependent patient.

The challenges of working with the ongoing ventilator-dependent population are many. All have survived some element of critical illness to arrive at the point of step-down care. The team challenge is to craft a plan of care unique to their needs. Working through patients' pain of loss of control, the team helps patients and their families accept what is ahead--finding meaning in the smallest accomplishments and making peace. If the patient is to return home, achieving quality of life for whatever time is left is important. The ventilator dependent individual is the outlier, the variance, and the exception. Such is the challenge for the team caring for the ventilator-dependent population. It is our opportunity to make a difference.

The relationship of mentoring to job satisfaction of critical care nurses.

Mentoring offers a potential buoy in the sea of change in healthcare. Mentoring as a relationship between a novice and an expert can help promote stability in nursing. Studies have revealed that mentorship enhances the professional growth of nursing leaders and educators, but little is found in literature describing mentors for nurses engaged in clinical practice. Seventy-six members of a critical care nursing specialty organization's clinical practice network, spanning regions across the United States, were surveyed by mail. The relationship between mentoring and job satisfaction, as measured by the Index of Work Satisfaction, was examined. Scores were higher in the mentored group as compared to the group without a mentor, but the relationship was not statistically significant. Subjects did identify positive characteristics of a mentor.

A review of normal saline instillation: implications for practice.

Nurses commonly use normal saline instillation (NSI) as a component of the suctioning procedure. The current research on NSI has not clearly identified many positive aspects of the procedure. Much of the research suggests it may actually be harmful. There has been little investigation into the reasons NSI is used. It is presumed that NSI is used to increase secretion removal when patients have thick endotracheal secretions due to inadequate humidity to the airway. Nurses need to be aware of the potential negative effects of routine NSI as well as alternative methods for maintaining adequate airway humidification.

Optimizing the flow of care for prevention and treatment of deep vein thrombosis and pulmonary embolism.

Critically ill patients have multiple risk factors for deep vein thrombosis and pulmonary embolism. The majority of patients with pulmonary embolism have a lower extremity deep vein thrombosis as a source of origin. Pulmonary embolism causes a high mortality rate in the hemodynamically compromised individual. Awareness of risk factors relative to the development of deep vein thrombosis and pulmonary embolism is important for the critical care nurse. Understanding the pathophysiology can help guide prophylaxis and treatment plans. The therapies, from invasive to mechanical, all carry risks and benefits, and are weighed for each patient. The advanced practice nurse, whether in the direct or indirect role, has an opportunity to impact the care of the high risk patient. Options range from teaching the nurse who is new to critical care, to teaching patients and families. Development of multidisciplinary protocols and clinical pathways are ways to impact the standard of care. Improved delivery of care methods can optimize the care rendered in an ever changing field of critical care.

Systemic inflammatory response syndrome, sepsis, and nutritional support.

This article reviews the metabolic alterations that occur in SIRS and sepsis and the management of these patients nutritionally. Practical clinical assessment parameters that can be used by the critical care nurse to determine the nutritional and metabolic needs of the patient are presented. Issues related to enteral and parenteral routes of delivery are presented, and a discussion of disease-specific nutritional formulas is included. An understanding of the determination of metabolic and nutrition needs and the provision of adequate support to meet those needs are vital to the care of the hypermetabolic septic patient.