Mentorship as a teaching strategy.

Nursing is facing challenges perhaps unparalleled in its history. As we face the opportunities of the future, mentors play a more important role than ever. Mentors have "provided inspiration, support, and encouragement during high and low points of my development." "have forever changed the course of our practice," taught through "her commitment to the advancement of her students and colleagues, her gentle but persistent encouragement to grow, and her generosity in providing pivotal opportunities," "taught me three lessons: caring gets results, family comes first, and passionate commitment is contagious," offers a potential buoy in the sea of change in health care, and possibly enhances clinical outcomes. Mentors can be found in your boss, teacher, spouse, friend, colleague, or peer. Mentorship is a gift between two people and must be given and accepted as such. Not everyone should act as a mentor; the relationship cannot occur and develop when there is no desire to share. Nursing is about learning and teaching. "The spirit of the nursing profession dies when it is reduced to a set of abstract theories, legal requirements, and expert skills. These are the results, not the goals, of scholarship and leadership. Scholarly endeavors always occur amidst communities of learners engaged in being better practitioners of their discipline." Mentors are the leaders amidst the community of nursing.

Understanding advanced hemodynamic concepts.

This article reviews the determinants of myocardial oxygen supply (MVO2) and consumption and revisits the effects of IABC on each. Measurements of MVO2, including diastolic pressure-time index (DPTI), tension-time index (TTI), and endocardial viability ratios (EVR), demonstrate the dramatic effects of balloon deflation and the resulting afterload reduction on MVO2. IABC enhances ventricular outflow, thus decreasing preload; reduces systolic and end-diastolic aortic pressures, causing a decrease in ventricular afterload; magnifies the intrinsic Windkessel effect in the aorta, leading to an increased stroke volume; decreases static work and accordingly, MVO2; and stimulates the baroreceptors, causing a reduction in peripheral vascular resistance. IABC also increase in heart rate. Bedside computers enable the clinician to take a closer look at balloon efficacy via DPTI, TTI, and EVR. New sources of information and understanding may provide opportunities for nurses to ensure optimum patient outcomes.

Plaque abrasion and intra-aortic balloon leak.

STUDY OBJECTIVE: To determine and correct cause of high incidence of intra-aortic balloon leaks (ruptures). DESIGN: Epidemiologic investigation of factors associated with intra-aortic balloon leak, and sequential application of corrective measures evaluated by continued concurrent data collection. SETTING: Thirty-four-bed ICU in 598-bed tertiary care medical center. INTERVENTIONS: Procedure changed to place smaller balloons (34 mL instead of 40 mL) in patients less than 163 cm in height. MEASUREMENTS AND RESULTS: Demographic and clinical data on all patients showed no change after initial interventions, followed by significant drop (8 to 2%) in incidence of balloon leak when smaller, shorter balloons were placed in shorter patients. CONCLUSIONS: Placement of larger, longer balloons in patients increases risk of perforation of balloon by calcific plaque in the distal thoracic and abdominal aorta.

Current nursing practice of point-of-care laboratory diagnostic testing in critical care units.

BACKGROUND: The development of user-friendly laboratory analyzers, combined with the need for rapid assessment of critically ill patients, has led to the performance of in vitro diagnostic testing at the point of care by personnel without formal laboratory training. OBJECTIVES: To determine the range of laboratory testing performed by critical care nurses and their attitudes toward this role. METHODS: A survey of critical care nursing consultants was conducted, using a modified Likert scale, to assess objective measures of point-of-care testing practice in critical care units and to determine nurses' attitudes toward the practice of point-of-care testing. Statistical analysis was performed to determine significant trends in responses. RESULTS: Of the units responding to the survey, 35% used critical care nurses exclusively to perform point-of-care testing, 32.5% used laboratory technicians and critical care nurses, and 25% used other personnel. Of critical care nurses performing laboratory testing, 95.5% performed blood glucose analysis; 18.7%, arterial blood gas analysis; 4.5%, electrolyte analysis; 4.5%, hematology profiles; and 22.7%, other testing. Most agreed that stat tests were not reported promptly, thereby necessitating bedside testing. Respondents indicated that they would prefer that laboratory personnel operate in vitro diagnostic equipment and that requirements for critical care nurses to perform laboratory testing detracted from other patient care duties. CONCLUSIONS: Most nurses who perform point-of-care testing responded that it was necessary and helpful in patient management. However, they would prefer, because of their other patient care responsibilities, that laboratory personnel take this responsibility.

Vascular complications of the patient undergoing intra-aortic balloon pumping.

Despite advances in intra-aortic balloon catheters and consoles, the vascular complication rate of IABP has not decreased. Predisposing complication factors identified through research include gender, diabetes, peripheral vascular disease, catheter size, prolonged pumping, ankle-arm index less than 1.0, and insertion method. Signs and symptoms of leg ischemia due to thromboembolus or compartment syndrome may occur in as high as 40 per cent of patients. Assessment, documentation, and teaching remain important aspects of the nurse's role in the prevention and detection of vascular complications.

Family perceptions of the intra-aortic balloon pumping experience.

A survey interview of family members of IABP patients suggested that their needs for education regarding their loved one's experience with the IABP were not being met by standard explanations offered by the attending physician, resident, or bedside nurse. All respondents indicated satisfaction with follow-up individual instruction provided by this researcher. Because of lack of time, it is not feasible for nurses to provide family-member instruction. Testing of videotape and family-member educational brochures as means of providing information on the IABP patient's experience is therefore recommended.