Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation.

Background: Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD).

Objectives: To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas.

Methods: A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media.

Using a virtual patient in an advanced assessment course.

Background: A virtual patient, Digital Clinical Experience (DCE), was incorporated into an advanced assessment course.

Method: Students conducted systems-based physical examinations on the DCE, documenting findings using a standard history format and physical examination skills checklists. Faculty reviewed transcripts generated from the students' history and physical examination to evaluate the logical order and progression of the examination.

Using a psychosocial registry as a data source for nurses.

Nurses at the bedside strive to base their practice on the best available information derived from evidence. However, issues related to patient care often arise for which evidence is either difficult to attain or not available. This can be particularly true for nurses who care for patients with diverse diagnoses because most studies focus on patients with a single cancer diagnosis.

Composite outcomes of chronically critically ill patients 4 months after hospital discharge.

Background: Data on likely postdischarge outcomes are important for decision making about chronically critically ill patients. It seems reasonable to categorize outcomes into "better" or overall desirable states and "worse" or generally undesirable states. Survival, being at home, and being cognitively intact are commonly identified as important to quality of life and thus may be combined to describe composite outcome states.

Advance directive use and psychosocial characteristics: an analysis of patients enrolled in a psychosocial cancer registry.

Advance directives (ADs) refer to a category of documents that enable individuals to state their preferences for future healthcare decisions in the event of incapacitation. The purpose of the study was to examine differences in psychosocial characteristics and AD completion rates in persons newly diagnosed with cancer. This sample comes from data collected for a psychosocial registry for patients with cancer.

Advanced Practice Nurse Service Provision During the Last Week of Life.

This secondary data analysis of a randomized clinical trial describes the contacts made by advanced practice nurses for long-term ventilator patients who were not receiving hospice services during their last week of life and for matched patients on long-term ventilators who did not die. The contacts were examined for a total of 64 patients (32 patients during their last week of life and 32 matched patients). There was a statistically significant difference in the total number of contacts for long-term ventilator patients during their last week of life compared to the matched patients.

Age differences in survival outcomes and resource use for chronically critically ill patients.

Purpose: Chronically critically ill (CCI) patients use a disproportionate amount of resources, yet little research has examined outcomes for older CCI patients. The purpose of this study was to compare outcomes (mortality, disposition, posthospital resource use) between older (> or =65 years) and middle-aged (45-64 years) patients who require more than 96 hours of mechanical ventilation while in the intensive care unit.

Methods: Data from 2 prospective studies were combined for the present examination.

Chronically critically ill patients: health-related quality of life and resource use after a disease management intervention.

Background: Chronically critically ill patients often have high costs of care and poor outcomes and thus might benefit from a disease management program.

Objectives: To evaluate how adding a disease management program to the usual care system affects outcomes after discharge from the hospital (mortality, health-related quality of life, resource use) in chronically critically ill patients.

Methods: In a prospective experimental design, 335 intensive care patients who received more than 3 days of mechanical ventilation at a university medical center were recruited.

Racial differences in perceptions held by caregivers of long-term ventilator patients at end of life.

Aim: The purpose of this pilot study was to describe and compare perceptions of preparation for death and satisfaction with end-of-life care in African American and Caucasian caregivers of long-term ventilator (LTV) patients.

Design: A comparative descriptive design was used to pilot test items from specific domains from the After-Death Bereaved Family Member Interview. Interviews were conducted on 37 bereaved caregivers of LTV patients who participated in a large experimental study.

Use of advance directives in the chronically critically ill.

Although it would be ideal that all patients have the presence of an advance directive documented in their medical chart, it is especially important in the chronically critically ill, a patient population with an in-hospital mortality rate of 40%. How has the documentation of advance directives in the medical chart of chronically critically ill patients changed from 1997 to 2003? This article describes the patient characteristics and patterns of death in chronically critically ill patients, with or without an advance directive, enrolled in 2 consecutive studies.

'My mother's leaving today?': A pilot study on awareness of discharge date in the chronically critically ill.

Chronically critically ill patients are a growing population. A pilot study determined nurses’ and family caregivers’ prior knowledge of the date of discharge for these patients. Despite complex needs, nurses and family caregivers were not aware of discharge until close to the target date.

Impact of a disease management program upon caregivers of chronically critically ill patients.

Objectives: Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge.

Design: Prospective experimental design.

Trial of a disease management program to reduce hospital readmissions of the chronically critically ill.

Background: Patients requiring prolonged periods of intensive care and mechanical ventilation are termed chronically critically ill. They are prone to continued morbidity and mortality after hospital discharge and are at high risk for hospital readmission. Disease management (DM) programs have been shown to be effective in improving both coordination and efficiency of care after hospital discharge for populations with single-disease diagnoses, but have not been tested with patients with multiple-disease diagnoses, such as the chronically critically ill.

Benefits and challenges in developing a program of research.

The ultimate goals of nursing research are knowledge generation and improvement in nursing practice. Designing studies that provide the evidence needed for practice change and that have clear implications for immediate application to current practice environments is particularly challenging. Research programs that consist of sequential studies, each building on and expanding on the results of the previous work, offer the greatest promise for generating understanding of the human phenomenon relevant to nursing practice.

Research partners: two teams, one study population.

Background: Two large research projects funded by the National Institutes of Health, the Disease Management project and the Thrive study, which examine different phenomena in the chronically critically ill population, have combined research teams. Each study has its own project manager and maintains a separate database and budget. Operational tasks for both grants are streamlined through the collaboration and cross-training of all team members.

Nurse practitioners and preventive screening in the hospital.

The purpose of this study was to investigate a reminder to discuss cervical cancer screening with hospitalized females. A quasi-experimental design was used to compare the association of a reminder intervention for nurse practitioners with two outcomes: prevalence of cervical cancer screening as documented in patients' charts and patients' self-report of cervical cancer screening 4 months after discharge. Data were collected by chart review and phone survey.