Bridging the Gap Between Clinical Practice and the AACN Practice Alert on Pulmonary Artery/Central Venous Pressure Monitoring in Adults.

Measuring and documenting accurate data from pulmonary artery and central venous pressure catheters is an important responsibility of critical care nurses. The American Association of Critical-Care Nurses Practice Alert titled Pulmonary Artery/Central Venous Pressure Monitoring in Adults provides evidence-based standards against which nurses can compare their practice related to obtaining valid hemodynamic data. Identifying and acting on improvement opportunities is also a nursing responsibility and helps to ensure that patients with pulmonary artery or central venous pressure catheters receive high-quality care.

Delirium in Trauma Patients: Prevalence and Predictors.

Background: Delirium is associated with increased mortality, morbidity, hospital costs, and postdischarge cognitive dysfunction. Most research focuses on nontrauma patients receiving mechanical ventilation in the intensive care unit.

Objectives: To determine the prevalence and predictors of delirium in trauma patients residing in intensive and intermediate care units of an academic medical center.

Using Procalcitonin in Septic Shock to Guide Antibacterial Therapy.

Over the last decade, the biomarkers procalcitonin and C-reactive protein have gained interest in sepsis research. Procalcitonin is a unique biomarker that is specific to bacterial infection and has demonstrated utility in the risk stratification of patients with potential life-threatening bacterial infections. In addition, procalcitonin has been documented as having a role in reducing the rate of unnecessary antibiotics while positively impacting antibiotic resistance rates and cost savings.

Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses.

The relationship of burnout (BO), compassion fatigue (CF), compassion satisfaction (CS), and secondary traumatic stress (STS) to personal/environmental characteristics, coping mechanisms, and exposure to traumatic events was explored in 128 trauma nurses. Of this sample, 35.9% had scores consistent with BO, 27.

Evidence-based practice habits: putting more sacred cows out to pasture.

For excellence in practice to be the standard for care, critical care nurses must embrace evidence-based practice as the norm. Nurses cannot knowingly continue a clinical practice despite research showing that the practice is not helpful and may even be harmful to patients. This article is based on 2 presentations on evidence-based practice from the American Association for Critical-Care Nurses' 2009 and 2010 National Teaching Institute and addresses 7 practice issues that were selected for 2 reasons.

Secondary traumatic stress in trauma nurses: prevalence and exposure, coping, and personal/environmental characteristics.

The purpose of this study is to determine the incidence of secondary traumatic stress (STS) in nurses who primarily care for trauma patients. A demographic/behavioral survey and Penn Inventory to measure the presence of STS were distributed to 262 nurses in a level I trauma center. Relationships between STS and years of experience, coping strategies, and personal and environmental characteristics were examined.

Outpatient cardiovascular management utilizing impedance cardiography.

Over the past decade, noninvasive hemodynamic and thoracic fluid status monitoring via impedance cardiography has provided clinicians practicing in the outpatient setting with a valuable tool for managing a myriad of cardiovascular disorders. This article reviews impedance cardiography technology and the use of impedance cardiography in the home and outpatient clinic settings for the assessment and management of heart failure, resistant hypertension, and dual-chamber pacemaker optimization.

The use of benchmarking to identify top performing critical care units: a preliminary assessment of their policies and practices.

Purpose: To describe the policies and practices of intensive care units (ICUs) with good patient survival and highly efficient resource use and to identify relevant variables for future investigation.

Materials And Methods: We used clinical data for 359,715 patients from 108 ICUs to compare the ratios of actual with Acute Physiology and Chronic Health Evaluation (APACHE) III predicted hospital mortality, ICU and hospital stay, and the proportion of low-risk monitor patients. The best performing ICUs (top 10%) were defined by a mortality ratio of 1.

Coagulopathies in trauma patients.

Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. Despite advances in trauma resuscitation, the problem of persistent, life-threatening coagulopathy continues to pose a significant challenge for the healthcare team, and sometimes is an insurmountable obstacle in the path to recovery of the patient with trauma.