Serious Illness Conversations: A Case Management Quality Improvement Project.

Purpose/objectives: The purpose of this project was to develop, implement, and evaluate an educational program and a serious illness (SI) protocol for a case management team of nurses and social workers to achieve the following: (1) utilize an SI protocol to identify patients with SI; (2) utilize a Serious Illness Structured Communication Guide to elicit these patients' goals and preferences for SI care; and (3) document in the electronic medical record the patients' elicited values and goals using a structured SI documentation template.

Primary Practice Setting And Sample: Seventeen nurse and 3 social work case managers in an Accountable Care Organization (ACO) in a large health system in a western suburb of Chicago participated in this project. The practice setting was the primary care clinics associated with the health system.

The Management of Nausea at the End of Life.

The evaluation and management of nausea in patients near the end of life can be more challenging than that of nausea in patients undergoing antineoplastic therapies. Unlike in the oncology setting in which nausea is primarily managed using antiemetic regimens that have been developed with the neuropharmacology and emetogenic potentials of chemotherapy agents in mind, many patients receiving end-of-life care have nausea of multifactorial etiology. Patients also may be older with reduced physiologic ability to metabolize and clear drugs.

Implementing Interprofessional Alcohol Screening, Brief Intervention, and Referral to Treatment in the Emergency Department: An Evidence-Based Quality Improvement Initiative.

Alcohol misuse is one of the leading causes of illness, disease, injury, and death in the Unites States. For many patients, the emergency department (ED) visit may provide the only therapeutic opportunity to influence problematic drinking behavior. Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach that may reduce alcohol-related morbidity and mortality and improve health outcomes and quality of life.

Pediatric Pain Assessment In the Emergency Department: A Nursing Evidence-Based Practice Protocol.

Background: Many children present to the emergency department (ED) in pain and/or experience pain as a result of interventions necessary to manage their illness. Pediatric pain assessment and management is complex and challenging. Despite the presence of published standards of care specific to pain assessment and management, nurses in the ED may not know about and/or consistently use these evidence-based practices.

Clostridium difficile infection: essential information for nurses.

Clostridium difficile (C. difficile) infection is a challenging problem in the acute care setting. Staff nurses are important in the early recognition, diagnosis, and prompt treatment of patients with this bacterial infection.

Providing palliative care to seriously ill patients with nonhealing wounds.

Patients may experience wounds at or near the end of life that are difficult to treat and may not be amenable to healing. In these cases, hospice and palliative care may be considered. Palliative care approaches include stabilization of existing wounds, prevention of new wounds, and symptom management with a focus on quality of life.

Quality of life in caregivers providing care for lung transplant candidates.

Context: Caregivers are essential members of the health care team who provide care, valued at more than $250 billion each year, to millions of persons who require assistance with health and daily care. Patients with respiratory diseases who are waiting for a lung transplant are required to have an identified caregiver. The caregivers are rarely studied.

Understanding and responding to the death rattle in dying patients.

Medical-surgical nurses in inpatient settings may encounter dying patients who exhibit a number of symptoms during the end of life. One symptom, the death rattle, refers to the noise of excessive secretions present during the inspiratory and expiratory phases of respiration. Symptom improvement can be obtained with pharmacologic and non-pharmacological measures.

Kyphoplasty. A treatment for osteoporotic vertebral compression fractures.

Patients experience more than 700,000 osteoporotic vertebral compression fractures each year in the United States, primarily because of bone brittleness and the inability of the vertebrae to resist increased forces applied to them. Patients diagnosed with this type of fracture are given the option of conservative or operative treatment approaches. Although a typical compression fracture generally heals in 6 to 12 weeks, patients may be offered the kyphoplasty procedure, which reduces the fracture and stabilizes it with cement.

Using the Roy Adaptation Model to explore the dynamics of quality of life and the relationship between lung transplant candidates and their caregivers.

Using theory to support nursing research may be considered superfluous by some authors, yet a theoretical framework provides structure and consistency to a research study. This article presents the use of the Roy Adaptation Model within the theoretical framework underpinning an investigation of quality of life as perceived by lung transplant candidates and their caregivers. Each step of the research process is identified in this article and the link to the theoretical framework is demonstrated.

Community-acquired methicillin-resistant Staphylococcus aureus: considerations for school nurses.

Methicillin-resistant Staphylococcus aureus (MRSA) is a disease-causing organism that has been present in hospital settings since the 1960s. However, a genetically distinct strain of MRSA, called community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), has emerged in recent years in community settings among healthy individuals. While this organism has been found to be less resistant to antibiotics, it is also more virulent and capable of causing a spectrum of illnesses.

Identifying and managing acute alcohol withdrawal in the elderly.

In the elderly population, alcohol-related problems may be misinterpreted as normal consequences of aging. However, alcohol is a commonly abused substance among older adults, and age-related changes predispose these patients to a greater sensitivity to its effects. All older patients should be screened for alcohol dependence and abuse on admission to an acute care facility.

Barriers to caregiver administration of pain medication in hospice care.

Barriers to adequate pain management in hospice and palliative care settings are an important area of investigation. In this study, a Caregiver Pain Medicine Questionnaire (CPMQ) was developed and psychometrically tested. The CPMQ is a 22-item self-report instrument that measures concern about reporting pain, concern about administering analgesics, and difficulty administering analgesics.

Repeating the call for restraint reduction.

Over the past 2 decades, great advances have been made in reducing the use of physical restraints in health care facilities. In this article, misconceptions and facts related to restraint use are reviewed and restraint reduction strategies are presented. Although all those involved in health care are called to carefully evaluate restraint use, medical-surgical nurses can take the lead in changing restraint practices in the acute care workplace.

Laryngeal edema: perioperative nursing considerations.

Laryngeal edema is a relatively rare yet serious postoperative complication for those patients undergoing general anesthesia. Maintenance of airway and breathing are always the first priority of perioperative patient care. Medical-surgical nurses working in postoperative settings must be familiar with the signs, symptoms, and necessary prompt treatment for this life-threatening condition.