Advocating for the Vulnerable: The Clinical Nurse Specialist and Nursing Home Reform.

Introduction: Nursing homes have been disproportionally affected by the COVID-19 pandemic, particularly because of resident vulnerability, inadequate staffing, and poor quality of care.

Current State: Despite billions of dollars in funding, nursing homes often do not meet minimum federal staffing requirements and are frequently cited for infection prevention and control deficiencies. These factors significantly contributed to resident and staff deaths.

Reducing Tracheostomy Medical Device-Related Pressure Injury: A Quality Improvement Project.

Objective: To reduce the incidence of medical device-related pressure injuries associated with tracheostomies performed with the percutaneous dilation technique using a standardized multidisciplinary intervention.

Methods: The intervention was developed using the Agency for Healthcare Research and Quality Preventing Pressure Injuries Toolkit. A fenestrated polyurethane foam dressing was sutured in place under the tracheostomy flange during insertion to reduce the risk of medical device-related pressure injuries.

Clinical Nurse Specialist Practice: Impact on Improving Sedation Practice in Critical Care.

Purpose/objectives: Prolonged mechanical ventilation results from deeper levels of sedation. This may lead to impaired respiratory muscle functioning that develops into pneumonia, increases antibiotic use, increases delirium risk, and increases length of hospitalization. A trauma and surgical intensive care unit interdisciplinary team conducted a quality improvement project to lighten sedation levels and shorten mechanical ventilation time.

Placement of Nasogastric Feeding Tube and Postinsertion Care Review.

Insertion and postinsertion care of enteral nasogastric feeding tubes are common procedures in the United States, with more than 1.2 million temporary nasogastric feeding tubes inserted annually. Although there are some evidence-based practice guidelines and recommendations for care of these tubes, variation in practice still exists.

Acute ischemic stroke or migraine with aura? Triage considerations.

This article discusses the complex relationship between acute ischemic stroke and migraine with aura, and critical nursing interventions.

Knowledge and barriers related to food insecurity screening in healthcare settings.

Objective: Assess healthcare professionals' knowledge, referral practices, readiness, and barriers for food insecurity policy and practice implementation in Johnson County, Kansas.

Design: An expert panel of regional anti-hunger advocates was convened to identify critical domains for instrument development.

Sample: The questionnaire was disseminated via REDCap to approximately 2800 healthcare professionals.

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

Background: The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device.

Survey of Nurses' Experiences Applying The Joint Commission's Medication Management Titration Standards.

Background: Critical care nurses titrate continuous infusions of medications to achieve clinical end points. In 2017, The Joint Commission (TJC) placed restrictions on titration practice, decreasing nurses' autonomous decision-making.

Objectives: To describe the practice and perceptions of nurses regarding the 2017 TJC accreditation/regulatory standards for titration of continuous medication infusions.

Awake Self-Prone Positioning: Implementation During the COVID-19 Pandemic.

Background: Prone positioning is a well-known beneficial intervention for patients with acute respiratory distress syndrome. As the COVID-19 pandemic emerged, hospitals rapidly adapted prone positioning for acutely ill patients into a new process: awake self-prone positioning. Could a large health care system safely and rapidly implement awake self-prone positioning in COVID-19 units to prevent respiratory failure from progressing among a surge of inpatients?

Review Of Evidence: The team extensively reviewed the literature.

Clinical Nurse Specialist Impact on COVID-19 Preparation at a Military Treatment Facility.

Purpose: The COVID-19 pandemic has significantly challenged healthcare organizations across the globe, forcing innovation, resourcefulness, and flexibility. The purpose of this article is to describe the impact of clinical nurse specialist practice on COVID-19 preparation at a military hospital.

Environment Of Care Changes: The pandemic required facilities to develop expansion plans to facilitate a potential surge of COVID-19 patients.

Impact of CPR Quality and Adherence to Advanced Cardiac Life Support Guidelines on Patient Outcomes in In-Hospital Cardiac Arrest.

Background: Sudden cardiac arrest is a major cause of death worldwide. Performance of prompt, high-quality cardiopulmonary resuscitation improves patient outcomes.

Objectives: To evaluate the association between patient survival of in-hospital cardiac arrest and 2 independent variables: adherence to resuscitation guidelines and patient severity of illness, as indicated by the number of organ supportive therapies in use before cardiac arrest.

Hiding in Plain Sight: Peripheral Intravenous Catheter Infections.

Topic: This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention.

Clinical Relevance: Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis.

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach.

Purpose: Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed.

Interprofessional Simulation to Improve the Understanding of Obstetric Sepsis.

Sepsis parameters are not well defined for the obstetric population, which can result in delayed recognition. The escape room-based simulation sought to improve obstetric providers' and nurses' understanding, identification, and timely treatment of maternal sepsis. Participants expressed interest and enthusiasm in using this learning style to improve care of the sepsis patient.