Am J Crit Care
September 2015
Heather C. Riemer is a critical care nurse, UW Medicine Valley Medical Center, Renton, Washington. Joanna Mates is a critical care nurse and Bonnie J. Schleder is a critical care clinical nurse specialist, Advocate Good Shepherd Hospital, Barrington, Illinois. Linda Ryan is an assistant professor, College of Nursing and Health Professions, Lewis University, Romeoville, Illinois.
Background: The benefits of quiet time, a therapeutic method of improving the health care environment, have been evaluated in patients, but only a few studies have examined the effects of quiet time on intensive care nurses.
Objective: To evaluate the effects of implementing quiet time in a medical-surgical intensive care unit on levels of light, noise, and nurses' stress.
Methods: Quiet time consisted of turning down the unit lights for a designated time.
Clin Nurse Spec
October 2016
Author Affiliations: Master of Science Clinical Nurse Specialist Student (Mr Suba), University of California San Francisco; and Critical Care Clinical Nurse Specialist, Quality and Regulatory Services, Kaiser Permanente, Oakland, and Critical Care Transport RN, Bayshore Ambulance, Foster City, California (Dr Scruth).
AACN Adv Crit Care
January 2017
Kathleen M. Stacy is Critical Care Clinical Nurse Specialist and Clinical Associate Professor, Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110
Maintaining a successful unit-based continuous quality improvement program for managing hospital-associated infections is a huge challenge and an overwhelming task. It requires strong organizational support and unit leadership, human and fiscal resources, time, and a dedicated and motivated nursing staff. A great deal of effort goes into implementing, monitoring, reporting, and evaluating quality improvement initiatives and can lead to significant frustration on the part of the leadership team and nursing staff when quality improvement efforts fail to produce the desired results.
View Article and Find Full Text PDFJ Nurses Prof Dev
May 2016
Shannon Johnson Bortolotto, RN, MS, CCNS, is Critical Care Clinical Nurse Specialist, University of Colorado Hospital, Aurora.
In 2014, newly graduated nurses are welcomed and recruited to practice in critical care, and hiring trends in hospitals support a demand for newly graduated nurses. At a 501-bed, quaternary care, academic medical center located in the Rocky Mountain region, an orientation program was formalized to prepare newly graduated nurses for critical care practice. The critical care clinical orientation program presented utilizes a dynamic approach that includes didactic study, case study integration, a clinical staging program, active preceptor development, and care-based simulation exercises.
View Article and Find Full Text PDFAm J Crit Care
May 2015
Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California.
Background: Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients.
Objective: To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit.
Clin Nurse Spec
October 2016
Author Affiliations: Critical Care Clinical Nurse Specialist (Dr Ozekcin), St Luke's University Health Network, Bethlehem; Assistant Professor (Dr Tuite) and Professor (Dr Hravnak), Acute and Tertiary Care, University of Pittsburgh School of Nursing; and Director (Ms Willner), Educational Services, Department St Luke's University Health Network, Bethlehem, Pennsylvania.
Purpose/objectives: The specific aim of this quality improvement project was to improve acute care nurses' ability to assess deteriorating patients, recognize signs of instability and immediate critical treatment, and escalate care in a timely manner.
Background: Early identification of and treatment of patient deterioration can improve patient and hospital/system spheres of clinical nurse specialist influence.
Rationale: An earlier response to clinical deterioration may result in improved patient outcomes.
Clin Nurse Spec
October 2016
Author Affiliations: Assistant Nurse Manager (Ms Emerson), Step-Down Unit, Highland Hospital, Alameda, California; Independent Nurse Consultant (Dr Pugh), Perth, Western Australia; and Critical Care Clinical Nurse Specialist (Dr Scruth), Quality and Regulatory Services, Kaiser Permanente, Oakland, California.
Clin Nurse Spec
September 2016
Author Affiliation: Cathy J. Thompson, PhD, RN, CCNS, CNE, president, CJT Consulting & Education, South Fork, Colorado. She is a certified acute critical care clinical nurse specialist and certified nurse educator. CJT Consulting & Education, provides expertise in evidence-based practice, the clinical nurse specialist role, acute critical care nursing, and curriculum development. She recently launched her Nursing Education Expert Web site (http://nursingeducationexpert.com). An award-winning educator, Dr Thompson has taught in the undergraduate graduate programs for over 20 years and coordinated the clinical nurse specialist option at the University of Colorado Anschutz Medical Campus, College of Nursing, in Aurora, Colorado. She currently holds the title of Special Visiting Professor for Innovation in Education at the Beth-El College of Nursing and Health Sciences at the University of Colorado at Colorado Springs. She has published presented on many topics relating to evidence-based practice, clinical nurse specialist role education, nursing leadership, and acute critical care of adult patients. Her research focuses on evidence-based practice the scholarship of teaching learning.
Clin Nurse Spec
September 2016
Author Affiliations: Critical Care Clinical Nurse Specialist, Stanford Healthcare, and Clinical Assistant Professor, Stanford University, California (Dr Lough); Clinical Research Directorate (Mr Seidel), Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, Frederick National Laboratory for Cancer Research, Frederick, Maryland.
Prof Case Manag
October 2016
Denise Kuhn, RN, MSN, ACM, is a RN case manager at New Hanover Regional Medical Center, Wilmington, NC, with the nurse-managed CHF Telephonic Program. She holds a master's degree in nursing from Grand Canyon University, Phoenix, AZ, and has been a registered nurse for 17 years. She is an Accredited Case Manager and has worked in the field for 11 years, specifically with CHF patients and the trends with readmissions and transitions from hospital to home. She is on the board of Nu Omega Chapter of Sigma Theta Tau, National Honor Society of Nursing, and is Treasurer on the North Carolina Chapter Board of the American Case Management Association (ACMA). Carolyn Brown, RN, MSN, CCNS, ACNS-BC, is an Outcomes Manager/Sepsis Coordinator at New Hanover Regional Medical Center. She received her master's degree in nursing from East Carolina University. She is certified as a Critical Care Clinical Nurse Specialist (CCNS) and is an Adult CNS-BC. She is currently in the nursing PhD program at East Carolina University and has more than 24 years of adult critical care and acute care experience.
Crit Care Nurse
February 2015
Melody R. Campbell is a critical care clinical nurse specialist and trauma program manager at Kettering Medical Center, Kettering, Ohio.Julie Fisher is a physical therapist and the lead therapist in the physical medicine and rehabilitation department at Good Samaritan Hospital, Dayton, Ohio.Lyndsey Anderson is an occupational therapist in the physical medicine and rehabilitation department at Good Samaritan Hospital, Dayton, Ohio.Erin Kreppel is a physical therapist in the physical medicine and rehabilitation department at Little Company of Mary Hospital, Evergreen Park, Illinois.
AACN Adv Crit Care
December 2016
Mary Fran Tracy is the Editor of AACN Advanced Critical Care and Critical Care Clinical Nurse Specialist, University of Minnesota Medical Center, 500 Harvard St. SE, Minneapolis, MN 55455
Crit Care Nurse
December 2014
Mary Kay Bader is a neuroscience/critical care clinical nurse specialist in the surgical trauma neurologic intensive care unit at Mission Hospital, Mission Viejo, California.Sonja E. Stutzman is a clinical research coordinator at The University of Texas Southwestern Medical Center, Dallas, Texas.Sylvain Palmer is a staff neurosurgeon at Mission Hospital and Orange County Neurosurgical Associates, Laguna Hills, California.Chiedozie I. Nwagwu is a staff neurosurgeon at Mission Hospital and a neurosurgeon and neurointerventional radiologist at Orange County Neurosurgical Associates.Gary Goodman is medical director of the pediatric intensive care unit at Children's Hospital of Orange County (CHOC) Children's at Mission Hospital.Margie Whittaker is nurse manager of the surgical trauma neurologic intensive care unit at Mission Hospital.DaiWai M. Olson is an associate professor of neurology and neurotherapeutics at The University of Texas Southwestern Medical Center.
Background: The Brain Trauma Foundation has developed treatment guidelines for the care of patients with acute traumatic brain injury. However, a method to provide broad acceptance and application of these guidelines has not been published.
Objective: To describe methods for the development, funding, and continued educational efforts of the Adam Williams Initiative; the experiences from the first 10 years may serve as a template for hospitals and nurses that seek to engage in long-term quality improvement collaborations with foundations and/or industry.
Am J Crit Care
November 2014
Melanie Roberts is a critical care Clinical Nurse Specialist at Medical Center of the Rockies in Loveland, Colorado. Laura Adele Johnson is a student registered nurse anesthetist at Westminster College in Salt Lake City, Utah. Trent L. Lalonde is an associate professor of applied statistics at the University of Northern Colorado and a statistical consultant at the Medical Center of the Rockies.
Background: Despite the general belief that mobility and exercise play an important role in the recovery of functional status, mobility is difficult to implement in patients in intensive care units.
Objectives: To compare a mobility platform with standard equipment, assessing efficiency (decreased time and staff required to prepare patient), effectiveness (increased activity time), and safety (no falls, unplanned tube removals, or emergency situations) for intensive care patients.
Methods: This observational study was approved by the institutional review board, and informed consent was obtained from the patient or the medical decision maker.
AACN Adv Crit Care
September 2016
Christine S. Schulman is Critical Care Clinical Nurse Specialist, Legacy Health, 1225 NE 2nd Ave, Portland, OR 97232 Christopher Bibro is Neurotrauma ICU Staff Nurse, ECMO Specialist, Legacy Health, Portland, Oregon. Diane Braxmeyer Downey is Neurotrauma ICU Supervisor, ECMO Specialist, Legacy Health, Portland, Oregon. Christine Lasich is Neurotrauma ICU Staff Nurse, ECMO Specialist, and Adult ECMO Education Coordinator, Legacy Health, Portland, Oregon.
Because of technological advancements and encouraging experiences during the 2009 influenza A (H1N1) epidemic, many critical care clinicians consider extracorporeal membrane oxygenation (ECMO) a reasonable strategy for managing patients with refractory hypoxemia when standardized therapies have failed. Although the literature remains unclear as to whether it should be considered a routine or a rescue strategy in the management of patients with severe acute respiratory distress syndrome, experts agree that ECMO therapy is most likely to result in positive outcomes and fewer complications when provided at regional ECMO centers. Some institutions have developed the expertise and resources required to provide this sophisticated therapy, but significantly more facilities may choose to send their patients to a tertiary ECMO center when they do not respond to usual care.
View Article and Find Full Text PDFClin Nurse Spec
September 2016
Author Affiliations: Critical Care Clinical Nurse Specialist (Ms Schneiderhahn), Missouri Baptist Medical Center, St Louis, and Associate Professor of Nursing (Dr Fish), University of Missouri-St Louis in a collaborative clinical partnership with Missouri Baptist Medical Center, St Louis.
Purpose/objectives: The purpose of this article was to describe the history and leadership dimensions of the role of resuscitation process manager and provide specific examples of how this role is implemented at a Midwest medical center.
Background: In 1992, a medical center in the Midwest needed a nurse to manage resuscitation care.
Rationale: This role designation meant that this nurse became central to all quality improvement efforts in resuscitation care.
Clin Nurse Spec
August 2015
Author Affiliations: Diabetes Clinical Nurse Specialist and Certified Diabetes Educator (Ms Klinkner) and Certified Critical Care Clinical Nurse Specialist (Dr Murray), University of Wisconsin Hospital and Clinics, Madison.
Purpose: The purpose of this evidence-based practice improvement project was to improve patients' blood glucose control after cardiac surgery, specifically aiming to keep blood glucose levels less than 200 mg/dL.
Background/rationale: Glycemic control is essential for wound healing and infection prevention. Multiple factors including the use of corticosteroids and the stress of critical illness put cardiac surgery patients at greater risk for elevated blood glucose levels postoperatively.
Am J Crit Care
May 2014
Joelle D. Hargraves is a critical care clinical nurse specialist at AtlantiCare Regional Medical Center, Mainland Campus, Pomona, New Jersey.
Background: Acute hyperglycemia following cardiac surgery increases the risk of deep sternal wound infection, significant early morbidity, and mortality. Insulin infusion protocols that target tight glycemic control to treat hyperglycemia have been linked to hypoglycemia and increased mortality. Recently published studies examining glycemic control in critical illness and clinical practice guidelines from professional organizations support moderate glycemic control.
View Article and Find Full Text PDFAm J Crit Care
May 2014
Lory Clukey is an associate professor, University of Northern Colorado, Greeley, Colorado. Ruth A. Weyant is a staff nurse in the cardiac intensive care unit, Melanie Roberts is a critical care clinical nurse specialist, and Ann Henderson is an education nurse specialist, Medical Center of the Rockies, Loveland, Colorado.
Background: The perceptions of patients who are restrained and sedated while being treated with mechanical ventilation in the intensive care unit are not well understood. The effectiveness of sedation used to aid in recovery and enhance comfort during intubation is unknown.
Objective: To explore the perceptions of patients who were intubated and receiving pain medication while sedated and restrained in the intensive care unit, in particular, their experience and their memories of the experience.
Clin Nurse Spec
February 2015
Author Affiliations: Critical Care Clinical Nurse Specialist (Dr Tracy), University of Minnesota Medical Center, Fairview, Minneapolis; and Distinguished Professor of Symptom Management Research (Dr Chlan), College of Nursing, the Ohio State University, Columbus.
AACN Adv Crit Care
April 2014
Mary Fran Tracy is Editor, AACN Advanced Critical Care, and Critical Care Clinical Nurse Specialist, University of Minnesota Medical Center, Fairview, PCU 4A, 500 Harvard St SE, Minneapolis, MN 55455
Intensive Crit Care Nurs
December 2012
Former Critical Care Clinical Nurse Specialist, Albert Einstein Healthcare Network, 5501 Old York Road, Philadelphia, PA 19141-3211, USA.
Brain death is characterised by a flaccid, areflexic neurological examination; fixed, dilated and midpoint pupils and total absence of intrinsic respiratory drive. A non-reversible clinical state or brain lesion must also be identified. Integral to brain death diagnosis is loss of respiratory drive.
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