Confounding factors in brain death: cardiogenic ventilator autotriggering and implications for organ transplantation.

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.

Promoting certification: the chapter's role.

The mission of the American Association of Critical-Care Nurses focuses on providing nurses with expert knowledge to promote delivery of excellent, safe, quality care to acutely and critically ill patients and their families. Chapters consist of professional leaders in a community who carry on the mission work of the American Association of Critical-Care Nurses at the local level. Chapters can emphasize the value of certification and continuing education, because they offer a wide spectrum of opportunities to meet the learning and developmental needs of nurses as they advance in their professional careers.

Open pneumothorax resulting from blunt thoracic trauma: a case report.

Cases of open pneumothorax have been documented as early as 326 BC. Until the last 50 years, understanding of the epidemiology and treatment of penetrating chest trauma has arisen from military surgery. A better understanding of cardiopulmonary dynamics, advances in ventilatory support, and improvement in surgical technique have drastically improved treatment and increased the survival rate of patients with penetrating thoracic trauma.

Factors influencing intentions to integrate tobacco education among advanced practice nursing faculty.

We report on the findings of a national survey that examined factors that influence faculty's intentions to integrate tobacco education in their advanced practice nursing curricula. The addiction component of tobacco use is taking its toll on the health of 48 million smokers in the United States. Several national health authorities recommend and/or mandate that tobacco prevention and tobacco cessation be addressed at every point of entry in the health care delivery system.

Living with chronic obstructive pulmonary disease: insiders' perspectives.

Aim: This paper reports a study of the experiences of older adults with severe chronic obstructive pulmonary disease, with the aim of gaining an understanding of how the disease had affected their lives.

Background: Chronic obstructive pulmonary disease is a major personal and public health burden and is the fifth cause of mortality worldwide. The brief encounters that healthcare professionals have with patients in hospitals, physicians' offices and other outpatient settings are insufficient to be able to truly understand the challenges that people face in the attempt to integrate a chronic illness into their lives.

Using evidence-based educational strategies to increase knowledge and skills in tobacco cessation.

To meet the demand for improved patient outcomes and accountability for healthcare delivery, nurses must embrace a culture of evidence-based practice (EBP). Integrating EBP for tobacco cessation in nursing practice is particularly important for the 44.5 million smokers in the United States who contribute to 157 billion dollars of healthcare costs annually.

Critical care providers' perceptions of the use of vasopressin in cardiac arrest.

Background: Although published algorithms and guidelines list epinephrine and vasopressin as either/or choices for treatment of ventricular fibrillation and/or pulseless ventricular tachycardia, little is known about how critical care providers respond to this recommendation.

Objectives: To assess the use of vasopressin as a first-line drug of choice for ventricular fibrillation and/or pulseless ventricular tachycardia and describe factors that may influence decision making for using vasopressin.

Methods: A convenience sample from 4 academic medical centers in the United States was recruited to complete a 20-item survey on demographic factors such as year of last Advanced Cardiac Life Support (ACLS) provider course, specialty certification, predominant practice responsibility, and beliefs related to the use of vasopressin for cardiac arrest.

Tension pneumothorax: a pulmonary complication secondary to regional anesthesia from brachial plexus interscalene nerve block.

Interscalene brachial plexus anesthesia is often used for surgeries involving the shoulder and upper arm. This method of regional anesthesia decreases pain, nausea, and vomiting associated with general anesthesia. One infrequent complication of interscalene brachial plexus block is tension pneumothorax.

Guided imagery: replication study using coronary artery bypass graft patients.

Replication of a guided imagery study, based on the work of D. Tusek and colleagues, was initiated for coronary artery bypass graft patients, using the Center for Advanced Nursing Practice's Evidence-Based Practice Model. Through the leadership of clinical nurse specialists and the support of perioperative and postoperative bedside clinicians, this initiative offered benefits to patients and served as a template for program expansion to other patient populations.

Selection and implementation of a transparent dressing for central vascular access devices.

The selection of new central venous access devices (CVADs), line dressing, and nursing clinical practices was guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model. The model's evidence-triggered, evidence-supported, evidence-observed, and evidence-based phases provided structure that guided a systematic process in which best practice was incorporated into the clinical setting, based on clinician insights, evaluation of authoritative literature, and examination of three CVAD dressings as an intervention using various study methods. This article discusses study findings, recommendations, and implications for nursing practice.

Peripherally inserted central catheter program.

The peripherally inserted central catheter (PICC) is a safe and less costly option to centrally inserted, tunneled, or implanted central vascular access devices. Support for PICC services and reports of results vary among organizations. A comprehensive PICC Program, guided by the Center for Advanced Nursing Practice's Evidence-Based Practice Model, was designed and implemented with successful outcomes.

Chest pain management: linking tertiary and rural settings.

The Center for Advanced Nursing Practice Evidence-Based Model was the catalyst and driving force that guided the application of evidence-based practice across boundaries of tertiary health care settings to rural health care settings. The intent of this effort was to enhance knowledge and to streamline practice for the management of patients with chest pain. The model successfully supported practice changes and improved outcome management for this aggregate population.