Critical Care Newsline — August 14, 2008

Critical Care Newline Home
 

Improving palliative and end-of-life care is one of AACN’s major initiatives. To provide optimal, quality care, the science and skills for prolonging life, as well as palliative therapies, must be embedded into the management of critically ill patients. For patients to receive quality care, palliation must be included throughout the trajectory of illness. Click here for more resources that will help you improve the palliative care for your patients.

2. Call to Action: Survey on Grief and Coping Mechanisms in Intensive Care Unit Nurses
Participate in a research project to help study investigators learn more about the degree of grief ICU nurses experience and the coping mechanisms they use to deal with each crisis in the unit. The study takes about 20 minutes to complete. For more information, click on the following link.

Moral distress is a critical, frequently ignored, problem in healthcare work environments. Unaddressed, it restricts nurses’ ability to provide optimal patient care and to find job satisfaction. AACN asserts that every nurse and every employer are responsible for implementing programs to address and mitigate the harmful effects of moral distress in the pursuit of creating a healthy work environment. To download a moral distress toolkit and read more about AACN’s position on this issue, click here .

3. Resource for your Safety: Free Safe Lifting Toolkit for Healthcare Workers
A new toolkit to assist health care professionals with the safe lifting of patients is available through the Safe Lifting Portal, a pro-bono healthcare site designed to support safe lifting and caregiver injury prevention programs. The toolkit features general guidelines for assessing patients, selecting the proper lift for patients with special needs, infection control and return on investment for safe patient handling.

4. Research: An Analysis of Electrical Current Flow Through Rescuers in Direct Contact With Patients During Biphasic External Defibrillation (Abstract)
Rescuers performing chest compressions during biphasic external defibrillation are exposed to low levels of leakage current, according to the results of this study. The findings support the feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral resuscitation. Researchers noted that this study may lead the scientific community to examine the feasibility of providing uninterrupted chest compressions during biphasic defibrillation.

5. Research: Mentoring Beyond the First Year: Predictors of Mentoring Benefits for Pediatric Staff Nurse Protégés (Abstract)
This study explored mentoring benefits among pediatric staff nurse protégés by applying a business mentoring model, the Mutual Benefits Model, to the nursing environment. The researchers found that the quality of mentoring was the single best predictor of mentoring benefits among pediatric staff nurse protégés. The major implication of this study is that nursing leaders and organizations can make lasting impacts through high-quality mentoring relationships even when they are time and resource limited, the researchers noted. The findings support the concept of effective mentoring relationships in nursing as a triad that includes the individual mentor, the protégé and the organization where they work rather than a dyad relationship between the mentor and protégé only.

AACN has long been an advocate of healthy work environments, which include authentic leadership. Learn more about the AACN Standards for Establishing and Sustaining Healthy Work Environments. To download the standards, click here.


6. Research: Impact of Time of Presentation on the Care and Outcomes of Acute MI (Abstract)
This study investigates the difference in medical care and in-hospital mortality for patients who had an acute MI and were admitted weekdays between 7 a.m. and 7 p.m. and those admitted on weekends, holidays and weeknights. The researchers found that there was no difference in hospital mortality between the two groups; however, they did find that there were fewer primary PCIs, fewer overall revascularizations and significantly longer door-to-balloon times in patients admitted with acute MI during off-hours. Despite slightly fewer primary percutaneous coronary interventions and overall revascularizations and significantly longer door-to-balloon times, patients admitted with acute MI during off-hours had in-hospital mortality similar to those presenting during regular hours. This research may inform patient management practices in your unit and could be a good discussion for your team to have in the appropriate meeting forum.

7. Research: Use of Corticosteroids in Managing Acute Respiratory Distress Syndrome (ARDS) (Abstract)
Corticosteroids have been used to treat ARDS in various stages of disease progression, from preventing the syndrome in high-risk patients to halting the disease’s evolution. In this review of randomized controlled trials on the role of corticosteroids in treating and preventing ARDS, the findings did not support the use of short-course, high-dose corticosteroids to prevent or treat early ARDS. The review showed that longer-course corticosteroid treatment may not improve survival in late-phase ARDS but provided some benefits. This research may provide an opportunity to evaluate how your unit is managing these patients and the outcomes you are experiencing.

8. Clinical Practice Resources

PATIENT SAFETY ISSUES
Simvastatin Used With Amiodarone - Risk of rhabdomyolysis when simvastatin is used with amiodarone
http://www.fda.gov/medwatch/safety/2008/safety08.htm#Simvastatin

Patient Safety Links:
Joint Commission
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.1.63602
Medline Plus
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.2.63602
National Patient Safety Foundation
http://jcrinc.co.mansellgroup.net/UM/T.asp?A2557.25634.1623.3.63602

Institute for Safe Medication Practices Newsletter
http://www.ismp.org/Newsletters/nursing/default.asp

AHRQ Patient Safety Network
http://psnet.ahrq.gov

GUIDELINES
Assessment: oxygenation and blood pressure. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12318

Assessment: pupil examination. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12320

Decision making within the EMS system: dispatch, scene, transportation and destination. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12324

Treatment: airway, ventilation, and oxygenation. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12321

Treatment: cerebral herniation. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12323

Treatment: fluid resuscitation. In: Guidelines for the Prehospital Management of Severe Traumatic Brain Injury, second edition. This updates a previously published guideline summary.
http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=12322

NEW EVIDENCE-BASED PRACTICE

Accidental and Nonaccidental Poisonings as a Cause of Apparent Life-Threatening Events in Infants (Abstract)
http://pediatrics.aappublications.org/cgi/content/abstract/122/2/e359

Association Between Self-report Pain Ratings of Child and Parent, Child and Nurse, and Parent and Nurse Dyads: Meta-analysis (Abstract)
http://www3.interscience.wiley.com/journal/120846746/abstract
 

Do you have a comment, question or story idea for the Critical Care Newsline? Send your email to enewsletter@aacn.org

UPDATE YOUR OWN INFORMATION ONLINE
Did you know you can update your demographic profile, including your e-mail address, online? Simply log in using your membership or customer identification number. Your default password is the first 15 letters of your last name. Go to: http://www.aacn.org/DM/CustomerProfile/UpdateCustomerProfile.aspx

*****************************************************************************************