Critical Care Newsline — October 23, 2008

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Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.


Oct. 23, 2008

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1. NEWS “The Nursing Shortage and the Crisis in Healthcare” Airs Tomorrow, Oct. 24 on PBS
2. EVIDENCE End-of-Life Conversations Benefit Patients, Caregivers (Abstract)
3. EVIDENCE Unmet Need for Communication Common Among Patients with Advanced Illness
4. EVIDENCE National Healthcare Report Card: Improve Care for Sickest Patients
5. EVIDENCE Nurses Working Outside of Nursing Societal Trend or Workplace Crisis? (Abstract)
6. EVENT National Nurse Practitioner Week Nov. 9-15; Resource Guide Available
7. EVENT Attend the 2009 Nurse in Washington Internship; Online Registration is Now Open
8. Clinical Practice Resources
9. AACN Resources
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1. NEWS “The Nursing Shortage and the Crisis in Healthcare” Airs Tomorrow, Oct. 24 on PBS
The Emmy Award-winning PBS news magazine, NOW, will explore the impact of the nursing shortage on patients in this special television program tomorrow, Oct. 24. Hosted by award-winning veteran journalist David Brancaccio, “The Nursing Shortage and the Crisis in Healthcare” will examine the root causes of the crisis, and explore innovative efforts to reverse the trend. Check your local TV listings for times. The show can also be accessed through On-Demand television, audio podcasting, video podcasting and streaming video on the NOW Web site.

2. EVIDENCE End-of-Life Conversations Benefit Patients, Caregivers (Abstract)
Despite the long-held belief by many doctors that discussing end-of-life issues with patients increases the patients' emotional distress, these conversations can actually lead to improved quality of life for patients and their loved ones, according to a recent study. Results show that patients who reported having end-of-life discussions with their physicians did not feel more depressed, worried or sad than those who did not. Patients who recalled such talks were more likely to accept that their illness was terminal and preferred comfort care over life-extending therapies. They received less aggressive medical treatment, such as resuscitation or admission to an intensive care unit, and they were more apt to enroll earlier in hospice programs. More aggressive medical care, which can cause upsetting side effects and hamper communication with loved ones, was associated with worse patient quality of life and worse adjustment by patients' bereaved caregivers. "To the best of our knowledge, this is the first study to show how care received affects the dying patient's quality of life, and the first to show that a patient's healthcare and quality of life near death significantly influence the adjustment of his or her bereaved survivors," researchers reported.

Palliative and end-of-life care is one of AACN’s major initiatives. Test your skill level and knowledge about caring for patients in this stage of life with the free, newly released Palliative and End-of-Life Care Self Assessment. The content features the self assessment plus resources for palliative care and end-of-life symptom management, airway management, dyspnea, delirium and pain management.

You can also preview our new e-learning course, “Promoting Excellence in Palliative and End-of-Life Care: An Interactive Learning Experience from AACN.” If your organization already has an AACN E-Learning system site license, you can immediately access this program. If your hospital doesn’t have a site license, ask about obtaining one so you and your colleagues can take advantage of all AACN’s innovative e-learning courses.

3. EVIDENCE Unmet Need for Communication Common Among Patients with Advanced Illness
There is often a lack of adequate communication between healthcare providers and those facing terminal conditions, according to a recent series of articles. Communication is of concern to older adults, because they comprise the vast majority — about 70 percent — of those contending with multiple chronic medical problems. The articles, representing four separate studies, point out the need to address treatment preferences and symptom burden among patients with advanced illness. The research highlights the importance of consistent, planned interactions with older adults and discussions about goals of care.
Early discussions about treatment choices are especially encouraged, because many older adults have limitations in health literacy and cognitive capacity brought on by multiple chronic illnesses.
The articles include:
Advance Care Planning and Health Care Preferences of Community Dwelling Elders: The Framingham Heart Study (Abstract)
Patient Age, Well-Being, Perspectives, and Care Practices in the Early Treatment Phase for Late-Stage Cancer (Abstract)
The Relationship of Reported Pain Severity to Perceived Effect on Function of Nursing Home Residents (Abstract)
Palliative Care Intervention for Choice and Use of Opiods in the Last Hours of Life (Abstract)

4. EVIDENCE National Healthcare Report Card: Improve Care for Sickest Patients
America does a mediocre job caring for its sickest patients, according to a new report suggesting that a lack of palliative care programs is partially to blame for the result. The national report card ratings give U.S. hospitals a C. Only Vermont, Montana and New Hampshire earned an A, according to “America's Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation's Hospitals.” Three states — Oklahoma, Alabama and Mississippi — got an F. The reports authors found that in states with more palliative care programs, patients are less likely to die in the hospital; don't have to go to the intensive care unit as much in the last six months of life; and spend fewer days in intensive care or the coronary unit in the last six months. That also saves hospitals money, which could help lower healthcare costs. "Without palliative care, people with serious illnesses like cancer often suffer unnecessarily from severe fatigue, pain, shortness of breath, nausea and other symptoms from their disease and treatments," researchers report.
To find out your state’s rating, click here.

5. EVIDENCE Nurses Working Outside of Nursing Societal Trend or Workplace Crisis? (Abstract)
The phenomenon of career inactivity in professional nursing has been historically portrayed in the literature as a major cause of disequilibrium in the registered nurse labor market. However, there remains a general lack of understanding of the diverse forces that shape the inactive nurse pool and the likelihood that this population will return to nursing. The purpose of this study was to examine the population of registered nurses who are active in the labor market but work in non-nursing employment. Specifically, this study sought to determine the relative importance of non-workplace- and workplace-related reasons for working outside of nursing. The results demonstrate that dissatisfaction with the nursing workplace is the key reason cited by actively licensed nurses for working outside of nursing employment. These findings suggest that policy and employer remedies are needed to improve the nursing workplace.

6. EVENT National Nurse Practitioner Week Nov. 9-15; Resource Guide Available
National NP Week 2008 will be celebrated Nov. 9-15. The American Association of Nurse Practitioners (AANP) has developed the NP Week Resource Guide to help members plan and execute promotions designed to educate the public about the value and benefits of having an NP as their healthcare provider. Review the resource guide and plan now to make NP Week 2008 an event to remember! For more information, contact membership@aanp.org.

7. EVENT Attend the 2009 Nurse in Washington Internship; Online Registration is Now Open
Do you want to learn how to influence healthcare through legislative and regulatory processes? Here’s the perfect opportunity: attend the 2009 Nurse in Washington Internship (NIWI) program March 29 -31 in Washington, D.C. You’ll have a chance to attend talks by health policy experts and government officials, network with other nurses and visit members of Congress. NIWI is open to any RN or nursing student who is interested in the legislative process. For more information or to register, call (859) 514-9157 or click here.

8. Clinical Practice Resources

EVIDENCE-BASED PRACTICE
Skin Conductance Versus the Modified COMFORT Sedation Score as a Measure of Discomfort in Artificially Ventilated Children (Abstract)

Propofol Infusion Syndrome (Abstract)

GUIDELINES
Delirium: Prevention, Early Recognition, and Treatment. In: Evidence-based Geriatric Nursing Protocols for Best Practice

PATIENT SAFETY ISSUES
OTC Cough and Cold Medicines- Product Labels Being Modified To State “Do Not Use" In Children Under 4 Years of Age
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