Critical Care Newsline — September 11, 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. Every week, our expert clinical practice staff reviews hundreds of journals and Web sites, choosing only the most pertinent information for Critical Care Newsline. 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 on a variety of topics to keep you informed on issues that affect nurses and the nursing profession.


Sept 11, 2008

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1. EVIDENCE Morphine Plus Ketamine Eases Post-Thoracotomy Pain (Abstract)
2. EVIDENCE Hospitals Reduce Pressure Ulcers Using Braden Scale Risk Assessment (Abstract)
3. EVIDENCE Epropostenol Use in Pulmonary Artery Hypertension (PAH) (Abstract)
4. EDUCATION Half-day Cardiac Care Workshops Across the U.S. Sponsored by PCNA-AACN
5. CALL TO ACTION Research and Creative Solutions and Chapter Poster Abstracts Sought for NTI 2009
6. EVIDENCE What Leadership Styles Should Senior Nurses Develop? (Free Full Text)
7. EVIDENCE Psychological Trauma That Lasts: Kids in the ICU
8. Clinical Practice Resources
9. AACN Resources
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1. EVIDENCE Morphine Plus Ketamine Eases Post-Thoracotomy Pain (Abstract)
Patients who undergo a thoracotomy are often plagued by severe pain that is difficult to control. Treating these patients presents a real challenge for caregivers who are trying to find ways to ease the pain. Results of a recent study showed that patients who received a combination of morphine and ketamine immediately after thoracotomy had less pain and fewer side effects than those who received only morphine.

2. EVIDENCE Hospitals Reduce Pressure Ulcers Using Braden Scale Risk Assessment (Abstract)
Some hospitals have successfully reduced the incidence of pressure ulcers by using risk assessment and surface support, according to the results of a recent literature review. Healthcare institutions that used the Braden Scale of Risk Assessment to identify at-risk patients and provided pressure reducing surfaces for those patients were instrumental in decreasing and preventing this common problem. “Risk assessment of all admitted patients followed by provision of specialized support surfaces to all deemed to be at risk offers real hope of reducing the present very high rate of hospital-caused pressure ulcers. With the growing understanding that some pressure ulcers have their origin in deep tissue, it no longer makes sense to wait for the appearance of Stage I or II ulcers before taking action” the study’s authors noted. Reducing and ultimately preventing hospital acquired pressure ulcers has become even more important recently, following the decision of the Center for Medicare & Medicaid Services and many third-party payers to decline payment for this condition.

3. EVIDENCE Epropostenol Use in Pulmonary Artery Hypertension (PAH) (Abstract)
Patients with advanced PAH are typically at greater risk of developing thrombocytopenia while receiving intravenous epoprostenol therapy. In this study, researchers found that the use of this drug and hemodynamic abnormalities were associated with the development of thrombocytopenia in patients with PAH, and that the risk was more prevalent when the medication was given to patients who had preexisting abnormalities.

4. EDUCATION Half-day Cardiac Care Workshops Across the U.S. Sponsored by PCNA-AACN
Free half-day CE programs across the US focus on improving cardiovascular disease outcomes. Hosted by the Preventive Cardiovascular Nurses Association (PCNA) in collaboration with AACN, the sessions focus on treatment pathways and breakthroughs for ACS and MI patients; point-of-care testing to improve outcomes for patients at risk of heart failure, dyslipidemia and coagulation disorders; and information about the residual risk of HDL and triglycerides. Online pre-registration is required. Click on one of the following to find a location near you.
Management of the Acute Heart Failure Patient
Stroke Prevention: Role of Inflammatory Markers
The Role of Home Blood Pressure Monitoring in the Management of Hypertension: An Alternative to Office Visits?

ACS and MI: Treatment Pathways and Breakthroughs
Point of Care Testing: Strategies to Improve Care for Patients at Risk for Heart Failure, Dyslipidemia, and Coagulation Disorders
Residual Risk, the HDL-Triglyceride Story

5. CALL TO ACTION Research and Creative Solutions and Chapter Poster Abstracts Sought for NTI 2009
Showcase your best practices and share what you’ve learned with your colleagues by submitting abstracts for presentation at NTI 2009 in New Orleans. The deadline is Oct.15, 2008. You do not have to be an AACN member.

6. LEADERSHIP What Leadership Styles Should Senior Nurses Develop? (Free Full Text)
Senior nurses are likely to engage in a range of leadership activities in their daily routine. Some will naturally adopt an effective leadership style, while others may find the concept of leadership or seeing themselves as leaders difficult to understand. Effective leadership is critical in delivering high-quality care, ensuring patient safety and facilitating positive staff development. This article outlines the characteristics of an effective leader, the political context and various leadership activities for senior nurses. It also discusses mentorship, different leadership models and the process of professional socialization. This article has highlighted the essential leadership role that senior nurses have in developing skilled and competent staff. Healthcare organizations need nurse leaders who can develop nursing care, are an advocate for the nursing profession and have a positive effect on healthcare through leadership.

Use the Nurse Manager Leadership Collaborative Nurse Manager Inventory Tool to self-rate your management skills.

7. EVIDENCE Psychological Trauma That Lasts: Kids in the ICU
Children who spend time in the ICU are especially vulnerable to fear, anxiety and worry and may be traumatized by the experience months after returning home, according to nurse scientists who authored this recent study. To help prevent this condition, they developed the Children’s Critical Illness Impact Scale to measure psychological distress in children ages 6 to 12 after they have been discharged. This is the first self-report scale ever created to measure the psychological impact of intensive care unit hospitalization on children. "We know some children suffer post traumatic stress symptoms after having spent time in the intensive care unit," the authors noted, "Parents and children have described delusional memories of their hospital experience which continue to bother the child after they go home. In addition, parents have described behavioral changes and ongoing fears in their children, and children have told us they don't feel the same as they did before they were critically ill. As a result, we found that some kids were falling through the cracks and not getting the help needed to cope with the stress of hospitalization."

8. Clinical Practice Resources

PATIENT SAFETY ISSUES
Alaris SE Pump (a.k.a. Signature Edition Infusion System) Recall Information

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

NEW EVIDENCE-BASED PRACTICE
Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis (Abstract)

Comparing Patient-Reported Hospital Adverse Events with Medical Record Review: Do Patients Know Something That Hospitals Do Not? (Abstract)

A Multidisciplinary Survey on Capillary Refill Time: Inconsistent Performance and Interpretation of a Common Clinical Test (Abstract)

Pulse Oximeter Accuracy and Precision Affected by Sensor Location in Cyanotic Children (Abstract)

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