RESUMEN
Incorporation of best clinical practices into the baccalaureate critical care nursing curriculum is important. At The College at Brockport, best clinical practices are introduced early in the semester and are reinforced throughout the semester in both class and clinical settings. Among the best clinical practices included are those recommended by the American Association of Critical-Care Nurses, The Centers for Medicare and Medicaid Services, the Institute for Healthcare Improvement, The Joint Commission, Quality and Safety Education for Nurses, the Surviving Sepsis Campaign, and the Institute for Safe Medication Practices. The culminating assignment of the semester requires students to focus on patient safety. Students describe the use of the National Patient Safety Goals and other best practices in the critical care setting. The role of the nurse leader and exploration of near-miss and work-around events also are described. Nursing students need to provide safe competent nursing care by incorporating best practices into their clinical practice now and in the future when they become registered professional nurses.
Asunto(s)
Enfermería de Cuidados Críticos/educación , Bachillerato en Enfermería/normas , Curriculum , New YorkRESUMEN
The role of vitamin D in critical illness is under investigation. Recent data indicate declining levels of serum vitamin D in multiple adult populations. Deficiencies have been strongly linked to infectious processes and certain chronic disorders. Vitamin D deficiency that is present at the onset of critical illness may impact the severity of illness and contribute to less-than-optimal outcomes. This article describes the function of vitamin D, the effects that deficiencies have on body systems, and the emerging role of vitamin D deficiency for critically ill patients.
Asunto(s)
Enfermedad Crítica , Deficiencia de Vitamina D/fisiopatología , Vitamina D/fisiología , Adulto , Femenino , Humanos , Masculino , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Cuidados Posoperatorios/enfermería , Robótica , Estudios de Cohortes , Humanos , Tiempo de Internación , Satisfacción del Paciente , Resultado del TratamientoRESUMEN
Rochester General Hospital developed an exceedingly well received homegrown database, CMReview, for its CMs. The right team comprised of a data analyst, IT programmers, technology-appreciative CMs, and administrative support has created an asset to the functioning of the care management department. Having the people on site with a vested interest in the success of the project has been a win/win for all of us.
Asunto(s)
Manejo de Caso , Sistemas de Administración de Bases de Datos , Competencia Profesional , Humanos , Relaciones Enfermero-Paciente , Atención al Paciente/normasRESUMEN
An empowering clinical nurse advancement system can facilitate institutional behaviors that embrace all of AACN's healthy work environment standards and thus serve as a building block for developing a flourishing health care environment. The results generate positive outcomes that are evident to health care professionals, patients, patients' families, and health care organizations. Patients benefit from highly satisfied employees who work in a culture of caring and excellence.
Asunto(s)
Cuidados Críticos/normas , Rol de la Enfermera , Competencia Profesional/normas , Sociedades de Enfermería/organización & administración , Lugar de Trabajo/normas , Toma de Decisiones , Eficiencia , Humanos , Satisfacción en el Trabajo , Liderazgo , Selección de Personal/organización & administración , Desarrollo de Programa/normas , Calidad de la Atención de Salud , Estados UnidosRESUMEN
Quality patient care has always been of the highest priority for nurses. With the current government emphasis on reporting, improving care, and reimbursement, nurses and their institutions are more responsible than ever for assuring the delivery and documentation of excellent patient care. Our institution achieved improved compliance reports for the CMS quality indicators through a combined effort of collegial interdisciplinary delivery of care, a more responsive documentation system, real-time quality assurance, and ongoing education.
Asunto(s)
Centers for Medicare and Medicaid Services, U.S. , Administración Hospitalaria , Relaciones Interinstitucionales , Rol de la Enfermera , Indicadores de Calidad de la Atención de Salud/organización & administración , United States Dept. of Health and Human Services , Centers for Medicare and Medicaid Services, U.S./organización & administración , Documentación , Humanos , Evaluación de Procesos y Resultados en Atención de Salud , Mecanismo de Reembolso , Gestión de la Calidad Total/organización & administración , Estados Unidos , United States Dept. of Health and Human Services/organización & administraciónRESUMEN
Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy, left ventricular apical ballooning syndrome, and broken heart syndrome, is a clinical entity first described in the early 1990s in Japan and now receiving increased attention in the United States. The clinical features include an onset of chest pain mimicking that of an acute myocardial infarction, electrocardiogram changes similar to those of an acute myocardial infarction, normal coronary arteries on cardiac catheterization, and a signature appearance on echocardiogram. Takotsubo cardiomyopathy results in a significantly decreased ejection fraction that, as long as the patient receives appropriate hemodynamic support, typically undergoes spontaneous reversal. This article describes the history, clinical presentation, and management strategies for Takotsubo cardiomyopathy and provides a case study.
Asunto(s)
Cardiomiopatía de Takotsubo/diagnóstico , Anciano , Estimulación Cardíaca Artificial , Femenino , Humanos , Factores de Riesgo , Volumen Sistólico , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/terapiaAsunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Cuidados Críticos/métodos , Hipotiroidismo , Tirotoxicosis , Anciano , Amiodarona/metabolismo , Amiodarona/farmacocinética , Antiarrítmicos/metabolismo , Antiarrítmicos/farmacocinética , Fibrilación Atrial/tratamiento farmacológico , Diagnóstico Diferencial , Interacciones Farmacológicas , Semivida , Humanos , Hipotiroidismo/inducido químicamente , Hipotiroidismo/diagnóstico , Hipotiroidismo/terapia , Masculino , Tasa de Depuración Metabólica , Monitoreo Fisiológico/enfermería , Rol de la Enfermera , Evaluación en Enfermería , Alta del Paciente , Educación del Paciente como Asunto , Valores de Referencia , Pruebas de Función de la Tiroides/métodos , Hormonas Tiroideas/fisiología , Tirotoxicosis/inducido químicamente , Tirotoxicosis/diagnóstico , Tirotoxicosis/terapiaRESUMEN
The prevalence of diabetes mellitus makes the occurrence of hyperglycemic emergencies a key component in clinical practice. The expert nurse is well positioned to manage both diabetic ketoacidosis and hyperosmolar hyperglycemic states. Patient care management includes a high index of suspicion for awareness for the possibility of diabetic ketoacidosis or hyperosmolar hyperglycemic states in patients based on a multifactorial etiology, evidence-based treatment of the emergent episode, and tertiary prevention to prevent recurrent episodes.
Asunto(s)
Cuidados Críticos/métodos , Cetoacidosis Diabética/terapia , Urgencias Médicas/enfermería , Coma Hiperglucémico Hiperosmolar no Cetósico/terapia , Glucemia/metabolismo , Causalidad , Cuidados Críticos/normas , Cetoacidosis Diabética/diagnóstico , Cetoacidosis Diabética/etiología , Cetoacidosis Diabética/metabolismo , Urgencias Médicas/epidemiología , Medicina Basada en la Evidencia , Familia/psicología , Fluidoterapia , Humanos , Hiperglucemia , Coma Hiperglucémico Hiperosmolar no Cetósico/diagnóstico , Coma Hiperglucémico Hiperosmolar no Cetósico/etiología , Coma Hiperglucémico Hiperosmolar no Cetósico/metabolismo , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Monitoreo Fisiológico/enfermería , Rol de la Enfermera , Evaluación en Enfermería , Educación del Paciente como Asunto , Prevalencia , Recurrencia , Respiración ArtificialRESUMEN
Dying is a journey for all involved. We have been fortunate to work in a hospital with both an ICU and a palliative care/hospice unit. We have transferred patients for whom care was withdrawn and who were still alive on the next day to the palliative care unit and have found the transfer to work to maximize comfort in dying. For many patients and families who have developed relationships with the staff in their ICU, the combination of established relationships, traditional therapies, and CAT maximizes the comfort during the dying process.