Dimensions of critical care nursing: DCCN

Published by Lippincott, Williams & Wilkins
Online ISSN: 0730-4625
Publications
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Learn how to facilitate implementation of OSHA's strengthened sharps safety requirements.
 
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This article presents an overview of the guidelines for the management of pregnant women with asthma. Emphasis is placed on the National Asthma Education and Prevention Program guidelines.
 
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As everyone is well aware, we are in the midst of a nursing shortage-one with no end in sight at the present time. But are you aware that we also have a shortage of nursing faculty? This article will briefly describe the current and predicted shortage of faculty, potential reasons for the shortage, current ways of coping, and the future for nursing faculty.
 
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Flow sheets provide a clear understanding of the patient in a timely manner, but designing the new charting format can be complex. This guide defines a patient-care document's purpose, flow sheet strengths, and the evaluation format.
 
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Although the first line of defense in cancer treatment often is surgery, studies suggest that postoperative pain and anesthetic drugs suppress the activity of cells that lyse metastatic cells, that is, natural killer cells. We assessed the affect of low-dose ketamine on natural killer cell activity. The findings are presented in this brief report.
 
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This paper specifically examines the critical care nurse's role in preventing cardiovascular complications for the abdominal aortic aneurysm (AAA) resection patient.
 
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Noninvasive ventilation has become a widespread tool of treatment and support for patients in acute care settings. The treatment is used for various clinical conditions, particularly chronic obstructive pulmonary disease and acute cardiogenic pulmonary edema. The utilization of a simple nursing care checklist allows treatment in a systematic fashion. This article discusses the respiratory features of this topic: criteria for noninvasive ventilation, choice of the interface for acute clinical conditions, ventilators and modes of ventilation in noninvasive ventilation, management of setting parameters, patient/ventilator interactions, and monitoring.
 
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Doctorally prepared nurses are the nursing profession's voice for the future. Currently, there is an urgent demand for these advanced nurses to move into positions of leadership in both clinical and nonclinical settings. The purpose of this article is to investigate the various nursing doctoral degrees, including the history of doctoral education in nursing and variances in terminal nursing degrees. Recommendations for choosing a doctoral program are proposed and the vital need for the encouragement and support of nurses interested in pursuing doctoral studies is discussed.
 
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Acute intermittent porphyria is a rare autosomal dominant hereditary inborn error of metabolism of the heme biosynthetic pathway that can be exacerbated through a multitude of environmental factors. This article is a case study describing the pathophysiology, clinical presentation management, and exacerbation prevention of acute intermittent porphyria. The disease is clinically manifested with severe abdominal pain, confusion, and seizures which may be life threatening. Specific treatment with heme preparations should be instituted as soon as increased excretion of porphobilinogen through urine sampling is confirmed. Supportive treatment includes opiate analgesia, monitoring for and treating complications such as hypertension and hyponatremia. Follow-up should include family counseling regarding genetic defects and individual counseling regarding lifestyle changes including avoidance of environmental factors that have been implicated in the exacerbation of the disease.
 
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This article focuses on translating arterial blood gas information into clinical benefits, with 3 case scenarios that focus on using arterial blood gases to manage mechanical ventilation.
 
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Radiofrequency ablation as a treatment for supraventricular and ventricular tachycardias has increased in popularity as a safe and effective mode of therapy. The critical care nurse's role includes pre-procedure, peri-procedure, and post-procedure observations and interventions that contribute to positive patient outcomes.
 
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To significantly reduce the morbidity, mortality and life long dependence on antiarrhythmic medications, radiofrequency catheter ablation has emerged as the treatment of choice for patients with preexcitation disorders occurring with the Wolff-Parkinson-White (WPW) syndrome. Radiofrequency ablation is usually highly successful (> 95%), with a near zero mortality and low morbidity. This article, the last in a series of two, focuses on preventing complications for patients undergoing this procedure.
 
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For select individuals with chronic, drug-resistant, paroxysmal atrial fibrillation, who have failed pharmacologic suppression or mechanical cardioversion, radiofreqency ablation of ectopic foci in and around the ostia of the pulmonary veins can restore normal sinus rhythm, prevent recurrence of the arrhythmia, and improve the quality of life. Radiofrequency ablation of these sites is an evolving process as improvements are made in the catheters and procedure. Major complications include pulmonary vein stenosis, stroke, and cardiac tamponade.
 
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Fast, safe, and effective, radiofrequency catheter ablation is becoming more common as a treatment for tachyarrhythmias. This article describes the procedure, which patients are eligible for it, and nursing considerations before, during, and after the procedure.
 
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Death is common in the intensive care unit. Some patients are surrounded by family; others, with only nurses and physicians by their side. This article describes the experience of a critical care nurse caring for a patient in his last hours and in the hours after his death. These extraordinary measures left her with a sense of peace and pride in being an intensive care unit nurse.
 
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This investigator found no differences between the needs of family members who selected "Do-Not-Resuscitate" (DNR) orders from those who did not. She suggests reevaluating the assumptions about families who select DNR.
 
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This article focuses on the process of preparing research abstracts for submission to scientific meetings of professional organizations. Perspectives on the process of specifying an abstract's focus, choosing a scientific meeting, selecting the type of presentation, developing an abstract, and writing an abstract in its form are presented.
 
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Substance abuse among nurses can have significant ramifications for patient care, productivity, and personal well-being. Existing evidence suggests that critical care nurses are especially vulnerable to pressures that induce substance abuse. Consequently, critical care leaders and nurses need to be prepared to help their impaired colleagues. This paper provides several valuable guidelines for addressing substance abuse based on an exploratory study of the types of drugs or substances most frequently abused among nurses.
 
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When you suspect that some of the injuries of your elderly trauma patient do not fit the explanation of cause, this elder abuse assessment tool will help you screen for possible abuse.
 
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Children are the future of the world and deserve their chance to succeed, cheered on by the caretakers and adults who surround them. Nurses in the pediatric intensive care unit do not need to be forensic specialists to effectively identify children who are at risk of abuse, but they should be forensically educated in an effort to increase awareness and serve as a patient advocate. Nurses have the opportunity and legal responsibility to stop the "cycle of violence" one life at a time when working with families living in an abusive environment. This article discusses several aspects of child abuse and the role of the critical care nurses.
 
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Collaboration between academia and practice settings has been cited frequently in the literature on baccalaureate nursing curriculum. This article applies the concept of collaboration to the development of a continuing educational program for practicing cardiovascular nurses.
 
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The purpose of this hermeneutic phenomenological research study was to assess the lived experience of seeking tenure while teaching and practicing at the bedside and to identify how a sense of balance was maintained throughout the process. Six nursing faculty were interviewed while actively seeking tenure or within 2 years after seeking tenure. Four themes were identified and will be discussed. The process of tenure is a stressful time for faculty and even more stressful when the faculty try to balance the demands for academe with clinical scholarship. These participants felt that their clinical practice was recognized or valued only when it was of benefit to the academic institution. In many institutions, creativity must be utilized to enhance the tenure portfolio.
 
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The Institute for Healthcare Improvement is an independent not-for-profit organization based in Cambridge, Massachusetts. It is a leading innovator in health and health care improvement with a global following.One important part of the IHI is the development and evolution of the "Open School." Launched in September 2008, the online community currently includes hundreds of thousands of students worldwide. The goals of the Open School are consistent with the IHI initial concepts: to build will for change, seek out innovation, share expertise, and build leaders. Each year, the Open School awards scholarships to select students to attend a Leadership Academy.The Student Quality Leadership Academy allows students to network with other future nurses, physicians, and health care administrators and explores how they feel about leadership. This is important to nursing as we will need to replace many leadership positions in the future, but often new nurses are uncertain about leadership roles.
 
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Stretching scarce resources is more than a managerial issue. Should an understaffed ICU accept the patient or divert him to another facility? The intense "medical utility" controversy focuses on a situation that critical care nurses now face every day.
 
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Gaining access to patients to conduct nursing research can be a difficult problem, especially in a critical care setting. This author describes techniques that can be used to select and establish research in your own or other hospitals.
 
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Pediatric hospice and palliative care continue to be an underutilized model of care. There is much confusion over the differences between hospice and palliative care. Nurses and physicians continue to need specialized training regarding end-of-life care and the pediatric population. Children and their families may needlessly be suffering during the dying process. Many barriers exist that prevent its use among medical professionals. This article discusses some of these barriers and strategies to reduce them. Recent changes in health care law will allow both curative and hospice care to be provided at the same time.
 
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When a patient is mentally incompetent to consent, the investigator has several legal choices in obtaining consent for the patient's participation in nursing research. Because each state's laws and procedures for proxy consent may be different, it is wise to check applicable laws before proceeding to obtain consent on behalf of an incompetent patient.
 
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Contemporary intensive care nurses are confronted daily with accelerated changes and unprecedented challenges. While advancements in critical care and medical technologies may reflect good intentions for patient care, misguided nursing development may pose a sea of fallibility for intensive care nursing. Conceivably, complex technological developments provoke exponential alienation of intensive care nurses from essential nursing duties. Accountability of the nurse is crucial. A winter of discontent is evident as intensive care nurses assume new roles amidst the new technology. Several themes will be presented in this article.
 
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Preparing for a JCAH review of your unit's standards of care can serve as an impetus for positive change, and can give staff an opportunity to share in the determination of the unit's policies and procedures.
 
Top-cited authors
Denise F Polit
  • Griffith University
Caoimhe Lillis
  • National University of Ireland, Galway
Michael Terrin
  • University of Maryland, Baltimore
A. Koneti Rao
  • Lewsi Katz School of MedicineTemple University
Ira Ockene
  • University of Massachusetts Medical School