Sandra Swoboda

Johns Hopkins Medicine | JHUSOM · Department of Surgery

Aim: The purpose of this article was to evaluate the ability of an interactive virtual reality (VR) platform guided by standards of best practice to provide an effective immersive learning environment. We specifically evaluated usability of the platform and learners' perceptions of the experience. Background: A variety of strategies are needed t...

Background Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulatio...

Aims and objectives To examine demographic and work characteristics of interdisciplinary healthcare professionals associated with higher burnout and to examine whether the four domains of moral resilience contribute to burnout over and above work and demographic variables. Background Healthcare professionals experience complex ethical challenges o...

Background Ethical challenges in clinical practice significantly affect frontline nurses, leading to moral distress, burnout, and job dissatisfaction, which can undermine safety, quality, and compassionate care. Objectives To examine the impact of a longitudinal, experiential educational curriculum to enhance nurses’ skills in mindfulness, resilie...

Background and purpose: As COVID 19 impacted schools of nursing, the impact of clinical training was immediate. Students were removed from clinical sites but clinical training was necessary to continue the education of nursing students at all levels. Select virtual clinical experiences were substituted for in person clinical experience to reinforce...

Background: Health care interprofessionals face competing obligations to their patients, employers, and themselves. When ethical conflicts ensue and competing obligations cannot be resolved, health care interprofessionals have reported experiencing symptoms of burnout, moral distress, and other types of moral suffering. Recently, moral resilience o...

Background: Preoperative advance care planning (ACP) may benefit patients undergoing major surgery. Objective: To evaluate feasibility, safety, and early effectiveness of video-based ACP in a surgical population. Design: Randomized controlled trial with two study arms. Setting: Single, academic, inner-city tertiary care hospital. Subjects: Pati...

Background: There is limited evidence comparing the clinical and simulation environments. Methods: This multicenter observational study compared traditional clinical to simulation on the type, number, and level of educational activities as determined by Miller's Pyramid. Results: Forty-two students’ experience revealed that skills, physical assessm...

This study explored BSN students' perceptions of learning with vSim for Nursing™. Using a mixed methods design with 99 students, key points of learning were medication administration and respiratory interventions. Qualitative data demonstrated learning of assessment, prioritization, and emergency management. The top student preferences of how to us...

There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs...

Family-centered care is an important component of holistic nursing practice, particularly in critical care, where the impact on families of admitted patients can be physiologically and psychologically burdensome. Family-centered care guidelines, developed by an international group of nursing, medical, and academic experts for the American College o...

Objective: To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU. Methods: We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary...

Facilitating a simulated clinical experience for prelicensure nursing students requires skills. Frequently, the experience is planned, presented, and debriefed by an educator assigned as the facilitator. The International Nursing Association for Clinical Simulation and Learning (INACSL) Best Practice Standards℠ provide the goals for all simulation...

Objectives: The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropr...

Background: Virtual simulation is an emerging technology that has been suggested as an effective pedagogical approach to teaching various skills in nursing education. The purpose of this study was to report students' experience with vSim for Nursing™. Method: This study used a descriptive, mixed-methods design with 54 accelerated Bachelor of Scienc...

Background: At a time when major disasters are occurring with increasing frequency, nurses must understand principles of disaster triage. The aim of this study was to determine the impact of a virtual simulation to teach nursing students concepts of triage using the Sort, Assess, Lifesaving Interventions, and Treatment/Transport model. Method: Usin...

Background: Students in nursing programs must learn how to communicate with patients in a culturally competent manner. Method: This article explores current best practices in nursing education regarding the inclusion of diversity and cultural humility in the program of study and provides recommendations for innovative ways of thoughtfully thread...

Significant health inequities persist among minority and socially disadvantaged patients. Better understanding of how unconscious biases affect clinical decision making may help to illuminate clinicians' roles in propagating disparities. To determine whether clinicians' unconscious race and/or social class biases correlate with patient management d...

Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. In a prospective study conducted among surgical RNs at the Johns Hop...

Pediatric nursing is an area that has shown to be associated with higher levels of fear, anxiety and perceived challenge than other clinical settings for the pre-licensure nursing student. A simulation curriculum has been developed to address the complexities that students face in the pediatric clinical setting. This curriculum addresses common ped...

This article describes the costs that nursing education leaders should consider when planning to integrate clinical simulation into prelicensure nursing curricula. This descriptive analysis demonstrates the cost calculation for simulation experiences, debriefing sessions, and evaluations of student performance. Calculations are based on resources n...

Background: Recent studies have found that unconscious biases may influence physicians' clinical decision making. The objective of our study was to determine, using clinical vignettes, if unconscious race and class biases exist specifically among trauma/acute care surgeons and, if so, whether those biases impact surgeons' clinical decision making....

Objective: Diagnosing ventilator-associated pneumonia (VAP) is difficult, and misdiagnosis can lead to unnecessary and prolonged antibiotic treatment. We sought to quantify and characterize unjustified antimicrobial use for VAP and identify risk factors for continuation of antibiotics in patients without VAP after 3 days. Methods: Patients suspe...

Background: Misdiagnosis of ventilator-associated pneumonia (VAP) can lead to inappropriate antibiotic use, which can occur as the result of unnecessary as well as prolonged therapy. We sought to quantify and characterize appropriate and inappropriate antimicrobial use for VAP and identify risk factors for inappropriate use. Methods: Ventilated pa...

To develop a guideline to help guide healthcare professionals participate effectively in the design, construction, and occupancy of a new or renovated intensive care unit. A group of multidisciplinary professionals, designers, and architects with expertise in critical care, under the direction of the American College of Critical Care Medicine, met...

High-quality care for intensive care unit patients and families includes palliative care. To promote performance improvement, the Agency for Healthcare Research and Quality's National Quality Measures Clearinghouse identified nine evidence-based processes of intensive care unit palliative care (Care and Communication Bundle) that are measured throu...

Studies involving physicians suggest that unconscious bias may be related to clinical decision making and may predict poor patient-physician interaction. The presence of unconscious race and social class bias and its association with clinical assessments or decision making among medical students is unknown. To estimate unconscious race and social c...

This paper introduces expressive writing as a new tool to build psychological resilience in nurses by helping them to reduce the negative impact of the primary sources of stress in their jobs. Delivering care to patients exposes nurses to intense stressors including staffing and workload problems, communication breakdowns, death, bereavement, and m...

To determine whether Candida glabrata colonization and invasive candidiasis (IC) increased among critically ill surgical patients 3 years after the introduction of fluconazole prophylaxis to a surgical intensive care unit (SICU). Fluconazole prophylaxis has been shown in randomized clinical trials to reduce the occurrence of candidiasis in some pat...

Candida species are an increasingly common cause of nosocomial infections. Candida infections have been associated with significant attributable morbidity and mortality, especially among critically ill patients. However, little is known about the cost implications of these increasingly common infections. In order to evaluate the costs associated wi...

To determine the effects of hypertonic saline (HS) as fluid resuscitation during or after major spinal surgery. We hypothesized that the administration of HS perioperatively would decrease morbidity and mortality rates. A two-year retrospective, pair-matched, case-control study of adult patients (57 pairs matched 1:1) admitted to the intensive care...

Barrier precautions (gowns and gloves) prevent horizontal transmission of pathogens. Nosocomial infections have been linked to poor hand hygiene. Isolation rooms for infection control improve hand hygiene and decrease nosocomial infections. We hypothesized that both patient isolation and electronic hand hygiene prompts incrementally improve hand hy...

The Clinical Pulmonary Infection Score (CPIS) has been used in the intensive care unit (ICU) as a decision tool for initiation of antibiotics in suspected pneumonia and also for discontinuing antibiotics if the CPIS score is <or=6 on day three of therapy, but it is not in common clinical use. We sought to determine if application of a CPIS score<or...

We evaluated whether the likelihood of developing invasive candidiasis (IC) differed depending upon the anatomic site of Candida colonization in 182 surgical intensive care unit (SICU) patients who participated in a randomized trial of fluconazole to prevent candidiasis. We also determined the impact of Candida colonization of different anatomic si...

Background: Fluconazole (FLU) prophylaxis administered to high-risk patients in the intensive care unit (ICU) reduces the occurrence of invasive candidiasis. FLU is routinely administered to Johns Hopkins Surgical ICU (SICU) patients with an expected length of stay (LOS) of > 3 days. It is not routinely administered to Medical ICU (MICU) patients....

Fluconazole is widely used in the intensive care unit for prevention and treatment of fungal infections. Case reports have described an association between fluconazole and adrenal dysfunction, an important cause of morbidity and mortality in critically ill patients. We sought to determine whether 400 mg of fluconazole per day administered to critic...

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To determine whether electronic monitoring of hand hygiene and voice prompts can improve hand hygiene and decrease nosocomial infection rates in a surgical intermediate care unit. Three-phase quasi-experimental design. Phase I was electronic monitoring and direct observation; phase II was electronic monitoring and computerized voice prompts for fai...

Candidemia is fourfold more common in 1990 compared to 1980. In addition, a shift to non-albicans species has occurred in some institutions. Antifungal prophylaxis (AP) is effective in high-risk patients including critically ill surgical patients, but its use has been attributed to a resultant shift to non-albicans candida species. We hypothesized...

Infected central venous catheters cause morbidity and mortality. To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes. Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Si...

• Background Infected central venous catheters cause morbidity and mortality. • Objective To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes. • Methods Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensi...

To determine the population pharmacokinetic parameters of enterally administered fluconazole in patients in a surgical intensive care unit (SICU). Population pharmacokinetics component of a prospective, randomized clinical study. The SICU at a university hospital. One hundred ten patients with an expected length of stay in the SICU of 3 or more day...

Long-term effects on patients' families after a prolonged stay in a surgical intensive care unit are unclear. We hypothesized that illnesses requiring more than 7 days' stay in the surgical intensive care unit would have significant, long-lasting effects on patients' families that would be related to patients' functional outcome. All patients who s...

To determine the economic and clinical outcomes associated with infection with vancomycin-resistant Enterococcus (VRE) and to compare these outcomes to those associated with infection with vancomycin-sensitive Enterococcus (VSE). During a 3-month, prospective, cohort study of 117 high-risk, critically ill patients we collected complete clinical and...

Enteral fluconazole, a triazole antifungal agent with an excellent oral bioavailability, has not been widely studied in critically ill surgical patients. During a randomized placebo-controlled trial of enteral fluconazole (N = 130) versus placebo (N = 130) for the prevention of fungal infections in critically ill surgical patients, trough fluconazo...

Nurse-to-patient ratios in the intensive care unit are associated with postoperative mortality, morbidity, and costs after some high-risk surgery. To determine if having 1 nurse caring for 1 or 2 patients ("more nurses") versus 1 nurse caring for 3 or more patients ("fewer nurses") in the intensive care unit at night is associated with differences...

Nosocomial infections can be transmitted from microorganisms on the hands of health care workers to patients. Handwashing (HW) has a proven benefit in preventing transmission of infection, yet compliance with handwashing, especially in intensive care units, ranges between 28% and 74%. To determine if HW behavior varies as a function of health care...

To evaluate the prophylactic use of enteral fluconazole to prevent invasive candidal infections in critically ill surgical patients. Invasive fungal infections are increasingly common in the critically ill, especially in surgical patients. Although fungal prophylaxis has been proven effective in certain high-risk patients such as bone marrow transp...

To determine the optimal site and frequency for vancomycin-resistant enterococci (VRE) surveillance to minimize the number of days of VRE colonization before identification and subsequent isolation. The increasing prevalence of VRE and the limited therapeutic options for its treatment demand early identification of colonization to prevent transmiss...

Catheter-related bloodstream infection (CRBSI) in critically ill surgical patients with prolonged intensive care unit (ICU) stays is associated with a significant increase in health care resource use. Prospective cohort study. Surgical ICU at a large tertiary care center. Critically ill surgical patients (N = 260) with projected surgical ICU length...

Heavy fungal colonization is a known risk factor for fungal infection, yet the value of fungal surveillance cultures is uncertain. To evaluate the utility of fungal surveillance cultures in predicting fungal infections, we evaluated surveillance fungal cultures over a three month period in a prospective, cohort study conducted at a university medic...

Quality of life after surgical critical illness is an important measure of outcome. The Sickness Impact Profile Score (SIP) has been validated in critically ill patients, but the Modified Short-Form (MSF) has not been directly compared with it. The SIP and MSF-36 were coadministered to 127 patients (surrogates) with a prolonged surgical critical il...

Candida species are an increasingly common cause of nosocomial infections. Candida infections have been associated with significant attributable morbidity and mortality, especially among critically ill patients. However, little is known about the cost implications of these increasingly common infections. In order to evaluate the costs associated wi...

To examine the functional outcome and costs of a prolonged illness requiring a stay in the surgical intensive care unit (SICU) of 7 of more days. The long-term benefits and costs after a prolonged SICU stay have not been well studied. All patients with an SICU length of stay of 7 or more days from July 1, 1996, to June 30, 1997, were enrolled. One...

To determine the risk factors and clinical impact of central line infections in critically ill surgical patients. Retrospective study. The surgical intensive care unit of a large tertiary care university hospital. A total of 232 consecutive central line catheters sent for culture from patients in a surgical intensive care unit during 1996 and 1997....

Sepsis is associated with an increased volume of distribution for aminoglycoside antibiotics. As a result of this increased volume of distribution, 2 mg/kg loading doses have previously been shown to be ineffective in producing adequate aminoglycoside peak plasma levels in critically ill patients. The main objective of this pharmacokinetic observat...

Background: Sepsis is associated with an increased volume of distribution for aminoglycoside antibiotics. As a result of this increased volume of distribution, 2 mg/kg loading doses have previously been shown to be ineffective in producing adequate aminoglycoside peak plasma levels in critically ill patients. The main objective of this pharmacokine...

Introduction Transport of critically ill patients for rfingtv or therapy nrr.MMiMr continued physiologie management. Changes in hemodynamics and ventilatory mechanics commonly affect this patient population. We previously investigated the self-contained bed and transport device developed by Hill-Rom, the CarePorter, and documented a decrease in res...

Introduction: A prolonged illness requiring SICU care is associated with both high mortality sod cost The quality of life after a prolonged (>6 days) SICU stay has not been well studied Moreover, when patients are critically ill, often a surrogate is asked to make decisions with respect lo continuation of care We investigated the correlation betwee...

Background: Transport of critically ill patients for diagnostic and/or therapeutic management involves significant consumption of resources. In an effort to improve the delivery of care to these patients and decrease resource utilization, Hill-Rom (Batesville, IN, USA) have developed a self-contained device (CarePorterTM) designed to provide both i...

We performed a 3 month prospective study of patients requiring >72 hour ICU admission to determine strategies for identification of VRE colonization or infection. Demographic data was collected and surveillance samples from the oropharynx and rectum, tracheal and gastric aspirates and urine specimens were cultured for the presence of VRE on admissi...

To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations. A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss. Tertiary care, inner-city university hospital. Eleven adult patients who underwent an elective surgical procedure...

Objective: To determine the effect of intraoperative blood loss on prophylactic cefazolin and gentamicin serum and tissue concentrations.Design: A prospective study of elective spinal instrumentation surgical procedures with an expected large blood loss.Setting: Tertiary care, inner-city university hospital.Patients: Eleven adult patients who u...