Critical Care Nursing - Science topic

See this too;

or this:

In Iran, the most important challenges include: Economic Sanctions, Uneven Distribution of healthcare infrastructure between urban and rural areas, and Workforce Shortage Poverty.

The warning of Robert John Wolff to be careful with this publisher should be taken seriously. There are numerous red flags:

-The publisher “i-manager publications” (http://www.imanagerpublications.com ) is mentioned in the updated version of the Beall’s list https://beallslist.net/#update

-The (outdated) info about being UGC approved (https://imanagerpublications.com/uploads/Catalogue%20for%20India.pdf ) is misleading since numerous titles were at the time removed, see https://lakshmibaicollege.in/Secure-admin/webroot/upload/customfiles/14022020122704Journals-Removed-from-UGC-Approved-List-of-Journals_removed%20(1).pdf

-FYI the replacement of the UGC approved journal list is the UGC CARE list, none of the titles of this publisher is listed (see https://ugccare.unipune.ac.in/apps1/home/index )

-The fact that the company clip https://www.linkedin.com/posts/renisha-winston-a1b51722_nopublishingfee-peerreview-collaboration-activity-7138433725960253440-xcFv?trk=public_profile makes use of https://www.shutterstock.com/video/clip-1024237781-side-view-young-arabic-man-dark-curly to suggest a highly professional image while the people depicted are unrelated to the company is misleading

-I searched for i-manager's Journal on Nursing in Google Scholar and the majority of the papers I found (and was able to read because they were uploaded in for example ResearchGate) were published in a suspiciously short period of time.

It is however not only disturbing:

-The papers are indexed in ProQuest (and the first page can be read to get a brief idea about the paper)

-The Dimensions link seems to work give the whole operation some degree of professionalism

-At least some (if not all) of their papers are indexed in Google Scholar

-If you search for i-manager then numerous of their titles are indexed here on RG (and the doi assigned to the papers I checked seem to work properly)

So, I would say it is somewhat ambiguous but as indicated by I think that looking at their website http://www.imanagerpublications.com and the inability to access the content of the various issues of a particular journal is lacking transparency and personally would make me wonder how anyone would find my paper once published in one of their titles. I personally would go for a subscription-based journal of a publisher with a better exposure (and reputation).

They are here on RG. You can message them from here.

A measure of critical care nurses' post-code stress

Monitor GCS

If ICP < 20.

Brain oxygen > 20

GCS is proportional to cerebral oxygen ation

The NAS is being referred to in terms of workload in the ICU. Please read the article below

DOI: 10.1016/j.iccn.2018.06.005.

Dear Dr. Fortunatti,

Revered Professor Paul M.W.Hackett,

I am happy to have known that you are writing a Book on Ethnography. I am teaching Ethnography Field Research for Rural Development more than a decade in the Department of Rural Development and Agricultural Extension, College of Agriculture, Wolaita Sodo University, Ethiopia, East Africa. I will be grateful to you Prof if I will have an opportunity to help you. I would like to know information from you Prof. I went along with my M.Sc. students to have Ethnography Field Survey on Australia funded Carbon Project near to my WSU university.

Regards

M.Senapathy

Hi, since you are preparing for Critical Care masters thesis, I am going to assume you mean in the ICU, in the AKI (acute kidney injury) setting. Indications for acute dialysis: All indications are relative, and that have already failed medical management (ex: reasonable dose diuretics, base supplements, etc) or medical management is contraindicated (ex: kayexelate not option for high potassium, anuric so diuretics not useful, etc) There is no absolute Blood urea nitrogen , creatinine, or cystatin C level that is a true indication for dialysis (although there will be debate about starting when BUN rises above 100 mg/dl as uremic effects may be seen more likely, see below)

Volume overload

Metabolic acidosis (lactate generated faster THANan it can be removed in some forms of lactic acidosis)

Electrolyte derangements(most often Hyperkalemia, but could be hypercalcemia, hyperuricemia in tumor lysis to prevent AKI or with AKI, other)

Hyperammonemia (inborn error of metabolism while awaiting

Intoxication by dialyzable drug or agent (most often NOT highly protein bound, other factors also affect, but databases for ability to remove drugs and toxins by different forms of dialysis available; methanol ingestion, lithium, antifreez)

Uremia: degree of AKI that interferes with physiologic functions (ex: BUN high enough that pt develops pericardial effusion, platelet function decreased, mental status changes, are examples.)

In pediatrics, dialysis/ some for of renal replacement therapy is indicated in AKI in order to provide nutritional support that would be impossible due to necessary fluid restriction imposed to avoid volume overload. We tend to want to start renal replacement therapy earlier rather than later to AVOID complications. Great papers on mortality associated with volume overload in pediatric patients by Stuart Goldstein et al, as an example in AKI setting

CKD many of the same issues cause start of dialysis therapy (chronic) , in addition to failure to thrive, fatigue , other "uremic symptoms" before the classic indication of creatinine clearance less than 10 ml/min/1.73m2 (some target 15 ml/min/1.73m2) as absolute indication. This is pediatrics, US-style units, but many indications are universal for adults and children/infants

I'm sure other responders will add to this list! Hope this is helpful to you

I would start by identifying what you are most interested in or has challenged your thinking or values.

Dear Fortunatti

Fernandes etal. 2010 mentioned that, In an ICU, nurses note daily whether critical patients will require prolonged assistance regarding the performance of routine procedures both upon admission and during their stay because organ instability can occur at any time over the course of the patients' stays in these units.

Panunto 2012 stated that Nursing workload consists of the time spent by nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. These activities can change depending on the patient's degree of dependency, the complexity of the disease, the characteristics of the institution, work processes, the physical layout and the nature of the professional team.

Try some of these links - I'm sure there is something here that you will find useful and assist you in your quest..

The limitations of the TISS-28 is it is based on how we provided critical care 20 years ago. A great deal of nursing care has changed since then that are not captured in the TISS-28. For example we keep patients more awake, promote more mobilization than before yet these items are not captured in the TISS-28.  I would argue, because it misses important advances in critical care, it has a tendency to underscore workload. 

Saying that, this tool does have a lot of validity and reliability evidence in ICUs around the world. 

 thank you all.

How much PEEP , what is the resp rate  , what is the I:E ratio ?

Excluding a mechanical cause ( ie equipment failure ) the mechanisms of refractory hypoxemia and moderate hypercapnia are either decreased alveolar ventilation  because of dead space and or v/q mismatch, or through increased shunt .

Researcher can prepare a  questionnaire on care of the premature neonatal infants by following recommended books and it can be used as a self administering questionnaire .for research. prepared questionnaire  can be validated by experts in the field before implementing or collecting data- Its my point of view

Hello Sharon

I hop this can help 

Regards, 

Mu'taman

NDNQI

in our center we have the following schedule:

2 Morning (06:00 AM - 14:00)

2 Evening (14:00 - 22:00)

2 Nights (22:00 - 06:00 AM)

this is very convenient and correlated with higher satisfaction and less sickness rates

The protocol of rehabilitation is divided in three stage acute, subacute and chronic,

It is expalening in my research you can see that in journal were it is publich

After educating the nurses you can led them to practice with the patients under your supervision if they become good you can assess the effect of your educational intervention on the patients outcomes thanks

I also think that retrospective analysis is the only option. Is it accurate to limit failure to rescue to cardiac arrest? Perhaps one of the early warning system frameworks (EWS; http://www.ihi.org/resources/Pages/ImprovementStories/EarlyWarningSystemsScorecardsThatSaveLives.aspx) could be used to expand the conceptualization of "failure to rescue" . It seems that failure to respond, or a delay in response, at any point when the evidence (i.e., vital signs, O2 sat) suggests an intervention could be on a continuum of failure to rescue.  

Training and continuous education contribute effectively.. I hope this paper could help 

Nurse Level of Education, Quality of Care and Patient Safety in the Medical and Surgical Wards in Malaysian Private Hospitals: A Cross-sectional Study

Warm regards, 

Mu'taman Jarrar

HI Rosario, as Edwin points out, self-efficacy is task specific, which people often confuse and why the general self-efficacy scale is questionable. I am not sure what specific task you are looking for in nursing, but I have developed an Evidence-Based Practice Self-Efficacy Scale, that measures one's confidence in how to approach and and implement EBP. We have published preliminary validity and reliability of the scale and have further supporting data not yet published. If interested, let me know and I will gladly get you a copy at no cost. We have a request form online at the University of Iowa Hospitals & Clinics, Hundreds of providers across the country and in several other countries have requested to use the scale. 

In the following article "super nurse" is not used, but the research supports best coping strategies for Critical Care and Emergency Department nurses.

Adriaenssens, Jef, Veronique De Gucht, and Stan Maes. "The Impact of Traumatic Events on Emergency Room Nurses: Findings from a Questionnaire Survey." International Journal of Nursing Studies 49 (2012): 1411-422.

We use IPC in all our patients who undergo pneumonectomy for five days postoperatively, combined with enoxoparin for six weeks. The rationale is to prevent (mostly fatal) embolic events in the unique remaining lung. This procedure is now in place for six years and we had no such events in this timeframe. (it is of course an event that is rare, but before we used ICP, major embolic events were seen in about 1% of pneumonectomy patients; we do 40+ pneumonectomies a year, so calculating the odds it seems an improvement).

For the use: the first three days the IPC is running 24/24, when the patient is fully mobilized the IPC is only used during the night. Most patients complain, not of discomfort wearing them, but from the noise the pumps make.

This is of course a totally different population from stroke patients, but we feel it works

Hi Julie - yes, I see the same in the ED setting, there is a considerable body of literature in relation to aspects of ED and hospital overcrowding, and I think for most specialty areas, where the back flow from high levels of hospital occupancy has resulted in failure of patient flow. It becomes a hospital wide problem (and essential a social problem as well) as wards cannot accommodate the patients from ICU due to their lack of space, which is linked to inability to discharge patients often associated with inadequate or insufficient community support systems. One of the challenges is to address the 'silo' effect that often occurs in health care, where individual areas focus on their own concerns without looking at the 'bigger picture'. It can be difficult to get buy in to processes aiming to improve patient flow, with out recognition that it needs to be a hospital wide approach.

Unfortunately, responses often do not occur until sentinel events raise the profile of the issue, and as you identify this is often in the form of increased mortality. Certainly in relation to ED practice, one of the factors that has led to greater priority in relation to overcrowding has been the development of research that has clearly linked patient outcomes (increased length of stay and mortality in particular) to this phenomenon. It has been shown that failure to be able to move patients on to the more appropriate areas is linked with measurable negative outcomes. I think that the need for such research is one way to highlight the issue and its severity. There also need to be moves ant a socio-political level, with increased public awareness of the issues and the potential outcomes, and a willingness to re-look at the traditional processes and priorities within the health care system. As you so rightly note, with the increasingly aged population, chronic disease and co-morbidities associated this issue will only expand.

I feel it depends the culure of the ICU. If the medical staff do not respond to the alarm and let it go off for long then a lot of noise will be produced. Some alarms are just so loud, such as high frequency ventilator, and unbearable. If all medical staff respond to alarm appropriately then we do not need a very loud alarm system and will improve the quality of patient care.

Euthanasia is illegal in the US but Assisted suicide or Physician aid in dying (PAD), is legal in the states of Washington, Oregon, Montana, and Vermont. While machinery and intubations can prolong life, they also can be legally removed to ensure death with dignity. Even feeding tubes can be removed legally. Often issues occur when the patient does not have a living will or advanced directives and the family members do not agree on what should be done. It is often difficult to see a loved one in the persistent unresponsive state. It is also difficult to make the decision that this loved one should be taken off machinery or tube feedings, thus causing their death. The Terri Schiavo case is an example of the difficulties families face.