A Comfort Measures Only Checklist for Critical Care Providers

2021 ◽  
Vol 35 (6) ◽  
pp. 303-313
Author(s):  
Emily Matone ◽  
Denise Verosky ◽  
Matthew Siedsma ◽  
Erica N. O'Kane ◽  
Dianxu Ren ◽  
...  
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2020 ◽  
Vol 136 (1) ◽  
pp. 39-46
Author(s):  
Joanna G. Katzman ◽  
Laura E. Tomedi ◽  
Karla Thornton ◽  
Paige Menking ◽  
Michael Stanton ◽  
...  

Project ECHO (Extension for Community Healthcare Outcomes) at the University of New Mexico is a telementoring program that uses videoconferencing technology to connect health care providers in underserved communities with subject matter experts. In March 2020, Project ECHO created 10 coronavirus disease 2019 (COVID-19) telementoring programs to meet the public health needs of clinicians and teachers living in underserved rural and urban regions of New Mexico. The newly created COVID-19 programs include 7 weekly sessions (Community Health Worker [in English and Spanish], Critical Care, Education, First-Responder Resiliency, Infectious Disease Office Hours, and Multi-specialty) and 3 one-day special sessions. We calculated the total number of attendees, along with the range and standard deviation, per session by program. Certain programs (Critical Care, Infectious Disease Office Hours, Multi-specialty) recorded the profession of attendees when available. The Project ECHO research team collected COVID-19 infection data by county from March 11 through May 31, 2020. During that same period, 9765 health care and general education professionals participated in the COVID-19 programs, and participants from 31 of 35 (89%) counties in New Mexico attended the sessions. Our initial evaluation of these programs demonstrates that an interprofessional clinician group and teachers used the Project ECHO network to build a community of practice and social network while meeting their educational and professional needs. Because of Project ECHO’s large reach, the results of the New Mexico COVID-19 response suggest that the rapid use of ECHO telementoring could be used for other urgent national public health problems.


Author(s):  
Sarah McLachlan ◽  
Hilary Bungay

Abstract Background Consensus methods such as the Delphi technique have been used widely for research priority setting in health care. Within pre-hospital emergency medicine, such approaches have helped to establish national and international research priorities. However, in a dynamic field such as pre-hospital critical care, it is necessary to regularly review the continued relevance of findings. Further, considering the variability between pre-hospital critical care providers, it is also important to determine priorities at the local level. Essex & Herts Air Ambulance (EHAAT) sought to develop a five-year research strategy that aligns with their clinical work streams and organisational priorities. Methods All staff and Trustees were invited to participate in an online Delphi study with three Rounds. The Delphi was administered via email and Online Surveys software. The first Round invited participants to submit up to five research questions that they felt were of greatest importance to EHAAT  to advance the care provided to patients. In Round 2, participants were asked to rate the importance of questions from Round 1, while Round 3 required participants to rank questions that were prioritised in Round 2 in order of importance. Results 22 participants submitted a total of 86 research questions in Round 1, which were reduced to 69 questions following deduplication and refinement. 11 participants rated the importance of the questions in Round 2, resulting in 14 questions being taken forward to Round 3. Following the ranking exercise in Round 3, completed by 12 participants, a top five research priorities were identified. The question deemed most important was “How does a pre-hospital doctor-paramedic team affect the outcome of patients with severe head injuries?”. Conclusions The top five research priorities identified through the Delphi process will inform EHAAT’s research strategy. Findings suggest that there is still work to be done in addressing research priorities described in previous literature.


Author(s):  
Ramiro E. Gilardino

During this coronavirus disease 2019 (COVID-19) global pandemic, nations are taking bold measures to mitigate the spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in order to avoid the overwhelming its critical care facilities. While these "flattening the curve" initiatives are showing signs of impeding the potential surge in COVID-19 cases, it is not known whether these measures alleviate the burden placed on intensive care units. Much has been made of the desperate need for critical care beds and medical supplies, especially personal protective equipment (PPE). But while these initiatives may provide health systems time to bolster their critical care infrastructure, they do little to protect the most essential element – the critical care providers. This article examines bolder initiatives that may be needed to both protect crucial health systems and the essential yet vulnerable providers during this global pandemic.


2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.


2020 ◽  
Vol 29 (1) ◽  
pp. e13-e18
Author(s):  
Karin Reuter-Rice ◽  
Elise Christoferson

Background Severe traumatic brain injury (TBI) is associated with high rates of death and disability. As a result, the revised guidelines for the management of pediatric severe TBI address some of the previous gaps in pediatric TBI evidence and management strategies targeted to promote overall health outcomes. Objectives To provide highlights of the most important updates featured in the third edition of the guidelines for the management of pediatric severe TBI. These highlights can help critical care providers apply the most current and appropriate therapies for children with severe TBI. Methods and Results After a brief overview of the process behind identifying the evidence to support the third edition guidelines, both relevant and new recommendations from the guidelines are outlined to provide critical care providers with the most current management approaches needed for children with severe TBI. Recommendations for neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, ventilation therapies, temperature control/hypothermia, nutrition, and corticosteroids are provided. In addition, the complete guideline document and its accompanying algorithm for recommended therapies are available electronically and are referenced within this article. Conclusions The evidence base for treating pediatric TBI is increasing and provides the basis for high-quality care. This article provides critical care providers with a quick reference to the current evidence when caring for a child with a severe TBI. In addition, it provides direct access links to the comprehensive guideline document and algorithms developed to support critical care providers.


1995 ◽  
Vol 4 (1) ◽  
pp. 77-81 ◽  
Author(s):  
C Clark ◽  
T Heidenreich

BACKGROUND: Spiritual well-being is the center of a healthy lifestyle and enables holistic integration of one's inner resources. However, the professional education process does not adequately provide socialization of nurses in the provision of spiritual care. Few studies exist that adequately address the spiritual aspect of nursing care. PURPOSE: To identify factors that contribute to providing spiritual care for patients in intensive care units. METHODS: A descriptive research design was used for this replication study conducted on a convenience sample of 63 patients in the critical care unit of a large midwestern military hospital. A trained interviewer asked each participant three open-ended questions regarding events that had created hope or meaning, created negative feeling, and could have contributed to hope or meaning. The interview took place 1 to 2 days after discharge from the intensive care unit. Predominant patterns were determined by content analysis. RESULTS: Three themes were identified as integral to the spiritual well-being of critical care patients: care providers, family/friends, and religion/faith. Nursing interventions identified for the three themes include establishing trusting relationships, providing in-depth spiritual assessment, conveying technical competence, and acting as facilitator among family, clergy, and other providers. CONCLUSIONS: We conclude that the key nursing interventions derived from this study include listening to patients' concerns and maintaining and conveying technical competence.


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