scholarly journals Organizing Safe Transitions from Intensive Care

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Marie Häggström ◽  
Britt Bäckström
Keyword(s):  
Intensive Care ◽  
Transitional Care ◽  
Qualitative Content Analysis ◽  
Early Mobilization ◽  
Care Process ◽  
Optimal Timing ◽  
Healthcare Team ◽  
Main Category ◽  
Team Members ◽  
General Wards

Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other staff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients’ transfers from high technological intensive care units (ICU) to general wards.Aim. To describe, as experienced by intensive care and general ward staff, what strategies could be used when organizing patient’s care before, during, and after transfer from intensive care.Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using qualitative content analysis.Results. The results showed that the categoriessecure,encourage,andcollaborateare strategies used in the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated how all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction was described: between staff and patient/families, between team members and involved units, and between patient/family and environment.Discussion/Conclusions. The findings highlight that ICU transitional care implies critical care rehabilitation. Discharge procedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, early mobilization, and a multidiscipline approach.

scholarly journals Improving Team Collaboration in Patient Transfer Processes by Co-Workers’ Perceptions and Suggestions

2021 ◽  
Vol 25 (2) ◽  
pp. 1-18
Author(s):  
Lilly-Mari Sten ◽  
Pernilla Ingelsson ◽  
Ingela Bäckström ◽  
Marie Häggström
Keyword(s):  
Quality Of Care ◽  
Transitional Care ◽  
Care Process ◽  
Team Collaboration ◽  
Holistic View ◽  
Team Members ◽  
Patient Transfers ◽  
Hospital Units ◽  
General Wards

Purpose: The purpose was twofold: first to describe how co-workers within a team perceived team collaboration in patient transfers from an intensive care unit (ICU) to general wards and, second, to describe co-workers’ suggestions for an improved future state of team collaboration. Methodology/Approach: Focus group discussions (FGDs) were conducted at two medium-sized hospitals located in Sweden. Participants were multidisciplinary and from both ICUs and general wards. Data were analysed using qualitative deductive content analysis. Findings: An expressed need for improving team collaboration was a defined and well-designed ICU transitional care process with a holistic view of how to create quality of care, and a standardised process for continuous improvements. This should involve co-workers from different professions and hospital units, as well as patients and relatives. Other views raised by the co-workers were clearer definitions of roles, responsibilities and deeper insights on how team members depend on each other’s work efforts to succeed. Research Limitation/Implication: This study was conducted at two hospitals, hence no generalizable conclusions can be made. Originality/Value of paper: Co-workers collaborating in a ICU transitional care process can have important insights in how to improve team collaboration. This can be of great importance in increasing quality of care where multiprofessional teams from different organisational cultures are collaborating.

scholarly journals The Process and Impact of Stakeholder Engagement in Developing a Pediatric Intensive Care Unit Communication and Decision-Making Intervention

2016 ◽  
Vol 3 (4) ◽  
pp. 108-118 ◽  
Author(s):  
Kelly N Michelson ◽  
Joel Frader ◽  
Lauren Sorce ◽  
Marla L Clayman ◽  
Stephen D Persell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Stakeholder Engagement ◽  
Pediatric Intensive Care ◽  
Healthcare Team ◽  
Team Members ◽  
Core Elements ◽  
Stakeholder Input

Stakeholder-developed interventions are needed to support pediatric intensive care unit (PICU) communication and decision-making. Few publications delineate methods and outcomes of stakeholder engagement in research. We describe the process and impact of stakeholder engagement on developing a PICU communication and decision-making support intervention. We also describe the resultant intervention. Stakeholders included parents of PICU patients, healthcare team members (HTMs), and research experts. Through a year-long iterative process, we involved 96 stakeholders in 25 meetings and 26 focus groups or interviews. Stakeholders adapted an adult navigator model by identifying core intervention elements and then determining how to operationalize those core elements in pediatrics. The stakeholder input led to PICU-specific refinements, such as supporting transitions after PICU discharge and including ancillary tools. The resultant intervention includes navigator involvement with parents and HTMs and navigator-guided use of ancillary tools. Subsequent research will test the feasibility and efficacy of our intervention.

scholarly journals Educational needs for practicing neonatal intensive care among Korean nursing students

2021 ◽  
Vol 27 (4) ◽  
pp. 339-353
Author(s):  
Hyun Young Koo ◽  
Bo Ryeong Lee
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Nursing Students ◽  
Medical Equipment ◽  
Neonatal Intensive Care ◽  
Qualitative Content Analysis ◽  
Educational Needs ◽  
Faculty Members ◽  
Care Practice ◽  
Team Members

Purpose: This study was conducted to investigate the educational needs for practicing neonatal intensive care among Korean nursing students.Methods: An explorative, sequential, mixed-methods design was used. Qualitative content analysis was conducted of in-depth interviews of six nursing students, five clinical practice faculty members, and five nurses in the neonatal intensive care unit. The results of a survey of 174 nursing students were analyzed quantitatively.Results: Nursing students, clinical practice faculty members, and nurses wanted opportunities for direct nursing practice and education in school during neonatal intensive care practice. In terms of specific educational content, nursing students expressed the highest observation-related educational needs for communication with medical team members, and they expressed the highest practice-related educational needs for operating medical equipment used for neonatal intensive care. The nursing students' needs with regard to the method of practice education were highest for orientation from the head nurses.Conclusion: Communication and operating medical equipment were found to be areas with high educational needs for practicing neonatal intensive care among Korean nursing students. Further research is needed to develop an educational framework and setting for practicing neonatal intensive care that would meet their needs.

scholarly journals A Qualitative Description of Millennial Nurse Administrators’ Perspectives on Leadership and Their Practice Environment

2019 ◽  
Vol 3 (2) ◽  
pp. 153 ◽  
Author(s):  
John Ian Lamasan ◽  
Ryan Michael F Oducado
Keyword(s):  
Qualitative Content Analysis ◽  
Quality Care ◽  
Qualitative Description ◽  
Healthcare Team ◽  
Practice Environment ◽  
Professional Relationship ◽  
Structured Interviews ◽  
Nurse Administrators ◽  
Team Members ◽  
Tertiary Hospitals

Introduction: Millennial nurses are beginning to accept leadership roles and will soon take over governance in the nursing profession and healthcare industry. This study aimed to describe the perspectives on leadership and their practice environment of millennial nurse administrators working in tertiary hospitals in Iloilo City, Philippines. Methods: Eight (8) millennial nurse administrators were purposively chosen. Through a qualitative descriptive inquiry by Sandelowski (2000), data were gathered using semi-structured interviews and analyzed employing qualitative content analysis. Results: Twelve (12) meaningful categories were derived directly from the interview transcripts. Millennial nurse administrators perceive leadership by way of (1) directing, (2) guiding, (3) empowering and (4) modeling to staff. They viewed their practice environment as (5) having a harmonious relationship while (6) maintaining professional relationship among the healthcare team members, (7) upholding standards and (8) ensuring client satisfaction as a measure of quality care. Millennial nurse administrators shared feelings of being (9) overwhelmed at the start yet (10) fulfilling in the end. Lastly, they had challenges in (11) dealing with older staff and in (12) assuming the full responsibility and accountability of their unit. Conclusions: Considering the complexities in the healthcare profession, millennial nurse administrators cope with the responsibilities brought by their position as major key players to ensure that unit operations abide with practice standards. Millennial nurse administrators must be provided with understanding, support, and mentoring, to enhance their leadership competencies as they progress into higher leadership positions.

Exercise as early mobilization in patients using vasoactive drugs

2020 ◽  
Vol 19 (4) ◽  
pp. 301
Author(s):  
Amanda Mariano Morais ◽  
Daiane Naiara Da Penha ◽  
Danila Gonçalves Costa ◽  
Vanessa Beatriz Aparecida Fontes Schweling ◽  
Jaqueline Aparecida Almeida Spadari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiovascular Response ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Scientific Basis ◽  
Routine Practice ◽  
Vasoactive Drugs ◽  
Early Ambulation ◽  
Early Mobility ◽  
The Face

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

Exercise in intensive care units, safety and hemodynamic monitoring

2020 ◽  
Vol 19 (1) ◽  
pp. 3
Author(s):  
Giulliano Gardenghi
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Hemodynamic Monitoring ◽  
Artificial Respiration ◽  
Exercise Physiology ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Cycle Ergometer ◽  
Search Terms

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

scholarly journals In-Hospital Mortality in Patients Receiving Percutaneous Coronary Intervention According to Nurse Staffing Level: An Analysis of National Administrative Health Data

2020 ◽  
Vol 17 (11) ◽  
pp. 3799
Author(s):  
Yunmi Kim ◽  
Jiyun Kim
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Nurse Staffing ◽  
Coronary Intervention ◽  
First Grade ◽  
Estimation Model ◽  
Staffing Level ◽  
Percutaneous Coronary ◽  
General Wards

The increasing incidence of ischemic heart disease is concomitantly increasing percutaneous coronary intervention (PCI) treatments. Adequate nurse staffing has enhanced quality of care and this study was conducted to determine the relationship between survival-related PCI treatment and the level of nursing staff who care for patients admitted to receive PCI. National Health Insurance claims data from 2014 to 2015 for 67,927 patients who underwent PCI in 43 tertiary hospitals were analyzed. The relationships of nurse staffing in intensive care units (ICUs) and general wards with survival after PCI were investigated using logistic regression analyses with a generalized estimation model. The in-hospital mortality rate in ICUs was lower in hospitals with first-grade nurse staffing {odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.23–0.48}, second-grade nurse staffing (OR = 0.55, 95% CI = 0.40–0.77), or third-grade nurse staffing (OR = 0.71, 95% CI = 0.53–0.95) than in hospitals with fifth-grade nurse staffing. Nurse staffing in general wards was not related to in-hospital mortality due to PCI treatment. This study found that nurse staffing in PCI patients requiring short-term intensive care significantly affected patient survival. An understanding of the importance of managing the ICU nursing workforce for PCI treatment is required.

Early mobilization in intensive care for patients with brain injury: e-Survey of current practices in France

2021 ◽  
Author(s):  
François Feuvrier ◽  
Claire Jourdan ◽  
Olivier Barber ◽  
Margrit Ascher ◽  
Karolina Griffiths ◽  
...  
Keyword(s):  
Intensive Care ◽  
Brain Injury ◽  
Early Mobilization ◽  
Current Practices

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

2021 ◽  
pp. 104990912198999
Author(s):  
Jung Kwak ◽  
Soyeon Cho ◽  
George Handzo ◽  
Brian P. Hughes ◽  
Sami S. Hasan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Self Report ◽  
Healthcare Team ◽  
Care Planning ◽  
Cross Sectional ◽  
Team Members ◽  
Roles And Responsibilities ◽  
Healthcare Settings ◽  
Academic Medical ◽  
Advance Care

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

633 Use of an ICU Rounding Tool Enhances Critical Care Learning for Trainees on a Burn Surgery Rotation

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
Lauren B Nosanov ◽  
Kaitlyn Libraro ◽  
Jamie Heffernan ◽  
Philip H Chang ◽  
Abraham Houng ◽  
...  
Keyword(s):  
Intensive Care ◽  
Ease Of Use ◽  
Convenience Sample ◽  
Team Members ◽  
Sepsis Risk ◽  
Burn Surgery ◽  
Ventilator Management ◽  
Patient Assessments ◽  
Continued Use ◽  
Additional Feedback

Abstract Introduction An institutional Burn Intensive Care Unit (ICU) Rounding Tool was implemented for both quality improvement data collection and trainee education. Forms are completed by trainee team members daily for all critically ill patients prior to teaching rounds. Gathered data are structured to facilitate evaluation of patient volume status, sepsis risk and ventilator management. The forms are then used to guide discussion among students, residents, mid-level providers, fellows, attending surgeons and other members of the multi-disciplinary rounding team. We conducted a series of interviews with trainees regarding their user experience to assess the tool’s educational utility. Methods A convenience sample of residents who had recently completed their Burn Surgery rotation were interviewed in a structured format. Questions focused on the form’s ease of use and comprehensibility. Emphasis was placed on the extent to which it stimulates learning while rounding. Additional feedback was sought for the purpose of improving the tool for continued use. Results Participants were post-graduate year one or two resident physicians training in General Surgery, Urology, Emergency Medicine or Anesthesia. Prior experience and comfort with ICU level care ranged from very little to moderate. All interviewees found the tool helpful in their patient assessments, though the current layout of the form was a frustration for many. Overall, they unanimously found the forms beneficial for preparation of patient presentations and felt that utilization during rounds facilitated learning. Conclusions Interviews with trainees on their burn surgery rotation demonstrate that implementation of an ICU Rounding Tool has provided educational benefit, particularly for those less experienced in intensive care. Feedback from this cohort will be used to improve the tool’s usability. Our next steps will include a more formal survey of all trainees involved since the inception of this project.

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