Caring for critically ill infants: strategies to promote physiological stability and improve developmental outcomes

1999 ◽  
Vol 19 (6) ◽  
pp. 64-79 ◽  
Author(s):  
LT Taquino ◽  
T Lockridge
Keyword(s):  
Supportive Care ◽  
Critically Ill ◽  
Care Setting ◽  
Well Being ◽  
Critical Care Nurses ◽  
Adverse Outcomes ◽  
Cognitive Growth ◽  
Staff Members ◽  
Improved Outcomes ◽  
Developmentally Supportive Care

Promoting organization and delivering developmentally supportive care leads to improved outcomes for infants and their families. Critical care nurses must function as catalysts to expand the thinking of caregivers from a dimension consisting primarily of physiology to one that embraces the emotional and cognitive growth and well-being of the patient, the patient's family, and staff members. For critically ill infants, developmentally supportive care that is relationship based and that promotes the balance of organized neurobehavioral and physiological function is an avenue to achieve that end. Beneficial or adverse outcomes of nursing care used during this critical period can persist long after an infant is discharged from the intensive care setting.

scholarly journals Web-Based Intervention to Teach Developmentally Supportive Care to Parents of Preterm Infants: Feasibility and Acceptability Study (Preprint)

2017 ◽  
Author(s):  
Thuy Mai Luu ◽  
Li Feng Xie ◽  
Perrine Peckre ◽  
Sylvana Cote ◽  
Thierry Karsenti ◽  
...  
Keyword(s):  
Child Development ◽  
Supportive Care ◽  
Preterm Infants ◽  
User Satisfaction ◽  
Well Being ◽  
Oral Feeding ◽  
Neurodevelopmental Outcomes ◽  
Web Based ◽  
Child Neurodevelopment ◽  
Developmentally Supportive Care

BACKGROUND Preterm birth affects 8% to 11% of the population and conveys a significant risk of developmental delays. Intervention programs that support child development have been shown to have a positive impact on early motor and cognitive development and on parental well-being. However, these programs are often difficult to implement in a real-life setting due to lack of resources. Hence, our multidisciplinary team developed Mieux Agir au Quotidien (MAQ) to teach developmentally supportive care to parents of preterm infants with the goal of improving child development and parental outcomes. Our intervention included 3 in-person workshops that occurred prior to hospital discharge and a Web-based platform with written and videotaped materials that addressed 5 main themes: (1) infant behavioral cues, (2) flexion positioning; (3) oral feeding support, (4) parent-infant interactions, and (5) anticipation of developmental milestones. OBJECTIVE This study aimed to test the feasibility and acceptability of the intervention by parents of preterm infants and assess clinical benefits on child neurodevelopment and parental outcomes during the first year of life. METHODS A total of 107 infants born at <30 weeks and admitted to Sainte-Justine Hospital neonatal intensive care unit and their parents were enrolled in a nonrandomized controlled before-and-after interventional study (intervention n=55, comparison n=52). Acceptability of the program was assessed with a user satisfaction questionnaire. When the infants were at 4 months’ corrected age, all parents completed questionnaires on infant temperament, parenting stress, sense of competence, and parenting satisfaction. At 12 months’ corrected age, neurodevelopmental testing was performed on infants using the Alberta Infant Motor Scale and the Bayley Scales of Infant and Toddler Development, Third Edition. Comparisons between the 2 groups were done using independent t tests, Wilcoxon rank-sum tests, and Fisher exact tests. RESULTS The majority of parents (43/45) were satisfied with the intervention program and all would recommend MAQ to others. MAQ met their need for evidence-based information that proved useful to support their child development. No difference in parental or child neurodevelopmental outcomes was detected in this pilot study for most outcomes except for higher median scores for parental coercive behaviors in the intervention group, although proportions scoring in the coercive range did not differ. CONCLUSIONS Acceptability of the program was high among parents thus supporting the relevance of such intervention. A larger study using a randomized controlled trial design is needed to better document impact on parent and children and investigate how Web-based technologies can efficiently complement individualized intervention to alleviate the burden on health care resources.

Evidence-Based Review of Clinical Trials in Neurocritical Care

2018 ◽  
Vol 29 (2) ◽  
pp. 195-203 ◽  
Author(s):  
Molly McNett ◽  
Cristina Moran ◽  
Halee Johnson
Keyword(s):  
Clinical Trials ◽  
Critically Ill ◽  
Care Setting ◽  
Neurocritical Care ◽  
Critical Care Nurses ◽  
Neurological Injury ◽  
Critically Ill Patient ◽  
Evidence Based ◽  
Advanced Practice ◽  
Evidence Based Care

Neurocritical care is a rapidly growing specialty of complex care for the critically ill patient with neurological injury. This rapid growth has led to an increase in the number of important clinical trials to guide clinical practice and evidence-based care of the critically ill patient with neurological injury. Specialty-trained critical care nurses and advanced practice providers are integral members of neurocritical care teams and must remain informed about pivotal trials shaping practice recommendations. This article presents a summary of recent trials that have affected current practice and influenced care recommendations in the neurocritical care setting.

Organizational Justice enhances Subjective Well-being

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Ms. Anjali Sahai ◽  
Prof. (Dr). Abha Singh
Keyword(s):  
Organizational Justice ◽  
Satisfaction With Life ◽  
Interactional Justice ◽  
Well Being ◽  
Adverse Outcomes ◽  
Satisfaction With Life Scale ◽  
Subjective Well Being ◽  
Negative Experience ◽  
Life Scale ◽  
The Relationship

Organizational Justice has the potential to create major impact on organizations and employees alike. These include greater commitment, trust, enhanced job performance, more citizenship behaviors and less number of conflicts. It has been reported that employees seem to have a universal concern for Justice that transcends the self and that many are subject to biases at various point of time in their work life. Sometimes these biases lead to adverse outcomes including decreased level of subjective well-being. Subjective well-being is a broad category that includes life satisfaction, positive affect, and low negative affect, such as anger, sadness and fear. Thus to study the relationship between Organizational justice and subjective well-being, a sample of 88 employees working in Private Universities of NCR region were examined. For this purpose, the Organizational Justice scales consisting of Measure of Procedural & Interactional Justice and Distributive Justice Index scale by Moorman, Blakely & Niehoff (1998) and Subjective Wellbeing Scales inclusive of the Satisfaction with Life Scale(SWLS),Scale of Positive and Negative Experience(SPANE) and Flourishing Scale (FS) by Ed Diener (2004)were used. Results indicate significant relationship between the three types of Organizational justice and subjective well-being of employees.

scholarly journals P131 Transferring critically ill Covid-19 patients in ITU - A multidisciplinary training exercise

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Alex Tebbett ◽  
Ian Purcell ◽  
Shereen Watton ◽  
Rathinavel Shanmugham ◽  
Alexandra Tebbett
Keyword(s):  
Human Factors ◽  
Critically Ill ◽  
Situational Awareness ◽  
Training Session ◽  
Real Life ◽  
Team Leadership ◽  
Simulation Method ◽  
Task Management ◽  
In Situ Simulation ◽  
Staff Members

Abstract Introduction During Covid-19 many staff members were redeployed to the Intensive Care Unit (ICU) with little opportunity to train in the new skills they would require. One such skill was the transfer of a critically ill, and contagious, patient from ICU; a risky and complicated procedure which requires planning, preparation, risk assessment, situational awareness and, ideally, experience. To assist our colleagues in this skill an existing ICU transfer course has been adapted to cover the Covid-19 situation, or any similar contagious pandemic, in patient transfer. Methods An in-situ simulation method was chosen as the most realistic method of immersing our participants into the environment of ICU and to highlight real-life complexities and issues they may face. A multidisciplinary training session was devised so that novice anaesthetists, ACCPs and nurses could learn together, reflective of the usual team. Human factors such as communication, team leadership, task management and situational awareness are the focus of the post-simulation debrief, and human factors sheets have been created to guide the participants in analysing these skills. Pre- and post-simulation confidence, knowledge and attitudes will be assessed using validated appraisal tools and questionnaires to gather both quantitative and qualitative data about the experience. Discussion Multidisciplinary training is often difficult to arrange, due to the different requirements, processes, and procedures each department demands. A hidden blessing of Covid-19 is the realisation that this barrier can be broken, for the benefit of our patients and colleagues alike, and training sessions like this implemented.

scholarly journals Approaches to Reducing Risk of COVID-19 Infections in Prisons and Immigration Detention Centers: A Commentary

2020 ◽  
pp. 073401682095770
Author(s):  
Kate Kelly ◽  
Nai Soto ◽  
Nadi Damond Wisseh ◽  
Shaina A. Clerget
Keyword(s):  
Public Health ◽  
Public Health Policy ◽  
Well Being ◽  
The United States ◽  
Correctional Staff ◽  
Staff Members ◽  
Detention Centers ◽  
Fast Spreading ◽  
Returning Home ◽  
The Face

Although often left out of public health efforts and policy decisions, prisons, jails, and detention centers are integral to community health. With an average of 650,000 citizens returning home from prison each year in the United States, and thousands of correctional staff members returning home every night, there are millions of touchpoints between outside communities and carceral settings. For this reason, carceral communities should be central to planning and policy making in response to the spread of the COVID-19 illness. As social workers and clinicians, we are urgently concerned that efforts to prevent COVID-19 infections in prisons are underdeveloped and inadequate in the face of a fast-spreading virus. In this commentary, we outline a set of public health, policy, and clinical recommendations based upon the existing literature to mitigate various risks to the well-being of carceral communities.

scholarly journals Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review

2019 ◽  
Vol 165 (5) ◽  
pp. 363-370 ◽  
Author(s):  
Lauren Rose Godier-McBard ◽  
L Ibbitson ◽  
C Hooks ◽  
M Fossey
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Scoping Review ◽  
Healthcare Providers ◽  
Well Being ◽  
Perinatal Period ◽  
Poor Mental Health ◽  
Adverse Outcomes ◽  
Military Spouses ◽  
Perinatal Mental Health

BackgroundPoor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems.MethodsA scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O’Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE.ResultsThirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support.ConclusionsUS literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.

Adrenocortical Insufficiency in the Critically Ill Patient

1992 ◽  
Vol 3 (3) ◽  
pp. 705-713
Author(s):  
Carol Diane Epstein
Keyword(s):  
Adrenal Insufficiency ◽  
Critically Ill ◽  
Patient Outcomes ◽  
Primary Diagnosis ◽  
Critical Care Nurses ◽  
Electrolyte Imbalance ◽  
Critically Ill Patient ◽  
Patient Assessment ◽  
Multiple Organs ◽  
Adrenocortical Failure

The fluid and electrolyte imbalances associated with adrenocortical failure affect multiple physiologic systems in the critically ill patient. Because of its widespread effect, the objective signs of adrenocortical failure may escape recognition. In the context of shock states affecting the function of multiple organs that have been previously diagnosed, empirical evidence suggesting the presence of adrenal insufficiency may be attributed to the primary diagnosis and illness. However, it is most important that critical care nurses question whether adequate adrenal function is present. When effective patient assessment and management are standard components of care, adrenocortical dysfunction may be reversed, while failure to assess for signs of adrenal insufficiency may lead to irreversible patient outcomes. This paper describes phenomena of adrenocortical failure in critically ill patients and presents the problems of fluid and electrolyte imbalance that accompany them

Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ann Smith ◽  
Kathleen Bledsoe ◽  
Thomas Madden ◽  
Jamie Artale ◽  
Ted Sindlinger
Keyword(s):  
Blood Pressure ◽  
Acute Care ◽  
Care Setting ◽  
Management Practice ◽  
Primary Objective ◽  
Adverse Outcomes ◽  
Acute Care Setting ◽  
Percentage Reduction ◽  
Improvement Project ◽  
The Impact

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP <90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP < 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

Epidemiology and outcomes of obese critically ill patients in Australia and New Zealand

2020 ◽  
Vol 22 (1) ◽  
pp. 35-44
Author(s):  
Paul Secombe ◽  
◽  
Richard Woodman ◽  
Sean Chan ◽  
David Pilcher ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adult Population ◽  
Diagnostic Category ◽  
Class Ii ◽  
Adverse Outcomes ◽  
Class I ◽  
Class I Obesity

OBJECTIVE: The apparent survival benefit of being overweight or obese in critically ill patients (the obesity paradox) remains controversial. Our aim is to report on the epidemiology and outcomes of obesity within a large heterogenous critically ill adult population. DESIGN: Retrospective observational cohort study. SETTING: Intensive care units (ICUs) in Australia and New Zealand. PARTICIPANTS: Critically ill patients who had both height and weight recorded between 2010 and 2018. OUTCOME MEASURES: Hospital mortality in each of five body mass index (BMI) strata. Subgroups analysed included diagnostic category, gender, age, ventilation status and length of stay. RESULTS: Data were available for 381 855 patients, 68% of whom were overweight or obese. Increasing level of obesity was associated with lower unadjusted hospital mortality: underweight (11.9%), normal weight (7.7%), overweight (6.4%), class I obesity (5.4%), and class II obesity (5.3%). After adjustment, mortality was lowest for patients with class I obesity (adjusted odds ratio, 0.78; 95% CI, 0.74– 0.82). Adverse outcomes with class II obesity were only seen in patients with cardiovascular and cardiac surgery ICU admission diagnoses, where mortality risk rose with progressively higher BMIs. CONCLUSION: We describe the epidemiology of obesity within a critically ill Australian and New Zealand population and confirm that some level of obesity is associated with lower mortality, both overall and across a range of diagnostic categories and important subgroups. Further research should focus on potential confounders such as nutritional status and the appropriateness of BMI in isolation as an anthropometric measure in critically ill patients.

Sign in / Sign up

Export Citation Format

Share Document