Quality Improvement or Research—Deciding Which Road to Take

2014 ◽  
Vol 34 (6) ◽  
pp. 58-63 ◽  
Author(s):  
Julie M. Stausmire
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Clinical Research ◽  
Low Cost ◽  
Critical Care Nurses ◽  
Evidence Based Practices ◽  
Care Nurse ◽  
Scarce Resources ◽  
Quality Patient Care ◽  
Broad Overview

Critical care nurses are constantly challenged to provide safe, high-quality patient care at a low cost with increasingly scarce resources while implementing the latest evidence-based practices into their own clinical practice. This article is the first in a 4-part series to provide a practical quality improvement guide for critical care nurses interested in implementing system process or performance improvement projects within their own units. Part 1 is designed to answer the question “What method is better for measuring real-world patient outcomes—quality improvement or clinical research?” A broad overview of the differences between quality improvement and clinical research is provided. A newly published checklist to differentiate between attributes of each process is introduced, and readers can test their own knowledge between quality improvement and research with a quick quiz of studies recently published in Critical Care Nurse.

Critical Care Nurse Burnout in Veterans Health Administration: Relation to Clinician and Patient Outcomes

2021 ◽  
Vol 30 (6) ◽  
pp. 435-442
Author(s):  
David C. Mohr ◽  
Lakshmana Swamy ◽  
Edwin S. Wong ◽  
Meredith Mealer ◽  
Marc Moss ◽  
...  
Keyword(s):  
Critical Care ◽  
Patient Outcomes ◽  
Employee Satisfaction ◽  
Veterans Health Administration ◽  
Critical Care Nurses ◽  
Veterans Health ◽  
Health Administration ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Nurse Burnout

Background Critical care nurses have a burnout rate among the highest of any nursing field. Nurse burnout may impact care quality. Few studies have considered how temporal patterns may influence outcomes. Objective To test a longitudinal model of burnout clusters and associations with patient and clinician outcomes. Methods An observational study analyzed data from annual employee surveys and administrative data on patient outcomes at 111 Veterans Health Administration intensive care units from 2013 through 2017. Site-level burnout rates among critical care nurses were calculated from survey responses about emotional exhaustion and depersonalization. Latent trajectory analysis was applied to identify clusters of facilities with similar burnout patterns over 5 years. Regression analysis was used to analyze patient and employee outcomes by burnout cluster and organizational context measures. Outcomes of interest included patient outcomes (30-day standardized mortality rate and observed minus expected length of stay) for 2016 and 2017 and clinician outcomes (intention to leave and employee satisfaction) from 2013 through 2017. Results Longitudinal analysis revealed 3 burnout clusters among the 111 sites: low (n = 37), medium (n = 68), and high (n = 6) burnout. Compared with sites in the low-burnout cluster, those in the high-burnout cluster had longer patient stays, higher employee turnover intention, and lower employee satisfaction in bivariate models but not in multivariate models. Conclusions In this multiyear, multisite study, critical care nurse burnout was associated with key clinician and patient outcomes. Efforts to address burnout among nurses may improve patient and employee outcomes.

Activities Performed by Acute and Critical Care Advanced Practice Nurses: American Association of Critical-Care Nurses Study of Practice

2006 ◽  
Vol 15 (2) ◽  
pp. 130-148 ◽  
Author(s):  
Deborah Becker ◽  
Roberta Kaplow ◽  
Patricia M. Muenzen ◽  
Carol Hartigan
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Clinical Judgment ◽  
American Association ◽  
Critical Care Nurses ◽  
Advanced Practice ◽  
Clinical Nurse ◽  
Care Nurse ◽  
Clinical Nurse Specialists

• Background Accreditation standards for certification programs require use of a testing mechanism that is job-related and based on the knowledge and skills needed to function in the discipline. • Objectives To describe critical care advanced practice by revising descriptors to encompass the work of both acute care nurse practitioners and clinical nurse specialists and to explore differences in the practice of clinical nurse specialists and acute care nurse practitioners. • Methods A national task force of subject matter experts was appointed to create a comprehensive delineation of the work of critical care nurses. A survey was designed to collect validation data on 65 advanced practice activities, organized by the 8 nurse competencies of the American Association of Critical-Care Nurses Synergy Model for Patient Care, and an experience inventory. Activities were rated on how critical they were to optimizing patients’ outcomes, how often they were performed, and toward which sphere of influence they were directed. How much time nurses devoted to specific care problems was analyzed. Frequency ratings were compared between clinical nurse specialists and acute care nurse practitioners. • Results Both groups of nurses encountered all items on the experience inventory. Clinical nurse specialists were more experienced than acute care nurse practitioners. The largest difference was that clinical nurse specialists rated as more critical activities involving clinical judgment and clinical inquiry whereas acute care nurse practitioners focused primarily on clinical judgment. • Conclusions Certification initiatives should reflect differences between clinical nurse specialists and acute care nurse practitioners.

Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification

2003 ◽  
Vol 12 (2) ◽  
pp. 154-164 ◽  
Author(s):  
◽  
Keyword(s):  
Critical Care ◽  
American Association ◽  
The United States ◽  
White Paper ◽  
Critical Care Nurses ◽  
Specialized Knowledge ◽  
Care Nurse ◽  
Call To Action ◽  
Knowledge And Skills ◽  
The Public

Today’s critically ill patients require heightened vigilance and extraordinarily intricate care. As skilled and responsible health professionals, the 403 000 critical care nurses in the United States must acquire the specialized knowledge and skills needed to provide this care and demonstrate their competence to the public, their employers, and their profession. Recognizing that nurses can validate specialty competence through certification, this white paper from the American Association of Critical-Care Nurses and the AACN Certification Corporation puts forth a call to action for all who can influence and will benefit from certified nurses’ contribution to patient care.

Quality assurance and the critical care nurse

1991 ◽  
Vol 11 (9) ◽  
pp. 34-40
Author(s):  
P Brown-Stewart
Keyword(s):  
Quality Assurance ◽  
Critical Care ◽  
Critically Ill ◽  
Monitoring And Evaluation ◽  
Critical Care Nurses ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Appropriateness Of Care ◽  
External Sources ◽  
The Way

Care of the critically ill has become increasingly challenging due to demands from external sources to measure the quality and appropriateness of care provided. Quality assurance is the responsibility of every critical care nurse and requires vigilance as well as a knowledge of the principles of standards, monitoring and evaluation. Through quality assurance activities, the contribution of critical care nurses in the achievement of patient outcomes can be measured. Quality assurance challenges us to evaluate the way we practice, and assists us to continuously improve the way we provide care to critically ill patients.

Perceptions and significance of patient deaths for pediatric critical care nurses

1992 ◽  
Vol 12 (3) ◽  
pp. 72-75 ◽  
Author(s):  
SW Benica ◽  
CB Longo ◽  
JH Barnsteiner
Keyword(s):  
Critical Care ◽  
Stress Management ◽  
Critical Care Nurses ◽  
The Other ◽  
Recruitment Strategies ◽  
Pediatric Critical Care ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Hospital Administrator ◽  
Dying Patients

This study provides nursing administrators with data regarding stressors of the pediatric critical care nurse in order of priority. Death of patients was the only item isolated and compared to the other stress categories. It is suggested that death of patients be compared to all other items on the audit. The authors recommend expanding this study by asking two additional questions: Does the amount of time spent caring for dying patients correlate with the nurses' estimate of patient deaths and is there a relationship between the time spent caring for patients who die and perception of death as a stressor? This information can be utilized at the unit level in the development of stress management activities. At the hospital administrator level, this information can assist in the expansion of retention and recruitment strategies.

Curriculum to Introduce Critical Care Nurses to Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 29 (4) ◽  
pp. 262-269
Author(s):  
Whitney D. Gannon ◽  
Lynne Craig ◽  
Lindsey Netzel ◽  
Carmen Mauldin ◽  
Ashley Troutt ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Reference Group ◽  
High Volume ◽  
Critical Care Nurses ◽  
Care Nurse ◽  
Membrane Oxygenation ◽  
Written Examination ◽  
Advanced User ◽  
Before And After

Background Despite the growing use of extracorporeal membrane oxygenation (ECMO) in intensive care units (ICUs), no standardized ECMO training pathways are available for ECMO-naive critical care nurses. Objectives To evaluate a critical care nurse ECMO curriculum that may be reproducible across institutions. Methods An ECMO curriculum consisting of a basic safety course and an advanced user course was designed for critical care nurses. Courses incorporated didactic and simulation components, written knowledge examinations, and electronic modules. Differences in examination scores before and after each course for the overall cohort and for participants from each ICU type were analyzed with t tests or nonparametric equality-of-medians tests. Differences in postcourse scores across ICU types were examined with multiple linear regression. Results Critical care nurses new to ECMO (n = 301) from various ICU types participated in the basic safety course; 107 nurses also participated in the advanced user course. Examination scores improved after completion of both courses for overall cohorts (P < .001 in all analyses). Median (interquartile range) individual score improvements were 23.1% (15.4%-38.5%) for the basic safety course and 8.4% (0%-16.7%) for the advanced user course. Postcourse written examination scores stratified by ICU type, compared with the medical ICU/cardiovascular ICU group (reference group), differed only in the neurovascular ICU group for the basic safety course (percent score difference, −3.0; 95% CI, −5.3 to −0.8; P = .01). Conclusions Implementation of an ECMO curriculum for a high volume of critical care nurses is feasible and effective.

Critical Care Nurse–Led Quality Improvement Hyperglycemia Reduction Initiative

2018 ◽  
pp. 1
Author(s):  
Lisa Neelon ◽  
Kim Basawil ◽  
Laura Whitney ◽  
Evelyn Kneblewicz ◽  
Sharon A. Watts ◽  
...  
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Care Nurse ◽  
Critical Care Nurse

Clinical management of DIC: early nursing interventions

1991 ◽  
Vol 11 (10) ◽  
pp. 42-53 ◽  
Author(s):  
C Epstein ◽  
A Bakanauskas
Keyword(s):  
Critical Care ◽  
Nursing Care ◽  
Clinical Manifestations ◽  
Nursing Interventions ◽  
Care Nurse ◽  
Critical Care Nurse ◽  
Quality Patient Care ◽  
Comprehensive Knowledge ◽  
Assessment Skills ◽  
Primary Nurse

Achievement of successful patient outcomes depends on the availability of a primary nurse responsible for all aspects of nursing care. A consistent caregiver not only has a grasp of phenomena at hand but possesses an overall perspective of recovery. Care can be evaluated and readjusted on a timely basis. Identification of signs of progress as well as deterioration may be facilitated through continuity of care. The primary nurse can provide meaningful, ongoing information to the patient and significant others as a means of optimizing their coping behaviors. Effective nursing care of the patient with DIC is enhanced by a thorough understanding of its pathophysiology and its clinical manifestations. When the critical care nurse has a comprehensive knowledge base and uses purposeful assessment skills, potential complications become much clearer and are avoided. The primary nurse who knows how to prioritize care is capable of anticipating the patient's needs. By integrating theory with practice, the critical care nurse functions from a position of strength in promoting quality patient care.

Continuous fentanyl infusion in children following open-heart surgery

1996 ◽  
Vol 16 (2) ◽  
pp. 113-118 ◽  
Author(s):  
C Jensen ◽  
S Cabeza
Keyword(s):  
Critical Care ◽  
Stress Responses ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Critical Care Nurses ◽  
Care Plan ◽  
Open Heart ◽  
Care Nurse ◽  
Nursing Diagnosis ◽  
Fentanyl Infusion

Fentanyl can be an effective drug for managing sedation and blunting the stress responses in children who have pulmonary hypertension after undergoing open-heart surgery. However, expert nursing care is required to anticipate and assess complications associated with fentanyl infusion. The critical care nurse must be prepared to identify symptoms of narcotic withdrawal and intervene appropriately. In an effort to minimize the complications associated with fentanyl infusion, a care plan was developed that emphasizes the nursing diagnosis related to the care of an anesthetized infant or child in the intensive care unit (Table 2). This care plan is a guide to help critical care nurses care for an infant or child receiving a continuous fentanyl infusion.

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