Examining the Evidence to Guide Practice: Challenging Practice Habits

2014 ◽  
Vol 34 (2) ◽  
pp. 28-45 ◽  
Author(s):  
Mary Beth Flynn Makic ◽  
Carol Rauen ◽  
Robin Watson ◽  
Ann Will Poteet
Keyword(s):  
Critical Care ◽  
Current Practice ◽  
American Association ◽  
Daily Practice ◽  
Feeding Tube ◽  
Critical Care Nurses ◽  
Current Evidence ◽  
Evidence Based ◽  
Health Care Workforce ◽  
In Infants And Children

Nurses are the largest segment of the nation’s health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients’ outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.

Continuing to Challenge Practice to Be Evidence Based

2015 ◽  
Vol 35 (2) ◽  
pp. 39-50 ◽  
Author(s):  
Mary Beth Flynn Makic ◽  
Carol Rauen ◽  
Kimmith Jones ◽  
Anna C. Fisk
Keyword(s):  
Critical Care ◽  
Daily Practice ◽  
Medication Administration ◽  
Chest Physiotherapy ◽  
Critical Care Nurses ◽  
Current Evidence ◽  
Care Practice ◽  
Evidence Based ◽  
Actual Weight ◽  
Daily Interruption

Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient’s actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.

scholarly journals Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

2015 ◽  
Vol 35 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Annette M. Bourgault ◽  
Janie Heath ◽  
Vallire Hooper ◽  
Mary Lou Sole ◽  
Elizabeth G. Nesmith
Keyword(s):  
Critical Care ◽  
American Association ◽  
Feeding Tube ◽  
Critical Care Nurses ◽  
Tube Placement ◽  
Evidence Based ◽  
Clinical Practices ◽  
Feeding Tubes ◽  
Verification Methods ◽  
Feeding Tube Placement

BACKGROUNDThe American Association of Critical-Care Nurses practice alert on verification of feeding tube placement makes evidence-based practice recommendations to guide nursing management of adult patients with blindly inserted feeding tubes. Many bedside verification methods do not allow detection of improper positioning of a feeding tube within the gastrointestinal tract, thereby increasing aspiration risk.OBJECTIVESTo determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses.METHODSThis study was part of a larger national, online survey that was completed by 370 critical care nurses. Descriptive statistics were used to analyze the data.RESULTSSeventy-eight percent of nurses used a variety of methods to verify initial placement of feeding tubes, although 14% were unaware that tube position should be confirmed every 4 hours. Despite the inaccuracy of auscultation methods, only 12% of nurses avoided this practice all of the time.CONCLUSIONSImplementation of expected clinical practices from this guideline varied. Nurses are encouraged to implement expected practices from this evidence-based, peer reviewed practice alert to minimize risk for patient harm.

Evidence-based practice: fever-related interventions

1999 ◽  
Vol 8 (1) ◽  
pp. 481-487 ◽  
Author(s):  
R Henker
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
American Association ◽  
Critical Care Nurses ◽  
Critically Ill Patient ◽  
Evidence Based ◽  
Common Phenomenon ◽  
Research Questions ◽  
Research Studies

Fever is a common phenomenon in critically ill patients. Ideally, all decisions about treatment of fever would be based on results of well-developed research studies. Instead, some research questions related to treatment of fever have been studied more extensively than others. This article is an evaluation of the usefulness of the research studies related to treatment of fever in the critically ill. Two questions are addressed: when is treatment of fever most beneficial to a critically ill patient, and how is fever most effectively treated in the critically ill? Evidence related to the treatment of fever is evaluated by using the recommendation levels of the research-based practice protocols of the American Association of Critical-Care Nurses.

Current Trends and Practices of Intensive Care Unit Visitations

2018 ◽  
Vol 11 (2) ◽  
pp. 169-174
Author(s):  
Geraldine C. Fike ◽  
Marilyn Smith-Stoner ◽  
Dawn I. Blue ◽  
Alham A. Abuatiq
Keyword(s):  
Critical Care ◽  
Acute Care ◽  
Practice Guidelines ◽  
American Association ◽  
Acute Care Hospital ◽  
Critical Care Nurses ◽  
Current Evidence ◽  
Care Hospital ◽  
Policy Changes ◽  
Current Trends

Background: Few topics have existed for decades and created as much of a debate as when discussing appropriate visitation policies for patients. Studies have continued to document the conflicted opinions of nurses to commit to fully open visiting hours for various reasons. Family members are very definite in their desire to be at their loved one’s bedside. Objective: To review the visiting policies of acute care hospitals in California and compare them to the American Association of Critical-Care Nurses recommendations. Methods: This descriptive study collected data from California acute care hospital websites about critical care visiting hours to assess visiting hours and the type, age, and number of visitors. Results: Review of 363 hospital websites demonstrated a wide variation in policies when listed. Those that did post their visitation rules had no consistent policies regarding visiting hours or age, relationship, or number of visitors. Conclusions: Hospital visitation policies in California are inconsistent and not evenly enforced. They do not reflect current evidence and practice guidelines. Implications for Nursing: Ethics require the nurses to advocate for their patient. In this role, nurses need to become proactive in implementing policy changes in their institution based on current evidence and practice guidelines.

Compassion Fatigue and the Healthy Work Environment

2017 ◽  
Vol 28 (4) ◽  
pp. 351-358 ◽  
Author(s):  
Lesly Kelly ◽  
Michael Todd
Keyword(s):  
Critical Care ◽  
Work Environment ◽  
Compassion Fatigue ◽  
American Association ◽  
Medical Center ◽  
Academic Medical Center ◽  
Compassion Satisfaction ◽  
Critical Care Nurses ◽  
Healthy Work Environment ◽  
Healthy Work

Background:Burnout is a concern for critical care nurses in high-intensity environments. Studies have highlighted the importance of a healthy work environment in promoting optimal nurse and patient outcomes, but research examining the relationship between a healthy work environment and burnout is limited.Objective:To examine how healthy work environment components relate to compassion fatigue (eg, burnout, secondary trauma) and compassion satisfaction.Methods:Nurses (n = 105) in 3 intensive care units at an academic medical center completed a survey including the Professional Quality of Life and the American Association of Critical-Care Nurses’ Healthy Work Environment standards.Results:Regression models using each Healthy Work Environment component to predict each outcome, adjusting for background variables, showed that the 5 Healthy Work Environment components predicted burnout and that meaningful recognition and authentic leadership predicted compassion satisfaction.Conclusions:Findings on associations between healthy work environment standards and burnout suggest the potential importance of implementing the American Association of Critical-Care Nurses’ Healthy Work Environment standards as a mechanism for decreasing burnout.

Acute pancreatitis and renal replacement therapy

2019 ◽  
pp. 179-190
Author(s):  
Clinton Lobo ◽  
Kim Gupta ◽  
Matt Thomas
Keyword(s):  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on pancreatitis and renal replacement therapy. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Sedation and delirium

2019 ◽  
pp. 145-160
Author(s):  
Nim Pathmanathan ◽  
Paul Nixon
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Case History ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study of sedation and delirium. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, together with relevant images, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Early management of multi-trauma

2019 ◽  
pp. 53-66
Author(s):  
Marius Rehn ◽  
David J. Lockey
Keyword(s):  
Critical Care ◽  
Critical Care Unit ◽  
Daily Practice ◽  
Care Staff ◽  
Evidence Based ◽  
Early Management ◽  
Patient Pathway ◽  
Standard Textbook ◽  
Learning Points

This chapter is centred on a case study on multi-trauma and describes the patient pathway from the incident scene through to rehabilitation. This topic is one of the key challenging areas in critical care medicine and one that all intensive care staff will encounter. The chapter is based on a detailed case history, ensuring clinical relevance, making this easily relatable to daily practice in the critical care unit. The chapter is punctuated by evidence-based, up-to-date learning points, which highlight key information for the reader. Throughout the chapter, a topic expert provides contextual advice and commentary, adding practical expertise to the standard textbook approach and reinforcing key messages.

Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses

2003 ◽  
Vol 12 (3) ◽  
pp. 246-257 ◽  
Author(s):  
Susan L. MacLean ◽  
Cathie E. Guzzetta ◽  
Cheri White ◽  
Dorrie Fontaine ◽  
Dezra J. Eichhorn ◽  
...  
Keyword(s):  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
American Association ◽  
Family Members ◽  
Invasive Procedure ◽  
Critical Care Nurses ◽  
Invasive Procedures ◽  
Emergency Nurses ◽  
Family Presence ◽  
Do So

• Background Increasingly, patients’ families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. • Objective To identify the policies, preferences, and practices of critical care and emergency nurses for having patients’ families present during resuscitation and invasive procedures. • Methods A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. • Results Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures). Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). • Conclusions Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

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