Hereditary Hemorrhagic Telangiectasia: A Primer for Critical Care Nurses

2016 ◽  
Vol 36 (3) ◽  
pp. 36-48 ◽  
Author(s):  
Kathleen M. Sacco ◽  
Thomas W. Barkley
Keyword(s):  
Critical Care ◽  
Health Care Providers ◽  
Genetic Disease ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Early Death ◽  
Signs And Symptoms ◽  
Critical Care Nurses ◽  
Care Providers ◽  
Abnormal Growth

Hereditary hemorrhagic telangiectasia is a rare, autosomal dominant genetic disease that causes abnormal growth of blood vessels and, subsequently, life-threatening arteriovenous malformations in vital organs. Epistaxis may be one of the initial clues that a patient has more serious, generalized arteriovenous malformations. Recommended treatment involves careful evaluation to determine the severity and risk of spontaneous rupture of the malformations and the management of various signs and symptoms. The disease remains undiagnosed in many patients, and health care providers may miss the diagnosis until catastrophic events happen in multiple family members. Prompt recognition of hereditary hemorrhagic telangiectasia and early intervention can halt the dangerous course of the disease. Critical care nurses can assist with early diagnosis within families with this genetic disease, thus preventing early death and disability.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

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.

Seeing the Patient and Family Through: Nurses and Physicians Experiences With Withdrawal of Life-Sustaining Therapy in the ICU

2018 ◽  
Vol 36 (1) ◽  
pp. 13-23 ◽  
Author(s):  
Debra L. Wiegand ◽  
Jooyoung Cheon ◽  
Giora Netzer
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Data Analysis ◽  
Health Care Providers ◽  
Quality Care ◽  
Phenomenological Approach ◽  
Critical Care Nurses ◽  
Care Providers ◽  
Therapy Decision ◽  
Nurses And Physicians

Withdrawal of life-sustaining therapy at the end of life is a complex phenomenon. Intensive care nurses and physicians are faced with caring for patients and supporting families, as these difficult decisions are made. The purpose of this study was to explore and describe the experience of critical care nurses and physicians participating in the process of withdrawal of life-sustaining therapy. A hermeneutic phenomenological approach was used to guide this qualitative investigation. Interviews were conducted with critical care nurses and physicians from 2 medical centers. An inductive approach to data analysis was used to understand similarities between the nurses and the physicians’ experiences. Methodological rigor was established, and data saturation was achieved. The main categories that were inductively derived from the data analysis included from novice to expert, ensuring ethical care, uncertainty to certainty, facilitating the process, and preparing and supporting families. The categories aided in understanding the experiences of nurses and physicians, as they worked individually and together to see patients and families through the entire illness experience, withdrawal of life-sustaining therapy decision-making process and dying process. Understanding the perspectives of health-care providers involved in the withdrawal of life-sustaining therapy process will help other health-care providers who are striving to provide quality care to the dying and to their families.

Making It Meaningful: Finding Quality Improvement Projects Worthy of Your Time, Effort, and Expertise

2015 ◽  
Vol 35 (6) ◽  
pp. 57-61 ◽  
Author(s):  
Julie M. Stausmire ◽  
Charla Ulrich
Keyword(s):  
Critical Care ◽  
Quality Improvement ◽  
Health Care Providers ◽  
Physical Environment ◽  
Critical Care Nurses ◽  
Care Providers ◽  
Improvement Project ◽  
Specific Patient ◽  
Critical Care Units ◽  
Part Quality

This article is the second of a 4-part quality improvement resource series for critical care nurses interested in implementing system process or performance improvement projects. The article is a brainstorming session on paper, written to assist nurses and managers in identifying possible quality improvement projects that are meaningful to them and will make a real difference in their critical care units. Every unit and institution has its own unique mix of resources, culture, physical environment, patient population, technology, documentation processes, health care providers, and multiple other factors. Thus specific patient care and safety challenges must be identified and prioritized individually for quality improvement by each unit. Projects also must be manageable and within the scope of time, effort, and expertise available—no quality improvement project is “too small” if it is applicable to your critical care area and will improve outcomes.

scholarly journals Innovative COVID-19 Programs to Rapidly Serve New Mexico

2020 ◽  
Vol 136 (1) ◽  
pp. 39-46
Author(s):  
Joanna G. Katzman ◽  
Laura E. Tomedi ◽  
Karla Thornton ◽  
Paige Menking ◽  
Michael Stanton ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Health Care ◽  
Critical Care ◽  
New Mexico ◽  
General Education ◽  
Health Care Providers ◽  
Healthcare Outcomes ◽  
Care Providers ◽  
Project Echo

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.

scholarly journals Reproductive awareness and recognition of unintended pregnancy: young women, key informants and health care providers perspectives in South Africa

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oluwaseyi Dolapo Somefun ◽  
Jane Harries ◽  
Deborah Constant
Keyword(s):  
South Africa ◽  
Health Care ◽  
Unintended Pregnancy ◽  
Health Care Providers ◽  
Signs And Symptoms ◽  
Second Trimester ◽  
Care Providers ◽  
Policy Makers ◽  
Abortion Care ◽  
Pregnancy Status

Abstract Background South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women’s experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers’ and policy makers’ ideas for public sector strategies to facilitate prompt confirmation of pregnancy. Methods We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis. Results Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible. Conclusion Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.

A survey of pediatric critical care nurses' knowledge of pain management

1997 ◽  
Vol 6 (4) ◽  
pp. 289-295 ◽  
Author(s):  
C Pederson ◽  
D Matthies ◽  
S McDonald
Keyword(s):  
Critical Care ◽  
Pain Management ◽  
Signs And Symptoms ◽  
Educational Interventions ◽  
Critical Care Nurses ◽  
Toxic Metabolite ◽  
Pediatric Critical Care ◽  
Related Information ◽  
Item Scale ◽  
Nurses Knowledge

BACKGROUND: Although nurses are accountable for pain management, it cannot be assumed that they are well informed about pain. Nurses' knowledge base underlies their pain management; therefore, it is important to measure their knowledge. OBJECTIVE: To measure pediatric critical care nurses' knowledge of pain management. METHOD: A descriptive, exploratory study was done. After a pilot study, an investigator-developed Pain Management Knowledge Test was distributed to 50 pediatric ICU nurses. Test responses were collected anonymously and coded by number. Item analysis was done, and descriptive statistics were calculated. Modified content analysis was used on requests for pain-related information. RESULTS: The test return rate was 38%. The overall mean score was 63%. Mean scores within test subsections varied from 50% to 92%. Other mean scores were 85% on a nine-item scale of drug-action items and 92% on a two-item scale of intervention items. However, no nurse recognized that cognitive-behavioral techniques can inhibit transmission of pain impulses; only 32% indicated that meperidine converts to a toxic metabolite, only 47% recognized nalbuphine as a drug that may cause signs and symptoms of withdrawal if given to a patient who has been receiving an opioid; and only 63% indicated that when a child states that the child has pain, pain exists. Thirteen nurses requested pain-related information, and all requests focused on analgesic medications. CONCLUSIONS: Testing nurses' knowledge of pain indicated gaps that can be addressed through educational interventions. Research is needed in which the test developed for this study is used as both pretest and posttest in an intervention study with pediatric critical care nurses or is modified for use with nurses in other clinical areas.

Barriers and Facilitators to Obtaining Informed Consent in a Critical Care Pediatric Research Ward in Southern Malawi

2019 ◽  
Vol 14 (2) ◽  
pp. 152-168
Author(s):  
Lucinda Manda-Taylor ◽  
Alice Liomba ◽  
Terrie E. Taylor ◽  
Kristan Elwell
Keyword(s):  
Critical Care ◽  
Informed Consent ◽  
Clinical Research ◽  
Critically Ill ◽  
Health Care Providers ◽  
Pediatric Intensive Care ◽  
Research Participant ◽  
Critically Ill Children ◽  
Parental Distress ◽  
Care Providers

Informed consent is an ethical requirement in clinical research. Obtaining informed consent is challenging in resource-constrained settings. We report results of a formative qualitative study that examined factors that facilitate and hinder informed consent for clinical research among critically ill children in Malawi. We argue that truly informed consent in a pediatric intensive care unit (PICU) is challenged by parental distress, time constraints when balancing care for critically ill patients with research-related tasks, and social hierarchies and community mistrust toward certain research procedures. We interviewed health care providers and parents of children attending a critical care unit to identify potential challenges and solicit strategies for addressing them. Providers and caregivers suggested practical solutions to enhance research participant understanding of clinical trial research, including the use of visual materials, community engagement strategies, and using patients as advocates in promoting understanding of research procedures.

A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room

2016 ◽  
Vol 32 (8) ◽  
pp. 514-519 ◽  
Author(s):  
Brian T. Wessman ◽  
Carrie Sona ◽  
Marilyn Schallom
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Health Care Providers ◽  
Night Shift ◽  
Surgical Trauma ◽  
Care Providers ◽  
Improvement Project ◽  
Glass Door ◽  
Patient Handover ◽  
Communication Errors

Background: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. Methods: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: “day team,” “night team,” and “surgery/consultant team.” Assigned areas for tracking “lines,” “antibiotics,” “ventilator weaning,” and “Deep vein thrombosis (DVT) screening” were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts. Results: Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patient handover communication errors. The post glass-door era had 4.26% of reported errors related to patient handover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds. Conclusions: Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall decrease in the number of handover communication errors.

Pediatric Triage and Allocation of Critical Care Resources During Disaster: Northwest Provider Opinion

2014 ◽  
Vol 29 (5) ◽  
pp. 455-460 ◽  
Author(s):  
Erin Margaret Johnson ◽  
Douglas S. Diekema ◽  
Mithya Lewis-Newby ◽  
Mary A. King
Keyword(s):  
Critical Care ◽  
Hurricane Katrina ◽  
Health Care Providers ◽  
Health Workers ◽  
Cognitive Outcome ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Publication Type ◽  
Pediatric Critical Care ◽  
Pediatric Hospitals

AbstractIntroductionFollowing Hurricane Katrina and the 2009 H1N1 epidemic, pediatric critical care clinicians recognized the urgent need for a standardized pediatric triage/allocation system. This study collected regional provider opinion on issues of care allocation and pediatric triage in a disaster/pandemic setting.MethodsThis study was a cross-sectional survey of United States (US) health care providers and public health workers who demonstrated interest in critical care and/or disaster care medicine by attending a Northwest regional pediatric critical care symposium on disaster preparation, held in 2012 at Seattle Children's Hospital in Seattle, Washington (USA). The survey employed an electronic audience response system and included demographic, ethical, and logistical questions. Differences in opinions between respondents grouped by professions and work locations were evaluated using a chi-square test.ResultsOne hundred and twelve (97%) of 116 total attendees responded to at least one question; however, four of these responders failed to answer every question. Sixty-two (55%) responders were nurses, 29 (26%) physicians, and 21 (19%) other occupations. Fifty-five (51%) responders worked in pediatric hospitals vs 53 (49%) in other locations. Sixty-three (58%) of 108 successful responses prioritized children predicted to have a good neuro-cognitive outcome. Seventy-one (68%) agreed that no pediatric age group should be prioritized. Twenty-two (43%) of providers working in non-pediatric hospital locations preferred a triage system based on an objective score alone vs 14 (26%) of those in pediatric hospitals (P = .038).JohnsonEM, DiekemaDS, Lewis-NewbyM, KingMA. Pediatric triage and allocation of critical care resources during disaster: Northwest provider opinion. Prehosp Disaster Med. 2014;29(5):1-6.

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