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Kılıç G, Eskigülek Y, Erdoğan B, Arpa H, Erbaş G, Baştürk B. Opinions of intensive care nurses on continuous renal replacement therapy: A qualitative study. Ther Apher Dial 2024. [PMID: 38867443 DOI: 10.1111/1744-9987.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION This is a phenomenologically designed qualitative study conducted to explore and conceptualize the problems experienced by intensive care nurses caring for patients undergoing continuous renal replacement therapy. METHODS Face-to-face, semi-structured interviews were conducted with the participants. The interviews were transcribed verbatim, then thematic analysis was conducted. RESULTS The study was conducted 12 intensive care nurses. As a result, 3 main and 6 sub-themes were identified. The themes identified were changing routines, uncertainty in terms of patient benefit, and need for adaptation. CONCLUSION It was found that nurses experienced challenges in providing care to patients undergoing continuous renal replacement therapy, spent more effort to prevent complications, and lacked information on the subject. It is recommended to consider institutional and individual actions to meet the educational needs of nurses for implementing continuous renal replacement therapy.
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Affiliation(s)
- Gülşen Kılıç
- Internal Intensive Care Unit, Baskent University Ankara Hospital, Ankara, Turkey
| | - Yasemin Eskigülek
- Faculty of Health Sciences, Department of Nursing, Baskent University, Ankara, Turkey
| | - Bülent Erdoğan
- Internal Intensive Care Unit, Baskent University Ankara Hospital, Ankara, Turkey
| | - Hilal Arpa
- Internal Intensive Care Unit, Baskent University Ankara Hospital, Ankara, Turkey
| | - Gizem Erbaş
- Internal Intensive Care Unit, Baskent University Ankara Hospital, Ankara, Turkey
| | - Beyza Baştürk
- Internal Intensive Care Unit, Baskent University Ankara Hospital, Ankara, Turkey
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Wu Z, Huang W, Ding Y, Jiang L, Zhao Y, Zhu X, Huang J. Construction of an evaluation index system of core competencies for critical care blood purification nurses in China: A Delphi study. Nurse Educ Pract 2023; 72:103751. [PMID: 37633075 DOI: 10.1016/j.nepr.2023.103751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/01/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023]
Abstract
AIM The purpose of this study was to construct a core competencies evaluation index system for critical care blood purification nurses in China. BACKGROUND While nursing is an integral part of critical care blood purification treatment, there are no established indicators to evaluate the core competencies of critical care blood purification nurses. DESIGN A Delphi study. METHODS An initial draft of the competencies evaluation index system for critical care blood purification nurses was developed through a literature review and semi-structured interviews. From February 2023 to March 2023, a two-round Delphi survey was conducted to consult with 18 experts in the field of critical care blood purification from eight provinces in China to rate the importance of each item and propose modifications to the evaluation index system. RESULTS The effective questionnaire recovery rates in two rounds of expert consultation were 94.4 % and 94.1 % and the average expert authority coefficients were 0.88 in both rounds. The core competencies evaluation index system of critical care blood purification nurses consisted of 39 items in five domains, namely theoretical knowledge, practical skills, professional development capability, critical thinking ability and personal qualities and attributes. The Kendall's W coefficients for the first- and second-level indicators were.21 and.20 in the first round and.23 and.25, respectively, in the second round of consultations (p < .01). CONCLUSION The core competencies evaluation index system of critical care blood purification nurses is scientific and reliable and can provide references for the recruitment, training and management of critical care blood purification nurses.
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Affiliation(s)
- Zhishan Wu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuefeng Ding
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liping Jiang
- Department of Nursing, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhao
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoye Zhu
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayi Huang
- Department of Blood Purification, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Price N, Wood AF. Acute kidney injury in the critical care setting. Nurs Stand 2023; 38:45-50. [PMID: 37458070 DOI: 10.7748/ns.2023.e12063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 07/18/2023]
Abstract
Acute kidney injury is a sudden reduction in renal function which impairs the kidneys' ability to maintain fluid, electrolyte and acid-base balance. The syndrome often develops secondary to severe illness and is associated with a significant increase in morbidity and mortality rate in critically ill patients. This article gives an overview of the pathophysiology and aetiology of acute kidney injury, as well as the associated complications and clinical diagnostic signs. The authors also describe some common causes of the syndrome in critically ill patients, specifically sepsis, liver failure and cardiac failure, and discuss patient management in the critical care setting, with a focus on haemodynamic support and continuous renal replacement therapy.
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Affiliation(s)
- Natasha Price
- division of nursing and paramedic science, school of health sciences, Queen Margaret University, Edinburgh, Scotland
| | - Alison Fiona Wood
- programme lead for independent prescribing, division of nursing and paramedic science, school of health sciences, Queen Margaret University, Edinburgh, Scotland
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Yu H, Lian M, Li J, Huang J, Zhang Y, Liu F. Effects of nursing intervention based on feedforward control on preventing unplanned interruption during continuous renal replacement therapy. Minerva Surg 2023; 78:462. [PMID: 35708445 DOI: 10.23736/s2724-5691.22.09595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Huixia Yu
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Meiqin Lian
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China -
| | - Jian Li
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jie Huang
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yingzhi Zhang
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Fanna Liu
- Blood Purifying Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Research on the Application Effect of Strengthening Risk Management in Continuous Renal Replacement Therapy Nursing of Critically Ill Patients. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2363877. [PMID: 35845585 PMCID: PMC9286961 DOI: 10.1155/2022/2363877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/21/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022]
Abstract
Objective To evaluate the efficacy of risk management in the nursing of critically ill patients on continuous renal replacement therapy (CRRT). Methods In this retrospective study, 80 critically ill patients on continuous renal replacement therapy in our hospital from February 2020 to February 2021 were recruited. They were randomly assigned to receive either the risk management treatment (risk management group) or the conventional management treatment (conventional management group) via the random number table method. Outcome measurements included the occurrence of adverse events, complications, psychological status, quality of life, treatment compliance, duration of CRRT, and nursing satisfaction. Results Risk management treatment was associated with lower incidence of adverse events compared to conventional management treatment (P value < 0.05). The risk management group also resulted in a lower incidence of complications compared to the conventional management group (P value < 0.05). Patients who received risk management treatments demonstrated a significantly lower anxiety/depression level and a higher World Health Organization Quality of Life Brief Version (WHOQOL-BREF) (P value < 0.05). The risk management group resulted in more cases with high compliance and fewer cases with moderate and poor compliance (P < 0.05). Risk management was associated with more cases with a CRRT duration less than 36 hours and 36–48 hours and fewer cases with a duration longer than 48 h (X2 = 2.999, P value < 0.05). Patients who were given a risk management treatment had a higher nursing satisfaction compared to conventional management treatment (X2 = 4.501, P value < 0.05). Conclusion Risk management treatment in caring of critically ill patients on CRRT shows better efficacy than conventional management treatments.
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do Nascimento JC, Sanches MB, Souza RCS. Validation of guidelines for the care of patients undergoing continuous renal replacement therapy. Nurs Crit Care 2021; 28:379-387. [PMID: 34585485 DOI: 10.1111/nicc.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Continuous renal replacement therapy is one of the most frequently used treatments for acute kidney injury (AKI) in intensive care units (ICUs). It requires professionals with specialized knowledge, specific facilities, and care guidelines to ensure appropriate clinical practice. AIMS AND OBJECTIVES To validate the care guidelines for patients undergoing continuous renal replacement therapy. METHOD This is a methodological study regarding consensual validation of the directives of care. These directives followed the formulation of the research question, a literature review, elaboration of the directive, and validation of the agreement by a committee consisting of seven expert judges. RESULTS The data were analysed based on the content validity index and described in four categories. Among 40 care-related items, 95% showed a degree of agreement above 80% for adequacy and 82.5% showed a degree of agreement above 75% for relevance. CONCLUSION The care-related items identified in the literature showed a high percentage of agreement among the judges and reflected the treatment requirements of these patients. RELEVANCE TO CLINICAL PRACTICE The guideline will be important to assist in the care process regarding patient safety and quality of care.
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Cassina T, Villa M, Soldani-Agnello A, Zini P. Comparison of two regional citrate anticoagulation modalities for continuous renal replacement therapy by a prospective analysis of safety, workload, effectiveness, and cost. Minerva Anestesiol 2021; 87:1309-1319. [PMID: 34527405 DOI: 10.23736/s0375-9393.21.15559-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, regional citrate anticoagulation (RCA) is the preferred approach for continuous renal replacement therapy (CRRT), and several RCA protocols are commercially available. This study was aimed at comparing two RCA modalities for CRRT in terms of safety, workload, effectiveness, and costs. METHODS We prospectively evaluated two different RCA approaches in patients admitted to our intensive care unit (ICU) who needed CRRT. Patients with acute liver failure were excluded. We compared a hypertonic sodium-citrate solution 136 mmol/L added before the filter as anticoagulant during bicarbonate continuous hemodialysis (RCA-CVVHD) versus citrate-buffered replacement fluid 13.3 mmol/L infused by predilution setting in continuous venovenous hemofiltration (RCA-CVVH). Alkalosis, calcium homeostasis, nursing workload, filter lifespan, urea-creatinine metabolic control, and costs were recorded. RESULTS Forty-five and 31 patients who underwent RCA-CVVH and RCA-CVVHD, respectively, were included. Alkalosis-free time distributions were significantly different in favor of a higher alkalosis incidence in the RCA-CVVHD group (log-rank test χ2(1)=8.18, P=0.004). Multivariable analysis showed that RCA-CVVHD was associated with a longer filter lifespan (HR=0.47; 95% CI: 0.28-0.78), higher total cost (1362 CHF [782-1901] vs. 976 CHF [671-1353], P<0.001), and higher number of anticoagulation adjustments (9 [IQR, 4-14] vs. 2 [IQR, 1-4]). The mean urea and creatinine reduction ratios at the first 24 hours were significantly higher in the RCA-CVVHD group. Calcium homeostasis and filter downtime were similar in the two groups. CONCLUSIONS Pre-filter hypertonic sodium-citrate solution (136 mmol/L) results in longer filter patency and improves depuration effectiveness. However, compared to RCA-CVVHF, it causes metabolic alkalosis and increases nursing interventions and cost.
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Affiliation(s)
- Tiziano Cassina
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Villa
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland -
| | - Annalisa Soldani-Agnello
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Piergiorgio Zini
- Department of Cardiac Anesthesiology and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
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Melo GAA, Silva RA, Galindo Neto NM, Lima MAD, Machado MDFAS, Caetano JÁ. KNOWLEDGE AND CARE PRACTICE OF NURSES OF INTENSIVE CARE UNITS REGARDING ACUTE KIDNEY INJURY. TEXTO & CONTEXTO ENFERMAGEM 2020. [DOI: 10.1590/1980-265x-tce-2019-0122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT Objective: to evaluate the knowledge and care practice of nurses in the care of patients with acute kidney injury in an intensive care unit. Method: cross-sectional study with 136 nurses from seven large public hospitals. Knowledge was measured by a questionnaire with 25 objective questions; and care practice, by a checklist with 15 questions. The instrument was created for this research and evaluated by judges regarding reliability, criterion and construct. Correlation tests, bivariate and multivariate analyses were used for data analysis. Results: the percentage of nurses' knowledge about acute kidney injury was 44.96%. The questions with the highest rates of correct answers dealt with nursing care. The percentage of execution of the practice was 47.54%. The most complete care was: applies protocol if the patient becomes hypotensive (89.7%); and checks skin condition, respiratory pattern and peripheral perfusion in complications (88.2%). Regarding professional data, it was observed that having a specialization in intensive care (p=0.034) and attending nephrology in specialization (p=0.030) were determining factors for greater knowledge, while specialization in intensive care (p=0.019) was a determining factor for practice. Conclusion: nurses obtained inadequate knowledge and care practice. It was observed that professionals with specialization in intensive care who attended a discipline or training in the area of nephrology showed better knowledge and care practices, when compared to those who did not. These data contribute to the construction of institutional policies that prioritize permanent education strategies in intensive care units.
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Andrade BRPD, Barros FDM, Lúcio HFÂD, Campos JF, Silva RCD. Intensivist nurse performance in the collaborative model of continuous hemodialysis: links with patient safety. Rev Esc Enferm USP 2019; 53:e03475. [PMID: 31291395 DOI: 10.1590/s1980-220x2018004603475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the Intensive Care Unit nurse's role in the management of continuous hemodialysis within the scope of the collaborative model, analyzing it regarding the links with patient safety. METHOD A descriptive, qualitative, exploratory study based on the Reason safety model performed at the Intensive Care Unit of a specialized hospital, with nurses working in the direct management of continuous hemodialysis, who were interviewed using a script with its contents being thematically analyzed. RESULTS 23 nurses participated. The role of the intensive care nurse in continuous hemodialysis involves performing preparation/planning and monitoring/follow-up activities, based on interaction with technology and the application of specialized knowledge. The adopted collaborative model reflects on its qualification and availability in relation to the activities that need to be performed, with repercussions on patient safety. CONCLUSION There are weaknesses in the participation by intensive care nurses in this continuous hemodialysis model which require elaboration of defensive barriers for the safety of the system.
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Affiliation(s)
| | - Fabiana de Mello Barros
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil
| | | | - Juliana Faria Campos
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Rio de Janeiro, RJ, Brazil
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Andrade BRPD, Barros FDM, Lúcio HFÂD, Campos JF, Silva RCD. Training of intensive care nurses to handle continuous hemodialysis: a latent condition for safety. Rev Bras Enferm 2019; 72:105-113. [PMID: 30942351 DOI: 10.1590/0034-7167-2018-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the repercussions of the training of nurses working in the Intensive Care Unit for the management of continuous hemodialysis regarding the safety of critical patients with acute renal failure. METHOD Qualitative research developed considering James Reason's reference in the Intensive Care Unit of a private hospital. The data was collected with 23 nurses who worked for more than three months in the management of continuous hemodialysis through a semi-structured interview, and analyzed with the thematic content analysis technique. RESULTS There are weaknesses in the training of intensive care nurses for the management of continuous hemodialysis that become a latent failure. Such a failure results in difficulties in handling hemodialysis, with risks for these professionals to commit active failures. FINAL CONSIDERATIONS The training program in service for the management of continuous hemodialysis must be perfected, to develop skills and competencies in nurses and improve their performance.
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Affiliation(s)
| | - Fabiana de Mello Barros
- Universidade Federal do Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Juliana Faria Campos
- Universidade Federal do Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Celestino da Silva
- Universidade Federal do Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro, Rio de Janeiro, Brazil
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Bennett DV. Outside-the-Box Skills Validation of Competency. J Contin Educ Nurs 2019; 50:59-60. [DOI: 10.3928/00220124-20190115-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Andrade BRPD, Barros FDM, Lúcio HFÂD, Campos JF, Silva RCD. EXPERIENCE OF NURSES IN THE MANAGEMENT OF CONTINUOUS HEMODIALYSIS AND ITS INFLUENCES ON PATIENT SAFETY. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the professional experience of intensive care nurses and its influence on their work activities in the continuous hemodialysis process and patient safety in the intensive care unit within the scope of the collaborative model. Method: qualitative and exploratory research, based on the systemic paradigm of patient safety, developed at the Intensive Care Unit of a private institution in the city of Rio de Janeiro, Brazil. There were 23 nurse participants who had been working for more than three months in study scenery and in direct contact with continuous hemodialysis. The data were produced from June to October of 2016 by means of observation, analyzed using thick description as well as semi-structured interviews, and then submitted to the content analysis technique. Results: were organized in two categories: the first one portrays the influence of the professional working experience on the safety of nurses' performance, which verified that in relation to continuous hemodialysis, inexperienced nurses follow guidelines and manuals, without a complete evaluation of this care situation and face difficulties in the performance of everyday care. The second category demonstrates the impact of the nurse´s inexperience on the occurrence of active errors, evidencing actions that result in the occurrence of adverse events. Conclusion: the insertion of inexperienced nurses is a latent condition in the investigated system that results in the occurrence of incidents in the continuous hemodialysis process, requiring the improvement of the collaborative model through the systematic monitoring of the performance of these professionals, such as the proposal of a safety barrier.
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Ede J, Dale A. A service evaluation comparing CVVH and CVVHDF in minimising circuit failure. Nurs Crit Care 2016; 22:52-57. [DOI: 10.1111/nicc.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/21/2015] [Accepted: 10/30/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Jody Ede
- Adult Intensive Care Unit, John Radcliffe Hospital; Oxford OX3 9DU UK
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Albarran J, Scholes J. What's in this issue? Nurs Crit Care 2015; 20:5-7. [PMID: 25557921 DOI: 10.1111/nicc.12156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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