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Halm MA. On Low-Value Nursing Care: Part 1, Why De-implementation Matters for Quality Care. Am J Crit Care 2022; 31:338-342. [PMID: 35773189 DOI: 10.4037/ajcc2022857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Margo A Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
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Von Rueden KT. Bridging the Gap Between Clinical Practice and the AACN Practice Alert on Pulmonary Artery/Central Venous Pressure Monitoring in Adults. AACN Adv Crit Care 2020; 31:34-40. [PMID: 32168514 DOI: 10.4037/aacnacc2020888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Measuring and documenting accurate data from pulmonary artery and central venous pressure catheters is an important responsibility of critical care nurses. The American Association of Critical-Care Nurses Practice Alert titled Pulmonary Artery/Central Venous Pressure Monitoring in Adults provides evidence-based standards against which nurses can compare their practice related to obtaining valid hemodynamic data. Identifying and acting on improvement opportunities is also a nursing responsibility and helps to ensure that patients with pulmonary artery or central venous pressure catheters receive high-quality care. This article reviews various strategies to compare nursing practice to the Pulmonary Artery/Central Venous Pressure Monitoring in Adults Practice Alert and to close identified gaps in clinical practice.
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Affiliation(s)
- Kathryn T Von Rueden
- Kathryn T. Von Rueden is a Critical Care Consultant, 913 Ravenshead Hill, Sherwood Forest, MD 21405
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Hallyburton A, Biswas P. Searching for the “sacred cow”: a conceptual analysis of the term in nursing literature. JOURNAL OF DOCUMENTATION 2018. [DOI: 10.1108/jd-05-2018-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The idiom “sacred cow” is problematic due to its inaccuracy and cultural insensitivity. The purpose of this paper is to examine the term’s meaning within the nursing literature, describe connotations in religious contexts, explore subject headings applied to research using the phrase, and discuss alternative terminology.
Design/methodology/approach
This paper employs Rodgers’ evolutionary concept analysis methodology to identify the concept “sacred cow” and surrogate terms, collect and analyze sample articles and headings, explore an exemplary case, and look for concept implications.
Findings
The term “sacred cow” appears frequently in the healthcare literature, particularly within the nursing literature. Its meaning within this literature pertains primarily to practices not supported by empirical evidence and performed to maintain a status quo. Headings applied to the relevant literature do not describe this concept, and more accurate headings could not be found within widely used controlled vocabularies.
Research limitations/implications
“Sacred cow” is an inaccurate descriptor for practices not supported by evidence as these practices do not usually apply to holiness or cattle. The term’s implied meaning comes only when viewed within a context satirizing beliefs considered as “other.”
Originality/value
This paper appears to be the first to methodically explore the concept of “sacred cow” within the nursing literature. The paper breaks ground in proposing solutions for the lack of applicable controlled vocabulary. By exploring these topics, it is hoped future authors use more accurate, culturally neutral terminology when discussing non-evidence-based practices and indexers increase discoverability by using more descriptive headings.
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Bourgault AM, Heath J, Hooper V, Sole ML, Nesmith EG. Methods used by critical care nurses to verify feeding tube placement in clinical practice. Crit Care Nurse 2016; 35:e1-7. [PMID: 25639583 DOI: 10.4037/ccn2015984] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The 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. OBJECTIVES To determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses. METHODS This 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. RESULTS Seventy-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. CONCLUSIONS Implementation 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.
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Affiliation(s)
- Annette M Bourgault
- Annette M. Bourgault is an assistant professor and interim assistant dean for assessment and development at Georgia Regents University, College of Nursing, in Augusta.Janie Heath is dean of the College of Nursing at University of Kentucky in Lexington.Vallire Hooper is the manager of nursing research at Mission Hospital in Asheville, North Carolina.Mary Lou Sole is the Orlando Health Distinguished Professor at University of Central Florida, College of Nursing, in Orlando.Elizabeth G. NeSmith is an associate professor and chair of the Department of Physiological and Technological Nursing at Georgia Regents University, College of Nursing, in Augusta.
| | - Janie Heath
- Annette M. Bourgault is an assistant professor and interim assistant dean for assessment and development at Georgia Regents University, College of Nursing, in Augusta.Janie Heath is dean of the College of Nursing at University of Kentucky in Lexington.Vallire Hooper is the manager of nursing research at Mission Hospital in Asheville, North Carolina.Mary Lou Sole is the Orlando Health Distinguished Professor at University of Central Florida, College of Nursing, in Orlando.Elizabeth G. NeSmith is an associate professor and chair of the Department of Physiological and Technological Nursing at Georgia Regents University, College of Nursing, in Augusta
| | - Vallire Hooper
- Annette M. Bourgault is an assistant professor and interim assistant dean for assessment and development at Georgia Regents University, College of Nursing, in Augusta.Janie Heath is dean of the College of Nursing at University of Kentucky in Lexington.Vallire Hooper is the manager of nursing research at Mission Hospital in Asheville, North Carolina.Mary Lou Sole is the Orlando Health Distinguished Professor at University of Central Florida, College of Nursing, in Orlando.Elizabeth G. NeSmith is an associate professor and chair of the Department of Physiological and Technological Nursing at Georgia Regents University, College of Nursing, in Augusta
| | - Mary Lou Sole
- Annette M. Bourgault is an assistant professor and interim assistant dean for assessment and development at Georgia Regents University, College of Nursing, in Augusta.Janie Heath is dean of the College of Nursing at University of Kentucky in Lexington.Vallire Hooper is the manager of nursing research at Mission Hospital in Asheville, North Carolina.Mary Lou Sole is the Orlando Health Distinguished Professor at University of Central Florida, College of Nursing, in Orlando.Elizabeth G. NeSmith is an associate professor and chair of the Department of Physiological and Technological Nursing at Georgia Regents University, College of Nursing, in Augusta
| | - Elizabeth G Nesmith
- Annette M. Bourgault is an assistant professor and interim assistant dean for assessment and development at Georgia Regents University, College of Nursing, in Augusta.Janie Heath is dean of the College of Nursing at University of Kentucky in Lexington.Vallire Hooper is the manager of nursing research at Mission Hospital in Asheville, North Carolina.Mary Lou Sole is the Orlando Health Distinguished Professor at University of Central Florida, College of Nursing, in Orlando.Elizabeth G. NeSmith is an associate professor and chair of the Department of Physiological and Technological Nursing at Georgia Regents University, College of Nursing, in Augusta
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Makic MBF, Rauen C, Jones K, Fisk AC. Continuing to challenge practice to be evidence based. Crit Care Nurse 2016; 35:39-50. [PMID: 25834007 DOI: 10.4037/ccn2015693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts.
| | - Carol Rauen
- Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts
| | - Kimmith Jones
- Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts
| | - Anna C Fisk
- Mary Beth Flynn Makic is a research nurse scientist in critical care at University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing, Aurora, Colorado.Carol Rauen is an independent clinical nurse specialist and education consultant in The Outer Banks of North Carolina.Kimmith Jones is the director of translation to nursing practice at the University of Maryland Medical Center, Baltimore, Maryland.Anna C. Fisk is a senior leadership nurse in the cardiac intensive care unit at Boston Children's Hospital, Boston, Massachusetts
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Confirming nasogastric tube placement: Is the colorimeter as sensitive and specific as X-ray? A diagnostic accuracy study. Int J Nurs Stud 2016; 61:248-57. [PMID: 27415975 DOI: 10.1016/j.ijnurstu.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The effect of delivering enteral nutrition or medications via a nasogastric tube that is inadvertently located in the tracheobronchial tract can cause respiratory complications. Although radiographic examination is accepted as the gold standard for confirming the position of patients' enteral tubes, it is costly, involves risks of radiation, and is not failsafe. Studies using carbon dioxide sensors to detect inadvertent nasogastric tube placements have been conducted in intensive care settings. However, none involved patients in general wards. OBJECTIVE The objective of this study was to ascertain the diagnostic measure of colorimeter, with radiographic examination as the reference standard, to confirm the location of nasogastric tubes in patients. DESIGN A prospective observational study of a diagnostic test. SETTING This study was conducted in the general wards of an approximately 1100-bed acute care tertiary hospital of an Academic Medical Center in Singapore. PARTICIPANTS Adult patients with nasogastric tubes admitted to the general wards were recruited into the study. METHODS The colorimeter was attached to the nasogastric tube to detect for the presence of carbon dioxide, suggestive of a tracheobronchial placement. The exact location of the nasogastric tube was subsequently confirmed by a radiographic examination. RESULTS A total of 192 tests were undertaken. The colorimeter detected carbon dioxide in 29 tested nasogastric tubes, of which radiographic examination confirmed that four tubes were located in the tracheobronchial tract. The colorimeter failed to detect carbon dioxide in one nasogastric tube that was located in the tracheobronchial tract, thus, demonstrating a sensitivity of 0.80 [95% CI (0.376, 0.964)]. The colorimeter detected absence of carbon dioxide in 163 tested nasogastric tubes in which radiographic examination confirmed 160 gastrointestinal and one tracheobronchial placements, demonstrating a specificity of 0.865 [95% CI (0.808, 0.907)]. The colorimeter detected one tracheobronchial nasogastric tube placement that the radiographic examination was misinterpreted. CONCLUSION The study found that the use of the colorimeter in the general ward setting was not 100% sensitive or specific in ascertaining the location of a nasogastric tube as previously reported by many studies undertaken in intensive care settings. This is the first study on the use of a colorimeter to confirm the placement of a nasogastric tube in adult patients in the general ward setting. More research on the use of a colorimeter in the general ward setting and its potential use in certain processes for confirming the placement of a nasogastric tube is warranted.
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8
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Makic MBF, Rauen C. Maintaining Your Momentum: Moving Evidence Into Practice. Crit Care Nurse 2016; 36:13-8. [PMID: 27037334 DOI: 10.4037/ccn2016568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is an associate professor, College of Nursing, University of Colorado, Aurora, Colorado. Dr Makic is a recognized expert in critical care and evidence-based practice.Carol Rauen is an independent clinical nurse specialist and education consultant. Carol is a recognized expert in critical care nursing and certification instruction.
| | - Carol Rauen
- Mary Beth Flynn Makic is an associate professor, College of Nursing, University of Colorado, Aurora, Colorado. Dr Makic is a recognized expert in critical care and evidence-based practice.Carol Rauen is an independent clinical nurse specialist and education consultant. Carol is a recognized expert in critical care nursing and certification instruction
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10
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The wicked question answered: positive deviance delivers patient-centered care. Dimens Crit Care Nurs 2015; 33:142-50. [PMID: 24704739 DOI: 10.1097/dcc.0000000000000038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients. OBJECTIVES The purpose was to understand nursing care when standard practice guidelines did not meet patient-specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care. METHODS Complexity theory and the framework of a wicked question were used to guide a 3-round online national Delphi study from November 2011 to February 2012. The panel was accessed through the American Association of Critical Care Nurses to expose the care provided when standard practice guidelines were lacking. RESULTS Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Dominant themes of positive deviance are recommended as priorities for future research. DISCUSSION Better guidelines are needed that work for nurses, instead of against them, that would not force a nurse into actions that are not patient centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.
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Makic MBF, Rauen C, Watson R, Poteet AW. Examining the evidence to guide practice: challenging practice habits. Crit Care Nurse 2015; 34:28-45; quiz 46. [PMID: 24692464 DOI: 10.4037/ccn2014262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
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.
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Hanrahan K, Wagner M, Matthews G, Stewart S, Dawson C, Greiner J, Pottinger J, Vernon-Levett P, Herold D, Hottel R, Cullen L, Tucker S, Williamson A. Sacred Cow Gone to Pasture: A Systematic Evaluation and Integration of Evidence-Based Practice. Worldviews Evid Based Nurs 2015; 12:3-11. [DOI: 10.1111/wvn.12072] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kirsten Hanrahan
- Associate Research Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Michele Wagner
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Grace Matthews
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Stephanie Stewart
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Cindy Dawson
- Director, Clinical Functions, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Joseph Greiner
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Jean Pottinger
- Infection Preventionist, Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Paula Vernon-Levett
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Debra Herold
- Education Director, Heart and Vascular Center, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Rachel Hottel
- Advanced Practice Nurse, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Laura Cullen
- Evidence-Based Practice Scientist, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Sharon Tucker
- Director, Nursing Research, Evidence-Based Practice and Quality, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Ann Williamson
- Associate Vice President for Nursing, Chief Nursing Officer, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics; Iowa City IA USA
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Chiavetta NM, Martins AR, Henriques IC, Fregni F. Differences in methodological quality between positive and negative published clinical trials. J Adv Nurs 2014; 70:2389-403. [DOI: 10.1111/jan.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2014] [Indexed: 12/24/2022]
Affiliation(s)
- Noelle M. Chiavetta
- Spaulding Neuromodulation Center; Spaulding Rehabilitation Hospital and Massachusetts General Hospital; Boston Massachusetts USA
| | - Ana R.S. Martins
- Spaulding Neuromodulation Center; Spaulding Rehabilitation Hospital and Massachusetts General Hospital; Boston Massachusetts USA
| | | | - Felipe Fregni
- Harvard Medical School Director; Spaulding Neuromodulation Center; Spaulding Rehabilitation Hospital and Massachusetts General Hospital Director; Principles and Practice of Clinical Research; Harvard Medical School; Boston Massachusetts USA
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Kang JH, Suh IS, Kim JY. Intensive Care Unit Nurses' Knowledge and Nursing Practices regarding Bedside Electrocardiograph Monitoring. ACTA ACUST UNITED AC 2014. [DOI: 10.5977/jkasne.2014.20.1.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. At the University of Michigan, we have turned the tides by creating a structured process to get our patients moving through the use of a standardized mobility protocol. Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.
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Affiliation(s)
- Jennifer McFarlane
- Huntington Hospital, 100 West Cakifornia Boulevard, Pasadena, CA 91105, USA.
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Makic MBF, Martin SA, Burns S, Philbrick D, Rauen C. Putting Evidence Into Nursing Practice: Four Traditional Practices Not Supported by the Evidence. Crit Care Nurse 2013; 33:28-42. [DOI: 10.4037/ccn2013787] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Mary Beth Flynn Makic
- Mary Beth Flynn Makic is a research nurse scientist at the University of Colorado Hospital and an associate professor at the University of Colorado, College of Nursing in Aurora
| | - Sarah A. Martin
- Sarah A. Martin is a pediatric nurse practitioner and cares for inpatients on the pediatric surgery service at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois. She is the associate editor for the Journal of Pediatric Health Care
| | - Suzanne Burns
- Suzanne Burns is an advanced practice nurse in critical care and a professor of nursing in the acute and specialty care program at the University of Virginia Health System in Charlottesville
| | - Dinah Philbrick
- Dinah Philbrick is a staff nurse on the intravenous team and a member of the Evidence Based Practice Council at Northern Westchester Hospital, Mt Kisco, New York
| | - Carol Rauen
- Carol Rauen is an independent clinical nurse specialist and education consultant in Kill Devil Hills, North Carolina
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Affiliation(s)
- Maureen A Seckel
- Medical Critical Care/Pulmonary Unit, Christiana Care Health System, Newark, DE 19718, USA.
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Mobilization of Intensive Care Cardiac Surgery Patients on Mechanical Circulatory Support. Crit Care Nurs Q 2013; 36:73-88. [DOI: 10.1097/cnq.0b013e31827532c3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Amidei C. Mobilisation in critical care: a concept analysis. Intensive Crit Care Nurs 2012; 28:73-81. [PMID: 22326102 DOI: 10.1016/j.iccn.2011.12.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 11/30/2011] [Accepted: 12/12/2011] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this paper is to analyse the concept of mobilisation within the context of the critical care setting. Mobilisation is a widely used term that belies the complexity of its use in practice. Whilst facilitating movement is a significant nursing concern, mobilisation practices vary widely amongst nurses, perhaps due to conceptual incongruence. METHODS Evolutionary methodology was used in this concept analysis. Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Database of Systematic Reviews and PsycInfo databases were searched from 1966 to present. Search terms included mobilisation, mobility and passive exercise, yielding 61 articles suitable for analysis. FINDINGS Findings indicate that mobilisation is an interdisciplinary, goal-directed therapy used to facilitate movement and improve outcomes. It involves energy expenditure and has both physical and psychological domains. Disciplines vary in applications of mobilisation and therapy parameters are essentially undefined. The energy expenditure attribute has been well-exemplified in physical therapy literature, but only to a minimal degree in nursing literature. CONCLUSION In spite of the wide use of mobilisation, the concept requires further development, particularly in the critical care setting. Barriers to mobilisation require further delineation as does the psychological domain. Ongoing concept analysis can be used to inform practice and guide research activities.
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Affiliation(s)
- Christina Amidei
- University of Central Florida, College of Nursing, Orlando, FL 32816, United States.
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Watson S, Aguas M, Bienapfl T, Colegrove P, Foisy N, Jondahl B, Yosses MB, Yu L, Anastas Z. Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate? J Perianesth Nurs 2011; 26:135-42. [PMID: 21641528 DOI: 10.1016/j.jopan.2011.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 12/10/2010] [Accepted: 02/07/2011] [Indexed: 11/19/2022]
Abstract
The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values.
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Affiliation(s)
- Sheri Watson
- Providence Portland Medical Center, Post Anesthesia Care Unit, Portland, OR 97213, USA.
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Affiliation(s)
- Shelley L Miller
- practical nursing instructor Francis Tuttle Technology Center. Oklahoma City, OK USA
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Evenson L, Farnsworth M. Skilled Cardiac Monitoring at the Bedside: An Algorithm for Success. Crit Care Nurse 2010; 30:14-22. [DOI: 10.4037/ccn2010471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The ECG lead monitoring algorithm was developed to provide a tool to assist bedside nurses in monitoring ST segments and dysrhythmias.
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Affiliation(s)
- Laura Evenson
- Laura Evenson is the nurse manager of a neurosurgical unit at Saint Marys Hospital, Mayo Clinic, Rochester, Minnesota. When this project was done, Laura was the clinical nurse specialist in the medical intensive care unit at St Marys Hospital
| | - Monica Farnsworth
- Monica Farnsworth is a nursing education specialist in the cardiac surgery and transplant intensive care and progressive care units, Division of Education and Professional Development, and an assistant professor of nursing in the College of Medicine, Mayo Clinic, Rochester
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Physiological rationale and current evidence for therapeutic positioning of critically ill patients. AACN Adv Crit Care 2009; 20:228-40; quiz 241-2. [PMID: 19638744 DOI: 10.1097/nci.0b013e3181add8db] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. This article reviews therapeutic positions including stationary positions (supine, semirecumbent with head of bed elevation, lateral, and prone) and active repositioning (manual, continuous lateral rotation, and kinetic therapy). The physiological rationale and current evidence for each position are described. Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.
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Abstract
Patient safety is one of the most critical issues for health care today. The escalating need to decrease preventable complications serves as a significant catalyst to identify and use evidence-based practice (EBP) at the bedside. Decreasing preventable complications requires a synergistic relationship between the nurses at the bedside and nursing leadership. This article presents an overview of the concepts and the specific structures and processes used at Baylor Health Care System to increase the use of EBP and improve patient safety.
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Affiliation(s)
- Dora Bradley
- Nursing Professional Development, Baylor Health Care System, Corporate Office of Chief Nursing Officer, 2001 Bryan Tower, Suite 600, Dallas, TX 75201, USA.
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Bourgault AM, Halm MA. Feeding tube placement in adults: safe verification method for blindly inserted tubes. Am J Crit Care 2009; 18:73-6. [PMID: 19116408 DOI: 10.4037/ajcc2009911] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Annette M. Bourgault
- Annette M. Bourgault is an instructor with the department of Physiological and Technological Nursing, Medical College of Georgia, Augusta, where she teaches critical care, medical/surgical nursing, and evidence-based practice. Margo A. Halm is a clinical nurse specialist and director of nursing research and quality at United Hospital in St Paul, Minnesota, where she leads and mentors staff in principles of clinical research and evidence-based practice
| | - Margo A. Halm
- Annette M. Bourgault is an instructor with the department of Physiological and Technological Nursing, Medical College of Georgia, Augusta, where she teaches critical care, medical/surgical nursing, and evidence-based practice. Margo A. Halm is a clinical nurse specialist and director of nursing research and quality at United Hospital in St Paul, Minnesota, where she leads and mentors staff in principles of clinical research and evidence-based practice
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