Evaluation Of An Intensive Care Unit ( Icu )

There have been many studies documented in the literature regarding the reduction of CLABSIs. The majority of the studies have reported statistically significant decreases in CLABSI rates post-implementation of a quality improvement initiative (O‟Grady et al., 2011). Some studies used approaches in which multiple strategies have been implemented together to improve compliance with the use of evidence-based guidelines. A seminal study conducted by Pronovost et al. (2006), known as the Keystone ICU project, included a collaborative cohort of 108 ICUs within the state of Michigan. The strategies in this study included the use of five evidence-based bloodstream infection prevention practices for CVC insertions, use of a checklist to ensure adherence

Some family members seen family presence not only as an essential right but likewise as a mode of giving support to their loved ones in this emergency of life crisis. Though, some family could have concern about feeling sensitively traumatized and beholden to observe the code when families may prefer to decline. Patients besides believed that the family had the right to have their families present. Some patients alleged to felt safer and less frightened when family was present. But, other patients described that they desired to face death alone and did not want estranged folks to be permitted to invade their own privacy. Healthcare workers seen family presence as an occasion to preserve the self-respect and personhood of patients but be frightened physical assault by distressed family members, augmented threats of legal responsibility and subsequent litigation, and loss of control above the code situation. Captivatingly, all parties involved arranged that family presence during the code could result in exposing patients to extended resuscitations in medically fruitless circumstances because the trauma team may be unwilling to call the code in the presence of the family of the patient. In the past decade, nurses have progressively promoted for family presence. Nurses mostly agree that family presence could be favorable for both patients and families, if patients and families wish it. For the reason of this belief, nurses endure to advocate for their patients by making an effort to revise policies that limit family presence in the

Relationships among workers in the ICU of Changeable Medical Center are at best, strained. In the past six months, the unit has expanded from 8 to 12 beds, changed to a different electronic health record vendor, and changed unit managers. Ten of thirty registered nurses have resigned or left, two of the remaining twenty are out on sick leave, and absenteeism is at a record high. As the new unit manager, you are looking for ways to improve morale and deal constructively with the many problematic relationship issues.

“The emergency nurse acts with compassion, integrity and respect for human dignity while recognizing and safeguarding the autonomy of the individual”, (ENA, 2015). While this provision appears simply stated, most nurses find it difficult to remember their patient as a human being with intricate needs and basic human rights. As an emergency nurse, I have to keep these needs and rights at the forefront of my thoughts during the care of the patient during a very vulnerable time. Patients come in under stress, sometimes involuntary and at the most desperate times in their lives. I constantly have to make a concerted effort to communicate with the patient during a chaotic time, take time to listen to the patients fears and concerns and communicate those to the team.

Delirium in the Intensive Care Unit (ICU) has become a genuine phenomenon and can be problematic for the patient and the staff caring for them. Delirium occurs when a patient is placed in an unfamiliar environment and has to endure the stress of not just the hospitalization but the stimuli of the environment, which can cause disturbances in consciousness. Patients can become confused, anxious, and agitated; making this difficult for the staff to correctly diagnosis and care for them. Sleep deprivation and environmental factors along with neurotransmitters are strongly related to the occurrence of ICU delirium. ICU staff needs to become more educated on prevention, detection, and proper treatment for the patient experiencing this

In critical care areas, nurses are frequently faced with difficult situations in which they are asked to provide emotional support and comfort to patients and families “experiencing significant emotional pain and/or physical distress” (Lombardo & Eyre, 2011). Lombardo & Eyre (2011) go on to describe fatigue, short attention span, exhaustion, frequent headaches and/or stomachaches, low resistance to becoming ill, depression, and anger as symptoms of compassion fatigue. According to the 2015 National Healthcare Retention & RN Staffing Report, the turnover rate for bedside RN’s has increased over the last 4 years from 11.2% to 16.4%. RN vacancies continue to trend negatively with 24.2% of hospitals reporting a vacancy rate of 10% or greater. The average cost of turnover for a bedside RN ranges from $36,900 to $57,300 resulting in the average hospital losing $6.2M. Critical Care RN’s have

41. Jennings BM. Stressors of critical care nursing. In: Thelan LA, Davie JK, Urden LD, et al., eds. Critical Care nursing. St. Louis, MO: Mosby; 1994. P. 75-84.

The inability to sleep is a source of anxiety and stress for patients in the intensive care unit (ICU); this inability can lead to cardiorespiratory disturbances, immune system dysfunction, impaired wound healing, hormonal and metabolic imbalances, cognitive changes, and delirium. Through the use of quiet times and nursing actions that encourage sleep, or, sleep hygiene bundles, nurses can assist in improving sleep quality in the ICU. These bundles include noise and light reduction, scheduling routine procedures outside of reserved sleep times, the use of earplugs and eye masks, and the grouping of nursing care activities to minimize sleep interruptions. The aim of this proposal, therefore, will be to implement a nurse-driven, sleep hygiene protocol, in order to improve patient care by promoting quality sleep in ICU patients. Barriers to implementation include staff resistance to the concept, concerns regarding patient care during sleep times and difficulties in coordinating care with other units. Studies used to gather information for this proposal were published between the years of 2011 and 2016 and were found in several databases: Academic Search Complete, Medline, and OVID Journals.

Based on the results of the six studies that were analyzed, it can be established that PACU visitation decreases stress and anxiety not only for patients and their families, but also for nursing staff. All studies concluded that, although there are overall concerns around visitation in the PACU, such as limited space, risk of infection, and potential breach of confidentiality, the benefits of visitation outweigh the concerns. All studies were in agreement, showing a drastic change in statistics among staff after being introduced to a visitation policy, leading nurses to start incorporating visitation in their plan of care for their patients. The results of this research can serve as a building block for convincing medical institutions to

Restricting family presence contradicts patient- and family-centered care (PFCC). Within the PFCC paradigm, the patient and family relationship is recognized as an inseparable entity. Encouraging unrestrictive family presence through an open visitation policy can ensure patients and family members are provided with the opportunity to remain connected during a hospitalization experience.1 Despite professional organizations for critical care nursing and patient- and family-centered care advocating for unrestrictive family presence, many critical care units have not adopted an open visitation policy. According to the American Association of Critical-Care Nurses (AACCN),

Patients are the most important piece of the healthcare system and their safety is of the utmost importance. The safety and satisfaction of patients is most directly affected by the work of nurses. Patient and family satisfaction is also shown to improve with more hours of nursing care per day and with registered nurses staffed versus other assistive personnel (Unruh, 2008). When a unit is understaffed, such as this ICU, how are nurses supposed to increase their hours of care per patient when they are asked to care for increasing numbers of high acuity patients? The decrease in nursing care time due to understaffing also causes a rise in hospital acquired infections including, but not limited to, UTI’s,

The purpose of this research group is to evaluate the effectiveness of bed/chair alarms in the prevention/intervention of adults 65 years and older in inpatient settings. The majority of the articles that were reviewed were conducted on inpatients, while the age of adults 65 years and older was not adhered to in every inclusion article.

Patient is a 58 year old female admitted and brought in by ambulance on February 16, 2017 due to PEA (pulseless electrical activity) arrest at home. This patient has a history of hypertension, diabetes type 2, chronic obstructive pulmonary disease (COPD) and found to have a mild pulmonary hypertension with possible interstitial lung disease, mixed connective tissue disease, peripheral neuropathy and bipolar disorder. According to patient’s spouse, the night before the incident, the patient was acting like her usual self and went to sleep around 2330 with her oxygen in place. She was found unresponsive and had foaming at the mouth and was gasping for air. Her code status did not require resuscitation

An episode is described as a continuous patient stay on a single hospital unit and can contain single or multiple nurse shifts or plan of care (POC). The nurses document a POC at every formal handoff (admission, shift change, discharge). Every time a patient is admitted, a new POC is created and updated at every single shift change. The POC, along with the different diagnoses, also includes current ratings for each nursing outcome and an expected rating at discharge (or death) which is the goal for the outcome. The scale of the rating is between 1 and 5 where the best outcome is represented by the score of 5, and the score of 1 symbolizes the worst possible outcome. Different nursing interventions (NICs) are used to achieve the expected outcome and are also contained within the POC record. Additionally, the demographic information of the patients and nurses is also saved in the database along with POC. Examples of two different episodes of Death Anxiety with multiple POCs that nurses documented is provided in the table

This study proposal will take place in one acute care hospital. Registered Nurses working in the Emergency Room, Intensive Care Units, and all Medical-Surgical Units who voluntarily offer to be study participants will be included. In attempts to maintain external validity, exclusion criteria will include any Registered Nurse who has under 2 years of experience as a Registered Nurse and any RN who works on a Per-Diem basis. In addition, factors such as age, race/ethnicity, sex, education level, socioeconomic status, and the shift in which the voluntary participant works will not be considered. Within the specific units, all volunteers who meet eligibility criteria will be included in the study. Within each unit, subgroups will be formulated for the purpose of data collection.