Critical care nursing quarterly
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The American Association of Critical-Care Nurses (AACN) is the world's largest specialty nursing organization. The AACN Certification Corporation provides credentialing to validate nursing practice in acute and critical care. ⋯ In their role as tele-ICU nurses, these skills are applied to the assessment, evaluation, and decision support of care for critically ill patients in various acute and critical care units from remote locations connected directly to the ICU through high-speed audio and video technology. This article outlines the journey of the advent of the CCRN-E (registered nurse in critical care) credential and its place in the new specialty of tele-ICU nursing practice.
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Technology always changes, yet change or evolution within the tele-ICU has been slow. In developing a modern telemedicine system to manage acute illness, there are several concepts the developer/administrator should consider to include "scalability," centralized/decentralized systems, open/closed architecture, inclusivity of the medical community, mobile technology, price set, and governmental regulation. The intent of this manuscript is to apply these concepts to current tele-ICU technology, explain the concepts in some depth, and finally, to speculate as to how the future tele-ICU might look.
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Management of the patient in the intensive care unit requires constant vigilance and monitoring. The nursing staff, and physicians must be readily available to alter therapy in response to adverse physiological changes and life-threatening events. In the face of limited staffing and overwhelming workloads, telemedicine has become a mainstay in ensuring safety for the critically ill patient. Nurses must respond to the challenge to utilize every aspect of this technology, and to become an active partner in improving the utilization of this tool for accessing physician interface and ensuring support when decision-making and immediate actions are required for optimum clinical outcomes.
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The success of telemedicine applications within health care begins with the process of implementing planned change. The attitudes of staff and their willingness to embrace new technology can be positively influenced in order to gain acceptance of new ways to perform tasks. Telemedicine applications have been designed to improve operational efficiency and obtain improved outcomes, but system designers and procurers are dependent upon the organization's leadership to effect attitudinal and behavioral changes that are essential for acceptance and usage of new technology.
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Comparative Study
Advance directives in an intensive care unit: experiences and recommendations of critical care nurses and physicians.
This study explored the experiences of critical care nurses and physicians with advance directives (ADs) in an intensive care unit (ICU) to identify the benefits and limitations of ADs and recommendations for improvement. ⋯ Results supported numerous problems with ADs described previously and identified additional problems, including inability of ADs to prevent unwanted aggressive treatments outside of health care facilities, and patient reluctance to share ADs for fear of physicians "throwing in the towel" too early. Although most subjects described ADs as "useless," one helpful aspect was using ADs to shift perceptions of responsibility for end-of-life decision making and outcomes from the family/providers to the patient by reframing "pulling the plug" to "honoring patient wishes." Recommendations are described, including evolving the current emphasis of increasing completion of ADs to encourage patient-family discussions focused on quality of life to increase the likelihood of discussions occurring.