American journal of critical care : an official publication, American Association of Critical-Care Nurses
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For patients with head and neck cancer who have undergone microvascular free flap surgery, securing a tracheostomy collar onto the neck using the traditional method (ie, with tracheostomy ties) is contraindicated because the ties may compress the newly vascularized tissue. However, no clear guidance exists for the use of other methods in these patients. Current techniques often use safety pins, which can cause injury to staff members. ⋯ Several practical methods exist for securing a tracheostomy collar in patients with head and neck cancer who have undergone free flap surgery. These methods may be good alternatives to the use of safety pins.
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Enteral feeding intolerance, a common type of gastrointestinal dysfunction leading to underfeeding, is associated with increased mortality. Tracheal pepsin A, an indicator of microaspiration, was found in 39% of patients within 24 hours of enteral feeding. Tracheal pepsin A is a potential biomarker of enteral feeding intolerance. ⋯ Four predictor variables for tracheal pepsin A (microaspiration) are also reported predictors of enteral feeding intolerance, supporting the exploration of tracheal pepsin A as a potential biomarker of enteral feeding intolerance. Identification of predictor variables using machine learning models may facilitate treatment of patients at risk for enteral feeding intolerance.
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Moral distress affects the well-being of health care professionals and can lead to burnout and attrition. Assessing moral distress and taking action based on this assessment are important. A new moral conflict assessment (MCA) designed to prompt action was developed and tested. ⋯ The evaluation revealed positive and negative features of the MCA. Prevention and amelioration of moral distress require attention to cultural, structural, and leadership issues through education and communication.
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Family satisfaction with intensive care is a measure of patient experience and patient-centered care. Among the factors that might influence family satisfaction are the timing of patient admittance to the intensive care unit (ICU), the ICU environment, and individual health care providers. ⋯ Family satisfaction with an ICU admission was not influenced by the timing of the admission. Overall satisfaction with the ICU was high. The qualitative analysis points to the importance of collecting qualitative data in addition to using standard survey tools to capture the richness of patient experience. Ongoing efforts to engage with families remain critical to the practice of family- and patient-centered care in the ICU.