American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Randomized Controlled Trial
Effect of Dynamic Light Application on Cognitive Performance and Well-being of Intensive Care Nurses.
Exposure to bright light has alerting effects. In nurses, alertness may be decreased because of shift work and high work pressure, potentially reducing work performance and increasing the risk for medical errors. ⋯ Daytime lighting conditions did not affect intensive care unit nurses' cognitive performance, perceived depressive signs and symptoms, or fatigue. Perceived quality of life, predominantly in the psychological and environmental domains, was lower for nurses working in dynamic light.
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Little is known about the effect of chaplains on critical care nurses who are caring for critically ill patients and their families. ⋯ Nurses considered spiritual care essential to holistic care and valued the support chaplains provide to patients, families, and staff in today's spiritually diverse society.
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Noninvasive Blood Pressure Monitoring and Prediction of Fluid Responsiveness to Passive Leg Raising.
Intravenous fluid boluses are administered to patients in shock to improve tissue hypoperfusion. However, fluid boluses result in clinically significant stroke volume increases in only about 50% of patients. Hemodynamic responses to passive leg raising measured with invasive and minimally invasive methods are accurate predictors of fluid responsiveness. However, few studies have used noninvasive blood pressure measurement to evaluate responses to passive leg raising. ⋯ A passive leg raising-induced change in stroke volume index measured by bioreactance differentiated fluid responders and nonresponders. Pulse pressure and systolic blood pressure measured by oscillometric noninvasive blood pressure monitoring were not sensitive or specific predictors of fluid responsiveness in healthy volunteers.
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Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. ⋯ A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.
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Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. ⋯ Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.