American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Early mobility interventions in the intensive care unit can improve patients' outcomes, yet they are not routinely implemented in many intensive care units. In an effort to identify opportunities to implement and sustain evidence-based practice, prior work has demonstrated that understanding the decision-making process of health professionals is critical for identifying opportunities to improve program implementation. Nurses are often responsible for mobilizing patients, but how they overcome barriers and make decisions to mobilize patients in the intensive care unit is not understood. ⋯ Deciding to mobilize patients in the intensive care unit is a multifaceted, individualized decision made by nurses, and numerous patient-, nurse-, and unit-related factors influence that decision. Future studies that target unit culture and interprofessional perspectives are needed.
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Intensive care unit stays can be stressful for patients' family members. Family-centered communication has 6 components: fostering relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management. Whether these communication components decrease family members' stress is unknown. ⋯ Stress levels were mild to moderate and communication scores were moderate to high. Better nurse communication with family members was associated with decreased acute stress, irrespective of personal characteristics or perceptions of the patient's medical status.
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Delivery of patient education materials to promote health literacy is a vital component of patient-centered care, which improves patients' decision-making, reduces patients' anxiety, and improves clinical outcomes. ⋯ Patients and caregivers strongly suggested that television is a useful tool for providing health literacy education in an intensive care unit.
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Generating evidence for care improvement has characterized my program of research spanning 20 years. Six domains are highlighted to advance the science and practice of critical care nursing in today's complex health care systems. Employee well-being and taking care of team members are key priorities for successful leaders. ⋯ Interventions to mitigate moral distress are necessary to foster moral resilience among critical care nurses. The challenge for the future will be to support organizational health through the coexistence of highly reliable processes and clinical innovation. Excellence is achieved when systems are designed to support professional practice and clinical teams and environments.