...Chronic Critical Illness Judith E. Nelson1, Christopher E. Cox2, Aluko A. Hope1,3 and Shannon S. Carson4 + Author Affiliations 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, New York; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; 3Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York; 4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, North Carolina Correspondence and requests for reprints should be addressed to Judith E. Nelson, M.D., J.D., Box 1232, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029. E-mail: Judith.nelson@mssm.edu Next SectionAbstract Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In...
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...What affect does foster care have on children? Is it a stable and supportive environment? Foster care allows kids to have a chance to live a somewhat normal life. There are advantages and disadvantages for kids living in foster homes, but questions arise when there are foster parents that do not provide a stable environment. When we are not aware of these situations of unstable foster homes the kids placed in those foster homes will not have a good survival rate for success. Although there are parents out there that provide security for their foster children, we still need to be aware of the circumstances of kids placed in foster homes that are not safe and secure. Foster care is a great system to provide kids with families who do not...
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... Education level of nurses makes differences in their nursing practice. Many surveys and researches have done to verify the quality of care providing to the patients by the nurses with associate degree and baccalaureate degree. “Research has shown that lower mortality rates, fewer medication errors, and positive outcomes are all linked to nurses prepared at the baccalaureate and graduate degree levels”(American association of colleges of nursing, fact sheet, 2011) EDUCATION LEVELS OF NUSING We have the opportunities to choose different levels of nursing education. That includes diploma, associate degree, baccalaureate degree, masters’ degree and nurse practitioner. As we educated more high levels, we are able to provide quality services to our people with our advanced knowledge. ASSOSCIATE DEGREE OF NURSING This education program mainly focus on technical skills than theoretical knowledge and with this student can become a registered nurse by passing the board exam. Many people like this because this allows a person to work early and earn money. BACCALAUREATE DEGREE OF NURSING This a 4 year course in United States, learn theories and technical skills, make students capable to provide quality care to the patients. Many institutions prefer to hire these nurses to work for specialized care units to advance the standard of nursing care to patients.” The national advisory council on nurse education and practice(NACNEP), policy advisors to congress and secretary of health...
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...Comparing the Competencies of BSN vs ADN C.M. Grand Canyon University August 17, 2014 Why are Baccalaureate nurses more desirable to employers than Associate degree nurses? Both BSN and ADN programs teach the fundamentals of nursing, to include health assessment, medication administration and care planning. Both must pass the NCLEX exam to qualify for entry level practice. But a BSN is a 4 year degree while and ADN is 2 years. BSN programs put more focus on the science of nursing, integrating theories and ethical decision making. Many hospitals are employing BSNs only in order to achieve ‘Magnet status’, recognizing them for quality patient care and nursing excellence. Nurses that are educated at the BSN level vs the ADN level are better trained for the workforce due to their theory background, their focus on evidence based practice and strong critical thinking skills leading to better patient outcomes. A nurse may wonder why knowledge of theory important while caring for patients at the bedside? As a particular religion guides a person for how they should live their life, theories act as guides for nursing practice. A theory provides a nurse with a tool to help them assist with describing, explaining and predicting why they do what they do. Creasia & Friberg, describe how theories provide frameworks to help give direction and guidance for nurses in their education, research and professional practice. (2011, p. 94) BSN programs provide more emphasis on theory than...
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...on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. Data Sources: MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. Study Selection: Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. Data Extraction: Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. Data Synthesis: This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. Conclusions: The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research. ...
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...practice in a health care setting. In the nursing profession, nurses are prepared at different levels. A baccalaureate nurse is a nurse who has completed a four years formal training in a university or senior college and has completed a 120 hours college and has acquired broader understanding in physical and social sciences, nursing research, public and community health, political, economic and social issues. While an associate degree nurse is a nurse who has completed a two years program in a community college and has completed a 60 hours college credit and only acquired understanding of fundamentals of nursing and sometimes lacks some basic knowledge to handle critical issues as they arise in patient care. Although both Educational levels took the same licensure exam after completing their program and have registered nurse license to practice as a registered nurse, there are still some enormous difference between the quality of their work in terms of positive patient outcome, lower mortality rates, quality patient care, clinical competency, administrative/leadership role, critical thinking and decision making. These roles are also incorporated in the GCU college of nursing philosophy where it states” the baccalaureate nursing practice incorporates the role of assessing , critical thinking and communicating , providing care , and teaching and leading,” Studies have linked a positive patient outcome to the educational level of the nurse taking care of the patient, Study...
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...opportunity to understand the reason for the occurrence of an event (McEwen & Willis, 2014, p. 413). In different clinical settings, nurses care for patients amidst all the interruption and distraction and therefore are prone to making medical errors despite their best intentions. Medical errors are common in most healthcare settings and more so in the critical care units. According to the 1999 Institute of Medicine (IOM) report, several thousand people die each year from avoidable medical errors. Medical errors have been defined in different ways by various authors but one that captures the essence of this problem is that contained in the IOM report of 1999 which described this issue as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” (IOM, 1999). Medical errors include but are not limited to medication errors, errors associated with medical and surgical procedures, those associated with transcription and charting activities, adverse drug events, restraint-related injuries, or mistaken identities and are more likely to occur in the emergency room, operating room and critical care units (IOM, 1999; Rogers, Dean, Hwang & Scott, 2008). The purpose of this paper is to address the serious problem of medical errors in healthcare in general and specifically the techniques critical care nurses employ to identify, correct and/or interrupt such problems (Henneman, Gawlinski, Blank, Hennema, Jordan & McKenzie,...
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...(RN) license and can gain employment in the workforce. With licensure as a RN come the core values that each nurse accepts while practicing nursing (Creasia J. & Friberg E., 2011). Both degrees hold the RN to the same level of accountability. These programs show varied curriculums, which produce differences in the outcome of the competencies that each RN exhibits. A BSN program is offered by a four-year college or university. The focus is on theory, collaboration, and evidence based practice, while encompassing and embracing the entire nursing picture. Within the BSN program, students discover perspectives about human diversity and promotion of spiritual and healthy wellbeing, as well as digging deeper into the ethical, political, historical, and social influences that have shaped and continue to shape the world of nursing (American Association of Colleges of Nursing, 2008). The number of BSN program options has steadily increased over the last several years. The ADN program is typically a two year program that centralizes its learning around the clinical skills and tasks of everyday nursing. It focuses on the learning the knowledge and skills required to care for individuals and families during illness and restoration after medical treatment, and usually reflects a more restricted nursing...
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...CONCEPT OF CRITICAL CARE Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. * As defined by the World Federation of Critical Care Nurses: Specialized nursing care of critically ill patients who have manifest or potential disturbances of vital organ functions. Critical care nursing means assisting, supporting and restoring the patient towards health, or to ease the patient’s pain and to prepare them for a dignified death. Aim To establish a therapeutic relationship with patients and their relatives and to empower the individuals’ physical, psychological, sociological, cultural and spiritual capabilities by preventive, curative and rehabilitative interventions. Illnesses and injuries commonly seen in patients on critical care units (CCUs) Gunshot wounds Traumatic injuries Cardiovascular disorders Surgeries Respiratory disorders Shock THE EVOLUTION OF CRITICAL CARE * Forty years of development in critical care and critical care nursing has given rise to a recognized specialty in nursing practice . * Critical care units have evolved over the last four decades in response to medical advances . HISTORICAL PRESPECTIVES * Florence nightingale recognized the need to consider the severity of illness in bed allocation of patients and placed the seriously ill patients near the nurses’ station. * Modern medicines boomed to its higher ladder after world war 2 * Dr. Walter...
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...goal is to work in critical care. My exposure to this area of nursing occurred when my mother was in the intensive care unit following exploratory surgery due to severe abdominal pain which revealed necrosis of a large portion of her large intestine. Following this, she spent many weeks in the intensive care unit with a diagnosis of septic shock. During her time in the ICU, she was mechanically ventilated for several weeks. In addition, she had evidence of kidney injury and subsequent hyperkalemia that resulted in cardiac irregularities. Her experience as a patient and my experience as the family point person in communicating with the healthcare team and observing the nursing staff played an important role that led to my decision to focus my future nursing career on critical care nursing. I was inspired by the overall knowledge, commitment, and diligence of the night shift nurse who cared for my mother consistently. He was very compassionate with us, extremely knowledgeable in responding to all of our questions about the pathophysiology of her condition, and explaining the rationale of the treatment approach made a positive difference in her outcome. “Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care.” (aacn.org) ...
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...ABSTRACT What are the differences in competencies between nurses prepared at the Associate-degree level versus the Baccalaureate-degree level? What are the advantages of the health care industry employing more nurses with a higher level of education? Is raising the educational standard for the nursing profession a means to help improve overall care? Studies have been done to understand the differences, if any, between the two levels of nursing. The health care industry is constantly focused on improving the efficiency and quality of care for patients and the community. These studies and comparisons between the two levels of nursing education are in effort to continue to enhance patient care and treatment outcome. The differences in competencies between nurses prepared at the Associate-degree level (ADN) versus the Baccalaureate-degree level (BSN) in nursing are important in specific settings of the profession where leadership and authoritative decision is required, in my opinion. The advanced nursing education curriculum that is prepared to transition an RN to a BSN has been “designed to facilitate the students’ abilities to creatively respond to continuously changing health care systems throughout the world” (Grand Canyon University College of Nursing Philosophy). I believe the two separate programs both help to prepare nurses with the practical skills needed to be successful in any basic clinical setting, while the BSN helps to build upon these skills and increases...
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...Intensive Care Units (ICUs) have undergone an impressive improvement and expansion over the last 50 years. In 1958, approximately 25% of community hospitals with more than 300 beds reported having an ICU. By 1997, more than 5,000 ICUs were operational in hospitals across the United States (7). Evidence has shown that the presence of specialized critical care teams which include an intensivist physician reduce patient mortality and morbidity (8, 9). The medical literature strongly supports the premise that patient outcomes in the ICU are improved when care is directed by a dedicated intensivist.15 High quality care to critically ill patients requires the adoption of a 24/7 intensivist model of critical care and the appropriate training, credentialing,...
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...Part Two The organization, that has been selected, is a Critical Access Hospital. A Critical Access Hospital also known as (CAH) is considered a hospital that is under a set of Medicare Conditions of Participation (CoP). With that being said, it is structured differently than the acute hospital CoP. With some of the requirements for the Critical Access Hospital certification that will include having not more than a 25 inpatient bed, while maintaining an annual average length of stay of no more than 96 hours for an acute inpatient care, while offering a 24 hour and 7 day a week emergency care. That being stated they are in a rural area, at least 35 miles away from any other hospital or CAH (What Are Critical Access Hospitals (CAH)?" n.d.). The limited size and the short stay being allowed to CAH's is to encourage a focus on providing the care for common conditions and the outpatient care, meanwhile referring other conditions to larger hospitals (What Are Critical Access Hospitals (CAH)?", n.d.). . The certification will allow Critical Access Hospitals to receive cost-based reimbursement from Medicare instead of the standard fixed payment rate, this compensation has been shown to enhance the financial performance of the small rural hospitals that have been losing money prior to the CAH conversion and has reduced to the hospital closure rates (What Are Critical Access Hospitals (CAH)?” n.d.). According to "What Are Critical Access Hospitals (CAH)?” CAH is not considered to be ideal...
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...Health care is a field that is changing dramatically. Many practicing nurses have various degrees in nursing like Associate Degree, Diploma, Baccalaureate and Master’s degree. Due to the varying levels of education and training, differences exist between the nurses prepared with an Associate degree (ADN) when compared to those nurses who have trained in a Baccalaureate degree (BSN). Though nurses getting these degrees have their differences in preparation, nurses earning these degrees have adequate theoretical and clinical learning experiences. The license qualifying examination for many states- National Council Licensure Examination (NCLEX) - does not differentiate between ADN and BSN degree prepared nurses and allows nurses with both degrees to take the licensing examination after completion of the degree regardless of the educational background of the applicant. The differences in competencies between nurses prepared with an ADN compared to those prepared with a BSN include the quality of training and duration of the course. From research shown in many well published studies and from my own practice, I feel that such differences in training create various approaches to patient management in similar clinical situations and hence do have a variable effect on patient outcomes. Nurses with an ADN or a BSN have distinctive differences in their preparation to get their degree. Nurses with an ADN obtain their degree through attending community colleges, nursing schools, or other...
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...prepared at a baccalaureate degree level are more competent in critical thinking, communication skills and leadership than nurses prepared at an associate degree level. Currently nurses spend the greatest amount of time at the bedside of the patient yet they have the least time spent being educated about the increasingly complex issues their patients face. Ancillary personal, such as social services and physical therapists are required to have graduate level educations, yet nurses do not. Why not? The ADN program was developed during the World War II as a way to produce more nurses to meet the rising shortage of nurses. The associate degree nursing programs are 2 years of education. They are taught fundamentals and basic nursing with a heavy focus on skills. It is task orientated through clinical training. It was designed to be a short time solution. The baccalaureate degree nursing programs are 4 years. The studies include all the ADN education study, but also include social science, nursing research, nursing management, quality and patient safety, and professional values. BSN students are offered a comprehensive understanding of the nursing profession. At the completion of both studies, successful students are eligible to take the National Council Licensure Exam (NCLEX). The first difference in competencies is a higher level of critical thinking in a BSN educated nurse. The dictionary.com website defines critical thinking as “disciplined thinking that is clear, rational,...
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