...does not always requires treatment. Because CAUTI infections are common, costly and preventable CMS no longer reimburse hospitals or receive any additional payments to compensate for additional cost for treatment. By Collaborating with nursing efforts to reduce and prevent CAUTI by simply minimizing the unnecessary use of urinary catheters when not needed and facilitating early catheter removal can help to improve care...
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...PROVIDING QUALITY CARE Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units Sung-Hyun Cho, Kyung Ja June, Yun Mi Kim, Yong Ae Cho, Cheong Suk Yoo, Sung-Cheol Yun and Young Hee Sung Aim. To examine the relationship between nurse staffing and nurse-rated quality of nursing care and job outcomes. Background. Nurse staffing has been reported to influence patient and nurse outcomes. Design. A cross-sectional study with a survey conducted August–October 2007. Methods. The survey included 1365 nurses from 65 intensive care units in 22 hospitals in Korea. Staffing was measured using two indicators: the number of patients per nurse measured at the unit level and perception of staffing adequacy at the nurse level. Quality of care and job dissatisfaction were measured with a four-point scale and burnout measured by the Maslach Burnout Inventory. Multilevel logistic regression models were used to determine the relationships between staffing and quality of care and job outcomes. Results. The average patient-to-nurse ratio was 2Æ8 patients per nurse. A fifth of nurses perceived that there were enough nurses to provide quality care, one third were dissatisfied, half were highly burnt out and a quarter planned to leave in the next year. Nurses were more likely to rate quality of care as high when they cared for two or fewer patients (odds ratio, 3Æ26; 95% confidence interval, 1Æ14–9Æ31) or 2Æ0–2Æ5 patients (odds ratio, 2Æ44; 95% confidence interval, 1Æ32–4Æ52), compared...
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...Research Proposal Running head: RESEARCH PROPOSAL 1 Research Proposal Kathryn Keiper Duke University School of Nursing Research Methods N307-01 Dr. Carla Gene Rapp Apr 20, 2005 Research Proposal Table of Contents 2 Introduction……………………………………………………………………………….3 Review of the Literature…………………………………………………………………..4 Purpose……………………………………………………………………………………8 Methods……………………………………………………………………………………9 Design and research questions…………………………………………………….9 Sample……………………………………………………………………………..9 Survey instrument……………………………………………………..…………10 Research procedures……………………………………………………………..10 Informed consent and IRB approval……………………………………………..11 Strengths and Weaknesses……………………………………………………………….11 Timeline and Cost Considerations……………………………………………………….12 Conclusion……………………………………………………………………………….13 Concept Model………………………………………………………………..Appendix A Sample Questions……………………………………………………………..Appendix B References……………………………………………………………………………….18 Research Proposal Research Proposal Introduction Intensive care units (ICUs) were designed to provide highly skilled, lifesaving nursing care to viable patients with acute illnesses or injuries. Patients with chronic and/or terminal illness were not expected to be admitted to these units, with the possible exception of acute exacerbations of reversible complications. Patients whose care needs changed from curative to palliative were intended to be transferred out of critical care to patient care environments more suited to end-of-life care. However...
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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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...Journal of Intensive Care Medicine http://jic.sagepub.com/ The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Carrie S. Sona, Jeanne E. Zack, Marilyn E. Schallom, Maryellen McSweeney, Kathleen McMullen, James Thomas, Craig M. Coopersmith, Walter A. Boyle, Timothy G. Buchman, John E. Mazuski and Douglas J. E. Schuerer J Intensive Care Med 2009 24: 54 originally published online 17 November 2008 DOI: 10.1177/0885066608326972 The online version of this article can be found at: http://jic.sagepub.com/content/24/1/54 Published by: http://www.sagepublications.com Additional services and information for Journal of Intensive Care Medicine can be found at: Email Alerts: http://jic.sagepub.com/cgi/alerts Subscriptions: http://jic.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://jic.sagepub.com/content/24/1/54.refs.html >> Version of Record - Jan 14, 2009 OnlineFirst Version of Record - Nov 17, 2008 What is This? Downloaded from jic.sagepub.com at UNIV OF THE INCARNATE WORD on April 15, 2013 Original Research The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit Journal of Intensive Care Medicine Volume 24 Number 1 January/February 2009 54-62 # 2009 SAGE Publications 10.1177/0885066608326972 http://jicm.sagepub...
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...Pollard, C. L., Wilde, C. D., Pellizzari, S. J., Chebbo, A., Song, J., & ... Meyer, T. (2012). Reduction in the Incidence of Ventilator-Associated Pneumonia: A Multidisciplinary Approach. Respiratory Care, 57(5), 688-696. Abstract BACKGROUND: We report the process implemented in our institution by a task force focused on the reduction of ventilator-associated pneumonia (VAP). METHODS: Retrospective cohort study of all adults admitted to one of our 4 adult ICUs, intubated on invasive mechanical ventilation. We implemented a ventilator bundle in April of 2007; we report the incidence of VAP in 2008, and, after adjustment in the process (oral care performed by respiratory therapists), the incidence in 2009. The primary outcome was reduction of the microbiologically confirmed VAP rate over a 2 year period. Other outcomes were duration of mechanical ventilation, antibiotic days, ICU and hospital stay, and mortality. RESULTS: During the study period, 2,588 patients received invasive mechanical ventilation in the adult ICUs. The VAP rate during 2008 was 4.3/1,000 ventilator days, and the 2009 rate was 1.2/1,000 ventilator days. The 2008 to 2009 VAP rate ratio was significantly greater than 1 (rate ratio 3.6, 95% CI 1.8-8.0, P < .001). Antibiotic days were less in 2009 versus 2008 (Hodges-Lehmann estimate of difference between 2008 and 2009, 1.0, 95% CI 0.0 -1.0, P = .002). The median stay in the ICU was unchanged, and in the hospital was decreased in 2009 (Hodges- Lehmann estimate...
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...Table of Contents Introduction…………………….………………………………………………………………….3 Review of literature………... …………………………………………………………………….3 Framework...............................................................................................................................…... 6 Hypothesis…….. …….……….………………………………………………………………….. 6 Research questions……. …….……………………………………………………………….…...6 Methods…………………….…………………………………………………………………..…4 Design …………………………………..………………………………………………….7 Intervention ……………..……………………………..………………………………….. 7 Sample/Setting …………………….…………………………..……………………………7 Power analysis …………………………………..…………….……………………………8 Instrumentation ...............................................................................................................…...8 Data collection ……………………………………..………….……………………………8 Statistics and data analysis …………………………………………………………….…...9 Expected results …………………………………………………………………………………..9 References cited………………………………………………………………………………….10 Appendix A………………………………………………………………………………………13 Appendix B………………………………………………………………………………………14 Appendix C………………………………………………………………………………………15 Appendix D………………………………………………………………………………………16 Ventilator associated pneumonia and chlorhexidine use in the traumatic brain injured patient Ventilator associated pneumonia (VAP), is defined as, a nosocomial pneumonia that develops more than 48 hours following endotrachial intubation and mechanical...
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...management by doctors combined with concerted nursing efforts have revolutionized the management of critically ill patients. With the persistent demographic trend towards an aging population nearing the age of 65 and above, the number of patients requiring critical care will rise but many patients who might have had no chance of survival can now be treated successfully. And during last two decades critical care medicine has undergone rapid changes and emerged as a discipline by itself. Intensive care units (ICU), also called critical care or intensive therapy departments, is highly specified and sophisticated area of a hospital which is specifically designed, staffed, located, furnished and equipped, dedicated to management of critically ill patients whose conditions are life-threatening and need constant, close monitoring and support from equipment and medication to keep normal body functions going. It is a department with dedicated medical, nursing and allied staff. It operates with defined policies; protocols and procedures, having its own quality control, education, training and research programmes. It is emerging as a separate specialty and can no longer be regarded purely as part of anaesthesia, Medicine, surgery or any other speciality. It has to have its own separate team in terms of doctors, nursing personnel and other staff who are tuned to the requirement of the speciality. Definition: “ICU is the specialty nursing unit designed, equipped, and staffed with specially...
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...Ebony Stewart May 7, 2014 Estimating Health Care Associated Infections and Deaths in U.S Hospitals as Oppose to Medical Malpractice Epidemiology Introduction This study was conducted for two important reasons. Deaths in the United States as well as an estimation to provide information for the number of healthcare-associated infections (HAI) were the purpose. The data sources used were 1) National Nosocomial Infections Surveillance 2) National Hospital Discharge Survey and 3) American Hospital Association all of these sources were used by Centers for Disease Control and Prevention’s. HAI occur in many different healthcare settings: acute care within hospitals, same day surgery centers, long-term facilities, and ambulatory outpatient care in health care clinics. HAI has resulted from and adverse reaction to toxins and evidence of infection isn’t presented during time of admission to hospital. Surveillance has also been a research base for HAI. NNIS is an ongoing system that has collaborated with CDC to monitor data on HAI”S and other nosocomial infections. It covers intensive care units, high risk nursery, and surgical patients. A major goal of NNIS is to develop data to prevent and control nosocomial diseases. NHDS was designed to meet needs of patients from non-federal hospitals that stayed only for a short period of time. The data collected from these surveys is collected to examine the importance of public health. The survey is conducted in three difference...
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...Vivek Punjabi University of Missouri September 2014 Abstract Background: Re-admissions back to the ICU is a growing problem in the United States which is of concern especially since these patients have higher in hospital mortality rates as well as longer inpatient length of stays. The objective of this study is to measure the incidence and determine the predictors of re-admissions to the Adult Intensive Care Unit. Methods: Medline (1946-present) was searched using combinations of the following search terms ‘Intensive Care Units’ OR ’Critical Care’ AND ‘Patient re-admissions’. The searches were limited to abstracts in English language between 1990 and 2014. This search was then narrowed to ‘core clinical journals’ to increase the quality of the articles but this limitation cut the number of articles down to 2/3rd and even though these articles were saved under a separate folder, eventually all 91 articles were included in the final search. The term ‘Intensive Care Units’ were narrowed to include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen...
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...traditional and well-established procedures and practices, health care practitioners are adopting innovative interventions that are based on best practices as well as solid research-based evidence. Evidence-based practice is one such technique and is quickly gaining popularity due to its potential to effectively handle clinical issues and provide better patient care (ANA 2003). Implementation of Evidence Based Practice places additional demands on nurses to apply credible evidence to individual client situations through searching related evidence, using clinical judgments, and considering client values and system resources. To effectively apply the Evidence Based Practice process, in addition to the basic skills required to undertake nursing work, a nurse must have the ability to: identify knowledge gaps, formulate relevant questions, conduct an efficient literature search, apply rules of evidence to determine the validity of studies, apply the literature findings appropriately to the patient's problem, and appropriately involve the patient in the clinical decision making. Evidence Based Practice involves reconciling client values with evidence and clinical judgment, which may be particularly difficult for them due to their limited...
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...Agile Care Team model Name: Institution: Agile Care Team model The current concern in most health care organizations is to devise the appropriate ways that will embrace the management of the departments within the premise. That should create, update, and continuously improve health care delivery aligned with the triple aim initiative. Mostly, their primary goal is to provide appropriate levels of patient care as well as care quality. Additionally, they target the patients and member population as well as well as the optimization of the costs for health care delivery. Thus, health care providers should learn from and implement Lean methodologies since the priorities focus on process efficiencies and health management outcomes. Notably, the focus of the approach is to understand and improve customer value within the organization. That will allow for remote access to various products and services. The improvement targets both the patients and providers, hence optimizing health care delivery. Agile Approach constitute the sequential execution of processes within a given period and provides a feedback loop to the clients to ensure solution validation. The goal of the model is to advance service delivery within various the hospitals since it enhances the relationship between the health providers and the patients. An example of a nurse-managed model The figure above illustrates the Triple Aim Model. Most health care models currently implement various...
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...Improving Hand Hygiene through Education Danielle Pizzoferrato NUR/598- Nursing Research Utilization February 10, 2014 Professor Maria Revell Improving Hand Hygiene through Education Section C: Research Support There has been a plethora of research compiled in regards to hand hygiene and infection control. This research has been the driving force behind evidenced based practice for years and has helped revolutionize effective infection control methods. There are still many gaps to be filled. One of the biggest happens to be improving compliance rates among hand hygiene. This has been classified as a problem, but there is not a large array of research on specific interventions. One of the interventions that have been put under the microscope is the effect that education plays on change behavior to increase hand hygiene compliance. The following research articles emphasize this intervention. Article 1 The first article was entitled “Increasing Hand Hygiene Compliance Requires Culture Change” written by Treon, Kelley, Kneebone, and Miles (2007). The purpose of this research focused on designing an innovative educational intervention to increase overall awareness of infection control practices, and to increase overall hand hygiene compliance. The research question proposed was looking to determine if education can cause change behavior and increase hand hygiene adherence. The design of this research consisted of both qualitative and quantitative research providing a blended...
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...(58%). Eleven cuffs grew a single pathogen and three cuffs grew a mixture, yielding a total of 18 isolates. Meticillin-susceptible Staphylococcus aureus was isolated from eight (33%) cuffs, meticillin-resistant S. aureus was isolated from two (8%) cuffs and Clostridium difficile was isolated from eight (33%) cuffs. This study serves as a reminder that hands are not the only fomite to go from patient to patient on hospital wards, and that measures should be taken to reduce the risks posed by blood pressure cuffs. AANA J. 1996 Apr;64(2):141-5. Nondisposable sphygmomanometer cuffs harbor frequent bacterial colonization and significant contamination by organic and inorganic matter. Base-Smith V. Source University of Cincinnati College of Nursing and Health, Ohio, USA. Abstract In the hurried milieu of operating rooms, emergency departments, and intensive care units, contaminated sphygmomanometers (blood pressure cuffs) may not be routinely sanitized or replaced with clean cuffs between patient use. Previous investigations, though few in number, have identified blood pressure cuffs as potential sources of nosocomial infection or vehicles for transmission of contagion in selected patient populations. In this study, presumed "clean" blood pressure cuffs were cultured and evaluated for organismal proliferation and contamination by organic and inorganic debris....
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...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 4 year colleges or even online (Mahaffey...
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