...Research Critique of a Quantitative Study The purpose of this research critique is to inform the reader of a randomized clinical study regarding the treatment of Neonatal Abstinence Syndrome (NAS). This writer is interested in the treatment of drug exposed infants and the goals of reducing babies’ hospitalization in the Neonatal Intensive Care Unit (NICU). The study researches the adjunct therapy for treatment of NAS. The study will be broken down into the following units: protection of human participants, type of data collection utilized in the study, data management and analysis, findings and interpretation of these findings and finally the conclusion of the study and its findings. Protection of Human Participants This study’s goal is to differentiate the efficacy of clonidine versus phenobarbital in adjunct therapy with morphine sulfate in the treatment of NAS. One of the benefits of this study is the importance of standardization of a weaning protocol. The weaning protocol did not change from day to day and provider to provider as can be the case outside of the study. Another benefit is the predefined measures for each study group that were considered adverse events. These measures worked as a safety net to ensure the study was done safely and not causing harm to the babies. One noted concern/risk noted by the author was the potential for prolonged exposure to phenobarbital on a baby’s developing brain. The concern is the phenobarbital may cause behavioral compromises...
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...over. My first short term goal I want to accomplish is being a staff nurse III, in my unit. A staff nurse III position is considered a nurse who is known as a nurse leader in the unit. A staff nurse III, is the resource person in the unit. They are required to keep staff up to date with new information and participate in quality improvement projects. The next step in my professional goal is to become a clinical instructor. Clinical instructors are professionals that teach nursing students to apply knowledge in clinical settings (Koharchik & Jakub, 2014). A long term goal I want to pursue is becoming an neonatal nurse practitioner (NNP). NNP is an advanced nursing practice that utilizes extended and expanded skills, experience and knowledge in assessment, planning, implementation, diagnosis, and evaluation of the care required for neonates (Freed, Dunham, Martyn, Nantais-Smith, & Moran, 2013 ). I enjoy teaching, and the professional goals that I have chosen will give me the opportunity to teach others in a health care setting. Strengths, Ethics, & Values There were a couple reasons that I decided to return to school. First, I wanted to show my son that education is very important. If he wants to have a career, he needs a college degree. I want to teach him that knowledge is key to success. Second, I have been a neonatal intensive care unit (NICU) nurse for seventeen years. I was at a point in my life that I want to further...
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...BRIEFING NOTE ISSUE: Bed crisis situation in Neonatal Intensive Care Unit (NICU). REASON: Inundate of admission of pre-term babies in the NICU related to abundance of pre-term deliveries . Background • Our NICU has expanded from housing 24 beds to current 40 beds in 2013. • Our hospital, as the main referral center for newborn babies suffering from complex and high-risk medical conditions, managed about 400- 450 admissions a year- an increase of 30% compared to a decade ago. • An increase of about 14% in NICU admissions at public sector hospital over the past six years. Current Status • Overcrowding in NICU is housing- 42 premature or ill babies which exceeded the maximum 40 beds. • Risks of compromise infection control, standards of care and privacy. • All ventilators are in used in NICU. • Nurses from other units are deployed to NICU to help out this overwhelming workload. • Insufficient specialized ICU trained staff in NICU to cater the current high work volume • Adding pressure on the unit's resources and staff. • There are still many high risk pregnancy patients currently admitted in Delivery Suite for monitoring. • Hospital is still accepting referral of high risk pregnancy from private sector for further management. Recommendation(s ) 1. Stop accepting referral for high risk management from other hospitals till further notice. 2. Will update the Obstetric Team and departments involve regarding the NICU bed status on a day-to-day basis,...
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...published in. The main problem I have seen with google scholar is that when trying to read the full text article, it often required payment. The second database I decided to explore was PubMed, http://www.ncbi.nlm.gov/pubmed/20334332 . I found this data to also be user friendly. Like google scholar you can go to advance search and put in the time frame of the publication. You could also check whether you wanted to only search full text and peer reviewed articles. The problem I had with PubMed is finding relevant articles in the time frame I needed them to be in. When searching with databases I had to use correct word phrases to get relevant articles. My topic is stridor in infants after intubation. We intubate infants in the Neonatal Intensive Care Unit (NICU) all the time. It is usually an emergency and we intubate as quick as possible, sometimes causing injury. The topic is an interest to me not only because I am a NICU nurse, but because I am a parent of an infant born at 27 weeks gestation, who was intubated at delivery. He had a difficult intubation where the Nurse Practitioner tried to intubate him four times until she got the tube in. I was looking on in horror. Caleb, my son develop stridor and was able to be extubated for one month. My son, now 2 years, has to have all liquids thickened. The article I found to support my topic is Predictors of difficult intubation in ICU: Are children and adults alike? It...
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...Chlorhexidine gluconate and neonatal skin integrity: A research critique Grand Canyon University Introduction to Nursing Research NRS-433V-0101 November 01, 2013 Chlorhexidine gluconate and neonatal skin integrity: A research critique The goal of this research study was to “determine the effects of chlorhexidine gluconate (CHG) skin inflammation and stratum corneum barrier integrity at peripherally inserted central catheter (PICC) sites among patients in the neonatal intensive care setting” (Visscher et al., 2009, p. 802). The benefit of this study was decreased central line associated blood stream infections, the risks of the study were very limited data on the use of CHG on neonatal skin and possible skin irritation beyond dryness or erythema, but a burn. The researchers of this study did identify that the mean gestational age of the infants in this study was 32 1/7 weeks, + 4.7. There were very few infants < 29 weeks gestation, so the researchers were unable to include that age group in the study. Some risks that were not originally identified and became apparent throughout the study was the trauma or irritation caused to the skin with the repeated removal of the tegaderm and the repeated use of CHG. The Institutional Review Board approved this study, and the parents/guardians of the infants provided written informed consent. Although the actual subject did not have the option to participate or not, the parents/guardians of the infants had the choice to participate...
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...Megan McCracken 1/15/16 Professor McElrath English 202- 8:00am The NICU’s Symbolic Significance Symbols are pictures or objects that have different connotations based upon each specific person. Each person’s past must be acknowledged to determine whether the memory associated with the symbol is one of negative or positive influence. A symbol of great importance to me is the NICU (Neonatal Intensive Care Unit). About 4 years ago, my younger sister was flown to mission to be placed in the NICU after birth. The thought of the NICU brings about an abundance of emotional responses. It was a nerve-wracking experience. The anticipation of knowing my sisters fate was almost unbearable and that time will forever leave a mark in my thoughts. The favorable experiences are not what made it memorable it was being terrified that something may have been wrong with my younger sister that made the everlasting impression. My outlook on the NICU has slowly changed from one of terror to one of passion. Not long ago I decided to pursue a career in nursing and specialize in the NICU. Specializing in NICU will give me the ability to relate with families on a personal basis. Although my thoughts on the NICU have transitioned, I know a close friend whose memories of the NICU will most likely haunt them forever. My close friend, Jenna, gave birth to a baby girl in 2006, and her baby was placed in the NICU hours after she was born. Jenna’s baby was born with a rare heart defect which needed many...
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...Neonatal Abstinence Syndrome in the Neonatal Intensive Care Unit Neonatal Abstinence Syndrome (NAS) is the withdrawing process that occurs in the postnatal life of newborns after being born to drug addicted mothers. Heroin, codeine, oxycodone, methadone and buprenorphine are opiates and narcotics that are commonly abused throughout pregnancy. Symptoms that an infant may exhibit within the first 24-72 hours of life are: hyperirritability, excessive sucking, inconsolable crying, sweating, diarrhea, sneezing (3-4 times within 30 minutes), tremors/seizures, poor feeding/regurgitation and mottling of the skin. The Association of Women’s Health, Obstetric and Neonatal Nurses, (AWOHNN), convene on an annual basis nationally and provide monthly webinars on various topics. The organization is subcategorized into multiple chapters within each of the 50 states, in which Pennsylvania has six divisions. “Care of Newborns Prenatally Exposed to Opiates” has been a webinar within the last year based on AWOHNN’s webinar calendar. I chose this committee based on their mission statement of improving and promoting the health of women and infants to support the nursing profession through research and education. The name of the journal published by AWOHNN is the Journal of Obstetric, Gynecologic and Neonatal Nursing (JOGNN). My research was done through CINAHL under Drexel’s library resource and by using the keywords of “neonatal abstinence syndrome”...
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...Decisions, decisions. We all make them, don’t we? Mine is where to live. I live with my husband who is called Graham. At the moment we live in Texas. If you do not know where there that is, it’s in United States of America and it’s the Deep South of America. I mean Deep South of America. It’s more known for its hot weather and a lovely hospitality than Texas Longhorn. Time goes by, when you are having fun. Believe it or not, our initial three-year stay in Texas will be up in August, and the pressure’s on to decide what to next. There is more than a possibility we can stay longer, and the idea is not unattractive. But it really depends on Graham Visa as I got another year on my Visa as Graham only got till December. Everyone who I bump into, into in the streets, are always asking me these annoying questions like; what are you doing right now? Do you think you’ll stay in Texas permanently? Then people back in the UK especially friends and relatives ask these questions; how long does Graham’s contract last? When are you coming back to the UK? Sometimes you come to a crossroads in life. Sometimes you come to a mass of decisions that feels more like Swindon’s magic roundabout. Fort Worth certainly has its good points, that legendary Southern hospitality. People say “Howdy!” when you are walking down the street. Families you barely know invite you for Thanksgiving. Of course lots of sunshine. S-p-a-a-a-c-e. Did you know England has a population density of about 990 people per...
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... 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, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified...
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...Millard Performance Measures An intensive care unit (ICU), also referred to as a critical care unit, is a healthcare operating unit that treats persons who have been inflicted with life-threatening injuries and illnesses. Patients in an intensive care unit are observed closely by specially trained health care providers. Problems that are treated range from accidents to severe breathing problems. Patients are normally exposed to monitors, intravenous (IV) tubs, feeding tubes, catheters, and breathing machines. These particular items are used to extend a patient’s life, but infection risk can become common also. In an intensive care unit, many patients recover and are moved to a regular hospital room to receive care. Death is a common outcome for patients in an intensive care unit. If a patient’s family and health care providers have to make end-of-life decisions, advance directives will help the individuals come to a final decision (“Critical Care“). In the article “The Competitiveness and Balanced Scorecard of Health Care Companies,” the balanced scorecard has become an idea that has become influential to the business aspect. A balanced scorecard measures employee knowledge, relationship with customers, cultures of innovation, and change generated success. Many businesses has improved their performance by improving processes and becoming more competitive in the market (Mavlutova, Babauska, 2013). In the article “Pabon Lasso and Data Envelopment Analysis: A Complementary Approach...
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...acute skills for nurses in critical care wards. In this section of the literature review, we will discuss policies in the nursing profession, case studies and various approaches to work based acute skills learning programmes. For our purposes we conducted a literature search using popular medical databases and terms such as ‘acute skills’ ‘learning programmes’ and ‘critical care learning’. Our review highlights on the several important approaches to work based learning ranging from reflective practice to experiential learning and work based formal practical training to enhance professional skills. A learning programme for acute ward nurses responsible for caring of critically ill patients has been the central focus of nursing practice development. According to Coad et al (2002), a work-based learning approach has been found to empower ward staff with the necessary skills of nursing and the authors studied the efficacy of a five-day competency based high dependency skills course in enhancing professionalism and quality of care in nursing. The aims of comprehensive critical care are developing leadership potential and enhancing networking opportunities for nurses within critical care and acute ward areas. Critical care is the most challenging aspect of nursing care and acute skills in nursing are enhanced not just by work-based learning programs but also from first hand nursing and emergency experiences. Titchen (2003) describes emergency care in which one professional learns from...
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...Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection Barbara C.C. Lam, Josephine Lee and Y.L. Lau Pediatrics 2004;114;e565; originally published online October 18, 2004; DOI: 10.1542/peds.2004-1107 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/114/5/e565.full.html PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2004 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. Downloaded from pediatrics.aappublications.org at University of Southern Queensland Library on August 5, 2014 Hand Hygiene Practices in a Neonatal Intensive Care Unit: A Multimodal Intervention and Impact on Nosocomial Infection Barbara C.C. Lam, MBBS, FRCP(Edin, Lond.), FRCPCH(UK), FHKCPaed; Josephine Lee, RN, MSN; and Y.L. Lau, MD (Hons), FRCP(Edin, Glasg. Lond.) FRCPCH(UK) ABSTRACT. Objective. Health care–associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However...
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...Patient Services/Intensive Care Nurses/Compassion Fatigue Intervention/BESt 173 Best Evidence Statement (BESt) Date: July 17, 2013 Title: Decreasing Compassion Fatigue* among Pediatric Intensive Care Nurses Using Self-Care Skills* and Compassion Fatigue Training* Clinical Question: P (Population/Problem) I (Intervention) C (Comparison) O (Outcome) Among pediatric intensive care nurses does functional knowledge of compassion fatigue and the practice of self-care skills, compared to not, demonstrate less compassion fatigue? Definitions for terms marked with * may be found in the Supporting Information section. Target Population for the Recommendation: Nurses working in pediatric intensive care settings who provide direct patient care Recommendation: It is recommended that nurses working in pediatric intensive care settings receive training that includes compassion fatigue awareness, coping strategies, stress management, relaxation techniques and self-care interventions to decrease the level of compassion fatigue experienced in the work environment (Marine, Ruotsalainen, Serra, & Verbeek (2009) [1a]; Gunusen, & Ustun (2010) [2a]; Kravits, McAllister-Black, Grant, & Kirk (2010) [4a]; Meadors & Lamson (2008) [4a]). Discussion/Synthesis of Evidence related to the recommendation: The evidence referred to a variety of concepts related to the manifestation of compassion fatigue, including burnout, emotional exhaustion, and workplace stress. The concepts...
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...Scandinavian Journal of Infectious Diseases, 2012; 44: 344–349 ORIGINAL ARTICLE Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units EKREM TEMIZ1, NIHAL PISKIN2, HANDE AYDEMIR2, NEFISE OZTOPRAK2, DENIZ AKDUMAN2, GUVEN CELEBI2 & FURUZAN KOKTURK3 From the 1Departments of Infectious Diseases and Clinical Microbiology, Bitlis Government Hospital, Bitlis, 2Departments of Infectious Diseases and Clinical Microbiology, and 3Department of Biostatistics, School of Medicine, Zonguldak Karaelmas University, Zonguldak,Turkey Abstract Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in inten- sive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. Methods: Between April and Octo- ber 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. Results: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 devel- oped nosocomial...
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...sources of support Centre for Clinical Studies - Women's and Children's Health, Mater Hospital, Sth Brisbane, Queensland, AUSTRALIA Department of Health and Ageing, Commonwealth Government, Canberra ACT, AUSTRALIA What's new This review updates the existing review of "Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality" which was published in The Cochrane Library Issue 2, 2003 (Webster 2003). No new trials were identified as a result of this updated search. The conclusions of the review are unchanged. Text of review Synopsis Gowning by attendants and visitors in newborn nurseries for prevention of neonatal morbidity and mortality Newborn nurseries and neonatal intensive care units often require staff and visitors to wear overgowns with the intention of preventing the spread of infection. It has also been thought that putting on an overgown will remind people to wash...
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