Posts Tagged ‘critical care nursing’

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Critical Care 2012: An Educational Extravaganza

May 29, 2012

By Maureen Shawn Kennedy, AJN editor-in-chief

So, for the 12th or 13th time (I’ve lost count), I attended the National Teaching Institute of the American Association of Critical-Care Nurses (the “other” AACN organization, not to be confused with the American Association of Colleges of Nursing) in Orlando last week. And as usual it was impressive—approximately 6,000 attendees, and rows and rows of exhibitors. There were two helicopters, a bus, and an ambulance in the exhibit hall, as well as two-story booths and classrooms. While there were some recruiters looking for staff, they were overshadowed by monitoring companies, bed and equipment manufacturers, and pharmaceutical companies.

Some highlights:

Left to right: Outgoing AACN president Mary Stahl and incoming president for 2013, Kathryn Roberts.

Kudos to the AACN for its creativity in making general sessions lively and interesting. This year, the organization held open auditions for a member to assist as “MC” for the general sessions (or “super sessions”). It was a tie, and attendees were treated to two of their own in action, hamming it up and enjoying the spotlight.

The “TED-talk” presentation style used by both AACN president  Mary Stahl and president-elect Kathryn Roberts was refreshing—and unique for nursing meetings.

I interviewed both presidents—click the link to listen to the podcast (it may take a minute to load). The 2013 president, Kathryn Roberts, MSN, RN, CNS, CCRN, CCNS, is a clinical nurse specialist in the pediatric ICU at The Children’s Hospital of Philadelphia; she chose “dare to” as her theme for the year.

My favorite session, hands down, was Elizabeth Bridges’ “Critical Care Studies You Should Know About,” in which she pulled apart recent research and evaluated it in the context of other studies. She is the only person I know who can have 500+ people laughing and learning statistical analysis. (After hearing her speak last year, I approached her to do a column for AJN. Her column, Critical Analysis: Critical Care, debuted earlier this year with “Central Venous Pressure Monitoring: What’s the Evidence?”—free until June 12. And she’s working on two more.)

The engaging super session featuring Robyn Benincasa—a firefighter, world class adventure racer (think Survivor and The Amazing Race combined), and motivational speaker—illustrated what one could achieve with team support, leadership, and perseverance. (Of course, being in superb shape for firefighting, endurance biking, and mountain climbing doesn’t hurt either.)

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Posted in nursing perspective, nursing research, Shawn Kennedy, AJN editor-in-chief | Tagged , , | Leave a Comment »

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Nurses Week: Comparing Notes on Matters of the Heart

May 9, 2012

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” was published in the May issue of AJN.

Image courtesy of Wikemedia Commons

Earlier this week I took care of a man who nearly coded, rather unexpectedly. I was standing next to his bed when his heart rate slowed suddenly and significantly, with one extraordinarily long pause between beats.

A pause doesn’t have to be extraordinarily long to feel like it is, especially when you’re standing next to someone, palpating their pulse while watching the monitor. In this case, in this five-second pause that felt like minutes, I’d dropped the bed rail, shouted out to my team, and was ready to start chest compressions when his heart beat again. His symptomatic bradycardia was treated accordingly; there were no chest compressions, and it was no code.

I had lunch with a good nurse-friend of mine who works in a nearby hospital. I was telling her how “bradycardia with a five-second pause” feels a lot like asystole, when you’re standing next to your patient, and she was telling me that her hospital had sort of cancelled Nurses Week this year. Instead of the traditional week of silly games, superlative awards, and physician-sponsored lunches, and then a later “Hospital Week,” her facility was having a combined “Team Member Week.”

“It feels like we’ve lost recognition,” my friend said. “We don’t feel appreciated, and we’re angry.”

I definitely see her point. Although Nurses Week festivities can seem campy sometimes, it’s the sentiment behind them that matters, and merging Nurses Week into an “everybody” celebration seems like a poor administrative move. I’m not sure I’d want to work for a hospital that didn’t specifically honor and recognize its nurses.

My friend and I agreed—whether in the case of marked bradycardia with a long pause, or in the exchange of Nurses Week for “Team Member Week,” the rhetoric doesn’t mitigate the reality, nor does it soften the reaction.

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Posted in nursing perspective, professional identity, writing and nursing | Tagged , , | 1 Comment »

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Critical Care: Where’s the Evidence for Central Venous Pressure Monitoring?

January 13, 2012

Editor’s note: This post is by Anne Dabrow Woods, MSN, RN, CRNP, who is AJN‘s publisher and chief nurse and publisher of Wolters Kluwer Health Medical Research. It was originally published on the blog of Lippincott’s Evidence-Based Practice Network.

I read with interest the article “Central Venous Pressure Monitoring: Where’s the Evidence?” (purchase required for nonsubscribers) in the January issue of AJN. It’s part of a series called Critical Analysis, Critical Care, which will appraise the evidence regarding common critical care practices. So much of what we do in nursing is not based on evidence but on how we have always done things in practice—or on research that was not credible.

This article looks at the evidence supporting the use of central venous pressure (CVP) monitoring alone to guide treatment decisions for patients. According to the article, a 2008 systematic review by Marik and colleagues concluded that CVP is not an accurate indicator of intravascular volume, nor is it an accurate predictor of fluid responsiveness (whether a patient will respond to a fluid bolus with an increase in stroke volume). The authors of the AJN article critically appraised the evidence and determined the following:

  • The relationship between intravascular volume and CVP is a weak relationship and clinicians should not use CVP to estimate a patient’s intravascular volume.
  • The absolute CVP value or a change in CVP should not be used to predict a change in the stroke volume or cardiac index.
  • There is not an absolute CVP value that can be used to determine what the next step of treatment should be, be it a fluid bolus or the use of a vasoactive medication.

In brief, the evidence tells us that we can’t base treatment decisions on just one hemodynamic indice. The clinician needs to look at the entire hemodynamic picture, including, for example, heart rate, blood pressure, mean arterial pressure, and urine output, when determining the best treatment option for the patient.

References
Kupchik, N. & Bridges, E., 2012. Central venous pressure monitoring: what’s the evidence? American Journal of Nursing. 112 (1).

Marik, P. et al. 2008. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 134(1).

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In Defense of On-the-Job Learning in the ICU

November 2, 2011

Image via Wikimedia Commons

By Marcy Phipps, RN, who is a regular contributor to this blog. She emphasizes that the identity of the impatient practitioner described in this post has been altered in significant ways to prevent any chance of recognition.

“This is why new nurses have no place in critical care!” said the trauma physician. “I’m sure she’s a fine nurse, but she should be getting experience with these situations on the floor!”

The issue of whether new nurses should work in critical care comes up from time to time. It seems to polarize people, and it always touches a nerve with me. I was hired directly into the ICU upon passing the boards, as were many of the nurses I work with. My hospital offers a program to new graduates that includes training and education specific to critical care and an extended clinical experience with a preceptor. Admittedly, there is a steep learning curve, but I wouldn’t consider it unsafe—and comments that suggest the contrary irritate me, because they undermine new nurses and foster negativity.

This patient probably would have pulled his PEG tube out no matter how experienced his nurse was, and I’m not sure the step-down floor would have been a “better” place for a new nurse to manage that situation. The patient acuity is lower on the floor, but there are also fewer nurses around to help out, and a patient would probably have more opportunities to pull a PEG tube out, assuming that was his intention, given the more private nature of the rooms. These things do happen occasionally, regardless of the precautions taken, and I don’t know any nurse who wouldn’t have been at least a little flustered, no matter where they were. I certainly would have been.

The new nurse came back the next night and had the same patient assignment. She was composed and professional, and it occurs to me that the trauma physician was right about one thing—she is a fine nurse. And she’ll get better all the time, here in the critical care unit, where she’s losing her “fluster” and thickening her skin, despite the glare of a doctor who doesn’t think she should be here in the first place.

*PEG = percutaneous endoscopic gastrostomy

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Posted in nursing students, professional identity | Tagged , , , , | 6 Comments »

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Giving Noise a Red Light

July 8, 2011

By Marcy Phipps, RN, whose essay, “The Soul on the Head of a Pin,” was published in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

This stoplight noise meter showed up at the nurse’s station last week.

I have to admit—we didn’t take it too seriously, at first.

It looks like something you could buy in a novelty shop, shelved next to lava lamps and strobe lights. And it’s modifiable; buttons and dials on the back of the gadget allow not only for sensitivity adjustments, but also give the option of changing the type of alarm that sounds when a noise infraction is detected. The default alarm warning is a soft-spoken, female “quiet, please!” that can be translated into Spanish, French, or German—but there’s also an option for a shrill siren, which seems ridiculous, considering that much of the cacophony of critical care is owed to noisy alarms and ringing phones.

We even discovered how to record our own admonishments (which opened the door to countless mischievous possibilities . . . not that we’d indulge in that sort of thing, of course).

In seriousness, noise reduction is vital to promoting a healing environment. In a recent article in Critical Care Nurse, the links between sleep deprivation and altered physiologic processes specific to the critical care population are reviewed. Noise reduction guidelines and recommendations from both the World Health Organization and Joint Commission are also discussed.

Our unit already implements scheduled “quiet time”—blocks of time several hours long during which we dim the lights and try to minimize noise, activity, and procedures. We do our best to promote uninterrupted rest periods, but in a busy nursing unit with an open floor plan, it’s rarely really quiet. I’m pretty sure I wouldn’t be able to sleep there.

In the midst of the pace and stressors of a typical day in critical care, we’re often preoccupied with issues that weigh more heavily on our minds than peace and quiet. On that note, and with service excellence and patient outcomes at the forefront of everything we do, a stoplight noise meter (although laughable, at first) serves its purpose well. It’s a good reminder of a high priority, even if it does look like a toy.

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Posted in patient perspective, writing and nursing | Tagged , , , | 2 Comments »

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Swimming from Alcatraz

April 25, 2011

by jitze couperus via Flickr

By Marcy Phipps, RN, whose essay “The Soul on the Head of a Pin” appeared in the May 2010 issue of AJN. She’s a frequent writer  for this blog.

I’m going to swim from Alcatraz.

It’s daunting, yet irresistible, and a challenge I’m not taking lightly. As part of my preparation, I’ve purchased the book Open Water Swimming: Lessons from Alcatraz. In it, Joe Oakes and Gary Emich deliver a wealth of information and practical advice in a very direct way. They’ve provided much to mull over during my long training swims—and I’ve been struck by how well the principles they stress can be applied to nursing:

“Never swim alone and always swim with a competent pilot.”

It would obviously be unwise to attempt a treacherous swim alone. Similarly, it’s vital to work with a team who can be trusted to back one another up. It’s also vital to know who the resource people are and to have a mentor, whether formally or informally.

“There are plenty of sharks in San Francisco Bay.”

Unfortunately, there are occasionally sharks amongst hospital staff, as well. Shark-like behavior should be identified for what it is, and handled accordingly. It should never be taken personally.

“Wet suits are the most obvious way to keep yourself insulated.”

The authors go on to discuss the relative merits of different types of wet suits, swim caps, booties, gloves, earplugs, and swim goggles. In the ICU, a decent stethoscope and good penlight are absolutely essential. Scrubs with good pocket placement are also important, as are comfortable shoes. Some of the other, almost limitless nursing gear available, like pen lanyards, badge holders, and stethoscope holders, are more arbitrary.

Regarding waves and choppy water, the authors advise, Read the rest of this entry ?

Posted in nursing perspective, professional identity, writing and nursing | Tagged , , , , | 6 Comments »

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What Lies Ahead? AACN Presidents Weigh In on Health Care Reform, Rapid Response Teams, and More

May 24, 2010

By Shawn Kennedy, AJN interim editor-in-chief

Kristine Peterson & Beth Hammer, incoming and outgoing AACN presidents

On my last day at the American Association of Critical-Care Nurses’ annual meeting last week in Washington, DC, I had a chance to speak with both Beth Hammer, whose term as president ended with the meeting, and Kristine Peterson, the new president. Our conversation ranged from how they felt about being president of such a large nursing organization to their views on health care reform and how rapid response teams are affecting the work environment of critical care nurses. You can hear the conversation free on AJN’s Web site: go to the Podcasts tab and click on Conversations. Or just click here (the download may take a minute or two).

And don’t miss my first post from the exhibit hall floor at the meeting (the National Teaching Institute & Critical Care Exposition, or “the NTI”)  and my second post on a conversation with a critical care nurse about a bad staffing practice, which seems to have hit a nerve!

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Posted in advocacy/political action, audio interviews, health care reform, nursing perspective, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , | Leave a Comment »

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Thousands of Critical Care Nurses, a Helicopter, and More! AACN’s National Teaching Institute & Critical Care Exposition

May 19, 2010

By Shawn Kennedy, AJN interim editor-in-chief

 

NTI exhibit hall crowds.

I’m writing to you this morning from Washington, DC, where I’m attending the American Association of Critical-Care Nurses (AACN) 2010 National Teaching Institute & Critical Care Exposition (known simply as “the NTI”). I’m probably miscounting, but I think this might be my 15th visit to the NTI. I first attended when I was an ED staff nurse at Bellevue Hospital in New York City. I marveled at the hundreds of nurses who attended from all across the country. It was energizing and inspiring and overwhelming, and I learned a lot.

Now, it’s not just hundreds but thousands of nurses who attend the NTI, and they come not only from states across this country but also from around the globe. It’s still energizing, and there’s no doubt I can still learn a lot. Throngs of nurses have crowded the sessions, so much so that it’s hard to remember there’s a nursing shortage; but critical care nurses are still much in demand, and representatives from many hospitals—as well as from all branches of the military—are manning recruitment booths. The exhibit hall is still overwhelming: this year there are more than 500 exhibitors and the exhibits include a Life Flight helicopter, a couple of full-size buses equipped as classrooms or EDs, and a fully-equipped military emergency treatment tent.

I’ve attended some very good sessions and a couple of clunkers—a better ratio than I’ve found at most conferences. Now I’m off to interview the incoming and outgoing presidents of the AACN—look for that post, with a link to a podcast of the interview, in the next few days. I’ve got to get inside that helicopter . . .

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Posted in health information technology (HIT), international nursing, nursing innovations, nursing shortage, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 1 Comment »

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