critical care Archives - Off the Charts

A Nurse-Led QI Project to Reduce ED to ICU Transition Time

Countless studies conclude that the longer an admitted patient boards in an emergency department (ED) the greater the risk for negative outcomes such as falls and hospital-acquired conditions. ED patients waiting for admission to the intensive care unit (ICU) may be at the greatest risk, as they are categorized as critical.

Transporting critical patients from the ED to the ICU requires coordination of multiple clinicians from both units, which can lead to delays. Leading and managing these coordination efforts is a challenge. However we are optimistic as small tests of change have led us to advancements in the timeliness of ICU admissions and improvements in quality and safety.

-Jonathan Nover, MBA RN, senior director of nursing, Mount Sinai Queens

The Project

Geneline Barayuga, MSN RN

The ED and ICU teams at Mount Sinai Queens, a 165-bed hospital with 70,000 annual ED visits in Queens, New York, performed a quality improvement (QI) project by developing a collaborative approach between the ICU and ED charge nurses to reduce the median […]

Guest Author2023-12-11T10:17:23-05:00December 11th, 2023|Nursing, Quality improvement|0 Comments

An ICU Nurse Reflects on ‘Returning Home from COVID Island’

“It’s hard to remember my job before all this began,” writes critical care nurse Deirdre McNally in this month’s Reflections essay, “Returning Home from COVID Island.” As the pandemic abates, she finds herself searching for a coherent narrative to understand what she’s experienced. But it’s not so simple. Memories of patients, moments, stray images from many months before slip unbidden into her head.

The difficulty of making sense of the past two years.

What does it mean to ‘make meaning’ from such an all-consuming experience? Maybe the answer will come with time. For now, she suggests, there are too many events, too many emotions and impressions to really absorb as things slowly resume a semblance of greater normalcy:

“For many health care providers,” she writes, “I think this is a protective mechanism meant to shield us from experiences too difficult to absorb.”

[…]

Jacob Molyneux, senior editor/blog editor2022-03-17T11:47:07-04:00March 17th, 2022|COVID-19, Nursing, nursing career, nursing stories|0 Comments

DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment

Every Frontline has a Backline: What Nursing Can Learn from Rugby

Photo credit: KJ Feury

Have you ever had a day at work that could only be fixed by an ice cream from your favorite creamery or by a hug from your best friend? Every shift during the height of the COVID-19 pandemic felt like this.

Unfortunately, because I work as an RN in a pediatric ICU at a large hospital in northern New Jersey, social restrictions that coincide with COVID-19 forestalled my usual comfort measures. After the start of the COVID-19 pandemic and during my reassignment in the COVID-19 ICU, I could no longer truly “leave” work. Work came home and walked with me throughout my day.

Dozens of IV pumps lining hallways, countless boxes of gowns, gloves, masks, and rubber shoes scattering the unit; ventilator alarms sounding; coworkers with surgical caps and masks, only identifiable by their eyes. The once medical–surgical unit transformed into a critical care unit equipped to care for COVID-19 patients.

After donning and doffing personal protective equipment (PPE), giving medication, adjusting ventilators, and updating families, you leave your 12+ hour shift wondering if you did your best. In the chaos of an unfamiliar unit, caring for patients with an unfamiliar virus, did I do everything to create the best outcome for my […]

Guest Author2020-07-22T10:18:03-04:00July 22nd, 2020|COVID-19, infectious diseases, Nursing, nursing perspective, nursing stories, Public health|3 Comments

May Issue Highlights: Pain Management in Critical Care, ECG Interpretation Basics, More

“The reality of an insufficient health care workforce and underfunded health care system is all too evident. . . . Perhaps things will change after this, and we will be ready the next time. I hope so.”—editor-in-chief Shawn Kennedy in her May Editor’s Note, “Life, Interrupted“

In case you’d like a break from COVID-19 headlines and want to keep up with some other nursing and health care topics, the May issue of AJN is now live. Here are the highlights:

Original Research: Exploring the Effects of a Nurse-Initiated Diary Intervention on Post–Critical Care Posttraumatic Stress Disorder

The authors examine how collaborative diary writing—by patients, visitors, and interdisciplinary team members—can affect the development of posttraumatic stress disorder and symptom severity in critical illness survivors.

CE: Managing Pain in Critically Ill Adults: A Holistic Approach

A review of the Society of Critical Care Medicine’s PADIS guidelines—and how they go beyond the earlier PAD guidelines—in providing specific guidance related to assessment and management of pain, use of opioids in critical illness, and use of adjunctive analgesia.

New Series: Strip Savvy: A Case of Bradycardia and Extreme Fatigue

This is the first article in a new series on the basics of electrocardiography (ECG) […]

Diane Szulecki, editor2020-04-27T09:02:16-04:00April 27th, 2020|Nursing|0 Comments

The Project

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The difficulty of making sense of the past two years.

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Nurses and the meaning of DNR.

Families and providers may understand DNR differently.

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