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Maximizing the Recovery of ICU Survivors: An Innovative Collaborative Care Model

By Sylvia Foley, AJN senior editor

Photo courtesy of the Muscular Dystrophy Association (MDA). Photo courtesy of the Muscular Dystrophy Association (MDA).

ICU stays are inherently stressful, and can result in various unique morbidities that adversely affect ICU survivors’ quality of life. To better care for such patients, providers at one Indiana facility decided to create a new care model. Authors Babar Khan and colleagues report on their efforts in one of this month’s CE features, “Critical Care Recovery Center: An Innovative Collaborative Care Model for ICU Survivors.” Here’s a brief overview.

Five million Americans require admission to ICUs annually owing to life-threatening illnesses. Recent medical advances have resulted in higher survival rates for critically ill patients, who often have significant cognitive, physical, and psychological sequelae, known as postintensive care syndrome (PICS). This growing population threatens to overwhelm the current U.S. health care system, which lacks established clinical models for managing their care. Novel innovative models are urgently needed.

To this end, the pulmonary/critical care and geriatrics divisions at the Indiana University School of Medicine joined forces to develop and implement a collaborative care model, the Critical Care Recovery Center (CCRC). Its mission is to maximize the cognitive, physical, and psychological recovery of ICU survivors. Developed around the principles of implementation and complexity science, the CCRC opened in 2011 as a clinical center […]

2017-07-27T14:41:49-04:00March 5th, 2015|Nursing|0 Comments
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System Barriers to RN Activation of Rapid Response Teams: New Evidence

By Sylvia Foley, AJN senior editor

Rapid response teams (RRTs) in acute care facilities are there to decrease mortality from preventable complications. But there is evidence that RRT systems “aren’t working as designed, particularly with regard to problems in the activation stage,” according to nurse researcher Jane Saucedo Braaten.

Figure 1. Five Domains of Cognitive Work Analysis and Corresponding Study Questions Figure 1. Five Domains of Cognitive Work Analysis and Corresponding Study Questions (click image to enlarge)

Interested in how hospital system factors influence RNs’ activation behavior, Braaten decided to investigate further. She reports on her findings in this month’s CE–Original Research feature, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis.” Here’s a summary.

Purpose: To use cognitive work analysis to describe factors within the hospital system that shape medical–surgical nurses’ RRT activation behavior.
Methods: Cognitive work analysis offers a framework for the study of complex sociotechnical systems and was used as the organizing element of the study. Data were obtained from interviews with 12 medical–surgical nurses and document review.
Results: Many system factors affected participants’ activation decisions. Systemic constraints, especially in cases of subtle or gradual clinical changes, included a lack of adequate information, the availability of multiple strategies, the need to justify RRT activation, a scarcity of human resources, and informal hierarchical norms in the […]

2017-07-27T14:42:21-04:00February 6th, 2015|nursing perspective, nursing research|1 Comment
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Enough Rants: On Fostering Meaningful Dialogue

Karen Roush PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

Angry woman, Ranting By Amancay Maahs/Flickr

“Patients are never satisfied!” “Only bedside nurses really understand nursing!” “Management always takes advantage of you!”

These are examples of the types of statements I’ve heard recently, whether talking with other nurses or reading blogs or other social media. Often presented as contributions to discussion, in reality they are rants—more interested in eliciting rote agreement than in true dialogue. This has got me thinking about how we create dialogue, especially about topics that stir an emotional response—particularly when anger is front and center. I’m a firm believer that:

  • creating dialogue is necessary and transformative
  • strong emotions are often the impetus for needed change

But we can’t allow emotions to dominate. When they do, our discussion is no longer a dialogue; it’s a rant. And rants are not productive for creating change. They eat up the energy that could otherwise be directed to positive action.

So, how do we do create dialogue about the issues that get our backs up? Here are my thoughts:

2016-11-21T13:03:05-05:00February 4th, 2015|healthcare social media, Nursing, nursing perspective|4 Comments
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So You’re a Nurse With a Story to Tell…

Madeleine Mysko, MA, RN, coordinator of AJN’s monthly Reflections column, is a poet, novelist, and graduate of the Johns Hopkins Writing Seminars who has taught creative writing in Baltimore for many years.

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

Whenever I meet someone new who happens to be a nurse—in both clinical and social settings—I wait for the right moment to mention my work at AJN on the Reflections column. It’s not only that I’m proud of the column. It’s also that I’m forever on the lookout for that next submission—for a fresh, compelling story I just know is destined to shine (accompanied by a fabulous professional illustration) on the inside back page of AJN.

“I imagine you have a story or two to tell,” I’ll say to a nurse I’ve just met—which is the same thing I say, whenever I have the chance, to nurses I’ve known for years. I mean it sincerely; given the vantage point on humanity that our profession affords, I actually do believe that every nurse is carrying around material for a terrific story.

The response I usually get (along with a wry smile, the raising of eyebrows, or a short laugh) is, “Oh yes. I have stories.”

But then—even as I’m mentioning the Reflections author guidelines, even as […]

2018-04-17T13:41:27-04:00January 30th, 2015|narratives, Nursing, nursing perspective, nursing stories|5 Comments
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Nursing Perspective: Why I Work in Corrections

By Megen Duffy, BA, BSN, RN. Her blog is Not Nurse Ratched.

Michael Coghlan/Flickr Michael Coghlan/Flickr

When I go to work, I go through a metal detector (did you know Danskos contain metal?), and all my belongings are scanned or gone through. I check out keys and a radio, and then I go through a series of sally ports to get to the medical area. I count every needle and pair of scissors I use. I never see patients without an armed guard nearby, and a good portion of my patients are cuffed and shackled. I’m on camera from the second I get out of my car.

Welcome to prison, nursing style!

“Why?” people ask me. “Couldn’t you get another job? Aren’t you scared? Didn’t you like the ER?” I worked in critical care/emergency nursing for a long time, and yes, I did like it. I brought those skills with me to corrections, where they are a lock-and-key fit. A surprising number of corrections nurses are ex-ER nurses. The same personality types work well in both settings.

Corrections nursing involves phenomenal nursing autonomy and uses many of the skills I honed in the ER:

  • quick triage
  • multitasking
  • sorting out who is lying from who is sick
  • knowing which assessments are the most important for each situation

The atmosphere tends to be quirky to chaotic and requires imagination, flexibility, and an ability to string […]

2016-11-21T13:03:08-05:00January 23rd, 2015|career, Nursing, nursing perspective|21 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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