Giving Voice: Nurse-Patient Communication in the Intensive Care Unit

2021 ◽  
Vol 30 (4) ◽  
pp. 256-265
Author(s):  
Mary Beth Happ
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Best Practice ◽  
Patient Communication ◽  
Evidence Based ◽  
Patient Relationship ◽  
Communication Partner ◽  
Seriously Ill Patients ◽  
Tools And Techniques ◽  
Seriously Ill

Communication is the essence of the nurse-patient relationship. The critical care nurse’s role in facilitating patient communication and enabling communication between patients and their families has never been more important or poignant than during the COVID-19 pandemic. We have witnessed tremendous examples of resourceful, caring nurses serving as the primary communication partner and support for isolated seriously ill patients during this pandemic. However, evidence-based tools and techniques for assisting awake, communication-impaired, seriously ill patients to communicate are not yet systematically applied across all settings. Missed communication or misinterpretation of patients’ messages induces panic and fear in patients receiving mechanical ventilation and can have serious deleterious consequences. This lecture presents a 23-year program of research in developing and testing combination interventions (eg, training, tailored assessment, and tools) for best practice in facilitating patient communication during critical illness. Evidence from related nursing and inter pro fessional research is also included. Guidance for unit-based assessment, tailoring, and implementation of evidence-based patient communication protocols also is provided.

scholarly journals Pathways Project: Development of a Multimodal Innovation to Improve Kidney Supportive Care in Dialysis Centers

Kidney360 ◽  
2020 ◽  
pp. 10.34067/KID.0005892020
Author(s):  
Dale E. Lupu ◽  
Annette Aldous ◽  
Glenda Harbert ◽  
Manjula Kurella Tamura ◽  
Laura Holdsworth ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Mixed Methods ◽  
Supportive Care ◽  
Kidney Failure ◽  
Best Practice ◽  
Technical Assistance ◽  
Data Feedback ◽  
Care Models ◽  
Seriously Ill Patients ◽  
Seriously Ill

Current care models for older patients with kidney failure in the U.S. do not incorporate supportive care approaches. The absence of supportive care contributes to poor symptom management and unwanted forms of care at the end-of-life. Using an Institute for Healthcare Improvement Collaborative Model for Achieving Breakthrough Improvement, we conducted a focused literature review, interviewed implementation experts, and convened a technical expert panel to distill existing evidence into an evidence-based supportive care change package. The change package consists of 14 best practice recommendations for the care of seriously ill patients with kidney failure, emphasizing three key practices: systematic identification of seriously ill patients, goals of care conversations with identified patients, and care options to respond to patient wishes. Implementation will be supported through a collaborative consisting of three intensive learning sessions, monthly learning and collaboration calls, site data feedback, and quality improvement technical assistance. To evaluate the change package's implementation and effectiveness, we designed a mixed methods hybrid study. 1) Effectiveness evaluation (including patient outcomes and staff perception of the effectiveness of the implementation of the change package), 2) Quality improvement monitoring via monthly tracking of a suite of quality improvement indicators tied to the change package; and 3) Implementation evaluation conducted by the external evaluator using mixed methods to assess implementation of the Collaborative processes. Ten dialysis centers across the country treating approximately 1,550 patients will participate. This article describes the process informing the intervention design, components of the intervention, evaluation design and measurements, and preliminary feasibility assessments.

Improving Oral Care in Patients Receiving Mechanical Ventilation

2005 ◽  
Vol 14 (5) ◽  
pp. 389-394 ◽  
Author(s):  
Constance J. Cutler ◽  
Nancy Davis
Keyword(s):  
Mechanical Ventilation ◽  
Best Practice ◽  
Current Practice ◽  
Oral Care ◽  
Implementation Strategies ◽  
Baseline Period ◽  
Evidence Based ◽  
Oral Secretions ◽  
Mucosal Tissues ◽  
Care Practices

• Background Comprehensive oral care is an evidence-based prevention strategy to reduce the risk of ventilator-associated pneumonia in patients receiving mechanical ventilation. Until recently, no comprehensive guidelines or standards existed to define necessary tasks, methods, and frequency of oral care to provide patients with optimal results. • Objectives To observe current practice of, define best practice for, and measure compliance with standardized comprehensive oral care. • Methods This observational study was part of a larger research study performed at 5 acute care hospitals. Time blocks of 4 hours were randomized over 8 intensive care units and the 7 days of the week. Baseline data were collected before implementation of multifaceted education on an oral-cleansing protocol; interventional data were collected afterward. • Results Oral care practices were observed for 253 patients. During the baseline period, oral cleansing was primarily via suction swabs. Toothbrushing and moisturizing of the oral tissues were not observed. Only 32% of the patients had suctioning to manage oral secretions. During the interventional period, 33% of patients had their teeth brushed, 65% had swab cleansing, and 63% had a moisturizer applied to the oral mucosal tissues. A total of 61% had management of oral secretions; 38% had oropharyngeal suctioning via a special catheter. • Conclusions Implementation of an evidence-based oral cleansing protocol improved the care of patients receiving mechanical ventilation. Multifaceted education and implementation strategies motivated staff to increase oral care practices.

The Oncotalk/Vitaltalk model

2017 ◽  
Author(s):  
Robert M. Arnold ◽  
Anthony L. Back ◽  
Walter F. Baile ◽  
Kelly A. Edwards ◽  
James A. Tulsky
Keyword(s):  
Communication Skills ◽  
Lessons Learned ◽  
Simulated Patients ◽  
Evidence Based ◽  
Learning Context ◽  
Small Group Teaching ◽  
Immediate Feedback ◽  
Dying Patients ◽  
Seriously Ill Patients ◽  
Seriously Ill

Clinicians can, with training, improve their communication skills. In this chapter, we describe an interactive, evidence-based method for teaching clinicians to communicate with seriously ill patients. The programme, Vitaltalk, emphasizes small-group teaching with simulated patients and immediate feedback to allow learners to practice how to give serious news, talk about goals of care, and about what is most important to dying patients. This chapter describes common evidence-based principles used in developing an advanced communication skills programme based on Oncotalk experiences, identifies unique aspects of the learning context within an intensive retreat structure, and illustrates the lessons learned that can be tested in other settings. The programme is effective in improving learners’ communication skills in clinical studies. The growth of this programme in multiple specialties is discussed, as are our plans for disseminating the programme in the future.

scholarly journals Reaction time of a health care team to monitoring alarms in the intensive care unit: implications for the safety of seriously ill patients

2014 ◽  
Vol 26 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Adriana Carla Bridi ◽  
Roberto Carlos Lyra da Silva ◽  
Carolina Correa Pinto de Farias ◽  
Andrezza Serpa Franco ◽  
Viviane de Lima Quintas dos Santos
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Reaction Time ◽  
Health Care Team ◽  
Care Team ◽  
Seriously Ill Patients ◽  
Seriously Ill

VENTILATOR ASSOCIATED PNEUMONIA-REVIEW ARTICLE

2021 ◽  
pp. 64-65
Author(s):  
Bharti Choudhary ◽  
Nishchint Sharma
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Review Article ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Evidence Based Practices ◽  
Prolonged Duration ◽  
Vap Bundle

Ventilator-associated pneumonia (VAP) is one of the most frequent ICU-acquired infections and a leading cause of death among patients in Intensive Care Unit (ICU). VAP is associated with prolonged duration of mechanical ventilation and ICU stay. The estimated mortality of VAP is around 10%. There are many risk factors including host related, device related and personnel related. For prevention of VAP it is recommended to minimize the exposure to mechanical ventilation and encouraging early liberation. VAP bundle as a group of evidence-based practices that, results in decrease in the incidence of VAP should be used. Patients should be reassessed daily to conrm ongoing suspicion of disease, antibiotics should be guided by cultures reports, and clinicians should consider stopping antibiotics if cultures are 1 negative.

scholarly journals Pharmacokinetics of a Clarithromycin Suspension Administered via Nasogastric Tube to Seriously Ill Patients

1999 ◽  
Vol 43 (5) ◽  
pp. 1277-1280 ◽  
Author(s):  
Douglas N. Fish ◽  
Edward Abraham
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nasogastric Tube ◽  
Pharmacokinetic Parameters ◽  
Intrapatient Variability ◽  
Seriously Ill Patients ◽  
Hydroxylated Metabolite ◽  
Ill Adults ◽  
Seriously Ill

ABSTRACT The pharmacokinetics of clarithromycin and its 14-(R)-hydroxylated metabolite were studied on two separate occasions after nasogastric administration of 500 mg of a clarithromycin suspension to 16 seriously ill adults in an intensive care unit. The clarithromycin suspension appeared to be adequately absorbed, and the pharmacokinetics of neither clarithromycin nor 14-(R)-hydroxyclarithromycin differed significantly between the two dosing periods. No substantial differences in pharmacokinetics were observed compared to previously published studies of other adult populations. Minimal intrapatient variability of pharmacokinetic parameters was observed in these seriously ill patients.

A comparison of seriously ill patients with or without AIDS requiring prolonged mechanical ventilation

2012 ◽  
Vol 27 (6) ◽  
pp. 594-601 ◽  
Author(s):  
J. Dermot Frengley ◽  
Giorgio R. Sansone ◽  
Kiranjit Uppal ◽  
John J. Vecchione ◽  
Robert J. Kaner
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Seriously Ill Patients ◽  
Seriously Ill

A study of alpha-amylase activity in tracheobronchial secretions of seriously ill patients with tracheostomies

1995 ◽  
Vol 109 (7) ◽  
pp. 640-643 ◽  
Author(s):  
V. Nandapalan ◽  
J. C. McIlwain ◽  
J. Hamilton
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Amylase Activity ◽  
Intensive Care Unit Setting ◽  
Alpha Amylase ◽  
Seriously Ill Patients ◽  
High Level ◽  
Seriously Ill ◽  
Severe Pulmonary Disease ◽  
Very High

AbstractThis study was undertaken to assess any salivary aspiration in seriously ill patients with tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheostomies in an Intensive Care Unit setting. The alpha-amylase activity in the tracheobronchial secretions of 15 such patients were analysed to evaluate the incidence of salivary aspiration. None of the patients had clinical or radiological evidence of lung disorder at the time of the commencement of the study. Six out of 15 patients showed very high levels of alpha-amylase activity in their tracheobronchial secretions on Day 3 and all six subsequently developed severe chest infections. The other nine patients showed a low level of amylase activity in their secretions. Two patients in the latter group developed severe pulmonary disease. This study demonstrates that a high level of alpha-amylase activity in the tracheobronchial secretions of tracheotomized, ventilated patients indicates that salivary aspiration may be taking place, and further suggests that progressively increasing levels may indicate the likelihood of a major pulmonary complication developing.

Sign in / Sign up

Export Citation Format

Share Document