Nurses Important Part of Interdisciplinary Team for Tracheostomy Patients

Critical care nurses are essential in helping patients with tracheostomies regain their ability to speak, according to an article in the December issue of Critical Care Nurse.

The article, "Restoring Speech to Tracheostomy Patients," notes that critical care nurses are an important part of an interdisciplinary team that includes respiratory therapists, speech pathologists, advanced practice nurses and physicians.

There are several determining factors in patients being able to speak after a tracheostomy; including patients having an adequate supply of air reach the vocal cords and the type or size of the tracheostomy tube itself, Advance Healthcare Network for Nurses reports.

Nursing interventions for tracheostomy patients can also vary, depending on if the patient is spontaneously breathing, being treated with intermittent mechanical ventilation, or is fully ventilator dependent, and nurses need to be aware of all the options available, according to the researchers.

The Advanced Healthcare Network for Nurses article is available here.
The Critical Care Nurse abstract is available here.

Delirium Effects Linger for Critical Care Patients; Nurses Key to Treatment

ICU patients often experience similar lingering emotional and psychological effects of delirium, according to a new study published in the November issue of the American Journal of Critical Care.

The research team interviewed 10 adult patients who had been diagnosed with delirium while in the ICU after they were no longer delirious. The overarching themes in patients’ reports were:

• Lack of recall about their experience, often accompanied by feelings of guilt and shame about their behavior while delirious; 
• Feeling disconnected while delirious and unable to communicate or move, leading to frustration and fear;
• Vivid hallucinations, disorganized thinking and periods of disorientation; and
• Believing they or their family were in danger while they were delirious. 

The study also looks at the importance of critical care nurses in early recognition and treatment of patients with delirium, and how that can positively influence patient outcomes. Nurses also help patients and families deal with the aftermath of delirium in the ICU, particularly the psychological effects, according to the researchers.

This work mirrors that of INQRI grantees Michele Balas and William Burke who conducted research on patients on ventilators in ICUs, who are typically at high risk for delirium and weakness. Their research focused on preventing complications in ventilated patients through use of the "Awakening and Breathing Coordination, Delirium assessment and management and Early Exercise and progressive mobility (ABCDE)" bundle.

Balas and Burke led a team to implement, analyze and disseminate an evidence-based, nurse-led, inter-professional, multi-component program focused on improving the care and outcomes of critically ill adults.  Their "Implementing the ABCDE Bundle at the Bedside" was selected as the American Association of Critical-Care Nurses' first PEARL (Practice, Evidence, Application, Resources and Leadership) web-based tool.

Click here to learn more about the Balas-Burke project "Implementation and Dissemination of an Interdisciplinary Nurse-Led Plan to Manage Delirium in Critically Ill Adults."

AACN Academy Shows Value of Investing in Nurse Leadership Development

After participating in a 16-month leadership and innovation training program, nurses at 42 hospitals nationwide went on to direct quality initiatives that improved patient outcomes and saved more than $28 million annually.

The AACN Clinical Scene Investigator (CSI) Academy is a 16-month leadership and innovation training program for staff nurses delivered by the American Association of Critical-Care Nurses (AACN) that seeks to empower nurses as clinician leaders and catalysts for change.

The CSI Academy trained 163 nurses to address clinical challenges such as health care associated infections, pressure ulcers, delirium, early mobility, falls, and patient handoffs. The nursing teams saw great success, according to AACN, significantly reducing many common hospital errors.

Regional groups working in Indiana, Massachusetts, New York, North Carolina, Pennsylvania and Texas showed progress in decreasing:

• Intensive care unit (ICU) and progressive care unit lengths of stay by one day; 
• Days on mechanical ventilation by 14 percent or approximately one day;
• Health care-acquired infections and ICU complications by 50 percent;
• Patient falls by 50 percent;
• Pressure ulcers by 40 percent;
• Catheter-associated urinary tract infections by 70 percent; and
• Confusion Assessment Method for the ICU (CAM-ICU) positive scores by 14 percent

“These outcomes solidly reaffirm the value of investing in bedside nurses’ leadership development,” AACN CEO Dana Woods said in a statement. “Our program evaluations confirm that dedicated time for nurses to apply their skills in leading organizational and behavioral change was vital to achieving the program’s impressive results.”

AACN provides project materials from each team, including plans, data collection tools, practice resources and references in a searchable online database, which can be accessed at www.aacn.org/csiprojects.

INQRI Blog featured previously released data from the Academy from regional groups working in Massachusetts  and North Carolina.

New INQRI Article on Delirium Treatment & Prevention

INQRI grantees Michele Balas and William Burke recently concluded their study focused on implementing, analyzing and disseminating an evidence-based, nurse-led, inter-professional, multi-component program focused on improving the care and outcomes of critically ill adults.  Their study focused on applying the ABCDE bundle (developed at Vanderbilt University) which is a program of delirium screening, prevention and treatment.*

To learn more about this very important work, check out the team's new article, recently published in Critical Care Nurse: "Critical care nurses' role in implementing the 'ABCDE bundle' into practice."

*Awakening, and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility bundle (ABCDE bundle).