Transesophageal echocardiography: implications for the critical care nurse

TEE is an exciting and useful diagnostic tool that is rapidly gaining widespread acceptance in both teaching centers and community hospitals. Because of the semi-invasive nature of the procedure, nursing expertise is essential to ensure patient safety and comfort during the TEE examination.     

Home care triage nurse

OBJECTIVE: To determine the contribution of mechanical factors to the function of different types of fundoplication. DESIGN AND SETTING: An experimental bench-top study using abattoir-sourced pig esophagus and stomach placed on a tray. Preliminary esophageal myotomy ensured free reflux of 'intragastric fluid'. INTERVENTIONS: Anterior, posterior, and total fundoplications were performed on each of ten sets of viscera. MAIN OUTCOME MEASURES: Lower esophageal sphincter pressure was measured using a conventional esophageal manometry catheter. Intragastric pressure was measured with a single channel intragastric manometry catheter, whilst the stomach was inflated with coloured water. The maximum intragastric pressure or the pressure measured when the fundoplication yielded to gastric distension was recorded. RESULTS: All three types of fundoplication restored adequate competence to the gastroesophageal junction, although high-volume gastric infusions resulted in fundoplication yield in 4/10 anterior and 4/10 posterior fundoplications. Gastric distension resulted in fundal dilatation and consequent compression of the adjacent esophagus. Fundoplication generated a median rise of 11-13.5 mmHg in lower esophageal sphincter pressure, comparable to pressures reported in the postoperative clinical setting. Significantly greater intragastric volumes and pressures were tolerated following total fundoplication. CONCLUSIONS: This study suggests that mechanical factors could be major contributors to the ability of a fundoplication to restore gastroesophageal competence. Anterior, posterior and total fundoplications are all effective procedures.     

A primary care nurse clinic

A nurse-driven clinic that uses a client-centered approach evolved from an independent ambulatory care program. The clinic operates 4 to 5 hours per day and provides patient counseling, health care maintenance, primary care, patient education, and therapeutic care.     

TQM in critical care

No consistently accepted methods reliably measure quality differences among and within critical care units (CCUs). With total quality management, physicians and nurses have the framework to accurately assess the organizational climate of their CCU. A study asks nurses to identify organizational components in their CCU.     

Handwashing in critical care

A mixed culture of fungi, enriched from degraded polymeric materials, formed biofilms on coupons of fiber-reinforced polymeric composites (FRPCs). They grew actively in aqueous extracts of the composites under ambient conditions. The data indicate that the fungi utilized the resins or fiber chemical sizing as carbon and energy sources. A progressive decline in impedance from above 10(7) Ohms to below 10(8) Ohms was detected in the inoculated FRPC panels by electrochemical impedance spectroscopy (EIS) after 179 days of incubation, but not on the sterile controls. The degradation proceeds through an initial ingress of water into the resins, followed by degradation of bonding between fiber surfaces and resins and finally separation of fibers from the resins. At the end of EIS study, the extent of disbonding in the inoculated composite was greater than the control observed by scanning electron microscopy. These results suggest that the composite materials are susceptible to microbial attack by providing nutrients for growth.     

The nurse as senior health care executive

This author describes the advantages of having a nursing, academic, and experiential background for career progression in the health care world. The combination of nursing and business competencies provide for a well-prepared leader in a rapidly changing health care environment. An historical perspective on nurses as leaders in health care as well as competencies required for health care leaders for the future is described.     

Advances in critical care monitoring

We report the eighteenth case of spontaneous rupture of the upper urinary tract in a pregnant woman (age = 24 years, term = 28 weeks). Sonography showed an anechogenic collection in the left perirenal area. Computed tomography confirmed the diagnosis of rupture. No cause could be determined due to the lack of an urography in post-partum. The first treatment was a double echo-guided percutaneous drainage. The pregnancy was completed to term with normal vaginal delivery of a live infant. Sonography showed complete cure.     

Utilization-focused evaluation of acute care nurse practitioner role

Using nurse practitioners in acute care is a relatively new phenomenon with little existing data on related expectations and effectiveness. This article describes one organization's program evaluation of the Advanced Practice Registered Nurse (APRN) role. It includes a conceptual model as well as pragmatic data on: perception of the performance of agreed-upon role expectations, influence on targeted aspects of care, retention of a focus on nursing, and factors facilitating or hindering APRN effectiveness.     

The geropsychiatric clinical nurse specialist in home care

Home care nurses often are asked to provide care to older adults with multiple problems, including psychiatric diagnoses. This article identifies areas of knowledge a general nurse needs to provide care for geropsychiatric patients and describes the role of the geropsychiatric clinical nurse specialist as part of a home care team.     

Implementation of the acute care nurse practitioner role

In this article, the experiences of two new acute care nurse practitioners working at the University of Pittsburgh Medical Center are described. Included are the experiences they encountered in initiating the role and some of the responsibilities they assumed.     

Integrated health care and the advanced practice nurse

As state-designed Medicaid reforms are enacted and commercial insurance carriers begin to manage care, advanced practice nurses (APNs) must be ready to aggressively pursue opportunities for clinical participation. Understanding the contractual obligations of becoming a provider, as well as adopting strategies for successful participation in these emerging integrated networks, will be critical for APNs. Successful contracting requires a carefully defined set of practice activities and a willingness to become a team player in a complex organization.     

Implementing nurse sensitive outcomes into care planning at a long-term care facility

This article describes one long-term care facility's efforts to implement standardized language in the care planning process. Federal regulations for long-term care mandate the use of a uniform comprehensive assessment tool. Eighteen Resident Assessment Protocols (RAPs) are identified for data collection. Computer databases were revised for care planning. Appropriate North American Nursing Diagnosis Association (NANDA) diagnoses were linked to each RAP. Nursing-Sensitive Outcomes (NOCs) were linked to each NANDA as goals. Nursing Interventions Classifications (NICs) were linked to NANDA diagnosis and NOC outcomes as approaches. The databases are illustrated, and frequently used NANDAs and NOCs are identified.     

Stress relief for critical care nurses

Critical care nurses' stress levels have increased due to patient-focused care models that supplement staffing with unlicensed assistive personnel. Stat nurse programs can alleviate nurses' anxiety by providing short-term professional critical care assistance without disrupting structured health care models.     

Acute and critical care in neurology

When subjects select a prime from a visual display while leaving a distractor prime unselected, response time (RT) or response accuracy to a subsequent probe may be impeded if the distractor prime and probe are identical, or if they are related to one another. This phenomenon, negative priming (NP), has obvious implications for understanding perceptual selection. However, it is not known whether NP results from other kinds of selection processes. The present studies were designed to investigate whether NP occurs when primes are selected from working memory rather than from a visual display. In the two experiments, the subjects memorized two primes, selected one prime for further processing, and classified the contents of a probe display. Significant NP occurred in both Experiments. In Experiment 2, however, NP occurred only under easy-selection conditions; the effect was reversed under difficult-selection conditions. The findings indicate a role for NP in memory processing, but contrast with the results from perceptual selection studies showing greater NP under difficult-selection than under easy-selection conditions. The present finding suggests a complex and perhaps strategy-dependent relationship between memory selection difficulty and NP.     

Informal care; a critical observation

In this article the policy aimed at cutting down expenses for professional care and at optimizing the contribution of informal, unpaid care (e.g. family caregivers and volunteers) is questioned. After a brief outline of the non-professional care system for the elderly, some problematic aspects of informal care are discussed, especially the influence of such care in terms of (over)burden, the quality of care and the consequences for the relationship between caregiver and person being cared for. Voluntary services are also questioned, particularly the lack of control, the power of volunteers and their knowledge, attitude and skills. It is concluded that expectations towards nonprofessional caregivers should not be too great. The importance of a finely tuned coordination and clear division of tasks in the care network is underlined. Finally a number of recommendations is made to settle the observed bottlenecks.