American Journal of Critical Care. 2007;16: 259
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
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Strategies for Increasing Cardiac Arrest Survival Rates
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Can you increase cardiac arrest survival rates in your unit? Consider these basic strategies described by Peters and Boyde for doing so:
- Encourage systematic education of all nursing and medical staff in basic life support/semiautomatic external defibrillation procedures.
- Enable nurses to perform early defibrillation.
- Advocate for placement of semiautomatic external defibrillators (SAEDs) in all clinical areas.
- Use a dedicated resuscitation coordinator.
See Article, pp 240–247
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Reducing Anxiety for CABG Surgery Patients
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Increased levels of anxiety associated with coronary artery bypass graft (CABG) surgery can increase postoperative pain levels among patients undergoing this procedure. What can bedside clinicians do? Gallagher and colleagues recommend the following:
- Provide detailed preoperative information about unit procedures for evaluating and treating pain.
- Specifically describe the unit’s goals and practices of pain management.
- Emphasize to the patient the importance of communicating his or her pain level to the caregiver.
- Be mindful of patients’ concerns such as having their personal effects close at hand.
See Article, pp 248–257
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Implementing a Tobacco Cessation Curriculum
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Don’t all nursing professionals have a responsibility to reduce tobacco use in their patients? Do you include this content in your acute care nurse practitioner (ACNP) program? Did you receive it when you were a student? Read how Heath and colleagues dramatically increased tobacco cessation content in nursing schools across the nation.
Originally targeted to pharmacists, the smoking cessation training program Rx for Change contains a series of evidence-based modules that were adapted by the authors for a nursing audience. Their program emphasizes the following topics:
- Health effects of tobacco use
- Risk of cancer from tobacco use
- Passive smoking health effects
- Overview of high-risk groups for tobacco use
- Nicotine withdrawal
- Anatomy of cigarette contents
- Pharmacological agents
- Behavior modification counseling
- The US Public Health Service’s 5 A’s that all providers should integrate into daily practice:
(1) ask patients about their tobacco use, (2) advise patients about the health effects of tobacco use, (3) assess patients’ readiness to quit, (4) assist with a plan to quit, and (5) arrange for follow-up. For more tobacco cessation curricular information, visit http://rxforchange.ucsf.edu.
See Article, pp 284–289
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Family Presence, CPR, and Invasive Procedures
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How do you feel about family presence during resuscitation and invasive surgical procedures? Do you encourage families to be with their loved ones during resuscitation efforts, or do you show them the door?
- Attitudes toward family presence seem to be changing. Duran and colleagues cite a 2000 study in which 80% of physicians and 61% of nurses were opposed to family presence. In 2003, in their own study, the authors found that 46% of physicians and 86% of registered nurses favored a protocol allowing family presence.
- Providers who had been involved in care with family present were more positive about the experience than those who had never experienced it.
- There is no evidence that family presence results in negative psychological effects for the family.
- Using the AACN Practice Alert is a great way to begin addressing family presence in your unit. See the AJCC Patient Care Page that follows this article on page 283. Visit www.aacn.org to view the full text of the AACN Practice Alert.
See Article, pp 270–283
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Detecting Depression in CABG Patients
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Depression often accompanies coronary artery bypass graft (CABG) surgery and can result in (1) increased postoperative morbidity and mortality, (2) increased postoperative complications, and (3) higher hospital costs.
Although clinicians have few practical tools with which to identify depression (structured diagnostic interviews are costly), the study by Doering and colleagues found that the following instruments, used with medical patients, also are useful with women following CABG surgery:
- Beck Depression Inventory, Short Form (13 items)
- Beck Depression Inventory, Primary Care (7 items)
- Hamilton Depression Rating Scale
See Article, pp 260–269
Clinical Pearls is designed to help implement evidence-based care at the bedside by summarizing some of the most clinically useful material from select articles in each issue. Readers are encouraged to photocopy this ready-to-post page and share it with colleagues. Please be advised, however, that any substantive change in patient care protocols should be carefully reviewed and approved by the policy-setting authorities at your institution.
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