American Journal of Critical Care. 2008;17: 100
Copyright © 2008 by the American Association of Critical-Care Nurses.
Clinical Pearls
By
Mary Jo Grap, RN, PhD, ACNP, Section Editor.
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Preparing Families for Withdrawal of Life Support
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Do you know how to prepare families for withdrawal of life support from their loved one? Do you know specifically what to tell them? Kirchhoff and colleagues describe the development and testing of an informational intervention to prepare families for what will happen during this process. Specific messages include the following:
- Uncertainty concerning time of death
- Reassurance that nursing care will continue
- Symptom management is the priority
- Privacy would be provided
- General signs: breathing pattern changes, skin color changes, muscle spasms
- Families may choose to stay or leave at any time
- Permission given to touch, talk to the patient, or assist with care Tailored information specific to each patient also was included. Families were receptive and seemed to be helped by the information.
See Article, pp 113–122
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Nurses’ Perceptions About the Benefits of Family Presence
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Do you offer the chance for your patients’ families to be with their loved one during resuscitation? AACN, the Emergency Nurses Association, and the American Heart Association urge you to do so! Twibell and colleagues studied nurses’ perceptions of the risk and benefits of this practice as well as their self-confidence in doing so. They found the following:
- Nurses generally have a positive attitude toward family presence during resuscitation.
- Nurses with greater self-confidence offered resuscitation presence more often.
- Nurses who were certified invited family presence more often than did noncertified nurses.
These authors also suggest that nurses confident about family presence should be members of code teams, should act as role models for novice nurses, and should teach families about presence during resuscitation.
See Article, pp 101–112
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Prevention of Upper GI Bleeding
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S tress ulcer prophylaxis is one component of the ventilator-associated pneumonia (VAP) bundle, a group of interventions aimed at reducing VAP. Ojiako and colleagues compare the efficacy of a proton pump inhibitor (PPI) versus a histamine2 receptor antagonist (H2RA).
- Although PPIs have greater reported efficacy in elevating gastric pH, they were not found to be superior to H2RAs for preventing upper GI bleeding in mechanically ventilated patients.
- However, the optimal regimen for prevention of upper GI bleeding has not been established.
See Article, pp 142–147
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Improving Glucose Control in the ICU
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How is your unit doing with the management of hyperglycemia? Even though insulin protocols are used, achievement of normoglycemia in day-to-day practice is a greater challenge than one might expect. Holzinger and colleagues describe the following:
- A mandatory, intensive education process for physicians and nurses
- Development of a collaborative hyperglycemia protocol, including challenges to instituting tight glucose control
- Results that show an increase in normoglycemia for their patients According to this study, cooperation between nurses and physicians leads to improved glucose control with higher success rates for reaching normoglycemia.
See Article, pp 150–158
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.
Related articles in AJCC:
- Nurses’ Perceptions of Their Self-confidence and the Benefits and Risks of Family Presence During Resuscitation
- Renee Samples Twibell, Debra Siela, Cheryl Riwitis, Joe Wheatley, Tina Riegle, Denise Bousman, Sandra Cable, Pam Caudill, Sherry Harrigan, Rick Hollars, Doreen Johnson, and Alexis Neal
AJCC 2008 17: 101-111.
[Abstract]
[Full Text]
- Preparing Families of Intensive Care Patients for Withdrawal of Life Support: A Pilot Study
- Karin T. Kirchhoff, Jenna Palzkill, Jennifer Kowalkowski, Anne Mork, and Elfa Gretarsdottir
AJCC 2008 17: 113-121.
[Abstract]
[Full Text]
- Famotidine Versus Pantoprazole for Preventing Bleeding in the Upper Gastrointestinal Tract of Critically Ill Patients Receiving Mechanical Ventilation
- Kizito Ojiako, Hiren Shingala, Christa Schorr, and David R. Gerber
AJCC 2008 17: 142-147.
[Abstract]
[Full Text]
- Improvement of Glucose Control in the Intensive Care Unit: An Interdisciplinary Collaboration Study
- Ulrike Holzinger, Monika Feldbacher, Adelbert Bachlechner, Reinhard Kitzberger, Valentin Fuhrmann, and Christian Madl
AJCC 2008 17: 150-156.
[Abstract]
[Full Text]
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