American Journal of Critical Care. 2008;17: 314
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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Teaching Communication Skills to Acute Care Nurse Practitioners
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Conducting difficult conversations with patients is poorly addressed in the education of nurse practitioners and is sorely needed in acute care. Topics related to empathetic communication, "breaking bad news," communicating with "angry" patients, and motivational interviewing are essential for acute care nurse practitioners (ACNPs).
In this issue, Rosenzweig and colleagues address this need with a unique patient communication simulation laboratory for ACNP students that uses standardized patients. They found that
- the lab was rated highly and enthusiastically accepted by students
- standardized patients were evaluated very favorably by students
- students showed improved confidence in their overall ability to conduct difficult conversations after the lab
See Article, pp 364–372
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Preventing and Managing Pressure Ulcers
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Pressure ulcers are a common cause of harm to patients, and even though they are largely preventable, they still occur at unacceptable rates in health care facilities.
In this issue, Elliott and colleagues describe a successful low-cost quality improvement program for pressure ulcer prevention using prevalence data, existing resources, and communication about the program’s success back to bedside clinicians. In addition, Tweed and Tweed report the development of a tool to assess nurses’ knowledge of pressure ulcer prevention and management as well as the effect of an educational session on their knowledge.
- Pressure ulcers significantly affect patients’ quality of life, morbidity, and mortality.
- Pressure ulcers add significant health care costs, both directly and indirectly.
- In 2007, the National Pressure Ulcer Advisory Panel redefined pressure ulcers and their stages, adding a stage for deep tissue injury resulting in skin changes due to damage of underlying soft tissue from pressure and/or shear.
See Articles, pp 328–337, 338–347
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Duration of Mechanical Ventilation After Introduction of Sedation and Pain Scales
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Adequate sedation and analgesia are essential to minimize the anxiety, panic, and discomfort associated with mechanical ventilation.
- The Society of Critical Care Medicine’s clinical practice guidelines for the use of sedatives and analgesics in critically ill adults recommend the use of a sedation scale.
- A common goal is to keep patients comfortable and easily arousable.
- The Richmond Agitation-Sedation scale is a valid and reliable tool.
- However, in this issue, Williams and colleagues found that introducing a sedation scale and an analgesia scale did not reduce the duration of mechanical ventilation. Changes in patients’ outcomes are most likely due to changes in patient care rather than to the use of a sedation scale.
See Article, pp 349–356
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:
- Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit
- Rosalind Elliott, Sharon McKinley, and Vicki Fox
AJCC 2008 17: 328-334.
[Abstract]
[Full Text]
- Intensive Care Nurses’ Knowledge of Pressure Ulcers: Development of an Assessment Tool and Effect of an Educational Program
- Carol Tweed and Mike Tweed
AJCC 2008 17: 338-346.
[Abstract]
[Full Text]
- Duration of Mechanical Ventilation in an Adult Intensive Care Unit After Introduction of Sedation and Pain Scales
- Teresa Ann Williams, Suzanne Martin, Gavin Leslie, Linda Thomas, Timothy Leen, Sheralee Tamaliunas, K. Y. Lee, and Geoffrey Dobb
AJCC 2008 17: 349-356.
[Abstract]
[Full Text]
- Patient Communication Simulation Laboratory for Students in an Acute Care Nurse Practitioner Program
- Margaret Rosenzweig, Marilyn Hravnak, Kathy Magdic, Michael Beach, Maurice Clifton, and Robert Arnold
AJCC 2008 17: 364-372.
[Abstract]
[Full Text]
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