Critical Care Nursing in India
This article describes the organization and practice of critical care nursing in India. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - December 22, 2020 Category: Nursing Authors: Angela Gnanadurai Source Type: research

The Glasgow Coma Scale
Although the Glasgow Coma Scale has made a positive contribution to the care of people with neurologic orders, variance exists in its understanding and application secondary to inconsistency in guidelines, their interpretation, and the educational approach to the use of the tool. This fragmentation has been evidenced to result in variances in practice, some potentially harmful. Also, recent evidence demonstrates human factors, such as distress, have not been addressed within such education and guidelines for use. An opportunity now exists to take a new, unified approach to education and standards for use of the tool, frame...
Source: Critical Care Nursing Clinics of North America - December 22, 2020 Category: Nursing Authors: Neal F. Cook Source Type: research

Care of the Patient with Acquired Brain Injury in Latin America and the Caribbean
Traumatic brain injury and stroke are the leading causes of death and disability in Latin American and Caribbean countries. Specific characteristics, models of health care systems, and risk factors may influence the patient's outcome in this region. Relevant literature suggest that important delay problems exist in seeking care, reaching care, and receiving care in patients with acute neurologic injuries. Minimizing the time lost before care can be provided are vital to reduce the morbidity, long-term disability, and improved survival. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - December 22, 2020 Category: Nursing Authors: Stefany Ortega-Perez, Mar ía Consuelo Amaya-Rey, Virginia Soto Lesmes Source Type: research

Risk Factors for Pressure Injury Development Among Critical Care Patients
Identification of the appropriate pressure injury (PI) risk factors is the first step in successful PI prevention. Measuring PI risk through formalized PI risk assessment is an essential component of any PI prevention program. Major PI risk factors identified in the empirical literature in the critical care population include age, diabetes, hypotension, mobility, prolonged intensive care unit admission, mechanical ventilation and vasopressor administration. Future risk assessment using sophisticated data analytics available in the electronic medical record may result in earlier, targeted PI prevention and will improve our ...
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Authors: Jill Cox Source Type: research

Pressure Injury Prevention Considerations for Older Adults
This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Authors: Linda Cowan, Vianna Broderick, Jenny G. Alderden Source Type: research

Pressure Injuries Among Critical Care Patients
CRITICAL CARE NURSING CLINICS OF NORTH AMERICA (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Authors: Jenny G. Alderden Source Type: research

Copyright
ELSEVIER (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Source Type: research

Contributors
CYNTHIA BAUTISTA, PhD, APRN, FNCS, FCNS (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Source Type: research

Contents
Jenny G. Alderden (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Source Type: research

Forthcoming Issues
International Perspectives in Critical Care Nursing (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 29, 2020 Category: Nursing Source Type: research

Best Practice in Pressure Injury Prevention Among Critical Care Patients
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and i...
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Jenny Alderden, Faygah Shibily, Linda Cowan Source Type: research

Best Practices in Pressure Injury Treatment
Pressure injury treatments are tailored to the characteristics of the wound. Wound depth, exudate, presence of infection, and patient goals of care will guide appropriate dressing and treatment selection. The interprofessional team, patient, and family should collaborate to create a plan of care for wound healing. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Andrea L. Roufogalis, Melissa L. Hutchinson Source Type: research

Pressure Injury Prevention and Treatment in Critically Ill Children
Pressure injury prevention in critically ill pediatric patients can be challenging. The current article discusses pressure injury prevention and treatment with attention to unique aspects of pediatric physiology that influence risk for pressure injury. Medical device –related pressure injuries are particularly problematic in pediatric patients; therefore, this article presents best practice in preventing pediatric medical device-related pressure injuries. Treatment of pressure injuries is also discussed, with special attention to products that should be used w ith caution or avoided. (Source: Critical Care Nursing Cl...
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Ann Marie Nie Source Type: research

Medical Device –Related Pressure Injuries
This article provides evidence-based information regarding the most common devices that cause pressure injuries in adults and describes current best evidence-based prevention strategi es. Evidence-based prevention strategies are key to minimizing the harm devices can cause. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Joyce Pittman, Carroll Gillespie Source Type: research

Unstageable Pressure Injuries
Unstageable pressure injuries are widely understood to be full-thickness pressure injuries in which the base is obscured by slough and/or eschar. Correct identification of these pressure injuries can be challenging among health care professionals and, although treatments vary, d ébridement is key. Although the available research on unstageable pressure injuries is growing, there still is considerable need for advancements in the science regarding identification, treatment, and outcomes in critical care patients. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Sunniva Zaratkiewicz, Mark Goetcheus, Holly Vance Source Type: research

Deep Tissue Pressure Injuries
Deep tissue pressure injury (DTPI) is a serious form of pressure injuries. The condition remains invisible for up to 48  hours and then progresses rapidly to full-thickness skin and soft tissue loss. Many other conditions that lead to purple skin can be misidentified as DTPI, making the diagnosis difficult at times. A thorough history exploring exposure to pressure is imperative. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Joyce M. Black, Christine T. Berke Source Type: research

Pressure Injuries Among Critical Care Patients
Nutrition is an important component in the prevention and treatment of pressure injuries. Although the point at which insufficient nutrient consumption affects the body ’s capability to support skin integrity has not been demarcated, what is known is that reduced intake of food and fluids/water and weight loss can increase the risk of developing pressure injuries. Protein and its building blocks, amino acids, are essential for tissue growth and repair during all phases of wound healing. Sufficient macronutrients (carbohydrates, protein, fats, and water) and micronutrients (vitamins and minerals) are vital for the bod...
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Nancy Munoz Source Type: research

Heel Pressure Injuries in the Adult Critical Care Population
Patients in critical care units have a multitude of diseases and conditions that contribute to their illness and as such are susceptible to comorbid conditions such as heel pressure injuries. Prevention is a key strategy to avoid heel pressure injury occurrence. Risk factor identification can help a clinician identify those patients at risk for a heel pressure injury requiring timely prevention strategies. The purpose of this article is to raise awareness regarding the critical care patient ’s vulnerability to heel pressure injuries and strategies that can help avoid their occurrence or expedite their healing if occu...
Source: Critical Care Nursing Clinics of North America - October 6, 2020 Category: Nursing Authors: Barbara Delmore, Elizabeth A. Ayello Source Type: research

Pressure Injuries Among Critical Care Patients
Pressure injuries (PrI), formerly known as pressure ulcers, decubitus ulcers, or bed sores, are one of the oldest documented medical problems. In the nineteenth century, Jean-Martin Charcot, a prominent French physician, described PrI and referred to them as “decubitus ominosus,” recognizing the presence of a PrI as an ominous finding. Despite major advances in prevention and treatment, PrI remain a major source of human suffering, particularly in the critical care environment. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - September 30, 2020 Category: Nursing Authors: Jenny Alderden Tags: Preface Source Type: research

Replenish at Work
Intensive care unit (ICU) nurses report some of the highest levels of stress and burnout because they are exposed to excessive workloads, end-of-life concerns, prolonged care, and ethical dilemmas. Supporting ICU staff through self-care and mindfulness programs is successful in improving stress and burnout and in promoting resilience. Addressing barriers to engaging in self-care practices and identifying unit-specific needs are important to consider when implementing wellness programs. Micro-restorative practices can alleviate immediate stress generated from patient care and provide a moment of peace in busy ICUs. Leadersh...
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Authors: Catherine Alvarez Source Type: research

Moral Resilience for Critical Care Nurses
Ethically challenging situations are an increasing phenomenon in the nurse's environment, and literature on the subject is growing. Morally challenging experiences common in the critical care environment include end-of-life situations, barriers to providing the best care possible, and lack of organizational resources. These experiences can lead to moral distress and subsequent negative impacts on the clinician. Emerging in the literature are strategies to address the impact of moral distress through the development of moral resilience. Moral resilience is gained through personal commitment and organizational support. (Sour...
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Authors: Karen Stutzer, Anna M. Rodriguez Source Type: research

Promoting the Well-Being of the Critical Care Nurse
CRITICAL CARE NURSING CLINICS OF NORTH AMERICA (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Authors: Susan Bartos Source Type: research

Copyright
ELSEVIER (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Source Type: research

Contributors
CYNTHIA BAUTISTA, PhD, APRN, FNCS, FCNS (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Source Type: research

Contents
Susan Bartos (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Source Type: research

Forthcoming Issues
Pressure Injuries Among Critical Care Patients (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - August 13, 2020 Category: Nursing Source Type: research

Is It Me or You? A Team Approach to Mitigate Burnout in Critical Care
This article reviews burnout in critical care nursing through the lens of emotio nal contagion. We offer suggestions for team-based interventions to address burnout in critical care nurses. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - July 10, 2020 Category: Nursing Authors: Jin Jun, Deena Kelly Costa Source Type: research

Integrative Health and Wellness Assessment Tool
This article discusses the role of the IHWA and a coaching process to aid critical care nurses in implementing sustainable self-care strategies. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - July 10, 2020 Category: Nursing Authors: Deborah McElligott, Joanne Turnier Source Type: research

Extinguish Burnout in Critical Care Nursing
Burnout is reaching epidemic levels among health care providers. It negatively impacts individual providers, the care team, facility, and patients. Increased employee turnover, job dissatisfaction, and conflict are found whenever staff becomes burned out. Patient outcomes and satisfaction are negatively impacted. Although burnout is increasing in health care, much can be done to change the level of burnout and improve employee satisfaction. Individuals can learn the factors that lead to burnout and specific actions that can help prevent and recover from burnout. This information can be used to transform health care and dec...
Source: Critical Care Nursing Clinics of North America - July 10, 2020 Category: Nursing Authors: Terri L. Bogue, Robert L. Bogue Source Type: research

Meaning, Joy, and Critical Care Nurse Well-Being
Healthy nurses are essential for optimizing population health, patient care experiences, and health care cost-efficiency. Critical care nurses are at increased risk of developing physical and psychological symptoms due to their high-stress work environment and exposure to traumatic events. There is growing recognition for the value of implementing nurse-centered, team-based, and organizational-wide levels of intervention designed to mitigate the impact of high work stress and trauma on health professionals. The central assertion of this article is that meaning and joy in nursing practice are contributors to professional we...
Source: Critical Care Nursing Clinics of North America - July 8, 2020 Category: Nursing Authors: Lee A. Galuska, Brenda Bursch Source Type: research

Self-Care in the Bereavement Process
This article provides suggestions for promoting physical, emotional, and spiritual self-care for nurses caring for dying intensive care unit patients and their families. A case scenario illustrates the importance of this concept. Practical examples of self-care are highlighted along with discussion on how leadership can support self-care and maintain a healthy work environment. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - July 8, 2020 Category: Nursing Authors: Jennifer L. McAdam, Alyssa Erikson Source Type: research

Igniting Change
This article provides historical perspectives on the stressors inherent in working in the critical care environment as well as the stressors of working in the academic environment. It proposes the application of the synergy model as a framework to help improve the well-being of academicians who practice and teach critical care. The most valuable strategy to improve professional well-being is for organizations to take a systems approach. The article focuses on approaches that are potentially within each individual ’s control. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - July 6, 2020 Category: Nursing Authors: Linda Nancy Roney, Audrey M. Beauvais, Susan Bartos Source Type: research

The Juxtaposition of Caring
Nursing sits at the juxtaposition of self-care. On one side is the career: the call of nursing: absolute and definitive selflessness. Nursing is the ability, skill, and desire to care for another being during a time of need and desperate vulnerability. On the other side is the insatiable, self-motivated hunger for more: more knowledge, more technology, more validation, and faster, more evidence-based advancement. The fast-paced, intense environment is magnified in the critical care unit and for those who practice within the environment. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - June 29, 2020 Category: Nursing Authors: Susan Bartos Tags: Preface Source Type: research

Self-Achievement Through Creativity in Critical Care
This article highlights how creativity and various mediums of artistic expressions may can be used as a self-care practice and aid in boosting empathy in health care providers. Theories on empathy are presented as well as selected representations of nursing as creative expressions and the importance of promoting creativity and empathy. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - June 19, 2020 Category: Nursing Authors: Susan Bartos Source Type: research

Humanizing Intensive Care
The International Research Project for the Humanization of Intensive Care Units (Proyecto HU-CI) was initiated in 2014. The aim of this project is to change the current paradigm toward a human-centered care model. Patients, families, and professionals (everyday stakeholders) were asked to describe their ideal intensive care unit (ICU). Using their opinions, 8 fields of research to improve the management of ICUs and change the reality of care throughout the world were designed. This replicable tested model to humanize the ICU care delivery model is presented. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Authors: Jos é Manuel Velasco Bueno, Gabriel Heras La Calle Source Type: research

Enhancing Family-Centered Care in Cardiothoracic Surgery
This article discusses FCC models an d why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Authors: Kelly A. Thompson-Brazill, Catherine C. Tierney, Lori Brien, Jeremy W. Wininger, Judson B. Williams Source Type: research

Intensive Care Unit Patient Diaries
Post –intensive care syndrome is a detrimental cluster of symptoms that can have a negative impact on life after discharge from the intensive care unit (ICU). The use of patient diaries while hospitalized in the ICU has been reported to help survivors and families create memories and fill in gaps from their hospitalization. A review of the literature revealed that patient selection, diary content, family involvement, and staff perceptions are essential to the implementation of a diary program. Understanding the importance and impact diaries can have on survivors increases compliance and sustainab ility of this progra...
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Authors: Erica McCartney Source Type: research

Family-Centered Care: A Reflection
Best practices based upon evidence from inspirational leaders around the globe have shaped family-centered care recommendations in national guidelines.1 However, operationalizing these recommendations is not without challenge. We can learn as much from the challenges as successes; so, in this issue of Critical Care Nursing Clinics of North America, both successful and disappointing attempts at optimizing family-centered care are shared for our collective learning. (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Authors: Judy E. Davidson, Carrie Anne Hudson Tags: Preface Source Type: research

Patient and Family Experience in the ICU
CRITICAL CARE NURSING CLINICS OF NORTH AMERICA (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Authors: Judy E. Davidson Source Type: research

Copyright
ELSEVIER (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Source Type: research

Contributors
CYNTHIA BAUTISTA, PhD, APRN, FNCS, FCNS (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Source Type: research

Contents
Judy E. Davidson and Carrie Anne Hudson (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Source Type: research

Forthcoming Issues
Promoting the   Well-Being of the Critical Care Nurse (Source: Critical Care Nursing Clinics of North America)
Source: Critical Care Nursing Clinics of North America - May 11, 2020 Category: Nursing Source Type: research

The Best Medicine
Companion animals can have a positive impact on people ’s health and well-being. Personal pet visitation and animal-assisted interventions (AAIs) can benefit patients’ pain, blood pressure, stress, depression, and anxiety, as well as increasing mobility and socialization with staff and families. Implementing personal pet visitation and/or AAI progra ms requires the involvement of stakeholders from multiple disciplines. AAI is generally well received by staff. Animal presence in the intensive care unit carries few risks for humans and animals but is not risk free. Programs should be designed to minimize these ri...
Source: Critical Care Nursing Clinics of North America - April 7, 2020 Category: Nursing Authors: Denise Barchas, Melissa Melaragni, Heather Abrahim, Eric Barchas Source Type: research

Impact of Patient and Family Involvement in Long-Term Outcomes
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness ...
Source: Critical Care Nursing Clinics of North America - April 7, 2020 Category: Nursing Authors: Christopher J. Grant, Lauren F. Doig, Joanna Everson, Nadine Foster, Christopher James Doig Source Type: research

The Critical Care Nurse Communicator Program
Twenty percent of Americans die in an intensive care unit (ICU), often incapacitated or requiring assisted decision making. Surrogates are often required to make urgent, complex, high-stakes decisions. Communication among patients, families, and clinicians is often delayed and inefficient with frequent missed opportunities to support the emotional and psychological needs of surrogates, particularly at the end of life. The Critical Care Nurse Communicator program is a nurse-led, primary palliative care intervention designed to improve the quality and consistency of communication in the ICU and address the informational, psy...
Source: Critical Care Nursing Clinics of North America - April 7, 2020 Category: Nursing Authors: Andrew O ’Donnell, April Buffo, Toby C. Campbell, William J. Ehlenbach Source Type: research

Family Integrated Care for Preterm Infants
Parent-infant separation is a major source of stress for parents of hospitalized preterm infants and has negative consequences for infant health and development. Family Integrated Care (FICare) uses a strengths-based approach, based on family-centered care principles to promote parental empowerment, learning, shared decision making, and positive parent-infant caregiving experiences. Outcomes of FICare include increased self-efficacy upon discharge and improved parent-infant relationships and infant developmental outcomes. In this article, the authors describe the FICare model and emerging evidence regarding outcomes of FIC...
Source: Critical Care Nursing Clinics of North America - March 30, 2020 Category: Nursing Authors: Linda S. Franck, Chandra Waddington, Karel O ’Brien Source Type: research

Sleep in the Intensive Care Unit
There is a clear relationship between lack of sleep, poor health outcomes, and delayed recovery from illness in the intensive care unit. Several factors can contribute to poor quality sleep in the intensive care unit, including (1) environmental disruptions such as light and sound, (2) physiologic disruptions such as discomfort, nausea, and pain, (3) psychological disruptions such as anxiety and a lack of privacy, and (4) health care provider-related disruptions, such as medication administration and nursing care. Nursing implications include increased attention to the role of sleep to promote intensive care unit patient &...
Source: Critical Care Nursing Clinics of North America - March 30, 2020 Category: Nursing Authors: Karin Reuter-Rice, Mary Grace McMurray, Elise Christoferson, Haley Yeager, Brooke Wiggins Source Type: research

Implementation of a Patient and Family-Centered Intensive Care Unit Peer Support Program at a Veterans Affairs Hospital
Peer support is a novel strategy to mitigate postintensive care syndrome and postintensive care syndrome –family. This project implemented a peer support program to address postintensive care syndrome for patients and family members. Using a free-flow, unstructured format, a chaplain, social worker, nurse, and intensive care unit survivor led veterans and loved ones in discussion of intensive care un it experiences, fears, and the challenges of recovery. Evaluations indicated group participation is beneficial for emotional support, coping, and understanding common situations related to prolonged intensive care unit s...
Source: Critical Care Nursing Clinics of North America - March 30, 2020 Category: Nursing Authors: Leanne M. Boehm, Kelly Drumright, Ralph Gervasio, Christopher Hill, Nancy Reed Source Type: research

The Facilitated Sensemaking Model As a Framework for Family-Patient Communication During Mechanical Ventilation in the Intensive Care Unit
Family caregivers of intensive care unit (ICU) patients are at high risk for adverse psychological outcomes. Communication difficulty due to mechanical ventilation may induce or worsen adverse psychological outcomes. The Facilitated Sensemaking Model (FSM) is the first model to guide nursing interventions to help ICU family caregivers overcome and prevent adverse psychological outcomes. We address an understudied phenomenon, communication between patients and family caregivers during mechanical ventilation. The FSM guides supportive interventions for critical care nurses to improve patient-family communication in the ICU. ...
Source: Critical Care Nursing Clinics of North America - March 30, 2020 Category: Nursing Authors: Ji Won Shin, Judith A. Tate, Mary Beth Happ Source Type: research