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Critical Care Nursing

Monitoring and Treatment for Advanced Nursing Practice

EDITED BY

Kathy J. Booker, PhD, RN, CNE

Professor, School of Nursing Millikin University Decatur, Illinois, USA

 

 

 

 

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Contributors

Jennifer Abraham, RN, BS
Staff Nurse Medical/Oncology
Advocate BroMenn Medical Center
Normal, IL., USA

Laura Kierol Andrews, PhD, APRN, ACNP-BC
Associate Professor
Yale School of Nursing
Orange, CT., USA and Senior ACNP, Department of Critical
Care Medicine
Hospital of Central Connecticut, New Britain, CT., USA

Lisa M. Barbarotta, RN, MSN, AOCNS, APRN-BC
Nurse Practitioner, Hematology-Oncology Service
Smilow Cancer Hospital at Yale-New Haven
New Haven, CT., USA

Catherine L. Bond, MS, MSED, ACNP-BC, TNS
Nurse Practitioner
Critical Care Team
Carle Foundation Hospital
Urbana, IL., USA

Kathy J. Booker, PhD, RN, CNE
Professor, School of Nursing,
Millikin University
Decatur, IL., USA

Dawn Cooper, MS, RN, CCRN, CCNS
Service Line Educator
Medical Intensive Care Unit
Yale New Haven Hospital York Street Campus
New Haven, CT., USA

Linda M. Dalessio MSN, ACNP-BC, CCRN
Assistant Professor, Nursing Western Connecticut State University
Danbury, CT., USA

Eleanor R. Fitzpatrick, RN, MSN, CCRN
Clinical Nurse Specialist for Surgical Intensive Care & Intermediate Care Units
Thomas Jefferson University Hospital
Philadelphia, PA., USA

Carey Heck, MS, MSN, ACNP-BC, CCRN, CNRN
Instructor
Jefferson School of Nursing
Philadelphia, PA, USA

Janice L. Hinkle, RN, PhD, CNRN
Nurse Author and Editor
Washington, DC, USA

Alexander P. Johnson, MSN, RN, CCNS, ACNP-BC, CCRN
Critical Care Clinical Nurse Specialist
Cadence Health, Central DuPage Hospital
Winfield, IL., USA

Mary Beth Voights, MS, RN, CNS
Trauma Services Coordinator
Carle Foundation Hospital
Urbana, IL., USA

Catherine Winkler, PhD, MPH, RN
Professor
Fairfield University
Fairfield, CT., USA

Critical Care Nursing: Monitoring and Treatment for Advanced Nursing Practice

Kathy J. Booker

Introduction

The many contributions to patient care and safety made by critical care nurses have been substantial since the inception of critical care units. As advanced nursing practice has expanded into high-risk and complex environments, the role of careful monitoring and surveillance to care management has become exponentially important to patient safety. However, wide variation in practice and outcomes across the nations’ critical care units continues. Monitoring the condition and progress of critically ill adults remains vital to good patient outcomes but many treatment and monitoring protocols are still grounded in descriptive and observational studies and expert practitioner experience. Although a substantial number of evidence-based protocols have been refined over the past decade, many monitoring practices have not been sufficiently studied. This book is designed to guide critical care nurses and advanced practitioners by examining guidelines and evidence-based treatment recommendations associated with assessment and monitoring of patient conditions commonly treated in critical care units. It embraces recent advancements in the concept of surveillance as a mainstay of clinical quality.

There is considerable variation in levels of evidence and practice guidelines. Within the National Clearinghouse Guidelines alone, vastly varied titles of guidelines can be found among the over 2500 guidelines housed in 2012 (Table 1). These title variations, while selected by authors and organizations, reflect the difficulty clinicians face in locating clinical practice guidelines and standards of care. As sources of published guidelines expand, clinicians may find multiple care practice patterns unique to customary practices by country, region, or clinical organization, further compounding the difficulty enacting practice changes.

Table 1 Titling of guidelines within the National Clearinghouse Guidelines Index (2012).

Medical guidelines Consensus statements
Clinical practice guidelines Practice parameters
Guidelines of care Guidelines for monitoring and management
Guidelines for practice Assessment guidelines
Evidence reports Evidence-based guidelines
Clinical guidelines Clinical policy: critical issues
Medical guidelines for clinical practice Quality indicators
Evidence-based interventions Standards of medical care
Medical position statements Practice advisories
Evidence-based patient safety advisories Evidence review and treatment recommendations
Best practice guidelines and policies Care of patient guidelines
Guidelines for management Clinical expert consensus
Recommendations for standardization and interpretation Recommendations for delivery of care and ensuring access

Despite titling confusion, clinicians have more data to guide practice than in prior decades. Within this text, chapter editors have sought to examine the evidence base of practices in critical care monitoring and care delivery in critical care systems. While no single evidence system has been applied, strong evidence is acknowledged in systematic reviews of phenomena amenable to randomized controlled studies. Moderate levels of evidence advocated by most sources are supported in published guidelines from well-designed qualitative and quantitative studies. However, many of the practices currently used to monitor critically ill patients remain at the level of weak evidence or expert opinion. Protocols, even those based on strong evidence, do not always apply to every unique patient condition. Patient choice and philosophy should guide implementation of any monitoring and treatment practice. In addition, in many practices that are not widespread or targeted by review organizations due to high risk for poor outcomes, weak evidence continues because of a lack of practice guidelines. Study funding remains a barrier to advancing best practice for the nation’s critically ill. As systems improve for organizing and applying research findings, improvements in patient outcomes will continue to be advanced. Always, critical care nursing practice remains grounded in human ethics and respect for individualized care.