Clinical Pearls.

Abstract

Patient-reported outcomes are an invaluable tool to provide patients’ perceptions of quality of care. Measurement of sedation and agitation has traditionally been done with clinician-determined sedation assessments. Although a new sedation index is a significant predictor of various outcomes, the relationship between patient-reported outcomes and clinician-determined assessments is not known.Malinowski and colleagues interviewed patients 24 to 96 hours after cessation of sedation to determine the usefulness of sedation and agitation indexes. They found thatThe agitation index was significantly correlated with several patient-related outcomes, including difficulty sleeping, inability to talk, and amount of noise. The authors suggest future clinical use of the index as a descriptor of the patient’s experience.See Article, pp 140-144It is well known that delirium can be a complication for patients receiving mechanical ventilation. Many also experience pain, anxiety, and physiological stress that require medication therapy, which may further increase the risk for delirium. Bundled protocols of care can reduce delirium, but low adherence has hindered their use.Khan and colleagues conducted a randomized controlled trial to test the feasibility of, adherence to, and acceptability of a music intervention in 3 groups of patients receiving mechanical ventilation: (1) personalized music chosen by the patient or a surrogate, (2) nonpersonalized slow-tempo music, (3) audiobooks. They found thatAlthough further research is warranted, the authors suggest that a music intervention is a scalable, low-burden intervention that is feasible to deliver in the intensive care unit.See Article, pp e31-e38Dyspnea is a subjective symptomatic experience that can be most distressing for patients undergoing mechanical ventilation. Although dyspnea has been linked with signs of posttraumatic stress disorder and is a predictor of morbidity and mortality, little information is available about the standardized assessment and documentation of dyspnea.Baker and colleagues examined the perceptions of nurses who conducted routine measurement and documentation of dyspnea with a standardized tool (0-10 numeric scale). They found thatMost of the nurses felt that it was important to use a standardized tool to measure dyspnea consistently. The authors suggest that Joint Commission standards, much like those established for pain assessment and intervention, be developed for dyspnea.See Article, pp 132-139As the shortage of nurses looms, focus has increased on identifying and managing burnout syndrome in nurses, especially those working in critical care. Resilience training is one strategy that has improved nurses’ practice of mindfulness, self-care, and well-being. Although research has shown positive effects of such training on student nurses’ current health and care of patients, it is not clear whether students are given the foundation to apply these strategies to future practice.Cochrane and colleagues examined the prevalence of resiliency training resources in nursing schools across the United States and found thatAlthough most schools had fitness facilities for students (85%), proactive resilience training and resources were lacking. The authors suggest that US nursing schools consider modifying curriculum to incorporate preventative strategies that better prepare nurses for clinical practice.See Article, pp 104-110