Clinical Pearls

Abstract

Ethical conflicts in intensive care units (ICUs) often reflect a tension between patients’ expectations and providers’ autonomy regarding medically appropriate care. These conflicts can cause moral distress for patients, families, and health care providers. Pavlish and colleagues developed an ethics screening tool for nurses to assess early indictors of ethical dilemmas and to analyze the level of risk likely to develop in specific situations. Use of the tool helped nurses to do the following:The authors advocate early screening for all patients and recommend that interventions such as family care conferences, ethical consultations, and palliative care services become more prominent and routine in the care of critically ill patients.—Rhonda Board, rn, phd, ccrnSee Article, pp 248–257What is the most common nosocomial infection in patients with intracerebral hemorrhage? Hinduja and colleagues did an analysis of 202 patients with intracerebral hemorrhage and found the following:—Janet F. Mulroy, rn, msn, acnp, ccns, ccrnSee Article, pp 227–231Elimination of hospital-acquired infections (HAIs) is a priority in health care and requires multimodal approaches. A common intervention to eliminate HAIs is adequate hand hygiene. Fox and colleagues added patient hand hygiene to their hospital’s hygiene protocol. This resulted in positive trends over a 12-month period. The authors noted the following:—Kimberly Whiteman, rn, dnpSee Article, pp 216–224Critically ill patients experience the highest prevalence of skin integrity issues. This contributes to increased lengths of stay, costs, morbidity, and mortality. Many pressure injuries (PIs) are preventable, but hypoxia, hemodynamic instability, or use of vasopressors place patients at risk. Coyer and colleagues compared patients who received standard skin care practices with patients who received a protocol that targets key areas of assessment, hygiene, repositioning, and prevention strategies. Their findings include the following:These results indicate that this new protocol warrants examination in other intensive care populations.—Rochelle Armola, rn, msn, ccrnSee Article, pp 199–210Assessment by critical care outreach teams (CCOTs) prevents deterioration of acutely ill patients or facilitates admission to the critical care unit. With continued difficulty discussing end-of-life care (EOLC) decisions, the appropriateness of escalating care to a CCOT is not broached early enough. This retrospective study in a United Kingdom cancer center determined how much time CCOTs spend with EOLC patients and their influence in those situations. Pattison and colleagues found the following:—Alethea Sment, rn, bsn, ccrn-cscSee Article, pp 232–240