Clinical Pearls

Abstract

Pressure injuries (PIs) are a common problem associated with poor outcomes for patients such as increased hospital length of stay, higher mortality rates, decreased patient satisfaction, and significant health care costs. The Centers for Medicare and Medicaid Services have considered PIs a “never event” since 2008. Although various nursing interventions have been used to decrease PIs, many intensive care unit (ICU) patients continue to experience this condition.Freeman and colleagues evaluated the effects of using specialty, silklike bed linens to reduce PI occurrence in adult cardiac and surgical ICU patients. They found the following:In addition, the specialty linens were 3 times more durable than cotton linens. The authors recommend use of specialty linens along with standard PI prevention care.See Article, pp 474–481Compassion fatigue is often unrecognized in health care professionals who work with patients undergoing traumatic or extremely stressful events. It comprises a combination of psychological and physiological responses, secondary traumatic stress, and burnout. The Critical Care Societies Collaborative stresses the importance of protecting critical care professionals’ mental health to decrease negative consequences for both workers and patients.Kelly and Lefton studied the effects of a meaningful recognition program on nurses’ compassion fatigue and compassion satisfaction. They found the following:Meaningful recognition can contribute to a healthy work environment. The authors recommend that nurse leaders raise awareness of this issue and acknowledge their staff to promote satisfaction and reduce burnout.See Article, pp 438–444Diabetic patients are often considered nonviable candidates for a heart transplant because of poor prognostic factors associated with their underlying disease. However, previous research has conflicting findings on morbidity and mortality outcomes after heart transplant in diabetic patients. Some researchers found negative consequences, such as worse short-term and long-term survival, more infections, and increased incidence of renal dysfunction, whereas other researchers found similar outcomes in the 2 groups.Jalowiec and colleagues compared 8 posttransplant outcomes in patients with preexisting diabetes versus patients without preexisting diabetes. They found the following:This study provides relevant clinical information on posttransplant outcomes and reasons for hospitalization in diabetic patients that can help providers monitor closely for posttransplant complications.See Article, pp 482–490Although delirium affects 2 out of 3 critically ill adults, many patients exhibit symptoms that do not meet formal criteria for a delirium diagnosis. This condition is called subsyndromal delirium (SSD) and may contribute to poor clinical outcomes such as longer hospital stay, lower cognitive and functional levels, and increased mortality. However, SSD screening is often not done, so the relationship between SSD prevalence and institutionalization is unknown.Brummel and colleagues used the popular Confusion Assessment method for the Intensive Care Unit (CAM-ICU) to assess noncomatose patients. They found the following:The authors recommend standardized nursing assessment and reporting for all types of acute brain dysfunction to evaluate and reduce modifiable risk factors.See Article, pp 447–455