Clinical Pearls

Abstract

Critical care nurses routinely provide end-of-life (EOL) care for patients and their families. Research in the late 1990s identified various obstacles that hindered nurses’ ability to deliver high-quality EOL care. However, it is unknown if progress has been made since that time.Beckstrand and colleagues surveyed critical care nurses to identify the current obstacles and helpful behaviors related to EOL care and compared them with the 1999 survey data. They foundThe authors recommend that nurses take the lead for improved EOL education with the general public. In addition, focused education for nurses can improve communication with and quality of care for families facing EOL.See Article, pp e81-e91Patients have traditionally received nothing by mouth (nil per os [NPO]) after surgery to prevent adverse outcomes such as nausea, vomiting, dysphagia, and aspiration pneumonia. However, oral hydration protocols vary widely among providers, with some causing patients further distress.Ford and colleagues examined the effects of early oral hydration on adverse events in adult patients after cardiac surgery and foundThis comprehensive early oral hydration protocol was easy for nurses to use and safely decreased patients’ thirst during the postoperative recovery period.See Article, pp 292-300Critically ill patients are at risk for delirium, with prevalence rates from 60% to 87%. Longer duration and greater severity of delirium have been associated with higher 1-year morbidity and mortality; however, it is unknown if these associations continue up to 2 years after discharge.Andrews and colleagues used the Confusion Assessment Method for the Intensive Care Unit-7 to measure delirium severity and found the following:Although findings support the association between delirium and higher 2-year posthospital mortality, the authors recommend future research to explore the relationship between delirium and utilization of other types of health care services and other clinical outcomes.See Article, pp 311-317Compassion fatigue is a syndrome of chronic distress that occurs in up to 40% of critical care health care providers. Nurses who work in a pediatric intensive care unit (PICU) have high rates of burnout and secondary traumatic stress, which can result from low compassion satisfaction. Although PICU nurses face high exposure to patient death, it is not known if this influences their compassion satisfaction.Richardson and colleagues surveyed PICU and neonatal intensive care unit nurses and foundAlthough further research is needed, the authors recommend that health care organizations provide education to best support nurses at risk for compassion fatigue.See Article, pp 285-291