Clinical Pearls

Abstract

Approximately 8% to 10% of patients in surgical intensive care units (ICUs) will have a hospital-acquired pressure injury (PI) during their stay. These injuries may result in increased pain, increased costs, and longer stays. Although stage 1 PIs are the most common type and can deteriorate to a more severe stage, no studies have addressed the clinical course or outcomes of stage 1 PIs in ICU patients.Alderden and colleagues conducted a retrospective chart review to identify stage 1 PI outcomes. They found the following:To prevent further injury, the authors suggest that nurses consider aggressive treatment of older patients and patients who have factors associated with PI development.See Article, pp 471-476Stress from the hospital workplace environment can cause burnout, which may include emotional exhaustion, reduced feelings of personal accomplishment, and symptoms such as anger and fatigue. In addition, nursing burnout has been associated with medical errors, high turnover, and even posttraumatic stress.Cordoza and colleagues studied the effects of nurses taking daily work breaks in an outside garden setting compared with indoor-only breaks. They found the following: The authors suggest that outdoor garden breaks be used with other interventions to moderate burnout and stress. Although the nurses in this study may have been biased by working in a hospital that already had outdoor space for use by staff, patients, and patients’ families, the findings support the use of outdoor daily work breaks.See Article, pp 508-512The practice of instilling normal saline during suctioning of endotracheal tubes has been controversial for the past 3 decades. Despite evidence showing short-term complications with instillation, such as decreased oxygen saturation and compromised hemodynamics, some clinicians remain reluctant to not use saline.McKinley and colleagues compared the use of (1) no saline, (2) 0.225% saline, and (3) 0.9% saline with intubated pediatric patients. They found the following:The authors acknowledge that significant differences may not have been found because of the high noncompliance in the no-saline group. However, the findings support the American Association for Respiratory Care’s recommendation that saline not be routinely used. Future research on nurses’ perceptions is warranted.See Article, pp 486-494Alcohol withdrawal syndrome (AWS) is a life-threatening condition that has traditionally been treated with benzodiazepines and continuous evaluation using the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar). However, the traditional protocol has several limitations, including nursing staff burden and need for adjuvant therapy. With little research on alternative therapies, few other options for management are available.Tidwell and colleagues compared the traditional CIWA-Ar protocol with a phenobarbital protocol in patients being treated for AWS. They found the following:Phenobarbital provides longer symptom control that can decrease the burden of nursing assessments. The authors recommend a phenobarbital protocol be considered as an alternative therapy for AWS.See Article, pp 454-460