Clinical Pearls

Abstract

Nursing productivity has been studied for years, but no current tools capture the cognitive workload of nursing care. Connor and colleagues developed the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) tool to include the multiple dimensions of pediatric critical care nursing in quantifying nursing workload and resource allocation. After using the CAMEO with 75 pediatric cardiac intensive care unit patients, they found the following:The CAMEO can be used to inform staffing needs, but more importantly, it considers cognitive workload and can offer guidance for staff synergy, educational innovations in theory, and clinical skills necessary for increasingly complex patient care.—Rhonda Board, rn, phd, ccrnSee Article, pp 297–308What is the best method to determine the need for suctioning? Sole and colleagues carried out a descriptive, comparative study to determine which assessments were best indicators for endotracheal suctioning. They found the following:Six previous studies and guidelines from the American Association of Respiratory Care were also carefully reviewed.—Bill Donnelly, rn, pmba, ccrnSee Article, pp 318–325Most research on pressure ulcers has focused on adult and geriatric populations and risk assessment tools. Manning and colleagues conducted a study that is the first to assess factors for the development of occipital pressure ulcers in pediatric patients. They found the following:A knowledge of risk factors can prospectively identify infants and children at risk and allow implementation of nursing interventions to prevent these ulcers.—Rochelle Armola, rn, msn, ccrnSee Article, pp 342–348The inclusion of patients and families in decision making is a hallmark of family-centered care. But what if the family is unable to visit the hospital? Epstein and colleagues used real-time videoconferencing via Skype and FaceTime to include family members of critically ill neonates in care discussions. The following should be considered:Although the sample size in this study is small, it provides evidence that daily videoconferencing updates may improve parents’ understanding of their infants’ condition.—Kimberly Whiteman, rn, dnpSee Article, pp 290–296Severity scoring systems for the critically ill may be unreliable for cardiac surgery patients due to the pathophysiologic consequences of cardiopulmonary bypass, which influences the variables usually scored. Exarchopoulos and colleagues tested these various scoring systems for morbidity and mortality in this patient population: Cardiac Surgery Score (CASUS), Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II. They found the following:Mortality was defined as death within 30 days after surgery, and morbidity variables included duration of mechanical ventilation, length of stay, readmission, and reintubation.—Alethea Sment, rn, bsn, ccrn-cscSee Article, pp 327–335