Clinical Pearls.

Abstract

Prolonged bed rest in critically ill patients contributes to many negative outcomes including ventilator-associated pneumonia, pressure injuries, thromboembolic disease, insulin resistance, and orthostasis. Numerous studies have shown that early mobilization minimizes these consequences, but various safety concerns of clinicians have limited this practice.Cooper and colleagues explored early mobility practices with orally intubated patients who met early out-of-bed (OOB) criteria. They found The authors recommend that unit leaders work to ensure that staff have the appropriate knowledge and competencies to provide early mobility care safely.See Article, pp 266-274Having a child hospitalized in the pediatric intensive care unit (PICU) is a stressful experience for parents. However, most studies have involved primarily White parents; the role of race/ethnicity on parental response is unknown.Ernst and colleagues examined the differences in stressors, coping behaviors, and level of distress for mothers with a child in the PICU or cardiac ICU (CICU). In a sample of 58% Hispanic, 26% non-Hispanic White, and 16% African American mothers they found Findings suggest that African American mothers may be at higher risk for negative mental health outcomes and not having their distress identified. Although more studies are needed, the authors encourage early identification of mothers’ distress and coping behaviors in order to individualize interventions used to reduce stress.See Article, pp 275-284Use of personal protective equipment (PPE) is a mandatory part of COVID-19 patient care. Although PPE has been used by health care staff for years, recent anecdotal reports show that the pandemic practice of nonstop, continuous wearing is causing device-related pressure injuries (DRPIs).Bambi and colleagues surveyed nurses working in COVID-19 units to examine the occurrence of DRPIs with the use of facial PPE (N95 masks, goggles, and face shields). They found The authors recommend urgent exploration into the prevention and treatment of PPE-related injuries and, in particular, the role of preventive wound dressings.See Article, pp 287-293The COVID-19 pandemic brought about many changes in the care of critically ill patients, including restricted visitation. Although many health care workers initially agreed with the global standard of no visitors, conflicts between providing morally compassionate care and protecting staff quickly emerged.Jones-Bonofiglio and colleagues examined the literature on moral injury/distress and pandemic care with palliative/end-of-life patients. Their findings show The authors developed an evidence-based protocol with a stepwise approach to decision-making for visitation. They emphasize that visitors must be included as a crucial part of the end-of-life care team, to avoid moral and psychological damage for both families and staff.See Article, pp 302-311