重症监护护士 (CCN) 是美国重症监护护士协会 (AACN) 的官方出版物。邀请作者提交手稿以供考虑和同行评审。临床主题必须符合 CCN 的使命，并解决急危重症患者的护理实践。

Critical Care Nurse is the official publication of the American Association of Critical-Care Nurses (AACN). We invite authors to submit manuscripts for consideration and peer review. Clinical topics must align with the mission of Critical Care Nurse and address the nursing practice for critically ill patients.

《Critical Care Nurse》是美国重症监护护士协会（AACN）的官方出版物。我们欢迎作者提交手稿以供考虑和同行评审。临床主题必须符合《Critical Care Nurse》的使命，并关注急危重症患者的护理实践。

Critical Care Nurse

Background Caring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process. Objectives To explore family surrogate decision-making for people with chronic critical illness. Methods In this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis. Results Family surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as frustrating, most surrogates reported that they were comfortable with this role. Major decision-making themes were as key in decision-making, impact of past experiences, and difficulties and coping. Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges. Conclusions Results support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes.

Karen O. Moss

Sara L. Douglas

Eric Baum

Barbara Daly

Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis

慢性危重病中的家庭替代决策：一项定性分析

Background Iatrogenic withdrawal syndrome is a well-known adverse effect of sedatives and analgesics commonly used in patients receiving mechanical ventilation in the pediatric intensive care unit, with an incidence of up to 64.6%. When standard sedative and analgesic treatment is inadequate, dexmedetomidine may be added. The effect of supplemental dexmedetomidine on iatrogenic withdrawal syndrome is unclear. Objective To explore the potentially preventive effect of dexmedetomidine, used as a supplement to standard morphine and midazolam regimens, on the development of iatrogenic withdrawal syndrome in patients receiving mechanical ventilation in the pediatric intensive care unit. Methods This retrospective observational study used data from patients on a 10-bed general pediatric intensive care unit. Iatrogenic withdrawal syndrome was measured using the Sophia Observation withdrawal Symptoms-scale. Results In a sample of 102 patients, the cumulative dose of dexmedetomidine had no preventive effect on the development of iatrogenic withdrawal syndrome (P = .19). After correction for the imbalance in the baseline characteristics between patients who did and did not receive dexmedetomidine, the cumulative dose of midazolam was found to be a significant risk factor for iatrogenic withdrawal syndrome (P &amp;lt; .03). Conclusion In this study, supplemental dexmedetomidine had no preventive effect on iatrogenic withdrawal syndrome in patients receiving sedative treatment in the pediatric intensive care unit. The cumulative dose of midazolam was a significant risk factor for iatrogenic withdrawal syndrome.

Barbara M. Geven

Jolanda M. Maaskant

Catherine S. Ward

Job B.M. van Woensel

Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

危重患儿中的右美托咪定与医源性戒断综合征

Use of physical restrainst is scrutinized in intensive care units today. Usage rates for the 5 intensive care units in the Christiana Care Health Services, Newark, Delaware, were higher than the National Database of Nursing Quality Indicators mean rate of 9.61% to 15.43% for many months during fiscal years 2013 and 2014.To reduce and sustain the restraint rates to less than the national database mean rates for all 5 intensive care units.A quality improvement process was used that included forming a multiunit restraint collaborative; reviewing restraint data, including self-extubation rates; surveying staff nurses to examine alignment with evidence-based practice; and selecting a new restraint-alternative product.All 5 intensive care units were able to successfully decrease restraint rates to less than the national database mean for the majority of the months since the start of the restraint collaborative in September 2012.Use of a restraint collaborative with subsequent adoption of restraint alternatives led to a decrease in restraint rates for the 5 intensive care units to less than the national database mean, enabled sustained success, and helped align nurses' beliefs with evidence-based practice.

Dannette A. Mitchell

Teresa Panchisin

Maureen A. Seckel

Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

减少重症监护病房约束使用的质量改进项目

Articles| October 01 1997 The ethical imperative to treat pain in infants: are we doing the best we can? LS Franck LS Franck Search for other works by this author on: This Site PubMed Google Scholar Crit Care Nurse (1997) 17 (5): 80–87. https://doi.org/10.4037/ccn1997.17.5.80 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Cite Icon Cite Get Permissions Citation LS Franck; The ethical imperative to treat pain in infants: are we doing the best we can?. Crit Care Nurse 1 October 1997; 17 (5): 80–87. doi: https://doi.org/10.4037/ccn1997.17.5.80 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentCritical Care Nurse Search Advanced Search You do not currently have access to this content.

L S Franck

The ethical imperative to treat pain in infants: are we doing the best we can?

婴儿疼痛治疗的伦理必要性：我们是否已尽全力？

Background Patients with cardiogenic shock have a 25% to 50% mortality rate despite the introduction of mechanical circulatory devices and coordinated medical treatment. The use of shock teams has improved outcomes for these patients. Local Problem A cardiovascular hospital with a multidisciplinary shock team had inconsistency and delays in recognition and diagnosis of patients with cardiogenic shock. Methods A nurse-led, preintervention-postintervention quality improvement project was performed in April and May 2021 and in April and May 2022 within a cardiovascular hospital in north Texas. The 2 nursing staff interventions regarding shock team activation were education and shock alert implementation. Time from first signs to diagnosis (for inpatients) and time from initial transfer request to acceptance (for transferring patients) were measured. Descriptive and statistical analyses were conducted using R, version 4.0.0 (R Foundation for Statistical Computing). Results The mean (SD) time to diagnosis of cardiogenic shock decreased significantly from 17.98 (28.39) hours in the preintervention group (n = 25) to 8.15 (12.26) hours in the postintervention group (n = 45; P = .045). For patients with cardiogenic shock transferring from referring hospitals, the median (IQR) time to acceptance was 1.55 (0.08-3.18) hours in the preintervention group and 0.35 (0.00-0.72) hours in the postintervention group (P &amp;lt; .001). Conclusions Nursing staff interventions regarding shock team activation significantly improved the time of diagnosis and acceptance of patients with cardiogenic shock in a cardiovascular hospital, enhancing the overall quality of care provided to these patients.

Suzanne Krais

Jenelle Sheasby

Jasjit Banwait

Natalie Lewis

Zhaoli Liu

Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation

通过护士教育和警报实施改善心源性休克团队激活

Background Although the benefits of improved transitions of care regarding medications are widely known, implementation is variable among inpatient settings and populations and requires an interprofessional effort. This article reviews the body of published research on challenges with medication history taking and reconciliation for inpatients requiring treatment of traumatic injuries or surgical intervention. Review of Evidence A comprehensive search of PubMed and MEDLINE databases from inception to February 2021, the reference lists of qualifying articles, and PubMed’s “similar article” suggestions were used to identify publications based on the following key terms: patient transfer, transitional care, medication reconciliation, general surgery, and surgical procedures. Publications relevant to trauma and surgical patient populations were selected. Only 11 articles met the full criteria. Implementation The general challenges of accurate medication reconciliation at admission are also often barriers in the trauma and general surgery population. Discerning trends in the literature and evidence-based practice may be helpful. Evaluation The publications revealed many barriers to medication reconciliation at admission, in the intensive care unit, and at intensive care unit and hospital discharge. Sustainability Practices that can overcome these challenges include persistence in obtaining accurate information, paying close attention to changes in dosage or dosage forms and resumption of home medications at intensive care unit discharge, and having a follow-up plan for prescribing and deprescribing at hospital discharge. Conclusion Clear guidelines are needed for performing medication assessments at the bedside, including the role of each health care professional who conducts them and how the process is coordinated.

Bethany R. Shoulders

Kelly L. Maguigan

Dironada K. Strange

Stephen J. Lemon

Medication Transitions of Care in Trauma and Acute Care Surgery Patients

创伤和急性外科手术患者的护理用药过渡

Annette M. Bourgault

Workplace Violence: An Uncomfortable, Yet Important Topic

工作场所暴力：一个令人不适但重要的话题

Introduction Nearly one-quarter of adult critical illness survivors develop posttraumatic stress disorder symptoms triggered by sensory stimuli after intensive care unit discharge. Intensive care unit delirium is a risk factor for posttraumatic stress disorder. Compressed virtual reality exposure therapy (C-VRET) incorporates sensory stimuli to reduce posttraumatic stress disorder symptoms through habituation. Clinical Findings and Diagnosis A critical illness survivor developed intensive care unit delirium and enrolled in a C-VRET trial to treat posttraumatic stress disorder. She reported self-isolation because of infection fears and posttraumatic stress disorder symptoms triggered by medical commercials and lawn equipment sounds. She repetitively checked her heart rate at night for fear of missing illness signs and waking up intubated. Interventions The participant completed therapy. Screening tests were administered before, 2 weeks after, and 3 months after therapy to measure posttraumatic stress disorder symptoms (Clinician-Administered PTSD Scale for DSM-5; range, 0-60), depression (Center for Epidemiologic Studies Depression Scale; range, 0-60), physical activity (International Physical Activity Questionnaire), and resiliency (Connor-Davidson Resilience Scale; range, 0-100). Outcomes The participant’s posttraumatic stress disorder symptom scores declined from 36 to 11 to 5; depression scores declined from 19 to 5 to 1; physical activity scores increased from 499 to 2013 to 4599; and resiliency scores increased from 70 to 76 to 83. Conclusion This report highlights the severity of posttraumatic stress disorder symptoms in critical illness survivors and the importance of strategies to limit delirium and posttraumatic stress disorder. Compressed virtual reality exposure therapy may reduce posttraumatic stress disorder symptoms in critical illness survivors.

Brian C. Peach

Caitlin L. Cox

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report

使用压缩虚拟现实暴露疗法治疗成年重症疾病幸存者：一例报告

Melissa Cortez

Addressing Workplace Violence in Critical Care: A Call for Comprehensive Training and Support

应对重症监护中的职场暴力：呼吁全面培训与支持

Abbreviation	Crit. Care Nurse
Journal Impact	2.02
Quartiles(Global)	NURSING(Q2)

ISSN	0279-5442, 1940-8250
h-index	51

Publication Information	Publisher: American Association of Critical-Care Nurses，Publishing cycle: Bimonthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1980，Proportion of original research papers: 93.10%，Self Citation Rate:10.00%， Gold OA Rate: 0.00%
Average review cycle	网友分享经验：>12周，或约稿
Average recruitment ratio	网友分享经验：容易

Critical Care Nurse

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Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis

Dexmedetomidine and Iatrogenic Withdrawal Syndrome in Critically Ill Children

Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

The ethical imperative to treat pain in infants: are we doing the best we can?

Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation

Improving Cardiogenic Shock Team Activation Through Nurse Education and Alert Implementation

Medication Transitions of Care in Trauma and Acute Care Surgery Patients

Workplace Violence: An Uncomfortable, Yet Important Topic

Using Compressed Virtual Reality Exposure Therapy for an Adult Critical Illness Survivor: A Case Report

Addressing Workplace Violence in Critical Care: A Call for Comprehensive Training and Support