This issue is devoted to the large and small initiatives that can result in improved outcomes within the intensive care unit. The physical characteristics of the unit, effective utilization of personnel, procedural changes, and even simple modifications in care routines can yield positive results for patients and staff.
The first article by Rashid, Kahn, and Jones, Physical and Visual Accessibilities in Intensive Care Units: A Comparative Study of Open-Plan and Racetrack Units presented results from 2 diverse unit designs. Their findings suggested that the open designs permit better interactions among staff and that visual accessibilities were more important than physical accessibilities. This article provides some valuable clues for managers and architectural planners involved in remodeling or new construction of the critical care unit.
Coen and Curry present compelling information about one method of care enhancement in their article: Improving Heart Failure Outcomes: The Role of the Clinical Nurse Specialist. Using a case study, the authors emphasize the dynamic and unique interactions with the patient, health care provider, and health care system that are vital for optimum care for one patient population
With the increasing popularity of point-of-care (POC) testing, there are associated concerns about reliability of this new method, which is a variant of the standard automated laboratory protocol typically employed within the hospital laboratory. Sardi, Lamoureux, Cohn, and Phillip-Samul present important findings in their article, Point-of-Care Testing of Troponin Level Compared With Automated Laboratory Evaluation: A Reliability Study. Findings indicated a systematic negative bias for the POC values when compared with the laboratory troponin values for indicating cardiac injury.
Johnson, Gilman, Lintner, and Butler report their successful implementation of a program to reduce catheter-associated urinary tract infections (CAUTIs). These nurses share their collaborative actions with various clinical partners to curtail this common problem among the critical care population. Nurse-Driven CAUTI Reduction Process and Protocol: Development Through an Academic-Practice Partnership should serve to inspire and empower others who are embarking on a strategy to improve patient outcomes.
Implementation of a Pediatric Early Warning Scoring System at an Academic Medical Center by Douglas, Collado, and Keller noted that despite adding a family-activated rapid response element to the rapid response team (RRT) algorithm, their Children's hospital did not note an increase in utilization of the RRT. The addition of a pediatric early warning score (PEWS) resulted in an increase in rapid response calls and a decrease in code team activations. Their suggestions for overcoming inherent barriers will be helpful for nurse leaders attempting to change inherent practices.
Effective use of ancillary nursing is vital for the professional nurses who rely on their support to accomplish their workload in the intensive care environment. Brady's article, An Exploration of Nursing Assistants' Perceptions about Job Satisfaction will help the reader understand the factors associated with both retention and attrition among this group of staff members. Career advancement opportunities were noted as key factors in achieving stability of the nursing assistant workforce. Administration recognizes that high turnover rates negatively impact patient care as well as the operating budget and productivity of the critical care unit.
Two international authors from Iran challenge us to consider changes in our practices related to enteral feedings. Their article, Gastric Residual Volume: Rethinking the Threshold by Zeydi, Sharafkhani, and Armat illustrates how unnecessary interruptions in feeding because of high residual volumes may negatively impact nutritional support for the critically ill patient who is dependent upon mechanical ventilation.
Improving outcomes in the ICU is a multifactorial issue and requires participation of many disciplines. The environment of care is central to patient satisfaction as well as care quality, and so we begin with a focus on architectural considerations. Beyond that, nursing management and clinical support teams must contribute by engaging in systematic analyses of care policies, procedures, and staff performance in an effort to identify strategies for outcome improvements.
-Carmen G. Warner, MSN, RN, MDiv, FAAN
Issue Editor