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, Misty M. Richmond, Nancy Munro
AACN Advanced Critical Care; doi:10.4037/aacnacc2021492

Abstract:
As COVID-19 continues to spread, with the United States surpassing 29 million cases, health care workers are beginning to see patients who have been infected with SARS-CoV-2 return seeking treatment for its longer-term physical and mental effects. The term long-haulers is used to identify patients who have not fully recovered from the illness after weeks or months. Although the acute symptoms of COVID-19 have been widely described, the longer-term effects are less well known because of the relatively short history of the pandemic. Symptoms may be due to persistent chronic inflammation (eg, fatigue), sequelae of organ damage (eg, pulmonary fibrosis, chronic kidney disease), and hospitalization and social isolation (eg, muscle wasting, malnutrition). Health care providers are instrumental in developing a comprehensive plan for identifying and managing post–COVID-19 complications. This article addresses the possible etiology of postviral syndromes and describes reported symptoms and suggested management of post-COVID syndrome.
Linda Bell
American Journal of Critical Care, Volume 30, pp 242-242; doi:10.4037/ajcc2021846

American Journal of Critical Care, Volume 30, pp 230-236; doi:10.4037/ajcc2021607

The publisher has not yet granted permission to display this abstract.
, Leyla Baran, Ülkü Yapucu Güneş
American Journal of Critical Care, Volume 30, pp 186-192; doi:10.4037/ajcc2021382

The publisher has not yet granted permission to display this abstract.
Katrina E. Hauschildt, Claire Seigworth, Lee A. Kamphuis, Catherine L. Hough, Marc Moss, Joanne M. McPeake, Molly Harrod, Theodore J. Iwashyna
American Journal of Critical Care, Volume 30, pp 221-229; doi:10.4037/ajcc2021825

Abstract:
Background Many patients confront physical, cognitive, and emotional problems after acute respiratory distress syndrome (ARDS). No proven therapies for these problems exist, and many patients manage new disability and recovery with little formal support. Eliciting patients’ adaptations to these problems after hospitalization may identify opportunities to improve recovery. Objectives To explore how patients adapt to physical, cognitive, and emotional changes related to hospitalization for ARDS. Methods Semistructured interviews were conducted after hospitalization in patients with ARDS who had received mechanical ventilation. This was an ancillary study to a multicenter randomized controlled trial. Consecutive surviving patients who spoke English, consented to follow-up, and had been randomized between November 12, 2017, and April 5, 2018 were interviewed 9 to 16 months after that. Results Forty-six of 79 eligible patients (58%) participated (mean [range] age, 55 [20-84] years). All patients reported using strategies to address physical, emotional, or cognitive problems after hospitalization. For physical and cognitive problems, patients reported accommodative strategies for adapting to new disabilities and recuperative strategies for recovering previous ability. For emotional issues, no clear distinction between accommodative and recuperative strategies emerged. Social support and previous familiarity with the health care system helped patients generate and use many strategies. Thirty-one of 46 patients reported at least 1 persistent problem for which they had no acceptable adaptation. Conclusions Patients employed various strategies to manage problems after ARDS. More work is needed to identify and disseminate effective strategies to patients and their families.
Rhonda Board
American Journal of Critical Care, Volume 30, pp 172-172; doi:10.4037/ajcc2021635

, Alai Tan, Andreanna Pavan Hsieh, Kate Gawlik, Cynthia Arslanian-Engoren, Lynne T. Braun, Sandra Dunbar, Jacqueline Dunbar-Jacob, Lisa M. Lewis, Angelica Millan, et al.
American Journal of Critical Care, Volume 30, pp 176-184; doi:10.4037/ajcc2021301

Abstract:
Background Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses’ overall health affects the occurrence of medical errors. Objective To examine the associations among critical care nurses’ physical and mental health, perception of workplace wellness support, and self-reported medical errors. Methods This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors. Results A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%). Conclusion Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.
American Journal of Critical Care, Volume 30; doi:10.4037/ajcc2021514

Feifei Zhang, Qiantao Zuo, Jingxia Cheng, Zhuyue Li, Longling Zhu, Yingying Li, Lijuan Xuan, Yu Zhou,
American Journal of Critical Care, Volume 30, pp 203-211; doi:10.4037/ajcc2021245

Abstract:
Background Emergency and intensive care unit nurses are the main workforce fighting against COVID-19. Their professional identity may affect whether they can actively participate and be competent in care tasks during the pandemic. Objective To examine the level of and changes in professional identity of Chinese emergency and intensive care unit nurses as the COVID-19 pandemic builds. Methods A cross-sectional survey composed of the Professional Identity Scale for Nurses plus 2 open-ended questions was administered to Chinese emergency and intensive care unit nurses through an online questionnaire. Results Emergency and intensive care unit nurses had a medium level of professional identity. Participants’ total and item mean scores in 5 professional identity dimensions were higher than the professional identity norm established by Liu (P < .001). The greatest mean item score difference was in the dimension of professional identity evaluation (3.57 vs 2.88, P < .001). When asked about their feelings witnessing the COVID-19 situation and their feelings about participating in frontline work, 68.9% and 83.9%, respectively, reported positive changes in their professional identity. Conclusions The professional identity of emergency and intensive care unit nurses greatly improved during the early stages of the COVID-19 pandemic. This finding may be attributed to more public attention and recognition of nurses’ value, nurses’ professional fulfillment, and nurses’ feelings of being supported, motivated, respected, and valued.
, Akiva Leibowitz
American Journal of Critical Care, Volume 30, pp 238-241; doi:10.4037/ajcc2021697

The publisher has not yet granted permission to display this abstract.
Grant A. Pignatiello, Aloen L. Townsend, Ronald L. Hickman
American Journal of Critical Care, Volume 30, pp 212-220; doi:10.4037/ajcc2021214

The publisher has not yet granted permission to display this abstract.
Cindy L. Munro, Aluko A. Hope
American Journal of Critical Care, Volume 30, pp 169-171; doi:10.4037/ajcc2021169

Eileen Kim, Charles Kast, Anika Afroz-Hossain, Michael Qiu, Karalyn Pappas, Liron Sinvani
American Journal of Critical Care, Volume 30, pp 193-200; doi:10.4037/ajcc2021591

Abstract:
Background Despite a growing cohort of intensive care unit (ICU) survivors, little is known about the early ICU aftercare period. Objective To identify gaps in early ICU aftercare and factors associated with poor hospital outcomes. Methods A multisite, retrospective study (January 1 to December 31, 2017) was conducted among randomly selected patients admitted to the medical ICU and subsequently transferred to acute medical care units. Records were reviewed for patient characteristics, ICU course, and early ICU aftercare practices and syndromes. Associations between practices and hospital outcomes were calculated with χ2 and Wilcoxon rank sum tests, followed by logistic regression. Results One hundred fifty-one patients met inclusion criteria (mean [SD] age, 64.2 [19.1] years; 51.7% male; 44.4% White). The most frequent diagnoses were sepsis (35.8%) and respiratory failure (33.8%). During early ICU aftercare, 46.4% had dietary restrictions, 25.8% had bed rest orders, 25.0% had a bladder catheter, 26.5% had advance directive documentation, 33.8% had dysphagia, 34.3% had functional decline, and 23.2% had delirium. Higher Charlson Comorbidity Index (odds ratio, 1.6) and midodrine use on medical units (odds ratio, 7.5) were associated with in-hospital mortality; mechanical ventilation in the ICU was associated with rapid response on medical unit (odds ratio, 12.9); and bladder catheters were associated with ICU readmission (odds ratio, 5.2). Conclusions Delirium, debility, and dysphagia are frequently encountered in early ICU aftercare, yet bed rest, dietary restriction, and lack of advance directive documentation are common. Future studies are urgently needed to characterize and address early ICU aftercare.
Stefano Bambi, , Alessandro Galazzi, Elisa Mattiussi, Irene Comisso, Matteo Manici, Moris Rosati, Alberto Lucchini
American Journal of Critical Care; doi:10.4037/ajcc2021178

Abstract:
Background Caring for patients with COVID-19 requires wearing a full set of personal protective equipment (PPE) to avoid contamination. Personal discomfort has been associated with use of PPE, and anecdotal reports describe pressure injuries related to wearing PPE. Objectives To investigate the occurrence of device-related pressure injuries due to wearing PPE among Italian nurses caring for patients with COVID-19 in critical care settings. Methods This descriptive study used an online survey investigating both the demographic characteristics of respondents and complications related to wearing PPE, including the development of pressure injuries. Results A total of 266 nurses throughout Italy completed the survey; 32% of respondents were men. Nurses’ median age was 36 years (range 22-59 years), and the median time spent working in their current clinical setting (an intensive care or high-dependency unit) was 3 years (range 0-32 years). Personal protective equipment was worn for a median duration of 5 hours (range 2-12 hours). While wearing PPE, 92.8% of nurses experienced pain and 77.1% developed device-related pressure injuries, mainly on the nose and forehead. Pain was more frequent among nurses with such injuries. Transparent dressings, emollient cream, and no dressing were associated with development of device-related pressure injury. Conclusions Pressure injuries related to PPE represent an important adverse effect for nurses caring for patients with COVID-19. This topic deserves study to determine adequate solutions for preventing and treating such injuries and their potential influence on nurses’ work tolerance.
, Tetsu Ohnuma, Raquel Bartz, Matthew Fuller, Nita Khandelwal, Krista Haines, Charles Scales, Karthik Raghunathan
American Journal of Critical Care; doi:10.4037/ajcc2021818

Abstract:
Background The COVID-19 pandemic created pressure to delay inpatient elective surgery to increase US health care capacity. This study examined the extent to which common inpatient elective operations consume acute care resources. Methods This cross-sectional study used the Premier Healthcare Database to examine the distribution of inpatient elective operations in the United States from the fourth quarter of 2015 through the second quarter of 2018. Primary outcomes were measures of acute care use after 4 common elective operations: joint replacement, spinal fusion, bariatric surgery, and coronary artery bypass grafting. A framework for matching changing demand with changes in supply was created by overlaying acute care data with publicly available outbreak capacity data. Results Elective coronary artery bypass grafting (n = 117 423) had the highest acute care use: 92.8% of patients used intensive care unit beds, 89.1% required postoperative mechanical ventilation, 41.0% required red blood cell transfusions, and 13.3% were readmitted within 90 days of surgery. Acute care use was also substantial after spinal fusion (n = 203 789): 8.3% of patients used intensive care unit beds, 2.2% required postoperative mechanical ventilation, 9.2% required red blood cell transfusions, and 9.3% were readmitted within 90 days of surgery. An example of a framework for matching hospital demand with elective surgery supply is provided. Conclusions Acute care needs after elective surgery in the United States are consistent and predictable. When these data are overlaid with national hospital capacity models, rational decisions regarding matching supply to demand can be achieved to meet changing needs.
Published: 26 April 2021
AACN Advanced Critical Care; doi:10.4037/aacnacc2021454

Abstract:
Nursing is a physically and emotionally demanding profession. Grueling job roles and challenging work environments, specifically in acute or critical care settings, place health care professionals at risk of burnout. Burnout in health care professionals results from a chronic negative work experience, leading to job dissatisfaction and, ultimately, poor patient outcomes. Symptoms and prevalence of burnout can be alleviated by implementing individual-focused strategies and minor modifications in work environments, job demands, and responsibilities. Currently, risk for burnout is increasing as COVID-19 challenges health care systems in which advanced practice nurses and other health care professionals struggle continuously to deliver high-quality patient care. In this article, the circumstances surrounding COVID-19 are considered and an overview is provided of burnout phenomenon, its causal factors, and its consequences. With consideration of current evidence in literature, I discuss some suggested strategies to improve resilience and facilitate well-being among health care professionals at individual and organizational levels.
, Colleen Snydeman, Virginia Capasso, Mary Ann Walsh, John Murphy, Xianghong Sean Wang
Published: 22 April 2021
AACN Advanced Critical Care; doi:10.4037/aacnacc2021848

Abstract:
Objective: As intensive care unit bed capacity doubled due to COVID-19 cases, nursing leaders created a prone team to support labor-intensive prone positioning of patients with COVID-related acute respiratory distress syndrome. The goal of the prone team was to reduce workload on intensive care teams, standardize the proning process, mitigate pressure injuries and turning-related adverse events, and ensure prone team safety. Methods: Staff were trained using a hybrid learning model focused on prone-positioning techniques, pressure injury prevention, and turning-related adverse events. Results: No adverse events occurred to patients or members of the prone ream. The prone team mitigated pressure injuries using prevention strategies. The prone team and intensive care unit staff were highly satisfied with their experience. Conclusion: The prone team provided support for critically ill patients, and team members reported feeling supported and empowered. Intensive care unit staff were highly satisfied with the prone team.
, Nico Nortjé, Laura Webster, Daniel Garros
American Journal of Critical Care; doi:10.4037/ajcc2021611

Abstract:
During the COVID-19 pandemic, evidence-based resources have been sought to support decision-making and strategically inform hospitals’ policies, procedures, and practices. While greatly emphasizing protection, most guiding documents have neglected to support and protect the psychosocial needs of frontline health care workers and patients and their families during provision of palliative and end-of-life care. Consequently, the stage has been set for increased anxiety, moral distress, and moral injury and extreme moral hazard. A family-centered approach to care has been unilaterally relinquished to a secondary and nonessential role during the current crisis. This phenomenon violates a foundational public health principle, namely, to apply the least restrictive means to achieve good for the many. Instead, there has been widespread adoption of utilitarian and paternalistic approaches. In many cases the foundational principles of palliative care have also been neglected. No circumstance, even a global public health emergency, should ever cause health care providers to deny their ethical obligations and human commitment to compassion. The lack of responsive protocols for family visitation, particularly at the end of life, is an important gap in the current recommendations for pandemic triage and contingency planning. A stepwise approach to hospital visitation using a tiered, standardized process for responding to emerging clinical circumstances and individual patients’ needs should be considered, following the principle of proportionality. A contingency plan, based on epidemiological data, is the best strategy to refocus health care ethics in practice now and for the future.
Published: 15 April 2021
AACN Advanced Critical Care; doi:10.4037/aacnacc2021302

Abstract:
COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.
, Msn Danielle Coyne, Msn Anna N. Garton, Msn Erin C. Hare, Msn Maureen A. Seckel
Published: 13 April 2021
Critical Care Nurse; doi:10.4037/ccn2021153

The publisher has not yet granted permission to display this abstract.
Lori B. Herges, Jacob C. Jentzer, Rn Diane D. Brighton, Joseph R. Herges, PharmD Narith N. Ou
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 44-50; doi:10.4037/ccn2021833

The publisher has not yet granted permission to display this abstract.
Dnp Kimberly Whiteman, Bsn Jason Yaglowski, Dnp Kimberly Stephens
Published: 1 April 2021
Critical Care Nurse, Volume 41; doi:10.4037/ccn2021914

The publisher has not yet granted permission to display this abstract.
PhD Brenda Recchia Jeffers
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 13-13; doi:10.4037/ccn2021597

, Bsn Shannon Vernon
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 78-80; doi:10.4037/ccn2021182

Sara Knippa, Kelly A. Thompson-Brazill, Laura Ullery
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 72-77; doi:10.4037/ccn2021298

Msn Linda Bell, Msn Michelle Sanchez
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 85-86; doi:10.4037/ccn2021826

PharmD Rebecca Conley, PharmD Rebecca L. Rich, PharmD Jennifer Montero
Published: 1 April 2021
Critical Care Nurse, Volume 41; doi:10.4037/ccn2021549

The publisher has not yet granted permission to display this abstract.
Bsn Rachel Black, Bsn Stacy Blackall, Bsn Chad Houseman, Bsn Morgan Roach,
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 83-84; doi:10.4037/ccn2021470

, Bsn Blake Lynch
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 8-10; doi:10.4037/ccn2021550

Kim Martz, Jenny Alderden, Rick Bassett, Dawn Swick
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 12-13; doi:10.4037/ccn2021186

, DNP Rebecca McClay, Bsn-Rn Jessica Natividad
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 36-42; doi:10.4037/ccn2021145

The publisher has not yet granted permission to display this abstract.
Ann M. Parker, Louay Aldabain, Narges Akhlaghi, Msn Mary Glover, Bsn Stephanie Yost, Ms Michael Velaetis, Otr/l Annette Lavezza, Ba Earl Mantheiy, Ba Kelsey Albert, Md Dale M. Needham
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 51-60; doi:10.4037/ccn2021551

The publisher has not yet granted permission to display this abstract.
, PhD Valerie Sabol, Msn Amanda Smith, Mha Heather Stafford, Julie A. Thompson, Dnp Margaret Bowers
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 62-71; doi:10.4037/ccn2021934

Abstract:
Background Catheter-associated urinary tract infections are the second most common health care–associated infections, occurring most frequently in intensive care units. These infections negatively affect patient outcomes and health care costs. Local Problem The targeted institution for this improvement project reported 13 catheter-associated urinary tract infections in 2018, exceeding the hospital’s benchmark of 4 or fewer such events annually. Six of the events occurred in the intensive care unit. Project objectives included a 30% reduction in reported catheter-associated urinary tract infections, 20% reduction in urinary catheter days, and 75% compliance rating in catheter-related documentation in the intensive care unit during the intervention phase. Methods This project used a pre-post design over 2 consecutive 4-month periods. The targeted population was critically ill patients aged 18 and older who were admitted to the intensive care unit. A set of bundled interventions was implemented, including staff education, an electronic daily checklist, and a nurse-driven removal protocol for indwelling urinary catheters. Data were analyzed using mixed statistics, including independent samples t tests and Fisher exact tests. Results No catheter-associated urinary tract infections were reported during the intervention period, reducing the rate by 1.33 per 1000 catheter days. There was a 10.5% increase in catheter days, which was not statistically significant (P = .12). Documentation compliance increased significantly from 50.0% before to 83.3% during the intervention (P = .01). Conclusions This bundled approach shows promise for reducing catheter-associated urinary tract infections in critical care settings. The concept could be adapted for other health care–associated infections.
Bsn Preston H. Miller, Ms C. Noelle Flaherty, PhD Jennifer R. Bail
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 11-12; doi:10.4037/ccn2021867

, Ms Diane Lynn Blume, Rd Katie Davis, PhD Hee Jun Kim
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 16-26; doi:10.4037/ccn2021556

The publisher has not yet granted permission to display this abstract.
Msn Spencer Dean, Msn Meghan Long, Bsn Edie Ryan, Rn Kelly Tarnoviski, Bs Antara Mondal,
Published: 1 April 2021
Critical Care Nurse, Volume 41; doi:10.4037/ccn2021213

The publisher has not yet granted permission to display this abstract.
Published: 1 April 2021
Critical Care Nurse, Volume 41, pp 88-88; doi:10.4037/ccn2021334

Ms Jeannine W.C. Blake, Bsee Robert Butterfield, PhD Karen K. Giuliano
Published: 25 March 2021
AACN Advanced Critical Care; doi:10.4037/aacnacc2021149

Daniel Puebla Neira, Justin Seashore
Published: 25 March 2021
AACN Advanced Critical Care; doi:10.4037/aacnacc2021801

Ba Ashlyn E. Carey,
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 113-118; doi:10.4037/aacnacc2021386

Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 110-112; doi:10.4037/aacnacc2021663

Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 51-63; doi:10.4037/aacnacc2021473

The publisher has not yet granted permission to display this abstract.
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 11-13; doi:10.4037/aacnacc2021920

Dnp John J. Gallagher, Dnp Jennifer Adamski
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 76-88; doi:10.4037/aacnacc2021235

The publisher has not yet granted permission to display this abstract.
, MS Karen A. McQuillan
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 29-50; doi:10.4037/aacnacc2021331

The publisher has not yet granted permission to display this abstract.
, Bsn Carmela Leone, Ms Tonie Owens
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 105-109; doi:10.4037/aacnacc2021122

Dnp Shanna Fortune,
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 89-104; doi:10.4037/aacnacc2021519

The publisher has not yet granted permission to display this abstract.
Published: 15 March 2021
AACN Advanced Critical Care, Volume 32, pp 64-75; doi:10.4037/aacnacc2021817

The publisher has not yet granted permission to display this abstract.
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