34 results on '"Mary Beth Flynn Makic"'
Search Results
2. Nursing Considerations for Patients With HIV in Critical Care Settings.
- Author
-
Graham L and Makic MBF
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Comorbidity, Drug-Related Side Effects and Adverse Reactions etiology, Female, Humans, Male, Middle Aged, Pregnancy, Pregnancy Complications, Infectious, United States, Young Adult, Antiviral Agents adverse effects, Antiviral Agents therapeutic use, Critical Care Nursing standards, Drug-Related Side Effects and Adverse Reactions nursing, HIV Infections drug therapy, HIV Infections nursing, Practice Guidelines as Topic
- Abstract
Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized., (©2020 American Association of Critical-Care Nurses.)
- Published
- 2020
- Full Text
- View/download PDF
3. Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit.
- Author
-
Haning C and Makic MBF
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Critical Care Nursing standards, Critical Illness nursing, Intensive Care Units standards, Practice Guidelines as Topic, Stroke nursing, Toothbrushing standards
- Published
- 2020
- Full Text
- View/download PDF
4. Continuing to challenge practice to be evidence based.
- Author
-
Makic MB, Rauen C, Jones K, and Fisk AC
- Subjects
- Critical Illness mortality, Female, Hospital Mortality, Humans, Male, Outcome Assessment, Health Care, Patient Care Team organization & administration, Risk Assessment, United States, Critical Care Nursing organization & administration, Critical Illness therapy, Evidence-Based Medicine organization & administration, Intensive Care Units organization & administration
- Abstract
Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient's actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice., (©2015 American Association of Critical-Care Nurses.)
- Published
- 2015
- Full Text
- View/download PDF
5. Staying Informed of Best Evidence to Guide Practice
- Author
-
Mary Beth Flynn Makic and Ellie Svoboda
- Subjects
Emergency Medicine ,General Medicine ,Critical Care Nursing - Published
- 2023
6. Personal Connection
- Author
-
Sara Knippa, Mary Beth Flynn Makic, and Angela Pal
- Subjects
General Medicine ,Critical Care Nursing - Published
- 2022
7. Give It a Name
- Author
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Mary Beth Flynn Makic, Sara Knippa, and Susan Bowles
- Subjects
2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Medicine ,General Medicine ,Critical Care Nursing ,business ,Virology - Published
- 2021
8. Reducing Hospital-Acquired Pressure Injuries During the COVID-19 Pandemic
- Author
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Kelly Wild and Mary Beth Flynn Makic
- Subjects
Pressure Ulcer ,COVID-19 ,Humans ,General Medicine ,Critical Care Nursing ,Pandemics ,Hospitals - Published
- 2022
9. Nursing Considerations for Patients With HIV in Critical Care Settings
- Author
-
Mary Beth Flynn Makic and Lucy Graham
- Subjects
Adult ,Male ,medicine.medical_specialty ,Chronic condition ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,Population ,HIV Infections ,Comorbidity ,Type 2 diabetes ,Disease ,030204 cardiovascular system & hematology ,Critical Care Nursing ,Antiviral Agents ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,law ,Critical care nursing ,medicine ,Humans ,030212 general & internal medicine ,Pregnancy Complications, Infectious ,Disease management (health) ,Intensive care medicine ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Intensive care unit ,United States ,Practice Guidelines as Topic ,Emergency Medicine ,Life expectancy ,Female ,business - Abstract
Infection with HIV is a chronic condition that requires daily medication to suppress viral replication. With appropriate treatment, people living with HIV have a life expectancy approaching that of the general population. However, they are at increased risk for comorbidities including cardiovascular disease, renal disease, type 2 diabetes, neurologic conditions, and cancers, often with worse outcomes than in patients without HIV. When they are admitted to critical care settings, care considerations, particularly regarding antiretroviral therapy, must be addressed. Antiretroviral therapy is critical for successful management of HIV infection and should be continued when possible during intensive care unit stays. However, many antiretroviral regimens result in drug-drug interactions, adverse drug-related events, and secondary complications such as insulin resistance and prolonged QT intervals. Critical care nurses have unique opportunities to provide safe, unbiased, and compassionate care that promotes health for a population of people who have a history of being stigmatized.
- Published
- 2020
10. Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit
- Author
-
Cailly Haning and Mary Beth Flynn Makic
- Subjects
Adult ,Male ,Toothbrushing ,medicine.medical_specialty ,business.industry ,Critical Illness ,MEDLINE ,General Medicine ,Middle Aged ,Critical Care Nursing ,Oral hygiene ,Intensive care unit ,law.invention ,Stroke ,Intensive Care Units ,law ,Practice Guidelines as Topic ,Emergency medicine ,Humans ,Medicine ,Female ,Toothbrush ,business - Published
- 2020
11. Is It Better to Give or to Receive?
- Author
-
Sara Knippa, Mary Beth Flynn Makic, and Carol Rauen
- Subjects
medicine.medical_specialty ,Certification ,030504 nursing ,business.industry ,General Medicine ,Critical Care Nursing ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Medical physics ,030212 general & internal medicine ,Periodicals as Topic ,0305 other medical science ,business - Published
- 2018
12. Providing Evidence-Based Practice During the COVID-19 Pandemic
- Author
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Mary Beth Flynn Makic
- Subjects
medicine.medical_specialty ,Respiratory Distress Syndrome ,Evidence-based practice ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Viral Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Pneumonia, Viral ,MEDLINE ,COVID-19 ,General Medicine ,medicine.disease ,Critical Care Nursing ,Pneumonia ,Critical care nursing ,Evidence-Based Practice ,Pandemic ,medicine ,Humans ,Intensive care medicine ,business ,Coronavirus Infections ,Pandemics ,Randomized Controlled Trials as Topic - Published
- 2020
13. CCRN Across the Life Span
- Author
-
Mary Beth Flynn Makic, Sara Knippa, and Tina Wallingford
- Subjects
Gerontology ,Adult ,Aged, 80 and over ,Male ,Certification ,Life span ,business.industry ,MEDLINE ,General Medicine ,Middle Aged ,Critical Care Nursing ,Practice Guidelines as Topic ,Medicine ,Humans ,Female ,Clinical Competence ,business ,Aged - Published
- 2019
14. Courageous or Compliant?
- Author
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Carol Rauen, Mary Beth Flynn Makic, and Sara Knippa
- Subjects
Certification ,Weight measurement scales ,business.industry ,Serum sodium level ,030208 emergency & critical care medicine ,General Medicine ,Fluid management ,Magnesium level ,Nursing Staff, Hospital ,030204 cardiovascular system & hematology ,Critical Care Nursing ,Bioinformatics ,United States ,03 medical and health sciences ,Sedation procedure ,0302 clinical medicine ,Intravenous fluid ,Test Taking Skills ,Practice Guidelines as Topic ,Humans ,Medicine ,Serum amylase raised ,business ,Opioid analgesics - Published
- 2017
15. Deimplementation in Clinical Practice: What Are We Waiting For?
- Author
-
Bradi B. Granger and Mary Beth Flynn Makic
- Subjects
Adult ,Male ,medicine.medical_specialty ,Advanced Practice Nursing ,business.industry ,MEDLINE ,General Medicine ,Evidence-Based Nursing ,Middle Aged ,Critical Care Nursing ,Nurse's Role ,United States ,Clinical Practice ,Text mining ,Family medicine ,Emergency Medicine ,medicine ,Humans ,Female ,business ,Quality of Health Care - Published
- 2019
16. We Do It for Our Patients
- Author
-
Carol Rauen, Karen Jeffries, and Mary Beth Flynn Makic
- Subjects
medicine.medical_specialty ,030504 nursing ,business.industry ,MEDLINE ,030208 emergency & critical care medicine ,General Medicine ,Critical Care Nursing ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Family medicine ,medicine ,0305 other medical science ,business - Published
- 2016
17. Maintaining Your Momentum: Moving Evidence Into Practice
- Author
-
Mary Beth Flynn Makic and Carol Rauen
- Subjects
03 medical and health sciences ,Momentum (technical analysis) ,0302 clinical medicine ,Classical mechanics ,030504 nursing ,business.industry ,Medicine ,030212 general & internal medicine ,General Medicine ,0305 other medical science ,Critical Care Nursing ,business - Published
- 2016
18. Critical Care Connection Nurses' Caring Behaviors
- Author
-
Mary Beth Flynn Makic
- Subjects
Restraint, Physical ,030504 nursing ,Critical Care Nursing ,Connection (mathematics) ,Intensive Care Units ,03 medical and health sciences ,Medical–Surgical Nursing ,0302 clinical medicine ,Nursing ,Critical care nursing ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Nurse-Patient Relations ,0305 other medical science ,Psychology - Published
- 2017
19. Examining the Evidence to Guide Practice: Challenging Practice Habits
- Author
-
Robin Watson, Mary Beth Flynn Makic, Carol Rauen, and Ann Will Poteet
- Subjects
Evidence-based nursing ,Evidence-based practice ,Critical Care ,Posture ,MEDLINE ,Psychological intervention ,Critical Care Nursing ,law.invention ,Enteral Nutrition ,Nursing ,law ,Thromboembolism ,Critical care nursing ,Realm ,Pedagogy ,Humans ,Medicine ,Intubation, Gastrointestinal ,business.industry ,Infant ,Evidence-Based Nursing ,General Medicine ,Intensive care unit ,Child, Preschool ,Norm (social) ,Sleep ,business - Abstract
Nurses are the largest segment of the nation’s health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients’ outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.
- Published
- 2014
20. Top 10 Review Tips
- Author
-
Carol Rauen, Lisa M. Soltis, and Mary Beth Flynn Makic
- Subjects
business.industry ,Medicine ,Library science ,General Medicine ,Critical Care Nursing ,business - Published
- 2014
21. Peer-to-Peer Nursing Rounds and Hospital-Acquired Pressure Ulcer Prevalence in a Surgical Intensive Care Unit
- Author
-
Alyson Dare Kelleher, Amanda Moorer, and Mary Beth Flynn Makic
- Subjects
medicine.medical_specialty ,Colorado ,Heel ,Quality management ,MEDLINE ,Prevalence ,Psychological intervention ,Nursing ,Critical care nursing ,medicine ,Humans ,Teaching Rounds ,Postoperative Care ,Pressure Ulcer ,Advanced and Specialized Nursing ,business.industry ,Middle Aged ,Skin Care ,Quality Improvement ,Intensive Care Units ,Medical–Surgical Nursing ,medicine.anatomical_structure ,Emergency medicine ,business ,Risk assessment - Abstract
We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters.
- Published
- 2012
22. Placement of an Esophageal Temperature Probe by Nurses
- Author
-
Karen Lovett, Mary Beth Flynn Makic, and M. Fareedul Azam
- Subjects
medicine.medical_specialty ,Esophageal temperature ,Statistics as Topic ,Nurses ,Survey result ,Core temperature ,Manikins ,Critical Care Nursing ,Body Temperature ,Dreyfus model of skill acquisition ,Esophagus ,Hypothermia, Induced ,Humans ,Medicine ,Medical physics ,Monitoring, Physiologic ,Distal esophagus ,business.industry ,General Medicine ,Surgery ,Background current ,Health Care Surveys ,Emergency Medicine ,Imaging technology ,Clinical Competence ,Clinical competence ,business - Abstract
Background Current guidelines support therapeutic hypothermia after cardiac arrest. An esophageal temperature probe (ETP) provides a core temperature assessment; however, accurate placement is necessary. Objectives To demonstrate accurate placement of an ETP and evaluate the effectiveness of high-fidelity simulation with anatomic imaging. Methods Registered nurses (RNs) were educated using 3-dimensional, high-fidelity simulation with VH Dissector technology (Touch of Life Technologies, Aurora, Colorado) to demonstrate ETP placement. The RNs provided survey responses on the effectiveness of simulation before and after using the simulator. Results Thirty-two RNs participated and did not demonstrate difficulties with the skill; however, 53.1% required more than 1 attempt for accurate placement in the distal esophagus. Survey results found that participants had increased confidence and high satisfaction with simulation and 3-dimensional imaging (P < .001). Conclusions Literature is lacking to guide ETP placement. In this study, RNs overestimated the depth for ETP insertion. Accurate temperature readings are highly dependent on accurate anatomical location placement. Providing skill competency training that incorporated anatomical imaging technology enhanced RNs’ awareness for effective skill acquisition.
- Published
- 2012
23. Management of Nausea, Vomiting, and Diarrhea During Critical Illness
- Author
-
Mary Beth Flynn Makic
- Subjects
Diarrhea ,medicine.medical_specialty ,Vomiting ,business.industry ,Nausea ,Critical Illness ,Psychological intervention ,MEDLINE ,General Medicine ,Disease ,Critical Care Nursing ,Quality of life (healthcare) ,Anticipation (genetics) ,Emergency Medicine ,Humans ,Medicine ,medicine.symptom ,business ,Intensive care medicine - Abstract
Symptoms are subjective patient experiences that may negatively impact the patient’s hospitalization, treatment plan, and quality of life. Critically ill patients frequently experience nausea, vomiting, and diarrhea related to underlying disease, procedures, and medical interventions (eg, medication, enteral feeding, surgery). Optimally, the nurse performs a subjective assessment that explores the patient’s perception and impact of these symptoms to develop a comprehensive plan of care. Unfortunately, little evidence is available to guide assessment of nausea, vomiting, and diarrhea in critically ill nonverbal patients. Understanding the disease processes, medical treatments, and pathophysioglogy of these symptoms will assist the critical care nurse in the anticipation of symptoms and development of a proactive plan to alleviate the symptom-associated discomfort.
- Published
- 2011
24. Evidence-Based Practice Habits: Transforming Research Into Bedside Practice
- Author
-
Elizabeth Bridges, Mary Beth Flynn Makic, and Carol Rauen
- Subjects
Evidence-based practice ,Critical Care ,Dopamine ,Dopamine Agents ,Posture ,MEDLINE ,Decision tree ,Nursing assessment ,Critical Care Nursing ,Nurse's Role ,Risk Assessment ,Clinical Nursing Research ,Humans ,Medicine ,Nursing Assessment ,Monitoring, Physiologic ,Specialties, Nursing ,Venous Thrombosis ,Medical education ,business.industry ,Decision Trees ,General Medicine ,Evidence-Based Practice ,Practice Guidelines as Topic ,Fluid Therapy ,Kidney Diseases ,Diffusion of Innovation ,Risk assessment ,business ,Algorithms - Published
- 2009
25. The Ventilated Patient's Experience
- Author
-
Ann Will Poteet, Kathleen S. Oman, Regina M. Fink, and Mary Beth Flynn Makic
- Subjects
Male ,medicine.medical_specialty ,Colorado ,medicine.medical_treatment ,Pain ,Emergency Nursing ,Anxiety ,Critical Care Nursing ,Sampling Studies ,Interviews as Topic ,Patient satisfaction ,Pain assessment ,medicine ,Humans ,Family ,Psychiatry ,Mechanical ventilation ,Inpatients ,business.industry ,Medical record ,Panic ,Middle Aged ,Respiration, Artificial ,Distress ,Intensive Care Units ,Patient Satisfaction ,Physical therapy ,Pain catastrophizing ,Female ,medicine.symptom ,business - Abstract
Background Critically ill intensive care unit (ICU) patients often experience pain, anxiety, panic, fear, dyspnea, and distress related to mechanical ventilation. Patients' recollections vary from having little or no memory of actual events to having total recall. Few studies have examined family members' memories and congruence with patients' symptom report and nurse observation. Objectives To describe the experience of the mechanically ventilated ICU patient. Aims (1) to explore patient and family memories of pain, anxiety, distress, and dyspnea following mechanical ventilation; (2) to determine if there is a correlation among nurse-documented pain assessment and patient- and family-reported pain intensity; and (3) to determine the level of patient and family satisfaction with care while on the ventilator. Methods This was a descriptive study design. A convenience sample of ICU patients (n = 84) and family members (n = 77) was interviewed. Medical record data abstraction included patient demographics, medication administration, and nurse assessment of pain and sedation. Results Most patient and family members reported memories of pain, anxiety/panic, nightmares or distress, and trouble breathing. Patients' perception of anxiety, nightmares, and dyspnea were moderately correlated with their pain perception (P = .000). Family members' memories of pain were correlated with nurse pain assessment behavioral scale ratings, but patients' memories of pain were not. Patients and family reported high satisfaction scores. Conclusion Further inquiry of the patient's experience with mechanical ventilation, the use of a ventilation sedation management protocol, and the evaluation of effective communication tools such as the use of bedside reporting or patient communication boards is warranted.
- Published
- 2015
26. Medical Device-Related Pressure Ulcers and Intensive Care Patients
- Author
-
Mary Beth Flynn Makic
- Subjects
Pressure Ulcer ,medicine.medical_specialty ,Medical device ,business.industry ,MEDLINE ,Medical–Surgical Nursing ,Intensive Care Units ,Equipment and Supplies ,Risk Factors ,Intensive care ,Critical care nursing ,Medicine ,Humans ,business ,Intensive care medicine - Published
- 2015
27. Continuing to challenge practice to be evidence based
- Author
-
Mary Beth Flynn Makic, Kimmith Jones, Anna C. Fisk, and Carol Rauen
- Subjects
Male ,medicine.medical_specialty ,Evidence-based practice ,Sedation ,medicine.medical_treatment ,Critical Illness ,Psychological intervention ,Chest physiotherapy ,Critical Care Nursing ,Risk Assessment ,Critical care nursing ,Health care ,Outcome Assessment, Health Care ,Medicine ,Humans ,Hospital Mortality ,Intensive care medicine ,Mechanical ventilation ,Patient Care Team ,Evidence-Based Medicine ,business.industry ,General Medicine ,medicine.disease ,United States ,Pneumonia ,Intensive Care Units ,Female ,medicine.symptom ,business - Abstract
Practice habits continue in clinical practice despite the availability of research and other forms of evidence that should be used to guide critical care practice interventions. This article is based on a presentation at the 2014 National Teaching Institute of the American Association of Critical-Care Nurses. The article is part of a series of articles that challenge critical care nurses to examine the evidence guiding nursing practice interventions. Four common practice interventions are reviewed: (1) weight-based medication administration, (2) chest tube patency maintenance, (3) daily interruption of sedation, and (4) use of chest physiotherapy in children. For weight-based administration of medication, the patient’s actual weight should be measured, rather than using an estimate. The therapeutic effectiveness and dosages of medications used in obese patients must be critically evaluated. Maintaining patency of chest tubes does not require stripping and milking, which probably do more harm than good. Daily interruption of sedation and judicious use of sedatives are appropriate in most patients receiving mechanical ventilation. Traditional chest physiotherapy does not help children with pneumonia, bronchiolitis, or asthma and does not prevent atelectasis after extubation. Critical care nurses are challenged to evaluate their individual practice and to adopt current evidence-based practice interventions into their daily practice.
- Published
- 2015
28. With change comes perfection
- Author
-
Carol Hinkle, Pat Baker, Carol Rauen, and Mary Beth Flynn Makic
- Subjects
Myocardial ischemia ,business.industry ,media_common.quotation_subject ,Perfection ,General Medicine ,Critical Care Nursing ,Intravenous fluid ,Education, Nursing, Continuing ,Medicine ,Educational Measurement ,business ,Opioid intoxication ,Hemodynamic instability ,media_common ,Law and economics - Published
- 2013
29. Putting evidence into nursing practice: four traditional practices not supported by the evidence
- Author
-
Sarah A. Martin, Carol Rauen, Suzanne M. Burns, Dinah Philbrick, and Mary Beth Flynn Makic
- Subjects
Nursing practice ,Adult ,medicine.medical_specialty ,Evidence-based nursing ,Evidence-based practice ,Catheters ,business.industry ,MEDLINE ,Oxygen Inhalation Therapy ,Pulmonary disease ,Blood Pressure Determination ,General Medicine ,Evidence-Based Nursing ,Critical Care Nursing ,Communicable Diseases ,Pulmonary Disease, Chronic Obstructive ,Realm ,medicine ,Infection control ,Humans ,Blood Transfusion ,Best evidence ,Intensive care medicine ,business ,Child - Abstract
Evidence-based nursing practice is essential to the delivery of high-quality care that optimizes patients' outcomes. Studies continue to show improved outcomes when best evidence is used in the delivery of patient care. Despite awareness of the importance of practicing by using best evidence, achieving and sustaining evidence-based practice within practice environments can be challenging, and research suggests that integration of evidence-based practice into daily clinical practice remains inconsistent. This article addresses 4 practice issues that, first, are within the realm of nursing and if changed might improve care of patients and, second, are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics addressed are (1) noninvasive measurement of blood pressure in children, (2) oxygen administration for patients with chronic obstructive pulmonary disease, (3) intravenous catheter size and blood administration, and (4) infection control practices to prevent infections. The related beliefs, current evidence, and recommendations for practice related to each topic are described.
- Published
- 2013
30. Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project
- Author
-
Mary Beth Flynn Makic, Kyra Fahlstrom, and Cameron Boyle
- Subjects
Protocol (science) ,medicine.medical_specialty ,Resuscitation ,Quality management ,Abdominal compartment syndrome ,business.industry ,Central venous pressure ,Retrospective cohort study ,General Medicine ,Lung injury ,Critical Care Nursing ,Pulmonary edema ,medicine.disease ,Nurse's Role ,Quality Improvement ,Emergency medicine ,medicine ,Humans ,Intensive care medicine ,business ,Burns ,Retrospective Studies - Abstract
Background Burn resuscitation, including titration of fluids and administration of colloids, is often driven by physicians’ orders. Inconsistencies in burn resuscitation cause overresuscitation, which has adverse consequences. Methods Retrospective chart reviews were completed to evaluate fluid resuscitation and complications for 12 months before and after development and implementation of a nurse-driven burn resuscitation protocol. Results Before implementation of the protocol, results at 24 hours after injury indicated that 58% of patients were overresuscitated, had a serum level of lactate of at least 2 mmol/L (100%), and had complications (pulmonary edema 20%, abdominal compartment syndrome 7%, acute lung injury/acute respiratory distress syndrome 30%) within the first 5 days. Two outcomes differed from before to after implementation of the protocol: serum level of lactate at 24 hours (t37.8 =2.38, P =.007) and central venous pressure at 48 hours (t31 =2.27, P =.03). After implementation of the protocol, no patients had abdominal compartment syndrome develop. Conclusions Implementation of the nurse-driven burn resuscitation protocol improved nurses’ awareness and assessment of fluid status during resuscitation and improved patients’ outcomes.
- Published
- 2013
31. Understanding advanced modes of mechanical ventilation
- Author
-
Shannon Johnson Bortolotto and Mary Beth Flynn Makic
- Subjects
Mechanical ventilation ,Adult ,medicine.medical_specialty ,business.industry ,Critically ill ,medicine.medical_treatment ,Ventilator-Induced Lung Injury ,Critical Care Nursing ,Respiration, Artificial ,Intensive Care Units ,Modes of mechanical ventilation ,Tidal Volume ,Medicine ,Humans ,Noninvasive ventilation ,business ,Intensive care medicine - Abstract
Approaches to mechanical ventilation (MV) are consistently changing and the level of ventilator sophistication provides opportunities to improve pulmonary support for critically ill patients. Advanced MV modes are used in the treatment of patients with complex pulmonary conditions. To achieve optimal patient outcomes MV modes that best meet the needs of patient's evolving pulmonary conditions are necessary. It's essential for nurses to integrate pulmonary MV knowledge in the care of critically ill patients. The purpose of this article is to describe the evidence supporting lung protective modes of MV used in the care of critically ill adults.
- Published
- 2012
32. Evidence-based practice habits: putting more sacred cows out to pasture
- Author
-
Mary Beth Flynn Makic, Carol Rauen, Jessica Chadwick, and Kathryn T. VonRueden
- Subjects
Evidence-based nursing ,Evidence-based practice ,Critical Care ,media_common.quotation_subject ,MEDLINE ,Suction ,Critical Care Nursing ,Nurse's Role ,Body Temperature ,Head-Down Tilt ,Education, Nursing, Continuing ,Nursing ,Excellence ,Critical care nursing ,Realm ,Nursing Interventions Classification ,Medicine ,Humans ,media_common ,Monitoring, Physiologic ,Gastric emptying ,business.industry ,General Medicine ,Evidence-Based Nursing ,Visitors to Patients ,Treatment Outcome ,Gastric Emptying ,Urinary Tract Infections ,Hypotension ,business ,Urinary Catheterization ,Cell Phone ,Fecal Incontinence - Abstract
For excellence in practice to be the standard for care, critical care nurses must embrace evidence-based practice as the norm. Nurses cannot knowingly continue a clinical practice despite research showing that the practice is not helpful and may even be harmful to patients. This article is based on 2 presentations on evidence-based practice from the American Association for Critical-Care Nurses' 2009 and 2010 National Teaching Institute and addresses 7 practice issues that were selected for 2 reasons. First, they are within the realm of nursing, and a change in practice could improve patient care immediately. Second, these are areas in which the tradition and the evidence do not agree and practice continues to follow tradition. The topics to be addressed are (1) Trendelenburg positioning for hypotension, (2) use of rectal tubes to manage fecal incontinence, (3) gastric residual volume and aspiration risk, (4) restricted visiting policies, (5) nursing interventions to reduce urinary catheter-associated infections, (6) use of cell phones in critical care areas, and (7) accuracy of assessment of body temperature. The related beliefs, current evidence, and recommendations for practice related to each topic are outlined.
- Published
- 2011
33. Clinically induced hypothermia: why chill your patient?
- Author
-
Mary Holden and Mary Beth Flynn Makic
- Subjects
Evidence-Based Medicine ,Critical Care ,Patient Selection ,Resuscitation ,General Medicine ,Recovery of Function ,Unconsciousness ,Critical Care Nursing ,Nurse's Role ,Patient Care Planning ,Heart Arrest ,Treatment Outcome ,Hypothermia, Induced ,Emergency Medicine ,Humans ,Nursing Assessment ,Monitoring, Physiologic - Abstract
Clinically induced hypothermia is an evidence-based intervention strategy that can improve the neurological outcome of unconscious patients after sudden cardiac arrest. Until recently, clinically induced hypothermia has been primarily used during surgery as a mechanism of preserving cardiovascular and neurologic stability of patients. Current evidence suggests that early use of mild hypothermia therapy in select populations of patients improves survival and neurologic outcome postdischarge. While clinically induced hypothermia is beneficial as a treatment to preserve neurologic function, it is not without complications. The purpose of this article is to review current literature and evidence-based nursing practice implications for managing the induction of a hypothermic state in adult patients who remain comatose after initial resuscitation from sudden cardiac arrest. Physiologic benefits of hypothermia, complications, and nursing care considerations will be presented.
- Published
- 2006
34. Symptom Management in Critically Ill Patients
- Author
-
Mary Beth Flynn Makic
- Subjects
medicine.medical_specialty ,Critically ill ,business.industry ,Symptom management ,medicine ,Emergency Medicine ,General Medicine ,Intensive care medicine ,business ,Critical Care Nursing - Published
- 2011
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