Oral care practices in non-mechanically ventilated intensive care unit patients: An integrative review.

AIMS AND OBJECTIVES: To explore current oral care practices in nonmechanically ventilated ICU patients. BACKGROUND: Oral hygiene is an important aspect of nursing care in hospitalised populations. Oral care is a disease preventive and cost-effective measure for patients, particularly in ICU patients. Numerous studies support the value of oral care practices in mechanically ventilated ICU patients. Due to evidence supporting the benefits of oral care in nonmechanically ventilated patients, it would be beneficial to examine the literature for oral care practices in this population. METHODOLOGY: Literature searches of the following databases were performed: CINAHL Plus, MEDLINE, PsychInfo, Academic Search Premier, Cochrane Database of Systematic Reviews, and Web of Science. Three peer-reviewed articles were included in the review after inclusion criteria were applied. Findings were appraised, organised conceptually and synthesised using Torraco (2016b) as a guiding framework. Evidence was appraised using the Johns Hopkins Nursing Evidence-based Practice Rating Scale. PRISMA reporting guidelines were followed, when applicable. RESULTS: Findings support the existing gap in the literature of oral hygiene practices in nonmechanically ventilated ICU patients. Themes included the type of oral care products used, frequencies of oral care, documented oral care practices and personnel that performed the care. STUDY IMPLICATIONS: This integrative review identified an important gap in the literature for oral care practices in nonmechanically ventilated ICU patient populations. Further research on current oral care practices and development of evidence-based guidelines for this population are recommended. RELEVANCE TO CLINICAL PRACTICE: Nurses should provide oral care to all hospitalised patients and follow oral care guidelines specific to their population, if available.

Telehealth across nursing education: Findings from a national study.

BACKGROUND: The onset of COVID-19 perpetuated the necessity for nursing students to be telehealth savvy upon graduation. There is minimal research regarding the integration of telehealth in nursing curricula across multiple levels. PURPOSE: The purpose of this survey study was to determine the current or future use of telehealth content and experiences in prelicensure and graduate nursing program curricula. METHODS: Following vetting, an adapted survey was sent to 386 nursing program or simulation directors in June 2020. FINDINGS: The survey had a 21 % (n = 82) response rate. Fifty-five percent of prelicensure and 40 % of graduate programs had no telehealth curricular content, while 22 % and 45 %, respectively, planned to integrate. The top barrier to integration was a lack of funds. DISCUSSION: Further research is needed to evaluate telehealth in nursing curricula. Due to many factors, the addition of telehealth curricula in nursing schools is inevitable.

Manual vs Automatic Prone Positioning and Patient Outcomes in Acute Respiratory Distress Syndrome.

BACKGROUND: Prone positioning is a standard treatment for moderate to severe acute respiratory distress syndrome (ARDS), but the outcomes associated with manual versus automatic prone positioning have not been evaluated. OBJECTIVE: To retrospectively evaluate outcomes associated with manual versus automatic prone positioning as part of a pronation quality improvement project implemented by a multidisciplinary team. METHODS: A retrospective, descriptive-comparative approach was used to analyze data from 24 months of a prone positioning protocol for ARDS. The study involved 37 patients, with 16 undergoing manual and 21 undergoing automatic prone positioning. Descriptive and nonparametric statistical analyses were used to evaluate outcomes associated with manual versus automatic prone positioning. RESULTS: Outcomes were similar between the 2 groups regarding time to initiation of prone positioning, discharge disposition, and length of stay. Manually pronated patients were less likely to experience interruptions in therapy (P = .005) and complications (P = .002). Pressure injuries were the most common type of complication, with the most frequent locations in automatically pronated patients being the head (P = .045), thorax (P = .003), and lower extremities (P = .047). Manual prone positioning resulted in a cost avoidance of $78 617 per patient. CONCLUSION: Manual prone positioning has outcomes similar to those of automatic prone positioning with less risk of interruptions in therapy, fewer complications, and lower expense. Further research is needed to determine whether manual prone positioning is superior to automatic prone positioning in patients with ARDS.

The impact of interprofessional collaboration on the effectiveness, significance, and future of advanced practice registered nurses.

Interprofessional collaboration was essential for the conduct of research that demonstrated the effectiveness and significance of advanced practice registered nurses (APRNs) in providing care, in reducing health care costs, and in developing innovative models of care for the nation's citizens. If the 2010 Affordable Care Act is to be implemented, APRNs, with their expertise and numbers, are essential to its implementation. Continued interdisciplinary collaboration is needed to expand the scope of APRN state practice regulations, to change reimbursement for APRN services, and to mute opposition to these changes by medical organizations.

Global considerations in measuring effectiveness of advanced practice nurses.

Documentation of advanced practice nurses' (APNs) effectiveness globally is essential in developing educational programs and standards, regulations, titling, prescribing privileges, and scope and standards of practice. Based on the body of research on APN effectiveness to date, two major factors have emerged in developing future studies, (1) careful, deliberate choice of outcomes and (2) dose effects. The purpose of this paper is to review these measurement issues. Careful selection in choice of patient outcomes important to regional and national health care challenges is essential in developing studies to document APN effects on outcomes important to the country and region. It is equally important to consider the concept of dose effects of the APNs. Dose effects consist of 3 components: dose (number of APNs at the clinical practice site, region or country and amount of APN care in minutes or contacts); APN (education, expertise, and experience); and host and host response (organizational, governmental or patient and/or family receptiveness to APNs and to APN practice). Considering each component of the concept is essential in developing studies to examine APN effectiveness internationally.

Health Problems and APN Interventions in Pregnant Women with Diabetes.

The purpose of this study was to compare health problems and advanced practice nursing (APN) interventions in two types of APN care provided to 41 childbearing women with diabetes. The study's design involved content analysis of interaction logs containing the process of APN care during two clinical trials: 1) APN care was added to physician care (n = 22); and, 2) half of physician care was substituted with APN care (n = 19). Women's' health problems and APN interventions were classified using the Omaha System's Problem Scheme and Intervention Scheme. The women, in the study, had a mean age of 30, and were predominantly Black, high school graduates, with a low income. The findings identified 61,004 health problems and 60,980 APN interventions from the interaction logs. APNs provided significantly more interventions antenatally to the women in the substitution group than to those in the additive group. However, the overall categories of problems were the same in both groups. Surveillance and health teaching/counseling were the top APN interventions antenatally and postpartum. Case management interventions were third most common for both groups, while treatments and procedures constituted the least number of APN interventions in each group before and after birth. When APNs shared care more equally with physicians, they intervened differently in type and number of interventions. Their broad range of skills and depth of understanding in clinical practice, health systems, family and personal issues allowed them to intervene early and effectively.