ABSTRACT
Rationale: During the first wave of the coronavirus disease (COVID-19) pandemic in New York City, the number of mechanically ventilated COVID-19 patients rapidly surpassed the capacity of traditional intensive care units (ICUs), resulting in health systems utilizing other areas as expanded ICUs to provide critical care. Objectives: To evaluate the mortality of patients admitted to expanded ICUs compared with those admitted to traditional ICUs. Methods: Multicenter, retrospective, cohort study of mechanically ventilated patients with COVID-19 admitted to the ICUs at 11 Northwell Health hospitals in the greater New York City area between March 1, 2020 and April 30, 2020. Primary outcome was in-hospital mortality up to 28 days after intubation of COVID-19 patients. Results: Among 1,966 mechanically ventilated patients with COVID-19, 1,198 (61%) died within 28 days after intubation, 46 (2%) were transferred to other hospitals outside of the Northwell Health system, 722 (37%) survived in the hospital until 28 days or were discharged after recovery. The risk of mortality of mechanically ventilated patients admitted to expanded ICUs was not different from those admitted to traditional ICUs (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.95-1.20; P = 0.28), while hospital occupancy for critically ill patients itself was associated with increased risk of mortality (HR, 1.28; 95% CI, 1.12-1.45; P < 0.001). Conclusions: Although increased hospital occupancy for critically ill patients itself was associated with increased mortality, the risk of 28-day in-hospital mortality of mechanically ventilated patients with COVID-19 who were admitted to expanded ICUs was not different from those admitted to traditional ICUs.
Subject(s)
COVID-19 , Critical Illness , COVID-19/therapy , Cohort Studies , Hospital Mortality , Humans , Intensive Care Units , New York City/epidemiology , Respiration, Artificial , Retrospective StudiesABSTRACT
This column outlines some of the challenges and opportunities for nurses in the coming years. Implications for nursing practice and education are highlighted.
Subject(s)
Health Care Reform , Nursing/trends , Patient Protection and Affordable Care Act , Accountable Care Organizations , Advanced Practice Nursing/trends , Electronic Health Records , Humans , United StatesABSTRACT
The purpose of this training program was to prepare nursing staff in family-centered geriatric care that emphasizes providing culturally competent care to hospitalized elders at two major tertiary hospitals in New York. This research report corresponds to the first phase of a 3-year project. In this research project, a descriptive exploratory design was used to identify the levels of cultural awareness and cultural competence of nursing staff who participated in a family-centered geriatric care training program.
Subject(s)
Clinical Competence/standards , Education, Nursing, Continuing/organization & administration , Family Nursing , Geriatric Nursing/education , Nursing Staff, Hospital/education , Transcultural Nursing/education , Aged , Attitude of Health Personnel , Awareness , Cultural Diversity , Curriculum , Educational Measurement , Health Knowledge, Attitudes, Practice , Humans , Inservice Training/organization & administration , New York , Nursing Education Research , Nursing Staff, Hospital/psychology , Patient-Centered Care/organization & administration , Program Evaluation , Surveys and QuestionnairesABSTRACT
This report describes a Nursing Care Quality Initiative (NCQI) through which a new model of care for hospitalized older adults and their families, the Family-Centered Geriatric Resource Nurse (FCGRN) model, was introduced. Eighteen units in 10 hospitals participated in the NCQI Project. Educational, clinical, and evaluation components of the NCQI Project are described.
Subject(s)
Aged , Family Nursing/organization & administration , Family , Geriatric Nursing/organization & administration , Hospitalization , Models, Nursing , Nurse Clinicians/organization & administration , Patient-Centered Care/organization & administration , Total Quality Management/organization & administration , Aged/psychology , Attitude of Health Personnel , Attitude to Health , Education, Nursing, Continuing , Family/psychology , Geriatric Nursing/education , Health Knowledge, Attitudes, Practice , Humans , Inservice Training , Nurse Clinicians/education , Nurse Clinicians/psychology , Nurse's Role , Nursing Evaluation Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Program Evaluation , Quality Indicators, Health CareABSTRACT
This article describes outcomes of a new model of care for hospitalized elders and their families. Patient functional and cognitive status on admission and discharge were evaluated for changes as a result of an educational program for preparing family-centered geriatric resource nurses. Patients in the intervention group (n = 173) demonstrated significant improvements in outcome measures (functional and cognitive status) from admission to discharge. A subset (n = 50) was selected from the 173 subjects who comprised the intervention group; this subset was compared with control subjects (n = 44); no statistically significant differences were noted between the 2 groups. Suggestions for future research are presented.
