[Acute care of patients with cerebral palsy in neuro-resuscitation surgery]. / La prise en soins des patients cérébrolésés à la phase aiguë en neuroréanimation chirurgicale.

Severe head trauma, with or without polytrauma, subarachnoid haemorrhage due to aneurysm rupture, is an unexpected tragedy for patients and their families. These accidents are likely to result in extremely serious neurological damage, with many of the patients under our care facing a life-threatening prognosis. To protect the brain, one solution is to put the patient into a deep sleep during the so-called "acute" phase, making it impossible to assess the repercussions of the initial injuries at the time: this is what we call "waiting resuscitation".

Study on clinical nursing pathway to promote the effective implementation of sepsis bundle in septic shock.

BACKGROUND: There is still a certain gap between the effective implementation and requirements of sepsis bundle. Our aim is to establish the clinical nursing pathway of the cluster treatment of septic shock in the Intensive Care Unit and promote effective implementation of the cluster treatment of septic shock. METHODS: By means of evidence-based method, quality control index requirements and on-site investigation, the implementation process of clinical nursing pathway of the cluster treatment within 6 h of diagnosis of septic shock was established. RESULTS: After the implementation of clinical nursing pathway, the completion rate of septic shock cluster treatment was 81.4% (66.4%) in 1 h, 89.4% (77.0%) in 3 h, 95.5% (82.3%) in 6 h (P < 0.05), which was significantly improved in the experimental group compared with the control group. CONCLUSIONS: The clinical nursing pathway of septic shock cluster treatment is guided by evidence-based nursing, which emphasizes standardization and standardization of septic shock cluster treatment nursing under the guidance of the guideline, and can promote the effective implementation of septic shock cluster treatment, significantly improve efficiency of septic shock treatment and the quality of medical care.

[Reducing False Alarms and Absent Treatments by Nurses During Resuscitation in the Emergency Department].

BACKGROUND & PROBLEMS: Medical management protocols prioritize the safety of patients during emergency resuscitation situations. According to a medical center in Taiwan statistics gathered in 2017, the unnecessary activation of resuscitation teams by new nurses because of their improper assessment of patient conditions was a significant cause of anxiety in patient relatives and source of complaints directed at the medical center. In June 2018, 18.7% of the emergency resuscitation calls in the emergency department (ED) were false alarms or absent treatment incidents. After investigation, lack of clearly stated resuscitation team member responsibilities and insufficient practical training for new nurses were primary factors associated with the high rate of false alarm/absent treatment incidents in the ED. PURPOSE: To decrease the rate of absent treatment by nurses during resuscitation from 18.7% to 0% in the ED. RESOLUTION: The assignments of emergency team members were revised, a new "Emergency app" was introduced, the assignment schedule of the emergency resuscitation team was distributed, SIM realistic education training was held, stronger team work was promoted, and a standard assignment review schedule was established and regularly monitored. RESULTS: After the introduction of the resolution measures, the false alarm / absent treatment incidents in the ED caused by ED nurses dropped from 18.7% to 0%. CONCLUSIONS: Resuscitation workflow is closely related to patient safety, and teamwork among colleagues critical to successful resuscitation. The project revised resuscitation teamwork assignments and organized resuscitation education training, including simulation courses, to enhance the understanding of team members. The strategy outlined in this paper may be used to raise awareness using posters and resuscitation record checklists to track and manage the team`s progress. This project was designed to enhance teamwork to decrease the rate of absent treatment and to provide safe and quality resuscitation care in order to improve resource management by the team to increase productivity.

Nurses Can Resuscitate.

Fluid resuscitation in the first 48 hours postburn is crucial in the management of burn shock. The primary purpose of this study was to evaluate nurses' adherence to a nurse-driven fluid resuscitation protocol at one adult burn center. Their secondary goal was to establish that the use of a nursing-driven protocol did not result in over resuscitation. Following implementation of a nurse-driven burn resuscitation protocol, a 48-hour data resuscitation data collection tool was developed by the burn physicians and nurses. All resuscitations were reviewed in real-time and in burn leadership meeting to identify opportunities for improvement. Follow-up with nursing staff was done in real time by the clinical nurse specialist following each burn resuscitation. Twenty-two patients requiring formal fluid resuscitation were included in the review. Patients had a median age of 36.5(IQR: 38.74) years and were predominantly male. They found that in the first 24 hours that patients received 3.47 ml/kg/hr and then in the next 24 hours they received an average of 2.68 ml/kg/hr. All 22 patients' resuscitation was initiated using the Parkland formula in the emergency department, and nurses were successful in consistently adjusting fluid infusions consistent with the protocol. Using a multidisciplinary approach and preparatory and real-time education processes, burn nurses can successfully guide burn resuscitation. Providing education and follow-up in real time can improve the process.

Validação de instrumento avaliativo para capacitação de enfermeiros em ressuscitação cardiopulmonar / Validation of evaluating instrument for training nurses in cardiopulmonary resuscitation / Validación de instrumento evaluador para la formación de enfermeras en reanimación cardiopulmonar

Objetivo: validar critérios de um instrumento para avaliação da capacitação de enfermeiros em ressuscitação cardiopulmonar. Método: estudo metodológico para validação de critério de um instrumento previamente validado quanto ao conteúdo. Realizou-se a aplicação de um instrumento pré e pós-teste de uma capacitação com 20 enfermeiros de um hospital do interior do Estado de São Paulo. Resultados: realizou-se a análise das respostas do pré e pós-teste sobre o entendimento dos participantes antes e após a realização de teoria atrelada a simulação sobre ressuscitação cardiopulmonar. Foram avaliadas as variáveis objetividade, simplicidade, clareza e pertinência, destacando-se que os participantes concordaram que os critérios citados foram atendidos. Conclusão: o instrumento investigado possui relação com os padrões definidos, sendo comprovadamente validado. Ao utilizar-se deste instrumento durante a avaliação de capacitações em ressuscitação cardiopulmonar, as equipes de trabalho, alunos e pacientes serão beneficiados, garantindo a padronização e melhor efetividade no atendimento a PCR

Objective: to validate criteria of an instrument for assessing the qualification of nurses in cardiopulmonary resuscitation. Method: methodological study for criterion validation of a previously validated instrument for content. The application of a pre and post test instrument of a training with 20 nurses from a hospital in the interior of the state of São Paulo was performed. Results: pre and post test answers were analyzed on the participants' understanding before and after the theory of the cardiopulmonary resuscitation simulation. The variables objectivity, simplicity, clarity and relevance were evaluated, highlighting that the participants agreed that the criteria mentioned were met. Conclusion: the instrument investigated is related to the defined standards and has been validated. By using this instrument during the assessment of training in cardiopulmonary resuscitation, workteams, students and patients will benefit through standardization and effectiveness of care

Objetivo: validar los criterios de un instrumento para evaluar la calificación de las enfermeras en reanimación cardiopulmonar. Método: estudio metodológico para la validación de criterios de un instrumento previamente validado para el contenido. Se realizó la aplicación de un instrumento de prueba previa y posterior a una capacitación con 20 enfermeras de un hospital en el interior del estado de São Paulo. Resultados: las respuestas previas y posteriores a la prueba se analizaron según la comprensión de los participantes antes y después de la teoría de la simulación de reanimación cardiopulmonar. Se evaluaron las variables objetividad, simplicidad, claridad y relevancia, destacando que los participantes estuvieron de acuerdo en que se cumplieron los criterios mencionados. Conclusión: el instrumento investigado está relacionado con los estándares definidos y ha sido validado. Al utilizar este instrumento durante la evaluación de la capacitación en reanimación cardiopulmonar, los equipos de trabajo, los estudiantes y los pacientes se beneficiarán mediante la estandarización y la eficacia de la atención

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol.

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

The Effects of Simulation-Based Advanced Life Support Education for Nursing Students.

Advanced life support education for nursing students is very important because nurses are first responders in emergency situations. The purpose of this study was to identify the effects of simulation-based advanced life support education on nursing students' knowledge, performance, self-efficacy, and teamwork. A nonequivalent control group posttest-only design was used. Fourth-year nursing students were randomly assigned to either simulation-based Korean Advanced Life Support (n = 30) or lecture-based education (n = 30) groups. Data were analyzed using descriptive statistics and the Mann-Whitney U test. The experimental group showed statistically significant higher scores in knowledge (P < .001), performance (P < .001), and self-efficacy (P = .049) when compared with the control group. However, there was no significant difference in teamwork scores between the two groups (P = .529). The 4.5-hour simulation-based Korean Advanced Life Support education was more effective than the 4.5-hour lecture-based education for nursing students in terms of knowledge, performance, and self-efficacy. Nurse educators should adopt simulation-based advanced life support education into the curriculum for the optimal competence of nursing students.

Family presence during resuscitation: A narrative review of the practices and views of critical care nurses.

BACKGROUND: The option of family presence during resuscitation was first presented in the late 1980s. Discussion and debate about the pros and cons of this practice has led to an abundant body of international research. AIM: To determine critical care nurses' experiences of, and support for family presence during adult and paediatric resuscitation and their views on the positive and negative effects of this practice. METHODS: A narrative literature review of primary research published 2005 onwards. The search strategy comprised an electronic search of three bibliographic databases, supplemented by exploration of a web-based search engine and hand-searching. RESULTS: Twelve studies formed the review. Research primarily originated from Europe. The findings were obtained from a moderately small number of nurses, and their views were mostly based on conjecture. Among the factors influencing family presence during resuscitation were dominant concerns about harmful effects. There was a noticeable absence of compliance with recommended guidelines for practice, and the provision of a unit protocol or policy to assist decision-making. CONCLUSION: A commitment to family-centred care, educational intervention and the uptake of professional guidance are recommended evidence-informed strategies to enhance nurses' support for this practice in critical care.

Response of the Australian Medical Services to restoration of mobile warfare on the Western Front in 1918 (part I).

On 21 March 1918, after nearly 4 years of static warfare on the Western Front, German forces launched a massive offensive from the Hindenburg Line against a depleted British Fifth Army. Elite storm troops smashed through British forward and battle zone positions and advanced more than 17 miles in 2 days. By 5 April, the Germans were outside the town of Villers-Bretonneux, 40 miles from their starting position and 15 miles from the railway junction of Amiens. This paper examines the response of the Australian Medical Services to the restoration of mobile warfare and explains the measures that were put in place to deal with the evacuation of casualties.

The role of the operating department practitioner on board Role 2 Afloat.

The Role 2 Afloat (R2A) is the Royal Navy (RN)'s Damage Control Resuscitation (DCR), including Damage Control Surgery, capability at sea. There are currently three operating department practitioners (ODP) in the deployed team. This article describes the role of the ODP in this team and the training which is required to fulfil this role.

CE: The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma.

: Hemorrhage is the leading cause of preventable death in trauma patients. In recent years, technological innovations and research efforts aimed at preventing death from hemorrhagic shock have resulted in the emergence of resuscitative endovascular balloon occlusion of the aorta (REBOA). REBOA offers a less invasive option for emergent hemorrhage control in noncompressible areas of the body without the added risks and morbidities of an ED thoracotomy. This article outlines the procedure and device used, describes the procedure's evolution, and discusses various considerations, pitfalls, and nursing implications.

Self-teaching to improve patient confidence in resuscitation skills: A quality improvement project.

BACKGROUND AND PURPOSE: Sudden cardiac death occurs predominantly at home where cardiopulmonary resuscitation (CPR) is often not provided. We tested the hypothesis that a self-teaching kit distributed to patients would effectively increase self-confidence in CPR. METHODS: Patients seen by an advanced registered nurse practitioner in a general cardiology clinic were offered a self-teaching kit to learn CPR. Four-point scale survey questions were assessed at distribution and via phone call at 30 days. CONCLUSIONS: Kits were distributed to 21 patients; of whom, 17 (81%) patients used the kit. Patients reported greater self-confidence of performing CPR (2.6 before versus 3.2 after, p < .05) and greater comfort if someone needed CPR (2.4 before versus 3.1 after, p < .05). IMPLICATIONS FOR PRACTICE: Self-teaching CPR kits were used by the substantial majority of patients and were effective at increasing both self-confidence and willingness to perform CPR. Similar nurse-run programs could increase awareness and impact of CPR in communities.

Emergency nurses' attitudes towards the concept of witnessed resuscitation.

OBJECTIVE: to review the most relevant evidence on the nurses' attitudes towards witnessed resuscitation, in the inpatient and out-of-hospital spheres. METHOD: integrative literature review, covering the period from 2008 till 2015, using the databases PubMed, Lilacs and SciELO; in Spanish, English and Portuguese. The pediatric context was excluded from the study. RESULTS: the synthesis of the data resulted in the inclusion of 10 articles, categorized as: positive attitudes and negative attitudes. CONCLUSIONS: discrepancies exist among the nurses from different contexts and geographical regions towards the concept; protocols need to be established for this situation, in view of the advantages evidenced in the literature, for the nursing professionals as well as the relatives. Witnessed resuscitation can represent an opportunity to understand and cope with the rational and irrational in the situation in a shared manner, as well as mitigate or dignify the mourning.

Parada cardiorrespiratória: vigilância, prevenção e cuidados após PCR / Paro cardíaco: vigilância, prevención y cuidados después de la PCR / Cardiorespiratory arrest: surveillance, prevention and care after PCR

Objective: to gather scientific productions about actions of surveillance, prevention and nursing care in cardiorespiratory arrest. Methods: Bibliographic search in the selected databases LILACS and MEDLINE. Results: The results of the bibliographic research according to research indicators were obtained 22 articles. Conclusions: Nursing is paramount in patient surveillance and prevention, recognizing predisposing factors that would lead to PCR. During PCR, in general, it is the first team to identify, trigger the rest of the professionals and initiate RCP. They assist the medical staff and make the nursing record in the patient’s chart. The nurse is a fundamental part in the distribution of the functions of the other members of the team and in the care after RCP.

Objetivo: reunir produções científicas acerca de ações de vigilância, prevenção e os cuidados de enfermagem na parada cardiorrespiratória. Métodos: Pesquisa bibliográfica nas bases de dados selecionadas LILACS e MEDLINE. Resultados: O resultado da pesquisa bibliográfica conforme indicadores de pesquisa obtiveram-se 22 artigos. Conclusões: A enfermagem é primordial na vigilância e prevenção do paciente, reconhecendo fatores predisponentes que levariam a uma PCR. Durante a PCR, em geral, é a primeira equipe a identificar, acionar o restante dos profissionais e iniciar a RCP. Auxiliam a equipe médica e fazem o registro de enfermagem no prontuário do paciente. O enfermeiro é peça fundamental na distribuição das funções dos demais membros da equipe e nos cuidados após RCP.

Objetivo: reunir producciones científicas sobre vigilancia, prevención y cuidados de enfermería en el paro cardíaco. Métodos: Una búsqueda bibliográfica en las bases de datos LILACS y MEDLINE seleccionados. Resultados: El resultado de la literatura de investigación como indicadores produjeron 22 artículos. Conclusiones: La enfermería es esencial para la vigilancia y la prevención de la paciente, reconociendo factores predisponentes que conducirían a una PCR. Durante la PCR, en general, es el primer equipo para identificar, involucrar al resto de los profesionales y comenzar la RCP. Ellos ayudan al personal médico y de enfermería hacen que el registro en el expediente del paciente. La enfermera es uma parte clave en la distribución de las funciones de los otros miembros Del equipo y el cuidado después de la RCP.

Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students' performance during simulated resuscitation: A quasi-experimental study.

BACKGROUND: Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. OBJECTIVE: To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. DESIGN: Two-group, non-randomised quasi-experimental design. SETTING: A simulation centre in a Chinese University School of Nursing. PARTICIPANTS: Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). METHODS: The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). RESULTS: Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p < 0.001] and defibrillation [CG 204 (174-240) vs. EG 167 (162-174); p < 0.001] at the end of the course, compared with compressions [CG 41 (32-49) vs. EG 42 (33-46); p > 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. CONCLUSION: A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a resuscitation simulation.

Impact of Trauma-Certified Registered Nurse Anesthetists Team on Intra-Operative Resuscitation and Postoperative Outcomes of Trauma Patients.

A Trauma Certified Registered Nurse Anesthetists Team (TCT) was created and trained to provide trauma-focused anesthesia and resuscitation. The purpose of this study was to examine patient outcomes after implementation of TCT. We conducted retrospective analyses of trauma patients managed with surgical intervention from March to December 2015. During the first five months, patients managed before the development of TCT were grouped No-TCT, patients managed after were grouped TCT. To assess outcomes, we used hospital and intensive care unit length of stay, ventilator days, and a validated 10-point intraoperative Apgar score (IOAS). IOAS is calculated using the estimated blood loss, lowest heart rate, and lowest mean arterial pressure during surgery. Higher IOAS are associated with significantly decreased complications and mortality after surgery. We used t test and nonparametric tests for analyses. Fifty two patients were included (mean age 39 years, 75% male; 46.2% managed with TCT). Patients in the No-TCT group had significantly lower use of vasopressors (0.019), lower mean IOAS (P = 0.02), and spent more days on ventilator (P = 0.005) than patients in the TCT. These results suggest that trauma centers should take into consideration implementation of TCT to improve intraoperative and overall outcomes.

The effectiveness of crisis resource management and team debriefing in resuscitation education of nursing students: A randomised controlled trial.

AIMS AND OBJECTIVES: The aim of this study was to investigate (i) whether integrating a course on crisis resource management principles and team debriefings in simulation training, increases self-efficacy, team efficacy and technical skills of nursing students in resuscitation settings and (ii) which phases contribute the most to these outcomes. BACKGROUND: Crisis resource management principles have been introduced in health care to optimise teamwork. Simulation training offers patient safe training opportunities. There is evidence that simulation training increases self-efficacy and team efficacy but the contribution of the different phases like crisis resource management principles, simulation training and debriefing on self-efficacy, team efficacy and technical skills is not clear. DESIGN: Randomised controlled trial in a convenience sample (n = 116) in Belgium. Data were collected between February 2015-April 2015. METHODS: Participants in the intervention group (n = 60) completed a course on crisis resource management principles, followed by a simulation training session, a team debriefing and a second simulation training session. Participants in the control group (n = 56) only completed two simulation training sessions. The outcomes self-efficacy, team efficacy and technical skills were assessed after each simulation training. An ancillary analysis of the learning effect was conducted. RESULTS: The intervention group increased on self-efficacy (2.13%, p = .02) and team efficacy (9.92%, p < .001); the control group only increased significantly on team efficacy (4.5%, p = .001). The intervention group scored significantly higher on team efficacy (8.49%, p < .001) compared to the control group. CONCLUSION: Combining crisis resource management principles and team debriefings in simulation training increases self-efficacy and team efficacy. The debriefing phase contributes the most to these effects. RELEVANCE TO CLINICAL PRACTICE: By partnering with healthcare settings, it becomes possible to offer interdisciplinary simulation training that can increase patient safety.

CE: Assessing Patients During Septic Shock Resuscitation.

: In 2015, the Surviving Sepsis Campaign six-hour bundle was updated. The revised version now recommends documenting the reassessment of volume status and tissue perfusion after initial fluid resuscitation through a repeated focused examination. This article addresses the practice and interpretation of two components of this examination in adults: capillary refill time and skin mottling score. It further discusses how to best integrate these noninvasive parameters into the care of patients undergoing resuscitation for septic shock.

The Nurse's Management of Shock and Hemorrhage.

: Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.This month's article, from the September 1908 issue, describes the nursing management of shock and hemorrhage. Hospital nurses are instructed to employ measures that today would be described as prehospital first aid. The author (a "Graduate of Bellevue Hospital, New York") directs the nurse to "work quickly and quietly, dismiss every one from the room who cannot be of intelligent assistance, and… in no way impart to the patient the serious nature of his or her condition." More than a century later, nursing interventions for shock are considerably more intense and complex, as illustrated in the feature article in this issue, "Assessing Patients During Septic Shock Resuscitation."