Purpose/Objectives:
This project involved developing therapeutic hypothermia guidelines for a medical-surgical intensive care unit (MSICU) as well as educating the staff regarding the use of the guidelines.
Significance:
In congruence with the needs of the MSICU and the objectives for her graduate class, the author developed this project to exemplify the role of the clinical nurse specialist (CNS) within the spheres of influence of patient and nursing practice. The CNS is essential in developing and implementing evidence-based guidelines to improve patient care.
Design/Background/Rationale:
The 2002 Hypothermia After Cardiac Arrest Study Group demonstrated favorable neurological outcomes and a reduced mortality in patients who underwent mild hypothermia (33-36[degrees]C). The American Heart Association advocates for the use of therapeutic cooling following cardiac arrest.
Methods/Description:
Following a literature review and review of guidelines from similar institutions, the CNS student worked with the CNS of the MSICU and the staff development instructor (SDI) of the emergency department (ED) to develop guidelines for therapeutic hypothermia following cardiac arrest. The guidelines and education plan incorporated the following: inclusion and exclusion criteria; induction, maintenance, and rewarming phases; use of cooling wraps and console; appropriate drug therapy, assessment, effects on body systems, and electrolyte monitoring.
Findings/Outcomes:
The guidelines were reviewed by ED and MSICU physicians as well as the unit-based committees. The CNS student provided education and handouts for two MSICUs within the health system. The CNS of the MSICU in conjunction with the unit-based Performance Improvement committee collected data related to patient outcomes.
Conclusions:
This project helped the graduate student utilize the leadership skills learned in the program and illustrated the impact of the CNS on patient care. The CNS student participated in planning and implementing a project, which culminated in the adoption of the hypothermia guidelines.
Implications for Practice:
The CNS role is vital in developing guidelines such as those related to hypothermia, which directly impact patient outcomes. Collaboration between the CNS, CNS student, and other members of the healthcare team cannot be underestimated. Healthcare organizations benefit from the knowledge and expertise of the CNS and should foster her involvement in developing guidelines which support best practice.
Section Description
The journal is proud to share the student abstracts accepted for poster presentation at the 2009 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.