Unique Challenges and Clinical Insights
Each year we receive some outstanding manuscripts that do not relate to a designated, quarterly topic. However, these unsolicited papers offer our readers some useful information that is seldom addressed in the critical care literature.
Akiyama, a noted authority on gang violence forensic science investigations and management of critical incidents, presents vital information in his article, "Surviving an Active Shooter Incident in the ICU." He emphasizes the importance of education, environmental surveillance, and active shooter drills to ensure the safety of staff, patients, and visitors.
Diagnostics, clinical monitoring, and pharmacological management are key components of intensive care practice. Fasolka and Chen enlighten us about an unusual set of circumstances that all emergency department and ICU staff might encounter in their contribution, "An Uncommon Cause of Chest Pain: Hypertriglyceridemia-Induced Pancreatitis." This article will serve as a reminder that the heart is not the only organ responsible for life-threatening chest pain. Glycemic control is an ongoing challenge for ICU personnel. Murphy discusses limitations of conventional methods for tracking blood glucose levels and makes a strong case for continuous glucose monitoring combined with computerized insulin titration algorithms to achieve the ideal and unique requirements of patients. Halpin, Inch, and O'Neill's article, "Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac Surgery" makes a strong case for choosing this agent over other conventional sedatives and analgesics for these postsurgical patients. Authors discuss various studies that support their recommendations.
The geriatric patient often has multiple comorbidities and physical limitations, which pose barriers to prompt, appropriate assessments. Pham and Lim offer helpful information in their article, "The Impact of Geriatric-Specific Triage Tools in the Emergency Department." The age-specific guidelines are designed to ensure that problems are not overlooked in this vulnerable population group.
In the next 2 articles, Quiban, Brook, and Armstrong consider challenges that ICU personnel face with autism spectrum disorder (ASD). "Adult Patient with Autism in the Critical Care Setting" and "Hospitalized Patients with Autism: Partnership with Parents" outline recommendations for managing the behavioral components of ASD and offer helpful guidance for supporting these patients' unique medication and nutritional requirements. These authors also emphasize the value of a strong caring partnership with parents and other family members in planning and managing nursing care.
The extended and unrelenting stress of a critical care environment takes a huge toll on staff performance and employment satisfaction. Kelly's contribution, "Burnout, Compassion Fatigue and Secondary Trauma in Nurses" reviews the underlying factors including unhealthy working conditions and poor communication and staff support. Nurses must engage in creating a personal resilience program, and health care organizations must address system-level solutions to reduce stressors. ICU staff members seldom consider music as a key component of the care environment. The compelling evidence presented in the article "Music Therapy on an Inpatient Surgical Unit" by Bojorquez, Jackson, and Andrews may serve as a stimulus to incorporate this novel therapy into patient care planning. Study results reveal a significant reduction in pain and anxiety when music is utilized.
"Lifestyle Risk Factors in Esophageal Cancer" by Zhao and Lim presents the various factors that are linked to this high burden condition. Although smoking, heavy alcohol consumption, and obesity are named as risk factors, drinking very hot beverages such as tea and coffee may predispose patients to esophageal thermal injury, eventually resulting in cancer. Education is a vital factor in creating an eventual reduction in this type of malignancy.
Yaglowski reports the efforts of frontline nursing staff members who developed new dressing kits resulting in a significant decrease in the rate of central line-association bloodstream infections (CLABSIs). "All-inclusive Central Line Dressing Kits" reports the team's approach that included the popular Lean methodology.
These articles encompass many aspects of intensive care nursing and offer some surprising insights to consider. Peruse this collection of interesting articles and be prepared to make some changes in your work environment and clinical practices that will enhance patient care and reduce the stressors for you and your colleagues.
-Carmen Warner, MSN, RN, MDiv, FAAN
Issue Editor