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02.23.2016

Report IDs nursing research that changed critical care

UW faculty member leads review of bench-to-bedside advances from 2015

By Elizabeth Hunter-Keller  |  HSNewsBeat  |  Updated 3:15 PM, 02.23.2016

Posted in: Research

  • Critical-care nurses treat a patient at Valley Medical Center in Renton, Washington. Clare McLean
Every year, nurse researchers conduct and publish thousands of studies that seek to improve clinical practice, prevent disease and disability, and improve the health of myriad populations of people. 

A recent paper in the American Journal of Critical Care highlights research published in the past year that has spurred changes in care for critically ill or injured patients. The paper was co-authored by Elizabeth Bridges, associate professor in the University of Washington School of Nursing and a UW Medicine clinical nurse researcher.

Said Bridges, “The advancement of care requires continuously learning: the creation of new knowledge through research, the translation of research into practice and, most importantly, asking the question: ‘Are we making a difference?’ ”

Here are a few examples of game-changing research cited by the report: 

Alarm safety and alarm fatigue
The issue:
If you’ve ever been to a hospital, you know the sound: constant, changing beeps and alarms. One study of an intensive-care unit found 187 audible alarms per patient per day. This constant beeping can take a toll on nurses, both in the way they respond to the patient and their own psychological well-being. 
The research: In the past year, nursing research that focused on tailoring and decreasing alarms has resulted in organization-level initiatives for change.  For example, nursing research identified alarms that signaled actionable responses versus alarms that provided information only. Information-only alarms were changed from audible to visual. 
Patient impact: A decrease in unnecessary alarms maintains patient safety without diluting the importance of crisis alarms or leading to alarm fatigue. 

Moral distress and moral courage among nurses
The issue:
Nurses are among the most trusted professionals, so it is unsurprising that they face high levels of moral distress – the feeling that occurs when one knows the ethically correct action to take but feels powerless to take it. Moral courage can counteract the anger, fear, confusion and powerlessness of moral distress.
The research:  In 2015, several studies examined elements of moral distress, such as ethical situations leading to conflict, and compassion fatigue. Disagreement between nurses and physicians about providing futile care created moral distress. Tactics used by nurses to improve moral courage included exercise and meditation; these nurses also reported stronger support systems and good co-worker relationships. This corroborates research that found higher levels of burnout or stress when nurses experience a change in management or systemic or practice change. 
Patient impact: Strategies to support moral courage, ethical conflict resolution and interdisciplinary approaches to futile care can combat moral distress that leads to nurse burnout. Patients are safer when nurses have a voice.

Massive blood transfusions
The issue:
In critically ill and injured patients, scientists had yet to identify the most beneficial ratio of blood products for massive blood transfusions. The nature of massive transfusions, necessitated in traumatic circumstances, makes collecting reliable data difficult. 
The research:large, multi-site study that examined blood-product rations in massive transfusions supported a ratio of 1:1:1 for platelets, plasma and red blood cells. (This 1:1:1 ratio is used by the U.S. military.)
Patient impact: The results from the PROPPR trial and military research have led to the use of 1:1:1 ratio for patients who need massive transfusions, which should improve outcomes for these critically ill and injured patients.

Thirst in ICU patients
The problem:
Thirst is one of the most prevalent symptoms reported by patients in intensive-care units (ICUs). Studies have shown thirst is one of the three strongest memories a patient has of their ICU time. 
The research: Thirst has been identified as one of the symptoms that should be routinely assessed in critically ill patients. Research examined when patients felt most thirsty, how thirsty they felt and how distressing their thirst was. Unfortunately, despite the evidence showing the fear and discomfort associated with ICU patients’ thirst, little research generated recommendations to mitigate thirst.
Patient impact: Nurses can use a simple intervention – moistened oral swabs and mouth sprays – to decrease the sense of distress patients may experience from thirst. More research is needed, however, to determine if the findings in this small study translate on a larger scale.

Tourniquet for hemorrhages
The problem:
The tourniquet, which had gained a negative reputation over time, saw increased interest due to its lifesaving role in recent-past war injuries. Likewise, interest in the use of tourniquets for civilian trauma has increased, particularly after its use at mass casualty events such as the Boston Marathon bombing.
The research: In 2015, a large civilian study found tourniquet use led to mortality rates lower than even what was reported by the military; two other studies supported its effectiveness in controlling hemorrhage in civilian trauma. During the response to the Boston bombing, 27 patients received improvised tourniquets before being hospitalized. 
Patient impact: Tourniquet for severe extremity trauma, used before the patient is transferred to the hospital, is safe and effective.  Results from research and the military experience with the use of tourniquets should be translated to the civilian community.
Tagged with: nursing, critical care
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