Bold Voices - August 2012 - (Page 18)

AT THE BEDSIDE In Our Journals Hot topics from this month’s AACN journal Delirium in critically ill older adults is associated with suboptimal outcomes — including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization and new onset of cognitive impairment. Nurses often have primary responsibility for detecting and treating delirium, which can be extraordinarily complex, because patients may be voiceless, extremely ill and require high sedation levels to facilitate mechanical ventilation. An aggressive, appropriate and compassionate strategy to manage delirium may reduce suffering and adverse outcomes and improve relationships among nurses, patients and families. (Balas et al, CCN, Aug 2012) Medical device-related errors are often misunderstood. Whether an error is manufacturer-related or involves device use, the sheer number and complexity of devices and their expanded use in new environments increases risk. Risk may be reduced by careful and deliberate evaluation of devices, along with application of human factors engineering principles during device development and implementation. Nurses can uniquely contribute to proactive evaluation of device-related risk and deeper understanding of devicerelated events and near misses. (Mattox, CCN, Aug 2012) Through active learning, rich anecdotal narratives are theorized to support the acquisition of cognitive, social, cultural and emotional knowledge, and motor skills. Case history narratives support studentcentered learning and development of clinical reasoning. To fi ll the information gap about their use in the education of acute and critical care advanced practice nursing students (APRNs), Winkelman and colleagues explore the value of case histories in APRN education and evaluation in distance and face-to-face learning. (Winkelman et al, CCN, Aug 2012) BBQ Grill Brush Wires Pose Ingestion Hazard A summer barbecue can lead to an emergency department visit if someone accidentally ingests metal wire bristles that become stuck in grilled meat, notes “Inadvertent Ingestion of Wire Bristles From a Grill Cleaning Brush: Radiologic Detection of Unsuspected Foreign Bodies” in American Journal of Roentgenology. Emergency physicians at Rhode Island Hospital, Providence, treated six cases of ingested metallic wire from grill-cleaning brushes in an 18-month span, according to a related EmaxHealth article, “Grilled Meat Danger Surgery.” Wiping a barbecue grill with in Rhode Island Requires Life-Saving abdominalEach patient who grills complained of painful swallowing or pain had cleaned with wire brushes just before cooking and was admitted within 24 hours a wet towel can remove of eating. hazardous wire bristles. The abdominal pain led to major surgery in three cases, with two perforations of the small intestine and one of the stomach and into the liver. Radiologic or computed topography showed bristles lodged in the neck of three patients, and they were removed with endoscopic techniques, the article reports. Wiping a grill with a wet paper towel can remove the potentially hazardous wire bristles, the article says. “The public should be aware of this potential danger,” David Grand, the hospital’s radiologist, tells EmaxHealth. The study acknowledges lack of information on how widespread this issue might be and thus seeks to raise awareness and encourage further research. 18 AUGUST 2012

Table of Contents for the Digital Edition of Bold Voices - August 2012

Front/Digital Edition Viewing Guide
Another Angle
‘AACN CSI Academy’ National Leadership Program Launches
Canadian Dynamics 2012: ‘Speak Up, Speak Out’
Grana Padano May Lower Blood Pressure
New Medicare Patient Satisfaction Requirement Misses Mark, Nurse Argues
FDA, The Joint Commission Aim to Reduce Alarm Fatigue
Fast Food in Hospitals Counters Goal of Healthy Eating
New Federal Hospital Visitation Standards
Nurse Obesity Linked to Long Hours
First-Ever Nurses Float Joins the 2013 Tournament of Roses Parade
AMA Urges Greater Focus on Ambulatory Patient Safety
Minimally Invasive Heart Valve Procedure Increases Patient Survival
Older Patients' in ICU at High Risk for HAI
Tele-ICU Symposium Explores Leading-Edge Technology
In Our Journals
Certification Capsules
Dare To
Contribute to the Evidence: Apply for an AACN Research Grant by Nov. 1
From the President

Bold Voices - August 2012