CPR Training With Advanced Clinical Simulation
The review emphasizes the need for ongoing CPR training and establishing high-fidelity simulation.
High-fidelity clinical simulation can enhance short-term CPR skills compared with traditional methods, leading to significant improvements in chest compression depth and short-term retention of theoretical knowledge.
“Effectiveness of High-Fidelity Clinical Simulation in Cardiopulmonary Resuscitation Training: A Systematic Review and Meta-Analysis of Controlled Trials,” in Clinical Simulation in Nursing, highlights the need for periodic CPR retraining due to an observed loss of skills and knowledge over time.
The review of 12 studies from December 2022 to January 2023 involved 1,520 participants composed of active nurses and nursing and medical students. Intervention groups received CPR training using high-fidelity simulations with manikins, while control groups mostly received traditional CPR training.
In addition to enhancing technical CPR skills, high-fidelity simulations boosted participants’ attitudes, self-efficacy and psychological preparedness, all of which are crucial to increase confidence during emergencies. The review underscores the need for ongoing CPR training and establishing high-fidelity simulation as a preferred method.
However, more research is recommended to assess the long-term retention of skills and knowledge. “This would assist in formulating guidelines that could potentially standardize CPR training protocols and improve the overall quality of emergency response in clinical settings,” the review notes.
A related study in American Journal of Critical Care (AJCC) reveals that by teaching critical care nurse practitioners to be CPR coaches in pediatric ICUs, hospitals can significantly increase the frequency of coaches being present during cardiac arrests.
The study in AJCC also notes that the intervention leads to clinically significant improvements in quality CPR metrics, and the findings are also a crucial first step in answering experts’ recommendations to add CPR coaches to code teams.
“Moreover, this educational intervention and evaluation study can function as a blueprint for other centers to pragmatically actualize evidence-based educational strategies, study the real-life effects, and ultimately affect patients’ resuscitation outcomes,” the study adds.
AI’s Potential to Save Time for Nurses
AI tools can reduce time spent on administrative tasks and documentation.
Artificial intelligence (AI) has the potential to assist with tasks ranging from transcription to remote patient monitoring and clinical decision-making.
“AI and the Art of Nursing,” in Medscape Medical News, describes how AI tools, such as nursing scribes and device integration, can reduce time spent on administrative tasks and documentation, which account for up to 15% of each shift. Staff at some large health systems are using generative AI to take notes during patient appointments, automatically entering them in electronic health records (EHRs).
For example, Stanford Health Care in Stanford, California, uses an AI-powered app with ambient voice recognition to generate written summaries of patient interactions, and ongoing pilot programs are evaluating new AI use cases. This hands-free experience could alleviate some of the cognitive burden nurses experience, Darren Batara, manager of nursing innovation at Stanford Health Care, adds in the article.
“Oftentimes, nurses document and look at the screen while the patient looks at the nurse,” Batara notes. “This is actually a whole new change in the way that we’re conducting nursing.”
Other health systems use predictive analytics in EHRs to identify trends that otherwise might be missed and incorporate chatbots to help triage patients. There is more untapped potential, the article adds. For example, AI-powered remote monitoring and wearable devices could be used to integrate data into EHRs with the aim of improving health outcomes.
Nurses being involved in developing and implementing AI tools is critical to ensure acceptance. Top strategies include establishing clear guidelines, showing evidence of effectiveness, soliciting input on design and providing education.
“We need to start small and stay really focused (on) raising the proficiency and understanding that AI can be just another tool in our bucket to coordinate,” Batara adds in the article. “At the end of the day, that’s what matters.”
Early Norepinephrine May Benefit Some Patients With Septic Shock
Further research will help determine the optimal timing of norepinephrine initiation for patients with septic shock.
Patients with sepsis who receive norepinephrine earlier in their ICU stay performed better on some secondary outcomes than those who received it later, but mortality rates were similar.
“Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock,” in Chest, reviewed four randomized controlled trials (RCTs) and eight observational studies, finding lower mortality rates for the early norepinephrine group in only two RCTs without a restrictive fluid strategy that also focused on vasopressors and lower volumes of IV fluids. “Further research is warranted to determine the optimal timing of norepinephrine initiation in relationship to fluid resuscitation in septic shock,” the review adds.
The RCTs that favored early use of norepinephrine showed significantly lower incidence of pulmonary edema, and observational studies showed more ventilator-free days in the early-use groups. “Early norepinephrine initiation might have beneficial effects, including minimizing the duration of hypotension, maintaining organ perfusion, and limiting the amount of fluid resuscitation.”
The review, which comprised 7,281 patients across 12 studies worldwide, found no significant difference in overall mortality. However, the definition of early or late use varied across the studies. The usual standard difference was about 1.5 hours, which might not be long enough to make definitive observations.
Mixed outcomes also occurred regarding length of ICU stay, but they were not significantly different even when patients averaged more ventilator-free days. “However, it is important to note that the ICU length of stay can be affected by several factors outside septic shock management, such as the patient’s overall health, comorbidities, and hospital discharge policies.”
Two observational studies suggested possible harms from early norepinephrine administration, but the review theorizes that patients in the early group may have more severe symptoms at baseline. “Several debates about the adverse effects of early vasopressor use are ongoing.”
Liberal Transfusion Strategy May Benefit Patients With TBI
The review suggests that a liberal transfusion strategy is associated with better neurologic outcomes.
Liberal transfusion strategies produce better neurologic outcomes than restrictive strategies for patients with traumatic brain injury (TBI), likely due to increased oxygen delivery to cerebral tissue.
“Transfusion Practices in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials,” in Critical Care Medicine, notes that the results of the Glasgow Outcome Scale in five studies were stronger with liberal transfusion strategies up to six months later. “We advocate for revising current guidelines to establish 9 g/dL as the standard threshold for transfusions in TBI patients,” the review adds.
Patients with TBI frequently develop anemia that reduces oxygen to the brain during critical periods, so the review focused on the potential benefits of transfusions on long-term neurologic recovery. “Nonetheless, transfusions may be associated with complications, such as infections, respiratory distress and thromboembolic events.”
The review included 1,533 patients, 769 in the liberal transfusion group (hemoglobin < 9 or 10 g/dL) and 764 in the restrictive group (hemoglobin < 7 g/dL). The two strategies produced no significant differences in hospital or ICU length of stay, infections or mortality, but the liberal group had significantly higher rates of acute respiratory distress syndrome.
To make a recommendation, the review excluded one trial that involved additional interventions that could have affected outcomes. “In this context, it can be concluded that, when considering only the trials that exclusively compare transfusion strategies for TBI, there is a significant benefit to adopting the liberal strategy.”
The review also attempts to determine the best hemoglobin threshold and notes that studies using 10 g/dL did not demonstrate additional advantages. Other trials found improvements in neurologic outcomes using a 9 g/dL threshold, so “it is reasonable to conclude that the 9 g/dL threshold strikes a better balance between ensuring adequate oxygen delivery and minimizing morbidity.”
Pain in Very Preterm Infants
The study involved live infants born at less than 32 weeks and discharged from January 2020 to June 2024
Managing pain in very preterm infants could be guided by visualizing pain epidemiology, procedures, conditions and treatments based on postnatal and gestational age (GA) – an approach that may help formulate research hypotheses and strategies to reduce adverse effects.
“Pain in Very Preterm Infants – Prevalence, Causes, Assessment, and Treatment. A Nationwide Cohort Study,” in Pain, involved live infants born at less than 32 weeks and discharged between January 2020 and June 2024. Using data from a nationwide Swedish cohort, the study reveals that among 3,686 infants (mean birthweight 1,176 grams, GA 28.2 weeks), 11.6% had a painful condition, and 84.1% were exposed to at least one potentially painful procedure.
About 75% of infants experienced pain overall, equating to 28,137 of 185,008 (15.2%) days of neonatal care, the study notes, adding that for every two-week increase in GA, significantly lower proportions of infants experienced pain. Pain scales assessed pain in 75% of infants, and 81.7% received pharmacological pain treatment, mainly topically or orally.
A related article in Contemporary Pediatrics notes that in the first month of life, the youngest and most fragile infants (born at 22 to 23 weeks of gestation) experienced the highest number of painful medical conditions and daily intensive care procedures, including ventilator treatments, tube feedings, blood vessel catheter insertions and surgeries.
Study author Mikael Norman, professor of paediatrics at Karolinska Institutet in Stockholm, underscores the need to develop better methods for measuring pain and improving treatments, potentially through combinations of drugs with a lower risk of adverse effects. He also emphasizes the urgency, noting that untreated pain can hinder brain development in premature infants.
“The vision for all neonatal care is to be pain-free,” Norman adds in the article. “The results of this survey will be of great importance for improving neonatal care and for future research in the field.”
Alarm Fatigue and Coping Strategies
Reducing alarm fatigue due to false, nonemergent and nonactionable alarms is imperative.
Oncology nurses who reported their experiences for a qualitative study on alarm fatigue emphasized that the high volume and frequency of alarms created overstimulation and exhaustion, leading to some ineffective coping strategies.
“Original Research: Alarm Fatigue: Exploring the Adaptive and Maladaptive Coping Strategies of Nurses,” in American Journal of Nursing, notes that the interviewed nurses have positive ways to reduce the impact of false and nonemergent alarms, but they also experience negative psychological, physiological and physical effects.
Using six-question interviews with nine oncology nurses at a large U.S. academic hospital, the study explains the challenges resulting from workflow disruption, mobile devices and desensitization to alarms. “Interviews were conducted either face-to-face in a private conference room on the unit” or via online videoconferencing.
Nurses were concerned about the number of false and nonemergent alarms and hearing alarms for patients they weren’t assigned to. Mobile devices can be distracting at inconvenient times or during conversations with patients and co-workers. The nurses also noted the negative impacts on patients due to repeated interruptions.
Additional issues include interviewees having auditory hallucinations, sweating, tachycardia, insomnia, anxiety and guilt, and using restrooms as temporary escapes. “Any assessment and reevaluation of a hospital’s safety culture will be incomplete without a deeper dive into the problem of alarm fatigue among all nurses,” the study adds.
“Practical measures are urgently needed to reduce nurses’ cognitive overload; shift nonnursing responsibilities to other staff; and implement efficiency-focused process changes, such as reengineering workflows to minimize interruptions. Every effort should be made to redesign protocols to reduce alarm fatigue, including by decreasing the number of false, nonemergent and nonactionable calls and alarms.”
AACN continuing education resources on alarm management include a quality improvement project to reduce alarm fatigue and an article on customizing monitors. A practice alert includes information on false alarms from electrocardiographic monitors and pulse oximetry devices.
President’s Video Chat: Leading From the Bedside With Jasmin Orange
In this video chat, AACN President Jennifer Adamski and nurse manager Jasmin Orange discuss a variety of topics, including mitigating workplace violence, the importance of mentorship and finding the daily Courage to Soar.
Nursing Certification: Just Go for It!
When colleagues at a Level 1 trauma center doubted her critical care nursing knowledge and skills, Brianna Valentine set out to prove something to them and herself. She hit the books and studied for the CCRN exam. Four months later, she earned her certification. “I’m a better and safer nurse … Certification reignited the fire of what I love about nursing.”