Debra Siela

Evaluation Standards for Management of Artificial Airways

Debra Siela is Assistant Professor of Nursing at Ball State University SON in Muncie, Indiana. Outcomes research is a new paradigm in research with scientific methods that set up the examination of nursing quality indicators. Outcomes research in health care is based on the theory established by Donabedian regarding health care and the process of evaluating it. The theory identifies 3 concepts to evaluate when appraising quality: structure, process, and outcome. It is ideal to evaluate all 3 concepts at the same time. However, this would require large sample sizes and has been difficult to accomplish in the clinical setting. Outcome research studies commonly examine the process aspect related to outcomes. Process variables in the evaluation of quality are often easy to identify as possible factors in contributing to a desired outcome. Standards of care include processes that are either known or suspected to contribute to the attainment of quality patient outcomes. Forms of standards of care include clinical guidelines, critical paths, and care maps. When using standards for care management and desired outcomes, the research evidence for each included process should be evaluated. All forms of standards of care should identify each level of evidence for each standard or criterion so ADebra Siela, RN, PhD, ACNSBC, CCRN, CCNS, CNE, RRT, replies:

Pulmonary Aspects of Obesity in Critical Care

Critically ill obese patients have many challenging pulmonary problems. The first key is to understand pathophysiology in the pulmonary system related to obesity. Second, it is important to identify the altered physical assessments and diagnostics that occur because of the pulmonary pathophysiology of obesity. Lastly, one should be aware of medical and nursing intervention options that treat symptoms or pulmonary problems of obesity. This article summarizes pulmonary issues related to obesity in critical care.

Use of a depression and sleep impairment treatment guideline to improve quality of life for patients with sickle cell disease

BACKGROUND Pain in sickle cell disease (SCD) is often joined by other affective disorders such as depression and/or sleep impairment that can impact pain levels and quality of life (QoL). AIM To develop a guideline to improve the process of assessment and treatment of depression and sleep impairment in patients admitted with SCD. METHOD An interdisciplinary team used the Stetler model to create the Guideline for the Evaluation and Treatment of Depression and Sleep Impairment in Sickle Cell Disease. Patients were assessed, offered treatments and reassessed during the project period. RESULTS Both depression and QoL scores showed significant improvement by the end of the project. Significant correlations were found between pain, depression and sleep; depression, pain, sleep and QoL; sleep, pain and depression; and QoL and depression. CONCLUSIONS Interdisciplinary teams are effective in creating a guideline to assess and treat depression and sleep impairment and their effects on pain and QoL in patients with SCD.

Oxygen Requirements for Acutely and Critically Ill Patients

&NA; Oxygen administration is often assumed to be required for all patients who are acutely or critically ill. However, in many situations, this assumption is not based on evidence. Injured body tissues and cells throughout the body respond both beneficially and adversely to delivery of supplemental oxygen. Available evidence indicates that oxygen administration is not warranted for patients who are not hypoxemic, and hyperoxia may contribute to increased tissue damage and mortality. Nurses must be aware of implications related to oxygen administration for all types of acutely and critically ill patients. These implications include having knowledge of oxygenation processes and pathophysiology; assessing global, tissue, and organ oxygenation status; avoiding either hypoxia or hyperoxia; and creating partnerships with respiratory therapists. Nurses can contribute to patients’ oxygen status well‐being by being proficient in determining each patients specific oxygen needs and appropriate oxygen administration.

Advanced Chest Imaging Interpretation of Acute Pulmonary Disorders

Bedside and advanced practice nurses in acute and critical care often view chest radiologic images of their patients. Correlation of findings on chest radiologic images with results of physical and other diagnostic assessments can provide information for making appropriate clinical judgments. Radiologic images of the chest available for acutely ill patients now include frontal/lateral chest radiographs and computed tomography (CT) scans. The purpose of this article is for the reader to review basic skills for interpreting chest radiographs, gain skill in reviewing CT scans of the chest, and be able to apply more advanced interpretation skills for both chest radiographs and chest CT scans. Several chest images are included for review.