Prophylactic Use of LMWH vs UFH in PE Patients

As a result of deep vein thrombosis (DVT), a pulmonary embo­lism (PE) can occur which creates a blockage in the body’s pulmonary circulation, leading to cell death. PE is the third leading cause of death in the U.S., while being the most common, most preventable cause of death in hospitalized patients. Understanding the signs and symptoms of PE is essential in order to save patients’ lives. The objective of this research study was to compare the prophylactic use of Unfractionated Heparin (UFH) and Low Molecular Weight Heparin (LMWH) in patients effected with PE. Information for this research project was gathered using a quantitative systemic review and meta-analysis approach. Data was collected from mul­tiple research studies and combined to identify the best approach for prophylactic treatment of PE. The findings of this study concluded that LMWH is overall more beneficial to patients with PE than UFH for many reasons. Because each dose is based on the patient’s weight, LMWH can reduce the frequency of lab testing while giving them the ability to have anticoagulation therapy at home, thus, reducing the length of stay in the hospital. Prophylactic use of LMWH in PE patients can save the hospital and the patient thousands of dollars a year while consistently preventing and treating this complication

Music Therapy in Preterm Infants in the NICU

A neonatal intensive care unit (NICU) provides life-saving care for premature and sick newborns. However, that environment is very stressful due to the noise of equipment, alarms, and constant activity. It is important to decrease the stress for the infant as well as the parents. The purpose of this literature review was to determine if there is benefit from the use of music in the NICU. The high level of stress and anxiety that parents experience during this time may put the parent/child relationship at risk. Overstimulation and ongoing noise in the NICU may delay improvement in health and increase stress. Studies examined if adding music therapy (MT) during daily care reduced infant and parental stress and had an effect on physiological outcomes of the infants and their families. Primary study methods included a control group and an intervention group. The infants in the interven­tion group were exposed to music of the parents’ choosing. During the therapy, the infant was connected to a pulse oximeter to monitor oxygen level and a monitor to assess heart rate and respiratory rate. The researchers reported significant outcomes. The overall average infant heart rate was reduced, there was in increase in ox­ygenation, and more stable breathing patterns. Because of these improvements, infants expended less calories and hospital stays were shorter. Parents of the infants also verbalized feeling less stressed and more relaxed. The studies provided evidence that music therapy was beneficial to the newborns and parents in the NICU

Pediatric Hospital Environments: Do They Make a Difference?

The environment can have an extreme impact on a child’s well-being, growth and health. This should be taken into consideration especially for those children that are surrounded by a hospital environment. The healthcare system can come across as extremely intimidating and frightening to young patients. The purpose of his research study is to change this mind-set by creating a more welcoming atmosphere through child-friendly interventions such as magic, colorful art, and nature. By conducting interviews with the children of these hospitals and using visual and exploratory techniques, the essence of what keeps a child’s spirit alive can be captured to fullest. The research has shown that it is important to take children’s perspectives into consideration and to implement them into the design of pediatric hospitals

Co-Bedding Preterm Infants in the NICU

Providing the best possible environment for premature infants continues to be a challenge in the neonatal inten­sive care unit (NICU). The purpose of this literature review was to examine the evidence related to the care of preterm twins and whether twins benefit from co-bedding verses keeping them separated. Co-bedding is defined as caring for two or more infants in the same incubator and is considered a developmental initiative to minimize adverse effects of preterm birth. Twins share a tight space in utero and support each other as they grow. Skin-to-skin contact with preterm infants and their mothers has been shown to increase the healing time and lead to better outcomes as shown in other studies. The five studies that were examined observed for improvements in self-regulation, quality of sleep, response to pain, weight gain, and safety. Based on the results, co-bedding was found to promote self-regulation, quiet sleep, weight gain, decreased crying, and decreased pain in the twin preterm infants. Co-bedding is a comforting measure for infants that can be implemented without significant adverse effects and is a noninvasive solution to improving overall physiological stability

Stop the Potential Killer: Prevention of Methicillin-Resistant Staphylococcus Aureus (MRSA)

The risk for hospital-acquired methicillin-resistant staphylococcus aureus (MRSA) infections in the ICU is great considering the length of stay and the invasive procedures most patients go through. MRSA infections may lead to death and contribute greatly to the cost of care. The purpose of this study was to examine the evidence for the best possible means of preventing MRSA. The methodology was a review of the current research. Some of the measures that were found to be beneficial included daily bathing with chlorhexidine, environmental decon­tamination, MRSA screenings upon admission, isolation precautions for positive patients, eradication therapy, and strict hand hygiene. Conclusions indicate that hospital acquired MRSA infections can be decreased with strict adherence to the correct regimen and continuous, hospital-wide education and awareness

Is the Current Concussion Protocol for Student Athletes Enough?

In the world of sports there are bound to be accidents and one of the most common kinds of accidents are concussions. It has been reported that 10-20% of high school student athletes will experience a concussion. The purpose of this study was to examine the current concussion protocol for student athletes and to identify the best practices for a diagnosis and follow-up to decrease the likelihood of any severe brain damage. The methodology was a literature review. Evidence in the literature reported that individual educational plans (IEP) have been shown to be good at helping student athletes get back to their original benchmark test scores. The IEP should fo­cus on lightening the student’s academic load as this will decrease the risks of presenting symptoms. A teamwork approach and individualized care will help student athletes that have been diagnosed with a concussion get back into the classroom and back onto the field/court

Umbilical Cord Milking at Birth

The World Health Organization recommends delaying cord clamping for at least 30-60 seconds after the birth of a full-term newborn. However, the recommendation on the time of cord clamping is not as clear with preterm infants or infants who need immediate resuscitation. The purpose of this study was to examine the best, most recent evidence regarding the timing of cord clamping. The methodology was a literature review. Recent research has focused on umbilical cord milking prior to cord clamping. Umbilical cord milking is described as “the unclamped umbilical cord is grasped and blood is pushed toward the infant several times before it is clamped to auto-infuse blood into the preterm neonate,” (Katheria et al, 2015, p. 62). This technique has been shown to have numerous benefits in preterm infants, including decreased rates of intraventricular hemorrhage, higher levels of hemoglobin/hematocrit, decreased risk of oxygenation at 36 weeks, and higher rates of systemic blood flow. Umbilical cord milking is a way to ensure more blood volume reaches the neonate at a time where delayed cord clamping is not an option

Critical Care Nurses at Higher Risk of Burnout

In practice today, units with high intensity, stress, and patient needs are being burnt-out quickly due to patients’ intense needs, uncertain outcomes, and the ongoing witnessing of suffering and death. The purpose of this paper is to determine if there is a significant relationship between critical care units, and a high risk of nurses who work on those units exhibiting more characteristics of burnout. The study was done to gauge burnout, strength, and prevalence of moral distress, differentiated moral distress from day-to-day stressors, and determine fortitude and other aspects indicative of resilience. There was a cross-sectional survey model to test the exposure of a high-stress nursing unit. Data from nurses completing six surveys and a sociodemographic data sheet was analyzed and summarized by a software. The methods hospitals are trying are multidimensional, but nurses are finding support strategies to reduce their fatigue, which is a better factor in nurse retention. The results proved the hypothesis to be true; there is a direct correlation between critical care units and a high risk of nurses who work on those units exhibiting more characteristics of burn out. Overall, nurses are feeling low levels of personal accomplishment and if this problem keeps occurring then there will be even more difficulty within high intensity units

Implementing Zero/Neutral Displacement IV Connectors to Reduce Blood Stream Infections

Catheter related blood stream infections are a major problem in the United States and account for over $225 million each year with over 1,300 infections occurring each day. By researching the most effective type of IV connector, health care providers can provide the best and safest care possible to patients requiring IV access. Zero/neutral IV connectors may be the answer to decreasing these infections as they produce no reflux in the connector which is a breeding ground for bacteria and occlusions. This literature review found that zero/neutral connectors performed better than positive and negative IV connectors when comparing both reflux and bacterial growth. By implementing zero/neutral connectors into everyday practice, over positive and negative connectors, the number of catheter related blood stream infections can be reduced and prevent additional harm to patients

Spontaneous Pushing vs Directed Valsalva Pushing

The purpose of this study is to determine if spontaneous pushing during the second stage of labor produces better maternal outcomes than the more commonly used directed Valsalva pushing. A literature review of the recent studies has been performed to determine if Valsalva pushing is simply archaic or absolutely necessary for healthier mother/baby outcomes. To recommend that women go against their primal urges to push in the man­ner that their own bodies are directing them, indicates that there must be research-based evidence to intervene in the natural order of things and use Valsalva pushing instead. When in fact, there are several study results proving that women using spontaneous pushing experienced less pain, fatigue, and appreciated an overall more positive experience over directed Valsalva pushing. Another study revealed decreased bladder capacity and problems with the first urge to void three months postpartum after use of the Valsalva pushing technique. The only current evidence to support directed Valsalva pushing is due to a shorter second stage of labor, although, despite the shorter duration, the maternal and fetal outcomes were the same using both techniques. At this point in time there does not seem to be enough research-based evidence to recommend one pushing technique over the other, therefore the only recommendation should be to allow birthing mothers to push naturally and sponta­neously, when their bodies instinctively tell them it is time to push