Biomedical subjects

Mary Jo Grap

Publications and source records attributed to Mary Jo Grap.

7 recordsLinked to original sources

PubMed2003

Predictors of backrest elevation in critical care.

Low backrest and supine positions are associated with increased mortality and ventilator associated pneumonia (VAP). Data are not available across ICU settings about the level of backrest position used and its relationship to enteral feeding and hemodynamic status. The purpose of this descriptive study was to document the level of backrest elevation and position and identify factors associated with and predict positioning in a medical, surgical and neuroscience intensive care unit. Data were collected randomly in each unit over a 6-week period, resulting in 506 observations for170 patients. Backrest elevation was determined by electronic bed read-out or bed frame elevation gauge. BP, HR and enteral feeding status were retrieved from the medical record. Results showed that mean backrest elevation was 19.2 degrees and 70% of subjects were supine. No difference in backrest elevation among units was found. Significant correlations between backrest elevation and systolic BP (r=0.15, P=0.006); and backrest and diastolic BP (r=0.13, P=0.02) were found. There was no difference in backrest elevation between patients being fed and not being fed. Differences in backrest elevation for intubated versus nonintubated patients approached significance (P=0.07) with intubated patients at lower backrest elevations. In summary, use of higher backrest elevations (>30 degrees ) is minimal, is not related to feeding and minimally related to hemodynamic status. Strategies to meet published recommendations for backrest elevation (30-45 degrees ) must include repeated feedback about nurse's use of backrest elevation and estimates of elevation.

Beds↗

PubMed2003

The effects of preparatory sensory information on ICU patients.

Preparatory sensory information (PSI) has been found to have significant effects in reducing distress, tension, restlessness, negative moods, and anxiety, and also in reducing length of postoperative hospitalization during various threatening medical events, but no evidence has demonstrated the effect of PSI on a patient during ICU hospitalization. On the basis of Lazarus' theory, a structural equation model was developed to examine the role of the nursing intervention, PSI, as a significant factor influencing patients' processes of cognitive appraisals and coping, adaptational responses, and patient care outcomes during ICU hospitalization. The analytical model examined the net effect of PSI on outcomes, controlling for the effects of mastery, interpersonal trust, social support, socioeconomic status, severity of illness, age, and gender. A quasi-experiment was executed in four large acute care hospitals. Data were collected from 41 subjects in the control group and from 42 in the treatment group receiving PSI before ICU admission. Structural equation modeling was employed to test the proposed analytic model. The initial tests of model fit indicate that the original model did not fit the data well with GFI = 0.85, AGFI = 0.76, RMSEA = 0.059, p_close = 0.28, and critical N = 78. A revised model was developed, and the fit indices suggested an adequate fit with GFI = 0.90, AGFI = 0.84, RMSEA = 0.00, p_close = 0.89, and critical N = 109. These findings provide empirical support for Lazarus' theory on stress, appraisal, and coping. The findings also verify the beneficial effects of the nursing intervention of PSI on ICU patients.

APACHE↗

PubMed2003

Oral care interventions in critical care: frequency and documentation.

BACKGROUND: No data have been collected to describe the products, methods, and frequency of oral care needed to reduce dental plaque, oral colonization, and ventilator-associated pneumonia in critically ill patients. OBJECTIVES: To describe the frequency of use of oral care interventions reported by nurses in several intensive care units in a large southeastern medical center. METHODS: Staff members completed a written survey describing their oral care practices, and oral care interventions were recorded from the unit's flow sheet for the previous 24 hours for all patients at 5 randomly selected times during 1 month. RESULTS: Most respondents (75%) reported providing oral care 2 or 3 times daily for nonintubated patients, and 72% reported providing care 5 times daily or more for intubated patients. However, oral care was documented on the unit's flow sheet a mean of 1.2 times per patient. Reported use of toothpaste and a toothbrush was significantly greater in nonintubated patients (P < .001), and use of a sponge toothette was significantly greater in intubated patients (P < .001). Nurses' mean rating of oral care priority was 53.9 on a 100-point scale. CONCLUSIONS: Despite evidence that they are ineffective for plaque removal, sponge toothettes remain the primary tool for oral care, especially in intubated patients in intensive care units. Nurses report frequent oral care interventions, but few are documented. Education and focus on good oral care strategies are required; nursing research to delineate the best procedure for all patients in intensive care units is needed.

Critical Care↗

PubMed2002

The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.

Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

Adult↗

PubMed2002

A description of patients' report of endotracheal tube discomfort.

The purpose of this descriptive study was to describe the type, location, and amount of endotracheal tube (ETT) discomfort. Twenty-two subjects (mean age 49.2 years) who had experienced ETT intubation for at least 6 hours (mean: 25.9 hours) after cardiac surgery, completed a 100-mm Visual Analogue Scale related to their experience with the endotracheal tube within 24 hours after extubation. A semi-structured interview was also conducted. There was no relationship between the duration of intubation and the level of discomfort described (r = -0.24; P = 0.29) or between the duration of intubation and whether medications relieved the discomfort (r = 0.34; P = 17). All subjects described some level of discomfort. The majority stated the discomfort was in the throat area. However, 27% (n = 6) described the discomfort as located in the chest. There was no difference in the level of discomfort based on discomfort location (f = -0.14; P = 0.71). The discomfort locations support the notion that ETT irritation occurs at multiple levels (i.e. pharyngeal, laryngeal, and tracheal mucosal areas). In addition, interventions that focus on ETT stability will not be sufficient to reduce discomfort but must re-focus nursing attention on reducing ETT movement as well as the movement of all ventilator tubing.

Adult↗

PubMed2002

Nurses' accuracy in estimating backrest elevation.

BACKGROUND: Positioning patients is a key component of nursing care and can affect their morbidity and mortality. The Centers for Disease Control and Prevention recommend that patients receiving mechanical ventilation have the head of the bed elevated 30 degrees to 45 degrees to prevent nosocomial pneumonia. However, use of higher backrest positions for critically ill patients is not common nursing practice. Backrest elevation may be affected by the accuracy of nurses' estimates of patients' positions. OBJECTIVES: To determine the difference between nurses' estimates of bed angles and measured bed angles and to describe the relationship between nurses' characteristics and the accuracy of their estimates. METHODS: A convenience sample of 67 nurses attending the 1999 American Association of Critical-Care Nurses National Teaching Institute and Critical Care Exposition in New Orleans, La. Each subject provided demographic information and estimated 3 bed angles. The angles were preselected by using a random number table. Summary statistics were used and were categorized according to the demographic information provided by participants. Estimated angles were correlated with measured angles, and accuracies in estimating angles were correlated with demographic characteristics. RESULTS: Nurses were accurate in estimating bed angles (correlation, 0.8488). Demographic information, including sex, age, years of practice, years of critical care practice, basic education, highest educational level, and present position had no relationship to accuracy. CONCLUSIONS: Nurses are able to estimate backrest elevation accurately. Other explanations are needed to understand why recommendations for backrest elevation are not used in practice.

Adult↗

PubMedDate not supplied

Subject recruitment in critical care nursing research: a complex task in a complex environment.

PURPOSE: This article serves to describe subject recruitment issues in a funded study in a the medical respiratory intensive care unit. BACKGROUND: Subject recruitment can be difficult in the critical care environment. Inadequate recruitment can reduce the ability to detect treatment differences. Though causes of recruitment difficulty have been documented in medical trials, little is known concerning recruitment in critical care nursing studies. METHODS/RESULTS: All patients admitted to a medical respiratory intensive care unit (ICU) were reviewed daily for study eligibility. Demographics and reasons for ineligibility and failure to consent were documented. Five hundred ninety-three patients were reviewed; 42 (7.1%) were enrolled; 457 (77.1%) were not eligible and not enrolled and 94 (15.8%) were eligible but not enrolled. Of those reviewed, 52% were male; 57% were black, and 41% were white. Of those eligible, but not enrolled, 40% were because of family unavailability for consent and 27% because of family unwillingness to consent. There were no significant differences in patient age or gender between those who consented and those who did not. However, those who did not consent consisted of a greater proportion of blacks than the population screened. Families' stated reasons for not consenting were primarily related to the family's stress level. CONCLUSIONS: Conducting clinical studies in the critical care environment, enrolling subjects, and obtaining consent may be complicated by the critical nature of the patient's illness, and researchers must be aware of these issues for study success.

Black or African American↗