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ENHANCING COMMUNICATION THROUGH THE USE OF AUGMENTATIVE AND ALTERNATIVE COMMUNICATION IN PATIENTS STATUS POST TRAUMATIC BRAIN INJURY
Title
ENHANCING COMMUNICATION THROUGH THE USE OF AUGMENTATIVE AND ALTERNATIVE COMMUNICATION IN PATIENTS STATUS POST TRAUMATIC BRAIN INJURY.
Creator
Greene, ReAnna, Amidei, Christina, University of Central Florida
Abstract / Description
Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of...
Show morePatients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.
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Date Issued
2011
Identifier
CFH0003859, ucf:44702
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0003859
PREVENTING NEUROMUSCULAR DECONDITIONING IN CRITICALLY ILL PATIENTS
Title
PREVENTING NEUROMUSCULAR DECONDITIONING IN CRITICALLY ILL PATIENTS.
Creator
Lakhani, Shahzia, Amidei, Christina, University of Central Florida
Abstract / Description
Critically ill patients can be prescribed bed rest as a therapeutic intervention. Immobility from bed rest can cause neuromuscular deconditioning and weakness. Preventing immobility by implementing mobilization activities may prevent these complications from occurring. Currently, mobility protocols are lacking. The purpose of this literature review is to analyze the evidence related to mobilizing patients in the Intensive Care Unit (ICU). In the future, a standard mobility protocol should be...
Show moreCritically ill patients can be prescribed bed rest as a therapeutic intervention. Immobility from bed rest can cause neuromuscular deconditioning and weakness. Preventing immobility by implementing mobilization activities may prevent these complications from occurring. Currently, mobility protocols are lacking. The purpose of this literature review is to analyze the evidence related to mobilizing patients in the Intensive Care Unit (ICU). In the future, a standard mobility protocol should be instituted for critically ill patients indicating when and how to begin mobilization. The efficacy of mobility protocols relies on an interdisciplinary team for positive outcomes to prevent complications of inactivity and promote patient safety. Future implementation of mobilization can decrease patients' lengths of stay and extensive rehabilitation from inactivity. Nursing education, practice and research should focus on interventions to prevent complications of immobility by identifying mobilization techniques, safety approaches and the use of protocols.
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Date Issued
2011
Identifier
CFH0003847, ucf:44704
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0003847
NURSING INTERVENTIONS IN THE CARE OF PATIENTS UNDERGOING INDUCED HYPOTHERMIA
Title
NURSING INTERVENTIONS IN THE CARE OF PATIENTS UNDERGOING INDUCED HYPOTHERMIA.
Creator
Zimmerman, Angela, Amidei, Christina, University of Central Florida
Abstract / Description
Use of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy...
Show moreUse of induced hypothermia for the purpose of lowering intracranial pressure and preserving neuronal function has increased as research data reveals a trend of positive outcomes in patients treated with this therapy. Recently induced hypothermia following cardiac arrest due to ventricular fibrillation has been deemed successful. Current research has expanded to evaluate the effectiveness of induced hypothermia as a treatment modality for severe stroke and head trauma. In spite of its efficacy, complications exist with this treatment modality. The purpose of this literature review is to examine potential complications secondary to induced hypothermia and highlight the nurse's role in managing patient care. At the present, patient protocols for induced hypothermia are lacking. The success of treatment is largely dependent on the skill of the healthcare team to prevent further harm and enhance therapeutic outcomes by providing astute assessment and management of complications in patients undergoing induced hypothermia. The desired outcome of this review is to promote integration of research in the development of evidence-based protocols for induced hypothermia.
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Date Issued
2011
Identifier
CFH0003836, ucf:44718
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH0003836
An Exploratory Study of Physiologic Responses to a Passive Exercise Intervention in Mechanically-ventilated Critically Ill Adults
Title
An Exploratory Study of Physiologic Responses to a Passive Exercise Intervention in Mechanically-ventilated Critically Ill Adults.
Creator
Amidei, Christina, Sole, Mary, Byers, Jacqueline, Covelli, Maureen, Smith, Gerald, University of Central Florida
Abstract / Description
Muscle weakness is the most common and persistent problem after a critical illness. Early mobilization of the critically ill patient, beginning with passive exercise and progressing to ambulation, may mitigate muscle effects of the critical illness. However, mobilization may produce adverse effects, especially early in the illness when risk for physiologic deterioration is common. If safe, introducing a mobility intervention early in the illness may facilitate ventilator weaning, shorten...
Show moreMuscle weakness is the most common and persistent problem after a critical illness. Early mobilization of the critically ill patient, beginning with passive exercise and progressing to ambulation, may mitigate muscle effects of the critical illness. However, mobilization may produce adverse effects, especially early in the illness when risk for physiologic deterioration is common. If safe, introducing a mobility intervention early in the illness may facilitate ventilator weaning, shorten intensive care unit and hospitals stays, and improve functional status and quality of life for mechanically ventilated critically ill patients. The aim of this study was assess the cardiopulmonary and inflammatory responses to an early standardized passive exercise protocol (PEP) in mechanically ventilated critically ill patients. Using a quasi-experimental within-subjects repeated measures design, mechanically ventilated critically ill adults who were physiologically stable received a single standardized PEP within 72 hours of intubation. The PEP consisted of 20 minutes of bilateral passive leg movement delivered by continuous passive motion machines at a rate of 20 repetitions per minute, from 5-75 degrees, to simulate very slow walking. Physiologic parameters evaluated included heart rate (HR), mean blood pressure (MBP), oxygen saturation, and cytokine levels (IL-6 and IL-10), obtained before, during, and after the intervention. The Behavioral Pain Scale (BPS), administered before, during and after the intervention was used as a measure of participant comfort. The study sample was comprised of 18 (60%) males and 12 (40%) females, with a mean age of 56.5 years (SD 16.9 years), who were primarily Caucasian (N=18, 64%). Mean APACHE II scores for the sample were 23.8 (SD 6.2) with a mean predicted death rate of 48.8 (SD 19.8), indicating moderate mortality risk related to illness severity. Number of comorbidities ranged from 1-10 (X=4). All participants completed the intervention with no adverse events. Using repeated measures analysis of variance (rmANOVA), no significant differences were found in HR, MBP, or oxygen saturation at any of the four time points in comparison to baseline. BPS scores were significantly reduced (F(2.43, 70.42)=4.08, p=.02) at 5 and 10 minutes after the PEP was started, and were sustained at 20 minutes and for one hour after the PEP was completed. IL-6 was significantly reduced (F(1.60, 43.1)=4.351, p=.03) at the end of the intervention but not at the end of the final rest period. IL-10 values were not significantly different at any of the three time points, but IL-6 to IL-10 ratios did decrease significantly (F(1.61, 43.38)=3.42, p=.05) at the end of the PEP and again after a 60 minute rest period. Passive leg exercise was well tolerated by study participants. HR, MBP, and oxygen saturation were maintained within order set-specified ranges during and for one hour after activity, and patient comfort improved during and after the intervention. A downward trend in HR was noted in participants, which is contrary to usual HR response during exercise, and may represent clinical improvement in this population related to reduction in pain. Reduction of mean IL-6 values at the end of the PEP, but not after the rest period, suggests that the PEP was responsible for the initial IL-6 improvement. Improvement of IL-6 to IL-10 ratios from the end of the PEP to the end of the final rest period suggests that IL-10, although non-significant, may have had some effect, indicating that IL-10 increases may occur later than the time period of study.Passive exercise can be used as an approach to facilitating mobilization in mechanically ventilated critically ill adults until they are ready to participate in more active exercise. It could be that more frequent and aggressive exercise, such as passive cycling at faster rates, four times daily, will be tolerated in this population. While the understanding of clinical significance of cytokine profiles in critically ill patients is still evolving, cytokine levels may be useful in explaining benefits of mobilization in this population. Further study is required to replicate the impact of passive exercise on pain, and it may represent a novel approach to pain management in critically ill patients.
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Date Issued
2012
Identifier
CFE0004350, ucf:49424
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004350