World Congress on
Intensive and Critical Care Nursing

Biography:

Alisa Mendonca is currently working as a Senior Nurse in Critical Care under the National Health Services, United Kingdom 

Abstract:

Music is a understudied intervention for mechanically ventilated critically ill patients with large benefits. Conscious and intubated patients in Critical Care are commonly subjected to high level of anxiety, agitation and pain related to intubation and clinical procedures, which could have a noxious impact on their clinical condition (Dewey et al, 2013).

Traditionally, they were treated with increasing sedative use which amplified polypharmacy and their risk of delirium. Consequently, Devlin et al (2018) recommended the use of non-pharmacological adjuncts including Music Therapy to reduce pain, anxiety and delirium. Music therapy has been found to improve the emotional and physiological well being of patients in Intensive Care Unit (ICU). It helps eliminate the need for pharmacological interventions to control agitation , pain and anxiety .(Saasatmand,2015)

• Moon Fai Chai et al 2008 recommended that music therapy could help reduce anxiety and promote better patient outcome.

• Linda L. Chlan et al (2013) revealed that music can decrease the pain and anxiety using the VAS score assessment tool and helped increasing the comfort level .

• Hatice Ciftci ,(2015) found that music not only reduces anxiety but also minimizes sedative exposure, which can help reduce cost and interestingly music could be self initiated by the patient.
•  Chiu-Hsiang Lee et al.(2017) used cortisol as a biomarker to examine the effects of stress and anxiety in the mechanically ventilated patient. 
• Music therapy is a anxiety reducing , non invasive nursing intervention which helps patients cope with stress better in a stressful ICU environment.
•  The Society of Critical Care Medicine, (2013) recommends the use of nonpharmacological interventions acknowledging the fact that not many studies have been published.

Conclusion & Recommendation

• Music therapy is beneficial to critically ill patients receiving mechanical ventilator support as they are unable to communicate effectively which leads to anxiety, fear and stress and decline in one’s health.
• Patients willingness and preference to music should be taken into account which help improve patients well being.

Biography:

Glenn Ramon Ocampo is currently working as a Quality & Patient Safety Coordinator at Hamad Medical Corporation, Qatar

Abstract:

Keyword:

Shared Governance, Transformational Leadership, Structured Empowerment, Professional Development, New Knowledge and Innovation. Empirical Outcome, Idea for improvement, and Autonomy at different level.

Learning Objective:

Optimizing organizational structures to shift the power and control for practice decisions from management to direct care nurses, decision is built from the point of care service outward. To promote Shared Governance, Professional Practice Model, Governance Framework, Escalation of idea for improvement and engagement of staff in decision making.

The benefits of shared governance process models implemented in many diverse and creative ways across generation and cultures and the primary aim is to support relationship between nurse and patient.

Abstract Details:

The professional practice model founded on the cornerstone principles of partnership, equity, accountability and ownership. Shared Governance is a culturally sensitive and empowering framework which enables sustainable and accountability-based decisions that support interdisciplinary design for excellent patient care. Shared governance acknowledges nurses as knowledge worker and requires organizational structure to promote partnership with leaders.

Shared Governance Engaged staff to participate in organizational clinical decision and promote staff driven and a lasting solution to any complex case, it promotes teamwork, encourages new ideas and innovation that allows original concept to morphed and fit with any health care institution.

The theory of Shared Governance was not new to the healthcare industry, it was introducing many years before by different leaders, in the form on autonomous organizational concept and promoting equal voice with physician within hospital. It became stronger when shared governance was introduced along with transformational leadership that distributes power and autonomy at different level, to promote collaborative work between leaders and frontline.

Biography:

Federica Bosso ios currently working as a nurse and representative of the infectious risk at the Rizzoli Orthopedic Institute, Italy

Abstract:

Palliative care is set up as a branch of medicine that deals with providing assistance to people in the advanced phase of illness; we are talking about an untreatable disease, that does not foresee treatments aimed at healing, a disease that Inevitably will continue its course culminating in the death of the assisted person. However, the fact that a disease cannot be healed does not necessarily means that it cannot be cured. In this context it is necessary to make a distinction between healing and cure, healing is a condition that foresees the regression, until the disappearance, of a morbid event, and instead the treatment involves an intervention aimed at the treatment of the symptoms of a certain affection, with the intent of guaranteeing a better quality of life.

All of this does not reduce to a purely practical assistance but to a global, universal assistance that in addition to the physical dimension includes the emotional, psychological, environmental, spiritual, of the patient himself but also of his family, in my personal opinion, also of the operators themselves, because it is a delicate work, in which being continually exposed to suffering and pain, together with the experience of each patient, can have psychological consequences even on operators themselves, so it is important to have a solid and united team of work and the awareness that they can count on the support of their colleagues at any time.

In this area of care many variables are to be taken into account, the pain , the illness, the life’s expectative but in my opinion the most important is communication, aimed at establishing therapeutic compliance with the patient, carefully evaluating When and How to relate to the patient, because it takes a long time to establish a therapeutic relation but a single second or a wrong word could destroy it and, without the patient compliance would be really difficult to carry on an assistance process.

Biography:

Vincenzo Niglio is currently working as a nursing professional in S.p.A, Italy

Abstract:

The goal of rehabilitation nursing is to assist individuals with a disability and/or chronic illness to attain and maintain maximum function. The rehabilitation staff nurse assists clients in adapting to an altered lifestyle, while providing a therapeutic environment for client's and their family's development. The rehabilitation staff nurse designs and implements treatment strategies that are based on scientific nursing theory related to self-care and that promote physical, psychosocial, and spiritual health. The rehabilitation staff nurse works in inpatient and outpatient settings that can be found in a range of acute to subacute rehabilitation facilities.

This role description has been developed by staff nurses to clarify and specify the responsibilities of the staff nurse in a rehabilitation setting and to promote professionalism based on the established scope and standards of rehabilitation nursing practice. General Responsibilities of the Rehabilitation Staff Nurse. Possesses the specialized knowledge and clinical skills necessary to provide care for people with physical disability and chronic illness Coordinates educational activities and uses appropriate resources to develop and implement an individualized teaching and discharge plan with clients and their families Performs hands-on nursing care by utilizing the nursing process to achieve quality outcomes for clients. Provides direction and supervision of ancillary nursing personnel, demonstrates professional judgment, uses problem solving techniques and time-management principles, and delegates appropriately. Coordinates nursing care activities in collaboration with other members of the interdisciplinary rehabilitation team to facilitate achievement of overall goals. Coordinates a holistic approach to meeting patient's medical, vocational, educational, and environmental needs Demonstrates effective oral and written communication skills to develop a rapport with clients, their families, and health team members and to ensure the fulfilment of requirements for legal documentation and reimbursement Acts as a resource and a role model for nursing staff and students and participates in activities such as nursing committees and professional organizations that promote the improvement of nursing care and the advancement of professional rehabilitation nursing Encourages others to become CRRN certified, obtain advance degrees, participate on committees, and/or join professional organizations. Facilitates community education regarding acceptance of people with disabilities. Actively engages in legislative Initiatives affecting the practice of rehabilitation nursing or the people in their care. Applies nursing research to clinical practice and participates in nursing research studies. Members of the Rehabilitation Team Rehabilitation nurses are key contributors to the care  of  individuals  with chronic  conditions  and disability,  and  they are  uniquely  prepared  to  lead  team-based care  coordination, including transitional care.  Rehabilitation is provided by additional professionals who collaborate with each other and the patient  and  family  to develop  patient-centered  goals  and  objectives.  This team approach values  all  members  of  the team,  with  the patient  and  family  in  the  center  of  the team. The roles and responsibilities  of  team  members  are further  defined. Patient • Communicate  with other  members  of  the team. •  Learn  about  his  or  her  illness  or  injury. •  Participate  in  therapies. •  Participate  in decisions  and preparations  for  next  level  of  care. Patient  Family/Caregiver/Significant  Other •  Learn  about  the  patient’s  injury  or  illness. •  Investigate  community  resources. •  Discuss  concerns  with  team  members  as  needed. •  Provide  information about  the  home  environment.   Physician •  Establish  a  medical diagnosis. •  Guide the  rehabilitation program.

Biography:

Mariacristina Di Fiore Marianni is currently working as a Clinical Specialist in Advanced Wound Management at Smith&Nephew – Italia

Abstract:

The traditional signs and symptoms of wound infection may often not be sufficient to properly guide clinical choices.

 It is essential for operators to better manage the resources to be allocated to patients with skin lesions. An accurate assessment of the wound, in fact, leads to a more appropriate treatment that can accelerate wound closure, thus reducing both the economic costs for the NHS and for the patient.

To remedy these problems a novel handheld fluorescence imaging device has recently enabled real-time detection of bacteria in wounds based on their intrinsic fluorescence characteristics

The MolecuLight i: X imaging device is a handheld instrument consisting of a high-resolution color LCD display and from a touch screen with integrated optical and microelectronic components. MolecuLight i: X uses technology patented to allow imaging with standard and fluorescent lighting of bacteria and tissue components in wounds and in the surrounding healthy skin of patients. Moreover with Moleculight is possible to measure wound surface area at the point of care. MolecuLight i:X emits a precise wavelength of safe violet light, which causes bacteria ≥ 104 CFU/g to fluoresce.

The MolecuLight i:X instantly visualizes the presence of potentially harmful levels of bacteria through endogenous autofluorescence without the need for contrast agents or contact with the patient. The intended use of the device is to assist health care professionals during the management of patients with wounds by enabling real-time visualization of potentially harmful bacteria. The device is intended to be used as part of routine clinical wound assessment processes which may include examination for characteristic signs and symptoms of infection. Under violet light illumination, the MolecuLight i:X can capture and document images or videos of wounds and surrounding areas where fluorescent bacteria may be present. The bacterial fluorescence signals detected by the device provide health care professionals with a visual indication of bacterial presence, load, and location within and around wounds. This information can be used to guide health care professionals in their selection, application, and response monitoring of wound therapies.

The indication for use of the device is to instantly visualize the presence of potentially harmful bacteria commonly found within or around wounds including S. aureus, P. aeruginosa, E. coli, Coagulase-negative staphylococci, Enterococcus spp, Proteus spp, Klebsiella pneumoniae, Beta-hemolytic streptococci (Group B) and Enterobacter spp during clinical assessment, treatment, and monitoring of treatment response of wounds.

Inserting the Moleculight in a standard care pathway helps the clinician detect the presence of bacteria by fluorescence, facilitates the taking of evidence-based decisions and has been shown to lead to:

- Better clinical results;

- Most effective sampling;

- Greater savings;

- Reduction of ineffective treatments;

- Reduction in the use of unnecessary drugs

Biography:

Abstract:

Assumptions for the study / empirical evidences

Organs and tissues donation is a theme of which we increasingly hear about. Through this work I’ve studied the interview for donation’s request between health professionals and family members of the potential donor, investigating the necessary training, the main causes of refusal and the approach that the staff has towards the donation itself.

I’ve also given a survey to the medical and nursing staff of the Reanimation and Critical Medicine Department and to the staff of the AOUS Coordination of organs and tissues donation and transplant to analyze the level of specific training and motivation.

Targets of the study

Through this study, using scientific literature, I proposed to investigate the relationship between the training of health professionals and the interview for the donation proposal. Specifically, if a proper training both of the department’s health professionals and of professionals in charge of conducting the interview for the donation proposal can influence the interview's performance and the possibility of obtaining more consents to donation.

Study population

The medical and nursing staff of the Reanimation and Critical Medicine Department and the staff of the AOUS Coordination of organs and tissues donation and transplan.

Materials and methods

Initially I’ve done a research to describe the process of donation, legislation, kinds of donor and the educational and behavioral requirements of health professionals involved in the interview for the donation request. Then I’ve done a research on PubMed to find a correlation between the qualification achieved by professionals and the effectiveness of the interview, using the following search strings: ("Brain Death" [Mesh]) OR "brain death" OR "brain dead ”OR“ brain deads ”OR (irreversible [tiab] AND coma [tiab])) AND (" Tissue and Organ Harvesting "[Mesh] OR" Organ Transplantation "[Mesh] OR organ donation OR organ transplantation) AND (" Family "[Mesh] OR" Caregivers "[Mesh] OR related * OR family OR caregiver *) AND (" Interviews as Topic "[Mesh] OR interview *) AND (" Nurse's Role "[Mesh] OR" Nursing "[Mesh] OR "nursing" [Subheading] OR nursing [tiab] OR nurse * [tiab]).

I’ve also given a survey to the medical and nursing staff of the Reanimation and Critical Medicine Department and the staff of the AOUS Coordination of organs and tissues donation and transplant, to analyze the levels of proper training in organs and tissues donation and transplantation and the levels of motivation.

Results and discussion

Healthcare staff interviews with the potential donor’s family are certainly one of the most important moments in the donation process.

The relationships established between the two parts are fundamental both for the outcome of the interview and for the process of bereavement’s acceptance by the family.

The relationship between family members and health professionals begins with the hospitalization.

Adequately informed, trained and capable of dialogue health professionals will help the potential donor’s family during the hospitalization and above all will be respectful and aware in conducting interviews regarding the donation proposal.

Specifically, nurses have the possibility to attain a first level Master's degree in "Nursing coordination and transplantation of organs and tissues".

The nurse has a important role in the entire system of transplants, takes actively part in the procedures for organs’ identifying, selecting and transplanting, and in the elaboration and execution of pre and post-transplant care pathways.

Conclusions 

I’ve observed how a properly trained healthcare staff is able to conduct more appropriate, structured and logical interviews with the relatives of the potential donor.

There are fundamental moments that must be faced in each interview, one of the most important is brain death declaration, another one is the request of consent or refusal to donate organs and tissues. From the research on PubMed I noticed how a properly trained staff can conduct a more logical and respectful interview.

The survey given to the healthcare staff shows a relationship between preparation and motivation towards the donation.

Professionals with proper training have a higher consideration of the interview and are in favor of the donation itself, increasing the motivation and the approval towards donation. On the contrary, the lack of a proper training reduces motivation and consideration of the interview, decreasing the consent to donation. Therefore the entire path of donation must be controlled by professionals with continuous and proper training.

Biography:

Mahmoud Abed is currently working as a infection control coordinator (manager) nursing at Jordan college of Nursing

Abstract:

1. Guidline for the Prevention of Surgical Site Infection.

The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the healthcare continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies.

This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.

2. CDC Guidline for Isolation Precautions

This updated guideline responds to changes in healthcare delivery and addresses new oncerns about transmission of infectious agents to patients and healthcare workers in the United States and infection control. The primary objective of the guideline is to improve the safety of the nation’s healthcare delivery system by reducing the rates of HAIs.

1. provide infection control recommendations for all components of the healthcare delivery system, including hospitals, long-term care facilities, ambulatory care, home care and hospice;

2. reaffirm Standard Precautions as the foundation for preventing transmission during patient care in all healthcare settings;

3. reaffirm the importance of implementing Transmission-Based Precautions based on the clinical presentation or syndrome and likely pathogens until the infectious etiology has been determined.

4. provide epidemiologically sound and,whenever possible, evidence-based recommendations.

3. Guideline for Prevention of Catheter-associated Urinary Tract Infections.

This Guidline  is intended for use by infection prevention staff, healthcare epidemiologists,healthcare administrators, nurses, other healthcare providers, and persons responsible for developing, implementing, and evaluating infection prevention and control programs for healthcare settings across the continuum of care. The guideline can also be used as a resource for societies or organizations that wish to develop more detailed implementation guidance for prevention of CAUTI.

    1. recommendations for who should receive indwelling urinary catheters (or, for certain populations, alternatives to indwelling catheters) .
2. recommendations for catheter insertion
3. recommendations for catheter maintenance.
4. quality improvement programs to achieve appropriate placement, care, and removal of catheters.
5. administrative infrastructure required.
6. surveillance strategies.

4. Guidline for Clostridium diffcile Infection Control Guidlines.

Clostridium difficile is a bacterium that causes mild to severe diarrhea and intestinal conditions like inflammation of the colon. It is the most frequent cause of hospital acquired diarrhea.

Clostridium difficile spores persist for a long time in the environment. Transmission due to contaminated environmental sources and poor hand hygiene practices contribute to its spread within health care institutions.

This lecture outlines the practice of Routine Practices and Additional Precautions (RP/AP) in health care settings across the continuum of care  including, but not limited to, pre-hospital care, acute care, complex continuing care, rehabilitation facilities, long-term care, chronic care, ambulatory care and home health care.

The goal of Routine Practices and Additional Precautions is to reduce the risk of transmission of microorganisms in health care settings through:

1.  understanding the concepts of the chain of transmission.
2. understanding the concepts and application of Routine Practices (RP)
3. understanding barriers and enablers that affect compliance with Routine Practices
4. knowing why and when to use Additional Precautions (AP).
5.  using, applying and removing personal protective equipment correctly when indicated for the protection of the client/patient/resident or the staff member.

Biography:

Marco Filonzi is currently working as National Sales Manager at Smith & Nephew, Italy 

Abstract:

Background:

Surgical site infections are a relevant problem for healthcare providers, prolonging patient’s stay and increasing management costs. After WHO published the new GLOBAL GUIDELINES FOR THE PREVENTION OF SURGICAL SITE INFECTION in 2016, the usage of Incisional Negative Pressure systems (iNPWT) became more popular, demonstrating their efficacy in different specialities. Nevertheless, the adoption in surgical protocols has been slowed down by hospital administrations, worried by the arising costs.

Content:

Since 2016 a body of qualitative clinical evidence has been developed to support the efficacy of sNPWT for the prevention of SSI, which led to the publication of some Medtech Innovation Briefings by NICE. That includes some interesting research focussed on economical and organizational sustainability of that practice.

This presentation will start from a brief review of clinical evidence available on clinical efficacy and will then illustrate a significant study, real world data based, that demonstrated the economical sustainability of an APPROPRIATE usage of sNPWT on high risk patients for the prevention of SSIs.