Rationale: The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality.Objectives: To describe how family members and clinicians experience and express spirituality during the dying process in a 21-bed medical–surgical ICU.Methods: Reflecting the care of 70 dying patients, we conducted 208 semistructured qualitative interviews with 76 family members and 150 clinicians participating in the Three Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by three investigators using qualitative interpretive description.Measurements and Main Results: Participants characterize dying as a spiritual event. Spirituality is an integral part of the life narrative of the patient before, during, and after death. Experiences and expressions of spirituality for patients, families, and clinicians during end-of-life care in the ICU are supported by eliciting and implementing wishes in several ways. Eliciting wishes stimulates conversations for people of divers...

Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit

Trauma-Informed Care for Violently Injured Patients in the Emergency Department.

Fostering compassion and reducing burnout: How can health system leaders respond in the Covid-19 pandemic and beyond?

Objectives:To describe the consequences of workplace stressors on healthcare clinicians in PICU, and strategies for personal well-being, and professional effectiveness in providing high-quality end-of-life care.Data Sources:Literature review, clinical experience, and expert opinion.Study Selection:A

Care for Dying Children and Their Families in the PICU: Promoting Clinician Education, Support, and Resilience.

Background:Working in healthcare is increasingly challenging for nurses, physicians, and other health professionals. Ongoing high stress takes a toll on clinicians and interferes with the quality of their patient care. Fostering clinician wellbeing needs to be a priority; if not, the human and financial consequences are significant.Objective:To describe the University of Virginia (UVA) School of Nursing's Compassionate Care Initiative (CCI) as an example of an organizational case study that is engaged in multi-pronged efforts to cultivate a resilient healthcare workforce committed to high-quality, compassionate, relationship-based care.Methods:This case report de scribes the development, implementation, and evaluation of the CCI at UVA. Various elements of the program are reviewed, which include harnessing talents and interests of the larger institution in the establishment of Compassionate Care Ambassadors, outreach to the community, innovative student-specific educational activities, and a national medi...

/pdf/prioritizing-clinician-wellbeing-the-university-of-virginia-4nv67hs3d5.pdf

Prioritizing Clinician Wellbeing: The University of Virginia's Compassionate Care Initiative.

To purchase electronic and print reprints, contact the American Association of Critical-Care Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273; fax, (949) 362-2049; e-mail, reprints@aacn.org. setting. After exclusions, 10 articles remained to serve as a framework for our Quiet Time development. The literature review was presented at a unit-based shared governance meeting. A Quiet Time subcommittee was created (comprising nurses from day and night shifts), and members were designated as “Quiet Time champions.” It was decided by the nursing staff that Quiet Time would be most beneficial from 2 to 3 PM and 2 to 4 AM daily. Education and information about the new Quiet Time initiative was disseminated to physicians, physical therapists, and other potential persons who might be affected. Nurses were encouraged to advocate for the rescheduling of routine procedures that occurred during our designated Quiet Time when appropriate. All admitted patients and their families are educated about Quiet Time during unit orientation. Families are encouraged to bring in music and other items that will specifically relax their family member (eg, a special blanket, soothing music). Before Quiet Time periods, nurses, if appropriate, premedicate for pain, pretoilet, and reposition patients to ensure a period of uninterrupted rest. When Quiet Time begins, a one-on-one announcement is made to every Critical care units can be hectic, chaotic, and generally overstimulating. The interventions that critical care patients require can interrupt normal sleep/wake cycles, causing cognitive and physiological disturbances such as delirium and hemodynamic instability. Providing a healing environment can often be a challenge, one that the coronary care unit (CCU) at The Valley Hospital has confronted head on with our Quiet Time initiative. Quiet Time was devised to promote adequate rest for our vulnerable critical care population. Two blocks of time (2-3 PM and 2-4 AM) have been designated during which lights are dimmed, noise-reduction strategies are implemented, and procedures are minimized. Our main goal is to implement strategies that will lower the noise level, promote rest and healing, and increase patient satisfaction. Our stated objectives are as follows: 1. Identify common noise sources that interfere with a patient’s ability to rest. 2. Measure sound levels in the CCU to which patients are often exposed. 3. Minimize procedures and disruptions during the designated time frame. 4. Increase patient satisfaction. We began by using the CINAHL database to perform a literature review, searching for the key words “quiet time,” “noise,” and “intensive care unit” and excluding articles that were not relevant to the CCU

Vivian Feldman

Papers

Dim Down the Lights: Implementing Quiet Time in the Coronary Care Unit