Summer 2005Volume 16,Number 2

Index:Dynamics of Critical Care 2005 – Abstracts .........10

CACCN 16 • 2 • Summer 2005 3

DYNAMICSThe Official Journal of the CanadianAssociation of Critical Care Nurses

Volume Sixteen, Number TwoSummer 2005

Clinical Editor:Paula Price, RN, PhD, Instructor,ACCN Program, Department of AdvancedSpecialty Health Studies, Mount RoyalCollege, 4825 Mount Royal Gate S.W.,Calgary, AB, T3E 6K6,Telephone: (403) 440-6553,Fax: (403) 440-6555,e-mail: pprice@mtroyal.caPublications Chairperson:Asha Pereira, RN, BA, BN,CNCC(C), CINA(C), Winnipeg, MBEditorial Review Board:Adult Consultants:Janice Beitel, RN, MSc,CNCC(C), CNN(C), Toronto, ONKathleen Graham, RN, MScN,Ottawa, ONMartha Mackay, RN, MSN, CNCC(C),CCN(C), Vancouver, BCPediatric Consultants:Franco Carnevale,RN, MSA, MEd, PhD,Kirkland, PQJudy Rashotte, RN, MScN, CNCC(C),Ottawa, ONNeonatal Consultant:Debbie Fraser Askin, RNC, MN,Winnipeg, MB

Dynamics, the Official Journal of theCanadian Association of Critical CareNurses, is printed on recycled paper.

Canadian Associationof Critical Care Nurses

Board of DirectorsPresident:Patricia Hynes, RN, MA,CNCC(C), Toronto, ONVice-President:Asha Pereira, RN, BA, BN,CNCC(C), CINA(C), Winnipeg, MBTreasurer:Glenda Roy, RN, BN, CNCC(C),CCN(C), Grand Falls-Windsor, NLDirectors at Large:Grace MacConnell, RN, BScN, MN,CNCC(C), Dartmouth, NSJoy Mintenko, RN, Regina, SKSusan Williams, RN, BScN,CNCC(C), St. Thomas, ONCACCN National OfficeAdministrator:Tracy PorchakP.O. Box 25322,London, Ontario N6C 6B1www.caccn.cae-mail: caccn@caccn.caphone: (519) 649-5284phone (toll-free) (866) 477-9077fax: (519) 649-1458

2005 Subscription Rates: Dynamics, the Official Journalof the Canadian Association of Critical Care Nurses, ispublished four times annually, Spring, Summer, Fall andWinter - Four Issues - $60 / Eight issues - $120 (plus 7%GST). Payment should be made by cheque, money order orby VISA only. International and institutional subscription rateis $75 per year or $150 for two years.Article reprints: Photocopies of articles appearing inDynamics, the Official Journal of the CanadianAssociation of Critical Care Nurses, are available from theCACCN National Office, P.O. Box 25322, London, Ontario,N6C 6B1, at a cost of $5 per article. Back issues can bepurchased for $18.

DYNAMICSThe Official Journal ofthe Canadian Associationof Critical Care Nursesis a refereed journalpublished four timesannually by PappinCommunications,Pembroke, Ontario.Printed in Canada.ISSN 1497-3715.Copyright 2005 by theCanadian Association ofCritical Care Nurses,P.O. Box 25322,London, Ontario, N6C 6B1.

No part of this journal maybe reproduced in anymanner without writtenpermission from CACCN.The editors, the associationand the publisher do notguarantee, warrant orendorse any product orservice mentioned in thispublication.For information onadvertising, contactHeather Coughlin,Pappin Communications,The Victoria Centre,84 Isabella St., Pembroke,Ontario, K8A 5S5,telephone (613) 735-0952,fax (613) 735-7983, e-mailheather@pappin.com,website: www.pappin.comSend manuscript enquiriesor submissions to PaulaPrice, ACCN Program,Faculty of Health andCommunity Studies, MountRoyal College, 4825 MountRoyal Gate S.W., Calgary,Alberta T3E 6K6

DYNAMICSThe Official Journal ofthe Canadian Associationof Critical Care Nursesis indexed in theCumulative Index toNursing and Allied HealthLiterature, EBSCO, theInternational Nursing Index,MEDLINE, and RNdex Top100: Silver Platter.

Adult certificationLisa AlmosPatricia ByneJenny ChinSusan ChristensenLois CrossmanTerrell CwynarTanya DeReusGregory EllardLorna EstabrooksSandra FletcherDolores FriesenLaurie HayJillian HodgsonDebbie KennedyHeather LambHolly MackinPeggy McCoyPam MooresDiane SchmidtRhonda SchollenbergArk ShumanMaureen TeevensTeresa ThurberCarlotte PoolerMargaret Manula

Linda Slater-MacLeanJanet TaylorGwen ThompsonJoan YakimetsPediatric certificationHabiba DesaiDebra HarrisRecertificationSuzanne FoxJanice GiassonPatricia HynesPauline LehmannGwynne MacDonaldDavid MandzukTracy PorcinaMaureen TeevensNancy TetlockA special congratulations to the followingpeople who have won the CACCN CertificationAwardsAdult certification: Lorna Estabrooks, RhondaSchollenberg and Janet TaylorPediatric certification: Habiba DesaiRecertification: Janice Giasson and Gwynne MacDonald

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Congratulations to the following CACCN members

Congratulations to those who successfully wrote theCNA Certification Exam in Adult Critical Care and those who successfullywrote the FIRST CNA Certification Exam in Pediatric Critical Care.A belated congratulations to all CACCN members who wrote the CNA Critical Care Certification exam or recertified in2004. As you know, due to the Privacy of Information Legislation, we have had problems getting the names of our memberswho have achieved this important goal. We have had to rely on members getting their names to us. As a result, our list maynot be complete and we apologize to all those whom we have missed.

CALL FOR NOMINATIONS TO THE BOARD OF DIRECTORS� N O M I N A T I O N F O R M �An active member of CACCN who is currently working in critical care may let his/her name stand for election as a directoron the national board of CACCN. Election of directors shall be by ballot of the membership of the association at the annualgeneral meeting. Three active members may nominate any duly qualified person for election to the board of directors. Suchnominations must be in writing, signed by the nominators, and must be accompanied by the written consent of the nominee toact as a director if elected. Each nominator may nominate one candidate only. Please print names clearly.

We, ___________________________, ___________________________ and ___________________________nominate ___________________________ for election to the CACCN National Board of Directors.I, ___________________________, consent to let my name stand for election to the CACCN National Board of Directors.Nominees must submit a completed board of directors nomination package and supporting documentation. Nomination packagescan be obtained by contacting the national office. Nominations must be complete and received in national office byMay 31, 2005.The term of office being elected at the annual general meeting in October 2005 is from April 1, 2006 to March 31, 2008. Thereare three positions available, one each from the eastern, western and central regions.

CACCN 16 • 2 • Summer 2005 5

NOTICE OFANNUAL GENERAL

MEETINGThe national board of directors of the CanadianAssociation of Critical Care Nurses (CACCN) wouldlike to extend an invitation to the membership toattend the 2005 annual general meeting of theCACCN. The CACCN annual general meeting will beheld on Monday, October 3, 2005, at 1630-1730 hrs,at the Fairmont Chateau Laurier Hotel, CanadianRoom, in Ottawa, Ontario. Members unable to attendthe annual general meeting are reminded that theirproxy vote must be received in CACCN nationaloffice by 2400 hrs, Sunday, October 2, 2005. Theproxy vote form is printed at right, and can also beobtained from your chapter president or CACCNnational office.

CACCN calendar of events

DATES TO REMEMBER!June 30, 2005 Deadline for nominations forCACCN’s national board ofdirectors. Contact nationaloffice for nominationpackages.June 1, 2005 Deadline for BaxterGuardian ScholarshipJuly 31, 2005 Deadline for CACCNchapter of the year awardsubmissionsSeptember 1, 2005 Deadline for SmithsEducational AwardsubmissionsSeptember 29-30, 2005 CACCN Board of Directors’face-to-face meeting,Ottawa, OntarioOctober 1, 2005 Chapter Connections Day,Ottawa, OntarioOctober 2-4, 2005 Dynamics of Critical Care2005 Conference, Ottawa,Ontario

Annual General MeetingProxy Vote 2005

Every active member may, by means of proxy, appoint aperson (not necessarily a member of the association), ashis/her nominee to attend and act at the annual generalmeeting in the manner and to the extent and with the powerconferred by the proxy. The proxy shall be in writing underthe hand of the member or his/her attorney, authorized inwriting, and shall cease to be valid after the expiration of one(1) year from the date thereof.Proxy votes must be received in the national officeno later than midnight, Sunday, October 2, 2005.Proxy votes may be mailed/faxed to: CanadianAssociationof Critical Care Nurses, P.O. Box 25322, London, OntarioN6C 6B1 (Fax) 519-649-1458The following shall be a sufficient form of proxy:

I, _____________________, of _____________________,an active member of the Canadian Association of CriticalCare Nurses hereby appoint_____________________ of ______________________,or failing her/him,_____________________ of ______________________,as my proxy to vote for me and on my behalf at themeeting of members of the association to be held on the3rd day of October 2005, and at any adjournment thereof.Dated at ____________________, this _____ dayof ____________________, 2005.Signature of Member: ____________________CACCN Membership Number: ____________________

Criteria for awards available tomembers of the CanadianAssociation of CriticalCare Nurses arepublished on pages32-34 of this issue ofDynamics.

Awards Availableto CACCNmembers

Patricia HynesCentral Region, PresidentI am looking forward to the upcomingyear, my final year as president ofCACCN. I feel honoured to be amember of the board of directors andin the company of such committed andhard-working professionals.I am a self-directed, goal-orientedindividual who has leadership experienceboth in the ICU and the CACCN. I am currently employed asthe manager for the Mount Sinai Hospital ICU in Torontowhere I provide management support for health professionalsin a dynamic medical-surgical ICU. My day-to-day workencompasses strategies for continuous quality improvementand ongoing motivation of interdisciplinary team membersthrough periods of uncertainty and change. Promoting aquality work environment, one in which the culture is linked toorganizational goals, has been one of my primary objectives. Ialso have held a clinical cross-appointment to the Universityof Toronto, Faculty of Nursing, for the past four years. InOctober 2004, I started an MBA program, again with a focuson quality measurement and improvement, and the role ofleadership in facilitating the changes needed to sustain qualitypatient- and family-centred care.Within CACCN, at the local level, I served two terms aspresident of the Toronto chapter and one term as educationchair. As a result of these experiences, I gained valuableinsights into the present and future needs of critical care nursesthat I believed I could represent as a member of the nationalboard of directors. I spent one year as national director-at-largeresponsible for recruitment and retention, and another as vice-president responsible for the research and publicationsportfolios. I have enjoyed being the CACCN president,especially meeting many of the members. I look forward tomeeting many more of you during my last year as president.Asha PereiraWestern Region, Vice-presidentI feel honoured to be a member of theCACCN national board of directorsand look forward to my final year asvice-president. I am fortunate to beworking with a group of individualswho are dedicated to their professionand committed to increasing theprofile of critical care nursing inCanada and beyond. I believe, throughthis increased profile, CACCN will beable to advocate strongly on our patients’ behalf.

I graduated with a Bachelor ofArts in Sociology and Psychologyin 1986 and entered the St. Boniface School of Nursing thefollowing year. After completing the two-year diploma program,I began working on a very active neuroscience ward at St.Boniface. In 1991, I completed the collaborative adult intensivecare unit course at St. Boniface Hospital and worked in thesurgical ICU until I expanded my horizons and switched to themedical ICU/CCU. Since 1999, I have been an educator at St.Boniface Hospital. I graduated with my BN from the Universityof Manitoba in 1998, obtained my CNA certification in criticalcare in 2001 and am currently studying toward my Masters inNursing at the University of Manitoba.I have been involved in CACCN at the local level since 1991.I am a past-president and have held various executive positionswith the Manitoba chapter over the years, including secretaryand conference chair. I have attended a number of Dynamicsconferences and was privileged to be part of the planningcommittee when Dynamics was held in Winnipeg in 1996.I look forward to continuing to represent the western region asvice-president and hope to continue to learn and grow alongwith our association in the future.Grace MacConnellEastern RegionAs I enter my second term of office onthe CACCN board of directors, I amhappy and proud to be representing theeastern region. I have enjoyed meetingso many critical care nurses fromacross the country during my first termof office. I look forward to meetingmany more in the next two years! Mycritical care experience is in the clinicalareas of neonatal and pediatric practice. As a pediatric criticalcare nurse, I am able to identify some of the unique challengeswe face in our everyday work with children and families.I feel privileged to be a member of the CACCN board ofdirectors. It is wonderful to be working with such anenthusiastic and dedicated group of nurses. I continue to serveas the director responsible for awards and sponsors. I lookforward to seeing many of you in Ottawa at Dynamics 2005!Joy MintenkoWestern RegionI have enjoyed my first year as ourwestern representative to the board ofdirectors. I bring more than 20 years ofcritical care experience to the board.Originally from Winnipeg, MB, wheremy focus was adult SICU, I now reside

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Message fromthe Board of Directors

in Regina, SK. I am currently working at the bedside in SICUand medical pediatric ICU and will be overseeing therecruitment and retention portfolio. I have been involved withCACCN for many years. I held the membership portfolio ofthe Manitoba chapter of CACCN and was involved with theplanning of the national Dynamics conference when it washeld in Winnipeg in 1996. I have continued my involvement asa member of the Saskatchewan chapter since my move toRegina. I have two fabulous teenagers, Christine and Rob, andhave been married to Dave (the man who brought me toSaskatchewan) for 26 years this September. I look forward tothis next year on the board and am committed to increasing ourmembership base.Sue WilliamsCentral RegionI am proud to be representing thecentral region for a second term. I wishto thank all those who haveencouraged and supported me duringmy first term.I graduated from Fanshawe Collegein London, Ontario, in 1976 andgraduated from the BScN program atthe University of Western Ontario in 1994. In 1995, I wrotethe CNA critical care certification exam and haverecertified in 2000 and 2005. I started my career ingeriatrics, moved to general surgery and, in 1982, started incritical care.During my time in critical care nursing, I have worked as astaff nurse, charge nurse, educator and am currently in the roleof clinical resource/charge nurse. I have also taught atFanshawe College.I have been involved in CACCN since 1994, and have been amember of the London regional chapter executive since 1995in a variety of roles including newsletter coordinator, treasurerand president. I have frequently attended Dynamicsconferences and Chapter Connections Days. I am thechairperson for Dynamics 2005 to be held in Ottawa inOctober.During my second term, I would like to see CACCN build onthe foundations that have been formed over the years. It is my

hope that we can increase our membership to make CACCN astrong and vibrant voice for critical care nursing acrossCanada.Glenda RoyEastern RegionIn 1974, I graduated from nursingwith my RN and worked for fiveyears in ICU/CCU with a shortduration in obstetrics. I took a leaveof absence from active nursingwhen my children arrived andcompleted the re-entry program in1996. After that, I was employed ina casual position in ICU/CCU,eventually leading to my currentposition as a full-time staff nurse in ruralNL.The bug for further education had bitten hard. I enrolledand completed levels one and two of the critical carenursing program from Mount Royal College andsuccessfully wrote the certification exams in critical careand cardiovascular nursing. In the spring of 2003, Igraduated from Athabasca University with my BN and Iam currently enrolled in the Masters of Nursing programthere.I am honoured to have been elected to your board in2004 and to serve you in the capacity of treasurer,which I find to be a fulfilling and challenging role.CACCN provides a strong voice for critical care nursesacross our vast country as we endeavour to provide thebest care to our patients and families. As critical carenurses, we need to be current with what we do, andnetworking with each other is one avenue available tous.As your board member from eastern Canada, I will continue towork hard to promote critical care nursing and CACCN aswell as continuing to be an advocate for our patients andfamilies. I look forward to working and learning with yourdedicated team in the next year in facing the many hurdles weencounter.Get INVOLVED; let your association work with and for you.

CACCN 16 • 2 • Summer 2005 7

What is the “TWIN AND WIN” contest and howdoes it work?

CACCN response:“Twin and Win” is not really a contest as much as it is arecruitment campaign. CACCN is making a consciouseffort to increase our membership base. We are committedto making CACCN viable through membership fees andnot dependent on the annual Dynamics conference makinga profit. BUT we don’t want to have to increasemembership fees.“Twin and Win” asked our existing members to recruit justONE new member into CACCN. Any member who signs

up a new member will receive a $10.00 coupon towardsyour membership renewal in 2006. You can actually collectup to $60.00 in coupons by signing up six new members.The coupons must be presented with your 2006membership renewal form and cannot be redeemed forcash. Make sure that your name appears in the “sponsor’sname” box on the new member’s application so that avoucher can be mailed to you. This campaign ran fromJanuary to April 30, 2005.Imagine the possibilities if we can double the strength ofour numbers and the strength of our voice.Watch for “TWINANDWIN 11” coming next January!Joy MintenkoBOD, Western Region Rep

Question to the Board

8 16 • 2 • Summer 2005 CACCN

D Y N A M I C SThe Official Journal of the Canadian Association of Critical Care Nurses

Information for Authors

Dynamics, the Official Journal of the Canadian Association of Critical Care Nurses (CACCN), is distributed tomembers of the CACCN, to individuals, and to institutions interested in critical care nursing. The editorial boardinvites submissions on any of the following: clinical, education, management, research and professional issues incritical care nursing. Critical care encompasses a diverse field of clinical situations which are characterized by thenursing care of patients and their families with complex, acute and life-threatening biopsychosocial risk. While thepatient’s problems are primarily physiologic in nature, the psychosocial impact of the health problem on the patientand family is of equal and sometimes lasting intensity. Articles on any aspect of critical care nursing are welcome.The manuscripts are reviewed through a blind peer review process. Manuscripts submitted for publication must followthe following format:1. Title page with the following information:• Author(s) name and credentials • Place of employment • If there is more than one author, the names should be listedin the order that they should appear in the published article • Indicate the primary person to contact and address forcorrespondence.2. A brief abstract of the article on a separate page not to exceed 100 words.3. Body of manuscript:• Length: a maximum of 15 pages including tables, figures and illustrations, and references • Format: double spaced,1 1/2 inch margins on all sides. Pages should be numbered sequentially including tables, figures and illustrations.Prepare the manuscript in the style as outlined in the American Psychological Association’s (APA) Publication Manual5th Edition. • Tables, figures, illustrations and photographs must be submitted each on a separate page after thereferences. • References: the author is responsible for ensuring that the work of other individuals is acknowledgedaccordingly. Direct or indirect quotes must be acknowledged according to APA guidelines • Permission to usecopyrighted material must be obtained by the author and included as a letter from the original publisher when used inthe manuscript.4. Copyright:• Manuscripts submitted and published in Dynamics become the property of the CACCN. Authors submitting to thejournal are asked to enclose a letter stating that the article has not been previously published and is not underconsideration by another journal.5. Submission:• The original and three copies should be forwarded to: CACCN National Office, P.O. Box 25322, London, Ontario,N6C 6B1 or to the editorial office as printed in the journal. Disks are not requested with the original submission. If themanuscript is accepted for publication, the author(s) will be requested to submit the manuscript on disk. Acceptedmanuscripts are subject to copy editing.

Saskatchewan Chapter

The CACCN Saskatchewan Chapter has had a busy spring.The chapter hosted a two-day conference at the beginning ofMarch. The conference was a huge success drawing more than150 total participants. Our annual April fashion show wasgiven rave reviews by all in attendance. Some of the profitsfrom the show were donated to the Hospitals of ReginaFoundation. As always, we are currently looking at ways torecruit/retain members. Elections for the executive were heldwith all positions except communication being filled. The buzzfor the Dynamics conference is starting already with manymembers looking forward to going. Hope to see you inOttawa.Darren Entner, President

CACCN 16 • 2 • Summer 2005 9

It’s finally here!

CACCN’s new websiteThe updates include:A new up-to-date lookAn easy-to-use menuCurrent information regarding:• Membership information• CACCN Position Statements• CACCN’s Constitution and by-laws• Your local chapter information• Online membership application• National conference information• Online registration for the conference• Contact information• Awards

Check it out atwww.caccn.caand let us knowwhat you think!

Chapter Highlights

Correction:In the last issue of Dynamics, Michelle Cleland wasaccidentally referred to as Michael Cleland. We apologizefor the error.

Abdominal TBWithout Borders:A Case Study

Marie Aue, Markham, ONTuberculosis (TB), once labelled the white plague, killsmore people in the world than any other infectiousdisease. It can affect any age and any socio-economicclass. With the advent of TB drugs in the 1940s, andbetter living standards, the incidence of tuberculosisdecreased.The 1980s saw a re-emergence of TB. Limited healthresources, low socio-economic standards, over-crowding, immigration of people from Third Worldcountries, and Immunodeficiency Virus (HIV) and AIDShave contributed to this increase in TB. Despite manychanges in health care, TB is a re-emerging globalemergency.The disease can affect any body system. In the abdomen, it canmimic any condition or infectious process. It is thereforenecessary to diagnose early and initiate early aggressivetreatment.The focus of this presentation is abdominal tuberculosis.Abdominal tuberculosis (TB) may vary in presentationdepending on the organs involved. With the assistance oftechnology, a case study will illustrate the complexities ofcare for an intubated and ventilated patient presenting

with abdominal TB. Challenges include dealing withrespiratory distress, psychosocial issues andcomplications. Pathophysiology, challenges andinterventions as managed by the ICU team will bediscussed in this presentation. This presentation willhighlight the team approach as it capitalizes on technologywhile utilizing the human touch.ReferencesDye, C., Scheele, S., Dolin, P., Pathania, V., &Raviglione, M.C., (1999). Consensus statement.Global burden of tuberculosis, estimated incidence,prevalence and mortality by country. WHO globalsurveillance and monitoring project. JAMA, 282,677-686.Heinrich, S., Hetzer, F.H., Bauerfeind, P., Jochum, W.,Demartines, N., & Clavien, P.A. (2004). Retroperitonealperforation of the colon caused by colonic tuberculosis:Report of a case. Diseases of the Colon and Rectum,47(12), 2211-4.Jadvar, H., Mindelzun, R., Olcott, E., & Levitt, D. (1997). Still thegreat mimicker: Abdominal tuberculosis. AmericanJournal Roentgenol, 168, 1455-60.Mclauglin, S., Jones, T., Pitcher, M., & Evans, P. (1998).Laparosopic diagnosis of abdominal tuberculosis.Australian & New Zealand Journal of Surgery, 68(8),599-601.Rai, S., & Thomas, W. (2003). Diagnosis of abdominaltuberculosis: The importance of laparoscopy.Journal of the Royal Society of Medicine, 96(12),586-588.10 16 • 2 • Summer 2005 CACCN

CRITICAL CARE NURSING ABSTRACTSFour of the strategic goals of CACCN are: 1) to provide educational opportunities for critical care nurses; 2) to optimizequality of critical care nursing practice; 3) to provide varied opportunities to profile critical care nursing research; and 4)to provide opportunities for nursing colleagues to network.CACCN’s national conference, Dynamics of Critical Care, provides an excellent venue for accomplishing all of thesegoals, however, only a portion of CACCN members are able to attend a Dynamics conference annually. Cognizant of this,CACCN is pleased to be printing its sixth annual “Special Dynamics of Critical Care Issue” which includes the abstractsfrom Dynamics of Critical Care 2005.The following abstracts represent the concurrent session and poster abstracts being presented during Dynamics of CriticalCare 2005 being held in Ottawa, Ontario, October 2-4, 2005.It is our hope that CACCN members interested in pursuing a profiled topic will contact our national office at(519) 649-5284 or e-mail caccn@caccn.ca to receive information regarding how to contact the author about the work.We hope you will carefully consider the critical care nursing topics currently being investigated and discussed in variouscentres across Canada!

Rathi, P., Amarapurakar, D., Parikh, S., Joshi, J., Koppikar, G.,Amarapurakar, A., & Kalro, R., (1997). Impact of humanimmunodeficiency virus infection on abdominaltuberculosis in Western India. Journal of ClinicalGastroenterology, 24(1), 43-48.Sharma, N., & Sharma, S., (2004). Tuberculous abscess of theabdominal wall and multiple spleen abscesses in animmunocompetent patient. Indian Journal of ChestDiseases & Allied Sciences, 46(3).Guillain-Barre Syndrome (GBS)Can Affect Anyone

Marie Aue, Markham, ONGuillain-Barre Syndrome (GBS) is “a demyelinatingneurological disorder in which the myelin sheath around theaxon of a nerve tissue is destroyed” (Morgan, 1991). Theoutcome is acute and crippling, often involving ascendinggeneralized limb weakness, loss of reflexes and abnormalsensation.GBS is rare, but sporadic. However, the syndromeafflicts “1.6 to 1.9 per 100,000 people “at any time ofyear, regardless of age, sex or nationality (Urden etal., 2002, p.690). Some literature mentions that GBSis autoimmune related. Most incidences relate to, “Amild upper respiratory infection that precedes theonset of the syndrome by a few days to weeks”(Morgan, 1991). Usually, GBS occurs days or weeksafter the patient has symptoms of a respiratory orgastrointestinal viral infection. Pregnancy, surgery orvaccination can trigger the syndrome. The changesvary in severity from mild to a very debilitatingillness with paralysis requiring care in the ICU. Theoutcome is dependent on timely and aggressivetreatment.A case study will illustrate the complexities of care foran intubated and ventilated patient presenting withGBS. Challenges include dealing with the respiratorydistress, the communication issues, the psychosocialissues and the long -term care issues. Pathophysiology,challenges and interventions as managed by the ICUteam will be discussed in this presentation. Thispresentation will highlight the team approach as itcapitalizes on technology while utilizing the humantouch.ReferencesMerck & Co. Inc. (n.d). Adult respiratory distress syndrome. TheMerck Manual, Section 6, Chapter 67 [Electronicversion]. Retrieved from http://www.merck.com/pubs/manualMorgan, S.P. (1991). A passage through paralysis. AmericanJournal of Nursing, 91( 10), 70-74.Ropper, A.H. (1992). The Guillain-Barre syndrome. TheNew England Journal of Medicine, 326(17), 1130-1135.Urden, L., Stacey, K., & Lough, M. (2002). Critical CareNursing, Diagnosis & Management. St. Louis, MO:Mosby.Van Der Meche, F.G.A., & Schmitz, P.I.M. (1992). Arandomized trial comparing intravenousimmunoglobulin and plasma exchange in Guillain-Barresyndrome. New England Journal of Medicine,326(17), 1123-1129.CACCN 16 • 2 • Summer 2005 11

Dead? Or Just Cold?Hypothermia: A Success Story

Joanne Baird, Margaret Power, Grand Falls, Windsor, NLMs. C., a 65-year-old woman, was found lying unconsciousin a snowbank. She reportedly had been there for four hours.On arrival at ER, she was cold, red all over, and her left footwas dusky blue. Temperature initially was 28.3°C rectally,and 23.1° esophageal one hour later. BP was 91/56, EKGwas unreadable due to shivering, cardiac monitor wastracing sinus bradycardia at 40 beats per minute, she had aweak femoral pulse and PO2 was 99% on non-rebreathermask. Applying warming blankets began active externalwarming; internal warming was initiated with warmed IVfluids. One hour after arriving in ER, the cardiac monitortraced junctional rhythm with very distinctive Osbournewaves, but, within two minutes, Ms. C. was in full cardiacarrest.Severe accidental hypothermia is an unintentional declinein core body temperature below 28°C. Victims can appearto be clinically dead, but full resuscitation with intactneurological recovery is possible, although unusual. TheCentral Newfoundland Regional Health Centre has 139beds and is located approximately five hours from theclosest tertiary health care facility. The patient wasdependent on our team, our knowledge, skills, speed ofintervention, and limited technological resources. CPR andactive re-warming of the patient continued for two hoursbefore resuscitation was successful. Ms. C.’s normal bodytemperature was not reached until 10 hours later in theICU.While the medical and nursing staff had previousexperience with hypothermic patients, this was the firstcase of severe hypothermia to survive at this centre. Thereare many treatments for re-warming, from external use ofwarming blankets to heated fluids and oxygenadministered internally. In this presentation, using Ms C.’ssuccessful story, we will discuss accidental hypothermia,resuscitation, intervention options, treatment andoutcomes. In addition, the role of the nurse in thecontinuum of care of the patient, from resuscitation team toICU aftercare, will be discussed. Further, the positiveimpact of this experience on the health care team in itsbroadest context will be discussed.ReferencesBangs, C. (2004). Hypothermia prevention, recognition andtreatment. Retrieved January 15, 2005, fromhttp://www.hypothermia.orgDanzl, D., & Pozos, R. (1994). Accidental hypothermia. The NewEngland Journal of Medicine, 331 (26), 1756-1760.Phillips, T. (2001). Hypothermia. Retrieved January 15, 2005,from http://www.emedicine.com/med/topic1144.htm

Whalen, P. (2001). Accidental hypothermia. Retrieved January 13,2005, from http://www.mgh.org/directry/docpage/notes/pcc01-26-2001.htmDevelopment of anICU-Specific Bedside Tool forY-Site Compatibility Information

Lisa Burry, Rick Quinlan, Alyhia Sarjoo-Devries,Jenny Chiu, Patricia Hynes, Stephen Lapinsky, Toni Bailie,Toronto, ONBackground: Critically ill patients frequently requirecontinuous infusions of intravenous (IV) medications.Nurses routinely have to adjust lines or sites toaccommodate drug compatibility issues. When medicationsare known to be compatible, Y-site devices are employed toallow multiple medications to be administered via the sameIV port.Objective: To create an ICU Y-site compatibility tool thatwould provide medication guidelines and facilitate point-of-care decision-making (i.e., at the bedside).Methods: A literature search (Medline, Embase, IPA) wasconducted to locate existing compatibility tools that couldbe easily employed at the bedside. A ‘useful’ tool wasdefined as portable, pocket-sized, up-to-date (i.e., newmedications, APC), and containing information about Y-sitecombinations, including the hours of compatibility and inwhich solutions.Results: No identified tool was found to be complete andup-to-date for the needs of our ICU. Therefore, our teamcreated a tool that would meet the needs of our staff. A listof commonly administered IV medications was generated. Aliterature search was then conducted to identifycompatibility information for two or more drugcombinations. Available data were tabulated into a pocket-sized document that was colour-coded for ease of use.Thrree acute care pharmacists, two ICU nurses and an ICUphysician determined the accuracy of the tabulatedcompatibility information. The card was subsequentlyapproved by the pharmacy and therapeutics committee forpublication and distribution to nursing and pharmacy staffand also via the hospital intranet.Conclusion: Based on the best available evidence, it ispossible to create a unit-specific Y-site compatibility tool thatis useful at the bedside. This tool was intended to support theICU team in providing optimal care by decreasing time awayfrom the bedside searching for compatibility information.ReferencesMacLaren, R., et al. (1999). CJHP, 52:, 393-7.Electrolyte Algorithm Study in CriticalCare (Project EAS-C)Lisa Burry, Virginia Carvalhana, Afsaneh Vazin,Eva Klien, Salima Saliq, Ioanna Tzianetas, Patricia Hynes,Robert Richardson, Stephen Lapinsky, Toronto, ONBackground: Electrolyte deficiencies are common in ICUpatients, especially those with severe sepsis and acutepancreatitis. The lack of controlled data in this setting tosupport electrolyte replacement, especially for patients

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with renal failure, makes prescribing replenishmentdifficult. There are several possible problems: lack ofconsistency, partial repletion, repeat doses per day, over-correction in patients with renal dysfunction, inappropriatelaboratory measurements and excessive administration ofIV fluid.Objectives: To develop an ICU-specific IV electrolytereplacement prescribing tool that accounted for the degree ofelectrolyte deficiency and degree of renal function, providedrecommendations for repeat laboratory work and providedstaff with safe administration guidelines.Methods:A literature search (Medline, Embase, IPA) for themanagement of four major electrolytes deficiencies (K+,Mg+, PO43-, Ca2+) was conducted. Two investigatorsreviewed the algorithm for accuracy and precision and actedas mediators when discrepancies were present in theliterature. Completed guidelines were subsequentlyapproved by the pharmacy and therapeutics committee fordistribution within the ICU. An ICU pharmacist and ICUnurse provided teaching sessions for all staff. A prospectiveevaluation of the algorithm’s efficacy and safety wasconducted. A retrospective cohort of patients with traditionalprescribing was used as the comparison.Results: No validated published algorithm has been shown toadequately meet the ICU patient population needs. Based onthe evidence, it is possible to propose electrolyte dosingguidelines that account for both degree of renal insufficiencyand severity of electrolyte deficiency for critically ill patients.Two-hundred and fifty-six patients were included in theproject to determine the implementation and validity (i.e.,efficacy, safety) of the prescribing tool.Conclusions: This tool was intended to support the ICU teamin the provision of electrolyte therapy to optimize prescribingand administration. Based on the best available evidence, it ispossible to create an algorithm that improves electrolyteprescribing and administration even in the setting ofsignificant renal dysfunction and dialysis.ReferencesKing, J.C. Guide to Parenteral Admixtures. Elizabeth A.Hudnell: 1993-2004.Trissel, L.A. (2004). Handbook on injectable drugs, (12th ed.).Bethesda, MD: American Society of Health-SystemPharmacists, Inc.Embracing Technology?:SWOT Approach to Implementinga Nurse-Driven CLRT Protocoland Nursing Attitudes Towardsthis Technology

Pamela A. Cybulski, Deanna MacNeil, Johanna Zantinge,Brampton, ONSetting: An eight-bed medical/surgical ICU Canadian tertiarycare hospital.Background: The frequency and cost associated with therental of kinetic therapy beds that provide continuous lateralrotation therapy (CLRT) prompted our ICU to purchase Hill-Rom SpORT therapy beds for the entire unit.

Current literature demonstrated that the low air loss therapymattress system provided pressure relief preventing thedevelopment of decubitus ulcers, and the CLRT optionimproved ventilation/perfusion relationships. As with allcritically ill patients, our Braden Scale scores andprevalence study indicated that the use of specialty bedswas frequently required to prevent the development ofpressure-related skin breakdown. Ahrens’s studydemonstrated that kinetic therapy decreased the occurrenceof ventilator-associated pneumonia (P=.002) and risk oflobar atelectasis (P=.02) (Ahrens, 2004). Nurses hadpreviously utilized a CLRT protocol when the beds wererented, to care for patients with severe pulmonarydysfunction.Our objective was to encourage nurses to optimally utilizethe technology that we now owned to prevent thecomplications of immobility. The development of a nurse-driven CLRT protocol was intended to be a preventativeapproach to the development of pulmonary complications.However, despite awareness of the benefits to both patientsand nursing staff, as well as the provision of ongoingeducation, it was found that CLRT was not being effectivelyutilized. In order for CLRT to be effective, patients must berotated at approximately 40 degrees for a minimum of 18hours/day. Routine checking of bed statistics revealed thatthis outcome was not being achieved. This poster willpresent a SWOT approach to implementing a nurse-drivenCLRT protocol and nursing attitudes towards thistechnology.ReferencesAhrens, T., Kollef, M., Stewart, J., & Shannon, W. (2004). Effectof kinetic therapy on pulmonary complications. AmericanJournal of Critical Care, 13, 376-383.Bein, T., Reber, A., Metz, C., Jauch, K.W., & Hedenstierna, G.(1978). Acute effects of continuous rotational therapy onventilation-perfusion inequality in lung injury. Intens CareMed, 24(2), 132-7.Dolovich, Myrna., Rushbrook, Jamie., Churchill, Elizabeth.,Mazza, Michael., & Powles, A.C. Peter. (1998, September).Effect of continuous lateral rotational therapy on lungmucus transport in mechanically ventilated patients.Journal of Critical Care, 13, 119-26.Fragala, G., & Santamaria, D. (1997). Heavy duties? On the jobback injuries are a bigger – and costlier – pain than youthink. Health Facil Manage, 10(5), 22-27.Kirschenbaum, L., Azz, E., Sfeir, T., Teitjen, P., & Astiz, M.(2002). Effect of continuous lateral rotational therapy onthe prevalence of ventilator-associated pneumonia inpatients requiring long-term ventilatory care. Crit CareMed, 30(9), 1983-1986.Krishnagopalan, S., Johnson, E.W., Low, L.L., & Kaufman, L.J.(2002). Body positioning of intensive care patients:Clinical practice versus standards. Crit Care Med, 30(11),2588-2592.Martin, A.H. (2001). Should continuous lateral rotation therapyreplace manual turning? Nursing Management, 32(8), 41-46.Mullins, C., Philbeck, T.E. Jr., Schroeder, W.J., & Thomas, S.K.(2002). Cost effectiveness of kinetic therapy in preventingnosocomial lower respiratory tract infections in patientssuffering from trauma. Managed Care Interface, 15(8),35-40.

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Powers, J., & Daniels, D. (2004). Implementing kinetic therapyin the ICU. Supplement to Nursing Management, 35, 1-8.Raoof, S., Chowdhrey, N., Raoof, S., Feuerman, M., King, A.,Sriraman, R., et al. (1999). Effect of combined kinetictherapy and percussion therapy on the resolution ofatelectasis in critically ill patients. Chest, 115(6), 1658-1666.Russell, T., & Logsdon, A. (2003). Pressure ulcers and lateralrotation beds: A case study. Wound Care, 30(3), 143-145.Takiguchi, S., Myers, S., Yu, M., Levy, M., & McNamara, J.J.(1995). Clinical and financial outcomes of lateral rotationlow air-loss therapy in patients in the intensive care unit.Heart and Lung, 24(4), 315-320.Wang, J.Y., Chuang, P.Y., Lin, C.J., Yu, C.J., & Yang, P.C. (2003).Continuous lateral rotational therapy in the medicalintensive care unit. Formos Med Assoc, 102, 788-92.PICU and Pediatric Palliative Care:A Partnership to Support Families

Barb Ellsmere, Denise MacIntyre, Cathy Whitelaw,Grace MacConnell, Dartmouth, NS

The loss of a child is one of the worst experiences for a familyto endure. Unfortunately, a number of children die in pediatricintensive care units (McCallum, Byrne, & Bruera, 2000).Bereavement follow-up can help to reduce immediate physicaland emotional distress while diminishing moderate long-termmorbidity associated with unresolved grief (Fauri, Ettmer, &Kovacs, 2000). Families have identified that a caringemotional attitude displayed by pediatric intensive care unit(PICU) staff has been of benefit in their bereavement, and thatsubsequent contact with their children’s caregivers after deathis helpful (Macnab et al., 2003; Meert, Thurston, & Thomas,2001).A bereavement follow-up program has been in place for anumber of years in our facility. However, in the past two years,a developing relationship between the PICU family-centredcare committee and the pediatric palliative care service(PPCS) allowed both groups to benefit from the sharing oftheir expertise. This sharing of knowledge has helped toprovide much needed support to bereaved families. As newtheories about parental grief are continuously being developed(Davies, 2004), it is beneficial to have the experience andknowledge of both critical care and palliative care nurses.The presenters will briefly discuss the PICU bereavementfollow-up, the pediatric palliative care service, and thecontributions of both groups as they continue their work insupporting bereaved families. This presentation will look athow nurses from the two disciplines have been able to build abridge enabling them to work together effectively insupporting grieving families.

ReferencesDavies, R. (2004). New understandings of parental grief:Literature review. Journal of Advanced Nursing, 46(5),506-13.Fauri, D.P., Ettmer, B., & Kovacs, P.J. (2000). Bereavementservices in acute care settings. Death Studies, 24, 51-64Macnab, A.J., Northway, T., Ryall, K., Scott, D., & Straw, G.(2003). Death and bereavement in a paediatric intensivecare unit: Parental perceptions of staff support. PaediatricChild Health, 8(6), 357-362.McCallum, D.E., Byrne, P., & Bruera, E. (2000). How childrendie in hospital. Journal of Pain and SymptomManagement, 20(6), 417-423.Meert, K.L., Thurston, C.S., & Thomas, R., (2001). Parentalcoping and bereavement outcome after the death of a childin the pediatric intensive care unit. Pediatric Critical CareMedicine, 2(4), 324-8.Timing is Everything -The Need for Speed with SepsisHolly Feist, Jennifer Giesbrecht, Calgary, ABSepsis is unquestionably the most challenging problemencountered in the ICU as the early stages remain largelyunder-recognized (Ahrens & Vollman, 2003). Despiteadvances in supportive therapy, patient outcomes havechanged little and sepsis remains a major cause ofmorbidity and mortality worldwide (Roman-Marchent,2004). Early recognition and goal-directed therapy in thetreatment of sepsis hasve been shown to greatly decreasemortality, as well as ICU and hospital length of stay (Levy,et al., 2004; Rivers, et al., 2004,; Roman-Marchent, 2004).The critical care nurse’s role is vital and can greatlyimprove outcomes for the septic patient (Kleinpell, 2003;Ely, et al., 2003).This presentation will focus on the benefits of early goal-directed, evidence-based therapy in the treatment of sepsis.The definitions of severe sepsis and septic shock, as well as anexploration of the most recent treatment modalities will bepresented. Referencing the initiatives of the sepsis groupwithin the Canadian ICU Collaborative; and findings fromthree ICUs in the Calgary Health Region, the process ofimplementing a sepsis treatment checklist will be introduced.Changes tested using PDSA methodology, key learnings fromthe implementation phase and outcomes will be discussed.Emphasis will be placed on the vital role of the critical carenurse in the prevention of sepsis and the importance of earlyrecognition of organ dysfunction.ReferencesAhrens, T., & Vollman, K. (2003). Severe sepsis management. Arewe doing enough? Critical Care Nurse, 23(5, Suppl. 11),2-15.Balk, R.A. (1998). Outcome of septic shock: Location, location,location. Critical Care Medicine, 26, 1020-1024.Beale, R.J., Hollengberg, S.M., Vincent, J.L., & Parrillo, J.E.(2004). Vasopressor and inotropic support in septic shock:An evidence-based review. Critical Care Medicine,32(11, Suppl.), S455-465.Bochud, P.Y., Bonten, M., Marchetti, O., & Calandra, T. (2004).Antimicrobial therapy for patients with severe sepsis andseptic shock: An evidence-based review. Critical CareMedicine, 32(11, Suppl.), S495-512.

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Cohen, J., Brun-Buisson, C., Torres, A., & Jorgensen, J. (2004).Diagnosis of infection in sepsis: An evidence-based review.Critical Care Medicine, 32(11, Suppl.), S466-494.Making Evidence-Based Practicein Critical Care Easier: How WeJoined the Canadian Collaborativeand Started Sharing Generouslyand Stealing Shamelessly toImprove Quality and Safetyof Patient Care in ICU

Jo Forbell, Etobicoke, ONThe science of critical care is still in its infancy, and the rate ofchange of technology seems to increase daily. How can criticalcare nurses adapt to always-evolving standards of best practiceand remain caring practitioners able to support patients andtheir families, as well as each other? Working in critical careoften means working in unison with many team members but,often, individual critical care units are isolated from eachother.This presentation will describe our experience as a newmember of the Canadian Collaborative for theImprovement in Patient Care and Safety in the ICU.Trillium is a 26-bed medical-surgical ICU which alsoserves as the regional neurosurgical centre in a large andthriving community hospital in Mississauga. Thecollaborative is a project supported by the ImprovementAssociates and the Institute for Healthcare Improvement.Its purpose is to accelerate the rate of improvement inhealth care in Canadian intensive care units, but we havediscovered many other benefits.Since joining the collaborative, we have discovered gains inthree areas.1. The ICU is better connected to other areas of the hospital.We have joined with staff in other departments of thehospital whose expertise was previously unknown to us.2. We are better connected to other critical care practitioners(nurses and physicians) across the country and feelsupported by the collaborative.3. Our ability to measure our achievements in the spectrum ofnational realities has given us a sense of validation andmotivation. It has also enhanced the profile of our ICUwhich is a popular destination for many critical care nurses.ReferencesCouves, L., Harries, B., & Moen, R. (2003). Overview of abreakthrough series collaborative. Retrieved January 22,2005, from http//www.improvementassociates.comDodek, P., Keenan, S., Cook, D., Heyland, D., Jacka, M., Hand,L., et al. (2004). Evidence-based clinical practiceguidelines for the prevention of ventilator associatedpneumonia. Annals of Internal Medicine, 141(4), 305-313.Fowler, R.A., & Berenson, M. (2003). Blood conservationstrategies. Crit Care Medicine, 31(12), S715-S720.Harries, B., & Couves, L. (nd). Improving patient care andsafety in the ICU: Improvement guide. RetrievedJanuary 22, 2005, fromhttp//www.improvementassociates.com

Hebert, P.C., & Fergusson, D.A. (2004). Do transfusions get to theheart of the matter. Journal of the American MedicalAssociation, 292(13), 1610-1611.Workplace Empowermentin Critical Care Settings

Frances Fothergill Bourbonnais,Sue Malone-Tucker, Ottawa, ONHaving an adequate supply of critical care nurses to carefor patients means that new nurses must be recruited to thespecialty and that those nurses already working in ICUmust be retained. Creating a positive work environment forcritical care nurses is key as the environment shapesbehaviours and attitudes. Kanter (1993) maintains thatwork environments that provide access to information,resources, support and the opportunity to learn and developare empowering and that they enable employees toaccomplish their work as well as engage in positiveorganizational activities. Given the nature of the criticalcare environment, it is often assumed that critical carenurses are among one of the most empowered groups innursing. To explore this assumption, the investigatorsconducted a survey on intensive care and emergencynurses at The Ottawa Hospital using the tools based onKanter’s (1997, 1993) theory of empowerment, developedand validated in a series of studies by Spence Laschinger(e.g., Spence Laschinger, Finegan, Shamian, & Casier,2000).Design: A survey was used which incorporated the followingtools: 1) Conditions of work effectiveness questionnaire(CWEQ) staff and manager – this tool measures nurses’perceptions of their access to the four work empowermentstructures described by Kanter (opportunity, information,support, resources); 2) organizational description opinionnaire(ODO) – measures staff perceptions of their immediatemanagers’ power in the organization and their perceptions ofthe existence of structural power characteristics in theworkplace; 3) job activities scale (JAS) -– focuses on jobflexibility, relevance and recognition; and. 4) organizationalrelationship scale (ORS) -– focuses on professionalrelationships.Sample: These questionnaires were administered twice tothe nursing staff: Time 1one was fall 2002 and time 2twowas summer 2003 which coincided with the before andafter implementation of the Model of Care at the OttawaHospital.Results: Demographic data will be presented as well asdescriptive statistics.ReferencesKanter, R.M. (1977, 1993).Men and women of the corporation.New York: Basic Books.Spence Laschinger, H., Finegan, J., Shamian, J., &Casier, S. (2000). Organizational trust andempowerment in restructured health care settings.Journal of Nursing Administration, 30 (9), 413-425.

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Critical Situation:Communication!

Jennifer Giesbrecht, Calgary, ABA report of 2,000 critical incidents shows that 70% to80% of medical errors are of interpersonal nature(Kaissi, Johnson, & Kirschbaum, 2003). However,communication failure is not simply the result of poortransmission or the exchange of information (Sutcliffe,Lewton, & Rosenthal, 2004). Differences in educationand training between disciplines, and inherentlimitations of human performance are factors thatincrease the risk of adverse events (Leonard, Graham, &Bonacum, 2004).It is suggested that small improvements in communicationmay substantially benefit information processes (Coiera,Jayasuriya, Hardy, Bannan, & Thorpe, 2002), and that toolsand concepts provided by cognitive psychology and humanfactors study are useful for application in health care(Donchin, et al., 2003). This poster presentation introduces astandardized situation, background, assessment,recommendation (SBAR) tool adapted to addresscommunication needs of the demanding, dynamic, andcomplex environment of the ICU when reporting criticalsituations to physicians, as well as focusing on human factorsstudy in health care.ReferencesBaker, G.R., Norton, P.G., Flintoft, V., Blais, R., Brown, A., Cox,J., et al. (2004). The Canadian Adverse Events Study: Theincidence of adverse events among hospital patients inCanada. Canadian Medical Association Journal,170(11), 1678-1686.Coiera, E.W., Jayasuriya, R.A., Hardy, J., Bannan, A., & Thorpe,M. (2002). Communication loads on clinical staff in theemergency department. Medical Journal of Australia,176, 415-418.Coiera, E.W., & Tombs, V. (1998). Communication behaviors in ahospital setting: An observational study. BMJ, 316, 673-676.Donchin, Y., Gopher, D., Olin, M., Badihi, Y., Biesky, M., Sprung,C.L., et al. (2003). A look into the nature and causes ofhuman errors in the intensive care unit.Quality and Safetyin Health Care, 12, 143-148.Kaissi, A., Johnson, T., & Kirschbaum, M.S. (2003). Measuringteamwork and patient safety attitudes of high risk areas.Nursing Economics, 21(5), 211-218.Leonard, M., Graham, S., & Bonacum, D. (2004). Thehuman factor: The critical importance of effectiveteamwork and communication in providing safe care.Quality and Safety in Health Care, 13(Suppl. 1),i85-i90.Reason, J. (2000). Human error: Models and management.British Medical Journal, 320, 768-770.

Sexton, J.B., Thomas, E.J., & Helmreich, R.L. (2000). Error,stress, and teamwork in medicine and aviation: Crosssectional surveys. British Medical Journal, 320, 745-749.Sutcliffe, K., Lewton, E., & Rosenthal, M.M. (2004).Communication failures: An insidious contributor tomedical mishaps. Academic Medicine, 79(2), 186-194.Anatomy of a Presentation

Ev Glasser, Mike Metzger, Calgary, ABPresenting at a professional conference, such asDynamics, can be an intimidating and nerve-rackingexperience. Experienced presenters make it look so easy,standing in front of an educated audience, speaking aboutcomplex topics with few, if any, signs of nervousness. Buteach presenter also had a first time, probablyaccompanied by damp palms and a shakey voice,preceded by many sleepless nights.All nurses have the opportunity to enhance theprofession by sharing their experiences and theknowledge they have gained. Speakers at Dynamics2004 encouraged critical care nurses to “tell theirstories”. The goal of this session will be to introduce theaudience to developing and presenting a professionalpresentation targeted towards colleagues, or in aconference setting. A step-by-step approach will beused, addressing topic selection, research, developmentand successful delivery. Some of the wealth ofinformation readily available about presentationdevelopment and public speaking will be introduced. Wewill share our experiences and the experiences of otherswho have made the leap from audience to presenter,including some of the personal benefits gained.A presentation similar to this was shared with colleagues at ourworkplace prior to Dynamics 2004, and several individualswere convinced to submit abstracts and subsequently present.It is our hope that we can encourage and empower reluctant,but intelligent, nurses to present at future conferences,including Dynamics.ReferencesCalechman, S. (2003). Speak easy.Men’s Health, 18(3).Cleary, M., Hunt, G., Walter, G., & Horsfall, J. (2003).Guidelines for presentations and publications.International Journal of Mental Health Nursing, 12(2),158-9.Jones, J. (2003). Well presented: Giving a presentation can bedaunting. Nursing Standard, 17(29), 96.Kushner, M. (1996). Successful Presentations for Dummies.Chicago: IDG Books.Rozakis, L.E. (1995). The Complete Idiot’s Guide toSpeaking in Public with confidence. New York: AlphaBooks.Starver, K., & Shellenbarger, T. (2004). Professionalpresentations made simple. Clinical Nurse Specialist,18(1), 16-20.Wilder, L. (1999). 7 Steps to Fearless Speaking. NewYork: JohnWiley and Sons, Inc.Williams, D. (1998). Powerful presentations: Prepare to be heard.Nursing Case Management, 3(3), 97-8.

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CSI: OttawaCase Study Investigation –Hemodynamic Profile Analysis:Making Sense of the Numbers

Sandra Goldsworthy, Leslie Graham, Oshawa, ONThis session is designed to assist novice critical care nurses intheir transition to expert practice. It will also benefitexperienced nurses in refreshing their knowledge ofhemodynamic profile analysis. Through case studyinvestigation (CSI), a systematic approach to analyzinghemodynamic profiles will be explored.This hands-on practical session will provide insight intopreload, afterload, contractility and perfusion and how thesevariables relate to selected hemodynamic conditions andtreatments.First, normal hemodynamic values will be identified. Next,abnormal values and their potential causes will be exploredas well as their relationship to selected hemodynamicprofiles. Through a systematic “grid” approach, theparticipant will be introduced to methods of discussing theprofile in relation to preload, afterload, contractility andoverall perfusion. From this point, the participant will becoached on relating these findings to potential diagnoses andexpected treatment. A case study approach will beincorporated.Nursing management of hemodynamic monitoring is anessential skill required in the critical care unit. Thispresentation is aimed at deepening the understanding andapplication of hemodynamic principles in order to provide safeand expert care to critically ill patients.ReferencesCurry, J., & Botti, M. (2003). Naturalistic decision making: Amodel to overcome methodological challenges in the studyof critical care nurses’ decision making about patient’shemodynamic status. American Journal of Critical Care,5, 21-25.Darovic, G., & Franklin, C. (1999).Handbook of HemodynamicMonitoring. Philadelphia: Saunders.Hung, D., & Lilly, C. (2003). Making the most of hemodynamicmonitoring in the ICU: Observing and optimizingappropriate parameters. Journal of Critical Illness, 5, 48-52.Kiekesen, M. (2004). Monitoring pulmonary artery pressure.Critical Care Nurse, 6, 11-18.Lanken, P. (2001). The Intensive Care Unit Manual. Philadelphia:Saunders.Schell, H., & Howie, J. (2003). An innovative educationalinitiative improves critical care nurses’ knowledge ofhemodynamic monitoring. American Journal of CriticalCare Nursing, 5(1), 21-24.Stillwell, S. (2002). Critical Care Nursing Reference. St Louis:Mosby.Swearingen, P., & Hicks, J. (2001). Manual of Critical CareNursing: Nursing Interventions and CollaborativeManagement. St. Louis: Mosby.Urden, L., Stacy, K., & Lough, M. (2002). Critical CareNursing: Diagnosis and Management. St. Louis:Mosby.

Reduction of MusculoskeletalInjuries in Intensive CareNurses Utilizing Ceiling-Mounted Patient Lifts

Maureen Haddock, Shirley Silverwood, Richmond, BCThis presentation demonstrates a practical application ofmechanical technology in the ICU, while ensuring a caringpractice for both patients and the health care team. Ourevidence shows ceiling-mounted patient lifts to be an effectivetool to reduce injuries and improve workplace morale.It was identified that the musculoskeletal injury (MSI) rate ofthe Richmond Hospital Intensive Care Unit nurses wasincreasing annually. The authors identified and assessed theproblem, developed a report and presented it to the ICU team.A plan was developed which included the installation ofceiling-mounted patient lifts (CMPL). The CMPL wastwofold: 1) Installation of the lift system; and 2) Incorporationof a patient repositioning sling in the bed make-up that wouldallow nurses to lift and move the patient anywhere within theICU room and permit turning the patient from side to sidewithout any manual lifting.The CMP lifts were installed in May 2002 in eight out of 11total beds. Education and in-service for the new equipmenttook place in June and, by the end of June, the unit was fullyoperational. The nurses completed an initial evaluation survey,which was repeated at three, six and 18 months. It identifiedany medical interventions due to a musculoskeletal injury,discomfort levels, fatigue levels and frustration levels beforeand after a 12-hour shift.The lifts received extremely positive feedback from all ICUstaff. The results show that the installation of ceiling-mountedpatient lifts along with the implementation of the repositioningsling in the intensive care unit significantly lowered the riskfor musculoskeletal injury while also promoting a morepositive workplace morale. Reductions in injury statistics andWCB claims are dramatic.ReferencesFeletto, M., & Graze, W. (2001). Aback injury prevention guidefor health care providers. California: CAL/OSHA.Retrieved January 6, 2005, from www.dir.ca.gov/dosh/PubOrder.aspFragala, G., Nelson, A., & Barker, R. (2001). Safe patienthandling and movement. Patient care ergonomicsresource guide. Tampa: VISN: Patient Safety Center ofInquiry. Retrieved January 6, 2004, fromwww.patientsafetycenter.comHealth and Safety Executive. (2002). Upper limb disorders inthe work place. Sudbury, UK: HSE Books.Lloyd, P., et al. (1997). The guide to the handling of patients:Introducing a safer handling policy (Rev. 4th ed.).Teddington, UK: National Back Pain Association incollaboration with the Royal College of Nursing.Occupational Health and Safety Agency for Healthcare in BC.(2000). Evaluation of the resident lifting system project,St. Joseph’s Hospital, Comox, BC. Retrieved January 10,2002, from http://www.ohsah.bc.ca/media/WCBComoxFINALCOPY_DEC19.pdf

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Occupational Health and Safety Agency for Healthcare in BC.(2000). Project update: The ceiling lift project at St.Joseph’s General Hospital: Follow up evaluationAugust 2002. Retrieved January 20, 2005 fromh t t p : / / w w w . o h s a h . b c . c a / m e d i a / O H S A H -CeilingLiftProjectatSt.JHospital.pdfTuohy-Main, K. (1999). A manual of handling people:Implementing a no-lift approach (2nd ed.). NewLambton Heights, Australia: Tuohy-Main Systems Pty.Wright, M., Taylor, C., & Sagar, M. (2004, November). Giving alift to nursing education. American Journal of Nursing,104(11), 112.Trendelenburg,It’s Time to Change Our Position!

Nicky Holmes, Toronto, ONThe Trendelenburg position has been used for more than 100years! Up until recently, using Trendelenburg duringhypotensive states has been considered a standard ofpractice. In the 1870s, a surgeon by the name of FriedrichTrendelenburg pioneered this technique, which involvespositioning patients on their backs with their head down andfeet elevated. The original intention was to improve surgicalaccessibility of pelvic organs (Fink, 1999). During World I,an American physiologist by the name of Walter Cannonpromoted using Trendelenburg position as a treatment forhemorrhagic shock because of its ability to return bloodfrom the lower extremities to the central circulation.It was thought that the head-down positioning displaced bloodfrom the lower extremities to the thorax and that this“autotransfusion” enhanced venous return, cardiac output,blood pressure and cerebral blood flow. Ironically, a decadelater, he denounced the use of the Trendelenburg position inhypotensive shock states (Johnson, 2004).As early as the 1950s, scientists began to question theresuscitative usefulness of the Trendelenburg position but,despite a lack of definitive literature, it continues to be used. Itis an example of a nursing intervention that is based ontradition and rituals rather than evidence-based science.Recent studies would suggest that placing a patient in theTrendelenburg position may be more harmful than helpful.Ostrow (1997) proposes that it stimulates vasodilation bycausing the baroreceptors to sense that the blood pressure ishigher than it really is, thereby decreasing the possibility of thebody correcting hypotension on its own.This presentation will focus on the current literatureavailable, highlighting and reviewing revisedrecommendations that no longer advocate using theTrendelenburg position to treat patients suffering from severehypotension.

ReferencesFink, K.C. (1999). Is Trendelenburg a wise choice? Journal ofEmergency Nursing, 25(1), 60-62.Johnson, S., & Henderson, S. (2004). Myth: The Trendelenburgposition improves circulation in cases of shock. CanadianJournal of Emergency Medicine, 6(1), 48-49.Martin, J.T. (1995). The Trendelenburg position: A review ofcurrent slants about head down tilt. Journal of AmericanAssociation of Nurse Anesthetists, 63, 29-36.Norman, E.M. (1998, January). Who benefits from theTrendelenburg? American Journal of Nursing, 98(1),16PP, 16RR.Ostrow, C.L. (1997). Use of the Trendelenburg position by criticalcare nurses: Trendelenburg survey. American Journal ofCritical Care, 6(3), 172-176.Powell, A.H. (1995). Value of Trendelenburg position questioned.American Journal of Nursing, 95(7), 51.Rodenberg, H. (2004). Calling Trendelenburg intoquestion. Journal of Emergency MedicalServices.Rollheiser, E. (1986). Shock and the Trendelenburg position.AARN Newsletter, 42(8), 17-18.Sing, R.F. (1994). Trendelenburg position and oxygen transport inhypovolemic adults. Annals of Emergency Medicine,23(3), 564-567.The Road Less Travelled:Bedside Placement of SmallBowel Feeding Tubes

Sheila Hunt, Mary Beth Billick, London, ONDysfunction of the upper GI tract is a common problemin critically ill patients. Difficulties arising fromdelayed gastric emptying will be discussed (Davies &Bellamo, 2004; Davies, Froomes, French, et al., 2002).Accessing the gut past the pylorus provides a methodof giving early enteral nutrition, the benefits of whichwill be presented (Mentec, Dupont, Bocchetti, et al.,2001).In our 26-bed critical care unit, patients traditionally wenton a precarious trip to flouroscopy for insertion of apostpyloric feeding tube. Travelling for the procedure wasdifficult for all patients and time-consuming for nursing andrespiratory therapy. The waiting period from request toprocedure was often days, hinging on the radiologists’availability and the patients’ stability for travel. The resultwas a delay in nutritional support and increased risk ofcomplications.A protocol based on a literature review was drafted, trialedand approved by the unit clinical practice committee. Theprotocol will be outlined. It includes a single dose ofErythromycin, air insufflation of the stomach, corkscrewtechnique, pH assessment of aspirated fluids, and auscultationof abdominal quadrants, followed by a bedside abdominal x-ray. Dedicated clinicians utilized the protocol and taught acore group of staff; the number trained grew from one to 26in only a year. Our statistics will be presented, which indicateincreasing success rates associated with repeated attempts.The procedure has been shown to be cost-, resource- andtime-effective.ReferencesDavies, A.R., & Bellamo, R. (2004). Establishment of18 16 • 2 • Summer 2005 CACCN

enteral nutrition: Prokinetics and small bowel feedingtubes. Current Opinions in Critical Care, 10, 156-161.Davies, A.R., Froomes, P.R., French, C.J., Bellomo, R.,Gutteridge, G.A., Nyulasi, I., et al. (2002). Randomizedcomparison of nasogastric and nasojejunal feeding incritically ill patients. Critical Care Medicine, 30, 586-590.Griffith, D.P., McNally, A.T., Battey, C.H., Forte, S.S., Cacciatore,A.M., Szeszycki, E.E., et al. (2003). Intravenouserythromycin facilitates bedside placement of postpyloricfeeding tubes in critically ill adults: A double-blind,randomized placebo-controlled study. Critical CareMedicine, 31(1), 39-44.Heyland, D.K., Dhaliwal, R., Drover, J.W., Gramlich, L., &Dodek, P. (2003). Canadian clinical practice guidelines fornutrition support in mechanically ventilated, critically illadult patients. Journal of Parenteral and EnteralNutrition, 27, 355-373.Mentec, H., Dupont, H., Bocchetti, M., Cani, P., Ponche, F., &Bleichner, G. (2001). Upper digestive intolerance duringenteral nutrition in critically ill patients: Frequency, riskfactors and complications. Critical Care Medicine,29(10), 1955-1961.Montejo, J.C., Grau, T., Acosta, J., Ruiz-Santana, S., Planas,M., Garcia-de-Lorenzo, A., et al. (2002). Multicenter,prospective, randomized, single blind studycomparing the efficacy and gastrointestinalcomplications of early jejunal feeding with earlygastric feeding in critically ill patients. Critical CareMedicine, 30(4), 796-800.Zaloga, G.P., & Roberts, P.R. (1998). Bedside placement ofenteral feeding tubes in the intensive care unit. CriticalCare Medicine, 26, 987-988.Creating Safe Passagefor Critically Ill Patients

Patricia Hynes, Karen Baguley, Ahilya Sarjoo-Devries,Jocelyn Bennett, Stephen Lapinsky, Scarborough, ONPurpose: As an urban tertiary care MSICU that receivesmany external referrals, we identified the need for clearcommunication processes around the care of patients whomay be transferred to our ICU. Recent experiences withinfectious illnesses also highlighted the need to bevigilant in screening for contagious diseases. To ensuresafety for patients and staff, and the delivery ofappropriate care, we developed an external transferchecklist for use prior to patient transfer during telephonediscussions with the referring facility staff. Integral to thecompletion of the checklist is a requirement for nurse-to-nurse consultation.Description: We piloted the external transfer checklist inhardcopy for three months. Information obtained wasthen reviewed for usefulness and compliance with thetool.Outcomes: Eighty-five external transfer checklists wereavailable for review. On four occasions, a referringhospital RN contact was not provided, three did notspecify whether a closed room was required for infectioncontrol reasons and 11 were incomplete on the infectioncontrol requirements item. With respect to patientoutcomes, 17 patients died, 24 were repatriated to thereferring institution and 29 were transferred tointermediate care or the wards in our institution. Of the

remaining 12 patients, several were transferred to otherICUs for specialized care, a couple of patients weredischarged home and, in three cases, information upondischarge was missing.Evaluation: An external transfer checklist focused ourapproach to accepting patients into our ICU. It has played arole in promoting a collaborative culture and assisted in theprovision of appropriate levels of care and safety within theunit. Preliminary statistics suggest that it is a valuable tool.It is currently used as a checklist only, with no furtherhardcopy requirement. The development of a policyregarding the acceptance of external transfers is a next stepfor us.Internal Patient Transfers– Streamlining the Process

Patricia Hynes, Corrie Ngan, Mary Dawson, Cynthia Harris,Grace Parucha, Jody Tone, Kim Parker, Toronto, ONNurses and respiratory therapists play a key role in thetransfer of patients to ICU and from ICU out to otherhospital departments. Unfortunately, such transfers are notlimited to daytime hours, but also happen at night and onweekends when staffing may be adjusted downward andmanagers and others in leadership roles are not readilyavailable. This potentially contributes to the stressclinicians report, even in the presence of policies andprocedures to guide the process and an understanding ofinstitutional flow patterns. One Canadian study showed thatseriously ill patients admitted through the ER on weekendsare more likely to die than patients admitted on weekdays(Bell & Redelmeier, 2001). In hospitals in Finland,weekend admission to ICU was associated with increasedICU mortality (Uusaro, Kari, & Ruokonen, 2003). Therehas been much to say about why hospital death rates vary,but no question that differences do exist (Halm & Chassin,2001).Recognizing the difficulty staff was experiencing, andallowing that they may lack the knowledge and skills toeffectively lead the process, we committed to conducting aseries of focus groups in our institution. The purpose wasto examine our internal transfer process from a patientsafety perspective and to engage staff in projects toimprove the process. Staff (RN and RT) from our medical-surgical ICU and acute medicine departments was invitedand the hospital risk manager was asked to facilitate thesessions.The purpose of this presentation is to share our outcomesand the tools (VI-STOP, ICU discharge orders, patientpamphlet, pre-transfer nursing assessment form) that staffdeveloped within allotted time. We concluded that a time-limited workgroup including staff from both areas andacross disciplines was an efficient and cost-effectivemeans of improving patient transfer processes in ourinstitution.ReferencesBell, C.M., & Redelmeier, D.A. (2001). Mortality among patientsadmitted to hospitals on weekends as compared with

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weekdays. New England Journal of Medicine, 345(9),663-8.Halm, E.A., & Chassin, M.R. (2001). Why do hospital deathrates vary? New England Journal of Medicine, 345,692-4.Uusaro, A., Kari, A., & Ruokonen, E. (2003). The effects of ICUadmission and discharge times on mortality in Finland.Intensive Care Medicine, 29(12), 2144-8.Developing a Unit-Based PediatricIntensive Care Education Committee

Tracy Lake, Jennifer Lewis, Susan Roper, Williamswood, NSThe diverse population in a multi-system pediatric intensivecare unit (PICU) requires critical care nurses to be highlyknowledgeable and skilled in physiological, emotional,spiritual and technological advances. In an environment ofconstant change, the continuing education of PICU nurses canbe challenging to nurse educators. Participation in continuingeducation is vital for maintaining clinical competence (Meyer& Elliott, 1996).The introduction of web-based learning modules for newstaff in the PICU at the Isaac Walton Killam Hospital sawsenior staff experiencing a plateau in continuing educationopportunities. Staff meetings identified a need for a formaleducation committee to ensure professional growth anddevelopment. The goal of continuing education is toenhance critical thinking skills and to improve nursing care(Koyama et al., 1996). The committee consisted of nurseswith varying levels of expertise and backgrounds. Walton(1996) suggests that nurses with diverse experiencesgenerate new ideas and challenge existing practices withinunits. Incorporating a variety of mediums (classroom,bulletin boards and internet-based), allowed the committeeto meet the needs of a large number of staff. This method issupported by Shaffer, Tallarica and Walsh (2000).Assessing the needs of learners is an essential prerequisiteto planning effective continuing education activities(Collins, 2002; Bice-Stephens, 2001). Our group devised askills-based needs assessment to guide our goals andobjectives.The presenters will discuss the initiation and management of aPICU peer-based education committee. It will review theprocess beginning with a needs assessment through to theplanning, implementation and evaluation stages.ReferencesBice-Stephens, W. (2001). Designing learning needs survey: 10steps to success. The Journal of Continuing Education inNursing, 32(4), 150-151.Collins, J. (2002). Reflections on the changing learning needs ofnurses: A challenge for nursing continuing educators. TheJournal of Continuing Education in Nursing, 33(2), 74-77.

Koyama, M., Holzemer, W.L., Kaharu, C., Watanabe, M., Yoshii,Y., Otawa, K. (1996). Assessment of a continuingeducation: Evaluation framework. The Journal ofContinuing Education in Nursing, 27(3), 115-119.Meyer, R., & Elliott, R.L. (1996). Pathway to excellence: A peer-based program in continuing education. The Journal ofContinuing Education in Nursing, 27(3), 104-107.Shaffer, B., Tallarica, B., & Walsh, J. (2000). Win-win mentoring.Nursing Management, 31(1), 32-34.Walton, J.C. (1996). The changing environment: New challengesfor nursing education. The Journal of NursingEducation, 35(9), 400-405.Companioning Donor Families:Innovation to Donation

Heather MacDonald, Tami Murphy,Dana McNamara-Morse, Corinne, Corning, Halifax, NSPurpose:Many Canadians are awaiting solid organ and tissuetransplantation and may die waiting for this gift of life. Acourageous decision has been made by many Canadianfamilies to donate a loved one’s organs and tissues fortransplantation, yet many are not approached. Despite agrowing need, demand exceeds supply. One barrier todonation identified by health professionals is the knowledgeand skill of health care providers, specifically critical carenurses, who play a pivotal role in approaching and offeringfamilies this option at end of life. Education, skill-building andtraining are needed, including donor identification, referral,maintenance and, most importantly, providing holistic carethat is required to facilitate the donation conversation andoptimize end-of-life care.A core team of nurses created Companioning Donor Families,a new model transforming end-of-life care for donor familiesby utilizing a patient-/family-centred care approach within acompanioning philosophy. This model will ensure that trainednurses are more comfortable to approach eligible families tooffer the option of organ and/or tissue donation as part of end-of-life care.This presentation will focus on the assessment, planning,implementation and evaluation phases of an innovativelearning opportunity for critical care nurses that will enhancetheir ability to provide optimal end-of-life care for potentialorgan and tissue donors and their families.Learning objectives:• To gain a meaningful understanding of ‘companioningdonor families’.• To acquire the knowledge, skill and competency inapproaching potential organ/tissue donor families andconducting the donation conversation.• Increase critical care nurses’ ability to support culturaldiversity with end-of-life decision-making.Description: A provincial needs assessment of critical carenurses’ competencies in approaching potential donor familiesresulted in the development of a comprehensive two-daytraining session consisting of donor family end-of-life care, thedonation conversation, articulation of brain death and donormaintenance, as well as bereavement theory, crisisintervention and simulated case scenario role playing.Clinical application and evaluation: An overview of theself-rated evaluation and analysis process demonstrated the

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effectiveness of the training. Measurable outcomesindicated strong clinical application, clinical decision-making, improved family care and increased approachrates. This initiative is patient-/family-focused, evidence-based, clinician-championed, and team- and systems-oriented.Conclusion: Companioning Donor Families has embracedthe philosophy of patient-/family-centred end-of-life careand is committed to excellence in critical care clinicalpractice. This information outlines the challenges andopportunities of ensuring all families are given the optionof donation. We will close by viewing a visual journey intothe lives of the patients, families and caregivers in criticalcare.ReferencesAndrew, C. (1998). Optimizing the human experience: Nursingthe families of people who die in intensive care. Intensiveand Critical Care Nursing, 3, 59-65.Bisnaire, D., Burden, J., & Monik, L. (1988). Brain stem death:Managing the family in crisis. The Canadian Nurse, 84(1),28-30.Braun, K., & Nichols, R. (1996). Cultural issues in death anddying. Hawaii Medical Journal, 55, 260-264.Colodny, C., Gianakos, D., Granat, P., Lenow, J., Maxwell, T.,Mockus Parks, S., et al. (2000, November 15). Ethicaldecision making at the end of life: A series of case studies.Patient Care, 130-136.Davies, C. (1997). Knowledge and attitudes of nurses on aregional neurological intensive therapy unit towards brainstem death and organ donation. Nursing in Critical Care,2(2), 131-143.Fine, R. (2000). Handling brain death and coma. Texas MedicineRounds, 26-27.Kemp, C. (2000). Culture and the end of life. Journal of Hospiceand Palliative Nursing, 2(3), 109-110.Maloney, A., & Wolfelt, A. (2001). Caring for Donor FamiliesBefore, During and After. Fort Collins, CO: CompanionPress.McClenahan Bradach, K., & Jordan, J. (1995). Long term effectsof a family history of traumatic death on adolescentindividuation. Death Studies, 19, 315-336.McQuay, J. (1995). Cross-cultural customs and beliefs related tohealth crisis, death, and organ donation/transplantation: Aguide to assist health care professionals understanddifferent responses and provide cross-cultural assistance.Critical Care Nursing Clinics of North America, 7, 581-594.Okamoto, S., Corso, C., Nolte, D., Rascher, W., Thiery, J.,Yamaoka, Y., et al. (1998). Impact of brain death onhormonal homeostasis and hepatic microcirculation oftransplant organ donors. Transplant International,1(Suppl.), 11.Powner, D., & Darby, J. (1999). Current considerations in theissue of brain death. Neurosurgery, 45, 1222-1227.Scott, H. (2002). Who owns a person’s body organs after death?British Journal of Nursing, 8(1), 4-5.Smith, M. (1998). Facing death: Donor and recipient responses tothe gift of life. Holistic Nursing Practice, 13(1), 32-40.Stewart, A., Teno, J., Patrick, D., & Lynn, J. (1998). The conceptof quality of life of dying persons in the context of healthcare. Journal of Pain and SymptomManagement, 17(2),93-108.

An Educational,Behavioural Approach to OptimizeComputerized APACHE II Calculations:Multimodal Strategies

Margaret Maclennan, Shona McIntyre, Michelle Kho,Laura Donahoe, Ellen McDonald, Peter Varga,Deborah Cook, Ancaster, ONBackground: The APACHE II score is used widely in theICU setting for administrative purposes, research andtreatment decisions. In a previous study (Kho et al., 2004),APACHE II scores collected by an expert researchcoordinator and two research clerks were reliable. However,when comparing these scores against clinical informationsystem (CIS, CareVue), reliability was suboptimal. Themost problematic areas included Chronic Health Index(CHI) and best verbal component of Glasgow Coma Scale(GCS-V).Objectives:1. Improve ICU nurses’ knowledge and compliance withdocumentation of the CHI and GCS-V of the APACHE IIscore, and2. Reconfigure CareVue to optimize APACHE calculation.Population and setting: ICU nurses in a 15-bed medicalsurgical, university-affiliated ICU.Methods: We implemented multimodal strategies toimprove ICU nurses’ knowledge and compliance withdocumentation of CHI and GCS-V of the APACHE II score.Strategies were:1. In-services conducted by an ICU educator andinformatician,2. Use of local opinion leaders,3. Real-time reminders,4. Audit and feedback,5. Administrative support, and,6. Restructuring the CIS, CareVue (Philips, Andover, MA).We used the intraclass correlation coefficient (ICC) tocalculate agreement in CHI and GCS-V scoring between anICU research coordinator and data entered into the CareVuesystem by nursing staff.Results: Complete data from 32 consecutive admissions wereused. The ICC (95% CI) of the overall APACHE II score was0.91 (0.82 to 0.95), CHI, 0.35 (0 to 0.62), and the GCS-V was0.65 (0.39 to 0.82).Conclusions: CareVue accurately captures the overallAPACHE II score. However, within the components of theAPACHE II score, some variability remains in GCS-Vcollection. Additionally, CHI is the most problematic. Moreeducation and re-evaluation is required to improve the humanelement of GCS-V and CHI scoring.ReferencesKho, M.E., McDonald, E., Donahoe, L., D’Elia, C., Stratford, P.,Takeuchi, L., et al. (2004). Reliability study of APACHE IIscores in a MSICU. Crit Care Med, 31(12, Suppl.), A68.

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“An Ounce of Preventionis Worth a Pound of Cure” –A Protocol for the Prevention ofVentilator-Associated Pneumonia ina Multidisciplinary Adult ICU

Sue Malone-Tucker, Angele Landriault,Mike Langill, Ottawa, ONVentilator-associated pneumonia (VAP) is the most commonintensive care unit (ICU) nosocomial infection, and itsincidence (10% to 30%) varies with the type of ICU and patientpopulation (Craven et al., 1988; Torres et al., 1990). Host riskfactors include advanced age, abdominal or thoracic surgery,previous antibiotic therapy, immune compromise, decreasedlevel of consciousness, burns trauma and witnessed aspirationto name a few (Torres et al., 1990). In a recent Canadian study(Heyland et al., 1999), the increased risk of death was 5.8%,with an increased average ICU stay of 4.3 days.Early onset VAP typically occurs within 48 to 96 hours afterendotracheal intubation, and often results from aspirationduring intubation (Kollef, 1999; Chastre & Fagon, 2002). Lateonset VAP occurs more than 96 hours after endotrachealintubation, and is more frequently caused by antibiotic-resistant pathogens.The pathogenesis is multifaceted, involving bacterialcolonization of the upper airways followed by aspiration ofcontaminated secretions into the lower airways. Thecontributing factors are numerous and include, but are notlimited to the presence of nasogastric tubes, the pooling ofcontaminated secretions above the cuff of the endotrachealtube, and contamination of the ventilator circuit (Craven &Steger, 1995).Many interventions have been reported to reduce the incidenceof VAP, but implementation of these is variable (Heyland et al.,2002). There exists not only the potential for producingimprovement in quality of patient care by effectivelyemploying these strategies, but also the potential forsignificant financial savings.In January 2000, we introduced a VAP prevention protocol inthe ICU at the Ottawa Hospital, General Campus. Amultidiscipinary team composed of nurses, physicians,respiratory therapists, and pharmacists developed this protocolby incorporating existing evidence-based measures shown toreduce the frequency of VAP. This multifaceted protocolincorporates low-risk and low-cost strategies, many of whichhad independent advantages of their own.Our experiences and results with this protocol will bepresented, along with the current literature regarding the statusof both established preventative measures and measures inneed of further research.

ReferencesChastre, J., & Fagon, J.Y. (2002). Ventilator associatedpneumonia. American Journal Respiratory CriticalCare Medicine, 165, 867-903.Craven, D., Kunches, L., Lichtenberg, D., Kollisch, N., Barry, M.,Heeren, T., et al. (1988). Nosocomial infection and fatalityin medical and surgical intensive care patients. ArchivesInternal Medicine, 148, 1161-8.Craven, D., & Steger, K. (1995). Epidemiology of nosocomialpneumonia: New perspectives on an old disease. Chest,108(Suppl.), 1S-16S.Harris, J., & Miller, T. (2000). Preventing nosocomial pneumonia:Evidence-based practice. Critical Care Nurse, 20(1), 51-66.Heyland, D., Cook, D., & Dodek, P. (2002). Prevention ofventilator associated pneumonia: Current practice inCanadian intensive care units. Journal of Critical Care,17, 161-7.Heyland, D., Cook, D., Griffth, L., Keenan, S., & Bron-Buisson,C. (1999). The attributable morbidity and mortality ofventilator-associated pneumonia in the critically ill patient.American Journal Respiratory Critical Care Medicine,159, 1249-56.Hixson, S., Sole, M.L., & King, T. (1998). Nursing strategies toprevent ventilator associated pneumonia. AmericanAssociation of Critical Care Nursing Clinical Issues:Advanced Practice inAcute andCritical Care, 9(1), 76-90.Kollef, M. (1999). The prevention of ventilator associatedpneumonia. New England Journal of Medicine, 340, 627-634.Torres, A., Aznar, E., Gatell, J., Jimenez, P., Gonzalez, J., Ferrer,A., et al. (1990). Incidence, risk, and prognostic factors ofnosocomial pneumonia in mechanically ventilated patients.American Journal Respiratory Critical Care Medicine,142(3), 523-8.A Top 10 List of Must Dos:Impacting Critical Care PatientOutcomes with Nursing Care

Catherine Mawdsley, London, ON1. We have the ability, evidence and power to change how wecare for patients – and these changes can result in betteroutcomes for our patients. Florence Nightingale once said,“The very first requirement of a hospital is that it shoulddo the sick no harm”. There is now evidence that suggestssome of our current practices may cause harm.2. Is your practice evidence-based? Does your practice helpor harm the patient?3. What are your practices around mobilizing patients?4. What happens to muscles after a week of bed rest and howshould this impact your mobilization of patients?5. What are the biggest stressors for ICU patients during theirstay in the ICU?6. Do your practices care and cure for the problems oraccentuate the problems?7. Sleep assessment – is your patient really sleeping?8. Does your unit have a sleep protocol?9. Is REM sleep better than NREM sleep for ICU patients?10. Is sleep debt really a critical care problem?22 16 • 2 • Summer 2005 CACCN

During this session, a “top 10 list of must dos” for critical carenurses will be presented, with emphasis on evidence-basedchanges to maximize patient outcomes.ReferencesBrook, A.D., Ahrens, T.S., Schaiff, R., Prentice, D., Sherman, G.,Shannon, W., et al. (1999). Effect of nursing implementedsedation protocol on the duration of mechanical ventilation.CCM, 27(12), 2609-2615.Collard, H.R., Saint, S., & Matthay, M.A. (2003). Prevention ofVAP: An evidence-based systematic review. Annals ofInternal Medicine, 138(6), 494-501.Dang, D., Johantgen, M.E., Pronovost, P.J., Jenckes, M.W., &Bass, E.B. (2002). Post-operative complications: Does ICUstaff nursing make a difference. Heart & Lung, 31(3),219-228.Dittmer, D., & Teasall, R. (1993). Complications of bedrest.Canadian Family Physician, 39, 1428-44.Dodek, P., & Raboud, J. (2003). Explicit approach to rounds in anICU improves communication and satisfaction ofproviders. Intensive Care Medicine, 29(9), 1584-1588.Drakulovic, B., Torres, A., & Bauer, T.T. (1999). Supine bodyposition as a risk factor for nosocomial pneumonia inmechanically ventilated patients: A randomized trial.Lancet, 354, 1851-1858.Edwards, G., & Schuring, L. (1993). Sleep protocol: A research-based practice change. CCN, 13, 84-88.Ely, E.W., Truman, B., Shintani, A., Thomason, J.W.W., Wheeler,A.P., Gordon, S., et al. (2003). Monitoring sedation statusover time in ICU patients: The reliability and validity of theRASS. JAMA, 289(22), 2983-2991.Fulbrook, P. (2003). Developing best practice in critical carenursing: Knowledge, evidence and practice. Nursing inCritical Care, 8(3), 96-102.

Gabor, J., Cooper, A.B., Crombach, S.A., Lee, B., Kadikar, N.,Bettger, H.E., et al. (2003). Contribution of ICUenvironment to sleep disruption in mechanically ventilatedpatients and healthy subjects. AJRCCM, 167(5), 708-715.Henry, L. (2003). Myth versus realities: Which is the correct ECGmonitoring lead. AACN News, 20(1).Hawryluck, L.A., Espin, S.L., Garwood, K.C., Evans, C.A., &Lingard, L.A. (2002). Pulling together and pushing apart:Tides of tension in the ICU team. Academic Medicine,77(10), S73-76.Honkus, V. (2003). Sleep deprivation in critical care units.CCNQ, 26(3), 179-89.Jacobi, J., Fraser, G.L., Coursin, D.B., Riker, R.R., Fontaine, D.,Wittbrodt, E.T., et al. (2002). Clinical practice guidelinesfor the sustained use of sedatives and analgesics in thecritically ill adult. CCM, 30(1), 119-141.Kasper, C.E., Talbot, L.A., & Gaines, J.M. (2002). Skeletalmuscle damage and recovery. AACN Clinical Issues,13(2), 237-247.Kollef, M. (1999). The prevention of VAP. NEJM, 340(8), 627-634.Kress, J.P., Pohlman, A.S., O’Connor, M.F., & Hall, J.B. (2000).Daily interruption of sedative infusions in critically illpatients undergoing mechanical ventilation. NEJM,342(20), 1471-1477.Kress, J.P., Gehlbach, B., Lacy, M., Pliskin, N., Pohlman, A.S., &Hall, J.B. (2003). The long term psychological effects ofdaily sedative interruption on critically ill patients.AJRCCM, 168, 1457-1461.Munro, C. L., & Grap, M.J. (2004). Oral health and care in theICU: State of science. AJCC, 13(1), 25-34.

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Pronovost, P., Berenholtz, S., Dorman, T., Lipsett, P.A.,Simmonds, T., & Haraden, C. (2003). Improvingcommunication in the ICU using daily goals. Journal ofCritical Care, 18(2), 71-5.Sessler, C.N., Gosnell, M.S., Grap, M.J., Brophy, G.M., O’Neal,P.V., Keane, K.A., et al. (2002). The RASS: Validity andreliability in adult ICU patients. AJRCCM, 166, 1338-1344.Thomas, E.J. (2003). Discrepant attitudes about teamworkamong critical care nurses and physicians. CCM, 31(3),956-960.Topp, R., Ditmyer, M., King, K., Doherty, K., & Hornyak, J., 3rd.(2002). The effect of bedrest and potential ofprehabilitation on patients in the ICU. AACN ClinicalIssues, 13(2), 263-276.Weinert, C.R., Chlan, L., & Gross, C. (2001). Sedating criticallyill patients: Factors affecting nurses’ delivery of sedativetherapy. AJCC, 10(3), 166-167.Come One! Come ALL!To a Critical Care Nursing Journal Club

Catherine Mawdsley, London, ON• Are you having difficulty analyzing research articles?• When articles are discussed in rounds, do you think of yourfavourite chocolate recipe?• Do your eyes glaze over when you see p values and NNT?• Has it been years since you have critiqued a research article?If you answered “YES” to any of the above questions, orif you have an interest in improving your criticalappraisal skills, plan to attend this session. During thisenergetic and interactive session, we will review twocurrent and relevant critical care research articles and,after analyzing the articles, will determine theappropriateness of applying these articles to yourpractice. While we will briefly address statistics, thissession will emphasize using your bedside experience andclinical reasoning to determine the usefulness of thearticles.The framework for reviewing the articles will be fromthe popular “Users’ Guides Series” from JAMA. Articlereview tools will be available from the CACCN websiteor from the presenter two months prior to theconference.Please note: favourite chocolate recipes and relevant websitesof the presenter will be reviewed as well (evidence-based, ofcourse).ReferencesGuyatt, G., & Rennie, D. (2002). Users’ Guides to theMedical Literature. AMA Press.

Websiteshttp://library.kent.ac.uk/library/info/subjectg/healthinfo/critapprais.shtmlhttp://www.cche.net/usersguides/main.asphttp://www.usersguides.org/CRRT + HIT = A Big Headache!!

Rachelle McCready, London, ONHeparin-induced thrombocytopenia (HIT) is an antibodymediated adverse effect of heparin that can precipitate thedevelopment of serious arterial and venous thrombosis(Warkentin, 2004). HIT occurs in .5% to 5% of patients whoreceive heparin (Rice, 2004) and is associated with highmortality and morbidity from events such as stroke, DVT andaortic thrombosis.Once HIT is suspected, all forms of heparin (includingheparin coated indwelling catheters, line flushes andinfusions) must be discontinued. This presents quite aconundrum if the patient is also receiving continuous renalreplacement therapy (CRRT) using heparin as theanticoagulating medication.This presentation will address the complexities of HIT fromdiagnosis through to treatment. As well, the variousanticoagulants that can be utilized in place of heparin forCRRT will be described with a particular emphasis onargatroban. Finally, a case study outlining the complex care ofa patient in hepato-renal failure post-heart valve replacementwho develops HIT while on CRRT will be presented.ReferencesCleveland, K. (2003). Argatroban: A new treatment option forheparin-induced thrombocytopenia. Critical Care Nurse,23, 61-66.Dager, W., & White, R. (2003). Argatroban for heparin-inducedthrombocytopenia in hepato-renal failure and CVVHD.The Annals of Pharmacotherapy, 37, 1232-1236.Hirsh, J., Heddle, N., & Kelton, J.G. (2004). Treatment ofheparin-induced thrombocytopenia: A critical review.Archives of Internal Medicine, 164, 361-369.Lewis, B., Wallis, D., Leya, F., Hursting, M., & Kelton, J.C.(2003). Argatroban anticoagulation in patients withheparin-induced thrombocytopenia. Archives of InternalMedicine, 163, 1849-1856.Rice, L. (2004). Heparin-induced thrombocytopenia: Myths andmisconceptions (that will cause trouble for you and yourpatient). Archives of Internal Medicine, 164, 1961-1964.Shrager, J.B., & Kaiser, L.R. (2004). Argatroban as a heparinsubstitute in cases of heparin-induced thrombocytopenia.Annals of Thoracic Surgery, 78, 2209-2209.Tang, I.Y., Cox, D.S., Patel, K., Reddy, B.V., Nahlik, L., Trevino,S., & Murray, P.T. (2005). Argatroban and renalreplacement therapy in patients with heparin-inducedthrombocytopenia. Annals of Pharmacotherapy, 39, 231-236.Warkentin, T., & Greinacher, A. (2004). Heparin-inducedthrombocytopenia: Recognition, treatment and prevention.Chest, 126, 311S-337S.Williamson, D.R., Boulanger, I., Tardif, M., Albert, M., &Gregoire, G. (2004). Argatroban dosing in intensive carepatients with acute renal failure and liver dysfunction.Pharmacotherapy, 24, 409-414.24 16 • 2 • Summer 2005 CACCN

The Full Monty:A New Minimalist Methodof Continuous EEG Monitoring

Rachelle McCready, London, ONMany patients in ICU are at risk of seizures or other EEGchanges which can reflect life-threatening conditions. Assome seizures and other EEG changes may have no clinicalsigns and, thus, are undetectable to the bedside clinician,monitoring for their presence with electroencephalography(EEG) is vital.With traditional EEG monitoring, 21 electrodes are placedon the scalp by a specially trained technician in astandardized pattern known as the International 10-20system. The data are collected over a short timeframe by amachine that the technician brings to the bedside. Withadvancements in software, the machine can now collectEEG data continuously, if desired. However, a specialtechnician still has to apply the electrodes and bring in thelarge machine.Currently, our ICU has implemented continuous EEGmonitoring using our Datex© bedside monitors and nineface/neck electrodes (“the full Monty”). This monitoringis done completely by the ICU nursing staff andphysicians; no outside staff/equipment are needed.Although it does not replace traditional EEG monitoring,it can be used to quickly obtain a general view of brainactivity to help make a diagnosis and determine plan ofcare.

This presentation will discuss the advantages/disadvantages ofcontinuous EEG monitoring, indications for use of “the fullMonty” and rudimentary EEG analysis. As well, a nursingprotocol for the use of bedside continuous EEG monitoringwill be outlined.ReferencesArbour, R. (2003). Continuous nervous system monitoring, EEG,the Bispectral Index, and neuromuscular transmission.AACN Clinical Issues, 14, 185-207.Buzea, C.E. (1995). Understanding computerized EEGmonitoring in the intensive care unit. Journal ofNeuroscience Nursing, 27, 292-297.Claassen, J., Mayer, S.A., Kowalski, R.G., Emerson, R.G., &Hirsch, L.J. (2004). Detection of electrographic seizureswith continuous EEG monitoring in critically ill patients.Neurology, 62, 1743-1748.Hickey, J.V. (2003). The clinical practice of neurological andneurosurgical nursing (5th ed., pp. 109-111).Philadelphia, PA: Lippincott, Williams and Wilkins.Hirsch, L.J. (2004). Continuous EEG monitoring in the intensivecare unit: An overview. Journal of ClinicalNeurophysiology, 21, 332-340.Jordan, K.G. (1993). Continuous EEG and evoked potentialmonitoring in the neuroscience intensive care unit. Journalof Clinical Neurophysiology, 10, 445-475.Jordan, K.G. (1999). Continuous EEG monitoring in theneuroscience intensive care unit and emergencydepartment. Journal of Clinical Neurophysiology, 16, 14-39.

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Kay, J. (1998). Continuous EEGmonitoring in the intensive care unit.Canadian Journal of Neurological Science, 25, S12-15.Leira, E.C., Bertrand, M.E., Hogan, R.E., Cruz-Flores, S.,Wyrwich, K.W., Albaker, O.J., et al. (2004). Continuous oremergent EEG: Can bedside caregivers recognizeepileptiform discharges? Intensive Care Medicine, 30,207-212.Scheuer, M.L., & Gotman, J. (2004). Data analysis for continuousEEG monitoring in the ICU: Seeing the forest and the trees.Journal of Clinical Neurophysiology, 21, 353-378.Have You Heard the Buzz Aboutthe BIS? Incorporating BispectralIndex Monitoring in Critical Care

Linda Nusdorfer, Mississauga, ONBispectral index monitoring, or BIS, is an objective tool thatprocesses electroencephalographic information and calculatesa number between 0 and 100 to provide a direct, continuousmeasure of a patient’s level of consciousness. The BIS is morecommonly known for its applications in conscious sedation,but is there an opportunity to use this technology within thecritical care setting? Possible situations in which the BIS hasbeen utilized in critical care are situations where extremetherapies are used, such as high frequency oscillation (HFO),extracorporeal membrane oxygenation (ECMO) and use ornon-use of paralytic agents, but where clinicians want toensure patients are well-sedated. Nurses in a leading Torontohospital are using this technology as an objective measure ofpatients’ level of consciousness to validate their subjectivemeasures of level of consciousness. The ability to titratemedications to ensure patients are sedated to a deep hypnoticstate helps to reduce the doubt of awareness of traumaticinterventions often preformed at the bedside. Casepresentations will demonstrate the nurses’ confidence in usingthis technology as a tool to objectively determine patients’level of consciousness during highly invasive procedures andextreme treatment modalities. Through a series of casepresentations, the reliability and validity of this technologywill be explored.ReferencesGilbert, T.T., Wagnern, M.R., Halukurike, V., Paz, H.L., &Garland, A. (2001). Use of bispectralelectroencephalogram monitoring to assess neurologicstatus in unsedated critically ill patients. Critical CareMedicine, 29(10), 1996-2000.Nasraway, S.A., Wu, E.C., Kelleher, R.M., Yasuda, C.M., &Donnelly, A.M. (2002). How reliable is the bispectral indexin critically ill patients?A prospective, comparative, single-blinded observer study. Critical Care Medicine, 30(7),1483-1487.Olson, D.M., Cheek, D.J., & Morgenlander, J.C. (2004) Theimpact of bispectral index monitoring on rates of Propofoladministration. AACN Clinical Issues, 15(1), 63-73.

Olson, D.M., Chioffi, S.M., Macy, G.E., Meek, L.G., & Cook,H.A. (2003). Potential benefits of bispectral indexmonitoring in critical care: A case study. Critical CareNurse, 23(4), 45-52.Riker, R.R., Fraser, G.L., & Wilkins, M.L. (2003). Comparing thebispectral index and suppression ratio with burstsuppression of the electroencephalogram duringpentobarbital infusion in adult intensive care patients.Pharmocotherapy 23(9), 1087-1093.Simmons, L.E., Riker, R.R., Prato, B.S., & Fraser, G.L. (1999).Assessing sedation during intensive care unit mechanicalventilation with the Bispectral Index and the Sedation-agitation Scale. Critical Care Medicine, 27(8), 1499-504.Building Teamworkthrough Groupwork:A Debriefing Group for Staff

Donna Occhipinti, Helene Borts, Mississauga, ONCritical care nurses have limited formal resources for copingwith the extreme sadness and grief they experience in theirwork. Stress in critical nursing can have a direct effect onpatient outcomes. The debriefing group in this ICU hasdeveloped into an integrated part of the work-week, providingongoing care and support for the health care team. Theprogram enhances the team’s ability to continue to do the goodwork they do in patient care.The group is co-facilitated by the social worker and thechaplain. In this process, group members review theimpressions and reactions that staff experiences afterparticularly difficult cases. The group provides an opportunityfor problem-solving difficult situations. It allows the staff tovent frustrations and to have their feelings normalized.Spirituality and the meaning of loss are addressed. Ethical issuesare frequently addressed. There is an educational component tothe program, and competence in cultural diversity isemphasized. The group is also a forum to discuss changes inpatient protocols. Although the group is mostly composed ofnurses, all team members are encouraged to participate.Trillium Health Centre’s ICU is a 26-bed unit servingmedical/surgical patients. THC holds the regionalneurosurgery and neurology programs. Staff complementincludes four intensivists (soon to be five), 200 nurses, 40rotating respiratory therapists, seven-days-a-week social work,.7 chaplain, .5 occupational therapist, one physiotherapist, onenutritionist, and one pharmacist.ReferencesArendt, M., & Elklit, A. (2001). Effectiveness of psychologicaldebriefing. Acta Psychiatrica Scandinavica, 104, 423-437.Bell, J.L. (1995). Traumatic event debriefing: Service deliverydesigns and the role of social work. Social Work, 40(1),36-43.Caine, R.M., & Ter-Bagdasarian, L. (2003). Early identificationand management of critical incident stress. Critical CareNurse, 23(1), 59-65.Devilly, G.J., & Cotton, P. (2003). Psychological debriefing andthe workplace: Defining a concept, controversies andguidelines for intervention. Australian Psychologist,38(2), 144-150.Hollister, R. (1996). Critical incident stress debriefing and thecommunity health nurse. Journal of Community HealthNursing, 13(1), 43-49.26 16 • 2 • Summer 2005 CACCN

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Mackenzie, L. (2002). Briefing and debriefing of studentfieldwork experiences: Exploring concerns and reflectingon practice. Australian Occupational Therapy Journal,49, 82-92.Rose, S., Bisson, J., & Wessely, S. (2004). Psychologicaldebriefing for preventing post-traumatic stress disorder(PTSD) (Systematic Review). Cochrane Database ofSystematic Reviews, 4.Smith, M. (2001). Critical incident debriefing in groups: A groupanalytic perspective. Psychodynamic Counselling, 7(3),329-346.Spitzer, W.J., & Burke, L. (1993). A critical-incident stressdebriefing program for hospital-based health care. Healthand Social Work, 18(2), 149-156.VIAGRA: An Arousing New Therapy forPulmonary Hypertension

Lee Petrin, Frances Smith, Mary Thornton, Ottawa, ONPulmonary hypertension is a chronic and debilitating diseasethat is challenging to treat and, ultimately, ends in death. Thereare two types of pulmonary hypertension. Primary pulmonaryhypertension is a rare condition with no evident etiology. Itaffects one to two people per million, most commonly foundin women between the ages of 20 and 50, ultimatelyprogresses to death, a life expectancy of two to five years, witha mean of 2.8 years. Secondary pulmonary hypertensionresults from a variety of underlying disease states orpathologies. Although mortality rates in secondary pulmonaryhypertension are much lower, quality of life may be sodiminished that enjoying the activities of daily life is greatlyimpaired.

Treatment strategies in the past have included oralanticoagulants, calcium channel blockers, diuretics, digoxinand oxygen. More recent therapies have includedintravenous epoprostenol, which has become a referencetreatment, and inhaled nitric oxide, both of which requirecomplex delivery systems. The challenge in treatingpulmonary hypertension is to develop effective alternativesto intravenous epoprostenol. Viagra (sildenafil), a potentvasodilator, has recently emerged as a promising therapy forpulmonary hypertension. This presentation will give a briefoverview of pulmonary hypertension and its classificationswith an explanation of the action of Viagra on pulmonaryhemodynamics. Finally, we will present a case studydemonstrating the exciting potential of the use of Viagra forthe treatment and symptomatic management of pulmonaryhypertension.ReferencesBharani, A., Mathew, V., Sahu, A., & Lunia, B. (2003). Theefficacy and tolerability of sildenafil in patients withmoderate-to-severe pulmonary hypertension. Indian HeartJournal, 55(1), 55-59.Galie, N., Manes, A., & Branzi, A. (2002). Emerging medicaltherapies for pulmonary arterial hypertension. Progress inCardiovascular Diseases, 45(3), 213-224.Ghofrani, H.A., Rose, F., Schermuly, R., Olschewski, H.,Wiedemann, R., Kreckel, A., et al. (2003). Oral sildenafil aslong-term adjunct therapy to inhaled iloprost in severepulmonary arterial hypertension. Journal of the AmericanCollege of Cardiology, 42(1), 158-164.A B S T R A C T S

Ghofrani, H.A., Wiedemann, R., Rose, F., Olschewski, H.,Schermuly, R.T., Weissmann, N., et al. (2002).Combination therapy with oral sildenafil and inhalediloprost for severe pulmonary hypertension. Annals ofInternal Medicine, 136(7), 515-522.Kanthapillai, P., Lasserson, T.J., & Walters, E.H. (2001).Sildenafil for pulmonary hypertension. The CochraneDatabase of Systematic Reviews 2004, 4, Art. No.:CD003562.pub2.DOI: 10.1002/14651858.CD003562.pub2.Kleinsasser, A., Loeckinger, A., Hoermann, C., Puehringer, F.,Mutz, N., Bartsch, G., et al. (2001). Sildenafil modulateshemodynamics and pulmonary gas exchange. AmericanJournal of Respiratory and Critical Care Medicine,163, 339-343.Michelakis, E.D., Tymchak, W., Noga, M., Webster, L., Wu, X.,Lien, D., et al. (2003). Long-term treatment with oralsildenafil is safe and improves functional capacity andhemodynamics in patients with pulmonary arterialhypertension. Circulation, 108(170), 2066-2069.Mikhail, G.W., Prasad, S.K., Wei, L., Rogers, P., Chester, A.H.,Bayne, S., et al. (2004). Clinical and haemodynamic effectsof sildenafil in pulmonary hypertension: Acute and mid-term effects. European Heart Journal, 25, 431-436.Sabo, J.A. (2002). Pulmonary hypertension. Retrieved January14, 2004, from http://www.netce.com/course.asp?Course+1018Websiteswww.aacn.orgwww.icudelirium.orgwww.lhsc.on.ca/critcare/icu/cctc/procprot/nursing.htmwww.qualityhealthcare.orgwww.ihi.orgwww.nise.ccTherapeutic Alliance:Its Place in Critical Care Nursing

Kirsti Pryde, Ottawa, ONThe concept of therapeutic alliance has been presented in theliterature as a theoretical and practical means for nursing staffto interact with patients (Hummelvoll, 1996). The premise oftherapeutic alliance is based on the core concepts of trust,empathy and developing common goals (Horvath, 2000). Theproponents of the concept suggest that by developing arelationship or an alliance with the patient and/or family, thenurse will establish a bond that facilitates communication andencourages the development of a mutually derived treatmentplan. As the challenges of critical care nursing increase, thedemands placed on nursing staff become more complex. Onesuch challenge that nurses face is discussing delicate, end-of-life issues with the patient’s family (Main, 2002). Therapeuticalliance lends itself to help meet this challenge by providing

the foundation for an effective rapport between nursing staffand families. The nurse’s role is central to the development ofa therapeutic alliance as nursing staff often has the mostfrequent contact with the family. As a graduate nursing studentdoing a clinical placement in the intensive care unit (ICU) atthe General Campus of the Ottawa Hospital, I was presentedwith the opportunity to study the concept of therapeuticalliance and its appropriateness and benefits for use by ICUnursing staff during family interactions. Informal inquiryrevealed that many of the experienced nursing staff alreadyutilized the elements of therapeutic alliance without it beingidentified as such. This inquiry led to the development of a listof tips for staff/family interactions to facilitate a therapeuticalliance that could be useful for new staff coming to ICU anda reminder for those more experienced.ReferencesHorvath, A. (2000). The therapeutic relationship: Fromtransference to alliance. Journal of ConsultingPsychology, 56(2), 163-173.Hummelvoll, J. (1996). The nurse-client alliance model.Perspectives in Psychiatric Care, 32(4), 12-21.Main, J. (2002). Management of relatives of patients who aredying. Journal of Clinical Nursing, 11, 794-801.Liver Dialysis:A New Approach for Liver Failure

Kristee Regozo, Toronto, ON; Nathalie Delmaire, Montreal, PQIntroduction: Liver failure presents a high mortality ratebecause of the usual complications associated with thisdisease, such as renal and pulmonary failure, hepaticencephalopathy and circulatory collapse. Up to now, currentstandard medical treatment (SMT) for liver failure includes thetreatment of symptoms and support to the affected organs.Liver transplantation is the only therapy that has a significantimpact on survival of the patients. However, the shortage ofsuitable donors and the waiting time required for the procedurelimits its use. Extracorporeal devices have been used tosupport the kidneys, the lungs and the heart, but have littleeffect on the liver’s detoxification function. Since itsdevelopment in Germany in 1999, Molecular AdsorbentRecirculating System (MARS) has gained popularity in itsability to fill this gap. This new mode of therapy is now beingintroduced in Canada.This presentation aims to impart an understanding of theanatomy, physiology and pathophysiology of the liver andprinciples involved with the treatment including MARS. It willdiscuss the experience and preliminary results in a majorCanadian liver centre and the benefits of this therapy in theICU.Discussion: The liver is the largest internal organ that iscapable of performing a multitude of functions that include:synthesis and metabolism of fat, protein, and carbohydrates,regulation of vascular function, maintenance of homeostasis,immunological and detoxification. Current SMT methods aimat substituting some of these functions, but fail to support thedetoxification process. The subsequent imbalance betweenproduction and excretion results in the accumulation of thesetoxins, affecting the functions of the other organs such as thekidneys, lungs, brain, heart and, eventually, death of the livercells.28 16 • 2 • Summer 2005 CACCN

Extracorporeal devices have been used to substitute for thedetoxification function of the liver. These include the use ofhemodialysis, continuous renal replacement therapies (CRRT),plasmapheresis and plasmadsorption using charcoal filters.Liver toxins that are mostly albumin-bound are not removedby hemodialysis or CRRT since the albumin molecules are toobig to pass through the pores of the membranes used in thesetherapies. Plasmapheresis and plasmadsorption are non-selective in the removal of molecules which, in turn, results inthe removal of the “good and bad stuff”. The development ofa new technology called “Molecular Adsorbent RecirculatingSystem (MARS) in Germany in 1999 has shown significantimprovement in stabilizing the hemodynamics, decreasing theeffects of complications of liver failure, and providing a bridgefor liver transplantation.MARS combines the technology of renal replacementtherapies, adsorption columns and albumin dialysis. Iteffectively removes the small to medium water-soluble toxinsnormally removed with the regular renal replacement therapiesand the albumin-bound toxins associated with liver failure. Theintroduction of this technology in Canada promises a new hopefor our patients with liver failure in the intensive care units.Clinical trial will start this year at different centres in Canada toevaluate the outcome of this therapy. Because MARS requiresthe use of a standard dialysis machine, collaboration betweennephrology and intensive care services will be necessary toensure a favourable outcome for our liver patients in ICU.Conclusion: MARS provides new hope for our liver patientsin Canada. Adequate training and collaboration between theICU and renal services will ensure favourable clinical outcomewith this therapy.ReferencesBertucci, C., Barsotti, M.C., Raffaelli, A., & Salvadori, P. (2001).Binding properties of human albumin modified by covalentbinding of penicillin. Biochimica et Biophysica Acta,1544, 386–392.Evans, T.W. (2002). Review article: Albumin as a drug–biologicaleffects of albumin unrelated to oncotic pressure. AlimentPharmacology & Therapeutics, 16(Suppl. 5), 6–11.Gambro. (nd). Basic Manual (chap. 2 & 4): MARS 1TCOperator’s manual (Version 4: 04: 14) [Software manual].Author.O‘Grady, J., Lake, J., & Howdle, P. (2000). ComprehensiveClinical Hepatology. St. Louis: Mosby.Sen, S., Jalan, R., & Williams, R. (2003). Liver failure: Basis ofbenefit of therapy with the molecular adsorbentsrecirculating system. Int J of Biochem Cell Biol, 35(9),1306–1311.Sen, S., Williams, R.,& Jalan, R. (2001). The PathopysiologyBasis of AoCLF. Liver, 22, 5-13.Treating a ThrombosedProsthetic Valve with Fibrinolysis —A Multidisciplinary Team Approach

Melissa Rose, Rhonda Noseworthy,Venus Ramsaywak, Toronto, ONThe purpose of this presentation is to review themultidisciplinary approach to caring for a patient with athrombosed prosthetic valve. It is a critically challenging eventand requires a coordinated effort from all team members. Ourpatient is a 55-year-old Tamil-speaking male. Our cardiologist

received the call mid-afternoon from a community hospitalthat there was an intubated, decompensating patient with athrombosed prosthetic valve that had been confirmed byechocardiography.The administration of tPA for a thrombosed prosthetic valve isa relatively new treatment. The thrombosis occursinfrequently, between 0.03 and 4.3% yearly, and is dependenton thromocity of the valve, valve location and quality ofanticoagulation. This patient had difficulty achievinganticoagulation secondary to his language barrier. Thistreatment is not without risk, including hemorrhagiccomplication, embolic events and mortality. The fibrinolysisrequires a coordinated effort from all the multidisciplinaryteam. Our cardiologist directed the care. We required an echocardiologist to perform serial transesophageal echos. Theserial echocardiograms during tPA administration will bereviewed during the presentation. Our CV surgeons and an ORsuite were on standby in case the fibrinolysis was not effectiveand the patient required emergency surgical intervention. Ourpharmacist prepared and delivered the tPA to the unit. Due tothe high level of acuity, this patient required diligent care andsupport from the nurses and respiratory therapist. Thefibrinolysis provided a favourable outcome and, with intenseeducation and follow-up, the patient was able to return home.ReferencesAlpert, J. (2003). The thrombosed prosthetic valve: Currentrecommendations based on evidence from the literature. JAm Coll Cardiol, 41, 659-60.

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Behrendt, P., Schwartzkopff, B., Perings, S., Gerhardt, A., Zotz,R.B., & Strauer, B.E. (2002, November/December).Successful thrombolysis of St. Jude Medical aorticprosthesis with tissue-type plasminogen activator in apregnant woman: A case report. Cardiol Rev, 10(6), 349-353.Durrleman, N., Pellerin, M., Couchard, D., Hebert, Y., Cartier, R.,Perrault, L.P., et al. (2004, May). Prosthetic valvethrombosis: Twenty-year experience at the Montreal HeartInstitute. Journal of Thoracic and CardiovascularSurgery, 127(5), 1388-1392.Morse, C., & Brown, M. (1999). Collaborative practice in theacute care setting. Critical Care Nursing Quarterly,21(4), 31-36.Roudaut, R., Lafitte, S.T., Roudaut, M.-F., Courtault, C., Perron,J.-M., Jais, C., et al. (2003). Fibrinolysis of mechanicalprosthetic valve thrombosis. J Am Coll Cardiol, 41(4),653-8.Stouffer, G., Sheahan, R.G., Lenihan, D.J., Tsiouris, N., &Ahmed, M. (2001). Prosthetic valve thrombosis andthrombolysis: A case report and review of the literature.American Journal of Medical Sciences, 322(4), 229-232.Tong, A., Roudaut, R., Ozkan, M., Sagie, A., Shahid, M.S.,Pontes, S.C., Jr., et al. (2004). Transesophagealechocardiography improves risk assessment ofthrombolysis of prosthetic valve thrombosis: Results of theInternational PRO-TEE Registry. J Am Coll Cardiol, 43,77-84.Topol, E. (2003). Anticoagulation with prosthetic cardiac valves.Archives of Internal Medicine, 163, 2251.Exploring CRRT Practice in ICU:A Survey of Canadian Hospitals

Sharon Slivar, Frances Fothergill Bourbonnais,Sue Malone-Tucker, Stephanie Langford, Gloucester, ONContinuous renal replacement therapy (CRRT) is a highlyspecialized therapy not only for patients with acute renalfailure, but also for patients with other critical careconditions. There is limited literature about the currentmanagement, modality choice and various techniques fortreating acute renal failure (ARF) in Canada (Hyman &Mendelssohn, 2002). They surveyed (by mail) all adultacademic and community registered Canadian nephrologycentres (and nephrologists) that offered treatment for ARFin Canada. The largest increase in treatment modality wasin CRRT. The literature in nephrology and critical carenursing indicates a paucity of research on CRRT (Paton,2003). The nursing work involved in CRRT is highlycomplex and the learning requirements are challenging.Hyman and Mendelssohn’s (2002) survey found that ICUnurses have taken over primary responsibility for CRRT.CRRT training requires ongoing and frequent sessions tosustain the level of competence required (Urquhard &Rebeyka, 2000). There are many risks associated withCRRT such as metabolic complications and adverse events

that can result from, but are not limited to theanticoagulation therapy utilized (Gabutti, et al., 2002;Urquhard & Rebeyka, 2000). National data on nursingexperience with CRRT will help to determine what practicestandards are required. To date, there has been noexploration of CRRT nursing practices in Canada.Therefore, the authors conducted a national survey.Findings will be presented in both descriptive statisticsformat and responses from open-ended questions.ReferencesGabutti, L., Marone, C., Colucci, G., Duchini, F., & Schonholzer,C. (2002). Citrate anticoagulation in continuousvenovenous hemodialfiltration: A metabolic challenge.Intensive Care Medicine, 28, 1419-25.Hyman, A., & Mendelssohn, D. (2002). Current Canadianapproaches to dialysis for acute renal failure in the ICU.American Journal of Nephrology, 22, 29-34.Paton, M. (2003). Continuous renal replacement therapy: Slowbut steady. Nursing, 33(6), 48-51.Urquhard, G., & Rebeyka, D. (2000). Continuous venoushemodiafiltration with trisodium citrate anticoagulation incardiac surgery patients. CACCN, 11(4), 22-25.A Surgical Approach to ChronicThromboembolic PulmonaryHypertension

Anne H. Stolarik, Nepean, ONChronic thromboembolic pulmonary hypertension (CTEPH)caused by obstructions to the blood flow in the pulmonarycirculation is one form of pulmonary hypertension which canpotentially be cured by surgery. Pulmonarythromboendarterectomies (PTE) have been performed at theUniversity of Ottawa Heart Institute since 1995. The surgery isvery high-risk and is performed at only a few centres aroundthe world. The patient outcomes at our institution have beenexceptional and rival the centre which has been performingthis surgery for two decades.CTEPH occurs as a result of pulmonary emboli which do notfibrinolyse despite appropriate treatment. Patients developpulmonary hypertension, a disease for which prognosis isdismal. The presenting symptoms are vague and non-specificand often attributed to other health problems. The time todiagnosis ranges from one to three years.The patient recovery following this surgery includesoxygenation problems caused by reperfusion pulmonaryedema and pulmonary steal syndrome, confusion and deliriumand late tamponade. The purpose of this presentation is todiscuss CTEPH and PTE and describe the patients’experiences following the surgery using a case study approach.In addition, the process of intense multidisciplinarycooperation, across provincial lines, essential to ensuresuccess for patients and families, will be outlined.ReferencesChin, K.M., Kim, N.H.S., & Rubin, L.J. (2005). The rightventricle in pulmonary hypertension. Coronary ArteryDisease, 16(1), 13-18.Doyle, R.L., McCrory, D., Channick, R.N., Simonneau, G., &Conte, J. (2004). Surgical treatments/interventions forpulmonary arterial hypertension. ACCP evidence-basedclinical guidelines. Chest, 126(1, Suppl.), 63S-71S.30 16 • 2 • Summer 2005 CACCN

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Fedullo, P.F., Auger, W.R., Kerr, K.M., & Kim, N.H. (2003).Chronic thromboembolic pulmonary hypertension.Seminars in Respiratory and Critical Care Medicine,24(3), 273-285.Lang, I.M. (2004). Chronic thromboembolic pulmonaryhypertension – not so rare after all. New England Journalof Medicine, 350(22), 2236-2238.Langer, F., Schramm, R., Bauer, M., Tscholl, D., Kunihara, T., &Schafers, H.J. (2004). Cytokine response to pulmonarythromboendarterectomy. Chest, 126(1), 135-141.Nick, H.S., Kim, N.H.S., Fesler, P., Channick, R.N., Knowlton, K.U.,Ben-Yehuda, O., et al. (2004). Preoperative partitioning ofpulmonary vascular resistance correlates with early outcomeafter thromboendarterectomy for chronic thromboembolicpulmonary hypertension. Circulation, 109(1), 18-22.Pengo, V., Lensing, A.W.A., Prins, M.H., Marchiori, A.,Davidson, B.L., Tiozzo, F., et al. (2004). Incidence ofchronic thromboembolic pulmonary hypertension afterpulmonary embolism.New England Journal of Medicine,350(22), 2257-2264.Families as Partners in Critical Care

Lieve Verhaeghe, Patricia Hynes, Toronto, ONFamilies of critically ill patients have long prioritized theirneed to receive regular information, reassurance and support,and to be close to the patient (Henneman, & Cardin, 2002).Having a philosophy of family-centred care recognizes theimportant role of each interdisciplinary team member inbringing these processes to focus. Patient care must beapproached in the context of a family unit if the best possiblecare is to be provided. All staff must be educated to include theneeds of families in the plan of care.

Often, these important needs can be met through simpleinterventions such as providing regular updates andflexible visitation. When family needs are more complex,they require a planned interdisciplinary approach. Timelyreferrals to team members such as the social worker,pastoral care and clinical nurse specialist can facilitate theprocess. In addition, a waiting room information pamphletdescribing the intensive care unit (ICU) and the roles andresponsibilities of team members can be enormouslyuseful. A satisfaction survey can help in refining ourpractices.The roles of critical care nurses and the social worker, inparticular, interface in numerous ways. When their work ischaracterized by effective communication and ongoingcollaboration, the opportunities to promote and supportfamily-centred care are maximized. In this presentation,we will share insights into how interdisciplinarycollaboration benefits critically ill patients and theirfamilies in one university-affiliated institution. Strategiesemployed to ensure that a philosophy of family-centredcare is ongoing will be shared.ReferencesHenneman, E., & Cardin, S. (2002). Family-centered critical care:A practical approach to making it happen. Critical CareNurse, 22, 12-19.

A B S T R A C T S

Abstracts are currently being accepted for oral and posterpresentations for Dynamics 2006, to be held in St. John’s,Newfoundland, September 24-26. Topics of interest includeclinical reviews and research, innovative projects andsolutions, and ethics. All submissions must be evidence-based.Abstract submission guidelinesSubmissions for Dynamics 2006 will be accepted as:Hard copy and 3 1/2” disk or CD ROM (Word orWordPerfect)OR e-mail and attached files (Word or WordPerfect)Submissions must include the following:• Abstract: maximum 300 words, include only title andabstract (do not identify author(s) on abstract)• Reference List: reference list in APA format(maximum 2 pages)• Presentation Information:(separated from the abstract and references)- identify preferred format of presentation (oral or poster)- list names of all authors- provide contact information for first author including:name, fax number, mailing address with postal code, homeand work telephone numbers, and e-mail address• Presentation experience:• for each author, indicate presentation experience(frequency, location of presentation, audience size,evaluation summaries and references)

Important note• Only completed submissions received by midnight,January 31, 2006, will be considered.• All correspondence will be with the first author only.• One presenter for each accepted abstract will be entitled toa discounted tuition.• All other expenses are the responsibility of the presenter(s).• Notification regarding selection decisions will be providedby March 1, 2006.• Abstracts accepted for presentation at Dynamics 2006 mustnot be presented at a national or provincial level for aperiod of 12 months prior to, and/or six months afterDynamics 2006. Abstracts are the property of CACCNduring this period of time, and may be published inDynamics, The Official Journal of the CanadianAssociation of Critical Care Nurses.Please Send Submissions To:

Dynamics 2006 Abstracts,CACCN, PO Box 25322,London, Ontario N6C 6B1or e-mail: caccn@caccn.ca (with file attached)Telephone: (519) 649-5284Fax: (519) 649-1458

DYNAMICS 2006 - CALL FOR ABSTRACTS

32 16 • 2 • Summer 2005 CACCN

CACCN Chapter of theYear Award ProgramPurposeTo recognize the effort, contributions and dedication of achapter of CACCN in carrying out the purposes and goals of theassociation.Criteria for the award program1. The award program will be for the period of July 1 to June 30each year.2. Chapters may win the award for one year followed by a two-year lapse before entering again.3. A point system has been developed to evaluate chapter activitiesduring the year. The chapter with the most points will be thewinner of the Chapter of the Year Award. CACCN reserves theright to adjust points depending upon supporting materialssubmitted.4. The award winner will be announced at Chapter ConnectionsDay.Conditions for the award program1. All chapters of CACCN are eligible to participate provided theyhave on file at national office all of their financial (quarterly) andactivity (bi-yearly) reports required for the qualifying period.2. Chapters must submit their entry forms and accompanyingbinders to national office, postmarked by July 31 of that year.3. Each chapter is required to record its activities and its totalpoints awarded for each activity.4. Supporting materials are to be typewritten in a looseleaf binder,separated by category.5. Each entry must contain a cover sheet listing the points accruedin each category and the total overall points.If the above conditions are not met, the entry will bedisqualified.The winning chapter will receive a plaque and cheque for$500.00 that will be presented at that year’s Dynamics.Announcement of the winner will be published in CACCNpublications. The winning chapter’s binder will be displayed atthat year’s Dynamics.Categories and their corresponding points1. List the educational programs, with an accompanying brochure orpamphlet, that occurred during the period of July 1 - June 30.Programs between:1-3 hours... 25 points each3-8 hours... 50 points each> 8 hours... 100 points each2. Submit the minutes of business meetings held during thequalifying period.

10 points for each meeting to a maximum of 5 meetings.3. Provide member attendance sheets for each program and/ormeeting, and calculate your points based on percentage ofmembers who attend the program and/or meeting out of the totalchapter membership.e.g., 100 members in chapter, 25 attend a program/meeting,therefore 25 ÷ 100 x 100% = 25% (30 points)1-10% ...................10 points 51-60%................60 points11-20%..................20 points 61-70%................70 points21-30% .................30 points 71-80%................80 points31-40% .................40 points 81-90%................90 points41-50%..................50 points 91-100% ............100 points

4. Submit a list of new members recruited from July 1 toJune 30 during the qualifying period, and include nationalCACCN membership numbers. Calculate your points basedon the percentage of new members recruited as compared tothe total membership of July 1 (prior to the qualifyingperiod).1-10% ...................10 points 51-60%................60 points11-20%..................20 points 61-70%................70 points21-30% .................30 points 71-80%................80 points31-40% .................40 points 81-90%................90 points41-50%..................50 points 91-100% ............100 points5. Submit a sample of each newsletter published for themembership. A minimum of three is required to qualify for thepoints. Special announcements are not to be included.100 points6. List each chapter member who has contributed an article(excluding executive reports) to the chapter newsletter for thequalifying period. Please provide the newsletter containing thearticles.25 points for each member7. Submit a copy of a written paper(s) authored or co-authored byat least one member of the chapter that is published in Dynamics,the Official Journal of the Canadian Association of CriticalCare Nurses for the qualifying period.100 points/paper8. List projects that provide public education, community serviceand/or promote the image of critical care nursing. These projectsmust be presented under the auspices of the CACCN chapter.i.e., participating in blood pressureclinics, teaching CPR to the public,participating in health fairs.Validation must be provided that the event was a CACCN-sponsored project by, for example, submitting a letter from thereceiving group or a picture of the event, etc.50 points for each project9. List each chapter member your chapter has funded to attendDynamics in the qualifying period. The points will be calculatedon a percentage of money spent on that member in relation to thecurrent financial account at that time. Please provide proof that themember attended.i.e., $350 spent on a member; total in financial account at that time= $3,500; therefore $350 ÷ $3,500 x 100% = 10% (10 points)1-10% ...................10 points 51-60%................60 points11-20%..................20 points 61-70%................70 points21-30% .................30 points 71-80%................80 points31-40% .................40 points 81-90%................90 points41-50%..................50 points 91-100% ............100 points

In the case of a tie, CACCN reserves the right todetermine the winner.Good luck in your endeavours!

Available Awards

CACCN Research GrantGrant available:A CACCN research grant has been established to provide funds($1,000) to support the research activities of a CACCN memberthat are relevant to the practice of critical care nursing. A grantwill be awarded yearly to the investigator of a research study thatdirectly relates to the practice of critical care nursing.Eligibility:The principal investigator must:• Be a member of CACCN in good standing for a minimum ofone year• Be licensed to practise nursing in Canada• Conduct the research in Canada• Publish an article related to the findings in Dynamics, theOfficial Journal of the Canadian Association of CriticalCare NursesCACCN members enrolled in graduate nursing programs mayalso apply. Members of the CACCN board of directors and theawards committee are not eligible.Application requirements:• A completed application form.• A grant proposal not in excess of five pages exclusive ofappendices. Appendices should be limited to essentialinformation, e.g., consent form, instruments, budget.• A letter of support from the sponsoring agency (hospital,clinical program) or thesis chairperson/advisor (universityfaculty of nursing).• Evidence of approval from an established institutional ethicalreview board for research involving human subjects and/oraccess to confidential records. Refer to the CNA publicationEthical Guidelines for Nursing Research Involving HumanSubjects.• A brief curriculum vitae for the principal investigator and co-investigator(s) describing educational and critical care nursingbackground, CACCN participation, and research experiences.An outline of their specific research responsibilities is to beincluded.• Proof of CACCN active membership.Budget and financial administration:• Funds are to be issued to support research expenses.• Funds must be utilized within 12 months from the date of awardnotification.Review process:• Each proposal will be reviewed by a research reviewcommittee. Its recommendations are subject to approval by theboard of directors of CACCN.• Proposals are reviewed for potential contribution to the practiceof critical care nursing, feasibility, clarity and relevance.• Deadline for receipt of application in CACCN national office isFebruary 15. The recipient of the research grant will be notifiedby mail.Terms and conditions of the award:• The research award is to be initiated within six months of thereceipt of the grant. Any changes to the study timelinesrequire notification in writing to the board of directors ofCACCN.• All publications and presentations arising from the researchstudy must acknowledge CACCN.• A final report is to be submitted to the board of directors ofCACCN within three months of the termination date of thegrant.• An article related to the research study is to be submitted toDynamics, the Official Journal of the Canadian Associationof Critical Care Nurses for publication.Deadline for submission February 15

Johnson & JohnsonEditorial AwardsThe awardsThe Johnson & Johnson Editorial Awards will be presentedto the authors of two written papers in Dynamics, theOfficial Journal of the Canadian Association of CriticalCare Nurses which demonstrate the achievement ofexcellence in the area of critical care nursing. A $750.00award will be given to the author(s) of the best article, and$250.00 given to the author(s) of the runner-up article. It isexpected that the money will be used for professionaldevelopment. More specifically, the funds must be used bythe recipient:1) within 12 months following the announcement of the winners,or within a reasonable time;2) to cover and/or allay costs incurred while attending critical carenursing-related educational courses, seminars, workshops,conferences or special programs or projects approved by theCACCN, and3) to further one’s career development in the area of critical carenursing.Eligibility1) The author is an active member of the Canadian Association ofCritical Care Nurses (minimum of one year). Should there bemore than one author, at least one has to be an active member ofthe Canadian Association of Critical Care Nurses (minimum ofone year)2) The author(s) is prepared to present the paper at Dynamics ofCritical Care (optional).3) The paper contains original work, not previously published bythe author(s).4)Members of the CACCN board of directors, awards committeeor editorial committee of Dynamics, the Official Journal of theCanadian Association of Critical Care Nurses are excludedfrom participation in these awards.Criteria for evaluation1) The topic is approached from a nursing perspective.2) The paper demonstrates relevance to critical care nursing.3) The content is readily applicable to critical care nursing.4) The topic contains information or ideas that are current,innovative, unique and/or visionary.5) The author was not the recipient of the award in the previousyear.StyleThe paper is written according to the established guidelines forwriting a manuscript for Dynamics, the Official Journal of theCanadian Association of Critical Care Nurses.Selection1) The papers are selected by the awards committee in conjunctionwith the CACCN board of directors.2) The awards committee reserves the right to withhold the awardsif no papers meet the criteria.Presentation1) The awards are presented by a representative of Johnson &Johnson at the Dynamics of Critical Care Conference.

CACCN 16 • 2 • Summer 2005 33

The Johnson & JohnsonInnovative Project AwardThe Johnson & Johnson Innovative Project Award will bepresented to a group of critical care nurses who develop a project thatwill enhance their professional development. The primary contactperson for the project must be an active member of CACCN (for atleast one year). If the applicant(s) are previous winners of this award,there must be a one-year lapse before submitting again.Applicationsmust be received in CACCN national office on or before January 15.Presentation of the award will be made at Dynamics.Applications will be judged according to the following criteria:1) the number of nurses who will benefit from the project2) the uniqueness of the project3) the relevance to critical care nursing4) consistency with current research/evidence5) ethics6) feasibility7) timeliness8) impact on quality improvement.Within one year, the winning group of nurses is expected topublish a report that outlines their project in Dynamics, theOfficial Journal of the Canadian Association of CriticalCare Nurses.Do you have a unique idea?Recognition, Recruitmentand Retention AwardThis CACCN initiative was established to recognize membersand the chapters for their outstanding achievements with respectto recruitment and retention. Individual members will berecognized for long-standing service to the association as well.Recognition InitiativeMembers will receive recognition at Dynamics for theirlong service to CACCN. This will be in the form of a pin thatwill be given to people with five years, 10 years, 15 yearsand 20 years of continuous membership in the association.Membership must be renewed within a two-month window inorder to qualify for continuous membership. Note: In thenew national membership database, all members’ “date ofjoining” is March 1996 or after.In addition, new members from the previous 12 months priorto each Dynamics will be given ribbons on their name tags if theyattend Dynamics that year.Recruitment InitiativeThis initiative will benefit the chapter if the followingrequirements are met:• If the chapter recruits 25-49 new members from April 1 toMarch 31 of the next year, they receive one full tuition toDynamics of that year.• If the chapter recruits 50-100 new members from April 1 toMarch 31 of the next year, they receive one full tuition toDynamics of that year plus $100.00.Retention InitiativeThis initiative will benefit the chapter if the followingrequirements are met:• If the chapter has 100% renewal of its previous year’smembers, the chapter will receive $250.00.• If the chapter has greater than 80% renewal of its previousyear’s members, the chapter will receive $150.00.• If the chapter has greater than 60% renewal of its previousyear’s members, the chapter will receive $100.00.

SMITHSEducational AwardsThe CACCN Educational Awards have been established toprovide funds ($750.00 each) to assist critical care nurses to attendcontinuing education programs at the baccalaureate, Masters anddoctorate of nursing levels. All critical care nurses in Canada areeligible to apply, except members of the CACCN board ofdirectors.Criteria for application1) be an active member of CACCN in good standing for aminimum of one (1) year.2) demonstrate the equivalent of one (1) full year of recentcritical care nursing experience in the year of the application.3) be an active member (minimum of one [1] year) of CACCNcommittee(s) and/or participate in other chapter-relatedactivities. Past participation is acceptable.4) submit a letter of reference from his/her current employer.5) be accepted to an accredited school of nursing orrecognized critical care program of direct relevance to thepractice, administration, teaching and research of criticalcare nursing.6) incomplete applications will not be considered; quality ofapplication will be a factor in selecting winners.7) was not the recipient of this award in the past two years.Application process1) submit completed CACCN educational award applicationforms to national office (forms package can be requested fromnational office).2) obtain a minimum of 250 merit points (preference will begiven to members with the highest number of merit points).3) keep a record of his/her own merit points, dating back three (3)years (forms included in package).4) submit all required documentation outlined in criteria -candidate will be disqualified if documentation is notsubmitted with application.Post-application process1) all applications will be acknowledged in writing from theawards committee.2) unsuccessful applicants will be notified individually by theawards committee.3) winners will be acknowledged at Dynamics of Critical Careand published in the official journal.

Deadlines for receipt ofapplications in national office are:September 1 and January 31of each year.For all awards, each newsubmission requires a newapplication34 16 • 2 • Summer 2005 CACCN