Clinical Pearls

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death, and the number of COPD-related hospitalizations is expected to increase. Noninvasive methods of ventilation (NIV) have been successful in decreasing the need for mechanical ventilation and reducing mortality. However, patients receiving NIV require continuous monitoring, which significantly increases nursing workload.Lange and colleagues examined trends in NIV use with patients hospitalized for acute exacerbations of COPD between 2010 and 2019. They found Use of NIV increased from 6.2% to 10.9% while use of mechanical ventilation decreased from 6.0% to 4.5%.Hospital mortality rates decreased from 2.6% to 2.0%.Mean hospital NIV caseloads increased from 207.3 to 360.4.Given the resource-intensive nature of NIV, the authors suggest future work focus on determining optimal resource allocation to accommodate the expected growth of COPD-related hospitalizations.See Article, pp 220–229Although most young adults are healthy, more than 50% have at least 1 chronic condition. Those who are experiencing a chronic or life-threatening condition are often unprepared for informed decision-making regarding their preferences for care. However, little research has been conducted with this age group to understand their needs.Erickson and colleagues explored the characteristics of young adults aged 18 to 39 years who were hospitalized in an intensive care unit. They found The study results contribute to the small body of literature on this population. Understanding the characteristics of young adults can guide future research in developing effective interventions.See Article, pp 174–182Healthy work environments (HWEs) improve patient and staff outcomes, job satisfaction, and intent to stay in practice. In addition, negative outcomes such as nurse burnout and compassion fatigue are reduced in a positive work environment.Parker and colleagues evaluated the implementation of the American Association of Critical-Care Nurses (AACN) HWE framework in a 6-year period. They found that Findings show that interventions grounded in the HWE framework are sustainable for a long period. The authors recommend that nursing leaders engage staff in opportunities to promote a healthy environment that improves work satisfaction and reduces turnover.See Article, pp 183–192Older adults often have oral diseases that can affect their oral health and quality of life. Oral health has been associated with pneumonia in hospitalized patients. Because oral microbial changes occur with age and older adults have a high risk of pneumonia, it is important to understand the impact of such changes on hospitalized older adults.Rathbun and colleagues assessed the oral microbiome among hospitalized older adults who were not receiving mechanical ventilation and compared results between patients admitted from home and patients admitted from a skilled nursing facility (SNF). They found that the SNF patients had These study findings support past research on the need for consistent oral care provided to patients at least twice daily to reduce negative outcomes. The authors recommend continued research on strategies to improve oral care in SNF patients.See Article, pp 208–217