BackgroundThe importance of enteral nutrition (EN) in critically ill patients is well documented. However, actual administration of EN frequently does not amount to prescribed nutrition goals. Persistent underfeeding may lead to impaired immune response, increased mortality, and higher costs. Traditionally, EN uses a rate‐based approach, utilizing slow titration to goal and a final fixed hourly rate, regardless of interruptions in feeding. Volume‐based feeding (VBF) establishes a 24‐hour EN goal volume, and the rate varies to achieve this daily goal when interruptions occur.Materials and MethodsThis was a retrospective, single‐center, quasi‐experimental study comparing traditional rate‐based feeding (RBF) to VBF in adult patients admitted to the medical and neurosurgical intensive care units (ICUs). The primary outcome was mean percentage of total goal energy received after EN initiation until 7 days, transfer from ICU, removal of feeding tube, or oral diet order placed. Secondary outcomes included mean percentage of total goal protein received, percentage of patients meeting 80% of nutrition goals, incidence of gastric residual volumes >400 mL, and incidence of moderate hyperglycemia (>250 mg/dL).ResultsThe study enrolled 189 patients. Mean percentage of goal energy delivered (75% RBF, 102% VBF; P < .001) and goal protein delivered (68% RBF, 87% VBF; P < .001) was significantly higher with VBF compared with RBF.ConclusionVBF demonstrated a significant increase in energy and protein delivery with no major safety or tolerability issues. VBF should be considered for use in ICU patients to optimize nutrition delivery.

Objective: Moral distress (MD) is a problem for nurses that may cause despair or disempowerment. MD can have consequences like dissatisfaction or resignation from the nursing profession. Techniques such as evidence-based debriefing may help nurses with MD. Creating opportunities for critical care nurses to debrief about their MD might equip them with the tools needed to overcome it. Measuring MD by using the Moral Distress Thermometer (MDT) could provide insight into how debriefings help nurses. The purpose of this pilot project was to examine the impact of evidence-based debriefing sessions on critical care nurses’ sense of MD.Methods: This pilot project used a quasi-experimental, one-group, before-during-after design. Critical care nurses (N = 21) were recruited from one unit at a large academic medical center. Four debriefing sessions were held every 2 weeks. Participants completed the MDT 2 weeks before the first session, at the end of each session they attended, and 1 month after the debriefing sessions.Results: In the pilot project, participants felt that debriefing was helpful by increasing their self-awareness, giving them time to commune with colleagues, and encouraging them to improve self-care habits; however, MDT scores did not change significantly when comparing pre with post intervention scores (t(12) = 0.78, p = .450).Conclusions: The use of debriefing may help nurses gain self-awareness of MD and it may offer nurses strategies to build moral resilience.

The expansion of nurse-led digital technology in acute and critical care hospital units holds promising potential for improving the quality and efficiency of patient care. Recognizing the need to adapt traditional models of care to accommodate a growing shortage of nurses and higher acuity patients, this article outlines three virtual nursing initiatives that provide real-time support to bedside caregivers and enhance patient safety. A new hybrid model of nursing care, which integrates virtual intensive care nursing, acute care telenursing, and remote telesitting services into clinical nursing workflow, maximizes the size and skill mix of both the remote and bedside nursing teams. Thoughtful stakeholder planning and a collaborative technology integration process has also enhanced sustainability efforts. In this way, new virtual nursing services complement and extend the impact of the primary clinical nursing team, offering tools and structural support that streamlines care delivery processes and eases workload burden without sacrificing the quality of patient care.

The current health care environment demands competent providers who possess advanced knowledge and skills necessary to care for an increasingly acute patient population. Nurse Practitioners (NPs) are uniquely positioned to meet the challenges of today's health care climate because they blend their ability to treat illness with a strong emphasis on patient safety and outcomes while providing patient-and family-centered care. The role of the NP requires sophisticated clinical and critical thinking skills that foster the ability to synthesize theoretical, scientific, and contemporary clinical knowledge for the assessment and management of both healthy and illness states. It is crucial that NPs possess advanced skills to provide safe and effective patient care outcomes. The literature suggests that there is a transition period after graduation for novice NPs. Developing additional focused educational opportunities to supplement the training phase of their graduate education can better prepare student NPs and consequently enhance this transition phase. As a result, newly licensed NPs can deliver high-quality, safe patient care sooner after obtaining their advanced practice license. At a time when health care reform is rapidly evolving, it is critical that NPs are reliable, competent professionals. Houston Methodist Hospital created an employment-based educational opportunity for elite graduate NP students: Leading Education and Advancing Professionals (LEAP). This 12-month program is a structured evidence-based internship program that incorporates didactic training, clinical rotations, and simulation. Students are provided hands-on training that features interdisciplinary and collaborative care model components from experienced Houston Methodist NPs. The goal is to help develop the next generation of health care providers in which the expectation is to lead and not follow in meeting today's health care challenges. The aim of this article is to present an overview of the LEAP program.

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