Papers by Patricia Moloney-Harmon
Critical Care Medicine, Jul 1, 2011
Objective: To provide a series of recommendations, based on the best available evidence, to guide... more Objective: To provide a series of recommendations, based on the best available evidence, to guide clinicians providing nursing care to patients with severe sepsis. Design: Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among entire group to achieve consensus. Methods: We used the Surviving Sepsis Campaign Guidelines (SSC) as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. Results: Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene and prevention of respiratory, central-line related, surgical site and urinary tract infections, while infection management recommendations related to both control of the infection source and transmission based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia and the role of therapeutic end points. Conclusion: Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.
AACN Advanced Critical Care, Jul 1, 2010
Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagula... more Pathophysiology The Virchow triad of venous stasis, injury to the vessel wall, and a hypercoagulable state is considered to be the chief mechanism for venous thrombosis development. The development of venous thrombosis occurs when coagulation is triggered in areas of decreased blood flow or areas where particles and xenobiotics are infused, or when the infused emulsion characteristics become altered because of physicochemical interactions. Thrombosis is set off by several interacting pathways (coagulation and complement pathways) often consisting of enzymes that intensify the effect of an early trigger event. A similar series of events result in fibrinolysis, and even though thrombus development and thrombolysis are constant actions, with increased stasis, procoagulant factors, or injury to the endothelium, the pathologic development of an obstructive thrombus may occur. Deep vein thrombosis of the lower extremity usually commences in the deep veins around the valve cusps or at venous branch points such as in calf or femoral veins. Venodilation can disturb the endothelial cell barrier and uncover the subendothelium. Platelets attach to the subendothelial surface (extrinsic pathway), activating neutrophils and platelets. A similar activation via the contact system (intrinsic pathway) can follow the insidious infusion of xenobiotics and particles. The coagulation and interacting complement pathway release procoagulant and inflammatory mediators (such as selectins), leading to an active inflammatory response in the vessel wall and the development of a thrombus. Most calf vein thrombi resolve spontaneously without therapy. Approximately 20% spread proximally. The process of adherence of a venous thrombus does not begin until 5 to 10 days after thrombus development. Until this process has been fully established, the nonadherent thrombus may propagate and/or embolize.
Critical Care Nursing Clinics of North America, Sep 1, 1994
Violence, especially that related to the use of firearms, has become a leading cause of death in ... more Violence, especially that related to the use of firearms, has become a leading cause of death in children in the United States. Providing physical and psychosocial care for the child with a gunshot wound is a nursing challenge. Nurses can and must play a major role in helping to prevent this public health problem.
Pediatric Critical Care Medicine, Aug 1, 2018
Objectives: To describe practical considerations and approaches to best practices for end-of-life... more Objectives: To describe practical considerations and approaches to best practices for end-of-life care for critically ill children and families in the PICU. Data Sources: Literature review, personal experience, and expert opinion. Study Selection: A sampling of the foundational and current evidence related to the withdrawal of life-sustaining therapies in the context of childhood critical illness and injury was accessed. Data Extraction: Moderated by the authors and supported by lived experience. Data Synthesis: Narrative review and experiential reflection. Conclusions: Consequences of childhood death in the PICU extend beyond the events of dying and death. In the context of withdrawal of life-sustaining therapies, achieving a quality death is impactful both in the immediate and in the longer term for family and for the team. An individualized approach to withdrawal of life-sustaining therapies that is informed by empiric and practical knowledge will ensure best care of the child and support the emotional well-being of child, family, and the team. Adherence to the principles of holistic and compassionate end-of-life care and an ongoing commitment to provide the best possible experience for withdrawal of lifesustaining therapies can achieve optimal end-of-life care in the most challenging of circumstances.
The impact of critical care on the child the impact of critical care on the family ethical issues... more The impact of critical care on the child the impact of critical care on the family ethical issues in paediatric critical care legal issues in paediatric critical care cardiovascular disorders pulmonary disorders neurologic disorders fluid and electrolyte disorders renal disorders gastrointestinal disorders immunologic disorders oncologic disorders endocrine disorders haematologic disorders shock trauma transplantation toxic ingestions thermal injuries human immunodeficiency virus resuscitation nutrition thermoregulation skin integrity pain management.
Critical Care Nurse, 1999
Page 1. The Synergy Model: Contemporary Practice of the Clinical Nurse Specialist Patricia A. Mol... more Page 1. The Synergy Model: Contemporary Practice of the Clinical Nurse Specialist Patricia A. Moloney-Harmon, RN, MS, CCRN ... The CNS ensures that collaboration at all levels occurs as the key to achieving optimal patient outcomes. ...
Critical Care Nursing Clinics of North America, 1989
Pediatric Critical Care Medicine, 2018
Objectives: To describe practical considerations and approaches to best practices for end-of-life... more Objectives: To describe practical considerations and approaches to best practices for end-of-life care for critically ill children and families in the PICU. Data Sources: Literature review, personal experience, and expert opinion. Study Selection: A sampling of the foundational and current evidence related to the withdrawal of life-sustaining therapies in the context of childhood critical illness and injury was accessed. Data Extraction: Moderated by the authors and supported by lived experience. Data Synthesis: Narrative review and experiential reflection. Conclusions: Consequences of childhood death in the PICU extend beyond the events of dying and death. In the context of withdrawal of life-sustaining therapies, achieving a quality death is impactful both in the immediate and in the longer term for family and for the team. An individualized approach to withdrawal of life-sustaining therapies that is informed by empiric and practical knowledge will ensure best care of the child and support the emotional well-being of child, family, and the team. Adherence to the principles of holistic and compassionate end-of-life care and an ongoing commitment to provide the best possible experience for withdrawal of lifesustaining therapies can achieve optimal end-of-life care in the most challenging of circumstances.
Critical Care Nursing Clinics of North America, 1999
A cute respiratory failure is generally the most common system failure seen in children. Acute re... more A cute respiratory failure is generally the most common system failure seen in children. Acute respiratory failure may result from numerous causes, and the severity can vary greatly. Acute respiratory distress syndrome (ARDS) is the most severe end point of the clinical spectrum of acute lung injury (ALI). Previously known as adult respiratory distress syndrome, this syndrome is associated with a variety of acute diseases in critically ill children. The estimate of the incidence of ARDS in children who were admitted to the hospital with sepsis, pneumonia, smoke inhalation, or drowning was 12% in one study. 10 Information from the Pediatric Critical Care Study Group found the overall mortality to be 52% for pediatric ARDS.31 One repolt demonstrates that an alveolar-alterial oxygen tension difference of greater than 420 is an early predictor of death. 10 Sepsis and multiple organ dysfunction syndrome appear to be the two events that contribute to the high mottality and morbidity seen in children with ARDS.
Critical Care Nursing Clinics of North America, 1994
Violence, especially that related to the use of firearms, has become a leading cause of death in ... more Violence, especially that related to the use of firearms, has become a leading cause of death in children in the United States. Providing physical and psychosocial care for the child with a gunshot wound is a nursing challenge. Nurses can and must play a major role in helping to prevent this public health problem.
Critical Care Nursing Clinics of North America, 1991
The care that the child receives during the initial resuscitation and stabilization of a life-thr... more The care that the child receives during the initial resuscitation and stabilization of a life-threatening injury makes a critical difference in long-term outcome. Children who die as a result of a traumatic injury usually do so because of airway compromise, irreparable CNS injury, or bleeding. Hypoxia is the final common event by which these three kill children. If hypoxia is prevented or recognized and treated early, its effects can be reversed before they become permanent. The potential for a good outcome is maximized by expert nursing care for the critically injured child. Expert nursing care includes rapid and accurate assessment and interventions during both the primary and secondary surveys. Knowledge of the anatomic and physiologic differences between children and adults guides the nurse in holistic care of pediatric trauma victims; the nurse must also understand and address the emotional needs of the patients and their families.
Nursing (Ed. española), 2015
Critical Care Nursing Clinics of North America, 2005
Nursing Critical Care, 2014
Nursing, 2015
while a vast amount of research and literature is available regarding the treatment of pediatric ... more while a vast amount of research and literature is available regarding the treatment of pediatric sepsis, the opportunities for continued investigation are innumerable. As research progresses, nursing practice must remain current to provide patients with interventions based on the strongest evidence available. ■ Earn CE credit online: Go to http://www.nursingcenter.com/CE/nursing and receive a certifi cate within minutes.
Critical Care Nursing Clinics of North America, 2004
Pediatric Critical Care, 2011
Pediatric Critical Care, 2006
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Papers by Patricia Moloney-Harmon