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Research at the bedside makes a difference for our patients, and also for our nurses. However, it is now time to broaden our focus from research on interventions or events at a narrow point in time to research that addresses care across the continuum. This continuum may start at the point of injury, such as the battlefield through en route care delivered during the 8000-mile journey home for our wounded warriors, or for critically ill patients as they move between the emergency department, operating room, and intensive care unit. This focus also requires researchers to consider "care within context," that is, research- and evidence-based practice tailored to the unique conditions of the care environment. Beyond conducting research and developing new knowledge is the challenge of translating evidence into practice. A culture of inquiry is a critical element in the successful translation of evidence into practice. In a culture of inquiry, nurses are encouraged to question and evaluate their practice, provide evidence-based care, and actively participate in and lead clinical inquiry. This article draws from a program of applied clinical research reflecting care across the continuum within both military and civilian health care settings and discusses how the application of these research findings and the advancement of a culture of inquiry make a difference for both patients and nurses., (©2015 American Association of Critical-Care Nurses.)

Background: Research on the accuracy and precision of noninvasive methods of measuring body temperature is equivocal., Objectives: To determine accuracy and precision of oral, ear-based, temporal artery, and axillary temperature measurements compared with pulmonary artery temperature., Methods: Repeated-measures design conducted for 6 months. Sequential temperature measurements on the same side of the body were obtained within 1 minute, with measurements repeated 3 times at 20-minute intervals. Accuracy, precision, and confidence limits were analyzed., Results: In 60 adults with cardiopulmonary disease and a pulmonary artery catheter, mean pulmonary artery temperature was 37.1 degrees C (SD 0.6 degrees C, range 35.3 degrees C-39.4 degrees C). Mean (SD) offset from pulmonary artery temperature (with the mean reflecting accuracy and SD reflecting precision) and confidence limits were 0.09 degrees C (0.43 degrees C) and -0.75 degrees C to 0.93 degrees C for oral measurements, -0.36 degrees C (0.56 degrees C) and -1.46 degrees C to 0.74 degrees C for ear measurements, -0.02 degrees C (0.47 degrees C) and -0.92 degrees C to 0.88 degrees C for temporal artery measurements, and 0.23 degrees C (0.44 degrees C) and -0.64 degrees C to 1.12 degrees C for axillary measurements. Percentage of pairs with differences greater than +/-0.5 degrees C was 19% for oral, 49% for ear, 20% for temporal artery, and 27% for axillary measurements. Intubation increased oral measurements compared with pulmonary artery temperatures (mean difference 0.3 degrees C, SD 0.3 degrees C, P = .001)., Conclusions: Oral and temporal artery measurements were most accurate and precise. Axillary measurements underestimated pulmonary artery temperature. Ear measurements were least accurate and precise. Intubation affected the accuracy of oral measurements; diaphoresis and airflow across the face may affect temporal artery measurements.

The integration of data from a pulmonary artery catheter when used as part of a goal-directed plan of care may benefit certain groups of critically ill patients. Integral to the successful use of the pulmonary artery catheter is to accurately obtain and interpret invasive pressure monitoring data. This article addresses commonly asked clinical questions and considerations for decision making under complex care conditions, such as obtaining hemodynamic measurements when the patient is prone or has marked respiratory pressure variations or increased intraabdominal pressure. Recommendations to optimize the invasive pressure monitoring system are presented. Finally, functional hemodynamic indices, which are more sensitive and specific indices than static indices (pulmonary artery and right artrial pressure) of the ability to respond to a fluid bolus, will be introduced.

Background: Despite demonstrated benefits of lateral positioning, critically ill patients may require prolonged supine positioning to obtain reproducible hemodynamic measurements., Objectives: TO determine the effect of 30 degree right and left lateral positions on pulmonary artery and pulmonary artery wedge pressures after cardiac surgery in critically ill adult patients., Methods: An experimental repeated-measures design was used to study 35 patients with stable hemodynamics after cardiac surgery. Subjects were randomly assigned to 1 of 2 position sequences. Pulmonary artery and pulmonary artery wedge pressures were measured in each position., Results: Measurements obtained from patients in the 30 degree left lateral position differed significantly (all Ps < .05) from measurements obtained from patients in the supine position for pulmonary artery systolic, end-diastolic, and mean pressures. Pulmonary artery wedge pressures did not differ significantly; however, data were available from only 17 subjects. The largest mean difference in pressures between the 2 positions was 2.0 +/- 2.1 mm Hg for pulmonary artery systolic pressures, whereas maximum differences for end-diastolic and pulmonary artery wedge pressures were 1.4 +/- 2.7 mm Hg and 1.6 +/- 2.4 mm Hg, respectively. Clinically significant position-related changes in pressure occurred in 12 (2.1%) of 581 pressure pairs. Clinically significant changes occurred in end-diastolic pressure in 2 subjects and in pulmonary artery wedge pressure in 1 subject., Conclusions: In patients with stable hemodynamics during the first 12 to 24 hours after cardiac surgery, measurements of pulmonary artery and pulmonary artery wedge pressures obtained in the 30 degree lateral and supine positions are clinically interchangeable.