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Article-at-a-Glance Background From 2003–2005, a comprehensive review of all cardiac/respiratory arrests at Mission Hospital (Mission Viejo, California) uncovered deficits in knowledge and judgment in the hours preceding 75% of our non-ICU patients. Nearly half of all arrests were occurring outside the ICU, with an overall mortality rate of 60%. In addition, transfers into ICU from the floor averaged 96 patients per month. Methods A multidisciplinary team met for 12 months to develop a specialized nurse-driven rapid response team (RRT) to reduce the incidence and mortality of non–ICU arrests, reduce transfers to the ICU from the floor, and provide ICU–level nursing care for emergency department (ED) patients in extremis. The team developed an RRT protocol, a methodology for rounds and calls, and a data collection system. After gaining consensus among the nursing managers, 4.2 full-time equivalent (FTE) RRT nurse positions were created by each unit contributing portions of an FTE. Results Prospective data collected demonstrated an inpatient call frequency averaging 118 calls per 1,000 discharges; 138 calls per month were in support of the ED. Floor codes were reduced from 36 to 17 per year, and the mortality rate in the floor-code patients decreased from 61% to 26%. Unanticipated transfers from the floor units to the ICU decreased significantly. Discussion The RRT initiative delivered measurable outcomes demonstrating the hospital's commitment to saving the vulnerable hospitalized patient population. In addition, the identification of critical system and clinical issues resulted in efforts to improve processes and identify patient subpopulations at risk (for example, patients with congestive heart failure, end-stage heart disease, high-dose narcotics).

One of the greatest challenges for critical care nurses and the multidisciplinary team is caring for patients with severe traumatic brain injuries. Interventions to reduce intracranial pressure, optimize cerebral perfusion, and minimize secondary brain injury are implemented in an effort to keep the brain protected after severe head injury. This article provides critical care nurses with practical clinical algorithms and protocols developed from recommendations in the scientific literature that will arm the multidisciplinary team with the necessary tools to maximize outcomes. The team must be prepared to revise the algorithms and protocols based on measured outcomes and new scientific advances.

An important aspect of nursing care is to assist patients in the process of adaptation as proposed by Roy. An individual's response to the diagnosis of stroke and the everchanging environment affords the nurse a tremendous opportunity to assess the patient and factors that may ultimately influence quality of living. Given the devastating consequences of stroke, the efforts directed at improving patient compliance are well placed. Nurses have the opportunity to teach those patients under their direct care as well as those individuals in the community setting. Nurses can also play an instrumental role in health promotion strategies, incorporating lifestyle modifications as well as information based on medication therapy. Taking advantage of professional organizations such as the National Stroke Association, the American Heart Association, and the multiple neuroscience organizations who have developed the Brain Attack Coalition, materials can be accessed and used for acute care and community health education programs. Acute care nurses interact with a variety of women on a daily basis. Each patient presents with her unique physiology and associated risk factors. Acute care nurses must be attuned to these factors and be ready to intervene with assessment, education, and collaboration with the health care team in order to reduce the incidence of stroke in women.