Comparison of diluted vs concentrated regional citrate anticoagulation in continuous renal replacement therapy: A quasi-experimental study

BACKGROUND

The incidence of coagulation of continuous renal replacement therapy circuits remains high. To the best of our knowledge, no scholar has published a protocol to avoid management errors when different types of citrates coexist in the same Intensive Care Unit.

AIM

To assess the safety and efficacy of the unification of two protocols with different concentrations of citrate solution.

STUDY DESING

A prospective, quasi-experimental study was carried out in the intensive care unit of a tertiary referral hospital (in Barcelona, Spain), over 3 years. Consecutive adult patients requiring continuous renal replacement therapy with citrate were included. The sample was divided into two groups, a control group (concentrated citrate) and an intervention group (diluted citrate). The decision to initiate anticoagulation with diluted (18 mmol/L) or concentrated (136 mmol/L) citrate was made based on the machine available and the decision of the doctor responsible for the patient. It was not possible to randomize the sample. Both protocols were matched with a starting citrate dose of 3.5 mmol/L, and a dialysis solution was used. Post-filter replacement was not used, and the citrate solution was the only fluid administered pre-filter.

RESULTS

The analysis included 59 circuits in the concentrated citrate group and 40 circuits in the diluted citrate group. An increased need for electrolyte replacement was observed in the diluted group (p < .001). The concentrated citrate group had a longer filter life (p < .05), and there was a slight trend toward alkalosis.

CONCLUSION

The diluted citrate group had a higher incidence of electrolyte replacement. The concentrated citrate group had longer circuit lifespan and a trend toward metabolic alkalosis, although this was not statistically significant. If these conclusions are considered, the protocol can be unified.

RELEVANCE TO CLINICAL PRACTICE

The present work aims to provide information on the differences in the use of regional anticoagulation with diluted or concentrated citrate. The objective is to pay special attention to aspects that can lead to complications. The unified protocol proposed in this paper could be extrapolated to any machine on the market that uses either of these two types of citrate concentration.

Priority analysis of educational needs for new nurses in the intensive care unit: A cross-sectional study

BACKGROUND

New intensive care unit (ICU) nurses often experience stress because of concerns about potentially harming their patients in a work environment that demands the rapid development of several skills in a limited training period.

AIM

This study aimed to investigate the prioritisation of educational needs within adult ICUs, focusing on how new nurses evaluate their current knowledge and perceive the most critical competencies.

STUDY DESIGN

A cross-sectional study was conducted among a convenience sample of 102 new ICU nurses in general and tertiary hospitals in South Korea. Educational needs were assessed using a structured questionnaire for new ICU nurses. This study investigated educational needs using paired t-tests, Borich's assessment model and the Locus for Focus model.

RESULTS

Only 48% of participants were satisfied with their education. The highest-rated educational content included preparing to use a defibrillator (95% CI = 2.44-3.28, p < .001), administering emergency drugs for cardiopulmonary resuscitation (CPR) (95% CI = 2.09-2.91, p < .001), starting and maintaining continuous renal replacement therapy (95% CI = 1.50-2.42, p < .001), applying and maintaining a ventilator (95% CI = 1.42-2.08, p < .001), preparing for intubation (95% CI = 1.23-1.97, p < .001), reporting to the emergency team, preparing equipment for CPR (95% CI = 1.12-1.94, p < .001) and drug calculation (95% CI = 0.87-1.53, p < .001).

CONCLUSIONS

These findings indicate that educational programmes for new ICU nurses should be developed considering the aforementioned priorities. Furthermore, nurse educators should adopt a practical and active instructional method to repeatedly clarify content, prioritising the improvement of knowledge and performance of new ICU nurses.

RELEVANCE TO CLINICAL PRACTICE

This study guides clinical educators and managers in focusing on areas where new ICU nurses need additional training. Effective nurse residency programmes tailored to the specific needs of new ICU nurses can enhance their confidence and ability to handle ICU nursing challenges.

A dimensional analysis of experienced intensive care unit nurses' clinical decision-making for bleeding after cardiac surgery

BACKGROUND

Bleeding following cardiac surgery is common and serious, yet a gap persists in understanding how experienced intensive care nurses identify and respond to such complications.

AIM

To describe the clinical decision-making of experienced intensive care unit nurses in addressing bleeding after cardiac surgery.

STUDY DESIGN

This qualitative study adopted the Recognition-Primed Decision Model as its theoretical framework. Thirty-nine experienced nurses from four adult intensive care units participated in semi-structured interviews based on the critical decision method. The interviews explored their clinical judgements and decisions in bleeding situations, and data were analysed through dimensional analysis, an alternative to grounded theory.

RESULTS

Participants maintained consistent vigilance towards post-cardiac surgery bleeding, recognizing it through a haemorrhagic dimension associated with blood loss and chest drainage and a hypovolemic dimension focusing on the repercussions of reduced blood volume. These dimensions organized their understanding of bleeding types (i.e., normal, medical, surgical, tamponade) and necessary actions. Their decision-making encompassed monitoring bleeding, identifying the cause, stopping the bleeding, stabilizing haemodynamic and supporting the patient and family. Participants also adapted their actions to specific circumstances, including local practices, professional autonomy, interprofessional dynamics and resource availability.

CONCLUSIONS

Nurses' decision-making was shaped by their personal attributes, the patient's condition and contextual circumstances, underscoring their expertise and pivotal role in anticipating actions and adapting to diverse conditions. The concept of actionability emerged as the central dimension explaining their decision-making, defined as the capability to implement actions towards specific goals within the possibilities and constraints of a situation.

RELEVANCE TO CLINICAL PRACTICE

This study underscores the need for continual updates to care protocols to align with current evidence and for quality improvement initiatives to close existing practice gaps. Exploring the concept of actionability further, developing adaptability-focused educational programmes, and understanding decision-making intricacies are crucial for informing nursing education and decision-support systems.

A study on the related influencing factors of the quality of bowel preparation and the compliance of middle-aged and elderly patients for colonoscopy

OBJECTIVE

Quality of bowel preparation and patient compliance are among the most important indicators to assess the quality of colonoscopy. To investigate the independent factors associated with the quality of bowel preparation in subjects undergoing colonoscopy and its impact on compliance.

METHODS

A total of 329 patient records were collected and were divided into an adequate bowel preparation group (272 cases) and an inadequate bowel preparation group (57 cases), or a compliant group (260 cases) and a non-compliant group (69 cases), based on bowel preparation quality or compliance. The quality of bowel preparation is evaluated using the Boston Bowel Preparation Scale. The comfort level of subjects during bowel preparation is assessed using the Kolcaba General Comfort Questionnaire (GCQ). Subjects' compliance was assessed according to a self-developed compliance questionnaire. Prediction analyses were conducted to identify factors associated with the quality of bowel preparation and compliance.

RESULTS

Age, bowel preparation duration, history of bowel inadequacy, and laxative dosage showed statistical differences between the adequate and inadequate bowel preparation groups (p < 0.05). Age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation quality. Correlation analysis showed that GCQ scores were significantly negatively correlated with age, bowel preparation duration, laxative dose, defecation frequency, and colonoscopy duration (r < 0, p < 0.05), and positively correlated with sleep duration (r > 0, p < 0.05). In addition, age, gender, bowel preparation duration, and laxative dosage showed statistical differences between the compliant and non-compliant groups (p < 0.05). Logistic regression analysis revealed that age, bowel preparation duration, and laxative dosage were independent influencing factors of bowel preparation compliance. Age and bowel preparation duration were independent influencing factors for bowel preparation adequacy and compliance.

CONCLUSIONS

Age, bowel preparation duration, and laxative dosage are independent influencing factors for bowel preparation adequacy and compliance among patients undergoing colonoscopy at the First Affiliated Hospital, School of Medicine, Zhejiang University. It is recommended that a one-day low-residue diet combined with a 2000 mL laxative dosage be used as the bowel preparation protocol for the general colonoscopy population.

Postintensive care syndrome: Development and psychometric validation of a knowledge test

INTRODUCTION

Postintensive care syndrome (PICS) is a combination of short-, medium- and long-term morbidities that occur in patients discharged from the Intensive care unit (ICU). ICU professionals have a crucial role in managing and understanding the PICS. This study aimed to develop the PICS Knowledge Test (PICS-KT), which measures ICU professionals' awareness and knowledge levels regarding PICS, and to determine its validity and reliability.

METHODS

The databases were searched in detail, scientific research related to PICS was analyzed, and the draft scale was created accordingly. A total of 117 doctors and nurses who had been working in the ICU for at least 6 months were included in the study. For the validity and reliability analysis of the test, content validity ratio, item difficulty index, item discrimination index values and Cronbach α were examined.

RESULTS

The Cronbach's α reliability coefficient for the 46-item PICS-KT is 0.93, indicating high reliability. Scores range from 0 to 46, with 32 or higher considered successful, suggesting adequate knowledge of PICS among ICU professionals. Scores of 14 or less indicate minimal knowledge. Those with scores between 14 and 32 possess some knowledge but need improvement. PICS-KT assesses knowledge in four main areas: general information, risk factors/causes, symptoms and findings and interventions. ICU professionals show high awareness of interventions for preventing and treating PICS, as indicated by a high mean score in the interventions subdimension.

CONCLUSION

The PICS-KT is crucial in assessing healthcare professionals' understanding of the various short-, medium- and long-term morbidities associated with PICS. The study ensures that the test is a robust and dependable instrument for evaluating ICU professionals' knowledge about PICS.

Patient recall of intensive care delirium: A qualitative investigation

BACKGROUND

Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU.

METHODS

Our study had a qualitative multicenter design applying individual interviews and thematic analysis. Participants were critically ill adult patients that were determined delirium positive according to validated delirium screening tools during ICU admission. The interviews were conducted after ICU discharge when patients were delirium-free as assessed by the "Rapid clinical test for delirium" (4AT) and able to participate in an interview.

RESULTS

We interviewed 30 patients choosing the main themes deductively: Delirium experience; Delirium related distress; and Delirium management. Despite variations in recollection detail, ICU survivors consistently reported delirium-related distress during and after their ICU stay, manifesting as temporal confusion, misinterpretations, and a sense of distrust towards ICU staff. Delusions were characterized by a blend of factual and fictional elements. Impaired short-term memory hindered communication and intensified feelings of isolation, neglect, and loss of control.

CONCLUSION

The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.

The effect of magnesium sulfate on emergence agitation in surgical adult patients undergoing general anesthesia: A systematic review and meta-analysis of randomized controlled trials

STUDY OBJECTIVE

Investigating the effect of magnesium sulfate (MS) on emergence agitation (EA) in adult surgical patients following general anesthesia (GA).

DESIGN

Systematic literature review and meta-analysis (PROSPERO number: CRD42023461988).

SETTING

Review of published literature.

PATIENTS

Adults undergoing GA.

INTERVENTIONS

Intravenous administration of MS.

MEASUREMENTS

We searched PubMed/MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of Science for publications until September 14, 2023. The primary outcome was the incidence of EA, while the secondary outcomes included the impact of MS on postoperative agitation score (PAS), emergence variables and adverse events. Relative risk (RR) with 95% confidence interval (CI) measured dichotomous outcome, while standardized mean difference (SMD) or mean difference (MD) with 95% CI measured continuous outcomes.

MAIN RESULTS

Meta-analysis of five randomized controlled trials (RCTs) indicated that MS was associated with a lower incidence of EA at various time points (0 min: RR = 0.62, 95% CI [0.41, 0.95]; p = 0.183, I2 = 43.6%; 5 min: RR = 0.29, 95% CI [0.16, 0.52]; p = 0.211, I2 = 36%; 10 min: RR = 0.14, 95% CI [0.06, 0.32]; p = 0.449, I2 = 0%; 15 min: RR = 0.11, 95% CI [0.02, 0.55]; p = 0.265, I2 = 19.5%; 30 min: RR = 0.05, 95% CI [0.00, 0.91]; the postoperative period: RR = 0.21, 95% CI [0.09, 0.49]; p = 0.724, I2 = 0%;). Additionally, MS was associated with a reduced PAS at various time points except for 0 min. However, no significant differences were observed in extubation time, the length of stay in the post-anesthesia care unit, postoperative nausea and vomiting or total complications.

CONCLUSIONS

Limited available evidence suggests that MS was associated with a lower incidence of EA. Nevertheless, further high-quality studies are warranted to strengthen and validate the effect of MS in preventing EA in adult surgical patients.

The Role of High Flow Nasal Therapy in Chronic Respiratory Failure

High-flow nasal therapy (HFNT) has an increasing role in the management of acute hypoxic respiratory failure. Due to its tolerable interface and ease of use, its role in chronic hypercapnic respiratory failure (CHRF) is emerging. This article examines the literature to date surrounding the short and long-term mechanisms of HFNT in sleep and wakefulness of CHRF patients. It is likely HFNT will have an increasing role in those patients intolerant of non-invasive ventilation.

Providing end of life care in the emergency department: A hermeneutic phenomenological study

BACKGROUND

Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department.

METHODS

A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken.

FINDINGS

Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department.

CONCLUSIONS

Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.

Vascular complications in extremities of physically restrained intensive care unit patients: A prospective, observational study

BACKGROUND

Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary.

AIMS

The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors.

STUDY DESIGN

A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann-Whitney U test and Pearson-χ2 test were used to analyse the data.

RESULTS

During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p < .05), lower GCS scores (p < .05) and higher INR values (p < .05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692-34.734, OR = 7.667, p = .032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062-11.599, OR = 3.510, p = .032).

CONCLUSIONS

Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values.

RELEVANCE TO CLINICAL PRACTICE

Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications.

Delirium and Coronavirus Disease 2019: Looking Back, Moving Forward

During the coronavirus disease 2019 pandemic, crisis changes in clinical care increased rates of delirium in the intensive care unit (ICU). Deep sedation, unfamiliar environments with visitor restrictions, and such factors due to high workload and health system strain contributed to the occurrence of delirium doubling in the ICU. As the pandemic wanes, health care systems and ICU leadership must emphasize post-pandemic recovery, integrating lessons learned about delirium management, evidence-based care, and family involvement. Strategies to empower clinicians, creatively deliver care, and integrate families pave the way forward for a more holistic approach to patient care in the post-pandemic era.

A pediatric teletrauma program pilot project: Improves access to pediatric trauma care and timely assessment of pediatric traumas

BACKGROUND

Geographic location is a barrier to providing specialized care to pediatric traumas. In 2019, we instituted a pediatric teletrauma program in collaboration with the Statewide Pediatric Trauma Network at our level 1 pediatric trauma center (PTC). Triage guidelines were provided to partnering hospitals (PHs) to aid in evaluation of pediatric traumas. Our pediatric trauma team was available for phone/video trauma consultation to provide recommendations on disposition and management. We hypothesized that this program would improve access and timely assessment of pediatric traumas while limiting patient transfers to our PTC.

METHODS

A retrospective cohort study was conducted at the PTC between January 2019 and May 2023. All pediatric trauma patients younger than 18 years who had teletrauma consults were included. We also evaluated all avoidable transfers without teletrauma consults defined as admission for less than 36 hours without an intervention or imaging as a comparison group.

RESULTS

A total of 151 teletrauma consults were identified: 62% male and median age of 8 years (interquartile range [IQR], 4-12 years). Teletrauma consults increased from 12 in 2019 to 100 in 2022 to 2023, and the number of PHs increased from 2 to 32. Partnering hospitals were 15 to 554 miles from the PTC, with a median distance of 34 miles (IQR, 28-119 miles). Following consultation, we recommended discharge (34%), admission (29%), or transfer to PTC (35%). Of those who were not transferred, 3% (3 of 97) required subsequent treatment at the PTC. Nontransferred teletrauma consults had a higher percentage of TBI (61% vs. 31%, p < 0.001) and were from farther distances (40 miles [IQR, 28-150 miles] vs. 30 miles [IQR, 28-50 miles], p < 0.001) compared with avoidable transferred patients without a teletrauma consult.

CONCLUSION

Teletrauma consult is a safe and viable addition to a pediatric trauma program faced with providing care to a large geographical catchment area. The pediatric teletrauma program provided management recommendations to 32 PHs and avoided transfer in approximately 63% of cases.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.

Responding to the real problem of sustainable resuscitation skills with real assessment. Mixed-methods evaluation of an authentic assessment programme

INTRODUCTION

The retention of resuscitation skills is a widespread concern, with a rapid decay in competence frequently following training. Meanwhile, training programmes continue to be disconnected with real-world expectations and assessment designs remain in conflict with the evidence for sustainable learning. This study aimed to evaluate a programmatic assessment pedagogy which employed entrustment decision and the principles of authentic and sustainable assessment (SA).

METHODS

We conducted a prospective sequential explanatory mixed methods study to understand and address the sustainable learning challenges faced by final-year undergraduate paramedic students. We introduced a programme of five authentic assessments based on actual resuscitation cases, each integrating contextual elements that featured in these real-life events. The student-tutor consensus assessment (STCA) tool was configured to accommodate an entrustment scale framework. Each test produced dual student led and assessor scores. Students and assessors were surveyed about their experiences with the assessment methodologies and asked to evaluate the programme using the Ottawa Good Assessment Criteria.

RESULTS

Eighty-four students participated in five assessments, generating dual assessor-only and student-led results. There was a reported mean score increase of 9% across the five tests and an 18% reduction in borderline or below scores. No statistical significance was observed among the scores from eight assessors across 420 unique tests. The mean student consensus remained above 91% in all 420 tests. Both student and assessor participant groups expressed broad agreement that the Ottawa criteria were well-represented in the design, and they shared their preference for the authentic methodology over traditional approaches.

CONCLUSION

In addition to confirming local sustainability issues, this study has highlighted the validity concerns that exist with conventional resuscitation training designs. We have successfully demonstrated an alternative pedagogy which responds to these concerns, and which embodies the principles of SA, quality in assessment practice, and the real-world expectations of professionals.

A Core Outcome Set for Research Evaluating Interventions to Enable Communication in Patients With an Artificial Airway: An International Delphi Consensus Study (Comm-COS)

OBJECTIVES

Critically ill adults requiring artificial airways experience profound communication deficits. Studies of interventions supporting communication report disparate outcomes, creating subsequent challenges in the interpretation of their effectiveness. Therefore, we aimed to develop international consensus for a communication core outcome set (Comm-COS) for future trials of communication interventions in this population.

DESIGN

1) Systematic review, 2) patient/family interviews, 3) two-round modified Delphi, and 4) virtual consensus meetings with a final voting round. A multidisciplinary expert steering committee oversaw all stages.

SETTING

Interviews and consensus meetings were conducted via videoconferencing. Digital methods were used for Delphi and final Comm-COS voting.

SUBJECTS

Three stakeholder groups: 1) patient and family members with lived experience within 3 years, 2) clinicians with experience working in critical care, and 3) researchers publishing in the field.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

We identified 59 outcomes via our systematic review, 3 unique outcomes from qualitative interviews, and 2 outcomes from our steering committee. Following item reduction, 32 outcomes were presented in Delphi round 1; 134 participants voted; 15 patient/family (11%), 91 clinicians (68%), and 28 researchers (21%). Nine additional outcomes were generated and added to round 2; 106 (81%) participants voted. Following completion of the consensus processes, the Comm-COS includes seven outcomes: 1) changes in emotions and wellbeing associated with ability to communicate, 2) physical impact of communication aid use, 3) time to functional communication, 4) ability to communicate healthcare needs (comfort/care/safety/decisions), 5) conversation agency, 6) ability to establish a communication connection to develop and maintain relationships, and 7) acceptability of the communication intervention.

CONCLUSIONS

This is the first COS to specifically focus on communication for critically ill adults. Limitations for operationalization include selection of measures to use with these outcomes. Identification of suitable measures and adoption of the Comm-COS in future trials will help establish effective interventions to ameliorate the highly prevalent and negative experience of communicative incapacity.

Maternal Sepsis

Sepsis is the second leading cause of pregnancy-related mortality in the United States. Early recognition, treatment, and escalation of care for the obstetric patient affected by sepsis mitigate the risk of mortality and improve patient outcomes. In this article, we provide an overview of maternal sepsis and address topics of maternal pathophysiology, early warning signs, diagnostic criteria, early goal-directed therapy, and contemporary critical care practices. We also present an overview of common etiologies of maternal sepsis and suggested treatment approaches.

Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences

BACKGROUND

Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice.

AIM

This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses.

STUDY DESIGN

This study adopted a mixed-methods approach.

METHODS

Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics.

RESULTS

Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training).

CONCLUSION

IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care.

RELEVANCE FOR CLINICAL PRACTICE

The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT.

Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context

BACKGROUND

Physical restraint is applied in pediatric intensive care units to carry out certain painful procedures and to ensure the maintenance and continuity of life support devices. There is a need to analyse the factors that influence the behaviour or intention to use physical restraint.

AIM

To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint.

STUDY DESIGN

A psychometric study. Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties.

RESULTS

The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75.

CONCLUSIONS

The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs.

RELEVANCE FOR CLINICAL PRACTICE

Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Nurses' experiences of using a computer-based triage decision support system in the emergency department

BACKGROUND

Emergency department triage is a vital and complex decision-making process. There is limited knowledge about nurses' experiences with triage decision support systems in emergency departments.

AIM

This study was conducted to examine nurses' experiences with a computer-based triage decision support system in the emergency department.

STUDY DESIGN

This is a qualitative and phenomenological study. Data were collected through interviews from 14 triage nurses who used a triage decision support system in the emergency department of a university hospital. The nurses were recruited for semi-structured interviews. All interviews were recorded on a voice recorder and then transcribed. Data were analysed with the inductive content analysis method. The interviewer asked comprehensive questions about the nurses' experiences with the triage decision support system.

RESULTS

Three main and 11 sub-themes were elicited as a result of the analysis of the in-depth interviews: (a) the facilitating the triage decision theme, which included help in case of a dilemma, team collaboration, monitoring/supervision, and error reduction sub-themes; (b) the contribution to professionalism theme, which included ease of learning and teaching triage, professional autonomy, creating a database, and evidence-based practice sub-themes; (c) the areas that need improvement theme, which included reducing screen clicks, the effect of the hospital automation system performance, and clinical descriptors not included in the algorithm sub-themes.

CONCLUSION

Triage nurses stated that the decision support system was beneficial and facilitated decision-making. The decision support system enabled triage nurses to make their own decisions using their clinical knowledge and experience, without a restriction on their professional autonomy, and this was perceived positively. It was emphasized that this system could be a support tool in educating nurses new to triage. However, nurses stated that the pace of the decision support system was affected by the performance of the hospital automation system and that the large number of steps used for electing items caused a waste of time. They also added that these were technical areas that needed improvement.

RELEVANCE TO CLINICAL PRACTICE

The study provides important data that will help healthcare organizations and professionals better understand the emergency department nurse triage decision support system and gain a versatile, comprehensive, and general understanding.

The knowledge and skills of emergency department registered nursing staff at an academic hospital in South Africa, on endotracheal tube cuff manometry, before and after a training session

Introduction

Accurate management of endotracheal tube cuff pressure is essential to prevent patient morbidity and mortality. Due to increased length of stay of critically ill patients in emergency departments, it has become an increasingly important skill among Emergency Department nurses.

Methods

This prospective longitudinal interventional study was performed among registered nurses at the emergency departments in a Johannesburg Academic Hospital. The study aimed to determine their current knowledge and practical skills on endotracheal tube cuff manometry and assess the effectiveness of a training program. The training program was provided once, in the form of a narrated PowerPoint presentation developed by the researchers and involved theoretical and practical components. The participants' theoretical knowledge and practical skills were measured by using questionnaires and skill assessments. The theoretical and practical scores were compared pre- and post-training.

Results

Of the 63 registered nurses employed in the emergency departments, 95 % (60) participated in this study. 86 % reported having never received any formal training on endotracheal tube cuff manometry. Only 38.9 % used cuff manometry as standard practice and only 12.8 % checked it at appropriate 12-hourly intervals. The pre-training median score on theory was 4.5 (IQR=3.0) and improved to 7.0 (IQR=3.0) post-training. The maximum achievable score was 11 with a pre-training average of 41.8 % and post-training of 64.5 % (p = 0.001).The practical pre-training median score was 1.0 (IQR=8.0) and improved to 12.0 (IQR=2.0) post-training. The maximum achievable score was 12 with a pre-training average of 29.1 % and a post-training average of 93.3 % (p = 0.001).

Conclusion

This study showed inadequate knowledge and skills on endotracheal cuff pressure manometry among registered nurses in the emergency department. It also correlates with other evidence that supports the need for ongoing training programs. Our training program led to significant improvement among participants in both knowledge and practical skills. This training program was well received by participants and deemed to be practice changing. The recommendation after this study will be for South African emergency units to consider using this study and training material as a guide for annual in-service training.

The parent perspective on paediatric delirium and an associated care bundle: A qualitative study

AIMS

To explore how parents experienced their child with delirium and how parents viewed our delirium management bundle.

DESIGN

We conducted a qualitative exploratory descriptive study using semi-structured individual or dyad interviews.

METHODS

Twelve semi-structured interviews with 16 parents of 12 critically ill children diagnosed with delirium in a paediatric intensive care unit were conducted from October 2022 to January 2023 and analysed through a reflexive thematic analysis.

FINDINGS

We generated five themes: (1) knowing that something is very wrong, (2) observing manifest changes in the child, (3) experiencing fear of long-term consequences, (4) adding insight to the bundle, and (5) family engagement.

CONCLUSION

The parents in our study were able to observe subtle and manifest changes in their child with delirium. This caused fear of lasting impact. The parents regarded most of the interventions in the delirium management bundle as relevant but needed individualization in the application. The parents requested more information regarding delirium and a higher level of parent engagement in the care of their child during delirium.

IMPACT

This paper contributes to understanding how parents might experience delirium in their critically ill child, how our delirium management bundle was received by the parents, and their suggestions for improvement. Our study deals with critically ill children with delirium, their parents, and staff working to prevent and manage paediatric delirium (PD) in the paediatric intensive care unit.

REPORTING METHOD

The consolidated criteria for reporting qualitative research guidelines were used to ensure the transparency of our reporting.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution to the research design. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL COMMUNITY?: - It increases awareness of the parent's perspective on PD in critically ill children. - It shows how PD might affect parents, causing negative emotions such as distress, frustration, and fear of permanent damage. - It shows that the parents in our study, in addition to the care bundle, requested more information on delirium and more involvement in the care of their delirious child.

Factors influencing decision-making processes for intensive care therapy goals: A systematic integrative review

BACKGROUND

Delivering intensive care therapies concordant with patients' values and preferences is considered gold standard care. To achieve this, healthcare professionals must better understand decision-making processes and factors influencing them.

AIM

The aim of this study was to explore factors influencing decision-making processes about implementing and limiting intensive care therapies.

DESIGN

Systematic integrative review, synthesising quantitative, qualitative, and mixed-methods studies.

METHODS

Five databases were searched (Medline, The Cochrane central register of controlled trials, Embase, PsycINFO, and CINAHL plus) for peer-reviewed, primary research published in English from 2010 to Oct 2022. Quantitative, qualitative, or mixed-methods studies focussing on intensive care decision-making were included for appraisal. Full-text review and quality screening included the Critical Appraisal Skills Program tool for qualitative and mixed methods and the Medical Education Research Quality Instrument for quantitative studies. Papers were reviewed by two authors independently, and a third author resolved disagreements. The primary author developed a thematic coding framework and performed coding and pattern identification using NVivo, with regular group discussions.

RESULTS

Of the 83 studies, 44 were qualitative, 32 quantitative, and seven mixed-methods studies. Seven key themes were identified: what the decision is about; who is making the decision; characteristics of the decision-maker; factors influencing medical prognostication; clinician-patient/surrogate communication; factors affecting decisional concordance; and how interactions affect decisional concordance. Substantial thematic overlaps existed. The most reported decision was whether to withhold therapies, and the most common decision-maker was the clinician. Whether a treatment recommendation was concordant was influenced by multiple factors including institutional cultures and clinician continuity.

CONCLUSION

Decision-making relating to intensive care unit therapy goals is complicated. The current review identifies that breadth of decision-makers, and the complexity of intersecting factors has not previously been incorporated into interventions or considered within a single review. Its findings provide a basis for future research and training to improve decisional concordance between clinicians and patients/surrogates with regards to intensive care unit therapies.

Adverse events associated with umbilical vascular catheters in the neonatal intensive care unit: A retrospective cohort study

BACKGROUND

Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice.

OBJECTIVES

The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU.

METHODS

A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included.

RESULTS

There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043).

CONCLUSION

Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.

Knowledge of pulse oximetry among emergency and critical care nurses

BACKGROUND

The pulse oximeter is a simple, cost-effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region.

AIM

To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry.

STUDY DESIGN

This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio-demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate.

RESULTS

The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively).

CONCLUSION

Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in-service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course.

Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study

BACKGROUND

Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana.

AIM

To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers.

STUDY DESIGN

The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist.

RESULTS

Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes.

CONCLUSION

The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice.

RELEVANCE TO CLINICAL PRACTICE

Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.

Prevalence and risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study

BACKGROUND

Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool.

AIMS

Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use.

STUDY DESIGN

A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect.

RESULTS

During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]).

CONCLUSION

The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial.

RELEVANCE TO CLINICAL PRACTICE

The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.

Impact of the restraint decision tree for physical restraint use in South Korean neurointensive care units

BACKGROUND

Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research-based PR protocol to support decision-making for nurses, especially for neurocritical patients.

AIM

This study developed a restraint decision tree for neurocritical patients (RDT-N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events.

STUDY DESIGN

This study employed a baseline and post-intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two-hundred and thirty-seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT-N. PR use and adverse events between the baseline and post-intervention periods were compared.

RESULTS

Post-intervention, total number of restrained patients decreased (20.7%-16.3%; χ2 = 7.68, p = .006), and the average number of PR applied per restrained patient decreased (2.42-1.71; t = 5.74, p < .001). The most frequently used PR type changed from extremity cuff to mitten (χ2 = 397.62, p < .001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high-risk group and 5.78 cases per 1000 patient days in the moderate-risk group; however, no URD cases were reported post-intervention.

CONCLUSIONS

The RDT-N effectively reduced PR use and adverse events. Its application can enhance patient-centred care based on individual condition and potential risks in NCUs.

RELEVANCE TO CLINICAL PRACTICE

Nurses can use the RDT-N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events.

Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury

BACKGROUND AND OBJECTIVES

To analyze the ability of prehospital lactate levels to predict 2-day in-hospital mortality in patients with traumatic brain injury (TBI), severe TBI (Glasgow Coma Scale (GCS) ≤ 8 points), and mild or moderate TBI (GCS ≥ 9 points). Second, 90-day mortality was also explored.

METHODS

This was a prospective, multicenter, emergency medical services (EMSs) delivery, ambulance-based, derivation-validation cohort study developed in 5 tertiary hospitals (Spain), from November 1, 2019, to July 31, 2022. Patients were recruited from among all phone requests for emergency assistance among adults who were later evacuated to referral hospitals with acute TBI. The exclusion criteria were minors, pregnancy, trauma patients without TBI, delayed presentations, patients were discharged in situ, participants with cardiac arrest, and unavailability to obtain a blood sample. The primary outcome was all-cause 2-day in-hospital mortality and 90-day mortality in patients with moderate or mild TBI compared with patients with severe TBI. Clinical and analytical parameters (lactate and glucose) were collected. The discriminative power (area under the receiver operating characteristic curve [AUC]) and calibration curve were calculated for 2 geographically separated cohorts.

RESULTS

A total of 509 patients were ultimately included. The median age was 58 years (interquartile range: 43-75), and 167 patients were female (32.8%). The primary outcome occurred in 9 (2.2%) of 415 patients with moderate or mild TBI and in 42 (44.7%) of 94 patients with severe TBI. The predictive capacity of the lactate concentration was globally validated in our cohort, for which the AUC was 0.874 (95% CI 0.805-0.942) for the validation cohort. The ability of the GCS score to predict lactate concentration was greater in patients with a GCS score ≥9 points, with an AUC of 0.925 (95% CI 0.808-1.000) and a negative predictive value of 99.09 (95% CI 98.55-99.64) in the validation cohort.

CONCLUSION

Our results show the benefit of using lactate in all patients with TBI, particularly in those with a GCS ≥9 points. Routine incorporation of lactate in the screening of patients with TBI could presumably reduce mortality and deterioration rates because of quicker and better identification of patients at risk.

Hospital costs for unplanned re-admissions within 30 days of hospitalisations with heart failure, Australia, 2013-2017: a retrospective cohort study

OBJECTIVES

To assess the direct hospital costs for unplanned re-admissions within 30 days of hospitalisations with heart failure in Australia; to estimate the proportion of these costs attributable to potentially preventable re-admissions.

STUDY DESIGN

Retrospective cohort study; analysis of linked admitted patient data collections data.

SETTING, PARTICIPANTS

People admitted to hospital (all public and most private hospitals in Australia) with primary diagnoses of heart failure, 1 January 2013 - 31 December 2017, who were discharged alive and re-admitted to hospital at least once (any cause) within 30 days of discharge.

MAIN OUTCOME MEASURES

Estimated re-admission costs based on National Hospital Cost Data Collection, by unplanned re-admission category based on the primary re-admission diagnosis: potentially hospital-acquired condition; recurrence of heart failure; other diagnoses related to heart failure; all other diagnoses. The first two groups were deemed the most preventable.

RESULTS

The 165 612 eligible hospitalisations of people with heart failure during 2013-2017 (mean age, 79 years [standard deviation, 12 years]; 85 964 men [51.9%]) incurred direct hospital costs of $1881.4 million (95% confidence interval [CI], $1872.5-1890.2 million), or $376.3 million per year (95% CI, $374.5-378.1 million per year) and $11 360 per patient (95% CI, $11 312-11 408 per patient). A total of 41 125 people (24.8%) experienced a total of 58 977 unplanned re-admissions within 30 days of discharge from index admissions; these re-admissions incurred direct hospital costs of $604.4 million (95% CI, $598.2-610.5 million), or 32% of total index admission costs; that is, $120.9 million per year (95% CI, $119.6-122.1 million per year), and $14 695 per patient (95% CI, $14 535-14 856 per patient). Re-admissions with potentially hospital-acquired conditions (21 641 re-admissions) accounted for 40.1% of unplanned re-admission costs, recurrence of heart failure (18 666 re-admissions) for 35.6% of re-admission costs.

CONCLUSION

Unplanned re-admissions after hospitalisations with heart failure are expensive, incurring costs equivalent to 32% of those for the initial hospitalisations; a large proportion of these costs are associated with potentially preventable re-admissions. Reducing the number of unplanned re-admissions could improve outcomes for people with heart failure and reduce hospital costs.

Planning for implementation success: insights from conducting an implementation needs assessment

AIM

The aim of this paper is to provide insights into conducting an implementation needs assessment using a case example in a less-research-intensive setting.

DESIGN AND METHODS

In the case example, an implementation needs assessment was conducted, including1 an environmental scan of the organization's website and preliminary discussions with key informants to learn about the implementation context, and2 a formal analysis of the evidence-practice gap (use of sedation interruptions) deploying a chart audit methodology using legal electronic reports.

RESULTS

Our needs assessment was conducted over 5 months and demonstrated how environmental scans reveal valuable information that can inform the evidence-practice gap analysis. A well-designed gap analysis, using suitable indicators of best practice, can reveal compliance rates with local protocol recommendations, even with a small sample size. In our case, compliance with the prescribed practices for sedation interruptions ranged from 65% (n=53) to as high as 84% (n=69).

CONCLUSIONS

Implementation needs assessments provide valuable information that can inform implementation planning. Such assessments should include an environmental scan to understand the local context and identify both current recommended best practices and local best practices for the intervention of interest. When addressing an evidence-practice gap, analyses should quantify the difference between local practice and desired best practice.

IMPACT

The insights gained from the case example presented in this paper are likely transferrable to implementation research or studies conducted in similar, less-research-intensive settings.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A257.

Patient safety during transfers from critical care: developing and assessing a checklist

Critically ill patients often need to be transferred from the intensive care unit (ICU) to the imaging department. This can compromise their safety, not only because of the inherent risk of deterioration but also because of the potential for incidents due to the inadequate preparation of medicines, equipment and monitoring. Using a patient transfer checklist can reduce the risk of human factor errors. This article reports on a quality improvement project conducted at the ICU of an acute hospital trust in the Midlands to develop and evaluate a patient transfer checklist. The checklist was developed based on guidance from the Intensive Care Society and evaluated using retrospective incident reports, an audit of staff compliance and a user survey. Using a transfer checklist in the ICU is likely to reduce patient safety incidents during transfers, but a shift in workplace culture may be needed to enhance incident reporting.

Automated Pain Spots Recognition Algorithm Provided by a Web Service-Based Platform: Instrument Validation Study

Background

Understanding the causes and mechanisms underlying musculoskeletal pain is crucial for developing effective treatments and improving patient outcomes. Self-report measures, such as the Pain Drawing Scale, involve individuals rating their level of pain on a scale. In this technique, individuals color the area where they experience pain, and the resulting picture is rated based on the depicted pain intensity. Analyzing pain drawings (PDs) typically involves measuring the size of the pain region. There are several studies focusing on assessing the clinical use of PDs, and now, with the introduction of digital PDs, the usability and reliability of these platforms need validation. Comparative studies between traditional and digital PDs have shown good agreement and reliability. The evolution of PD acquisition over the last 2 decades mirrors the commercialization of digital technologies. However, the pen-on-paper approach seems to be more accepted by patients, but there is currently no standardized method for scanning PDs.

Objective

The objective of this study was to evaluate the accuracy of PD analysis performed by a web platform using various digital scanners. The primary goal was to demonstrate that simple and affordable mobile devices can be used to acquire PDs without losing important information.

Methods

Two sets of PDs were generated: one with the addition of 216 colored circles and another composed of various red shapes distributed randomly on a frontal view body chart of an adult male. These drawings were then printed in color on A4 sheets, including QR codes at the corners in order to allow automatic alignment, and subsequently scanned using different devices and apps. The scanners used were flatbed scanners of different sizes and prices (professional, portable flatbed, and home printer or scanner), smartphones with varying price ranges, and 6 virtual scanner apps. The acquisitions were made under normal light conditions by the same operator.

Results

High-saturation colors, such as red, cyan, magenta, and yellow, were accurately identified by all devices. The percentage error for small, medium, and large pain spots was consistently below 20% for all devices, with smaller values associated with larger areas. In addition, a significant negative correlation was observed between the percentage of error and spot size (R=-0.237; P=.04). The proposed platform proved to be robust and reliable for acquiring paper PDs via a wide range of scanning devices.

Conclusions

This study demonstrates that a web platform can accurately analyze PDs acquired through various digital scanners. The findings support the use of simple and cost-effective mobile devices for PD acquisition without compromising the quality of data. Standardizing the scanning process using the proposed platform can contribute to more efficient and consistent PD analysis in clinical and research settings.

What would have made work in the COVID-19 ICU less demanding? A qualitative study from 13 Swedish COVID-19 ICUs

BACKGROUND

The COVID-19 pandemic stretched Swedish intensive care unit (ICU) resources to an extent never experienced before, but even before the pandemic staffing was difficult and the number of staffed ICU beds was low. Studies have revealed high levels of COVID-19 ICU staff burn-out and fatigue, and as similar situations with high demands are likely to occur in the future a better understanding of resources that improve staff resilience is important. Using the job-demand resource theory as a framework, we explored ICU professionals' views on demands and resources when working in COVID-19 ICUs with the aim to highlight factors that increased the job resources.

METHODS

Data were collected via a web survey distributed to COVID-19 ICU professionals, including both regular and temporary roles, working in 13 COVID-19 ICU wards in Stockholm and Sörmland counties during the spring 2021. A total of 251 written responses to the question "What would have made work in the COVID-19 ICU less demanding?" were analyzed using thematic analysis. One year later a member-checking focus group interview was conducted to validate and further explore staff experiences.

RESULTS

The main themes were work strategy, fairness and support, continuity, accessible leadership, introduction/information, and crisis preparedness. The analysis of the focus group conducted confirmed the main results and the extreme demands on ICU staff during the initial stages of the pandemic.

CONCLUSION

To increase staff health and performance in a long-term crisis our results suggest; maintaining workplace leadership, scheduling work in advance and, when possible, schedule for recovery.

Music-based interventions and theoretical mechanisms in post-ICU survivors: A critical narrative synthesis

BACKGROUND

Hospitalization in the ICU can have long-term physiological and psychological impacts, affecting functional recovery and quality of life of post-ICU patients. Despite systematic reviews showing the impact of music interventions on physiological and psychological outcomes in ICU patients, their applicability and effectiveness in the post-ICU context remain unclear.

AIM

This review aimed to summarize: a) the types and characteristics of music/sound of interventions used in the rehabilitation of ICU patients, b) evidence on the feasibility, safety and acceptability of sound and music interventions for post ICU survivors, c) the types of post-ICU outcomes explored and the effects of sound and music interventions on any type of outcome in post-ICU survivors, and d) potential mechanisms or theoretical frameworks underlying the effects of sound and music interventions.

METHOD

We combined current systematic review search methods with a critical narrative approach to synthesize a diverse body of evidence.

RESULTS

Results showed that music interventions positively affect the psychological well-being and health outcomes of post-ICU patients. Outcomes included improvements in stress, anxiety, mood, movement, sleep, and pain, despite differences in patient populations and intervention design. No safety concerns were reported. The identified theoretical frameworks described physiological, neurobiological and/or psycho-social pathways as key mediators, however, these mechanisms are not completely understood.

CONCLUSION

Research evidence supports the positive effects of music interventions in post-ICU patients. Further experimental studies are required, especially in adult post-ICU populations to elucidate the characteristics, components, feasibility, and long-term effects of sound/music interventions.

IMPLICATION TO PRACTICE

1. Music interventions help in post-ICU patients' recovery benefitting stress, anxiety, PTSD, mood, movement, sleep, and pain. 2. Integrating theoretical frameworks into music interventions can expand outcome measures to include physiological markers alongside psychological ones, improving quality of life. 3. Further rigorous interventional studies are required to identify the effectiveness of sound and music interventions in post-ICU patients.

Navigating the trauma-The experiences of significant others supporting patients with severe burn injury: A narrative inquiry

AIM

To explore the experiences of significant others of adult patients with severe burn injury in the Intensive Care Unit. Specifically, this study explored the strategies implemented by significant others and obstacles faced that served to protect or placed them at risk of psychological sequelae during their experience of trauma.

DESIGN

A qualitative study using a Narrative Inquiry approach was undertaken.

METHODS

Individual semi-structured interviews were conducted with 17 participants during 2021-2022, who were a significant other of an adult patient in ICU with severe burn injury. These participants were recruited from the two major severe burns receiving hospitals in New South Wales, Australia. Participants' stories were analysed using a narrative analysis approach informed by Polkinghorne. The COREQ guideline was used in reporting.

RESULTS

As each participant navigated the traumatic experience of supporting a loved one with a severe burn injury, they faced unique obstacles to maintaining their own mental health and well-being. They employed strategies that were likely to protect them on this journey. Psychologically protective factors included taking back control, coexisting in the trauma with the patient and forging a trauma bond. These strategies effectively contained the trauma and protected others (such as children, extended family and friends). While this allowed significant others an element of control, it also effectively isolated them from the support of family and friends.

CONCLUSION

This study shows that significant others may also experience personal trauma and may not recognize this as they focus all their attention on supporting the patient with the burn injury.

IMPLICATIONS FOR PRACTICE

With increased awareness of both protective and risk factors, support can be directed towards enhancing protective factors and addressing risk factors, thereby decreasing their impact and improving support for significant others.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Thirst in adult patients in the intensive care unit: A scoping review

PURPOSE

To review the literature on thirst in intensive care unit (ICU) patients and report potential causes, risk factors, diagnosis and measurement tools, as well as potential co-occurrence with other distressing symptoms, and the management of thirst in the ICU.

DESIGN

A scoping review employing the Joanna Briggs Institute methodology.

METHODS

PubMed, MEDLINE, EMBASE and CINAHL were searched from inception to April 2024. Any type of empirical study reporting thirst or associated xerostomia in adult patients (≥18 years) admitted to an ICU or high dependency unit for more than 24 h were included.

RESULTS

The search yielded 907 unique records, and after evaluating 65 full-text publications, 21 studies were included. Thirst intensity was addressed most often (eleven studies), whereas the experience (or quality) of thirst and the validation of a measurement instrument, were addressed in only one study. Although co-occurrence of symptoms was addressed in four studies, only one pilot study looked into the interaction of thirst with other symptoms. Intervention studies have been focussing primarily on mouth-care interventions.

CONCLUSION

Thirst is a distressing symptom in the ICU, with reported high prevalence and intensity. Knowledge about its causes, interventions that incorporate minimising its risk, occurrence and intensity are limited.

IMPLICATIONS FOR CLINICAL PRACTICE

Health care providers should acknowledge thirst as a prominent symptom for ICU patients. They should possess knowledge on the factors that potentially evoke or aggravate thirst. Regular and timely relief of thirst by oral care with cold swabs and the application of menthol can be regarded as a first choice of intervention.

[What is the Impact of Early Rehabilitation and Rehabilitation Management on Outcome after Polytrauma?]

Patients with polytrauma and other severe musculoskeletal injuries often suffer from permanently impaired functionality and quality of life. This results in long-term damage with high costs for the social system. A narrative review will show the impact of targeted coordination in the rehabilitation process from early rehabilitation to long-term case management on patients with severe musculoskeletal injuries. A systematic database search of MEDLINE and the Cochrane Library identified studies of multiple injuries that compared the outcome of early rehabilitation and rehabilitation management with other types of care. Studies of predominantly neurologic injury types, soldiers, and mild injury types with an ISS less than 9 or AIS less than 3 were excluded. Four studies were included and analyzed. They looked at functionality, quality of life, psychological impairment, and costs. While treatment and total costs were higher for early rehabilitation and rehabilitation management, no better results for improved function, psychological condition and quality of life could be demonstrated in the group comparison. An effect estimate is possible due to small group differences and the small number of individual studies included. There are insufficient studies to draw conclusions about the effectiveness of the early interventions. Future studies are needed that take into greater account structures of standard care and national differences in social security systems, as well as the chosen rehabilitation management interventions.

Factors related to resilience and attitudes towards care of the dying among critical care nurses

BACKGROUND

Many critical care nurses provide care to patients who are injured or ill and are at the end-of-life. Therefore, they are at high risk for developing negative emotional responses due to exposure to patient suffering and death.

AIM

To determine the association between attitudes towards care of the dying, resilience, and Sense of Coherence.

STUDY DESIGN

A cross-sectional descriptive approach was used. Head nurses at 74 hospitals in Japan were sent a letter about the study; 29 head nurses agreed to send information to the critical care nurses in their hospital. Demographic factors, attitudes towards care of the dying, resilience, and Sense of Coherence were collected using Google Forms. Structural equation modelling was used to analyze the associations among the variables.

RESULTS

A total of 229 nurses completed the survey. The average years of clinical experience were 10.5 ± 8.4 years. Factors directly related to positive attitudes towards care of the dying were higher resilience, more years of clinical nursing experience, and having a Master's degree. Sense of Coherence was the strongest predictor of resilience. Other predictors for higher resilience included confidence in nursing skills, social support, and religious beliefs towards death. The main predictor for higher Sense of Coherence was workplace satisfaction.

CONCLUSION

Nurses with higher resilience had more positive attitudes about care of the dying. Individual factors, such as a Sense of Coherence, confidence in caring for patients, and religious beliefs were the most important factors related to resilience.

RELEVANCE TO CLINICAL PRACTICE

It is necessary to support newer nurses especially those with lower educational attainment, to increase workplace satisfaction, Sense of Coherence and resilience. It is necessary to develop educational programs focused on care of dying patients and to evaluate their effect so that critical care nurses have a positive response to caring for dying patients.

Long-term effects of flexible visitation in the intensive care unit on family members' mental health: 12-month results from a randomized clinical trial

PURPOSE

The aim of this study was to assess the effects of flexible intensive care unit (ICU) visitation on the 1-year prevalence of post-traumatic stress, anxiety and depression symptoms among family members of critically ill patients.

METHODS

This is a long-term outcome analysis of a cluster-crossover randomized clinical trial that evaluated a flexible visitation model in the ICU (12 h/day) compared to a restrictive visitation model (median 1.5 h/day) in 36 Brazilian ICUs. In this analysis, family members were assessed 12 months after patient discharge from the ICU for the following outcomes: post-traumatic stress symptoms measured by the Impact Event Scale-6 and anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale.

RESULTS

A total of 519 family members were analyzed (288 in the flexible visitation group and 231 in the restrictive visitation group). Three-hundred sixty-nine (71.1%) were women, and the mean age was 46.6 years. Compared to family members in the restrictive visitation group, family members in the flexible visitation group had a significantly lower prevalence of post-traumatic stress symptoms (21% vs. 30.5%; adjusted prevalence ratio [aPR], 0.91; 95% confidence interval [CI] 0.85-0.98; p = 0.01). The prevalence of anxiety (28.9% vs. 33.2%; aPR 0.93; 95% CI 0.72-1.21; p = 0.59) and depression symptoms (19.2% vs. 25%; aPR, 0.78; 95% CI 0.60-1.02; p = 0.07) did not differ significantly between the groups.

CONCLUSION

Flexible ICU visitation, compared to the restrictive visitation, was associated with a significant reduction in the 1-year prevalence of post-traumatic stress symptoms in family members.

Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits

BACKGROUND

The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes.

AIM

We aimed to quantify practice change following TARGET.

METHODS

Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test.

RESULTS

The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively.

CONCLUSION

In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.

N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study

AIM/OBJECTIVES

Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.

METHODS

A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.

RESULTS

Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07-2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.

CONCLUSIONS

Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.

Creating a home with a critically ill child: A qualitative study exploring the experiences of parents of children admitted to paediatric critical care following treatment in neonatal care

BACKGROUND

Survival of children with complex medical conditions has increased over time. Around 5% of children admitted to a neonatal unit (NNU) later have an admission to a paediatric intensive care unit (PICU) in early life. No work to date has explored the needs of parents who have a child admitted to both of these healthcare settings.

OBJECTIVE

The overall aim of this study was to understand parents' experiences as they navigate the transition between admissions to the NNU and the PICU. This paper reports on one of the themes (creating a home) identified inductively from the dataset.

METHODS

We used a qualitative research design using semistructured interviews with parents who had a child (or children) who had been admitted to neonatal care after birth and then subsequently were also admitted to a PICU. We recruited a national purposive sample of parents with experiences of having a child treated in an NNU before being admitted to the PICU. We undertook the interviews and transcribed them before taking a reflexive thematic analysis approach.

RESULTS

A total of 15 mothers and three fathers, of 17 children, were interviewed between January and March 2022. 'We identified 'creating a home' as a key inductive theme with three subthemes: (i) developing parental roles; (ii) creating a physical home; and (iii) creating core memories.

CONCLUSIONS

There is a growing cohort of children living with chronic health conditions. In this work, we have explored how their parents establish a home whilst often spending significant periods within the public arena of intensive care. Families across settings need support from healthcare professionals to help them develop their role as parents, build a home, and to create memories together.

Beyond the Bedside: Decoding Patient Profiles for Smarter Virtual Patient Observation

BACKGROUND

Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety.

PURPOSE

The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO.

METHODS

A retrospective analysis was conducted. Differences in total VPO hours between groups were examined, followed by a hierarchical regression to investigate the effect of predictor variables on VPO utilization variance.

RESULTS

A total of 286 patient charts were reviewed. Mean VPO hours were higher in patients with an intensive care unit admission history. Adjusted for gender and history of dementia/Alzheimer's/memory impairment, the prediction of total VPO hours increased with the patient's intensive care unit admission history and overall hospital length of stay.

CONCLUSIONS

Examining the prevalence and variability in the pattern of VPO utilization by specific patient characteristics is essential for identifying what patients could best benefit from this technology.

"The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist"

Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.

Arterial catheter outcomes in intensive care: An analysis of 1117 patients

BACKGROUND

Access to arterial circulation through arterial catheters (ACs) is crucial for monitoring and decision-making in intensive care units (ICU) but carries the risk of complications including bloodstream infection (BSI).

METHODS

We conducted a secondary analysis of data from four randomised controlled trials in Australian ICUs, investigating the efficacy of different AC interventions. De-identified data were combined into a single dataset, and per-patient outcomes analysed. The primary outcome was AC-BSI, defined as laboratory confirmed bloodstream infection (LCBI) type 1 or 2, with a concurrent local infection. All-cause AC failure was defined as any unplanned removal. AC infection and failure were reported as rates per 1000 catheter days and hours.

RESULTS

Data from 1117 adult patients were analysed. Mean age was 58.8 years (±16.6); and 41% (n = 462) were male. Median AC dwell time was 110 h (IQR 28.3-168.0). There was one case (<0.1%; 0.18/1000 catheter days [95% CI 0.03-1.29]) of AC-BSI, and 14 cases of LCBI (1%; 13 LCBI-1 and 1 LCBI-2; 2.54/1000 catheter days [95% CI 1.51-4.30]). LCBI were most commonly Enterococcus faecalis; Escherichia coli and Klebsiella pneumoniae. There were four cases of local infection (<1%; 0.73/1000 catheter days [95% CI 0.27-1.94]). Overall AC failure rate was 13% (n = 146) or 26.53/1000 catheter days (95% CI 22.56-31.20).

CONCLUSION

This study identified a relatively low incidence of complications. This is likely reflective of poor monitoring of ACs in intensive care. Better surveillance and a rigorous prospective evaluation of AC outcomes is required to understand the true risk ACs pose to critically ill patients.

The impact of a clinical academic nurse researcher in critical care: A 1-year service review

AIMS

To outline the activity and impact from implementing a clinical academic nurse researcher in a multi-centre critical care unit.

DESIGN

A prospective exploratory activity audit informed by the Plan, Do, Study, Act framework.

METHODS

Quantitative data on clinical academic activity, from 1 April 2023 to 31 March 2024, were collected in a Microsoft Excel © [2022, version 16.66.1] spreadsheet. Activity narratives were detailed in qualitative data and the impact categorized.

RESULTS

A total of 1500 clinical academic activity hours were logged (accounting for annual leave entitlement and sickness). Of these, 973 h were directly categorized within clinical academic activity. Most frequently undertaken clinical academic activities were academic writing (17.6%), data collection/analysis (9.6%), grant and funding workup (6.8%), Intensive Care Unit service development (6.6%), clinical activity (5.2%) and local level capability and capacity (4.9%) and other supportive tasks such as administration, unscheduled meetings, critical planning time and peer support (38%). Improvements broadly mapped onto five healthcare improvement domains; organizational, process design, data optimization and utilization, evidenced-based practice, and patients/staff impact.

CONCLUSIONS

Our data indicate system mechanisms afforded by the clinical academic role that have not been explored within the contemporary literature. A nursing clinical academic demonstrates impact across the broad organization whilst increasing the visibility of nursing work and the potential for system resilience. In conclusion, our service review underscores the transformative potential of clinical academics in shaping the future of healthcare. Utilizing their expertise and contributions paves the way for innovation, excellence and sustainability in patient care.

IMPACT

This review has provided clarity about clinical academic activity of a nurse researcher during the first year. There is international impact of this work for both clinical academics who may be evaluating such roles and healthcare management developing similar roles locally.

PATIENT AND PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Nutrition intake, muscle thickness, and recovery outcomes for critically ill patients requiring non-invasive forms of respiratory support: A prospective observational study

BACKGROUND

Use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in the intensive care unit (ICU) is increasing, yet reporting of nutrition intake, muscle thickness, or recovery outcomes in this population is limited.

OBJECTIVE

The objective of this study was to quantify muscle thickness, nutrition intake, and functional recovery outcomes for patients receiving HFNC/NIV within the ICU.

METHODS

A single-centre, prospective, observational study in adult ICU patients recruited within 48 hrs of commencing HFNC/NIV. Change in quadriceps muscle layer thickness using ultrasound (primary outcome) and 24 hr nutrition intake from study inclusion to day 7 (D7), functional capacity (Barthel Index), and quality of life (EuroQol five-dimension five-level utility index) at D90 were assessed. Data are n (%), mean ± standard deviation or median [interquartile range], are compared using paired sample t-test, and a P value of <0.05 was considered significant.

RESULTS

Primary outcome data were available for n = 28/42: 64 ± 13 y, 61% male, body mass index: 29.1 ± 9.0 kg/m2, and Acute Physiology and Chronic Health Evaluation II score: 17 ± 5. Quadriceps muscle layer thickness reduced from 2.41 ± 0.87 to 2.12 ± 0.73 cm; mean difference: -0.29 cm (95% confidence interval: -0.44, -0.13). Nutrition intake increased from study inclusion to D7: 1735 ± 1283 to 5448 ± 2858 kJ and 17.4 ± 16.6 to 60.9 ± 36.8g protein. Barthel Index was 87 ± 20 at baseline and 91 ± 15 at D90 (out of 100). Quality of life was impaired at D90: 0.64 ± 0.23 (health = 1.0).

CONCLUSION

Critically ill patients receiving HFNC/NIV experienced muscle loss and impaired quality of life.

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit

INTRODUCTION

Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents.

AIM

Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU.

DESIGN

Qualitative study using ethnographic data collection techniques.

METHODS

Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis.

RESULTS

Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities.

CONCLUSION

Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial.

RELEVANCE TO CLINICAL PRACTICE

Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities.

REPORTING METHOD

Adherence to the COREQ guidelines.

Added predictive value of prehospital measurement of point-of-care lactate in an adult general EMS population in Sweden: a multi-centre observational study

BACKGROUND

Emergency medical services (EMS) personnel must rapidly assess and transport patients with time-sensitive conditions to optimise patient outcomes. Serum lactate, a valuable in-hospital biomarker, has become more accessible in EMS settings through point-of-care (POC) testing. Although POC lactate levels are valuable in specific patient groups, its broader application in EMS remains unclear. This study assessed the additional predictive value of POC lactate levels in a general adult EMS population.

METHODS

This prospective observational study (March 2018 to September 2019) involved two EMS organisations in Västra Götaland, Sweden. Patients were triaged using the Rapid Triage and Treatment System (RETTS). POC lactate levels were measured using StatStrip Xpress devices. Non-consecutive patients who received EMS and were aged 18 years and above were available for inclusion if triaged into RETTS levels: red, orange, yellow, or green if respiratory rate of ≥ 22 breaths/min. Outcomes were adverse outcomes, including a time-sensitive diagnosis, sequential organ failure assessment (SOFA) score ≥ 2, and 30-day mortality. Statistical analyses included descriptive statistics, imputation, and regression models to assess the impact of the addition of POC lactate levels to a base model (comprising patient age, sex, presence of past medical conditions, vital signs, pain, EMS response time, assessed triage condition, and triage level) and a RETTS triage model.

RESULTS

Of 4,546 patients (median age 75 [57, 84] years; 49% male), 32.4% had time-sensitive conditions, 12.5% met the SOFA criteria, and 7.4% experienced 30-day mortality. The median POC lactate level was 1.7 (1.2, 2.5) mmol/L. Patients with time-sensitive conditions had higher lactate levels (1.9 mmol/L) than those with non-time-sensitive conditions (1.6 mmol/L). The probability of a time-sensitive condition increased with increasing lactate level. The addition of POC lactate marginally enhanced the predictive models, with a 1.5% and 4% increase for the base and RETTS triage models, respectively. POC lactate level as a sole predictor showed chance-only level predictive performance.

CONCLUSIONS

Prehospital POC lactate assessment provided limited additional predictive value in a general adult EMS population. However, it may be beneficial in specific patient subgroups, emphasizing the need for its judicious use in prehospital settings.

Mobilisation of post-ICU patients - a crucial teamwork between physiotherapists and nurses at surgical wards: a qualitative study

PURPOSE

To describe experiences of the ward nurse in relation to extended physiotherapy and mobilising of post-ICU patients.

METHODS

Individual semi-structured interviews were conducted with 17 registered nurses working on surgical wards in a Swedish regional hospital. Qualitative content analysis was used to analyse the data. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ).

RESULTS

The study findings are presented in three categories: challenges to mobilising post-ICU patients, shared responsibility facilitates mobilisation, and extended physiotherapy is beneficial for patients' wellbeing. Nurses stated that they lacked knowledge and skills to perform the safe mobilisation of post-ICU patients due to their complex medical history and needs. Collaboration with physiotherapists was perceived to facilitate mobilisation and to be beneficial for patients' wellbeing outcome.

CONCLUSIONS

The study indicates that post-ICU patients are at risk of remaining immobilised because ward nurses find mobilisation too complex to conduct without support from physiotherapists. Shared responsibility through multi-professional teamwork regarding patient rehabilitation is perceived as contributing the knowledge required to achieve safe mobilisation that enhances autonomy and physical ability in post-ICU patients.

Prevalence of sleep disturbances among intensive care nurses: A systematic review and meta-analysis

BACKGROUND

Demanding intensive care unit (ICU) work environments may lead to sleep disturbances in nurses, impacting their health and potentially patient safety. Yet, the prevalence remains unclear around the world.

AIMS

To quantify the prevalence of sleep disturbances in intensive care nurses.

STUDY DESIGN

Systematic review and meta-analysis. A database search was conducted in Embase, PubMed, Web of Science, Scopus and CINAHL from their inception to April 2024 for relevant studies. Data from observational studies (cross-sectional or cohort) that reported the prevalence of sleep disturbances, assessed using the Pittsburgh Sleep Quality Index (PSQI > 5), pooled in random-effects meta-analyses. Subgroup analyses were used to investigate variations in the prevalence estimates in terms of available variables. A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant protocol was registered in PROSPERO (CRD42023476428).

RESULTS

In total, 24 articles were included in this study published from 1996 to 2023. Included studies were from 15 unique countries. Almost all of the studies were descriptive cross-sectional studies (n = 22; 91.7%). The included studies encompassed a range of intensive care nurses, from 42 to 605, involving a total of 3499 intensive care nurses. The reported proportion of intensive care nurses with sleep disturbances ranged from 20.0% to 100.0%, with a median of 76.7% (interquartile range: 62.9-85.7). The pooled prevalence of sleep disturbances in intensive care nurses was 75.1% (95% confidence interval: 37.2-53.1; 95% prediction interval: 30.5-95.4).

CONCLUSIONS

Sleep disturbance is a common issue in intensive care nurses. The study results highlight the importance of implementing effective interventions as early as possible to improve ICU sleep quality.

RELEVANCE TO CLINICAL PRACTICE

High prevalence of sleep disturbances among intensive care nurses necessitates global interventions. Gender-neutral approaches that acknowledge comparable risks and stable prevalence over time require long-term strategies. Raising awareness through programmes is vital for implementing evidence-based interventions to promote sleep health in intensive care nurses.