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Dash J, Andereggen E, Bentellis I, Massalou D. Comparison of adult versus elderly patients with abdominal trauma: A retrospective database analysis. PLoS One 2024; 19:e0309174. [PMID: 39159197 PMCID: PMC11332922 DOI: 10.1371/journal.pone.0309174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The growing geriatric population has specific medical characteristics that should be taken into account especially in trauma setting. There is little evidence on management of abdominal trauma in the elderly and this article compares the management and outcomes of younger and older patients in order to highlight fields of improvement. METHOD We conducted a retrospective database analysis from two European university hospitals selecting patients admitted for abdominal injury and extracted the following data: epidemiological data, mechanisms of the trauma, vital signs, blood tests, injuries, applied treatments, trauma scores and outcomes. We compared to different age group (16-64 and 65+ years old) using uni- and multivariable analysis. RESULTS 1181 patients were included for statistical analysis. The main mechanisms of injury in both group were traffic accidents and in the elderly group, falls were more frequent. Both had similar Abbreviated Injury Score except for the thoracic injuries, which was higher in the elderly group. We reported a death rate of 13% in the elderly group and 7% in the younger group. However, multivariable analysis did not report age as an independent predictor of mortality. The management including surgery, blood transfusion and need for intensive care were similar in both groups. CONCLUSION Although elderly patients suffering abdominal trauma have an almost two fold higher mortality, their management is quite similar leading to an important point of improvement in regards to triage and lower threshold for more aggressive management and surveillance. Age itself does not seem to be a reliable predictor of mortality. Introducing a frailty score when taking care of elderly trauma patients could improve the outcomes.
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Affiliation(s)
- Jeremy Dash
- Departement of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Elisabeth Andereggen
- Departement of Digestive Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Imad Bentellis
- Departement of Urology, University Hospital of Nice, Nice, France
| | - Damien Massalou
- Emergency Surgery Unit, Digestive Surgery, University Hospital of Nice, Nice, France
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De Rosa S, Schaller SJ, Galarza L, Ferrer R, McNicholas BA, Bell M, Helms J, Azoulay E, Vieillard-Baron A. Barriers to female leadership in intensive care medicine: insights from an ESICM NEXT & Diversity Monitoring Group Survey. Ann Intensive Care 2024; 14:126. [PMID: 39158624 PMCID: PMC11333654 DOI: 10.1186/s13613-024-01358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND The underrepresentation of women in leadership remains a pervasive issue, prompting a critical examination of support mechanisms within professional settings. Previous studies have identified challenges women face, ranging from limited visibility to barriers to career advancement. This survey aims to investigate perceptions regarding the effectiveness of women's leadership programs, mentoring initiatives, and a specialized communication course. Particularly it specifically targets addressing the challenges encountered by professional women. METHODS This multi-center, observational, international online survey was developed in partnership between ESICM NEXT and the ESICM Diversity and Inclusiveness Monitoring Group for Healthcare. Invitations to participate were distributed to both females and men through emails and social networks. Data were collected from April 1, 2023, through October 1, 2023. RESULTS Out of 354 respondents, 90 were men (25.42%) and 264 were women (74.58%). Among them, 251 completed the survey, shedding light on the persistent challenges faced by women in leadership roles, with 10%-50% of respondents holding such positions. Women's assertiveness is viewed differently, with 65% recognizing barriers such as harassment. Nearly half of the respondent's experience interruptions in meetings. Only 47.4% receiving conference invitations, with just over half accepting them. A mere 12% spoke at ESICM conferences in the last three years, receiving limited support from directors and colleagues, indicating varied obstacles for female professionals. Encouraging family participation, reducing fees, providing childcare, and offering economic support can enhance conference involvement. Despite 55% applying for ESICM positions, barriers like mobbing, harassment, lack of financial support, childcare, and language barriers were reported. Only 14% had access to paid family leave, while 32% benefited from subsidized childcare. Participation in the Effective Communication Course on Career Advancement Goals and engagement in women's leadership and mentoring programs could offer valuable insights and growth opportunities. Collaborating with Human Resources and leadership allies is crucial for overcoming barriers and promoting women's career growth. CONCLUSIONS The urgency of addressing identified barriers to female leadership in intensive care medicine is underscored by the survey's comprehensive insights. A multifaceted and intersectional approach, considering sexism, structural barriers, and targeted strategies, is essential.
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Affiliation(s)
- Silvia De Rosa
- Centre for Medical Sciences, CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy.
| | - Stefan J Schaller
- Department of Anesthesiology, and Intensive Care Medicine (CCM/CVK), Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, Munich, Germany
| | - Laura Galarza
- Department of Intensive Care, Hospital General Universitari de Castelló, Castelló de la Plana, Spain
| | - Ricard Ferrer
- SODIR Research Group, Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, 08035, Barcelona, Spain
| | - Bairbre A McNicholas
- Nephrology Services, Galway University Hospitals, SAOLTA University Healthcare Group, Galway, Ireland
| | - Max Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Elie Azoulay
- Intensive Care Department, Medical Intensive Care Unit, APHP, Hôpital Saint Louis, Paris Cité University, Paris, France
| | - Antoine Vieillard-Baron
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France
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Stevens G, Larmuseau M, Damme AV, Vanoverschelde H, Heerman J, Verdonck P. Feasibility study of the use of a wearable vital sign patch in an intensive care unit setting. J Clin Monit Comput 2024:10.1007/s10877-024-01207-5. [PMID: 39158782 DOI: 10.1007/s10877-024-01207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/05/2024] [Indexed: 08/20/2024]
Abstract
Multiple studies and review papers have concluded that early warning systems have a positive effect on clinical outcomes, patient safety and clinical performances. Despite the substantial evidence affirming the efficacy of EWS applications, persistent barriers hinder their seamless integration into clinical practice. Notably, EWS, such as the National Early Warning Score, simplify multifaceted clinical conditions into singular numerical indices, thereby risking the oversight of critical clinical indicators and nuanced fluctuations in patients' health status. Furthermore, the optimal deployment of EWS within clinical contexts remains elusive. Manual assessment of EWS parameters exacts a significant temporal toll on healthcare personnel. Addressing these impediments necessitates innovative approaches. In this regard, wearable medical technologies emerge as promising solutions capable of continual monitoring of hospitalized patients' vital signs. To overcome the barriers of the use of early warning scores, wearable medical technology has the potential to continuously monitor vital signs of hospitalised patients. However, a fundamental inquiry arises regarding the comparability of their reliability to the current used golden standards. This inquiry underscores the imperative for rigorous evaluation and validation of wearable medical technologies to ascertain their efficacy in augmenting extant clinical practices. This prospective, single-center study aimed to evaluate the accuracy of heart rate and respiratory rate measurements obtained from the Vivalink Cardiac patch in comparison to the ECG-based monitoring system utilized at AZ Maria Middelares Hospital in Ghent. Specifically, the study focused on assessing the concordance between the data obtained from the Vivalink Cardiac patch and the established ECG-based monitoring system among a cohort of ten post-surgical intensive care unit (ICU) patients. Of these patients, five were undergoing mechanical ventilation post-surgery, while the remaining five were not. The study proceeded by initially comparing the data recorded by the Vivalink Cardiac patch with that of the ECG-based monitoring system. Subsequently, the data obtained from both the Vivalink Cardiac patch and the ECG-based monitoring system were juxtaposed with the information derived from the ventilation machine, thereby providing a comprehensive analysis of the patch's performance in monitoring vital signs within the ICU setting. For heart rate, the Vivalink Cardiac patch was on average within a 5% error range of the ECG-based monitoring system during 85.11±10.81% of the measured time. For respiratory rate this was during 40.55±17.28% of the measured time. Spearman's correlation coefficient showed a very high correlation of ρ = 0.9 8 for heart rate and a moderate correlation of ρ = 0.66 for respiratory rate. In comparison with the ventilated respiratory rate (ventilation machine) the Vivalink and ECG-based monitoring system both had a moderate correlation of ρ = 0.68 . A very high correlation was found between the heart rate measured by the Vivalink Cardiac patch and that of the ECG-based monitoring system of the hospital. Concerning respiratory rate the correlation between the data from the Vivalink Cardiac patch, the ECG-based monitoring system and the ventilation machine was found to be moderate.
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Affiliation(s)
- Guylian Stevens
- Departement of Electronics and Information Systems - IBiTech, Ghent University, Korneel Heymanslaan, Gent, 9000, East-Flanders, Belgium.
- H3CareSolutions, Henegouwenstraat 41, Gent, 9000, East-Flanders, Belgium.
| | - Michiel Larmuseau
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Annelies Van Damme
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Henk Vanoverschelde
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Jan Heerman
- Partnership of Anesthesia, AZ Maria Middelares Hospital, Buitenring Sint-Denijs 30, Gent, 9000, East-Flanders, Belgium
| | - Pascal Verdonck
- Departement of Electronics and Information Systems - IBiTech, Ghent University, Korneel Heymanslaan, Gent, 9000, East-Flanders, Belgium
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Hayajneh AA, Al-Younis MO, Rababa M, Qahah I. Effect of Mindfulness Intervention on Compassion Fatigue Among Nurses: A Randomized Controlled Trial Study. Holist Nurs Pract 2024:00004650-990000000-00037. [PMID: 39166821 DOI: 10.1097/hnp.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Compassion fatigue is a syndrome defined by both mental and physical restlessness. Mindfulness intervention can enhance one's emotions with nonjudgmental awareness and greater consciousness of thoughts and feelings. This study aims to examine the effect of mindfulness intervention on compassion fatigue among nurses. A randomized controlled trial was conducted, recruiting 100 nurses from three hospitals and dividing participants into an intervention and a control group. Increased mindfulness awareness was found in the comparison group in the research. The intervention group's mean burnout level was significantly lower than the comparison group. Age, gender, marital status, household size, and household income were among the sociodemographic factors that significantly correlated with compassion fatigue, which was determined through burnout and secondary traumatic stress. Nurses reported significant levels of compassion fatigue; however, this was significantly decreased through mindfulness intervention.
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Affiliation(s)
- Audai A Hayajneh
- Author Affiliations: Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan (Dr Hayajneh, Ms Al-Younis, and Dr Rababa); The World Islamic Sciences and Education University, Amman, Jordan (Dr Qahah)
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105
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Sterr F, Bauernfeind L, Knop M, Rester C, Metzing S, Palm R. Weaning-associated interventions for ventilated intensive care patients: A scoping review. Nurs Crit Care 2024. [PMID: 39155350 DOI: 10.1111/nicc.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Mechanical ventilation is a core intervention in critical care, but may also lead to negative consequences. Therefore, ventilator weaning is crucial for patient recovery. Numerous weaning interventions have been investigated, but an overview of interventions to evaluate different foci on weaning research is still missing. AIM To provide an overview of interventions associated with ventilator weaning. STUDY DESIGN We conducted a scoping review. A systematic search of the Medline, CINAHL and Cochrane Library databases was carried out in May 2023. Interventions from studies or reviews that aimed to extubate or decannulate mechanically ventilated patients in intensive care units were included. Studies concerning children, outpatients or non-invasive ventilation were excluded. Screening and data extraction were conducted independently by three reviewers. Identified interventions were thematically analysed and clustered. RESULTS Of the 7175 records identified, 193 studies were included. A total of six clusters were formed: entitled enteral nutrition (three studies), tracheostomy (17 studies), physical treatment (13 studies), ventilation modes and settings (47 studies), intervention bundles (42 studies), and pharmacological interventions including analgesic agents (8 studies), sedative agents (53 studies) and other agents (15 studies). CONCLUSIONS Ventilator weaning is widely researched with a special focus on ventilation modes and pharmacological agents. Some aspects remain poorly researched or unaddressed (e.g. nutrition, delirium treatment, sleep promotion). RELEVANCE TO CLINICAL PRACTICE This review compiles studies on ventilator weaning interventions in thematic clusters, highlighting the need for multidisciplinary care and consideration of various interventions. Future research should combine different interventions and investigate their interconnection.
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Affiliation(s)
- Fritz Sterr
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Witten, Germany
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Lydia Bauernfeind
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
- Institute of Nursing Science and Practice, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Knop
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Christian Rester
- Faculty of Applied Healthcare Sciences, Deggendorf Institute of Technology, Deggendorf, Germany
| | - Sabine Metzing
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Sciences, Witten/Herdecke University, Witten, Germany
- School VI Medicine and Health Sciences, Department of Health Services Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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106
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Loutfy A, Zoromba MA, Mohamed MA, El-Gazar HE, Andargeery SY, El-Monshed AH, Van Belkum C, Ali AS. Family-centred care as a mediator in the relationship between parental nurse support and parental stress in neonatal intensive care units. BMC Nurs 2024; 23:572. [PMID: 39152458 PMCID: PMC11330068 DOI: 10.1186/s12912-024-02258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/12/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Within the NICU, there is a delicate equilibrium between providing assistance to parents by nurses and prioritising family-centred care (FCC). The FCC assumes the role of a mediator, effectively conveying compassion. The intricate dynamics between FCC, parental nurse support, and parental stress in neonatal intensive care units (NICUs) necessitate comprehensive investigation. OBJECTIVE This study examines the mediating effect of FCC on the relationship between parental nurse support and parental stress in NICUs. METHODS This cross-sectional observational study used convenience sampling to select 223 parents (202 mothers) from Mansoura City hospitals in Egypt. Data were collected using the Nurse Parent Support Tool (NPST), Family-Centered Care Self-Assessment Tool (FCCS-NICU), and the Parental Stressor Scale: NICU (PSS: NICU). Mediation analysis was used to examine the relationships between variables. RESULTS Nurse support was positively associated with FCC (β = 0.81, p < 0.001) and negatively related to parental stress (β=-1.156, p < 0.001). FCC was found to reduce parental stress (β=-0.18, p < 0.001). Mediation analysis confirmed that FCC partially mediated the relationship between nurse support and parental stress (indirect effect β = 0.145, 95% CI: 0.055-1.007). CONCLUSIONS This study highlights a significant association in the mediating role of FCC between nurse support and parental stress. Strengthening FCC practices can be an effective strategy for nurses to support parents and alleviate their stress in NICU settings. IMPLICATIONS TO PRACTICE NICUs should implement FCC-oriented training for nurses, foster a culture that supports FCC principles, and develop policies to establish FCC as a cornerstone of neonatal care.
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Affiliation(s)
- Ahmed Loutfy
- Department of Nursing, College of Health Sciences, University of Fujairah, Fujairah, UAE
- Pediatric Nursing Department, Faculty of Nursing, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed Ali Zoromba
- Nursing Department, College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt.
| | - Mai Adel Mohamed
- Pediatric Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Heba Emad El-Gazar
- Administration Department, Faculty of Nursing, Port-Said University, Port-Said, Egypt
| | - Shaherah Yousef Andargeery
- Nursing Management and Education Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia
| | - Ahmed Hashem El-Monshed
- Department of Nursing, College of Health and Sport Sciences, University of Bahrain, Manama, Bahrain
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Corrien Van Belkum
- Department of Nursing, College of Health Sciences, University of Fujairah, Fujairah, UAE
| | - Ahmed Salah Ali
- Pediatric Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Luo L, Li Y, Wang L, Sun B, Tong Z. Ultrasound evaluation of cardiac and diaphragmatic function at different positions during a spontaneous breathing trial predicting extubation outcomes: a retrospective cohort study. BMC Med Imaging 2024; 24:217. [PMID: 39148010 PMCID: PMC11328514 DOI: 10.1186/s12880-024-01357-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 07/05/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND The ratio (E/Ea) of mitral Doppler inflow velocity to annular tissue Doppler wave velocity by transthoracic echocardiography and diaphragmatic excursion (DE) by diaphragm ultrasound have been confirmed to predict extubation outcomes. However, few studies focused on the predicting value of E/Ea and DE at different positions during a spontaneous breathing trial (SBT), as well as the effects of △E/Ea and △DE (changes in E/Ea and DE during a SBT). METHODS This study was a reanalysis of the data of 60 difficult-to-wean patients in a previous study published in 2017. All eligible participants were organized into respiratory failure (RF) group and extubation success (ES) group within 48 h after extubation, or re-intubation (RI) group and non-intubation (NI) group within 1 week after extubation. The risk factors for respiratory failure and re-intubation including E/Ea and △E/Ea, DE and △DE at different positions were analyzed by multivariate logistic regression, respectively. The receiver operating characteristic (ROC) curves of E/Ea (septal, lateral, average) and DE (right, left, average) were compared with each other, respectively. RESULTS Of the 60 patients, 29 cases developed respiratory failure within 48 h, and 14 of those cases required re-intubation within 1 week. Multivariate logistic regression showed that E/Ea were all associated with respiratory failure, while only DE (right) and DE (average) after SBT were related to re-intubation. There were no statistic differences among the ROC curves of E/Ea at different positions, nor between the ROC curves of DE. No statistical differences were shown in △E/Ea between RF and ES groups, while △DE (average) was remarkably higher in NI group than that in RI group. However, multivariate logistic regression analysis showed that △DE (average) was not associated with re-intubation. CONCLUSIONS E/Ea at different positions during a SBT could predict postextubation respiratory failure with no statistical differences among them. Likewise, only DE (right) and DE (average) after SBT might predict re-intubation with no statistical differences between each other.
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Affiliation(s)
- Ling Luo
- Department of Respiratory and Critical Care Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yidan Li
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lifang Wang
- Epidemiology Research Center, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, NO. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, NO. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China.
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Wang Y, Liang Y, Zheng X, Zhang X, Feng L. Exploring the genuine psychological experiences of novice nurses at emergency resuscitation events: A qualitative interview study. Heliyon 2024; 10:e35153. [PMID: 39157395 PMCID: PMC11328028 DOI: 10.1016/j.heliyon.2024.e35153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/14/2024] [Accepted: 07/23/2024] [Indexed: 08/20/2024] Open
Abstract
Purpose An emergency rescue situation is an inevitable challenge in medical work, requiring collaborative efforts from healthcare professionals. Due to a lack of practical experience, novice nurses may encounter difficulties in successfully managing emergency resuscitation events. This study aimed to analyse the authentic psychological experiences of novice nurses participating in emergency resuscitation events by exploring applicable coping methods and management strategies. Methods This study utilized a hermeneutic phenomenological qualitative research method. We employed purposive sampling to select 27 Novice nurses from West China Hospital of Sichuan University for face-to-face semistructured interviews. Data collection for this study was conducted from November 2023 to January 2024. The interviews were fully audio-recorded and transcribed verbatim. The data were coded, categorized and summarized with the help of Nvivo 20.0 software based on the interpretation of phenomenological research methods. Thematic analysis was performed to deeply analyse and extract corresponding themes. The COREQ criteria were used to guide the reporting of this study. Results The authentic psychological experiences of novice nurses participating in emergency rescue events mainly include six aspects: lack of rescue knowledge reserves and related abilities, psychological and emotional changes, psychological stress after the rescue, rational arrangement of manpower, team cooperation, and postevent reflection and learning. Their authentic psychological experiences directly affect whether novice nurses can effectively respond to emergency rescue events. Conclusions This study suggested enhancing novice nurses' knowledge, improving their resuscitation skills, and improving their psychological well-being during resuscitation events. It advocates for organized staffing, effective teamwork, and robust support systems to empower novice nurses and improve their overall capabilities in emergencies. These findings offer valuable insights for future research in this area.
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Affiliation(s)
- Yiqing Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Yuanyuan Liang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
| | - Xuemei Zheng
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, China
| | - Xiaoxia Zhang
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, China
| | - Liwei Feng
- Department of Pediatric Surgery, West China Hospital, Sichuan University, China
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LaValley M, Chavers-Edgar T, Wu M, Schlosser R, Koul R. Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-20. [PMID: 39146218 DOI: 10.1044/2024_ajslp-23-00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. METHOD Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. RESULTS Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. CONCLUSIONS There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26506102.
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Affiliation(s)
- Mimi LaValley
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | | | - Mengxuan Wu
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Ralf Schlosser
- Department of Communication Sciences and Disorders, Northeastern University, Boston, MA
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, MA
| | - Rajinder Koul
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Centre for Augmentative and Alternative Communication, University of Pretoria, South Africa
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Krewulak KD, Jaworska N, Lee L, Louis JS, Dmitrieva O, Leia MP, Doig C, Niven DJ, Parhar KKS, Rochwerg B, West A, Stelfox HT, Leigh JP, Fiest KM. Impact of restricted family presence during the COVID-19 pandemic on critically ill patients, families, and critical care clinicians: a qualitative systematic review. BMC Health Serv Res 2024; 24:936. [PMID: 39148067 PMCID: PMC11328402 DOI: 10.1186/s12913-024-11398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 08/02/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND We aimed to synthesize the qualitative evidence on the impacts of COVID-19-related restricted family presence policies from the perspective of patients, families, and healthcare professionals from neonatal (NICU), pediatric (PICU), or adult ICUs. METHODS We searched MEDLINE, EMBASE, Cochrane Databases of Reviews and Clinical Trials, CINAHL, Scopus, PsycINFO, and Web of Science. Two researchers independently reviewed titles/abstracts and full-text articles for inclusion. Thematic analysis was completed following appraising article quality and assessing confidence in the individual review findings using standardized tools. RESULTS We synthesized 54 findings from 184 studies, revealing the impacts of these policies in children and adults on: (1) Family integrated care and patient and family-centered care (e.g., disruption to breastfeeding/kangaroo care, dehumanizing of patients); (2) Patients, families, and healthcare professionals (e.g., negative mental health consequences, moral distress); (3) Support systems (e.g., loss of support from friends/families); and (4) Relationships (e.g., loss of essential bonding with infant, struggle to develop trust). Strategies to mitigate these impacts are reported. CONCLUSION This review highlights the multifaceted impacts of restricted visitation policies across distinct care settings and strategies to mitigate the harmful effects of these policies and guide the creation of compassionate family presence policies in future health crises. REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290263 .
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Affiliation(s)
- Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, Pediatric Intensive Care Unit, Children's Hospital Research Institute, Faculty of Nursing, University of Calgary, Calgary, Alberta, AB, Canada
| | - Julia St Louis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Olesya Dmitrieva
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Madison P Leia
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Christopher Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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111
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Arevalo-Buitrago P, Collado MJB, Martínez ÁG, Villarejo RC, Recio MER, Díaz EQ, López FJD, Gomáriz AAM, García GEC, Montoro FJC, López-Soto PJ. Impact of nursing interventions on the prevention of ocular surface disorders in critical care patients: A systematic review. Nurs Crit Care 2024. [PMID: 39140297 DOI: 10.1111/nicc.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/18/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD). AIM This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods. STUDY DESIGN A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation. RESULTS Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD. CONCLUSIONS Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well-trained nursing teams are crucial for reducing ocular injuries in ICU settings. RELEVANCE TO CLINICAL PRACTICE The findings underscore the importance of implementing evidence-based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery.
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Affiliation(s)
- Pedro Arevalo-Buitrago
- UCI, Hospital Universitario Reina Sofia, Cordoba, Spain
- Falculty of Nursing, Universidad de Córdoba, Cordoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba, Cordoba, Spain
| | | | | | | | | | | | | | | | | | | | - Pablo Jesús López-Soto
- Falculty of Nursing, Universidad de Córdoba, Cordoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba, Cordoba, Spain
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112
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Salins N, Dhyani VS, Mathew M, Prasad A, Rao AP, Damani A, Rao K, Nair S, Shanbhag V, Rao S, Iyer S, Gursahani R, Mani RK, Bhatnagar S, Simha S. Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review. Intensive Care Med 2024:10.1007/s00134-024-07565-7. [PMID: 39141091 DOI: 10.1007/s00134-024-07565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission. METHODS Seven databases were systematically searched for systematic reviews, and the umbrella review was conducted according to the guidelines laid out by the Joanna Briggs Institute (JBI). RESULTS Out of 3122 initial records identified, 40 systematic reviews were included in the synthesis. Six key themes were generated that reflect the palliative and end-of-life care practices in the ICUs and their outcomes. Effective communication and accurate prognostications enabled families to make informed decisions, cope with uncertainty, ease distress, and shorten ICU stays. Inter-team discussions and agreement on a plan are essential before discussing care goals. Recording care preferences prevents unnecessary end-of-life treatments. Exceptional end-of-life care should include symptom management, family support, hydration and nutrition optimisation, avoidance of unhelpful treatments, and bereavement support. Evaluating end-of-life care quality is critical and can be accomplished by seeking family feedback or conducting a survey. CONCLUSION This umbrella review encapsulates current palliative care practices in ICUs, influencing patient and family outcomes and providing insights into developing an appropriate care framework for critically ill patients needing end-of-life care and their families.
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Affiliation(s)
- Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | | | - Mebin Mathew
- Karunashraya Bangalore Hospice Trust, Bangalore, India
| | | | - Arathi Prahallada Rao
- Department of Health Policy, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Anuja Damani
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Krithika Rao
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shreya Nair
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Vishal Shanbhag
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shivakumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth University Medical College, Pune, India
| | | | | | - Sushma Bhatnagar
- Oncoanaesthesia and Palliative Medicine, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Thorn L, Bro ML, Lund TH, Dreyer P. Live music in the intensive care unit-A mixed-methods pilot study exploring the experience and impact of live music played for the adult intensive care patient. Aust Crit Care 2024:S1036-7314(24)00202-9. [PMID: 39147694 DOI: 10.1016/j.aucc.2024.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Evidence for music's beneficial effect on physical and mental disorders is mounting. Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using a music-based intervention. Few studies have examined the experience and the physical impact of patient-tailored live music offered by trained health musicians in an adult ICU. AIMS This study aimed to explore the experience of live music in adult patients admitted to an ICU, focusing on its effects on relaxation, stress, and pain. STUDY DESIGN A pilot study with a convergent mixed-methods design. A total of 27 intensive care patients at a Danish University Hospital were offered patient-tailored live music by trained musicians in a single-session design. We performed participant observation and conducted patient interviews using an observational and semistructured interview guide. These data were supported by quantitative pre-post measurements of heart rate, respiration rate, mean arterial blood pressure, subjective pain experience, and heart-rate variability. The study was conducted from February 2020 to December 2021. FINDINGS Using a Ricoeur-inspired analysis of observations and interviews, we elicited four themes: 'A break where you can swim away and relax', 'The living presence makes the play unique', 'Happy memories of the past and longing for home', and 'An intense and meaningful experience'. The quantitative analysis showed a significant decrease in heart rate (4.33 bpm, p < 0.02), respiration rate (2.93, p < 0.001), and blood pressure (3.30, p < 0.05) and a significant increase in heart-rate variation (-0.22, p < 0.01). Seven patients reported pain reduction after the music intervention, corresponding to a 24% reduction. CONCLUSION Live music contributes to meaningful moments by bringing elements of everyday life into the ICU and may promote relaxation and reduce stress and pain. RELEVANCE TO CLINICAL PRACTICE Our findings indicate that live music is a nonpharmacological experience that creates meaningful moments for critically ill patients.
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Affiliation(s)
- Linette Thorn
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
| | - Margrethe Langer Bro
- The Danish National Academy of Music, Esbjerg, Denmark; The Royal Academy of Music, Aarhus/Aalborg, Denmark.
| | | | - Pia Dreyer
- Aarhus University, Department of Public Health, Department of Science in Nursing, Aarhus C, Denmark; Aarhus University Hospital, Department of Intensive Care, Aarhus N, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
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114
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Chuang YC, Shiu SI, Lee YC, Tsai YL, Cheng YY. Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in Patients With COVID-19: A Systematic Review and Meta-analysis. J Intensive Care Med 2024:8850666241268437. [PMID: 39140376 DOI: 10.1177/08850666241268437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Intensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients' recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population. METHODS We searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors. RESULTS The pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63). CONCLUSIONS The prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.
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Affiliation(s)
- Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Evidence-Based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan, ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan, ROC
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
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115
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Maher A, Bennett M, Huang HCC, Gaughwin P, Johnson M, Brady M, Patterson K, Buettikofer T, Morris J, Rainbird VM, Mitchell I, Bissett B. Personalized Exercise Prescription in Long COVID: A Practical Toolbox for a Multidisciplinary Approach. J Multidiscip Healthc 2024; 17:3981-3991. [PMID: 39161542 PMCID: PMC11330745 DOI: 10.2147/jmdh.s465946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/01/2024] [Indexed: 08/21/2024] Open
Abstract
Objective To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature. Background There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation. Methods Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure). Discussion We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts. Conclusion In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.
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Affiliation(s)
- Allison Maher
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Michelle Bennett
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Hsin-Chia Carol Huang
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - Philip Gaughwin
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Mary Johnson
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Madeleine Brady
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | - Kacie Patterson
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Tanya Buettikofer
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
| | - Jo Morris
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
| | | | - Imogen Mitchell
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- College of Health and Medicine, Australian National University, Canberra ACT, Australia
| | - Bernie Bissett
- Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia
- Faculty of Health, University of Canberra, Canberra ACT, Bruce, Australia
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116
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Almeida MP, Winck JC, Marques A. InspireGBs - Inspiratory muscle training in people with Guillain-Barré syndrome: A feasibility study. PM R 2024. [PMID: 39140186 DOI: 10.1002/pmrj.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 05/20/2024] [Accepted: 06/13/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is a rare immune-mediated peripheral nerve disease often preceded by infections. Respiratory muscle weakness is a common complication in this population, leading to decreased vital capacity, weakened coughing ability, atelectasis, and pulmonary infections. Inspiratory muscle training (IMT) has been widely used to enhance inspiratory muscle strength and pulmonary function in various diseases; however, its application in GBS is unknown. OBJECTIVE To assess the safety, feasibility, and preliminary effectiveness of an IMT protocol-InspireGBs-in people with GBS. METHODS A pre/post feasibility study was conducted. Feasibility was determined by participant recruitment/retention, adherence, time spent in each session, and adverse events. Secondary outcome was inspiratory muscle strength. InspireGBs consisted of twice daily sessions 5 times/week, three sets of 10 breaths in each session, for 6 weeks. Initial resistance was set at 50% of participant's baseline maximal inspiratory pressure (MIP) and with a weekly increase of 10% calculated from the previous week's training intensity, if tolerated, otherwise the increase was 5%. RESULTS Eleven patients (63% male; 63 ± 9 years) were recruited from inpatient rehabilitation and 10 completed the study. Recruitment and retention rates were high (79% and 91%, respectively). Excellent adherence rate (96%) was obtained with no reported adverse effects or safety issues. Sessions lasted from 4 to 6 minutes. The MIP improved (pretraining: 39 [26.5-50] cm H2O vs. posttraining: 61 [56.3-64.5] cm H2O, p = .005 and pretraining: 38 [30.5-53.8] % of predicted vs. posttraining: 60 [54.28-71.58] % of predicted, p = .009) with the InspireGBs. CONCLUSION InspireGBs is safe, feasible, and may be effective in improving inspiratory muscle strength in individuals with GBS. A randomized controlled trial is now needed to strengthen these findings.
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Affiliation(s)
- Miguel P Almeida
- North Rehabilitation Centre, Local Health Unit Gaia e Espinho, Vila Nova de Gaia, Portugal
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | | | - Alda Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
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117
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Gill FJ, Cooper A, Falconer P, Stokes S, Roberts A, Szabo M, Leslie GD. Feasibility and acceptability of implementing an evidence-based ESCALATION system for paediatric clinical deterioration. Pediatr Res 2024:10.1038/s41390-024-03459-y. [PMID: 39134760 DOI: 10.1038/s41390-024-03459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation. METHODS A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis. RESULTS There were 650 audits (Study I-IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II-IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III-IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway. CONCLUSION The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementation. IMPACT This series of four studies used a co-production approach built on the Medical Research Council framework to understand feasibility and acceptability of an intervention to improve recognition and response to clinical deterioration in children to the point of full-service implementation. We have reported a detailed, systematic approach to assessing feasibility and acceptability of a complex intervention using established methodologies for whole of health system implementation. The ESCALATION System is an evidence based paediatric early warning system that is a highly refined, well accepted and accommodates a health system that has substantial contextual variation.
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Affiliation(s)
- Fenella J Gill
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
- Nursing Research, Perth Children's Hospital, Child & Adolescent Health Services, Nedlands, WA, Australia.
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Murdoch, WA, Australia.
| | - Alannah Cooper
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Nursing Research, St John of God Healthcare, Subiaco, WA, Australia
- Clinical Nursing Research Unit, Royal Perth Hospital, Perth, WA, Australia
| | - Pania Falconer
- Nursing Research, Perth Children's Hospital, Child & Adolescent Health Services, Nedlands, WA, Australia
| | - Scott Stokes
- Kimberley Regional Paediatric Service, Broome Hospital, Western Australia Country Health Service, Kimberley, WA, Australia
- National School of Nursing and Midwifery, University of Notre Dame Australia, Broome, WA, Australia
| | - Alison Roberts
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Child and Adolescent Health Service, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Matthew Szabo
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Murdoch, WA, Australia
| | - Gavin D Leslie
- School of Nursing, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Nursing and Midwifery Research Unit, South Metropolitan Health Service, Murdoch, WA, Australia
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118
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Bazbaz A, Varon J. Neuroprognostication, withdrawal of care and long-term outcomes after cardiopulmonary resuscitation. Curr Opin Crit Care 2024:00075198-990000000-00202. [PMID: 39150054 DOI: 10.1097/mcc.0000000000001194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Survivors of cardiac arrest often have increased long-term risks of mortality and disability that are primarily associated with hypoxic-ischemic brain injury (HIBI). This review aims to examine health-related long-term outcomes after cardiac arrest. RECENT FINDINGS A notable portion of cardiac arrest survivors face a decline in their quality of life, encountering persistent physical, cognitive, and mental health challenges emerging years after the initial event. Within the first-year postarrest, survivors are at elevated risk for stroke, epilepsy, and psychiatric conditions, along with a heightened susceptibility to developing dementia. Addressing these challenges necessitates establishing comprehensive, multidisciplinary care systems tailored to the needs of these individuals. SUMMARY HIBI remains the leading cause of disability among cardiac arrest survivors. No single strategy is likely to improve long term outcomes after cardiac arrest. A multimodal neuroprognostication approach (clinical examination, imaging, neurophysiology, and biomarkers) is recommended by guidelines, but fails to predict long-term outcomes. Cardiac arrest survivors often experience long-term disabilities that negatively impact their quality of life. The likelihood of such outcomes implements a multidisciplinary care an integral part of long-term recovery.
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Affiliation(s)
| | - Joseph Varon
- Dorrington Medical Associates, PA
- The University of Houston College of Medicine, Houston, Texas, USA
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119
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Curley MAQ, Dawkins-Henry OS, Kalvas LB, Perry-Eaddy MA, Georgostathi G, Yuan I, Wypij D, Asaro LA, Zuppa AF, Kudchadkar SR. The Nurse-Implemented Chronotherapeutic Bundle in Critically Ill Children, RESTORE Resilience (R2): Pilot Testing in a Two-Phase Cohort Study, 2017-2021. Pediatr Crit Care Med 2024:00130478-990000000-00373. [PMID: 39133067 DOI: 10.1097/pcc.0000000000003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Pilot test the nurse-led chronotherapeutic bundle in critically ill children, RESTORE Resilience (R2). DESIGN A two-phase cohort study was carried out from 2017 to 2021. SETTING Two similarly sized and organized PICUs in the United States. PATIENTS Children 6 months to 17 years old who were mechanically ventilated for acute respiratory failure. INTERVENTIONS R2 seven-item chronotherapeutic bundle, including: 1) replication of child's pre-hospital daily routine (i.e., sleep/wake, feeding, activity patterns); 2) cycled day-night light/sound modulation; 3) minimal effective sedation; 4) night fasting with bolus enteral daytime feedings; 5) early progressive mobility; 6) nursing care continuity; and 7) parent diaries. MEASUREMENTS AND MAIN RESULTS Children underwent environmental (light, sound) and patient (actigraphy, activity log, salivary melatonin, electroencephalogram) monitoring. Parents completed the Child's Daily Routine and Sleep Survey (CDRSS) and Family-Centered Care Scale. The primary outcome was post-extubation daytime activity consolidation (Daytime Activity Ratio Estimate [DARE]). Twenty baseline-phase (2017-2019) and 36 intervention-phase (2019-2021) participants were enrolled. During the intervention phase, nurses used the CDRSS to construct children's PICU schedules. Overall compliance with nurse-implemented R2 elements 1-5 increased from 18% (interquartile range, 13-30%) at baseline to 63% (53-68%) during the intervention phase (p < 0.001). Intervention participants were exposed to their pre-hospitalization daily routine (p = 0.002), cycled day-night light/sound modulation (p < 0.001), and early progressive mobility on more PICU days (p = 0.02). Sedation target identification, enteral feeding schedules, and nursing care continuity did not differ between phases. Parent diaries were seldom used. DARE improved during the intervention phase and was higher pre-extubation (median 62% vs. 53%; p = 0.04) but not post-extubation (62% vs. 57%; p = 0.56). CONCLUSIONS In the PICU, implementation of an individualized nurse-implemented chronotherapeutic bundle is feasible. Children who received the R2 bundle had increased pre-extubation daytime activity consolidation compared to children receiving usual care. Given variation in protocol adherence, further R2 testing should include interprofessional collaboration, pragmatic trial design, and implementation science strategies.
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Affiliation(s)
- Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Laura Beth Kalvas
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, Storrs, CT
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Pediatric Intensive Care Unit, Connecticut Children's Medical Center, Hartford, CT
| | - Georgia Georgostathi
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ian Yuan
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Athena F Zuppa
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sapna R Kudchadkar
- Pediatric Intensive Care Unit, Children's Center, Johns Hopkins Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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Liao C, Guan Q, Ma X, He X, Su Y, Fan D, Liu J, Ye J, He X, Cui P. Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity. J Clin Nurs 2024. [PMID: 39128973 DOI: 10.1111/jocn.17385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/28/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE Developing a severity assessment scale for critically ill patients' thirst and conducting reliability and validity tests, aiming to provide healthcare professionals with a scientific and objective tool for assessing the level of thirst. METHODS Based on literature review and qualitative interviews, a pool of items was generated, and a preliminary scale was formed through two rounds of Delphi expert consultation. Convenience sampling was employed to select 178 ICU patients in a top-three hospital from May 2023 to October 2023 as the study subjects to examine the reliability and validity of the severity assessment scale for critically ill patients' thirst. RESULTS The developed severity assessment scale for critically ill patients' thirst consists of 8 evaluation items and 26 evaluation indicators. The agreement coefficients for two rounds of expert consultation were 100% and 92.6% for the positive coefficient, and the authority coefficients were .900 and .906. Kendall's concordance coefficients were .101 and .120 (all p < .001). The overall Cronbach's α coefficient for the scale was .827. The inter-rater reliability coefficient was .910. The Item-Content Validity Index (I-CVI) ranged from .800 to 1.000, and the Scale-Content Validity Index/Average (S-CVI/Ave) was .950. CONCLUSION The critically ill patients' thirst assessment scale is reliable and valid and can be widely used in clinical practice. PATIENT OR PUBLIC CONTRIBUTION The AiMi Academic Services (www.aimieditor.com) for English language editing and review services. IMPLICATIONS FOR CLINICAL PRACTICE The scale developed in this study is a simple and ICU-specific scale that can be used to assess the severity of thirst in critically ill patients. As such, the severity of thirst in critically ill patients can be evaluated quickly so that targeted interventions can be implemented according to the patient's specific disease and treatment conditions. Therefore, patient comfort can be improved, and thirst-related health problems can be prevented.
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Affiliation(s)
- Chunli Liao
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Qiongyao Guan
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Xiangping Ma
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Xueting He
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Yan Su
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Dandan Fan
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
| | - Jing Liu
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Jinyu Ye
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Xifeng He
- Department of Nursing, Lancang First People's Hospital, Puer, China
| | - Pengyu Cui
- Department of Intensive Care Medicine, The Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Kunming, China
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Lovegrove J, Fulbrook P, Yuan C, Lin F, Liu XL. The Chinese Mandarin COMHON Index and Braden Scale to assess pressure injury risk in intensive care: An inter-rater reliability and convergent validity study. Aust Crit Care 2024:S1036-7314(24)00203-0. [PMID: 39129066 DOI: 10.1016/j.aucc.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/29/2024] [Accepted: 05/29/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND The COMHON Index is an intensive-care-specific pressure injury risk assessment tool, which has demonstrated promising psychometric properties. It has been translated into Chinese Mandarin but requires inter-rater reliability testing and comparison to the standard care instrument (Braden Scale) before clinical use. OBJECTIVES This study aimed to test and compare the inter-rater reliability and convergent validity of the Chinese Mandarin versions of the COMHON Index and Braden Scale. METHODS The study was conducted in a Chinese comprehensive intensive care unit. Based on a sample size calculation, five registered nurse raters with at least 6-months experience independently conducted risk assessments for 20 adult patients using both the COMHON Index and Braden Scale. Intraclass correlations (ICC) for inter-rater reliability, standard errors of measurement (SEM), and minimally detectable change (MDC) were calculated. Convergent validity was assessed using Pearson Product Moment Correlation for sum scores and Spearman's rho for subscales. RESULTS Inter-rater reliability of COMHON Index and Braden Scale sum scores was very high (ICC [1,1] = 0.973; [95% confidence interval 0.949-0.988]; SEM 0.54; MDC 1.50) and high (ICC [1,1] = 0.891; [95% confidence interval 0.793-0.951]; SEM 0.93; MDC 2.57), respectively. All COMHON-Index subscales demonstrated ICC values >0.6, whereas two Braden Scale subscales (Mobility, Activity) were below this threshold. Instrument sum scores were strongly correlated (Pearson's r = -0.76 [r2 = 0.58]; p < 0.001), as were three subscale item pairs (mobility rs= -0.56 [r2 = 0.32]; nutrition rs= -0.63 [r2 = 0.39]; level of consciousness/sensory perception rs= -0.67 [r2 = 0.45] p < 0.001). CONCLUSION Both the COMHON Index and Braden Scale demonstrated high levels of inter-rater reliability and measured similar constructs. However, the COMHON Index demonstrated superior inter-rater reliability and the results suggest that it better detects changes in patient condition and subsequently pressure injury risk. Further testing is recommended.
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Affiliation(s)
- Josephine Lovegrove
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Southport, Australia; Herston Infectious Diseases Institute, Metro North Health, Herston, Australia; School of Nursing, Midwifery & Social Work, Faculty of Health & Behavioral Sciences, The University of Queensland & UQCCR, Herston, Australia; Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia.
| | - Paul Fulbrook
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Australia; School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Australian Catholic University, Banyo, Australia; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cui Yuan
- Peking University First Hospital, Beijing, China
| | - Frances Lin
- Peking University First Hospital, Beijing, China; Flinders University, Adelaide, Australia
| | - Xian-Liang Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong SAR, China
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Bloomer MJ, Saffer L, Hewitt J, Johns L, McAuliffe D, Bonner A. Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping review. Palliat Med 2024:2692163241268449. [PMID: 39126283 DOI: 10.1177/02692163241268449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
BACKGROUND Assisted dying, also commonly known as euthanasia and physician-assisted suicide, is legal in many countries. Interest in assisted dying is growing due to evolving societal understandings of a good death and a desire for choice. Ethico-legal perspectives are well-known, but as societies become more heterogenous, a greater understanding of the perspectives of people from diverse racial, ethnic, and cultural backgrounds is needed. AIM To explore perspectives of people from diverse racial, ethnic and cultural backgrounds about assisted dying. DESIGN Scoping review with narrative synthesis. The protocol was registered with Open Science Framework. DATA SOURCES Medline, CINAHL Complete, PsycINFO and ProQuest Dissertations & Theses Global were searched from inception to May 2023. Citations were independently assessed against inclusion and exclusion criteria. RESULTS Of the 17 included studies, perspectives of assisted dying were presented according to religion, religiosity, spirituality, race, ethnicity and ancestry. Perspectives were diverse, presenting more as a spectrum, with multiple intersections and interconnections. Support and/or opposition for assisted dying differed according to cultural attributes, but even amongst those with similar cultural attributes, perspectives differed according to life experiences and notions of suffering. CONCLUSION Perspectives on assisted dying are dynamic and evolving. Even where assisted dying is legalised, individual's cultural attributes contribute to unique perspectives of assisted dying as an end-of-life option. Thus, understanding a person's culture, beliefs, expectations and choices in illness, treatment goals and care is fundamental, extending beyond what may be already considered as part of clinician-patient care relationships and routine advance care planning.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health and Hospital Service, Woolloongabba, QLD, Australia
| | - Laurie Saffer
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Intensive Care Unit, Epworth HealthCare, Richmond, VIC, Australia
| | - Jayne Hewitt
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Queen Elizabeth II Hospital, Metro South Health and Hospital Service, Coopers Plains, QLD, Australia
- Law Futures Centre, Griffith University, Nathan, QLD, Australia
| | - Lise Johns
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Donna McAuliffe
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD, Australia
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Herston, QLD, Australia
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Shi J, Cao X, Chen Z, Pang X, Zhuang D, Zhang G, Mao L. Sensory processing sensitivity and compassion fatigue in intensive care unit nurses: A chain mediation model. Aust Crit Care 2024:S1036-7314(24)00199-1. [PMID: 39129065 DOI: 10.1016/j.aucc.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Compassion among intensive care unit (ICU) nurses is an essential component of humanistic care in the ICU However, the enormous pressures of the job and the lack of social support have led to persistently severe compassion fatigue. Sensory processing sensitivity, as a personality trait for individuals to perceive external factors, has underlying significance for compassion fatigue. AIMS This study aims to investigate the internal and external environmental factors and the underlying mechanisms that influence the impact of sensory processing sensitivity among ICU nurses on the development of compassion fatigue. STUDY DESIGN A cross-sectional descriptive study was conducted with 290 nurses from various hospitals in five cities in China. METHOD A self-designed demographic questionnaire, the Chinese version of the Professional Quality of Life Scale, the Chinese version of the Highly Sensitive Person Scale, the Chinese version of the Perceived Social Support Scale, and the Chinese version of the Perceived Stress Scale were used to survey 290 ICU nurses. The mediating roles of perceived social support and perceived stress between sensory processing sensitivity and compassion fatigue were tested. RESULTS The research results indicate that the total effect of sensory processing sensitivity on compassion fatigue is significant (0.245 [0.093, 1.160]), whereas the direct effect of sensory processing sensitivity on compassion fatigue is not significant (-0.43 [-0.402, 0.247]). Perceived social support and perceived stress exhibit serial mediating effects between sensory processing sensitivity and compassion fatigue (-0.065 [-0.142, -0.013]). CONCLUSION Our results revealed, for the first time, the underlying mechanism between sensory processing sensitivity and compassion fatigue among ICU nurses. Providing necessary stress-relief condition and abundant social support are important measures for nursing managers to reduce compassion fatigue and improve the quality of critical care humanistic nursing services.
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Affiliation(s)
- Jiaqi Shi
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
| | - Xinmei Cao
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
| | - Zhi Chen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
| | - Xinyue Pang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
| | - Danwen Zhuang
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
| | - Guohua Zhang
- Key Research Center of Philosophy and Social Sciences of Zhejiang Province, Institute of Medical Humanities, Wenzhou Medical University, 325035, China; The Affiliated Kangning Hospital, Wenzhou Medical University, Wenzhou, 325035, China.
| | - Lijie Mao
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China.
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Bellizzi S, Panu Napodano CM, Murgia P. Family-centered care for newborns: a global perspective and review. J Trop Pediatr 2024; 70:fmae026. [PMID: 39142805 DOI: 10.1093/tropej/fmae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Person-centered models of care built on newborn and family needs and rights, such as nonseparation immediately after birth and during the care process, can address the complex needs of the newborn, family, and health system. This is particularly important in low- and middle-income countries, where cost-effective modalities are highly needed to accelerate the survival of newborn babies. We conducted a systematic review to explore country experiences on implementation and challenges to implement and scale-up family-centered newborn care models of care. MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched to identify studies on patient-centered care and newborns between 1990 and 2023. Studies meeting our predefined inclusion criteria were quality assessed and relevant data extracted. We utilized the World Health Organization framework on integrated people-centered health services to summarize and analyze findings while highlighting patterns. Forty-one studies were included for review (including approximately 60% from low- and middle-income countries). Different research conducted over time highlighted how immediate and uninterrupted skin-to-skin care facilitates a series of critical processes for newborns, parents, and health system, including breastfeeding initiation and exclusivity rates, reduced incidence of post-partum depression, and prevention of infection and hospitalization. Thanks to the close contact of the kangaroo position or skin-to-skin contact, parents recount becoming more and more attached to and familiar with their baby, easily establishing a relationship. Overall, countries could transform the newborn care service in terms of family center care by adopting three simple rules: (i) minimizing mother-child separation; (ii) involving fathers; (iii) empowering parents from the time of birth. A paradigm shift is required to change the conventional model of provider-centric care to one of person-centered neonatal health care. Such an approach is feasible in diverse country settings and should be facilitated through political commitment and policies enabling early focus on the maternal-infant relationship. This could, in turn, help achieve improved dignity of care and help create a more efficient and responsive health system and society.
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Affiliation(s)
- Saverio Bellizzi
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Catello M Panu Napodano
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Paola Murgia
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
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Crossfield C, Ozavci G, Digby R, Bucknall T. A systematic review on the effect of telehealth communication with intensive care unit families on patient and family outcomes. Aust Crit Care 2024:S1036-7314(24)00204-2. [PMID: 39127603 DOI: 10.1016/j.aucc.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/19/2024] [Accepted: 06/25/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND During the Covid-19 pandemic, family visitation to intensive care was severely restricted. In response, family communication moved to remote-only options. The effect on patients and families of this communication change is poorly understood. OBJECTIVE The aim of this review was to synthesise the available research on remote-only communication interventions and their effect on patient and family outcomes within the intensive care environment. REVIEW METHOD USED A systematic review of relevant studies was undertaken. DATA SOURCES Databases included CINAHL, APA PsychINFO, MEDLINE, and Ovid Embase. REVIEW METHODS Databases were searched with a date restriction of June 1st, 2011, to June 1st, 2023. Two independent reviewers assessed each study using the Mixed Methods Appraisal Tool, version 2 of the Cochrane risk-of-bias tool for randomised controlled trials, and the Risk Of Bias In Nonrandomised Studies of Interventions tool for methodological quality and risk of bias. Of the 2292 articles screened, 10 studies met the inclusion criteria. RESULTS Ten studies were included (n = 3861). Methodological quality was mostly poor, with one study evaluated as high on Mixed Methods Appraisal Tool quality criteria. Two themes were derived from the literature: (i) patient and family satisfaction; and (ii) patient and family psychological distress symptoms. Five studies reported patient and family satisfaction, with four studies finding statistically significant improvement following the communication intervention. However, only one of the five studies specifically evaluated the satisfaction with the communication intervention. Nine studies reported patient and family psychological distress symptoms, using 12 measurement tools. A variable effect of interventions was found within this theme. CONCLUSIONS This review identified important gaps in the research examining remote-only family communication interventions in intensive care. Inconsistent delivery of remote-only communication interventions, biased research methods, and variable outcome measurement tools impacted the reliability and validity of current evidence. Further research on remote-only communication interventions and the effect on families is recommended.
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Affiliation(s)
- Claire Crossfield
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia.
| | - Guncag Ozavci
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia; Alfred Health, 55 Commercial Rd, Melbourne VIC, 3004, Australia.
| | - Robin Digby
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia; Alfred Health, 55 Commercial Rd, Melbourne VIC, 3004, Australia.
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety, Research, Institute for Health Transformation, Faculty of Health, Geelong, VIC, 3220, Australia; Alfred Health, 55 Commercial Rd, Melbourne VIC, 3004, Australia.
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Choi MH, Kim HJ, Yoo HJ. Nurses' perspectives about end-of-life care when family presence is restricted during a pandemic: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00201-7. [PMID: 39127604 DOI: 10.1016/j.aucc.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND To prevent the infection from spreading, patients who were dying from COVID-19 were treated in isolation with restricted family access, which differed from existing end-of-life care procedures. This was a significant change that affected the care provided by nurses. OBJECTIVES This study explored nurses' end-of-life care experiences in a limited family visitation setting during the COVID-19 pandemic. METHODS A descriptive qualitative study was conducted. Data were collected through individual, in-depth, semistructured interviews with ten critical care nurses who provided end-of-life care to patients with COVID-19 in South Korea. The data were analysed using thematic analysis. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the study's rigour. FINDINGS Three themes were identified: 'Witnessing patients' and families' heartbreak over separation', 'The gaps between the ideals and realities of end-of-life care', and 'Efforts to provide patients with a comfortable final journey'. Nurses realise the importance of their central role in supporting interactions between patients and families during end-of-life care. CONCLUSIONS Family participation, facilitated by nurses' interest and efforts as mediators connecting patients and families, is essential for achieving high-quality care for inpatients facing end of life. This study is significant as it emphasises that the direction of end-of-life care should be family centric, even in a pandemic situation with limited family participation. To improve interaction between patients and families, creating an environment based on family participation that builds trust and strengthens communication is essential. Additionally, hospital support, such as professional education and counselling, should be provided to strengthen nurses' end-of-life care competency.
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Affiliation(s)
- Myung Hui Choi
- Department of Nursing, Dankook University Hospital, Cheonan, Republic of Korea
| | - Hyun Jung Kim
- Department of Nursing, Dankook University Hospital, Cheonan, Republic of Korea
| | - Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, Republic of Korea.
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Huang W, Gao Y, Zhou L, Xiao X, Xu H, Lu L, Deng J, Wu J. Effects of ICU diaries on psychological disorders and sleep quality in critically ill patients and their family members: A systematic review and meta-analysis. Sleep Med 2024; 122:84-91. [PMID: 39137664 DOI: 10.1016/j.sleep.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND The psychological health and sleep quality of intensive care unit (ICU) patients and their families have health implications, and greater attention should be devoted to developing effective interventions to address these concerns. Due to an increasing amount of evidence on ICU diary interventions, their comparative effectiveness should be evaluated. AIMS This systematic review and meta-analysis aimed to evaluate the effect of ICU diaries on psychological disorders and sleep quality in critically ill patients and on psychological disorders in their family members. METHODS The PubMed, Embase, Web of Science, Cochrane Library, China Biomedical Literature Database, China National Knowledge Network, Wanfang Database, and Weipu Chinese Journal databases were searched up to November 2023 to identify randomized controlled trials. We used the Cochrane Risk of Bias Tool for quality assessment, and we used Review Manager 5.4 software to conduct meta-analysis. RESULTS Eleven studies with a total of 1682 patients met the inclusion criteria. PATIENTS PTSD (7 studies, 1015 patients): OR 0.63 (95%CI 0.45-0.87), p = 0.005; Anxiety (6 studies, 546 patients): OR 0.52 (95%CI 0.22-1.27), p = 0.15; Depression (6 studies, 546 patients): OR 0.62 (95%CI 0.39-0.97), p = 0.04; sleep quality (2 studies, 203 patients): OR -3.97 (95%CI -7.71-0.23), p = 0.04. Family members: PTSD (2 studies, 652 patients): OR 0.81 (95%CI 0.37-1.79), p = 0.60; Anxiety (2 studies, 650 family members): OR 1.09 (95%CI 0.79-1.49), p = 0.62; Depression (2 studies, 650 patients): OR 1.03 (95%CI 0.71-1.50), p = 0.87. The pooled results of the meta-analysis showed that ICU diaries reduced the incidence of depression and post-traumatic stress disorder and improved sleep quality in patients, but had no significant effects on patients' anxiety status or family members' psychological disorders. Three of the included studies had a high quality, and the remaining eight studies had a moderate quality. CONCLUSIONS For patients, ICU diaries can improve their depression and post-traumatic stress disorder, improve sleep quality, but has no significant effect on anxiety; For family members, ICU diaries were not significant. Due to the existence of bias and the limited sample size, the results should be interpreted with caution. Researchers need to further elucidate the multidisciplinary collaborative process of diary-based treatment in ICUs and its impact on psychological disorders in family members. Furthermore, large-scale, multicentre, robust studies should be conducted in the future.
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Affiliation(s)
- Wenjie Huang
- Medical School of Nantong University, Nantong, 226001, China
| | - Yang Gao
- Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Lingjun Zhou
- Medical School of Nantong University, Nantong, 226001, China
| | - Xiaojuan Xiao
- Medical School of Nantong University, Nantong, 226001, China
| | - Hong Xu
- Medical School of Nantong University, Nantong, 226001, China
| | - Lizhou Lu
- Medical School of Nantong University, Nantong, 226001, China
| | - Jinhao Deng
- Medical School of Nantong University, Nantong, 226001, China
| | - Juan Wu
- Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Bosch Alcaraz A, Belda Hofheinz S, Corrionero Alegre J, Miguel García Piñero J, Gil Domínguez S, Fernández Lorenzo R, Mata Ferro M, Martín Gómez A, Serradell Orea M, Luna Castaño P, Ángeles Saz Roy M, Zuriguel Pérez E, Martínez Oliva M, González Rivas S, Añaños Montoto N, José Espildora González M, Martín-Peñasco Osorio E, Carracedo Muñoz E, López Fernández E, Lozano Almendral G, Victoria Ureste Parra M, Gomez Merino A, García Martínez A, Morales Cervera D, Frade Pardo L, Díaz Lerma A, Piqueras Rodríguez P. Prevalence of use of physical restraints in pediatric intensive care units and correlated variables: A Spanish multicenter study. Intensive Crit Care Nurs 2024; 85:103788. [PMID: 39116510 DOI: 10.1016/j.iccn.2024.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/07/2024] [Accepted: 07/31/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVE To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables. METHODS We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient's medical history, and asking the professionals involved in the patient's care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months. RESULTS A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20-24]) and infectious patients the least (15 h [14-20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15-24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4-24]). CONCLUSIONS The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR. IMPLICATIONS FOR CLINICAL PRACTICE Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients.
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Affiliation(s)
- Alejandro Bosch Alcaraz
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | | | | | | | | | | | - María Mata Ferro
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
| | | | | | - Patricia Luna Castaño
- Alfonso X el Sabio University, Madrid, Spain; Member of the Health Care and Services Research Unit (Investén-ISCIII), Spain
| | - M Ángeles Saz Roy
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | - Esperanza Zuriguel Pérez
- Department of Knowledge Management and Evaluation, Vall d'Hebron Hospital, Barcelona, Spain; Multidisciplinary Nursing Research Group. Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pedro Piqueras Rodríguez
- Pediatric Intensive Care Unit, La Paz Hospital, Madrid, Spain; Health Research Institute, La Paz Hospital - IdiPAZ, Madrid, Spain
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Pongsuwun K, Puwarawuttipanit W, Nguantad S, Samart B, Saikaew K, Ruksakulpiwat S. Factor Impacting Quality of Life Among Sepsis Survivors During and After Hospitalization: A Systematic Review of Current Empirical Evidence. J Multidiscip Healthc 2024; 17:3791-3802. [PMID: 39131747 PMCID: PMC11316489 DOI: 10.2147/jmdh.s477873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/26/2024] [Indexed: 08/13/2024] Open
Abstract
Background There remains a gap in understanding post-sepsis outcomes, particularly regarding the factors that influence the quality of life (QOL) among sepsis survivors during and after hospitalization. Objective To determine factors impacting QOL among sepsis survivors during and after hospitalization based on the evaluation and synthesis of current evidence. Methods This review encompassed studies published from January 2020 to December 2024, sourced from Scopus, PubMed, Medline, ScienceDirect, CINAHL Plus with Full Text, and Web of Science. The process of identifying, screening, excluding, and including articles followed the guidelines set by the Preferred Reporting Items for Systematic Reviews (PRISMA). Data synthesis for theme generation was conducted using the convergent integrated analysis framework as recommended by the Joanna Briggs Institute. Results A total of 1164 records were identified from the databases. After removing 130 duplicates, 1034 articles remained for screening based on their titles and abstracts according to the inclusion and exclusion criteria. At this stage, 1021 articles did not meet the criteria and were excluded, leaving 13 articles eligible for full-text screening. During this phase, 5 articles were excluded for various reasons, resulting in eight studies being included in the systematic review. Data synthesis of these studies revealed seven themes related to factors impacting QOL among sepsis survivors during and after hospitalization: 1) Physical Health Dimension, 2) Mental Health Dimension, 3) Treatment During Hospitalization, 4) Spiritual Dimension, 5) Social Support, 6) Mortality, and 7) Blood Biomarkers. Conclusion This systematic review provides valuable insights into the factors affecting the quality of life among sepsis survivors during and after hospitalization. These findings enhance the current knowledge base and offer clinicians, researchers, and policymakers actionable insights to improve outcomes and well-being for sepsis survivors.
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Affiliation(s)
- Kewalin Pongsuwun
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | | | - Sunisa Nguantad
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Khalinee Saikaew
- Department of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suebsarn Ruksakulpiwat
- Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
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130
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Zhang L, Luo Y, Long J, Yin Y, Fu Q, Wang L, Patil S. Enhancing Standardized Practices for Oral Mucositis Prevention in Pediatric Hematopoietic Stem Cell Transplantation: A Best Practice Implementation Project. Risk Manag Healthc Policy 2024; 17:1909-1920. [PMID: 39130104 PMCID: PMC11316476 DOI: 10.2147/rmhp.s471877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024] Open
Abstract
Background Oral mucositis (OM) poses a significant challenge in children undergoing hematopoietic stem cell transplantation (HSCT). There is a gap between clinical practice and the evidence, and nursing practices is not standardized. Objective This study aims to evaluate the effectiveness of applying the evidence for preventing HSCT chemotherapy-induced OM in children and to elevate the nurses' compliance to the evidence. Methods Following the clinical evidence practice application model of the Joanna Briggs Institute (JBI) evidence-Based Care Center. The process included reviewing literature, extracting evidence, identifying gaps, developing audit criteria, conducting a baseline audit, creating an action plan, implementing evidence-based interventions, and assessing outcomes. Results After the evidence implementation, 6 out of 12 audit criteria with poor compliance are significantly improved, with statistically significant differences (P<0.05). The incidence of OM decreases, with a statistically significant difference (66.6% vs 36.7%, P=0.02). The incidence of grade I, II, III, and IV OM also decreases (30% vs 23.3%, 23.3% vs 13.4%, 10% vs 0%, and 3.3% vs 0%). Ultimately, the standardized oral care practice routine and workflows to prevent OM were established. Conclusion Bridging the gap between evidence and clinical practice can standardize nurse behavior, decrease the incidence of OM, and lower the OM severity in children undergoing HSCT.
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Affiliation(s)
- Luyang Zhang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yuan Luo
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Jiewen Long
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Yan Yin
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Qin Fu
- Department of Nursing, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Lei Wang
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
| | - Sandip Patil
- Department of Haematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong Province, People’s Republic of China
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131
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Mariani I, Vuillard CLJ, Bua J, Girardelli M, Lazzerini M. Family-centred care interventions in neonatal intensive care units: a scoping review of randomised controlled trials providing a menu of interventions, outcomes and measurement methods. BMJ Paediatr Open 2024; 8:e002537. [PMID: 39106991 DOI: 10.1136/bmjpo-2024-002537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/12/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Benefits of different types of family-centred care (FCC) interventions in neonatal intensive care units (NICUs) have been reported. However, a comprehensive review of existing FCC intervention studies was lacking. OBJECTIVE This review aimed at synthesising the characteristics of FCC interventions, related outcomes and measurement methods in randomised controlled trials (RCTs) in NICU, and providing menus of options to favour implementation and further research. METHODS We searched PubMed, EMBASE, Web of Science and the Cochrane Library up to 31 January 2022. Interventions were mapped according to five categories as defined by a previous Cochrane review. We described outcome types, measurement populations, measurement methods and timelines. Subgroup analyses were also performed. RESULTS Out of 6583 studies identified, 146 met eligibility criteria. Overall, 52 (35.6%) RCTs tested more than one category of intervention, with a large variety of combinations, with the most frequent category of intervention being the educational (138 RCTs, 94.5%). We identified a total of 77 different intervention packages, and RCTs comparing the same interventions were lacking. The 146 RCTs reported on 425 different outcomes, classified in 13 major categories with parental mental health (61 RCTs, 41.8% of total RCTs) being the most frequent category in parents, and neurobehavioural/developmental outcomes being the most frequent category in newborns (62 RCTs, 42.5%). For several categories of outcomes almost every RCT used a different measurement method. Educational interventions targeting specifically staff, fathers, siblings and other family members were lacking or poorly described. Only one RCT measured outcomes in health workers, two in siblings and none considered other family members. CONCLUSIONS A large variety of interventions, outcomes and measurement methods were used in FCC studies in NICU. The derived menus of options should be helpful for researchers and policy makers to identify interventions most suitable in each setting and to further standardise research methods.
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Affiliation(s)
- Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Martina Girardelli
- Department of Pediatrics, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health - IRCCS 'Burlo Garofolo', Trieste, Italy
- London School of Hygiene & Tropical Medicine, London, UK
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132
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Erkoc A, Polat Dunya C, Uren S. Night-time sleep of intensive care patients: A qualitative study. Nurs Crit Care 2024. [PMID: 39103974 DOI: 10.1111/nicc.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/23/2024] [Accepted: 07/14/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND The quality of the sleep in the intensive care unit (ICU) is generally poor. It is known that several factors contribute to this situation. AIMS AND OBJECTIVES To describe the experiences of adult patients during night-time sleep in the ICU. DESIGN A qualitative study using a phenomenological approach was conducted from May to October 2021. Patients were intensive care patients (n = 10) who were treated for at least 24 h in tertiary ICUs. METHODS The data were obtained through semi-structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed. RESULTS The analysis resulted in three main themes: (a) inadequate sleep at night; (b) factors negatively affecting night-time sleep; and (c) patient expectations for improved night-time sleep. Night-time sleep of patients treated in intensive care were determined to generally have inadequate and be interrupted. Patients associated the cause of this situation with the physical environment conditions in the ICU, loud noises made by health employees and emotional reactions. It was stated that some physical environment changes that can be made in ICUs and psychological support will positively affect sleep. CONCLUSIONS Intensive care patients may not have quality night-time sleep because of multifactorial reasons. Noise in the ICU is a significant factor preventing patients from sleeping. In addition to reorganization of the physical environment to ensure adequate sleep, there is a need for an integrated approach dealing with patients' feelings and concerns. RELEVANCE TO CLINICAL PRACTICE Each patient has their own unique sleep pattern. To ensure effective management of sleep problems, health professionals should organize care and physical conditions in line with guidelines and create patient-specific night-time sleep management programmes.
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Affiliation(s)
- Arzu Erkoc
- Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | | | - Sibel Uren
- Kanuni Sultan Suleyman Training and Research Hospital, Istanbul Health Sciences University, Istanbul, Turkey
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133
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Cussen J, Mukpradab S, Tobiano G, Haines KJ, O'Connor L, Marshall AP. Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study. Aust Crit Care 2024:S1036-7314(24)00120-6. [PMID: 39107155 DOI: 10.1016/j.aucc.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.
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Affiliation(s)
- Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Sasithorn Mukpradab
- Griffith University, Southport, Queensland, Australia; Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand.
| | - Georgia Tobiano
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia.
| | - Lauren O'Connor
- Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Silvester L, Higo A, Kearney RS, McWilliams D, Palmer S. Key components of rehabilitation programmes for adults with complex fractures following traumatic injury: A scoping review. Injury 2024; 55:111801. [PMID: 39128165 DOI: 10.1016/j.injury.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/30/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION Complex fractures are severe injuries that cause considerable disability, particularly in the working population. Effective rehabilitation is essential to achieve good outcomes, however, it is unclear what the best rehabilitation strategy is for adults with complex fractures, after their discharge from hospital. The aim of this scoping review was to identify and map the breadth of evidence available on this topic. METHODS A systematic search was completed on 24th July 2023 using a combination of subject and specialist databases. In addition, a secondary search assessed unpublished literature from trial registries. A citation search was completed on the selected studies. The template for intervention description and replication (TIDieR) checklist was used to extract consistent data on the interventions reported in the studies. The Joanna Briggs Institute methodology for scoping reviews was followed. RESULTS 19,253 studies were identified from the search strategy of which 25 studies met the eligibility criteria. Most interventions were exercise-based and delivered by physiotherapists. Some studies compared manual therapy treatments to other forms of physiotherapy or a placebo, whilst others investigated psychosocial interventions, such as cognitive behavioural therapy, in comparison to usual care. Two studies took a multidisciplinary team approach, incorporating components such as exercise, functional activities and self-management strategies. DISCUSSION The studies included were heterogenous in terms of population (fracture type, location and complexity), intervention content and therapeutic aims. However, commonalities were found with most interventions or comparators including range of movement, strengthening and task specific exercises; functional tasks; gait and balance training; and advice on return to activities as components. Value was attributed to components such as, a coordinated team approach, person-centred rehabilitation, supervised exercise and psychosocial support. CONCLUSION There is a broad and varied approach to the rehabilitation of complex fractures. The studies differed in population and approach, with a wide range of injuries, interventions and modes of delivery reported. Fidelity was poorly described, with only a third of studies reporting adherence or acceptability. There was inconclusive evidence to inform clinical practice and further research is advised. Qualitative, expert consensus, and coproduction approaches are recommended methods to develop complex interventions and best practice guidance.
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Affiliation(s)
- Lucy Silvester
- Institute for Applied & Translational Technologies in Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom.
| | - Anna Higo
- Research Centre for Healthcare & Communities, Coventry University, Priory Street, Coventry CV1 5FB, United Kingdom
| | - Rebecca S Kearney
- Bristol Trials Centre, University of Bristol, Whiteladies Road, Bristol BS8 1NU, United Kingdom
| | - David McWilliams
- Centre for Care Excellence, Coventry University, Priory Street, Coventry CV1 5FB, United Kingdom
| | - Shea Palmer
- School of Healthcare Sciences, Cardiff University, Cardiff CF14 4YU, United Kingdom
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Lazzerini M, Bua J, Vuillard CLJ, Squillaci D, Tumminelli C, Panunzi S, Girardelli M, Mariani I. Characteristics of intervention studies on family-centred care in neonatal intensive care units: a scoping review of randomised controlled trials. BMJ Paediatr Open 2024; 8:e002469. [PMID: 39103175 DOI: 10.1136/bmjpo-2023-002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/10/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Different definitions of family-centred care (FCC) exist in the newborn setting, and many FCC interventions have been tested, while a comprehensive review synthesising characteristics of existing intervention studies is still lacking. OBJECTIVE This review aims at summarising the characteristics of randomised controlled trials (RCTs) on FCC interventions in neonatal intensive care units. METHODS We searched PubMed, Embase, Web of Science and the Cochrane Library up to 31 January 2022, and reference lists of included studies and other reviews. Interventions were grouped into five categories according to a previous Cochrane review: (1) family support, (2) educational, (3) communication, (4) environmental interventions and (5) family-centred policies. Subgroup analyses by time period (RCTs published before vs after 2016) and by country income (based on the World Bank Classification) were conducted. RESULTS Out of 6583 retrieved studies, 146 RCTs met the eligibility criteria, with 53 (36.3%) RCTs published after 2016. Overall, 118 (80.8%) RCTs were conducted in high-income countries, 28 (19.1%) in middle-income countries and none in low-income countries. Only two RCTs were multicountry. Although mothers were the most frequent caregiver involved, fathers were included in 41 RCTs (28.1%). Very few studies were conducted in at-term babies (nine RCTs); siblings (two RCTs) and other family members (two RCTs), maternity care units (two RCTs). The role of health professionals was unclear in 65 (44.5%) RCTs. A large variety of intervention combinations was tested, with 52 (35.6%) RCTs testing more than 1 category of interventions, and 24 (16.4%) RCTs including all 5 categories. CONCLUSION There is a large and rising number of RCTs on FCC interventions in neonatal intensive care units, with specific research gaps. The large variety of FCC interventions, their high complexity, the need to tailor them to the local context and major gaps in implementation suggest that implementation research is the current priority.
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Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
- Maternal Adolescent Reproductive and Child Health Care Centre, Faculty of Epidemiology and Population Health, LSHTM, London, UK
| | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Domenica Squillaci
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cristina Tumminelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Silvia Panunzi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Martina Girardelli
- Department of Paediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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136
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Perry RT, Weimer JW, Pratt C, Newcome MD, Bagameri G, Bohman JK. Nurse Practitioner and Physician Assistant-led Cardiovascular Surgery Postoperative Intensive Care Unit Staffing Model. J Intensive Care Med 2024:8850666241268458. [PMID: 39094588 DOI: 10.1177/08850666241268458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
OBJECTIVES To determine whether a nurse practitioner and physician assistant (NP/PA)-led rapid staffing. Model in the cardiac surgical intensive care unit (ICU) can optimize resource utilization without compromising safety or increasing hospital length of stay (LoS). DESIGN Retrospective observational cohort study comparing before-and-after implementation of an NP/PA-led rapid recovery pathway. SETTING A large tertiary referral academic cardiac surgery ICU. PARTICIPANTS There were 116 patients in the prerapid recovery cohort and 153 in the postimplementation rapid recovery phase. INTERVENTIONS Low-risk cardiac surgery patients were selected for postoperative care by an NP/PA-led ICU staffing model. MEASUREMENTS AND MAIN RESULTS Mean hospital LoS in the prerapid recovery cohort was 5.7 days compared to 5.2 days in the rapid recovery pathway cohort (P = .02). Thirty-day hospital readmission in the prerapid recovery pathway cohort was 7.8% compared with 2.0% in the rapid recovery cohort (P = .04). The ICU readmission rate for prerapid recovery cohort was 4.3%, while the rapid recovery percentage was 2.0% (P = .30). CONCLUSIONS Overall, implementation of an NP/PA-led postcardiac surgical ICU team (rapid recovery pathway) was associated with similar ICU LoS, hospital LoS, ICU readmission rates, 30-day readmission rates, and no significant signal of increased adverse events or safety concerns.
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Affiliation(s)
- Ralph T Perry
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - John W Weimer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Carrie Pratt
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Marci D Newcome
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - J Kyle Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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137
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Jiang BSJ, Huff E, Hanna A, Gourabathini H, Bhalala U. Nursing insights on the effectiveness of automated pupillometry in two distinct pediatric intensive care units. J Pediatr Nurs 2024:S0882-5963(24)00294-X. [PMID: 39097436 DOI: 10.1016/j.pedn.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/26/2024] [Accepted: 07/26/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE Automated pupillometry (AP) facilitates objective pupillary assessment. In this study, we aimed at assessing nursing perspective about the utility of AP in neurocritically ill children to understand acceptance and usage barriers to guide development of a standardized use protocol. METHODS We conducted a web-based, cross-sectional, anonymous, Google™ survey of nurses at two independent pediatric ICUs which have been using AP over last four years. The survey included questions related to user-friendliness, barriers, acceptance, frequency of use, and method of documenting AP findings. RESULTS A total of 31 nurses responded to the survey. A total of 25 nurses (80.6%) used the automated pupillometer and 19 (61.3%) nurses preferred to use the automated pupillometer on critically ill intubated patients. Respondents rated the pupillometer a median [IQR] frequency of use of 7/10 [4-9] and a mean user-friendliness of 8/10 [7-10]. Barriers to pupillometer use included pupillometer unavailability, technical issues, lack of perceived clinical significance, and infection control. CONCLUSION Nurses have widely adopted the use of automated pupillometer in the PICU especially for critically ill intubated patients and rate it favorably for user-friendliness. Barriers against its use include limited resources, infection concerns, technical issues, and a lack of perceived clinical significance and training. Implementation of standardized PICU protocol for AP usage in critically ill children, may enhance the acceptance, increase usage and aid in objective assessments. PRACTICE IMPLICATIONS These findings can be used to create a standardized protocol on implementing automated pupillometry in the PICU for critically ill children.
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Affiliation(s)
- B S Jessie Jiang
- Texas A&M School of Medicine, 8447 Riverside Pkwy, Bryan, TX 77807, United States of America; Driscoll Children's Hospital, 3533 S Alameda St, Corpus Christi, TX 78411, United States of America.
| | - Erionne Huff
- Driscoll Children's Hospital, 3533 S Alameda St, Corpus Christi, TX 78411, United States of America.
| | - Ashley Hanna
- Driscoll Children's Hospital, 3533 S Alameda St, Corpus Christi, TX 78411, United States of America.
| | - Hari Gourabathini
- Beacon Children's Hospital, 615 N Michigan St, South Bend, IN 46601, United States of America
| | - Utpal Bhalala
- Texas A&M School of Medicine, 8447 Riverside Pkwy, Bryan, TX 77807, United States of America; Driscoll Children's Hospital, 3533 S Alameda St, Corpus Christi, TX 78411, United States of America
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138
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Bear DE, Summers MJ, Chapple LAS. Dietary protein in the ICU in relation to health outcomes. Curr Opin Clin Nutr Metab Care 2024:00075197-990000000-00168. [PMID: 39150402 DOI: 10.1097/mco.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
PURPOSE OF REVIEW Critical care nutrition guidelines recommend provision of higher protein doses than recommended in health. These recommendations have been predominately based on lower quality evidence and physiological rationale that greater protein doses may attenuate the significant muscle loss observed in critically ill patients. This review discusses the mechanistic action of protein in the critically ill, details results from recent trials on health outcomes, discusses considerations for interpretation of trial results, and provides an overview of future directions. RECENT FINDINGS Two recent large clinical trials have investigated different protein doses and the effect on clinical outcome. Important findings revealed potential harm in certain sub-groups of patients. This harm must be balanced with the potential for beneficial effects on muscle mass and physical function given that two recent systematic reviews with meta-analyses demonstrated attenuation of muscle loss with higher protein doses. Utilizing biological markers such as urea: creatinine ratio or urea levels may prove useful in monitoring harm from higher protein doses. SUMMARY Future research should focus on prospectively investigating biological signatures of harm as well as taking into the consideration elements that will likely enhance the effectiveness of protein dose.
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Affiliation(s)
- Danielle E Bear
- Department of Nutrition and Dietetics
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust
- Department of Nutritional Sciences, King's College London, London, UK
| | - Matthew J Summers
- Intensive Care Research, Royal Adelaide Hospital
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lee-Anne S Chapple
- Intensive Care Research, Royal Adelaide Hospital
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
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139
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Abedi F, Zarei B, Elyasi S. Albumin: a comprehensive review and practical guideline for clinical use. Eur J Clin Pharmacol 2024; 80:1151-1169. [PMID: 38607390 DOI: 10.1007/s00228-024-03664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration. METHODS Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication. RESULTS A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation. CONCLUSION Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.
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Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran
| | - Batool Zarei
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
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Voeltzel J, Garnier O, Prades A, Carr J, De Jong A, Molinari N, Jaber S, Chanques G. Assessing pain in paralyzed critically ill patients receiving neuromuscular blocking agents: A monocenter prospective cohort. Anaesth Crit Care Pain Med 2024; 43:101384. [PMID: 38710326 DOI: 10.1016/j.accpm.2024.101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/06/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Given the absence of established recommendations for pain assessment in pharmacologically paralyzed Intensive-Care-Units (ICU) patients under Neuro-Muscular-Blocking Agents (NMBA), this study assessed the validity of various parameters for evaluating pain in this specific population. PATIENTS AND METHODS Four electrophysiological parameters (instant-Analgesia-Nociception-Index (ANI), Bispectral index (BIS), Heart Rate (HR) and Mean Arterial Blood Pressure (ABP)) and one clinical parameter (Behavioural-Pain-Scale (BPS)) were recorded during tracheal-suctioning in all consecutive ICU patients who required a continuous infusion of cisatracurium, before and just after paralysis recovery measured by Train-of-Four ratio. The validity of the five pain-related parameters was assessed by comparing the values recorded during different situations (before/during/after the nociceptive procedure) (discriminant-validity, primary outcome), and the effect of paralysis was assessed by comparing values obtained during and after paralysis (reliability, secondary outcome). RESULTS Twenty patients were analyzed. ANI, BIS, and HR significantly changed during the nociceptive procedure in both paralysis and recovery, while BPS changed only post-recovery. ANI and HR were unaffected by paralysis, unlike BIS and BPS (mixed-effect model). ANI exhibited the highest discriminant-validity, with values (min 0/max 100) decreasing from 71 [48-89] at rest to 41 [25-72] during tracheal suctioning in paralyzed patients, and from 71 [53-85] at rest to 40 [31-52] in non-paralyzed patients. CONCLUSIONS ANI proves the most discriminant parameter for pain detection in both paralyzed and non-paralyzed sedated ICU patients. Its significant and clinically relevant decrease during tracheal suctioning remains unaltered by NMBA use. Pending further studies on analgesia protocols based on ANI, it could be used to assess pain during nociceptive procedures in ICU patients receiving NMBA.
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Affiliation(s)
- Jules Voeltzel
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Océane Garnier
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Albert Prades
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Julie Carr
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Audrey De Jong
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, University of Montpellier La Colombière Hospital, and Institut Montpelliérain Alexander Grothendieck (IMAG), University of Montpellier, CNRS, Montpellier, France
| | - Samir Jaber
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Gerald Chanques
- Department of Anaesthesia & Critical Care Medicine, Saint Eloi Montpellier University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
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Hassinger AB, Mody K, Gomez R, Wrotniak BH, Falkowski K, Breuer R, Mennie C, Flagg LK. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med 2024; 20:1251-1258. [PMID: 38456806 PMCID: PMC11294136 DOI: 10.5664/jcsm.11116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
STUDY OBJECTIVES Observational data suggest pediatric intensive care unit-related sleep and circadian disruption (PICU-SCD) affects many critically ill children. Multicenter trials exploring PICU-SCD have been impractical because measuring sleep in this setting is challenging. This study validates a questionnaire for caregivers to describe children's sleep in the PICU. METHODS This prospective, multicenter, case-control study enrolled caregivers of children in 4 PICUs or in a hospital-based sleep laboratory (controls). Survey items were compiled from validated adult ICU and pediatric in- and outpatient sleep questionnaires. Control responses were compared to polysomnography to determine accuracy. A score was calculated by summing the level of disruption of sleep timing, duration, efficiency, quality, and daytime sleepiness and irritability. RESULTS In responses from 152 PICU and 61 sleep laboratory caregivers, sleep survey items had acceptable internal reliability (α = 0.75) and reproducibility on retest surveys (interclass correlation coefficient > 0.600). Caregivers could not assess sleep of sedated children. Factor analysis identified 3 subscales of PICU-SCD. Control parents had good agreement with polysomnography sleep onset time (κ = 0.823) and sleep onset latency (κ = 0.707). There was a strong correlation between sleep scores derived by parental reporting to those by polysomnography (r = .844, P < .001). Scores had a linear association with caregiver-reported child sleep quality. There were no site-specific differences in sleep quality. Nearly all respondents found the survey easy to understand and of appropriate length. CONCLUSIONS The Survey of Sleep Quality in the Pediatric Intensive Care Unit provides a reliable, accurate description of inpatient sleep disruption in nonsedated children, generalizable across PICUs. It offers practical means to quantify PICU-SCD daily in future investigations. CITATION Hassinger AB, Mody K, Gomez R, et al. Validation of the Survey of Sleep Quality in the Pediatric Intensive Care Unit (SSqPICU). J Clin Sleep Med. 2024;20(8):1251-1258.
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Affiliation(s)
- Amanda B. Hassinger
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, University at Buffalo School of Medicine and Biomedical Sciences and John R. Oishei Children’s Hospital, Buffalo, New York
| | - Kalgi Mody
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Robert Wood Johnson Medical School and Bristol-Myers Squibb Children’s Hospital, New Brunswick, New Jersey
| | - Raquel Gomez
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Brian H. Wrotniak
- Department of Pediatrics, University at Buffalo School or Medicine and Biomedical Sciences, Buffalo, New York
| | - Kim Falkowski
- Master of Public Health Program, Daemen University, Amherst, New York
| | - Ryan Breuer
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University at Buffalo School of Medicine and Biomedical Sciences and John R. Oishei Children’s Hospital, Buffalo, New York
| | - Colleen Mennie
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren K. Flagg
- Pediatric Intensive Care Unit, Yale New Haven Children’s Hospital, New Haven, Connecticut
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Lane B, Loftus NW, Thomas A, Kalakoutas A, Wells J. Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 83:103713. [PMID: 38749261 DOI: 10.1016/j.iccn.2024.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/31/2024] [Accepted: 04/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients. METHODS Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness. RESULTS The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness. CONCLUSION This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients. IMPLICATIONS FOR CLINICAL PRACTICE Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.
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Affiliation(s)
- Bethany Lane
- St. Bartholomew's Hospital, London, UK; Imperial College, London, UK; City, University of London, UK.
| | | | - Ashley Thomas
- St. Bartholomew's Hospital, London, UK; Queen Mary University London, UK
| | - Antonis Kalakoutas
- St. Bartholomew's Hospital, London, UK; Barking, Havering and Redbridge University Hospitals NHS Trust, UK
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den Boogaard MV, Leenders M, Pop-Purceleanu M, Tilburgs B. Performance and validation of two ICU delirium assessment and severity tools; a prospective observational study. Intensive Crit Care Nurs 2024; 83:103627. [PMID: 38301387 DOI: 10.1016/j.iccn.2024.103627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The clinical statistical performance of the Confusion Assessment Method Intensive Care Unit (CAM-ICU, including CAM-ICU-7) and Intensive Care Delirium Screening Checklist (ICDSC) have rarely been studied. Additionally, delirium severity is often not measured due to a lack of validation of delirium assessment tools. OBJECTIVE The aim was to determine the statistical performance of both delirium assessment tools in daily practice, and the correlation with the gold standard Delirium Rating Scale (DRS)-R98, for delirium severity. RESEARCH METHOD CAM-ICU-7 and ICDSC, performed by nurses were compared with the DRS-R98 assessed by delirium experts, twice weekly. Within a time-window of one hour all assessments were independently performed. DESIGN A prospective observational study performed between October and December 2020. MAIN OUTCOME MEASURES Sensitivity, specificity, positive and negative predictive value of both tools was determined. The correlation between DRS-R98 and CAM-ICU-7 and ICDSC was used for validation of delirium severity. RESULTS In total, 104 CAM-ICU-7 and 105 ICDSC assessments in 86 patients were compared with the DRS-R98. For the CAM-ICU-7 and ICDSC, respectively, the sensitivity was 90% and 95%, the specificity was 92.4% and 92.3%. The positive predictive value was 0.76 and 0.80, and negative predictive value was 0.77 and 0.97. Correlation of the CAM-ICU-7 score and ICDSC score with the DRS-R98 score was 0.74 (95% CI 0.64-0.81) and 0.70 (95%CI 0.59-0.79; both p < 0.001), respectively. CONCLUSION Both CAM-ICU-7 and ICDSC demonstrated good statistical performance and correlated well with the delirium severity tool DRS-R98. IMPLICATIONS FOR CLINICAL PRACTICE Nurses can either use the CAM-ICU(-7) or the ICDSC in their practice, both are accurate in delirium diagnosis. Total CAM-ICU-7 and ICDSC score reflects delirium severity well; the higher the score, the more severe the delirium. This enables nurses to gauge the impact of their interventions and enhance the well-being of patients experiencing delirium by minimizing distressing occurrences.
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Affiliation(s)
- Mark van den Boogaard
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands.
| | - Margot Leenders
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands
| | - Monica Pop-Purceleanu
- Radboud University Medical Center, Department of Psychiatrie, Nijmegen, the Netherlands
| | - Bram Tilburgs
- Radboud University Medical Center, Department Intensive Care, Nijmegen, the Netherlands
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Galazzi A, Petrei M, Palese A. Tools used to assess comfort among patients undergoing high flow nasal cannula: A scoping review. Intensive Crit Care Nurs 2024; 83:103719. [PMID: 38718552 DOI: 10.1016/j.iccn.2024.103719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/11/2024] [Accepted: 04/30/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE The aims were twofold: (a) to map tools documented in the literature to evaluate comfort among patients undergoing high flow nasal cannula (HFNC) treatment; and (b) to assess if the retrieved tools have been validated for this purpose. METHODS A scoping review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR). In July 2023, PubMed, Scopus, CINAHL and Cochrane Library were consulted. Studies assessing comfort in adult, paediatric, and neonatal patients undergoing HFNC were included. RESULTS Seventy-four articles were included, among which nine (12.2 %) investigated comfort as the primary aim. Twenty-five different tools were found, classifiable into 14 types, mostly unidimensional and originating from those measuring pain. The most widely used was the Visual Analogic Scale (n = 27, 35.6 %) followed by the Numerical Rating Scale (n = 11, 14.5 %) and less defined generic tools (n = 10, 13.2 %) with different metrics (e.g. 0-5, 0-10, 0-100). Only the General Comfort Questionnaire and the Comfort Scale were specifically validated for the assessment of comfort among adults and children, respectively. CONCLUSION Although the comfort of patients undergoing HFNC is widely investigated in the literature, there is a scarcity of tools specifically validated in this field. Those used have been validated mainly to assess pain, suggesting the need to inform patients to prevent confusion while measuring comfort during HFNC and to develop more research in the field. IMPLICATIONS FOR CLINICAL PRACTICE Comfort assessment is an important aspect of nursing care. Given the lack of validation studies in the field, efforts in research are recommended.
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Affiliation(s)
| | - Matteo Petrei
- Department of Medicine, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medicine, University of Udine, Udine, Italy
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Haegdorens F, Lefebvre J, Wils C, Franck E, Van Bogaert P. Combining the Nurse Intuition Patient Deterioration Scale with the National Early Warning Score provides more Net Benefit in predicting serious adverse events: A prospective cohort study in medical, surgical, and geriatric wards. Intensive Crit Care Nurs 2024; 83:103628. [PMID: 38244252 DOI: 10.1016/j.iccn.2024.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES This prospective cohort study aimed to assess the predictive value of the Nurse Intuition Patient Deterioration Scale (NIPDS) combined with the National Early Warning Score (NEWS) for identifying serious adverse events in patients admitted to diverse hospital wards. RESEARCH METHODOLOGY/DESIGN Data was collected between December 2020 and February 2021 in a 350-bed acute hospital near Brussels, Belgium. The study followed a prospective cohort design, employing NIPDS alongside NEWS for risk assessment. Patients were monitored for 24 h post-registration, with outcomes recorded. SETTING The study was conducted in a hospital with a Rapid Response System (RRS) and electronic patient record wherein NEWS was routinely collected. Patients admitted to two medical, two surgical, and two geriatric wards were included. MAIN OUTCOME MEASURES The primary outcome included death, urgent code calls, or unplanned ICU transfers within 24 h after NIPDS registration. The secondary outcome comprised rapid response team activations or changes in Do-Not-Resuscitate codes. RESULTS In a cohort of 313 patients, 10/313 and 31/313 patients reached the primary and secondary outcome respectively. For the primary outcome, NIPDS had a sensitivity of 0.900 and specificity of 0.927, while NEWS had a sensitivity of 0.300 and specificity of 0.974. Decision Curve Analysis demonstrated that NIPDS provided more Net Benefit across various Threshold Probabilities. Combining NIPDS and NEWS showed potential for optimizing rapid response systems. Especially in resource-constrained settings, NIPDS could be used as a calling criterion. CONCLUSION The NIPDS displayed strong predictive capabilities for adverse events. Integrating NIPDS into existing rapid response systems can objectify nurse intuition, enhancing patient safety. IMPLICATIONS FOR CLINICAL PRACTICE The Nurse Intuition Patient Deterioration Scale (NIPDS) is a valuable tool for detecting patient deterioration. Implementing NIPDS alongside traditional scores such as NEWS can improve patient care and safety. The optimal NIPDS threshold to activate rapid response is ≥5.
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Affiliation(s)
- Filip Haegdorens
- Workforce management and Outcome Research in Care (WORC) group of the Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium.
| | - Julie Lefebvre
- Intensive Care Unit, Algemeen Ziekenhuis Sint-Maria Halle, Belgium
| | | | - Erik Franck
- Workforce management and Outcome Research in Care (WORC) group of the Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
| | - Peter Van Bogaert
- Workforce management and Outcome Research in Care (WORC) group of the Centre for Research and Innovation in Care (CRIC), University of Antwerp, Belgium
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Song B, Wu Z, Liu M, Zhang Q, Ma X, Li X, Liu Y, Lin F. Barriers and facilitators of adherence to evidence-based pressure injury prevention clinical practice guideline among intensive care nurses: A cross-sectional survey. Intensive Crit Care Nurs 2024; 83:103665. [PMID: 38471401 DOI: 10.1016/j.iccn.2024.103665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To explore intensive care unit (ICU) nurses' perceptions of their adherence to pressure injury prevention clinical practice guideline and identify the perceived barriers and facilitators that influence evidence-based pressure injury prevention practices in Chinese tertiary hospitals. RESEARCH METHODOLOGY/DESIGN This was a multi-site, quantitative, cross-sectional study. Data were collected using a self-report questionnaire with three sections: participant demographic information, adherence to pressure injury prevention clinical practice guideline, and barriers to and facilitators of pressure injury prevention clinical practice guideline implementation. SETTING Thirty-three adult ICUs in 16 tertiary general hospitals in 5 major cities in Liaoning Province, China. RESULTS In total, 473 nurses responded to the survey. The mean score for adherence to pressure injury prevention clinical practice guideline was 159.06 ± 20.65, with 65.3 % reporting good adherence. Multiple stepwise regression analysis indicated that smaller ICU size (β = -0.114, p = 0.012) and having participated in training on pressure injury prevention clinical practice guideline (β = 0.149, p = 0.001) were statistically significantly associated with better adherence. ICU nurses identified the low priority given to pressure injury prevention as the top barrier. The top three facilitators were awareness of evidence-based practice, the current documentation format for pressure injury risk/nursing interventions, and leadership support. CONCLUSION ICU nurses' adherence to pressure injury prevention clinical practice guideline was satisfactory, and they reported low-to-moderate barriers and moderate facilitators. IMPLICATIONS FOR CLINICAL PRACTICE Participating in training on pressure injury prevention clinical practice guideline was a predictor of ICU nurses' adherence. Therefore, it is highly recommended that healthcare organisations consider providing training to nurses and address the barriers identified to improve nurses' adherence to evidence-based pressure injury prevention guidelines.
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Affiliation(s)
- Bing Song
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China; School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Zijing Wu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China; School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Miao Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| | - Qian Zhang
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| | - Xiaolu Ma
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| | - Yu Liu
- School of Nursing, China Medical University, Shenyang, Liaoning Province, PR China.
| | - Frances Lin
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; College of Nursing and Health Sciences, Flinders University, South Australia, Australia; Caring Futures Institute, Flinders University, South Australia, Australia; School of Health, University of the Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
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Rony MKK, Numan SM, Johra FT, Akter K, Akter F, Debnath M, Mondal S, Wahiduzzaman M, Das M, Ullah M, Rahman MH, Das Bala S, Parvin MR. Perceptions and attitudes of nurse practitioners toward artificial intelligence adoption in health care. Health Sci Rep 2024; 7:e70006. [PMID: 39175600 PMCID: PMC11339127 DOI: 10.1002/hsr2.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024] Open
Abstract
Background With the ever-increasing integration of artificial intelligence (AI) into health care, it becomes imperative to gain an in-depth understanding of how health care professionals, specifically nurse practitioners, perceive and approach this transformative technology. Objectives This study aimed to gain insights into nurse practitioners' perceptions and attitudes toward AI adoption in health care. Methods This qualitative research employed a descriptive and phenomenological approach using in-depth interviews. Data were collected through a semi-structured questionnaire with 37 nurse practitioners selected through purposive sampling, specifically Maximum Variation Sampling and Expert Sampling techniques, to ensure diversity in characteristics. Trustworthiness of the research was maintained through member checking and peer debriefing. Thematic analysis was employed to uncover recurring themes and patterns in the data. Results The thematic analysis revealed nine main themes that encapsulated nurse practitioners' perceptions and attitudes toward AI adoption in health care. These included nurse practitioners' perceptions of AI implementation, attitudes toward AI adoption, patient-centered care and AI, quality of health care delivery and AI, ethical and regulatory aspects of AI, education and training needs, collaboration and interdisciplinary relationships, obstacles in integrating AI, and AI and health care policy. While this study found that nurse practitioners held a wide range of perspectives, with many viewings AI as a tool to enhance patient care. Conclusions This research provides a valuable contribution to the evolving discourse surrounding AI adoption in health care. The findings underscore the necessity for comprehensive education and training in AI, accompanied by clear and robust ethical and regulatory guidelines to ensure the responsible integration of AI in health care practice. Furthermore, fostering collaboration and interdisciplinary relationships is pivotal for the successful incorporation of AI in health care. Policymakers should also address the challenges and opportunities that AI presents in the health care sector. This study enhances the ongoing conversation on AI adoption in health care by shedding light on the perspectives of nurses, thereby shaping future strategies for AI integration.
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Affiliation(s)
| | - Sharker Md. Numan
- School of Science and TechnologyBangladesh Open UniversityGazipurBangladesh
| | - Fateha tuj Johra
- Masters in Disaster ManagementUniversity of DhakaDhakaBangladesh
| | - Khadiza Akter
- Master of Public HealthDaffodil International UniversityDhakaBangladesh
| | - Fazila Akter
- Dhaka Nursing Collegeaffiliated with the University of DhakaDhakaBangladesh
| | - Mitun Debnath
- Master of Public HealthNational Institute of Preventive and Social MedicineDhakaBangladesh
| | - Sujit Mondal
- Master of Science in NursingNational Institute of Advanced Nursing Education and Research MugdaDhakaBangladesh
| | - Md. Wahiduzzaman
- School of Medical SciencesShahjalal University of Science and TechnologySylhetBangladesh
| | - Mousumi Das
- Master of Public HealthLeading UniversitySylhetBangladesh
| | - Mohammad Ullah
- College of NursingInternational University of Business Agriculture and TechnologyDhakaBangladesh
| | | | - Shuvashish Das Bala
- College of NursingInternational University of Business Agriculture and TechnologyDhakaBangladesh
| | - Mst. Rina Parvin
- Bangladesh Army (AFNS Officer)Combined Military Hospital DhakaDhakaBangladesh
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Macpherson D, Hutchinson A, Bloomer MJ. Factors that influence critical care nurses' management of sedation for ventilated patients in critical care: A qualitative study. Intensive Crit Care Nurs 2024; 83:103685. [PMID: 38493573 DOI: 10.1016/j.iccn.2024.103685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce. AIM To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making. DESIGN Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis. SETTING AND PARTICIPANTS This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate. FINDINGS Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation. CONCLUSION Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns. IMPLICATIONS FOR CLINICAL PRACTICE Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making.
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Affiliation(s)
- Danielle Macpherson
- Intensive Care Unit, Epworth HealthCare Richmond, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.
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149
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Phillips EK, Monnin C, Gregora A, Smith K, S H Schultz A, O'Keefe-McCarthy S, Arora RC, Duhamel TA, Chudyk AM. A scoping review of incidence and assessment tools for post-intensive care syndrome following cardiac surgery. Intensive Crit Care Nurs 2024; 83:103718. [PMID: 38761612 DOI: 10.1016/j.iccn.2024.103718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Post-intensive care syndrome is a new or worsening persistent deterioration in cognitive, mental, and/or physical health following a prolonged admission to an intensive care unit. Post-intensive care syndrome remains underexplored following cardiac surgery, with a lack of understanding of the incidence and tools used to measure the symptoms. A scoping review was conducted to determine the incidence and to identify the tools commonly used to measure symptoms of post-intensive care syndrome following cardiac surgery. METHODS The electronic databases Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Scopus, and CINAHL (EBSCOhost) and Google Scholar were searched with keywords and controlled vocabulary to describe both cardiac surgery and post-intensive care syndrome (cardiac surgical procedures, heart surgery, and post-intensive care symptoms) and symptoms (delirium, depression, mobility and quality of life). Included were articles written in English and published after 2005 that described cognitive, mental, and physical symptoms of post-intensive care syndrome following cardiac surgery. 3,131 articles were found, with 565 duplicates, leaving 2,566 articles to be screened. Of these, seven unique studies were included. RESULTS Five studies explored cognitive health, three mental health, one cognitive and mental health, and none physical health. No identified studies reported the overall incidence of post-intensive care syndrome following cardiac surgery. The incidence of cognitive health issues ranged from 21% to 38%, and mental health issues ranged from 16% to 99%. In total, 17 different tools were identified - 14 for cognitive health and three for mental health. No identified studies used the same tools to measure symptoms. No single tool was found to measure all three domains. CONCLUSION This scoping review identified a literature gap specific to the incidence and inconsistency of assessment tools for post-intensive care syndrome in cardiac surgery patients. CLINICAL IMPLICATIONS This work impacts clinical practice for the bedside nurse by raising awareness of an emerging health issue.
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Affiliation(s)
- Emily K Phillips
- Applied Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | - Kathy Smith
- Person with lived experience partner, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Sheila O'Keefe-McCarthy
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | - Rakesh C Arora
- Harrington Heart and Vascular Institute University Hospitals - Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Todd A Duhamel
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada; Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | - Anna M Chudyk
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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150
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Walker SB, Clack JE, Dwyer TA. An integrative literature review of factors contributing to hypothermia in adults during the emergent (ebb) phase of a severe burn injury. Burns 2024; 50:1389-1405. [PMID: 38627163 DOI: 10.1016/j.burns.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 03/08/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND During the emergent (ebb) phase (first 72 h), the adult person with a severe burn experiences loss of body heat, decreased metabolism, and poor tissue perfusion putting them at risk of hypothermia, increased morbidity, and mortality. Therefore, timely and targeted care is imperative. AIM The aim of this integrative literature review was to develop a framework of the factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase. METHODS An integrative review of research literature was undertaken as it provides an orderly process in the sourcing and evaluation of the literature. Only peer reviewed research articles, published in scholarly journals were selected for inclusion (n = 26). Research rigor and quality for each research article was determined using JBI Global appraisal tools relevant to the methodology of the selected study. FINDINGS Contributing factors were classified under three key themes: Individual, Pre-hospital, and In-hospital factors. CONCLUSION The structured approach enabled the development of an evidence-based framework identifying factors contributing to hypothermia in adults with a severe burn injury during the emergent (ebb) phase and adds knowledge to improve standardized care of the adult person with a severe burn injury.
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Affiliation(s)
- Sandra B Walker
- School of Nursing, Midwifery and Social Sciences Central Queensland University Bruce Highway Rockhampton, Queensland 4702, Australia.
| | - Jessica E Clack
- Ramsay Health Peninsula Private Hospital, Langwarrin, Victoria, Australia
| | - Trudy A Dwyer
- Appleton Institute - Central Queensland University, Australia
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