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Peng B, Yu L, Qian J, Zheng B, Zhang Y, Zhu C. Oral Application of Mother's Own Milk for Reducing Necrotizing Enterocolitis in Preterm Infants: An Updated Meta-Analysis of RCTs. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:7378064. [PMID: 37064945 PMCID: PMC10104743 DOI: 10.1155/2023/7378064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/24/2022] [Accepted: 01/05/2023] [Indexed: 04/18/2023]
Abstract
Background Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are the major contributors to mortality and morbidity in preterm infants. This updated meta-analysis was aimed to assess the effects of mother's milk on the incidence of NEC, LOS, and other clinical outcomes in preterm infants. Methods PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Results A total of 13 RCTs with 1330 infants were included in the final analysis. Significant difference in NEC (stage 2 or 3) was found between the intervention group and the control group (RR = 0.508, 95% CI: 0.314-0.822, and P=0.008). The incidence of proven LOS (RR = 0.809, 95% CI: 0.610-1.071, and P=0.139) and death (RR = 0.800, 95% CI: 0.571-1.122, and P=0.196) was comparable between the two groups. Statistical differences in the incidence of proven or probable LOS (RR = 0.705, 95% CI: 0.577-0.862, and P=0.001) and length of hospitalization (WMD = -4.868, 95% CI: -6.608 to -3.128, and P < 0.001) between the intervention group and the control group were observed. Conclusions The results of this updated meta-analysis showed that compared to the placebo, mother's milk provides better effects in reducing the incidences of NEC, proven or probable LOS, and the length of stay, whereas no significant benefit of mother's milk was observed in reducing the incidence of proven LOS and death.
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Affiliation(s)
- Bo Peng
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Lei Yu
- Infection Management Division, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Jing Qian
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Baoying Zheng
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yi Zhang
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Chunmei Zhu
- Department of Respiratory, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
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Collins T, Plowright C, Gibson V, Stayt L, Clarke S, Caisley J, Watkins CH, Hodges E, Leaver G, Leyland S, McCready P, Millin S, Platten J, Scallon M, Tipene P, Wilcox G. British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units. Nurs Crit Care 2020; 26:224-233. [PMID: 33124119 DOI: 10.1111/nicc.12570] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. AIM To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. DESIGN A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. METHODS The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non-ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non-ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. RESULTS The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. CONCLUSION Oral care is an important part of the care of critically ill patients, both ventilated and non-ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. RELEVANCE TO CLINICAL PRACTICE Effective oral care is integral to safe patient care in critical care.
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Affiliation(s)
| | | | | | | | - Sarah Clarke
- Acute Care Team, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jo Caisley
- Princess Mary's Royal Air Force Nursing Service, UK
| | - Claire Harcourt Watkins
- Intensive Care, Glangwili General Hospital, Hywel Dda University Health Board, Haverfordwest, UK
| | - Emily Hodges
- The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - Gillian Leaver
- Thames Valley and Wessex Operational Delivery Network, UK
| | - Sarah Leyland
- Clinical Placements, St Georges University Hospitals NHS Foundation Trust, UK
| | | | | | - Julie Platten
- North of England Critical Care Network, North Shields, UK
| | | | - Patsy Tipene
- The Queen Elizabeth Hospital NHS Foundation Trust, King's Lynn, UK
| | - Gabby Wilcox
- Swansea Bay University Health Board, Morriston Hospital, Swansea, UK
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Soh KL, Davidson PM, Leslie G, DiGiacomo M, Soh KG. Nurses' perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study. Contemp Nurse 2020; 55:221-236. [PMID: 31403398 DOI: 10.1080/10376178.2019.1643751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Quality improvement projects have been widely adopted to prevent complications in the ICU. Objective: This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. Design: A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. Results: The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Discussion: Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU.
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Affiliation(s)
- Kim Lam Soh
- a Department of Nursing and Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia , Malaysia
| | - Patricia M Davidson
- b John Hopkins School of Nursing , Baltimore , MD , USA.,c University of Technology Sydney , Sydney , Australia
| | - Gavin Leslie
- d Curtin Health Innovation Research Institute, Curtin University , Perth , Australia
| | | | - Kim Geok Soh
- e Department of Sport Studies, Faculty of Educational Studies / Sport Academy, Universiti Putra Malaysia , Malaysia
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Tao J, Mao J, Yang J, Su Y. Effects of oropharyngeal administration of colostrum on the incidence of necrotizing enterocolitis, late-onset sepsis, and death in preterm infants: a meta-analysis of RCTs. Eur J Clin Nutr 2020; 74:1122-1131. [PMID: 31901083 PMCID: PMC7222151 DOI: 10.1038/s41430-019-0552-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 12/18/2022]
Abstract
Necrotizing enterocolitis (NEC) and late-onset sepsis (LOS) are two major contributors to death among preterm infants. Oropharyngeal administration of colostrum (OAC) has been proved as an easy, safe, and economically viable technique to help preterm neonates to build up their immunity. In this review, we assessed the effects of OAC on preterm infants. Several mainstream databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and a website of clinical trials. Randomized controlled trials (RCTs) comparing OAC vs. placebo or no intervention in preterm infants (gestation age <34 weeks or birth weight <1500 g) were eligible. Overall, nine RCTs (n = 689) were included in the review. Meta-analysis showed no statistical significance in terms of the incidence of NEC (RR = 0.59, 95% CI = 0.33-1.06, p = 0.08), LOS (RR = 0.78, 95% CI = 0.60-1.03, p = 0.08) and mortality rate (RR = 0.63, 95% CI = 0.38-1.05, p = 0.07). No significant difference was found in the subgroup analysis, apart from the group of the undeveloped region in NEC and mortality. In addition, time was significantly reduced in terms of achieving full enteral feeding (MD = -3.60, 95% CI = -6.55-0.64, p = 0.02) and hospital stay (MD = -10.38, 95% CI = -18.47-2.29, p = 0.01). The results show that OAC does not reduce the incidences of NEC, LOS, and death in preterm infants, but there is a trend toward a positive effect. It is therefore recommended as routine care for preterm infants in the NICU.
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Affiliation(s)
- Jiaxin Tao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jixin Yang
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yanwei Su
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Poursadra E, Anvari-Tafti M, Dehghani A, Eghbali-Babadi M, Rafiei Z. Comparing the Effect of Henna Oil and Olive Oil on Pressure Ulcer Grade One in Intensive Care Units Patients. Adv Biomed Res 2019; 8:68. [PMID: 31897406 PMCID: PMC6909547 DOI: 10.4103/abr.abr_207_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/23/2019] [Accepted: 09/29/2019] [Indexed: 11/04/2022] Open
Abstract
Background One of the most common problems in the intensive care unit (ICU) is the incidence of pressure ulcer or bedsore. This research was conducted with the aim to compare the effect of henna and olive on pressure ulcer grade one in ICU patients hospitalized in the selected hospitals of Isfahan University of Medical Science in 2016. Materials and Methods This study conducted on 108 ICU patients with pressure ulcer. Patients were randomly divided into three groups. The two intervention groups were treated with olive oil and henna oil, respectively, and the third group was the control group. Data were collected using a demographic information questionnaire, Braden pressure ulcer risk assessment scale, and a table for daily record of the skin temperature before and within 1 week of the study. Data were analyzed in SPSS 22 using independent t-test, repeated-measures ANOVA, and Fisher's exact test. Results The results showed a significant difference between the two henna and olive groups in the mean score of pressure ulcer measured through the pressure ulcer scale for healing tool (P < 0.05). The mean area of the ulcer on days 4 and 7 in the henna oil group was lower than that in the olive oil and control groups (P < 0.001). Conclusion The results of this study showed that both henna and olive oils were effective in healing the pressure ulcer. However, henna oil showed better results in reducing the area of pressure ulcers over time.
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Affiliation(s)
- Elahe Poursadra
- Department of Nursing, Faculty Member, Faculty of Nursing and Midwifery, Young Researches and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Motahare Anvari-Tafti
- Department of Emergency Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asieh Dehghani
- Department of Nursing, Faculty Member, Faculty of Nursing and Midwifery, Young Researches and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Maryam Eghbali-Babadi
- Hypertension Research Center, Isfahan Cardiovascular Research Institute, School of Nursing and Midwifery, Isfahan, Iran
| | - Zahra Rafiei
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Understanding critically ill patients hemodynamic response to mobilization: using the evidence to make it safe and feasible. Crit Care Nurs Q 2013; 36:17-27. [PMID: 23221438 DOI: 10.1097/cnq.0b013e3182750767] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In today's critical care environment, we face a difficult but essential task. We must provide comprehensive, compassionate, complex, technological care without causing harm to our patients. To foster a patient-safe environment, we must examine care practices and processes to reduce the chance of error. Successful early mobilization of critically ill patients can reduce several complications including atelectasis and ventilator-associated pneumonia and shorten ventilator time along with cognitive and functional limitations that linger 1 to 5 years after discharge from the intensive care unit. A long-standing challenge to successful mobilization of critically ill patients is the safety concern of hemodynamic instability. An in-depth exploration of what happens to a critically ill patient physiology during mobilization was done to foster a better understanding of strategies that promote adaptation. The article examines the evidence supporting the need to assess readiness for mobilization to reduce the risk of adverse events. Evidence-based tools and techniques to help clinicians prevent hemodynamic instability before, during, and after in-bed or out-of-bed mobilization are discussed. With safety serving as the overriding goal, we can overcome the barriers and succeed in creating and sustaining a culture of early progressive mobility programs within the intensive care unit.
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Interventional patient hygiene: discussion of the issues and a proposed model for implementation of the nursing care basics. Intensive Crit Care Nurs 2013; 29:250-5. [PMID: 23746440 DOI: 10.1016/j.iccn.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 04/09/2013] [Accepted: 04/15/2013] [Indexed: 11/21/2022]
Abstract
More than 140 years ago, Florence Nightingale wrote "It may seem a strange principal to enunciate as the very first requirement in a Hospital that it should do the sick no harm." Data suggests that 63% of all preventable errors are related to clinical problems that are within nursing's independent scope of practice. Many of these fall in the category of "interventional hygiene" activities and include prevention of skin injury, post-operative respiratory complications and failure to rescue. As nurses we are called upon to assure higher levels of safety and quality for our patients by our governments, professional organisations and hospital administrations. It is essential that we implement evidence based nursing care strategies to reduce avoidable errors in care so that clinical outcomes improve. The author of this paper, who coined the team "interventional patient hygiene", discusses the science related to many of these care issues and proposes an Interventional Care Model for use by nurses in redesigning how we approach nurse sensitive care practices in the future. Additionally, a change framework called "Sustaining Nursing Clinical Practice" is described to ensure reintroduction and valuing of evidence basic nursing care in conjunction with the right resources and systems to sustain the new practice.
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Exploring the use of mothers' own milk as oral care for mechanically ventilated very low-birth-weight preterm infants. Adv Neonatal Care 2013; 13:190-7. [PMID: 23722491 DOI: 10.1097/anc.0b013e318285f8e2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to explore the use of mothers' own milk (colostrums, transitional milk, and mature milk) as oral care in the ventilator-associated pneumonia (VAP)-prevention bundle of mechanically ventilated preterm infants weighing 1500 g or less. SUBJECTS Mechanically ventilated preterm infants weighing 1500 g or less admitted to a regional level III NICU in the Gulf South between January 1, 2006, and December 31, 2009. DESIGN Retrospective descriptive. METHODS Oral care with mothers' own milk was implemented as part of the VAP-prevention bundle in the neonatal intensive care unit in the fourth quarter of 2007. Using retrospective deidentified data retrieved from the electronic medical record, the primary and secondary outcome variables were collected among eligible infants (≤1500 g) admitted January 1, 2006, to December 31, 2007 (before implementation) and January 1, 2008, to December 31, 2009 (after implementation). Sample characteristics, including infant gestational age, birth weight, and gender, as well as maternal age, type of delivery, and incidence of maternal chorioamnionitis, were also collected. Data analysis included frequencies and distributions to summarize sample characteristics and variables of interest. Appropriate tests for differences were conducted on outcome variables between the before and after groups of the human milk oral care intervention. MAIN OUTCOME MEASURES The feasibility outcome variable included nursing compliance with the oral care procedure. The safety outcome variable included record of any adverse events associated with the oral care procedure. The efficacy health outcomes included the rate of positive tracheal aspirates, positive blood cultures, the number of ventilator days, and length of stay. RESULTS Infant age (26.1-26.6 weeks) and weight (840-863 g) were similar in the before (n = 70) and after (n = 68) sample subjects. There were no statistically significant differences in ventilator days, χ² (46, n = 115) = 46.22, P = .46, and length of stay, χ (75, n = 115) = 78.78, P = .36, between groups. Although the rate of positive tracheal aspirates and positive blood cultures reduced after implementation of oral care with mothers' own milk, these differences were not statistically significant (U(47) = 250, z = -7.1, P = .48; U(47) = 217.5, z = -1.44, P = .15). CONCLUSIONS There were no statistically significant differences in the rates of positive tracheal aspirates and blood cultures after implementation of oral care with mothers' own milk. The findings of this study suggest that using mothers' own milk as part of the VAP-prevention bundle is a feasible and safe practice; however, further research is needed to determine the immunological benefits of this practice.
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Mahanes D, Quatrara BD, Shaw KD. APN-led nursing rounds: an emphasis on evidence-based nursing care. Intensive Crit Care Nurs 2013; 29:256-60. [PMID: 23669052 DOI: 10.1016/j.iccn.2013.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 02/20/2013] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Abstract
In today's healthcare environment, nursing staff are challenged to care for patients with increasingly complex needs in an ever-changing environment. Nurses are expected to stay up to date on a tremendous number of institutional initiatives, best practice guidelines, and policies and procedures. These practice imperatives are often disseminated through passive means of information-sharing such as staff meetings and electronic mail. In this setting, it is difficult for nurses to simultaneously focus on incorporating practice updates while continuing to value basic nursing functions such as oral care, skin care, and incontinence management. The concept of Interventional Patient Hygiene emphasises that basic nursing functions are not only tasks, but also important evidence-based interventions that contribute to improved health for the patient. Interventional Patient Hygiene facilitates the integration of science and practice. This article describes a quality improvement intervention, Advanced practice nurse-led nursing rounds, which supports Interventional Patient Hygiene and be used to help staff integrate best practices while balancing the multiple priorities inherent in nursing care.
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Affiliation(s)
- Dea Mahanes
- Nerancy Neuroscience Intensive Care Unit, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Hillier B, Wilson C, Chamberlain D, King L. Preventing Ventilator-Associated Pneumonia Through Oral Care, Product Selection, and Application Method. AACN Adv Crit Care 2013. [DOI: 10.4037/nci.0b013e31827df8ad] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objective:Review the literature to identify the most effective method of oral hygiene to reduce the incidence of ventilator-associated pneumonia (VAP).Background:Ventilator-associated pneumonia is the most common nosocomial infection in patients being treated with mechanical ventilation.Method:This study is a systematic literature review. The databases searched included Web of Science, Cumulative Index to Nursing and Allied Health Literature, Ovid, and MEDLINE.Results:Implementation of oral care protocols and nurse education programs reduced VAP. Although chlorhexidine was the most popular oral care product, no consensus emerged on concentration or protocols for oral care.Conclusion:No consensus on best practice for oral hygiene in patients being treated with mechanical ventilation was found. Chlorhexidine was the most popular oral care product. Implementation of an oral care protocol, ongoing nurse education, and evaluation were important in reducing the incidence of VAP. Future research should analyze chlorhexidine concentration, application techniques, and frequency of oral care, to optimize VAP prevention.
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Affiliation(s)
- Bianca Hillier
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Christine Wilson
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Di Chamberlain
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
| | - Lindy King
- Bianca Hillier is Intensive and Critical Care RN, Flinders Medical Centre, Adelaide, Australia. Christine Wilson is Lecturer in Paramedical Studies, Flinders University, Sturt Rd, Bedford Park, Adelaide, Australia . Di Chamberlain is Senior Lecturer in Nursing, Flinders University, Adelaide, Australia. Lindy King is Associate Dean, Higher Degrees, Flinders University, Adelaide, Australia
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Dale C, Angus JE, Sinuff T, Mykhalovskiy E. Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature. Intensive Crit Care Nurs 2012; 29:266-74. [PMID: 23092851 DOI: 10.1016/j.iccn.2012.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 09/11/2012] [Accepted: 09/22/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this critical ethnographic literature review was to explore the evolution of nursing discourse in oral hygiene for intubated and mechanically ventilated patients. METHODS The online databases CINAHL and MEDLINE were searched for nurse-authored English language articles published between 1960 and 2011 in peer-reviewed journals. Articles that did not discuss oral problems or related care for intubated adult patients were excluded. Articles that met the inclusion criteria were chronologically reviewed to trace changes in language and focus over time. RESULTS A total of 469 articles were identified, and 84 papers met all of the inclusion criteria. These articles presented an increasingly scientific and evaluative nursing discourse. Oral care originally focused on patient comfort within the literature; now it is emphasized as an infection control practice for the prevention of ventilator-associated pneumonia (VAP). Despite concern for its neglected application, the literature does not sufficiently address mouth care's practical accomplishment. CONCLUSIONS Mouth care for orally intubated patients is both a science and practice. However, the nursing literature now emphasises a scientific discourse of infection prevention. Inattention to the social and technical complexities of practice may inhibit how nurses learn, discuss and effectively perform this critical aspect of patient care.
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Affiliation(s)
- Craig Dale
- Trauma, Emergency and Critical Care Program, Sunnybrook Health Sciences Centre, B508 - 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5.
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Bassett RD, Vollman KM, Brandwene L, Murray T. Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit Care Nurs 2012; 28:88-97. [PMID: 22227355 DOI: 10.1016/j.iccn.2011.12.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND ICU immobility can contribute to physical deconditioning, increased ICU and hospital length of stay and complications post discharge. Despite evidence of the beneficial outcomes of early mobility, many ICUs and providers lack necessary processes and resources to effectively integrate early mobility into their daily practice. OBJECTIVE To create a progressive mobility initiative that will help ICU teams to address key cultural, process and resource opportunities in order to integrate early mobility into daily care practices. METHODS An initiative to integrate the latest evidence on mobility practice into current ICU culture in 13 ICUs in eight hospitals within the US was launched. A user-friendly, physiologically grounded evidence-based mobility continuum was designed and implemented. Appropriate education and targeted messaging was used to engage stakeholders. To support and sustain the implementation process, mechanisms including coaching calls and various change interventions were offered to modify staffs' practice behaviour. Qualitative data was collected at two time points to assess cultural and process issues around mobility and provided feedback to the stakeholders to support change. Quantitative date on ventilator days and timing of physical therapy consultation was measured. RESULTS Qualitative reports of the mobility programme participants suggest that the methods used in the collaborative approach improved both the culture and team focus on the process of mobility. There were no significant differences demonstrated in any of the mobility intervention group measurement however, a reduction in ventilator days (3.0days pre vs. 2.1 days post) approached significance (p=0.06). CONCLUSION This multi-centre, ICU collaborative has shown that improvements in team culture, communication and resources can improve adoption of early mobility in ICU patients.
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Innovative solutions: beds, baths, and bottoms: a quality improvement initiative to standardize use of beds, bathing techniques, and skin care in a general critical-care unit. Dimens Crit Care Nurs 2011; 30:169-76. [PMID: 21478715 DOI: 10.1097/dcc.0b013e31820d25b1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
As a quality improvement initiative, nurses in a general critical-care unit at a Midwest hospital constructed a plan for interventional hygiene. A nationally recognized nursing expert inspired the theoretical framework used as a basis for the initiative. A critical-care nursing clinical excellence team examined the current state and developed, implemented, and evaluated the interventional hygiene plan. Goals included standardizing bathing procedures and use of beds and reducing nosocomial infections and incontinence-associated dermatitis in critically ill adults. During the evaluation period, incidence of unit-acquired methicillin-resistant Staphylococcus aureus and incontinence-associated dermatitis decreased. Nurses reported favorable reviews for new skin care products and decreased nursing time associated with bathing.
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Coyer FM, O'Sullivan J, Cadman N. The provision of patient personal hygiene in the intensive care unit: A descriptive exploratory study of bed-bathing practice. Aust Crit Care 2011; 24:198-209. [DOI: 10.1016/j.aucc.2010.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 07/07/2010] [Accepted: 08/03/2010] [Indexed: 11/16/2022] Open
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Caraviello KAP, Nemeth LS, Dumas BP. Using the beach chair position in ICU patients. Crit Care Nurse 2010; 30:S9-S11. [PMID: 20360446 DOI: 10.4037/ccn2010425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. Bed rest has molecular and systemic effects, ultimately affecting functional outcomes in healthy individuals as well as in those with acute and critical illnesses. Using empirical sources, the purpose of this article was to describe the consequences of bed rest and immobility, especially consequences with implications for critically ill adults in the intensive care unit. This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/ metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.
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Affiliation(s)
- Chris Winkelman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA.
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19
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Abstract
OBJECTIVE To successfully educate, integrate, and empower nonlicensed personnel in the surgical intensive care unit in the use of a skin care protocol to maintain and improve skin integrity. DESIGN Observational intervention study. SETTING Surgical intensive care unit. PATIENTS Data related to alterations in skin integrity were collected over 4 months, representing approximately 2000 patient-days. A total of 97 specific events representing 121 "areas of concern" were identified by nonlicensed personnel. INTERVENTIONS Nonlicensed staff members' knowledge in 6 key areas related to pressure ulcer (PrU) development was surveyed before and after implementation of an interventional patient hygiene (IPH) program incorporating comprehensive bathing and incontinence protocols. A unique point-of-use skin inspection tool was used by nonlicensed personnel to communicate areas of concern to licensed personnel (registered nurses [RNs]). MAIN OUTCOME MEASURES Reduction in PrUs and improvement in nonlicensed staff knowledge of facility protocols. MAIN RESULTS Incidence of new PrUs decreased from 7.14% at baseline to 0% at the end of the study. Nonlicensed staff knowledge increased to 100% in all 6 knowledge areas. CONCLUSION Implementation of an IPH program incorporating comprehensive bathing and incontinence management resulted in enhanced communication between nonlicensed staff and RNs as well as improved patient outcomes.
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Halm MA, Krisko-Hagel K. Instilling Normal Saline With Suctioning: Beneficial Technique or Potentially Harmful Sacred Cow? Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.5.469] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Margo A. Halm
- Margo A. Halm is a clinical nurse specialist and director of nursing research and quality at United Hospital in St Paul, Minnesota, where she leads and mentors staff in principles of clinical research and evidence-based practice. Kathryn Krisko-Hagel is a learning and development specialist at United Hospital in St Paul, Minnesota
| | - Kathryn Krisko-Hagel
- Margo A. Halm is a clinical nurse specialist and director of nursing research and quality at United Hospital in St Paul, Minnesota, where she leads and mentors staff in principles of clinical research and evidence-based practice. Kathryn Krisko-Hagel is a learning and development specialist at United Hospital in St Paul, Minnesota
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Elliott R, McKinley S, Fox V. Quality Improvement Program to Reduce the Prevalence of Pressure Ulcers in an Intensive Care Unit. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.4.328] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Critically ill patients are at increased risk for pressure ulcers, which increase patients’ morbidity and mortality. Quality improvement projects decrease the frequency of pressure ulcers.
Objectives To improve patients’ outcomes by reducing the prevalence of pressure ulcers, identifying areas for improvement in prevention of pressure ulcers, and increasing the adoption of preventive strategies in an intensive care unit.
Method Quasi-experimental methods were used for this quality improvement project in which 563 surveys of patients’ skin were performed during 22 audits conducted during a 26-month period. One-on-one clinical instruction was provided to bedside nurses during the surveys, and pressure ulcer data were displayed in the clinical area.
Results The frequency of pressure ulcers of all stages showed an overall downward trend, and the prevalence decreased from 50% to 8%. The appropriate allocation of pressure-relieving devices increased from 75% up to 95% to 100%. The likely origin of the ulcer (ie, whether it was hospital or community acquired) and the anatomical site of the pressure ulcers did not change during the study period.
Conclusions This program was successful in reducing the prevalence of pressure ulcers among vulnerable intensive care patients and indicates that quality improvement is a highly effective formula for improving patients’ outcomes that is easily implemented by using clinical expertise and existing resources.
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Affiliation(s)
- Rosalind Elliott
- Rosalind Elliott is a clinical nurse consultant in the intensive care unit at the Royal North Shore Hospital, Sydney, Australia
| | - Sharon McKinley
- Sharon McKinley is a professor of critical care nursing on the faculty of nursing, midwifery, and health at the University of Technology Sydney and Northern Sydney and Central Coast Area Health Service, Australia
| | - Vicki Fox
- Vicki Fox is a patient safety officer in the clinical governance unit of the Northern Sydney Central Coast Area Health Service, Australia
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