Perceptions of registered and enrolled nurses on thirst in mechanically ventilated adult patients in intensive care units-a phenomenographic study

Knowledge, attitude and practice regarding thirst management in surgical patients among intensive care unit nurses: A cross-sectional study

BACKGROUND

The prevalence of thirst in intensive care unit (ICU) surgical patients is high, and its impact is significantly harmful. Nurses play a crucial role in managing thirst. It is essential to develop targeted training programmes for nurses, focusing on their knowledge, attitude and practice (KAP).

AIMS

To investigate KAP regarding thirst management in surgical patients among ICU nurses and the potential influencing factors related to demographic characteristics.

STUDY DESIGN

This is a cross-sectional study. From August to September 2023, a self-developed questionnaire was distributed online in the ICUs of 14 tertiary general hospitals in Shanghai, China. This questionnaire aimed to assess the KAP of ICU nurses concerning thirst management. Influencing factors were analysed using ANOVA and the rank-sum test. Spearman correlation analysis and stratified regression analysis were employed to evaluate the relationship among KAP. The study was reported according to the STROBE checklist.

RESULTS

A total of 530 valid questionnaires were obtained online with a response rate of 86.60%. While ICU nurses generally held a positive attitude towards thirst management, there was a noticeable deficiency in knowledge and a lack of standardization in practice. Nurses with higher educational levels, lower academic titles, who had received training and who were familiar with the consensus and guidelines on thirst management had better attitude towards managing thirst. Younger nurses, those with less ICU working experience, lower academic titles, who had received training and who were acquainted with the guidelines showed better practice. It was observed that knowledge and attitude both had a significant positive influence on practice.

CONCLUSIONS

KAP regarding thirst management of surgical patients among ICU nurses are interconnected and require enhancement. Targeted training, focused on the identified weakness and influencing factors, needs to be carried out.

RELEVANCE TO CLINICAL PRACTICE

An innovative and stratified training system can improve the quality of practice, as well as contributing to the professional development of ICU nurses. Further, the findings of the study provide a foundational understanding of thirst management, promoting the advancement of related scientific research.

Factors influencing thirst in ICU patients: A mixed methods systematic review

OBJECTIVE

To systematically review the factors influencing thirst in ICU patients, providing a reference for effective management of thirst in ICU patients and the formulation of intervention measures.

METHODS

A total of 12 electronic databases were searched from inception to July 2023. The synthesis method of JBI mixed methods research systematic review was used. The quantitative studies were analyzed by Stata17.0 and RevMan 5.3 software, and the qualitative studies by meta-aggregation.

RESULTS

A total of 13 studies were included, including 2 qualitative studies and 11 quantitative studies. The quantitative study was carried out by meta-aggregation, extracting seven categories to form two synthesized findings. Quantitative meta-analysis revealed that 11 factors, including marital status, whether to use mechanical ventilation for the first time, air leakage, mechanical ventilation mode, simplified acute physiology score, respiratory rate, mask comfort, serum sodium concentration, breathing pattern, diuretics, and vasoactive drugs, were all associated with the occurrence of thirst in ICU patients. The qualitative and quantitative results were integrated into 5 categories, namely personal characteristics and lifestyle, disease factors, treatment factors, psychological factors, and nurse factors.

CONCLUSIONS

Thirst is a prevalent and severe issue among ICU patients, and effective interventions are required to address it. Considering its various causes, managing thirst in ICU patients should involve multiple levels of intervention. Treatment-related factors contribute significantly to thirst, and these factors should be taken into consideration when developing a thirst management strategy. Personal characteristics and lifestyle, psychological factors, drug-related factors, and nursing factors should be identified and optimized as soon as possible.

IMPLICATIONS FOR CLINICAL PRACTICE

Healthcare professionals should pay attention to thirst symptoms in ICU patients and promptly take effective preventive or intervention measures based on the influencing factors.

Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity

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.

Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU

Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.

Use of a menthol popsicle in managing postoperative thirst in patients undergoing radical prostatectomy: A randomized clinical trial

Background and aim: Thirst is a real bother that most patients feel in the immediate postoperative period when they still need to fast. Many approaches regarding symptomatic relief strategies have been described in the literature, but strategies with cold water and/or menthol are effective in quenching thirst, as they act on pre-absorptive mechanisms. This study aims to evaluate the effectiveness of using menthol popsicles in relieving postoperative thirst in patients undergoing radical prostatectomy. Material and methods: This is a randomized controlled clinical trial with a quantitative approach. In all, 44 patients were evaluated in the immediate postoperative period of radical prostatectomy, with the intensity and discomfort of thirst being evaluated initially and subsequently. The study consisted of two groups: (1) the placebo group, popsicles without the addition of menthol substrates and (2) the experimental group, popsicles with the addition of 0.05% minty substrates. Results: The results demonstrate that the sociodemographic and clinical characteristics were homogeneous at the α = 5% significance level, except the occupation variable. The test detected changes in the intensity and discomfort of thirst in relation to the pre- and post-intervention times for the primary outcome when the groups were analyzed separately and for the interaction of the group versus time, there was no statistical difference between the groups. Conclusion: It was possible to prove that both the menthol popsicle and the popsicle without the addition of menthol were effective in relieving postoperative thirst in patients undergoing radical prostatectomy, but there was no statistically significant difference when comparing the two groups. Trial registration: The Brazilian Registry of Clinical Trials (RBR-8c3chr7).

Effect of menthol lozenges after extubation on thirst, nausea, physiological parameters, and comfort in cardiovascular surgery patients: A randomized controlled trial

OBJECTIVES

To determine the effect of post-extubation oral menthol lozenges on thirst, nausea, physiological parameters, and comfort level in patients undergoing cardiovascular surgery.

RESEARCH METHODOLOGY/DESIGN

The study was a single-centre, randomized controlled trial.

SETTING

This study included 119 patients undergoing coronary artery bypass graft surgery in a training and research hospital. Patients in the intervention group (n = 59) received menthol lozenges at 30, 60, and 90 min after extubation. Patients in the control group (n = 60) received standard care and treatment.

MAIN OUTCOME MEASURES

The primary outcome of the study was the change in post-extubation thirst assessed by Visual Analogue Scale after using menthol lozenges compared to baseline. Secondary outcomes were changes in post-extubation physiological parameters and nausea severity assessed by Visual Analogue Scale compared to baseline, and comfort level assessed with Shortened General Comfort Questionnaire.

RESULTS

Between-group comparisons showed that the intervention group had significantly lower thirst scores at all time points and nausea at the first assessment (p < 0.05) and significantly higher comfort scores (p < 0.05) than the control group. There were no significant differences between the groups in physiological parameters at baseline or any of the postoperative assessments (p > 0.05).

CONCLUSION

In patients undergoing coronary artery bypass graft surgery, the use of menthol lozenges effectively increased comfort level by reducing post-extubation thirst and nausea, but had no effect on physiological parameters.

IMPLICATIONS FOR CLINICAL PRACTICE

Nurses should be vigilant for complaints such as thirst, nausea, and discomfort in patients after extubation. Nurses' administration of menthol lozenges to patients may help reduce post-extubation thirst, nausea, and discomfort.

Thirst in adult patients in the intensive care unit: protocol for a scoping review

INTRODUCTION

Thirst is one of the most bothersome symptoms experienced by intensive care unit (ICU) patients. Effective diagnosis and management of thirst in the ICU is essential, particularly as patients are less sedated than previously and more aware of this problem. Currently, no overview of publications on thirst identification and management in ICU patients exists. The scoping review will address the broad question 'What is known about thirst as a symptom in adult critically ill patients?' It aims to provide an overview of the causes and risk factors, diagnosis and measurement, the symptom dimensions and its interaction with other symptoms, and thirst management.

METHODS AND ANALYSIS

The review will follow the Joanna Briggs Institute methodology framework to guide the process and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Methods include: defining the review questions, eligibility criteria, concepts of interest and context; and outlining the search strategy, study selection process, data extraction and analysis. PubMed, MEDLINE, EMBASE and CINAHL will be searched from inception to April 2022.

ETHICS AND DISSEMINATION

Ethical approval is not required, as the scoping review will synthesise information from available publications. The scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with ICU support groups and the critical care professional community.

Thirst Interventions in Adult Acute Care-What Are the Recommended Management Options and How Effective Are They?: A Systematic Review

PURPOSE

The aim of this study was to review the scope and quality of evidence for thirst treatment in adult acute care.

METHODS

A systematic review was completed by 2 independent reviewers using MEDLINE, PubMed, BNI, EMBASE, EMCARE, and CINAHL databases and additional hand searching in June 2020. Interventions to relieve thirst for inpatients receiving acute care were included. Evidence was appraised against the levels of evidence for therapeutic studies, and a risk-of-bias assessment was completed for included studies. Outcomes are presented via narrative synthesis. Meta-analysis was planned.

RESULTS

Four studies (out of 844) were eligible reporting thirst outcomes from 611 critical care patients. Meta-analysis could not be completed because a priori criteria were not met. Two randomized controlled trials represented the highest level of evidence. Thirst assessment was completed via a self-reported scale in all reviewed works. Interventions included cold water sprays or swabs, menthol lip moisturizer, and use of humidification. Three works demonstrate reduced thirst scores; all interventions in these studies exploit cooling effects to the oropharynx with the aim of preabsorptive satiation of thirst. A humidified oxygen circuit showed a neutral response when compared with a nonhumidified circuit.

CONCLUSIONS

There is a limited but growing evidence base related to thirst treatment in the acute setting. Studies using a "bundle" of topical interventions incorporating cooling and menthol treatments showed positive effects in reducing symptom burden. Work to explore the scope of application for thirst treatment for patients unable to self-report, consideration of sustained effects, and a study of individual versus combined effects of bundle elements would be welcomed as the evidence base continues to develop.

A qualitative study of nurses' perception on patients' thirst in intensive care units

BACKGROUND

Thirst is a prevalent and intense symptom among patients in intensive care units. Occurrence of thirst in the intensive care unit cannot be avoided because of the nature of critical illnesses and their treatments like the side effects of administered medication or dehydration. In the intensive care unit, nurses have the opportunity and responsibility to prevent and reduce thirst by recognizing the different types of thirst. Thus, knowing nurses' perception on patients' thirst is crucial.

OBJECTIVES

Exploration of intensive care nurses' perception on patients' thirst.

RESEARCH DESIGN

A qualitative descriptive study.

METHODS

Data were collected from December 2020 to January 2021 and analyzed by using a phenomenographic methodology. Data were transcribed verbatim and thematic analysis was performed.

RESULTS

Sixteen nurses, in Chongqing, China, aged 25-48 years, were interviewed. Four themes emerged: (1) perceived barriers for thirst; (2) perceived signs of thirst; (3) perceived reasons of thirst; (4) perceived consequences for thirst. Overall nurses' perception of patients' thirst is poor. Nurses give a low priority and insufficient attention to the issue of thirst in intensive care patients.

CONCLUSION

Intensive care nurses' perception on thirst in patients should be evaluated and, if necessary, this issue should be given more attention in training in order to create sufficient awareness about the topic.

Thirst in patients admitted to intensive care units: an observational study

Background

Despite various studies reporting a high prevalence, reaching 71%, the sensation of thirst in intensive care unit (ICU) patients, its prevention, detection, and management, is not well known nor considered. Limited research has examined the causes of thirst in ICU patients, while it has been examined in other patient populations.

Aim

To determine the incidence and intensity of thirst in patients admitted to ICU and its association with airway devices (endotracheal tube, tracheostomy, oxygen mask), airway humidification, patients’ characteristics, and therapy (serum sodium concentration, hematocrit, fluid balance, possibility of oral hydration, and dosage of diuretics).

Methods

Patients were interviewed daily to report the presence of thirst and rate its intensity on a Numeric Rating Scale (NRS) from 0 (no thirst) –10 (intolerable thirst). Other data were obtained through direct evaluation or by consulting medical records. Patients admitted to three ICUs from May to August 2014 in a university hospital in Italy were included.

Results

A total of 220 Patients were enrolled. Thirst was found in 76.1% of patients’ observations, with a mean thirst score of 5.37. Thirst intensity was predicted by high doses of diuretics (> 100 mg/die), increasing serum sodium concentration, absence of oral hydration and the presence of xerostomia. Thirst was associated with the use of humidified Venturi mask.

Conclusions

Thirst is highly prevalent among patients in this population of intensive care patients. It would be desirable to evaluate this stressor at least daily, to eliminate or relieve this sensation.

Underrecognition and undertreatment of thirst among hospitalized patients with restricted oral feeding and drinking

Thirst is distressing but overlooked by healthcare professionals. Patients experience thirst due to comorbidities, physical or cognitive limitations, and iatrogenesis. Nasogastric tube (NGT) use and nil-by-mouth(NBM) orders are common practices that can lead to thirst. However, thirst in these populations has never been formally studied. We aim to examine prevalence of recognition and treatment of thirst among NGT + NBM and NBM patients. Our descriptive study was conducted intermittently over 25 weeks, across 1.5 years, in 12 adult general medicine wards of a tertiary hospital. Cognitively intact NGT + NBM or NBM inpatients, defined as Abbreviated Mental Test score ≥ 8, were studied. One-time questionnaire was administered. Variables included: demography, co-morbidities, clinical condition, feeding route, thirst defined by thirst distress and/or intensity ≥ 3, pain, hunger and volume status. 88 NGT + NBM and NBM patients were studied. 69.3% suffered from thirst. Thirsty patients experienced significant thirst-related distress (mean score ± SD: 5.7 ± 2.5). Subjects with previous stroke and who were euvolemic tended towards thirst. 13.6% were asked about thirst by doctors or nurses. Thirst was a major source of patient distress in our study. We suggest that thirst needs to be actively identified and targeted to achieve person-centred care.

Impact of oral care on thirst perception and dry mouth assessments in intensive care patients: An observational study

OBJECTIVES

To investigate the impact of oral care on thirst perception and dry mouth assessments.

RESEARCH DESIGN

Single-centre observational study.

SETTING

Intensive care unit in a university hospital.

MAIN OUTCOME

We assessed thirst perception and dry mouth in adult patients before and after oral care. Thirst perception was assessed using a numerical rating scale and dry mouth was assessed using an oral moisture checking device and the modified Revised Oral Assessment Guide including tongue, mucous membranes and saliva.

RESULTS

Eighty-six patients were included. After oral care, thirst scores decreased by 1 (0 to 3, p < 0.01) and remained low only for one hour. Oral moisture was maintained at a normal level ≥ 27.0%, and mROAG was at a low level ≤ 4 before and after the oral care. The numerical rating score did not correlate with oral moisture (ρ = -0.01, p = 0.96) or the modified revised oral assessment guide (ρ = 0.09, p = 0.42). Among patients with thirst, 60 (70%) patients complained of thirst at the assessment timepoints, but only 17 (20%) patients complained independently.

CONCLUSION

Thirst perception was dissociated from dry mouth before and after oral care. Thirst must be frequently assessed and treated.

Oral Health and Brain Injury: Causal or Casual Relation?

Background

To systematically review the current literature investigating the association between oral health and acquired brain injury.

Methods

A structured search strategy was applied to PubMed, Embase, Web of Science, and CENTRAL electronic databases until March 2017 by 2 independent reviewers. The preferred reporting items for systematic review and meta-analysis guidelines were used for systematic review.

Results

Even though the objective was to assess the association between oral health and acquired brain injury, eligible studies focused solely on different forms of stroke and stroke subtypes. Stroke prediction was associated with various factors such as number of teeth, periodontal conditions (even after controlling for confounding factors), clinical attachment loss, antibody levels to Aggregatibacter actinomycetemcomitans and Prevotella intermedia. The literature showed no consensus on the possible association between gingivitis and stroke. Patients with stroke generally had poorer oral hygiene practices and oral health. Dental prophylaxis and professional intervention reduced the incidence of stroke.

Conclusions

Overall, oral health and stroke were related. Periodontitis and tooth loss were independently associated with stroke. However, prevention and timely intervention may reduce the risk of stroke. Stroke was the main cerebral lesion studied in the literature, with almost no publications on other brain lesions.

Strategies for thirst relief: integrative literature review

Objective:

to analyze the strategies used to relieve the thirst of hospitalized patients.

Method:

an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva.

Results:

the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion.

Conclusion:

the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.

Patients' experience of thirst while being conscious and mechanically ventilated in the intensive care unit

BACKGROUND

Because of changes in sedation strategies, more patients in the intensive care unit (ICU) are conscious. Therefore, new and challenging tasks in nursing practice have emerged, which require a focus on the problems that patients experience. Thirst is one such major problem, arising because the mechanical ventilator prevents the patients from drinking when they have the urge to do so. To gain a deeper understanding of the patients' experiences and to contribute new knowledge in nursing care, this study focuses on the patients' experiences of thirst during mechanical ventilation (MV) while being conscious.

AIMS

To explore patients' experience of thirst while being conscious and mechanically ventilated.

DESIGN

This hermeneutic study used qualitative interviews of 12 patients.

METHOD

Data were analyzed based on content analysis. Interviews were conducted between September and October 2014 in two large ICUs in Denmark.

RESULT

Four themes relating to the patients' experiences of thirst during MV were identified: a paramount thirst, a different sense in the mouth, deprivation of the opportunity to quench thirst and difficulties associated with thirst.

CONCLUSION

Patients associate feelings of desperation, anxiety and powerlessness with the experience of thirst. These feelings have a negative impact on their psychological well-being. A strategy in the ICU that includes no sedation for critically ill patients in need of MV introduces new demands on the nurses who must care for patients who are struggling with thirst.

RELEVANCE TO CLINICAL PRACTICE

This study shows that despite several practical attempts to relieve thirst, it remains a paramount problem for the patients. ICU nurses need to increase their focus on issues of thirst and dry mouth, which are two closely related issues for the patients. Communication may be a way to involve the patients, recognize and draw attention to their problem.

Oral health status in patients with acquired brain injury: a systematic review

OBJECTIVE

To undertake a systematic review of the current knowledge and future perspectives regarding the status of various oral health factors, including social and behavioral aspects, in patients with acquired brain injury (ABI).

STUDY DESIGN

A structured search strategy was applied to PubMed, Embase, and Scopus electronic databases until January 2016 to identify studies presenting assessments of the oral health status of patients afflicted with any kind of ABI. The search strategy was restricted to English-language publications that enrolled patients aged more than 18 years. Studies on the association of oral health conditions and brain injury were excluded. No study was excluded based on its qualitative analysis.

RESULTS

A total of 27 studies were reviewed. Stroke was the most commonly studied ABI. Stroke patients had a higher number of missing teeth, poorer plaque and gingival index scores, and higher colonization of Candida albicans in saliva, all of which were significantly reduced after intervention. Oral health-related quality of life was poorer in patients compared to the general population.

CONCLUSION

Stroke was the most predominant brain injury condition studied in the literature, with few publications focusing on other forms of brain injury. Overall, oral health has been noted to be poor in patients with ABI, but oral hygiene and oral health-related quality of life have been found to improve when oral hygiene interventions are provided to patients.

Predictors of thirst in intensive care unit patients

CONTEXT

Thirst is a pervasive, intense, and distressing symptom in intensive care unit (ICU) patients. Although thirst may be avoided and/or treated, scant data are available to help providers identify patients most in need.

OBJECTIVES

This study was designed to identify predictors of the presence, intensity, and distress of thirst in ICU patients.

METHODS

This descriptive cross-sectional study enrolled 353 patients from three ICUs (medical-surgical, cardiac, and neurological). To measure outcomes, patients were asked to report the presence of thirst (yes/no) and, if present, to rate its intensity and distress on zero to 10 numeric rating scales (10=worst). Predictor variables were demographic (e.g., age), treatment-related (e.g., opioids), and biological (e.g., total body water). Data were analyzed with logistic regression and truncated regression with alpha preset at 0.05.

RESULTS

Thirst presence was predicted by high opioid doses (≥ 50 mg), high furosemide doses (>60 mg), selective serotonin reuptake inhibitors, and low ionized calcium. Thirst intensity was predicted by patients not receiving oral fluid and having a gastrointestinal (GI) diagnosis. Thirst distress was predicted by mechanical ventilation, negative fluid balance, antihypertensive medications, and a GI or "other" diagnosis.

CONCLUSION

Thirst presence was predicted by selected medications (e.g., opioids). Thirst intensity and/or thirst distress were predicted by other treatments (e.g., mechanical ventilation) and medical diagnoses (e.g., GI). This is one of the first studies describing predictors of the multidimensional characteristics of thirst. Clinicians can use these data to target ICU patients whose thirst might warrant treatment.

Perioperative thirst: an analysis from the perspective of the Symptom Management Theory

A theoretical study aimed to analyze the existing knowledge in the literature on the perioperative thirst symptom from the perspective of Symptom Management Theory, and supplemented with the experience of the study group and thirst research. Thirst is described as a very intense symptom occurring in the perioperative period, and for this reason it cannot be ignored. The Symptom Management Theory is adequate for understanding the thirst symptom and is a deductive theory, focused on the domains of the Person, Environment and Health / Illness Status, as well as on the dimensions of Experience, Management Strategies and Symptom Outcomes. Using the theory leads us to consider perioperative thirst in its multifactorial aspects, analyzing the interrelation of its domains and dimensions in order to draw attention to this symptom that has been insufficiently valued, recorded and treated in clinical practice.

Experiências de doentes críticos com a ventilação mecânica invasiva

O objetivo deste estudo foi conhecer as experiências vividas por pacientes que fizeram uso de ventilação mecânica invasiva em Unidades de Terapia Intensiva de dois hospitais do extremo sul do Brasil. A presente pesquisa foi conduzida na perspectiva qualitativa, sendo realizada com 10 pacientes que salientaram suas principais dificuldades e necessidades durante o período em que fizeram uso de ventilação mecânica invasiva. Os resultados apontam que as dificuldades relatadas relacionaram-se especialmente com a presença da via aérea artificial, sendo elas: sensação de sufocamento, náuseas, lesões decorrentes do tubo endotraqueal, acúmulo de secreções no tubo endotraqueal e cavidade oral e afonia. Além disso, os pacientes referiram necessidades de comunicação, sede e alterações da rotina pessoal. Os achados deste estudo elucidaram a vivência do paciente crítico, mediante esse recurso invasivo, trazendo elementos importantes a serem considerados para o cuidado de enfermagem.

Mouth care for orally intubated patients: a critical ethnographic review of the nursing literature

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.

The impact of hospitalization on oral health: a systematic review

BACKGROUND

Poor oral health of hospitalized patients is associated with an increased risk of hospital-acquired infections and reduced life quality.

OBJECTIVES

To systematically review the evidence on oral health changes during hospitalization.

DATA SOURCES

Cochrane library, Medline, OldMedline, Embase and CINAHL without language restrictions.

STUDY ELIGIBILITY CRITERIA

Observational longitudinal studies.

DATA APPRAISAL AND SYNTHESIS METHODS

Two independent reviewers screened studies for inclusion, assessed the risk of bias and extracted data. Risk of bias was assessed using the Newcastle-Ottawa assessment scale. A narrative synthesis was conducted.

RESULTS

Five before and after studies were included. The data suggest a deterioration in oral health following hospitalization with an increase in dental plaque accumulation and gingival inflammation and a deterioration in mucosal health.

LIMITATIONS

While before and after studies are at a general risk of bias, other specific study characteristics were judged to have a low risk of bias. However, methodological issues such as unvalidated outcome measures and the lack of assessor training limit the strength of the evidence.

CONCLUSION

Hospitalization is associated with a deterioration in oral health, particularly in intubated patients.

Symptoms experienced by intensive care unit patients at high risk of dying

OBJECTIVE

To provide a focused, detailed assessment of the symptom experiences of intensive care unit patients at high risk of dying and to evaluate the relationship between delirium and patients' symptom reports.

DESIGN

Prospective, observational study of patients' symptoms.

SETTING

Two intensive care units in a tertiary medical center in the western United States.

PATIENTS

One hundred seventy-one intensive care unit patients at high risk of dying.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients were interviewed every other day for up to 14 days. Patients rated the presence, intensity (1 = mild; 2 = moderate; 3 = severe), and distress (1 = not very distressing; 2 = moderately distressing; 3 = very distressing) of ten symptoms (that is, pain, tired, short of breath, restless, anxious, sad, hungry, scared, thirsty, confused). The Confusion Assessment Method-Intensive Care Unit was used to ascertain the presence of delirium. A total of 405 symptom assessments were completed by 171 patients. Patients' average age was 58 ± 15 yrs; 64% were males. Patients were mechanically ventilated during 34% of the 405 assessments, and 22% died in the hospital. Symptom prevalence ranged from 75% (tired) to 27% (confused). Thirst was moderately intense, and shortness of breath, scared, confusion, and pain were moderately distressful. Delirium was found in 34.2% of the 152 patients who could be evaluated. Delirious patients were more acutely ill and received significantly higher doses of opioids. Delirious patients were significantly more likely to report feeling confused (43% vs. 22%, p = .004) and sad (46% vs. 31%, p = .04) and less likely to report being tired (57% vs. 77%, p = .006) than nondelirious patients.

CONCLUSIONS

Study findings suggest that unrelieved and distressing symptoms are present for the majority of intensive care unit patients, including those with delirium. Symptom assessment in high-risk intensive care unit patients may lead to more focused interventions to avoid or minimize unnecessary suffering.