Does time of transfer from critical care to the general wards affect anxiety? A pragmatic prospective cohort study

Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study

BACKGROUND

Transferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters.

OBJECTIVE

The aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it.

METHODS

This prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients' vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory.

RESULTS

The mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001).

CONCLUSIONS

The transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned.

IMPLICATIONS FOR CLINICAL PRACTICE

The patients' demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.

A practical approach to establishing a critical care outreach service: An expert panel research design

BACKGROUND

For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting.

AIM

The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting.

METHOD

An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed.

FINDINGS

There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation.

CONCLUSION

An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice.

Patients' experience while transitioning from the intensive care unit to a ward

BACKGROUND

Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience.

AIM

To describe the patients' experience while transitioning from the ICU to a general ward.

DESIGN

A descriptive qualitative study.

METHOD

Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

FINDINGS

Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories.

CONCLUSION

Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward.

RELEVANCE TO CLINICAL PRACTICE

It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.

Research Article Women's experience of maternity high-dependency care following a complicated birth: A cross-sectional study

OBJECTIVE

There is limited evidence around childbearing women's experience following a complicated birth requiring maternity high-dependency care. Our objective was to explore women's experience and wellbeing following a complicated birth within this context.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional study captured women's experience through a postal survey four weeks post birth.

SETTING

A convenience sample of 112 women who received care in the first 24 hours of their stay in a Western Australian maternity high dependency unit.

MAIN OUTCOME MEASURES

A validated tool designed to explore patients' intensive care experience was modified and six items were added based upon the literature and in consultation with clinicians.

RESULTS

Women felt they were given choice (78%; n = 86); were not glad to be transferred to a ward (62%; n = 68) and were in pain during the first 24 hours of their admission (70%; n = 78). Women who did not feel scared were more likely than those who felt scared to have a clinician explain what had happened (95% vs 78%, P = 0.007); were more likely to feel in control (94% vs 75%, P = 0.006); and were less likely to feel helpless (27% vs 62%, P = <0.001).

CONCLUSION

The transfer experience to a postpartum ward requires further investigation as does the management of pain for these childbearing women regardless of their birth mode.

Study of the sleep quality and psychological state of patients with hepatitis B liver cirrhosis

AIM

We aimed to investigate sleep quality, mild hepatic encephalopathy, anxiety, and depression in patients with hepatitis B cirrhosis by using a variety of scales and questionnaires.

METHOD

A cohort of 341 patients with hepatitis B liver cirrhosis were categorized by Child-Pugh grading (A, B, and C) in this cross-sectional study. Pittsburgh Sleep Quality Index (PSQI), Number Connection Test-A (NCT-A), and Hospital Anxiety and Depression (HAD) evaluated the questionnaires and statistically analyzed the intrinsic correlation. The control group included 50 healthy individuals. Of 341 patients, 213 had a PSQI index >5 points.

RESULTS

The PSQI, NCT-A, anxiety scale (HAD [a]), and depression scale (HAD [d]) of the patients were significantly different. The NCT-A-positive patients revealed 214 cases of possible minimal hepatic encephalopathy (MHE) during a preliminary screening of patients. The PSQI score of NCT-A-positive patients was significantly elevated compared to NCT-A-negative patients (P < 0.001). HAD (a) and HAD (d) were significantly different between the NCT-A-positive and NCT-A-negative groups (P = 0.002 and P = 0.006, respectively). Univariate Pearson's correlation analysis found that NCT-A and HAD (a) were positively correlated with PSQI (P < 0.001 and P = 0.045, respectively); however, Child-Pugh score and HAD (d) were not correlated with PSQI (P = 0.061 and P = 0.059, respectively).

CONCLUSION

These results indicated that patients with hepatitis B liver cirrhosis have a disturbed sleep, which might be an MHE symptom, further causing considerable anxiety. Thus, the evaluation of sleep quality and psychological state of patients with hepatitis B liver cirrhosis necessitates further investigation to guide positive intervention.