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Wilsey HA, Hicks MH. A road less traveled in critical care: A call for improved acceptance and implementation of palliative and supportive care. Am J Health Syst Pharm 2024; 81:903-909. [PMID: 38801236 DOI: 10.1093/ajhp/zxae145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Indexed: 05/29/2024] Open
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Mitchell E, Azulay Chertok IR. Critical Care Nurses' Perspectives of Caring for Patients With Cancer. Dimens Crit Care Nurs 2024; 43:239-245. [PMID: 39074226 DOI: 10.1097/dcc.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Critical care nurses are expected to work with patients who present with a wide range of health problems, but may lack sufficient education, skill development, and resources needed for providing psychosocial cancer care. OBJECTIVE The purpose of this study was to gain a deeper understanding of nononcologic critical care nurses' experience working with patients and their families affected by cancer. METHOD A phenomenological qualitative study using semistructured interviews was conducted with 15 nononcologic critical care nurses. Colaizzi's 7-step methodology was followed for data analysis and interpretation of findings. Audio recordings were transcribed verbatim, the narrative data were analyzed and coded, and themes were identified that were confirmed by participants. RESULTS Four themes emerged from the nurses' narratives: lack of professional preparation refers to the perceived lack of education, skill development, and resources; collaboration and teamwork pertain to the importance of communication and moral support; being present expresses their perceived role in providing compassionate care; and nurtured empathy reflects the impact of cancer care on the nurses. DISCUSSION The narratives provide insight into the experience and perceptions of the nononcologic critical care nurses caring for patients with cancer. Information from the themes and narratives can be used to inform the development of knowledge and skills for nononcologic nurses who provide care to patients with cancer.
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Xu J, Cheng P, Yu H, Zhou N, Lan M. The work experiences and career development expectations of Chinese respiratory therapists: a descriptive qualitative study. Front Med (Lausanne) 2024; 11:1452508. [PMID: 39267959 PMCID: PMC11390457 DOI: 10.3389/fmed.2024.1452508] [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: 06/21/2024] [Accepted: 08/19/2024] [Indexed: 09/15/2024] Open
Abstract
Background Respiratory therapists (RTs) play a vital role in healthcare, specializing in the treatment and management of heart and lung conditions, particularly during the COVID-19 pandemic. Despite the importance of RTs, little attention has been paid to RTs in the Chinese health system. This study aimed to understand and describe the work experiences and career development expectations of RTs in China. Methods This study utilized a qualitative research design and conducted semi-structured, in-depth, audio-recorded interviews with 16 RTs aged 28-40 years, purposively selected from six regions in mainland China from May to June 2024. Qualitative thematic content analysis was conducted to identify and group the themes that emerged from the discourse. Interviews were transcribed and analyzed using thematic analysis. Results Four key themes were identified: (1) "Complex Career Motivation" delves into the career trajectories and role adaptations of RTs; (2) "Positive Career Feedback" explores feelings of job satisfaction and career accomplishments; (3) "Uncertain Career Predicament" sheds light on the negative impact of multidimensional career challenges; (4) "Demand-Driven Future Outlook" reflects RTs' urgent expectations for professional advancement. Conclusion The barriers and facilitators in the professional journey of Chinese RTs maintain a fragile balance, and the future development of the profession may determine whether they can persist in their careers. Healthcare managers and leaders should pay attention to the real needs of RTs, enhance their professional confidence, and adopt effective coping strategies to avoid the loss of human resources and promote the development of the professional team.
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Affiliation(s)
- Jianfeng Xu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Pengfei Cheng
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Hangqing Yu
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Niya Zhou
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Meijuan Lan
- Department of Nursing, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Tingsvik C, Henricson M, Hammarskjöld F, Mårtensson J. Physicians' decision making when weaning patients from mechanical ventilation: A qualitative content analysis. Aust Crit Care 2024:S1036-7314(24)00206-6. [PMID: 39122604 DOI: 10.1016/j.aucc.2024.06.015] [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: 11/06/2023] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Weaning from mechanical ventilation is a complex and central intensive care process. This complexity indicates that the challenges of weaning must be explored from different perspectives. Furthermore, physicians' experiences and the factors influencing their decision-making regarding weaning are unclear. OBJECTIVES This study aimed to explore and describe the factors influencing physicians' decision-making when weaning patients from invasive mechanical ventilation in Swedish intensive care units (ICUs). METHODS This qualitative study used an exploratory and descriptive design with qualitative content analysis. Sixteen physicians from five ICUs across Sweden were purposively included and interviewed regarding their weaning experiences. FINDINGS The physicians expressed that prioritising the patient's well-being was evident, and there was agreement that both the physical and mental condition of the patient had a substantial impact on decision-making. Furthermore, there was a lack of agreement on whether patients should be involved in the weaning process and how their resources, needs, and wishes should be included in decision-making. In addition, there were factors not directly linked to the patient but which still influenced decision-making, such as the available resources and teamwork. Sometimes, it was difficult to point out the basis for decisions; in that decisions were made by gut feeling, intuition, or clinical experience. CONCLUSION Physicians' decision-making regarding weaning was a dynamic process influenced by several factors. These factors were related to the patient's condition and the structure for weaning. Increased understanding of weaning from the physicians' and ICU teams' perspectives may improve the weaning process by broadening the knowledge about the aspects influencing the decision-making.
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Affiliation(s)
- Catarina Tingsvik
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping SE-551 11, Sweden; Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping SE-55185, Sweden.
| | - Maria Henricson
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping SE-551 11, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås SE-501 90, Sweden.
| | - Fredrik Hammarskjöld
- Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping SE-55185, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping SE-581 83, Sweden.
| | - Jan Mårtensson
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping SE-551 11, Sweden.
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Varma B, Katz JN, Alviar CL. Building a cardiogenic shock response team: key considerations necessary to improve outcomes. Curr Opin Crit Care 2024; 30:354-361. [PMID: 38872365 DOI: 10.1097/mcc.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
PURPOSE OF REVIEW This review provides key information about cardiogenic shock (CS) teams, including published evidence and practical recommendations to create a CS team and program. RECENT FINDINGS CS is a complex disease process with a high in-hospital mortality rate ranging from 30% to 70% according to recent registries and randomized studies. The explanation for the elevated rates is likely multifactorial, including the various etiologies of cardiogenic shock as well as delays in recognition and deployment of appropriate therapies. Accordingly, the use of cardiogenic shock team has been implemented with the aim of improving outcomes in these patients. The CS team typically consists of members with critical care or cardiac critical care expertise, heart failure, cardiothoracic surgery, and interventional cardiology. A number of retrospective studies have now supported the benefits of a CS team, particularly in selecting the appropriate candidates for tailored mechanical circulatory support therapies and providing interventions in a timely manner, which have translated into improved outcomes. SUMMARY CS teams provides a platform for expedited recognition of CS and timely, standardized, and multidisciplinary discussions regarding appropriate management and care.
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Affiliation(s)
- Bhavya Varma
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center
| | - Jason N Katz
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center
- Bellevue Hospital Center, New York, New York, USA
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiovascular Medicine, New York University Grossman School of Medicine, NYU Langone Medical Center
- Bellevue Hospital Center, New York, New York, USA
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Antoszewska A, Gutysz-Wojnicka A. Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study. Intensive Crit Care Nurs 2024; 83:103667. [PMID: 38471399 DOI: 10.1016/j.iccn.2024.103667] [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: 09/18/2023] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Rationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. OBJECTIVES This study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. METHODOLOGY A cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SETTINGS Intensive Care Units in Warmia and Mazury Region in Poland. MAIN OUTCOME MEASURES Level of Nursing Care Rationing in Intensive Care Units. RESULTS The majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being -0.36 for the HWEAT and -0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. CONCLUSIONS It is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. IMPLICATIONS FOR CLINICAL PRACTICE Interventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.
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Affiliation(s)
- Anna Antoszewska
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
| | - Aleksandra Gutysz-Wojnicka
- School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Department of Nursing, Żołnierska 14c Street, 10-561 Olsztyn, Poland.
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Yumoto T, Hongo T, Obara T, Ageta K, Aokage T, Tsukahara K, Nakao A, Naito H. Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. J Clin Med 2024; 13:4324. [PMID: 39124591 PMCID: PMC11312900 DOI: 10.3390/jcm13154324] [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: 06/28/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan; (T.H.); (T.O.); (K.A.); (T.A.); (K.T.); (A.N.); (H.N.)
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McVey C, Katigbak C. Telemedicine and Teamwork Among Health Care Professionals: State of the Science. Telemed J E Health 2024. [PMID: 39023072 DOI: 10.1089/tmj.2024.0068] [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: 07/20/2024] Open
Abstract
Background: As telemedicine becomes further rooted in standard patient care delivery, it is critical to understand how it may affect teamwork among health care providers. Understanding the state of the science between telemedicine and teamwork is an important first step. Obejctive: The purpose of this state-of-the-science review was to synthesize the published research on teamwork within the context of telemedicine. Methods: Data abstraction and analysis were structured following the Virtual Team Performance and the "Big Five" of Teamwork theoretical frameworks. The concepts within these models were used to organize data extraction. This state of the science used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: A total of 14 studies met the inclusion criteria after final review. The most common variables were communication, tasks, leadership, team orientation, and team cohesion. Despite variable commonalities across the included articles, there was a discrepancy between improved and reduced teamwork outcomes with telemedicine. Conclusions: Multiple teamwork variables are influential across health care teams using telemedicine technologies-those that include communication, task facilitation, leadership, team orientation, and cohesion appear to have the greatest impact. However, it is not an individual teamwork variable, type of technology, or care environment alone that influences positive or negative outcomes among health care teams using telemedicine. Instead, it is a combination of factors and mechanisms that facilitate or hinder teamwork outcomes. A comprehensive model that describes the interaction of these common variables in teamwork among blended virtual and in-person health care teams is needed.
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Affiliation(s)
- Caitlin McVey
- Cizik School of Nursing, University of Texas Health Houston, Houston, Texas, USA
- Memorial Hermann Health System, Houston, Texas, USA
| | - Carina Katigbak
- Cizik School of Nursing, University of Texas Health Houston, Houston, Texas, USA
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Alanazi NH. Intensive Care Unit Nurses' Experiences in Caring for End-of-Life Patients in Saudi Arabia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:931. [PMID: 39063507 PMCID: PMC11277339 DOI: 10.3390/ijerph21070931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Background: Although extensive research on appropriate treatments has been conducted, how nurses provide care to patients at the end-of-life (EOL) is unclear, particularly among intensive care unit (ICU) nurses in Saudi Arabia. Purpose: To explore intensive care unit nurses' experiences in providing end-of-life care in Saudi Arabia. Methods: This study utilized an exploratory, descriptive, qualitative approach. A purposive sampling technique was used to recruit ICU nurses (n = 10) working in ICUs at a tertiary teaching hospital in Riyadh, Saudi Arabia. Using a semi-structured interview guide, ten individual interviews were conducted. Data were analyzed using thematic analysis. The trustworthiness of this study was ensured by following Lincoln and Guba's (1985) criteria. Findings: Four major themes related to ICU nurses' experiences of providing EOL care emerged, including: "feeling challenged but driven", "holistic caring", "collaborative working ethics", and "caring for the undying and dying". Conclusions: This study adds to the body of knowledge about the experience of ICU nurses caring for EOL patients. It offers valuable insights into challenges, coping strategies, holistic caring, collaboration, and the management of critical or dying patients at EOL in the ICUs.
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Affiliation(s)
- Naif H Alanazi
- Medical-Surgical Department, College of Nursing, King Saud University, Riyadh 12372, Saudi Arabia
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Elbus LMS, Mostafa MG, Mahmoud FZ, Shaban M, Mahmoud SA. Nurse managers' managerial innovation and it's relation to proactivity behavior and locus of control among intensive care nurses. BMC Nurs 2024; 23:485. [PMID: 39014395 PMCID: PMC11251221 DOI: 10.1186/s12912-024-02084-8] [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: 02/05/2024] [Accepted: 06/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The nursing profession is undergoing rapid transformation, requiring innovation in management approaches and proactive behaviors among staff. Nurse Managers play a vital role through managerial innovation, but its impacts on intensive care nurses' proactivity and locus of control remain underexplored. OBJECTIVES This study aimed to assess the levels of Nurse Managers' managerial innovation and relate it to proactivity behaviors and locus of control orientations among intensive care nurses. METHODS A cross-sectional correlational design was adopted, recruiting 242 intensive care nurses from Tanta University Hospital, Egypt. Participants completed standardized questionnaires measuring perceived managerial innovation, proactivity behavior, and locus of control. RESULTS Nurse Managers demonstrated moderately high innovation across all dimensions, especially in continuous learning and development (mean = 4.65) and advanced technology use (mean = 4.56). Nurses exhibited sound proactivity levels, particularly in adaptability (mean = 4.40) and planning (mean = 4.35). The majority of nurses showed an internal locus of control (64.5%). Managerial innovation had significant positive correlations with nurses' proactivity (r = 0.45, p < 0.001) and internal locus of control (r = 0.42, p < 0.001). Regression analysis revealed age, gender, experience, education, and ICU type as significant predictors of proactivity and locus of control. CONCLUSION Innovative nursing leadership positively influences staff's proactivity levels and perceived control over their practice. This underscores the vital role of nurse managers in creating empowering environments in intensive care.
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Affiliation(s)
| | | | | | - Mostafa Shaban
- Community Health Nursing Department, College of Nursing, Jouf University, Sakak, Saudi Arabia
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Johnson NL, Moeckli J. Conceptualizations of interprofessional communication in intensive care units: findings from a scoping review. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:130-142. [PMID: 38197399 DOI: 10.1080/17538068.2023.2297124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Clinical errors in intensive care units (ICUs) are consistently attributed to communication errors. Despite its importance for patient safety and quality in critical care settings, few studies consider interprofessional communication as more than the basic exchange of information. METHODS We conducted a scoping review of interprofessional communication in ICUs to (1) characterize how communication is defined and measured and (2) identify contributions the field of health communication can make to team communication in ICUs. Through a series of queries in PubMed and Communication and Mass Media Complete databases, we identified and compared persistent gaps in how communication is framed and theorized in 28 publications from health services and 6 from social science outlets. We identified research priorities and suggested strategies for discussing communication more holistically in future health services research. RESULTS 34 articles published from 1999 to 2021 were included. Six explicitly defined communication. Six were published in social science journals, but none were authored by a communication studies scholar. Half of the articles addressed communication as a transaction focused on information transfer, and the other half addressed communication as a process. CONCLUSIONS Methodological implications are identified with the intent to encourage future interdisciplinary collaboration for studying communication in ICUs. We discuss the importance of (1) using language to describe communication that facilitates interdisciplinary engagement, (2) prioritizing communication as a process and using qualitative methods to provide insight, and (3) engaging health communication theories and experts to assist in developing more fruitful research questions and designs.
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Affiliation(s)
- Nicole L Johnson
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Jane Moeckli
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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Hochberg CH, Case AS, Psoter KJ, Brodie D, Dezube RH, Sahetya SK, Outten C, Street L, Eakin MN, Hager DN. Lung Protective Ventilation Adherence and Outcomes for Patients With COVID-19 Acute Respiratory Distress Syndrome Treated in an Intermediate Care Unit Repurposed to ICU Level of Care. Crit Care Explor 2024; 6:e1127. [PMID: 39018303 PMCID: PMC11257666 DOI: 10.1097/cce.0000000000001127] [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] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, some centers converted intermediate care units (IMCUs) to COVID-19 ICUs (IMCU/ICUs). In this study, we compared adherence to lung protective ventilation (LPV) and outcomes for patients with COVID-19-related acute respiratory distress syndrome (ARDS) treated in an IMCU/ICU versus preexisting medical ICUs (MICUs). DESIGN Retrospective observational study using electronic medical record data. SETTING Two academic medical centers from March 2020 to September 2020 (period 1) and October 2020 to May 2021 (period 2), which capture the first two COVID-19 surges in this health system. PATIENTS Adults with COVID-19 receiving invasive mechanical ventilation who met ARDS oxygenation criteria (Pao2/Fio2 ≤ 300 mm Hg or Spo2/Fio2 ≤ 315). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We defined LPV adherence as the percent of the first 48 hours of mechanical ventilation that met a restrictive definition of LPV of, tidal volume/predicted body weight (Vt/PBW) less than or equal to 6.5 mL/kg and plateau pressure (Pplat) less than or equal to 30 cm H2o. In an expanded definition, we added that if Pplat is greater than 30 cm H2o, Vt/PBW had to be less than 6.0 mL/kg. Using the restricted definition, period 1 adherence was lower among 133 IMCU/ICU versus 199 MICU patients (92% [95% CI, 50-100] vs. 100% [86-100], p = 0.05). Period 2 adherence was similar between groups (100% [75-100] vs. 95% CI [65-100], p = 0.68). A similar pattern was observed using the expanded definition. For the full study period, the adjusted hazard of death at 90 days was lower in IMCU/ICU versus MICU patients (hazard ratio [HR] 0.73 [95% CI, 0.55-0.99]), whereas ventilator liberation by day 28 was similar between groups (adjusted subdistribution HR 1.09 [95% CI, 0.85-1.39]). CONCLUSIONS In patients with COVID-19 ARDS treated in an IMCU/ICU, LPV adherence was similar to, and observed survival better than those treated in preexisting MICUs. With adequate resources, protocols, and staffing, IMCUs provide an effective source of additional ICU capacity for patients with acute respiratory failure.
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Affiliation(s)
- Chad H. Hochberg
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Aaron S. Case
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kevin J. Psoter
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Rebecca H. Dezube
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Sarina K. Sahetya
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Carrie Outten
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Lara Street
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - David N. Hager
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
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Salimi-Bani M, Pandian V, Vahedian-Azimi A, Moradian ST, Bahramifar A. A respiratory critical care nurse training program for settings without a registered respiratory therapists: A protocol for a multimethod study. Intensive Crit Care Nurs 2024; 82:103662. [PMID: 38382240 DOI: 10.1016/j.iccn.2024.103662] [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: 02/08/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The increasing elderly population and prevalence of chronic diseases have raised the need for ICU beds. However, limited bed availability often causes delays in admission, leading to wasted treatment time. OBJECTIVES This study aims to create and implement a training program for respiratory critical care nurses (RCCNs) in settings without registered respiratory therapists (RRTs). RESEARCH METHODOLOGY/DESIGN The study will use a multimethod sequential research design, including a scoping review, content analysis, Delphi methods, and a randomized clinical trial. The scoping review will gather extensive information on respiratory care for critically ill patients and the responsibilities of RCCNs. Content analysis and expert interviews will identify opportunities and challenges in RCCNs' provision of respiratory care. The Delphi method will integrate the results to develop a comprehensive training program for RCCNs. Subsequently, five RCCNs will undergo theoretical and practical examinations after completing the three-month training program, and the impact of RCCNs on critically ill patients' outcomes will be evaluated through a clinical trial. ANTICIPATED FINDINGS The study aims to provide a comprehensive training program for RCCNs and investigate its impact on the outcomes of critically ill patients through a clinical trial. CONCLUSION The training program will equip RCCNs with the necessary skills and knowledge to provide respiratory critical care from the emergency department to hospital discharge. This pioneering study aims to improve patient outcomes in settings without RRTs by offering a unique program for RCCNs. IMPLICATIONS FOR CLINICAL PRACTICE The development and implementation of this training program for RCCNs in settings without RRTs will address the gap in respiratory care and potentially improve patient outcomes. By empowering RCCNs with specialized training, healthcare facilities can ensure the provision of high-quality respiratory care throughout a patient's critical illness journey, enhancing the efficiency and effectiveness of healthcare teams, especially in resource-limited settings.
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Affiliation(s)
- Malihe Salimi-Bani
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, United States
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Bahramifar
- Trauma Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Grunberg NE, Doorley JD, Barry ES. Sport Psychology: Principles and Practices for Sports Medicine Physicians. Curr Sports Med Rep 2024; 23:192-198. [PMID: 38709945 DOI: 10.1249/jsr.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
ABSTRACT Sport psychology is the scientific study and application of psychological principles to enhance performance and well-being in sport, exercise, and physical activity. It has numerous applications to sports medicine, as psychological factors are associated with sport injury risk, recovery, successful return to play, and overall health. This article addresses how sport psychology is important to sports medicine and what applied sport psychologists do. We discuss several psychological principles and practices relevant to individual performance and well-being, including goal setting, communication, arousal and performance, imagery/mental rehearsal, attention management, managing psychological distress, and behavioral health. We also discuss principles and practices of sport psychology relevant to team performance, including stages of team development, goal setting, communication, arousal and performance, and behavioral health. Sport psychology and applied sport psychology practitioners can be valued assets to sports medicine teams in supporting individual and team performance and injury recovery.
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Affiliation(s)
- Neil E Grunberg
- Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD
| | | | - Erin S Barry
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD
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15
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Camenzind E, Vetter L, Exl MT, Jeitziner MM. [Lessons from the COVID-19-Pandemic : Experiences of critical care nurses during the COVID-19 pandemic: a qualitative explorative study]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01120-4. [PMID: 38459360 DOI: 10.1007/s00063-024-01120-4] [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: 07/12/2023] [Revised: 12/08/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND When the workload for critical care nurses becomes too high, this can have consequences for both personal health as well as patient care. During the COVID-19 pandemic, critical care nurses were confronted with new and dynamic changes. OBJECTIVE The aim of this study was to describe the experiences of critical care nurses regarding the ad hoc measures taken and the perceived physical and psychological burden experienced during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This was a cross-sectional study conducted at two hospitals using an online survey. The open questions addressing the challenges faced during the COVID-19 pandemic were subjected to content analysis according to Mayring. RESULTS A total of 179 critical care nurses participated in the online survey. From the results, the following four categories were developed: "not meeting one's own quality of care requirements," "uncertainties in everyday professional and private life," "increased responsibility with lack of relief," and "insufficient coping strategies for physical and psychological burden." CONCLUSION Critical care nurses require structures and processes which support them in situations of high workload. The focus should be on the self-imposed requirements of quality of care as well as potentially relieving measures.
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Affiliation(s)
- Elena Camenzind
- Universitätsklinik für Anästhesiologie und Schmerzmedizin, Universitätsspital Bern (Inselspital), Bern, Schweiz
| | - Luzia Vetter
- Pflegeentwicklung und -qualität, Luzerner Kantonsspital, Luzern, Schweiz
| | - Matthias Thomas Exl
- Universitätsklinik für Intensivmedizin, Universitätsspital Bern (Inselspital), Bern, Schweiz.
| | - Marie-Madlen Jeitziner
- Universitätsklinik für Intensivmedizin, Universitätsspital Bern (Inselspital), Bern, Schweiz
- Departement Public Health (DPH), Pflegewissenschaft - Nursing Science (INS), Universität Basel, Basel, Schweiz
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Teele SA, Tremoulet P, Laussen PC, Danaher-Garcia N, Salvin JW, White BAA. Complex decision making in an intensive care environment: Perceived practice versus observed reality. J Eval Clin Pract 2024; 30:337-345. [PMID: 37767761 DOI: 10.1111/jep.13930] [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: 01/12/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
RATIONALE Advancing our understanding of how decisions are made in cognitively, socially and technologically complex hospital environments may reveal opportunities to improve healthcare delivery, medical education and the experience of patients, families and clinicians. AIMS AND OBJECTIVES Explore factors impacting clinician decision making in the Boston Children's Hospital Cardiac Intensive Care Unit. METHODS A convergent mixed methods design was used. Quantitative and qualitative data sources consisted of a faculty survey, direct observations of clinical rounds in a specific patient population identified by a clinical decision support system (CDSS) and semistructured interviews (SSIs). Deductive and inductive coding was used for qualitative data. Qualitative data were translated into images using social network analysis which illustrate the frequency and connectivity of the codes in each data set. RESULTS A total of 25 observations of eight faculty-led interprofessional teams were performed between 12 February and 31 March 2021. Individual patient characteristics were noted by faculty in SSIs to be the most important factor in their decision making, yet ethnographic observations suggested faculty cognitive traits, team expertise and value-based decisions were more heavily weighted. The development of expertise was impacted by role modeling. Decisions were perceived to be influenced by the system and environment. CONCLUSIONS Clinician perception of decision making was not congruent with the observed behaviours in a complicated and dynamic system. This study identifies important considerations in clinical curricula as well as the design and implementation of CDSS. Our method of using social network analysis to visualize components of decision making could be adopted to explore other complex environments.
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Affiliation(s)
- Sarah A Teele
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | | | - Peter C Laussen
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole Danaher-Garcia
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
| | - Joshua W Salvin
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bobbie Ann A White
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA
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17
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Bouchez T, Cagnon C, Hamouche G, Majdoub M, Charlet J, Schuers M. Interprofessional clinical decision-making process in health: A scoping review. J Adv Nurs 2024; 80:884-907. [PMID: 37705486 DOI: 10.1111/jan.15865] [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: 12/27/2021] [Revised: 07/19/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
AIMS To describe the key elements of the interprofessional decision-making process in health, based on published scientific studies. To describe the authors, reviews and subject matter of those publications. DESIGN Scoping review of the literature. DATA SOURCES MEDLINE, APA Psycinfo OpenGrey, Lissa and Cochrane databases were searched in December 2019 and January 2023. REVIEW METHODS References were considered eligible if they (i) were written in French or English, (ii) concerned health, (iii) studied a clinical decision-making process, (iv) were performed in an interprofessional context. 'PRISMA-scoping review' guidelines were respected. The eligible studies were analysed and classified by an inductive approach RESULTS: We identified 1429 sources of information, 145 of which were retained for the analysis. Based on these studies, we identified five key elements of interprofessional decision-making in health. The process was found to be influenced by group dynamics, the available information and consideration of the unique characteristics of the patient. An organizational framework and specific training favoured improvements in the process. CONCLUSION Decision-making can be based on a willingness of the healthcare organization to promote models based on more shared leadership and to work on professional roles and values. It also requires healthcare professionals trained in the entire continuum of collaborative practices, to meet the unique needs of each patient. Finally, it appears essential to favour the sharing of multiple sources of accessible and structured information. Tools for knowledge formalization should help to optimize interprofessional decision-making in health. IMPACT The quality of a team decision-making is critical to the quality of care. Interprofessional decision-making can be structured and improved through different levels of action. These improvements could benefit to patients and healthcare professionals in every settings of care involving care collaboration. IMPACT STATEMENT Interprofessional decision-making in health is an essential lever of quality of care, especially for the most complex patients which are a contemporary challenge. This scoping review article offers a synthesis of a large corpus of data published to date about the interprofessional clinical decision-making process in healthcare. It has the potential to provide a global vision, practical data and a list of references to facilitate the work of healthcare teams, organizations and teachers ready to initiate a change.
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Affiliation(s)
- Tiphanie Bouchez
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
| | - Clémence Cagnon
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Gouraya Hamouche
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Marouan Majdoub
- Department of Education and Research in General Practice, University Côte d'Azur, RETINES, HEALTHY, Nice, France
| | - Jean Charlet
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Assistance Publique-Hôpitaux de Paris/DRCI, Paris, France
| | - Matthieu Schuers
- Sorbonne University, INSERM, University Sorbonne Paris-Nord, LIMICS, Paris, France
- Department of General Practice, University of Rouen, Rouen, France
- Department of Medical Informatic, Academic Hospital of Rouen, Rouen, France
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18
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Kok N, Hoedemaekers C, Fuchs M, van der Hoeven H, Zegers M, van Gurp J. Evaluating the use of casuistry during moral case deliberation in the ICU: A multiple qualitative case study. Soc Sci Med 2024; 345:116662. [PMID: 38364726 DOI: 10.1016/j.socscimed.2024.116662] [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: 10/06/2023] [Revised: 12/27/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
Intensive care unit (ICU) professionals engage in ethical decision making under conditions of high stakes, great uncertainty, time-sensitivity and frequent irreversibility of action. Casuistry is a way by which actionable knowledge is obtained through comparing a patient case to previous cases from experience in clinical practice. However, within the field of study as well as in practice, evidence-based medicine is the dominant epistemic framework. This multiple case study evaluated the use of casuistic reasoning by intensive care unit (ICU) professionals during moral case deliberation. It took place in two Dutch hospitals between June 2020 and June 2022. Twentyfive moral case deliberations from ICU practice were recorded and analyzed using discourse analysis. Additionally, 47 interviews were held with ICU professionals who participated in these deliberations, analyzed using thematic analysis. We found that ICU professionals made considerable use of case comparisons when discussing continuation, withdrawal or limitation. Analogies played a role in justifying or complicating moral judgements, and also played a role in addressing moral distress. The language of case-based arguments is most often not overtly normative. Rather, the data shows that casuistic reasoning deals with the medical, ethical and contextual elements of decisions in an integrated manner. Facilitators of MCD have an essential role in (supporting ICU professionals in) scrutinizing casuistic arguments. The data shows that during MCD, actual reasoning often deviated from principle- and rule-based reasoning which ICU professionals preferred themselves. Evidence-based arguments often gained the character of analogical arguments, especially when a patient-at-hand was seen as highly unique from the average patients in the literature. Casuistic arguments disguised as evidence-based arguments may therefore provide ICU professionals with a false sense of certainty. Within education, we should strive to train clinicians and ethics facilitators so that they can recognize and evaluate casuistic arguments.
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Affiliation(s)
- Niek Kok
- Radboud University Medical Center, Department of IQ Health, Kapittelweg 54, 6525, EP, Nijmegen, Netherlands.
| | - Cornelia Hoedemaekers
- Radboud University Medical Center, Department of Intensive Care, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, Netherlands
| | - Malaika Fuchs
- Canisius Wilhelmina Hospital, Department of Intensive Care, Weg Door Jonkerbos 100, 6532, SZ, Nijmegen, Netherlands
| | - Hans van der Hoeven
- Radboud University Medical Center, Department of Intensive Care, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, Netherlands
| | - Marieke Zegers
- Radboud University Medical Center, Department of Intensive Care, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, Netherlands
| | - Jelle van Gurp
- Radboud University Medical Center, Department of IQ Health, Kapittelweg 54, 6525, EP, Nijmegen, Netherlands
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Huang M, Yang L, Zhang C, Gan X. Glucose management in critically ill adults: A qualitative study from the experiences of health care providers. Heliyon 2024; 10:e24545. [PMID: 38322901 PMCID: PMC10845247 DOI: 10.1016/j.heliyon.2024.e24545] [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: 06/24/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
Aims and objective To explain the components and elements of glucose management in critically ill adult patients from the healthcare providers' experiences. Background Critically ill adults are highly susceptible to stress-induced hyperglycaemia due to glucose metabolic disorders. Healthcare workers play a key role in the glycaemic management of critically ill patients. However, there is a lack of qualitative studies on the content and elements of glycaemic management and healthcare workers' perceptions about glycaemic management in China. Design Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Methods Individual semi-structured interviews were conducted from January to April 2022. Fifteen physicians and nurses were recruited from ten hospitals in mainland China. Data were analysed using inductive thematic analysis. Results Glucose management in critically ill adult patients from their experiences included two parts: the inner ring (practice behaviours) and the external space (methods and drivers). The practice behaviours of glucose management include five elements, while the methods and drivers of glucose management focus on three elements. The content covered under each element was identified. Conclusion This study developed a glycaemic management model for critically ill adult patients, clarified its elements based on the perceptions of healthcare providers and elaborated on the methods and drivers covered under each element to provide a reference for physicians and nurses to develop a comprehensive glycaemic management guideline for critically ill adult patients. Relevance to clinical practice Our study proposed a glucose management practice model for critically ill adult patients, and the elements and components included in this model can provide a reference for physicians and nurses when performing glucose management in critically ill patients.
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Affiliation(s)
- Miao Huang
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Li Yang
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanlai Zhang
- Gneral ICU, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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20
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Carolina B de S Giusti A, Estevam Cornélio M, Machado de Oliveira E, Giguère JF, Cecília B J Gallani M. Standard practices in cardiac monitoring: training needs of intensive care unit nurses. BMC Nurs 2024; 23:82. [PMID: 38297281 PMCID: PMC10832196 DOI: 10.1186/s12912-024-01742-1] [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: 02/16/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Enforcing practice standards for cardiac monitoring in intensive care units (ICUs) has been shown to reduce misdiagnoses and inappropriate interventions. Continuous professional development (CPD) programs are committed to aligning clinical practices with recommended standards. The crucial initial phase in CPD development involves assessing the training needs of the targeted population. OBJECTIVE To assess the training needs of ICU nurses in cardiac monitoring. The overarching goal was to formulate a focused Continuous Professional Development (CPD) program geared towards implementing standard practices in cardiac monitoring. METHODS This study employed a generic qualitative approach with a descriptive design, utilizing interviews and focus groups from July to September 2018. Involving 16 ICU nurses. Content analysis was employed, encompassing transcription, fluctuant and iterative reading, unitization, categorization, coding, description, and interpretation. RESULTS All nurses recognized cardiac monitoring's importance in the ICU but reported barriers to its effective implementation which were related to factors that could addressed by a CPD as insufficient knowledge and skills. Training needs were identified in both clinical and technical aspects, with recommendations for practical and theoretical activities and e-learning strategies. Barriers related to organizational aspects (equipment and communication within the healthcare team) were also mentioned. CONCLUSION ICU nurses presented clear and specific training needs related to cardiac monitoring as knowledge, skills, and competencies. Other organizational aspects were also reported as barriers. Addressing these learning needs through targeted CPD aligned with organizational initiatives can contribute to enhancing the quality of cardiac monitoring practices in ICUs.
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Grants
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
- 2881/19 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas
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21
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Wising J, Ström M, Hallgren J, Rambaree K. Certified Registered Nurse Anaesthetists' and Critical Care Registered Nurses' perception of knowledge/power in teamwork with Anaesthesiologists in Sweden: a mixed-method study. BMC Nurs 2024; 23:7. [PMID: 38163862 PMCID: PMC10759417 DOI: 10.1186/s12912-023-01677-z] [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: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024] Open
Abstract
Efficient teamwork is crucial to provide optimal health care. This paper focuses on teamwork between Anaesthesiologists (ANES), Certified Registered Nurse Anaesthetists' (CRNA) and Critical Care Registered Nurses (CCRN) working in challenging environments such as the intensive care unit (ICU) and the operating room (OR). Conflicts are common between physicians and nurses, negatively impacting teamwork. Social hierarchies based on professional status and power inequalities between nurses and physicians plays a vital role in influencing teamwork. Foucault was a famous thinker especially known for his reasoning regarding power/knowledge. A Foucauldian perspective was therefore incorporated into this paper and the overall aim was to explore CCRN/CRNA perception of knowledge/power in teamwork with ANES.Methods A mixed-method approach was applied in this study. Data was collected using a web-based questionnaire containing both closed-end and open-ended questions. A total of 289 CCRNs and CRNAs completed the questionnaire. Data analysis was then conducted through five stages as outlined by Onwuebugzie and Teddlie; analysing quantitative data in SPSS 27.0 and qualitative data with a directed content analysis, finally merging data together in ATLAS.ti v.23.Results The result reveals a dissonance between quantitative and qualitative data; quantitative data indicates a well-functioning interdisciplinary teamwork between CCRN/CRNA and ANES - qualitative data highlights that there are several barriers and inequalities between the two groups. Medicine was perceived as superior to nursing, which was reinforced by both social and organisational structures at the ICU and OR.Conclusion Unconscious rules underlying current power structures in the ICU and OR works in favour of the ANES and biomedical paradigm, supporting medical knowledge. To achieve a more equal power distribution between CCRN/CRNAs and ANES, the structural hierarchies between nursing and medicine needs to be addressed. A more equal power balance between the two disciplines can improve teamwork and thereby reduce patient mortality and improve patient outcomes.
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Affiliation(s)
- Jenny Wising
- School of Health Sciences, University of Skövde, Skövde, Sweden.
| | - Madelene Ström
- Region Västra Götaland, Skaraborgs Hospital Skövde, Dept of Anesthesia, Skövde, Sweden
| | - Jenny Hallgren
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Komalsingh Rambaree
- Department of Social Work and Criminology, University of Gävle, Gävle, Sweden
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22
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Alostaz Z, Rose L, Mehta S, Johnston L, Dale CM. Interprofessional intensive care unit (ICU) team perspectives on physical restraint practices and minimization strategies in an adult ICU: A qualitative study of contextual influences. Nurs Crit Care 2024; 29:90-98. [PMID: 36443064 DOI: 10.1111/nicc.12864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Guidelines advocate for minimization of physical restraint (PR) use in intensive care units (ICU). Interprofessional team perspectives on PR practices can inform the design and implementation of successful PR minimization interventions. AIM To identify ICU staff perspectives of contextual influences on PR practices and minimization strategies. STUDY DESIGN A qualitative descriptive study in a single ICU in Toronto, Canada. One-on-one semi-structured interviews were conducted with 14 ICU staff. A deductive content analysis of interviews was undertaken using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. RESULTS Five themes were developed: risk-averse culture, leadership, practice monitoring and feedback processes, environmental factors, and facilitation. Participants described a risk-averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation thereby avoiding blame from colleagues. Perceived absence of leadership and interprofessional team involvement situated nurses as the primary decision-maker for restraint application and removal. Insufficient monitoring of restraint practices, lack of access to restraint alternatives, and inability to control environmental contributors to delirium and agitation further increased PR use. Recommendations as to how to minimize restraint use included a nurse facilitator to advance leadership-team collaboration, availability of restraints alternatives, and guidance on situations for applying and removing restraints. CONCLUSIONS This analysis of contextual influences on PR practices and minimization using the i-PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring, and collaborative decision-making processes. A team approach to changing behaviour and culture should be considered for successful implementation and sustainability of PR minimization. RELEVANCE TO PRACTICE The establishment of an interprofessional facilitation team that addresses risk-averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Medical Surgical Intensive Care Unit, Mount Sinai Hospital, Sinai Health, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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Diaz CM, Egide A, Berry A, Rafferty M, Amro A, Tesorero K, Shapiro M, Ko B, Jones W, Slocum JD, Johnson J, Stey AM. Defining conditions for effective interdisciplinary care team communication in an open surgical intensive care unit: a qualitative study. BMJ Open 2023; 13:e075470. [PMID: 38097232 PMCID: PMC10729088 DOI: 10.1136/bmjopen-2023-075470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Poor interdisciplinary care team communication has been associated with increased mortality. The study aimed to define conditions for effective interdisciplinary care team communication. DESIGN An observational cross-sectional qualitative study. SETTING A surgical intensive care unit in a large, urban, academic referral medical centre. PARTICIPANTS A total 6 interviews and 10 focus groups from February to June 2021 (N=33) were performed. Interdisciplinary clinicians who cared for critically ill patients were interviewed. Participants included intensivist, transplant, colorectal, vascular, surgical oncology, trauma faculty surgeons (n=10); emergency medicine, surgery, gynaecology, radiology physicians-in-training (n=6), advanced practice providers (n=5), nurses (n=7), fellows (n=1) and subspecialist clinicians such as respiratory therapists, pharmacists and dieticians (n=4). Audiorecorded content of interviews and focus groups were deidentified and transcribed verbatim. The study team iteratively generated the codebook. All transcripts were independently coded by two team members. PRIMARY OUTCOME Conditions for effective interdisciplinary care team communication. RESULTS We identified five themes relating to conditions for effective interdisciplinary care team communication in our surgical intensive care unit setting: role definition, formal processes, informal communication pathways, hierarchical influences and psychological safety. Participants reported that clear role definition and standardised formal communication processes empowered clinicians to engage in discussions that mitigated hierarchy and facilitated psychological safety. CONCLUSIONS Standardising communication and creating defined roles in formal processes can promote effective interdisciplinary care team communication by fostering psychological safety.
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Affiliation(s)
| | - Abahuje Egide
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Andrew Berry
- Department of Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
| | - Miriam Rafferty
- 19th floor Strength+Endurance AbilityLab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation & Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ali Amro
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | | | - Michael Shapiro
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Bona Ko
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Whitney Jones
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - John D Slocum
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
| | - Julie Johnson
- Department of Surgery, Northwestern University, Evanston, Illinois, USA
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Vinar AL, Cipher DJ, Ormand M, Carlisle B, Behan D. Multidisciplinary Teamwork Perceptions When Mobilizing Ventilated Neurosurgery Patients. J Neurosci Nurs 2023; 55:199-204. [PMID: 37612259 DOI: 10.1097/jnn.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
ABSTRACT BACKGROUND: Multidisciplinary teamwork is essential in delivering holistic care to critically ill populations, including ventilated neurosurgery patients. Although it is considered a safe and feasible aspect of patient care, mobilization is often missed in this population because of negative healthcare provider perceptions regarding barriers and patient safety. Nurse-led teamwork has been suggested to overcome these barriers and to achieve earlier mobilization for patients, as well as positive provider perceptions, which may affect the culture and frequency of mobilization on neurointensive care units. Quantitative studies analyzing multidisciplinary teamwork perceptions to mobilize ventilated neurosurgery patients with or without a nurse-led protocol have not been previously conducted. Analyzing such perceptions may provide insight to team-related barriers related to missed mobility. This pilot quasi-experimental study aimed to determine whether the use of a nurse-led mobility protocol affects teamwork perceptions when mobilizing ventilated neurosurgery patients. METHODS: A sample of multidisciplinary teams, composed of nurses, patient care technicians, and respiratory therapists, mobilized ventilated neurosurgery patients according to either standard of care (for the control group) or a nurse-led mobility protocol (for the interventional group). Teamwork perceptions were measured via the reliable and valid Nursing Teamwork Survey tool. RESULTS: Linear mixed model analyses revealed that multidisciplinary teams in the nurse-led mobility protocol group had significantly higher levels of overall perceived teamwork than those in the control group, t3 = -3.296, P = .038. Such differences were also noted for teamwork variables of team leadership and mutual trust. CONCLUSION: Nurse-led mobility protocols should be considered to increase teamwork when performing multidisciplinary teamwork-based mobility for ventilated neurosurgery patients. Future studies should continue to evaluate teamwork perceptions after nurse-led mobility.
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Liu Q, Zhao L, Guo X, Zhang Y, Xin C, Gai Y. Leisure crafting and work engagement among Chinese ICU nurses: The multiple mediation effect of recovery experience and humanistic care ability. Int Nurs Rev 2023. [PMID: 38041443 DOI: 10.1111/inr.12914] [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: 05/27/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
AIMS Based on the conservation of resources theory, this study explored the intermediary role of intensive care unit (ICU) nurses' recovery experience and humanistic care ability between leisure crafting and work engagement. BACKGROUND As the ICU is an important life-saving department, the level of work engagement of nurses directly affect the quality of life and health outcomes of patients. Actively seeking countermeasures to improve the work engagement level of ICU nurses is of great significance to enhancing the nursing quality of the ICU. According to the theory of resource conservation, the resources owned by individuals are limited and must be replenished promptly and effectively to maintain relatively stable physical, mental, and working states. Therefore, determining ways for ICU nurses to supplement the consumed resources effectively and efficiently in a limited time to maintain a high level of work engagement is the main concern of this study. METHODS In this cross-sectional study from January 2023 to March 2023, 478 ICU nurses were recruited by convenience sampling. The survey tools included the Leisure Crafting Scale, the Utrecht Work Engagement Scale-9, the Caring Ability Inventory, and the Recovery Experience Questionnaire. Descriptive data and Pearson correlation coefficients were analyzed via SPSS 26.0 (IBM Corp.). PROCESS v4.0 (by Andrew F. Hayes) Macro Model 6 was applied to analyze the serial multiple mediator models. We used the STROBE checklist to report the results. RESULTS First, the results showed that leisure crafting, humanistic care ability, and recovery experience were positively correlated with work engagement. Second, recovery experience and humanistic care ability played a partially mediating role between leisure crafting and work engagement, respectively. Third, recovery experience and humanistic care ability also had a serial mediation effect between leisure crafting and work engagement. CONCLUSION The findings of the study indicated that improving nurses' active control of leisure time may have particularly positive effects on ICU nurses' work engagement through increasing recovery experience and humanistic care ability. IMPLICATIONS FOR NURSING AND NURSING POLICY Administrators can formulate intervention measures to improve the leisure crafting level of ICU nurses, promote work-life balance, which enhances recovery and supports engagement with patient-focused humanistic care, and have a positive impact on the work engagement of ICU nurses.
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Affiliation(s)
- Qingwei Liu
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Zhao
- Nuclear Medicine Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojing Guo
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuchen Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chen Xin
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yubiao Gai
- Department of Critical Medicine, Head Nurse of the Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Jordan J, Tume L, Clarke M, McAuley D, McDowell C, McIlmurray L, Morris K, Peters M, Walsh T, Blackwood B. Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation. PLoS One 2023; 18:e0293063. [PMID: 38011103 PMCID: PMC10681213 DOI: 10.1371/journal.pone.0293063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes. METHODS 10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics. RESULTS The intervention led to a reduced duration of IMV (adjusted median difference- 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59-85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership. CONCLUSIONS The SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN16998143.
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Affiliation(s)
- Joanne Jordan
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes, England
| | - Lyvonne Tume
- Faculty of Heath, Social Care & Medicine, Edge Hill University, Ormskirk, England
- PICU, Alder Hey Children’s NHS Trust, Liverpool, England
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, Royal Hospitals, Belfast, Northern Ireland
| | - Lisa McIlmurray
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Kevin Morris
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, England
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Mark Peters
- Great Ormond Street Institute of Child Health, NIHR Biomedical Research Centre, University College London, London, England
- Great Ormond Street Hospital, London, England
| | - Timothy Walsh
- Institute of Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
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Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Cardiac intensive care unit: where we are in 2023. Front Cardiovasc Med 2023; 10:1201414. [PMID: 38075954 PMCID: PMC10704904 DOI: 10.3389/fcvm.2023.1201414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/03/2023] [Indexed: 01/19/2024] Open
Abstract
Cardiac intensive care has been a constantly evolving area of research and innovation since the beginning of the 21st century. The story began in 1961 with Desmond Julian's pioneering creation of a coronary intensive care unit to improve the prognosis of patients with myocardial infarction, considered the major cause of death in the world. These units have continued to progress over time, with the introduction of new therapeutic means such as fibrinolysis, invasive hemodynamic monitoring using the Swan-Ganz catheter, and mechanical circulatory assistance, with significant advances in percutaneous interventional coronary and structural procedures. Since acute cardiovascular disease is not limited to the management of acute coronary syndromes and includes other emergencies such as severe arrhythmias, acute heart failure, cardiogenic shock, high-risk pulmonary embolism, severe conduction disorders, and post-implantation monitoring of percutaneous valves, as well as other non-cardiac emergencies, such as septic shock, severe respiratory failure, severe renal failure and the management of cardiac arrest after resuscitation, the conversion of coronary intensive care units into cardiac intensive care units represented an important priority. Today, the cardiac intensive care units (CICU) concept is widely adopted by most healthcare systems, whatever the country's level of development. The main aim of these units remains to improve the overall morbidity and mortality of acute cardiovascular diseases, but also to manage other non-cardiac disorders, such as sepsis and respiratory failure. This diversity of tasks and responsibilities has enabled us to classify these CICUs according to several levels, depending on a variety of parameters, principally the level of care delivered, the staff assigned, the equipment and technologies available, the type of research projects carried out, and the type of connections and networking developed. The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have detailed this organization in guidelines published initially in 2005 and updated in 2018, with the aim of harmonizing the structure, organization, and care offered by the various CICUs. In this state-of-the-art report, we review the history of the CICUs from the creation of the very first unit in 1968 to the discussion of their current perspectives, with the main objective of knowing what the CICUs will have become by 2023.
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Affiliation(s)
- Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
| | - Nabila Ismaili
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Department of Cardiology, Mohammed VI University Hospital, Mohammed First University, Oujda, Morocco
- Faculty of Medicine and Pharmacy, LAMCESM, Mohammed First University, Oujda, Morocco
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Volpi L, Giusino D, Pietrantoni L, De Angelis M. Does Organizational Commitment to Mental Health Affect Team Processes? A Longitudinal Study. J Healthc Leadersh 2023; 15:339-353. [PMID: 38020722 PMCID: PMC10680482 DOI: 10.2147/jhl.s429232] [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: 07/06/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Team processes, such as reflexivity and participation, are critical for organizational sustainability, especially in high-reliability professions such as healthcare. However, little is known about health-related predictors of team processes. Basing our hypotheses on the Input-Process-Output (IPO) model, this study investigates the influence of perceived organizational commitment to mental health (OCMH) on healthcare workers' team reflexivity and participation via mental health-specific leadership (MHsL) and team autonomy. Patients and Methods The study involved 82 participants (ie, physicians, nurses, healthcare assistants, healthcare technicians, and physiotherapists) working in the Medicine, Emergency, and Neurological Departments at a large public healthcare organization in Italy. Data was gathered at 2-time points, 14 months apart. Results The results suggest that healthcare workers' perception of their organization's support for mental health at T1 significantly impacts team participation at T2 through MHsL and team autonomy. Likewise, the indirect effect of OCMH through MHsL and team autonomy was also significant in the model predicting team reflexivity. However, in both models, no direct relationship of OCMH on the dependent variables was found. Conclusion The findings highlight the importance of a mental health-supportive environment and leadership to foster team autonomy and, subsequentially, team processes, which are fundamental for performance and patient care.
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Affiliation(s)
- Lucia Volpi
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Davide Giusino
- Department of Psychology, University of Bologna, Bologna, Italy
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Boltey E, Iwashyna T, Cohn A, Costa D. Identifying the unique behaviors embedded in the process of interprofessional collaboration in the ICU. J Interprof Care 2023; 37:857-865. [PMID: 37086195 DOI: 10.1080/13561820.2023.2202218] [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: 06/30/2022] [Revised: 02/16/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
Interprofessional collaboration (IPC) is an important aspect of high-quality care in intensive care units (ICUs). The practice of IPC, however, is complex and the components that constitute IPC are not well defined. We sought to identify distinct behaviors embedded in clinician workflow that indicate engagement in the IPC process. We conducted a clinical ethnography in two ICUs in southeastern Michigan. From March 2017 to March 2019, we collected 31 hours of observations and completed 12 separate clinician shadowings and 12 interviews with ICU nurses, physicians, and respiratory therapists. We applied an iterative analytical approach to identify two types of IPC behaviors which we a priori labeled as "enablers" (i.e. the ways clinicians transition into or facilitate collaboration) and "collaborative activities" (i.e. behaviors clinicians use to directly collaborate with other professionals). 18 IPC behaviors were identified - ten "enablers" and eight "collaborative activities." Specifically, the enablers include: active listening, approach, coordinating work, intraprofessional consultation, invitation, nonverbal accessibility, reflexive questioning, sending pages/call, validation, and verbal accessibility. The collaborative activities are: correction, fill in the gap, information exchange, negotiation, providing help, socializing, teaching/training, and troubleshooting. By identifying IPC behaviors embedded in clinician workflow, our results may support more focused assessments of IPC in practice and guide clinicians toward behaviors they can use to engage in the IPC process.
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Affiliation(s)
- Emily Boltey
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Theodore Iwashyna
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
| | - Amy Cohn
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
| | - Deena Costa
- School of Nursing, Yale University, New Haven, CT
- Department of Internal Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT
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Brown JC, Ding L, Querubin JA, Peden CJ, Barr J, Cobb JP. Lessons Learned From a Systematic, Hospital-Wide Implementation of the ABCDEF Bundle: A Survey Evaluation. Crit Care Explor 2023; 5:e1007. [PMID: 37954897 PMCID: PMC10637401 DOI: 10.1097/cce.0000000000001007] [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] [Indexed: 11/14/2023] Open
Abstract
Objective We recently reported the first part of a study testing the impact of data literacy training on "assessing pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium monitoring/management, early exercise/mobility, and family and patient empowerment" [ABCDEF [A-F]) compliance. The purpose of the current study, part 2, was to evaluate the effectiveness of the implementation approach by surveying clinical staff to examine staff knowledge, skill, motivation, and organizational resources. DESIGN The Clark and Estes Gap Analysis framework was used to study knowledge, motivation, and organization (KMO) influences. Assumed influences identified in the literature were used to design the A-F bundle implementation strategies. The influences were validated against a survey distributed to the ICU interprofessional team. SETTING Single-center study was conducted in eight adult ICUs in a quaternary academic medical center. SUBJECTS Interprofessional ICU clinical team. INTERVENTIONS A quantitative survey was sent to 386 participants to evaluate the implementation design postimplementation. An exploratory factor analysis was performed to understand the relationship between the KMO influences and the questions posed to validate the influence. Descriptive statistics were used to identify strengths needed to sustain performance and weaknesses that required improvement to increase A-F bundle adherence. MEASUREMENT AND RESULTS The survey received an 83% response rate. The exploratory factor analysis confirmed that 38 of 42 questions had a strong relationship to the KMO influences, validating the survey's utility in evaluating the effectiveness of implementation design. A total of 12 KMO influences were identified, 8 were categorized as a strength and 4 as a weakness of the implementation. CONCLUSIONS Our study used an evidence-based gap analysis framework to demonstrate key implementation approaches needed to increase A-F bundle compliance. The following drivers were recommended as essential methods required for successful protocol implementation: data literacy training and performance monitoring, organizational support, value proposition, multidisciplinary collaboration, and interprofessional teamwork activities. We believe the learning generated in this two-part study is applicable to implementation design beyond the A-F bundle.
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Affiliation(s)
- Joan C Brown
- Office of Performance and Transformation, Keck Medicine of USC, University of Southern California, Los Angeles, CA
- Departments of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Li Ding
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jynette A Querubin
- Office of Performance and Transformation, Keck Medicine of USC, University of Southern California, Los Angeles, CA
| | - Carol J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Juliana Barr
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- VA Palo Alto Health Care System, Palo Alto, CA
| | - Joseph Perren Cobb
- Departments of Surgery and Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Wang P, Huang Y, Li J, Cao D, Chen B, Chen Z, Li J, Wang R, Liu L. Balanced crystalloid solutions versus normal saline in intensive care units: a systematic review and meta-analysis. Int Urol Nephrol 2023; 55:2829-2844. [PMID: 37017820 PMCID: PMC10560196 DOI: 10.1007/s11255-023-03570-9] [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: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Intravenous fluid therapy is important for pediatric and adult patients in intensive care units (ICUs). However, medical professionals continue to struggle to determine the most appropriate fluids to obtain the best possible outcomes for each patient. OBJECTIVE We conducted a meta-analysis involving cohort studies and randomized controlled trials (RCTs) to compare the influence of balanced crystalloid solutions and normal saline among patients in ICUs. PATIENTS AND METHODS Studies that compared balanced crystalloid solutions and saline in ICU patients from databases including PubMed, Embase, Web of Science, and Cochrane Library were systematically searched up to July 25, 2022. The primary outcomes were mortality and renal-related outcomes, which included major adverse kidney events within 30 days (MAKE30), acute kidney injury (AKI), new receipt of renal replacement therapy (RRT), maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline. Service utilization including length of hospital stay, ICU stay, ICU-free days and ventilator-free days were also reported. RESULTS A total of 13 studies (10 RCTs and 3 cohort studies) involving 38,798 patients in ICUs met the selection criteria. Our analysis revealed that each subgroup had no significant difference in mortality outcomes among ICU patients between balanced crystalloid solutions and normal saline. A significant difference was detected between the adult groups (odds ratio [OR], 0.92; 95% confidence interval [CI], [0.86, 1.00]; p = 0.04) indicating that the AKI in the balanced crystalloid solutions group was lower than that in the normal saline group. Other renal-related outcomes, such as MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline showed no significant difference between the two groups. Regarding secondary outcomes, the balanced crystalloid solution group had a longer ICU stay time (WMD, 0.02; 95% CI, [0.01, 0.03]; p = 0.0004 and I2 = 0%; p = 0.96) than the normal saline group among adult patients. Furthermore, children treated with balanced crystalloid solution had a shorter hospital stay time (WMD, - 1.10; 95% CI, [- 2.10, - 0.10]; p = 0.03 and I2 = 17%; p = 0.30) than those treated with saline. CONCLUSIONS Compared with saline, balanced crystalloid solutions could not reduce the risk of mortality and renal-related outcomes, including MAKE30, RRT, maximum creatinine increasing, maximum creatinine level, and final creatinine level ≥ 200% of baseline, but the solutions may reduce total AKI incidence among adult patients in ICUs. For service utilization outcomes, balanced crystalloid solutions were associated with a longer length of ICU stay in the adult group and shorter length of hospital stay in the pediatric group.
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Affiliation(s)
- Puze Wang
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Yin Huang
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Jin Li
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Dehong Cao
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Bo Chen
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Zeyu Chen
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Jinze Li
- Department of Urology, West China Hospital of Medicine, Chengdu, China
| | - Ruyi Wang
- Department of Urology, West China Hospital of Medicine, Chengdu, China
- Department of Urology, Hospital of Chengdu University, Chengdu, China
| | - Liangren Liu
- Department of Urology, West China Hospital of Medicine, Chengdu, China.
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Alharbi KK, Arbaein TJ, Alzhrani AA, Alzahrani AM, Monshi SS, Alotaibi AFM, Aljasser AI, Alruhaimi KT, Alotaibi SDK, Alsultan AK, Arafat MS, Aldhabib A, Abd-Ellatif EE. Factors Affecting the Length of Stay in the Intensive Care Unit among Adults in Saudi Arabia: A Cross-Sectional Study. J Clin Med 2023; 12:6787. [PMID: 37959252 PMCID: PMC10649797 DOI: 10.3390/jcm12216787] [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: 10/04/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
This study aimed to assess patient-related factors associated with the LOS among adults admitted to the ICU in Saudi Arabia. The Ministry of Health provided a cross-sectional dataset for 2021, which served as the data source for this study. The data included data on adults admitted to different ICUs at various hospitals. The number of days spent in the ICU was the outcome variable of interest. The potential predictors were age, sex, and nationality, as well as clinical data from the time of admission. Descriptive statistics and bivariate analysis were used to analyse the association between the predictors and the ICU LOS and characterize how they were distributed. We used negative binomial regression to examine the relationship between the study predictors and the ICU LOS. A total of 42,884 individuals were included in this study, of whom 25,520 were men and 17,362 were women. The overall median ICU LOS was three days. This study showed that the ICU LOS was highly influenced by the patient's age, sex, nationality, source of admission, and clinical history. Several predictors that affect how long adults stay in the ICU in Saudi Arabian hospitals were identified in this study. These factors can be attributed to variances in health care delivery systems, patient demographics, and cultural considerations. To allocate resources efficiently, enhance patient outcomes, and create focused treatments to reduce ICU LOS, it is essential to comprehend these elements.
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Affiliation(s)
- Khulud K. Alharbi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (T.J.A.); (A.A.A.); (A.M.A.); (S.S.M.)
| | - Turky J. Arbaein
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (T.J.A.); (A.A.A.); (A.M.A.); (S.S.M.)
| | - Abdulrhman A. Alzhrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (T.J.A.); (A.A.A.); (A.M.A.); (S.S.M.)
| | - Ali M. Alzahrani
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (T.J.A.); (A.A.A.); (A.M.A.); (S.S.M.)
| | - Sarah S. Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (T.J.A.); (A.A.A.); (A.M.A.); (S.S.M.)
| | - Adel Fahad M. Alotaibi
- Department of Preventive Health, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.F.M.A.); (A.I.A.); (K.T.A.); (S.D.K.A.)
| | - Areej I. Aljasser
- Department of Preventive Health, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.F.M.A.); (A.I.A.); (K.T.A.); (S.D.K.A.)
| | - Khalil Thawahi Alruhaimi
- Department of Preventive Health, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.F.M.A.); (A.I.A.); (K.T.A.); (S.D.K.A.)
| | - Satam Dhafallah K. Alotaibi
- Department of Preventive Health, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.F.M.A.); (A.I.A.); (K.T.A.); (S.D.K.A.)
| | - Ali K. Alsultan
- Emergency Medicine, Saudi Medical Appointment and Referral Center, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.K.A.); (M.S.A.); (A.A.)
| | - Mohammed S. Arafat
- Emergency Medicine, Saudi Medical Appointment and Referral Center, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.K.A.); (M.S.A.); (A.A.)
| | - Abdulrahman Aldhabib
- Emergency Medicine, Saudi Medical Appointment and Referral Center, Ministry of Health, Riyadh 13717, Saudi Arabia; (A.K.A.); (M.S.A.); (A.A.)
| | - Eman E. Abd-Ellatif
- Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt;
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Lindberg HB, Steindal SA, Kvande ME. Critical care nurses' experiences of caring for patients with iatrogenic opioid withdrawal in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2023; 78:103452. [PMID: 37178587 DOI: 10.1016/j.iccn.2023.103452] [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: 12/06/2022] [Revised: 04/20/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To explore critical care nurses' experiences of caring for adult patients experiencing iatrogenic opioid withdrawal in the intensive care unit. RESEARCH METHODOLOGY/DESIGN A qualitative study with an explorative and descriptive design was conducted. Data were collected through semi-structured interviews and systematic text condensation was used to analyse the data. The study was reported according to the consolidated criteria for reporting qualitative research checklist. SETTING AND PARTICIPANTS Ten critical care nurses, working at three different intensive care units in two university hospitals in Norway. FINDINGS Three categories were identified in the data analysis. "Subtle signs and symptoms of opioid withdrawal", lack of a systematic approach to opioid withdrawal, and the prerequisites for appropriate management of opioid withdrawal. Critical care nurses experienced challenges in identifying opioid withdrawal due to subtle and vague signs and symptoms, especially when not knowing their patient or when difficulties were encountered with patient communication. A systematic approach to opioid withdrawal and increased knowledge, definitive plans for weaning, as well as interdisciplinary unity and collaboration, could improve the management of opioid withdrawal. CONCLUSION Validated assessment tools, systematic strategies, and guidelines are essential for the management of opioid withdrawal in opioid naïve patients in intensive care units. The prerequisites for an appropriate management of opioid withdrawal are an accurate and effective communication among critical care nurses and other healthcare professionals involved in patient care. IMPLICATIONS FOR CLINICAL PRACTICE There is a need for a validated assessment tool, systematic strategies, and guidelines for the management of opioid withdrawal in opioid naïve patients in intensive care units. Increased emphasis needs to be placed on the process of identifying iatrogenic opioid withdrawal and improving opioid withdrawal management in the education system and clinical practice.
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Affiliation(s)
- Hedda Bekken Lindberg
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway.
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Faculty of Health Studies, VID Specialized University, Oslo, Norway.
| | - Monica Evelyn Kvande
- Lovisenberg Diaconal University College, Lovisenberggata 15B, 0456 Oslo, Norway; Department of Anaesthesiology and Surgery, University Hospital of North Norway, Tromsø, Norway.
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Abstract
Data science has the potential to greatly enhance efforts to translate evidence into practice in critical care. The intensive care unit is a data-rich environment enabling insight into both patient-level care patterns and clinician-level treatment patterns. By applying artificial intelligence to these novel data sources, implementation strategies can be tailored to individual patients, individual clinicians, and individual situations, revealing when evidence-based practices are missed and facilitating context-sensitive clinical decision support. To achieve these goals, technology developers should work closely with clinicians to create unbiased applications that are integrated into the clinical workflow.
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Affiliation(s)
- Andrew J King
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3500 Terrace Street, Suite 600, Pittsburgh, PA 15261, USA; Department of Health Policy and Management, University of Pittsburgh School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA.
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Elsheikh E, Alkhteeb N, Alamer A, Alarfaj MO, AlQarni G, Alsultan J. Medical Students' Competency and Confidence in Interpreting Electrocardiograms at King Faisal University, Al-Ahsa. Cureus 2023; 15:e46393. [PMID: 37927746 PMCID: PMC10620545 DOI: 10.7759/cureus.46393] [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] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Electrocardiography is a crucial emergency tool in the pre-hospital situation. It is a useful non-invasive diagnostic technique for quickly identifying various heart disorders. The clinical value of the electrocardiogram (ECG) depends on the clinician's ability to interpret the result of the ECG accurately. Aims This study aims to assess the competency as well as the confidence in the interpretation of ECG among medical students at King Faisal University, Al Ahsa, Saudi Arabia. Methods This cross-sectional study was conducted among medical students enrolled at King Faisal University. Four hundred and ten (410) medical students from all five years completed an electronic self-administered pre-validated questionnaire. The questionnaire includes basic demographic data and ECG strips to assess medical students' competency and confidence levels in interpreting each case. Results More than half of the medical students were considered to have low competency (56.1%) and confidence (59%) levels. Increased competency and confidence scores were associated with fifth-year medical students and those who learned more about ECG interpretation through teaching during clinical rotations. The majority of medical students correctly interpreted anterior MI (69.3%), ventricular tachycardia (65.6%), and supraventricular tachycardia (61.2%). On the other hand, most students were unable to correctly identify pacemaker ECG (19.8%), long QT (21.2%) and left bundle branch block (33.4%). Conclusion Medical students' competency and confidence in ECG interpretation seems to be lacking. Fifth-year medical students who learned more ECG skills through teaching during clinical rotations tended to be more competent and confident with their ECG interpretation skills.
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Affiliation(s)
- Eman Elsheikh
- Internal Medicine, College of Medicine, King Faisal University, Al-Ahsa, SAU
- Cardiology, College of Medicine, Tanta University, Tanta, EGY
| | | | - Aisha Alamer
- Internal Medicine, King Faisal University, Al-Ahsa, SAU
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Williams G, Fulbrook P, Alberto L, Kleinpell R, Christensen M, Sitoula K, Kobuh ND. Critical care nursing policy, practice, and research priorities: An international cross-sectional study. J Nurs Scholarsh 2023; 55:1044-1057. [PMID: 36894518 DOI: 10.1111/jnu.12884] [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: 08/23/2022] [Revised: 02/01/2023] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To examine the status of critical care nursing internationally, assess the impact of the COVID-19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide. DESIGN A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess international critical care nursing needs and provide evidence to inform critical care nursing policy, practice and research priorities globally. METHODS The sixth World Federation of Critical Care Nurses survey of CCNOs was emailed to potential participants from countries with CCNOs or known critical care nurse leaders. Data were collected online using Survey Monkey™. Responses were entered into SPSS version 28 software (IBM Corp.) and analyzed by geographical region and national wealth group. FINDINGS Ninety-nine national representative respondents participated in the survey (70.7% response rate). The most important issues identified were working conditions, teamwork, staffing levels, formal practice guidelines, wages, and access to quality education programs. The top five CCNO services that were of most importance were providing national conferences, local conferences, workshops and education forums, practice standards and guidelines, and professional representation. Important pandemic-related services and activities provided by CCNOs included addressing emotional and mental well-being of nurses, providing guidance related to nurse staffing/workforce needs, assisting to coordinate efforts to obtain personal protective equipment supplies, serving as a country liaison with the World Health Organization's COVID-19 response activities, and assisting in the development and implementation of policies regarding standards of care. The most important contributions expected from the World Federation of Critical Care Nurses were standards for professional practice, standards for clinical practice, website resources, professional representation, and providing online education and training materials. The top five research priority areas were: stress levels (inclusive of burnout, emotional exhaustion and compassion fatigue); critical care nursing shortage, skill mix and workforce planning; recruitment, retention, turnover, working conditions; critical care nursing education and patient outcomes; and adverse events, staffing levels, patient outcomes. CONCLUSIONS The results highlight priority areas for critical care nursing internationally. The COVID-19 pandemic impacted critical care nurses as direct care providers. As a result, addressing the ongoing needs of critical care nurses remains a priority area of focus. The results also highlight important policy and research priorities for critical care nursing globally. Results of this survey should be incorporated into strategic action plans at the national and international levels. CLINICAL RELEVANCE Issues of importance to critical care nurses including research and policy priorities during and following COVID-19 are now clarified through this survey. The impact and importance that COVID-19 has had on critical care nurses and their preferences and priorities are provided. Clear guidance to leaders and policy makers on where critical care nurses would like to see greater focus and attention to help strengthen the contribution of critical care nursing practice to the global healthcare agenda.
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Affiliation(s)
- Ged Williams
- School of Nursing & Midwifery, Griffith University, Gold Coast, Queensland, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Paul Fulbrook
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Brisbane, Queensland, Australia
- Nursing Research & Practice Development Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Alberto
- Escuela de Enfermería & Instituto de Investigación en Medicina y Ciencias de la Salud, Universidad del Salvador, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, Tennessee, USA
- Rush University College of Nursing, Chicago, Illinois, USA
| | | | - Kabita Sitoula
- Regional Federation of Critical Care Nurses-South Asia Association for Regional Cooperation, Kathmandu, Nepal
| | - Ntogwiachu Daniel Kobuh
- Experiential University Institute of Science and Technology, Yaoundé, Cameroon
- African Federation of Critical Care Nurses, Douala, Cameroon
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Li L, Xu Q, Cai G, Gong S, Liu D, Qiu H, Yu K, Chen D, Guan X, Yan J. Chinese critical care certified course in intensive care unit: a nationwide-based analysis. BMC MEDICAL EDUCATION 2023; 23:576. [PMID: 37582757 PMCID: PMC10428552 DOI: 10.1186/s12909-023-04534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND A training program for intensive care unit (ICU) physicians entitled "Chinese Critical Care Certified Course" (5 C) started in China in 2009, intending to improve the quality of intensive care provision. This study aimed to explore the associations between the 5 C certification of physicians and the quality of intensive care provision in China. METHODS This nationwide analysis collected data regarding 5 C-certified physicians between 2009 and 2019. Fifteen ICU quality control indicators (three structural, four procedural, and eight outcome-based) were collected from the Chinese National Report on the Services, Quality, and Safety in Medical Care System. Provinces were stratified into three groups based on the cumulative number of 5 C certified physicians per million population. RESULTS A total of 20,985 (80.41%) physicians from 3,425 public hospitals in 30 Chinese provinces were 5 C certified. The deep vein thrombosis (DVT) prophylaxis rate in the high 5 C physician-number provinces was significantly higher than in the intermediate 5 C physician-number provinces (67.6% vs. 55.1%, p = 0.043), while ventilator-associated pneumonia (VAP) rate in the low 5 C physician-number provinces was significantly higher than in the high 5 C physician-number provinces (14.9% vs. 8.9%, p = 0.031). CONCLUSIONS The higher number of 5 C-certified physicians per million population seemed to be associated with higher DVT prophylaxis rates and lower VAP rates in China, suggesting that the 5 C program might have a beneficial impact on the quality of intensive care provision.
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Affiliation(s)
- Li Li
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Guolong Cai
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Shijin Gong
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, No. 23, Youzheng Road, Nangang District, Harbin, Heilongjiang, China
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin North Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201801, China
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
| | - Jing Yan
- Department of Critical Care Medicine, Zhejiang Hospital, 12 Lingyin Road, Hangzhou, 310013, China.
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Dhala A, Fusaro MV, Uddin F, Tuazon D, Klahn S, Schwartz R, Sasangohar F, Alegria J, Masud F. Integrating a Virtual ICU with Cardiac and Cardiovascular ICUs: Managing the Needs of a Complex and High-Acuity Specialty ICU Cohort. Methodist Debakey Cardiovasc J 2023; 19:4-16. [PMID: 37547898 PMCID: PMC10402825 DOI: 10.14797/mdcvj.1247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/12/2023] [Indexed: 08/08/2023] Open
Abstract
A long-standing shortage of critical care intensivists and nurses, exacerbated by the coronavirus disease (COVID-19) pandemic, has led to an accelerated adoption of tele-critical care in the United States (US). Due to their complex and high-acuity nature, cardiac, cardiovascular, and cardiothoracic intensive care units (ICUs) have generally been limited in their ability to leverage tele-critical care resources. In early 2020, Houston Methodist Hospital (HMH) launched its tele-critical care program called Virtual ICU, or vICU, to improve its ICU staffing efficiency while providing high-quality, continuous access to in-person and virtual intensivists and critical care nurses. This article provides a roadmap with prescriptive specifications for planning, launching, and integrating vICU services within cardiac and cardiovascular ICUs-one of the first such integrations among the leading academic US hospitals. The success of integrating vICU depends upon the (1) recruitment of intensivists and RNs with expertise in managing cardiac and cardiovascular patients on the vICU staff as well as concerted efforts to promote mutual trust and confidence between in-person and virtual providers, (2) consultations with the bedside clinicians to secure their buy-in on the merits of vICU resources, and (3) collaborative approaches to improve workflow protocols and communications. Integration of vICU has resulted in the reduction of monthly night-call requirements for the in-person intensivists and an increase in work satisfaction. Data also show that support of the vICU is associated with a significant reduction in the rate of Code Blue events (denoting a situation where a patient requires immediate resuscitation, typically due to a cardiac or respiratory arrest). As the providers become more comfortable with the advances in artificial intelligence and big data-driven technology, the Cardiac ICU Cohort continues to improve methods to predict and track patient trends in the ICUs.
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Affiliation(s)
- Atiya Dhala
- Houston Methodist Hospital, Houston, Texas, US
| | | | - Faisal Uddin
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Divina Tuazon
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
| | - Steven Klahn
- Department of Virtual Medicine, Houston Methodist Hospital, Houston, Texas, US
| | | | - Farzan Sasangohar
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, Texas, US
- Texas A&M University, College Station, Texas, US
| | | | - Faisal Masud
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, US
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Bourne RS, Jeffries M, Phipps DL, Jennings JK, Boxall E, Wilson F, March H, Ashcroft DM. Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study. BMJ Open 2023; 13:e066757. [PMID: 37130684 PMCID: PMC10163459 DOI: 10.1136/bmjopen-2022-066757] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE To understand the sociotechnical factors affecting medication safety when intensive care patients are transferred to a hospital ward. Consideration of these medication safety factors would provide a theoretical basis, on which future interventions can be developed and evaluated to improve patient care. DESIGN Qualitative study using semistructured interviews of intensive care and hospital ward-based healthcare professionals. Transcripts were anonymised prior to thematic analysis using the London Protocol and Systems Engineering in Patient Safety V.3.0 model frameworks. SETTING Four north of England National Health Service hospitals. All hospitals used electronic prescribing in intensive care and hospital ward settings. PARTICIPANTS Intensive care and hospital ward healthcare professionals (intensive care medical staff, advanced practitioners, pharmacists and outreach team members; ward-based medical staff and clinical pharmacists). RESULTS Twenty-two healthcare professionals were interviewed. We identified 13 factors within five broad themes, describing the interactions that most strongly influenced the performance of the intensive care to hospital ward system interface. The themes were: Complexity of process performance and interactions; Time pressures and considerations; Communication processes and challenges; Technology and systems and Beliefs about consequences for the patient and organisation. CONCLUSIONS The complexity of the interactions on the system performance and time dependency was clear. We make several recommendations for policy change and further research based on improving: availability of hospital-wide integrated and functional electronic prescribing systems, patient flow systems, sufficient multiprofessional critical care staffing, knowledge and skills of staff, team performance, communication and collaboration and patient and family engagement.
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Affiliation(s)
- Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Mark Jeffries
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Denham L Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Boxall
- Department of Pharmacy, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Franki Wilson
- Department of Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen March
- Department of Pharmacy, Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Oldham, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Robinson FE, Huffman LCS, Bevington LCD, French D, Rothwell C, Stucky LC, Tharp M, Hughies A. Team Coordination Style Is an Adaptive, Emergent Property of Interactions Between Critical Care Air Transport Team Personnel. Air Med J 2023; 42:174-183. [PMID: 37150571 DOI: 10.1016/j.amj.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Critical Care Air Transport (CCAT) teams care for critically ill or injured patients during long-duration flights. Despite the differences between the CCAT domain and a more traditional clinical setting, CCAT clinicians are not explicitly trained how to coordinate care in the aircraft environment. We characterized the team coordination patterns adopted by CCAT teams and explored any links between team coordination style and performance. METHODS This retrospective study used transcripts from 91 CCAT teams as they completed simulated patient care scenarios during an advanced training course. Qualitative and quantitative measures were used to characterize team behavior. RESULTS Vocalized content varied by team role, with physicians acting as leaders. The type of content verbalized by each team role depended on the team coordination style. The team coordination style and the content of vocalized messages were not affected by prior team member deployment or the characteristics of particular scenarios, and the team coordination style did not predict measures related to patient status. CONCLUSION Individual team member coordination behaviors vary depending on the coordination style used by the team as a whole. Coordination style appears to arise from the interactions among individual team members rather than in response to situational factors external to the team.
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Affiliation(s)
- F Eric Robinson
- Naval Medical Research Unit Dayton, Wright-Patterson Air Force Base, OH United States.
| | - Lt Col Sarah Huffman
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH
| | - Lt Col Daniel Bevington
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH
| | - DeAnne French
- Naval Medical Research Unit Dayton, Wright-Patterson Air Force Base, OH United States; ICON GPHS, Lexington, KY
| | - Clayton Rothwell
- Air Force Research Laboratory, 711th Human Performance Wing, Wright-Patterson Air Force Base, OH; Infocitex, Beavercreek, OH
| | | | - Marissa Tharp
- Naval Medical Research Unit Dayton, Wright-Patterson Air Force Base, OH United States; Parsons, Sharonville, OH
| | - Ashton Hughies
- Naval Medical Research Unit Dayton, Wright-Patterson Air Force Base, OH United States; ORISE, Oak Ridge, TN
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Scendoni R, Bury E, Lima Arrais Ribeiro I, Cingolani M, Cameriere R, De Benedictis A, De Micco F. Leading Pathogens Involved in Co-Infection and Super-Infection with COVID-19: Forensic Medicine Considerations after a Systematic Review and Meta-Analysis. Pathogens 2023; 12:pathogens12050646. [PMID: 37242315 DOI: 10.3390/pathogens12050646] [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: 03/06/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 pandemic raised concerns about the potential for co-infection or over-infection with other respiratory infections, as they can complicate the diagnosis, treatment and prognosis of the disease. This is also a challenge for forensic pathologists, who may come across cases where the presence of co-infection or over-infection is suspected or confirmed, and it is important that they take this into account when determining the cause of death. The aim of this systematic review is to analyse the prevalence of each specific pathogen co-infecting or over-infecting patients with SARS-CoV-2 infection. In total, 575 studies were selected from the Scopus and Pub-Med online databases and 8 studies were included in a meta-analysis. Male gender, advanced age and nursing home care are risk factors associated with the development of co-infection, whereas age, tachypnoea, hypoxaemia and bacterial infection are predictors of mortality. Overall, however, having a SARS-CoV-2 infection does not represent a real risk for the development of co-infections/super-infections.
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Affiliation(s)
- Roberto Scendoni
- Department of Law, University of Macerata, 62100 Macerata, Italy
| | - Emanuele Bury
- Department of Law, University of Macerata, 62100 Macerata, Italy
| | | | | | - Roberto Cameriere
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy
| | - Francesco De Micco
- Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Roma, Italy
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, 00128 Roma, Italy
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Jung SJ, Song JE, Bae SH, Lee Y, Gwon SH, Park JH. Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses. NURSE EDUCATION TODAY 2023; 126:105823. [PMID: 37080013 DOI: 10.1016/j.nedt.2023.105823] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit. OBJECTIVES To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit. DESIGN A quasi-experimental study. SETTINGS The study was conducted at a university in Korea. PARTICIPANTS A total of 44 newly graduated nurses working in the intensive care unit of a university hospital. METHODS A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA. RESULTS The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention. CONCLUSIONS The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.
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Affiliation(s)
- Su Jin Jung
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Ju-Eun Song
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Sun Hyoung Bae
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Youngjin Lee
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea
| | - Seok Hyun Gwon
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jin-Hee Park
- College of Nursing Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea.
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Nurok M, Nunnally ME, O'Connor M, Pierson RN, Baran DA, Harper MD, Malinoski D, El Banayosy A, Orija A, Hall S, Edelman JD, Sundt TM, Levine D, Kobashigawa J, Nelson D. Guidelines and principles for the care of the cardiothoracic transplant patient in the intensive care unit. Clin Transplant 2023:e14978. [PMID: 36964943 DOI: 10.1111/ctr.14978] [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: 02/03/2023] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/27/2023]
Abstract
Heart and lung transplant recipients require care provided by clinicians from multiple different specialties, each contributing unique expertise and perspective. The period the patient spends in the intensive care unit is one of the most critical times in the perioperative trajectory. Various organizational models of intensive care exist, including those led by intensivists, surgeons, transplant cardiologists, and pulmonologists. Coordinating timely efficient intensive care is an essential and logistically difficult goal. The present work product of the American Society of Transplantation's Thoracic and Critical Care Community of Practice, Critical Care Task Force outlines operational guidelines and principles that may be applied in different organizational models to optimize the delivery of intensive care for the cardiothoracic organ recipient.
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Affiliation(s)
- Michael Nurok
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | | | - David A Baran
- Cleveland Clinic Heart, Vascular and Thoracic Institute, Weston, Florida, USA
| | - Michael D Harper
- Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Aly El Banayosy
- Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | | | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | - Jon Kobashigawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - David Nelson
- Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
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Experience of Nurses Caring for COVID-19 Patients Supported by Venovenous Extracorporeal Membrane Oxygenation (ECMO) After ECMO Educational Crash Course. ASAIO J 2023; 69:267-271. [PMID: 36731047 PMCID: PMC9949368 DOI: 10.1097/mat.0000000000001807] [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: 02/04/2023] Open
Abstract
During a 6 week period beginning early March 2020, 30 patients with severe coronavirus disease 2019 (COVID-19) were supported with venovenous extracorporeal membrane oxygenation (ECMO). This volume increase mandated rapidly training 116 nurses with no prior ECMO experience via a 2 hour crash course. A qualitative study using semistructured, in-depth interviews was conducted to evaluate the experiences of this unique nursing cohort. Fourteen registered nurses meeting inclusion criteria of no prior ECMO experience, attendance of ECMO educational crash course, direct assignment of COVID-19 patients requiring ECMO, and willingness to consent to recorded interviews participated in the study. Two semistructured interviews were conducted, audio recorded, and transcribed verbatim. Thematic analysis of the interviews was completed using Colaizzi's phenomenological method. Six themes identified were anxiety and fear of patient harm, isolation and depersonalization, value of didactic education with reinforced clinical experience, professional growth, importance of team collaboration, and pride and gratitude. Subthemes were additionally extracted. Nurses faced multiple obstacles during the pandemic. ECMO added a layer of complexity, as these patients required labor-intensive, high acuity nursing care. The impact of the pandemic and its unique challenges on nursing and medical staff warrants further investigation.
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45
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Bagshaw SM. Nephrologists Rather Than Intensivists Should Manage Kidney Replacement Therapy in the ICU: CON. KIDNEY360 2023; 4:10-12. [PMID: 36700898 PMCID: PMC10101554 DOI: 10.34067/kid.0000092022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
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Andersson M, Fredholm A, Nordin A, Engström Å. Moral Distress, Health and Intention to Leave: Critical Care Nurses' Perceptions During COVID-19 Pandemic. SAGE Open Nurs 2023; 9:23779608231169218. [PMID: 37089200 PMCID: PMC10116007 DOI: 10.1177/23779608231169218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Moral distress increases the risk that critical care nurses will lose the ability to provide quality nursing care. Aims To describe person-related conditions and perceptions of moral distress, health and intention to leave among critical care nurses in intensive care units, and to examine the relationship between person-related conditions, moral distress, health and intention to leave. Method Cross-sectional, with 220 critical care nurses in 15 Swedish ICUs, and data gathered via a self-reported questionnaire. Results Highest moral distress scores were reported in futile care and poor teamwork and 21% reported entertaining an intention to leave. Self-reported health was lower than before the COVID-19 pandemic and 4.1% reported pronounced exhaustion disorder. Self-reported health, reduced capacity to tolerate demands under time pressure, emotional instability or irritability, physical weakness, or being more easily fatigued and with decreased well-being were factors that had a relationship with futile care. Sleeping problems and intention to leave had a relationship with poor teamwork. Conclusions Different strategies are needed to reduce moral distress and the leadership is crucial for managing crises such as the COVID-19 pandemic.
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Affiliation(s)
- Maria Andersson
- Swedish Red Cross University College, Huddinge, Sweden
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
| | - Angelica Fredholm
- County Council Värmland, Karlstad, Sweden
- Department of Health Science, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Anna Nordin
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
- Department of Health Science, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden
| | - Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
- Åsa Engström, Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, SE-97187 Luleå, Sweden.
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Nygaard AM, Haugdahl HS, Brinchmann BS, Lind R. Interprofessional care for the ICU patient's family: solitary teamwork. J Interprof Care 2023; 37:11-20. [PMID: 35285396 DOI: 10.1080/13561820.2022.2038548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study was to explore how interprofessional family care by ICU teams was reflected in their daily work. Data were collected from four ICUs in Norway. Fieldwork and focus groups with ICU nurses and physicians were conducted in addition to dyadic and individual interviews of surgeons and internists. In line with a constructivist grounded theory approach, the core category "solitary teamworking" was constructed. Together with three sub-categories, proximity and distance, silent interprofessional work and a connecting link, this core category conceptualizes interprofessional family care as a form of contradictory cooperation where physicians and nurses alternate between working alone and as a team. The sub-categories reveal three notable characteristics of interprofessional family care: (1) it is emotionally challenging, affected by proximity and distance to the families and between the clinicians, (2) it is silent, at a strategic and organizational level, and (3) nurses and family members have an essential role as a connecting link in the ICU team. Interprofessional family care needs strong involvement by an organization that supports and prioritizes family care, includes family members as an active part of the ICU team and emphasizes interprofessional dialogue.
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Affiliation(s)
- Anne Mette Nygaard
- Department of Health and Care Sciences, UiT, the Arctic University of Norway, Tromso, Norway
| | - Hege Selnes Haugdahl
- Department of Public Health and Nursing, Levanger Hospital, Nord-Trøndelag Hospital Trust and NTNU Norwegian University of Science and Technology, Norway
| | | | - Ranveig Lind
- Department of Health and Care Sciences, UiT the Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Tromso, Norway
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Escher C, Nagy E, Creutzfeldt J, Dahl O, Ruiz M, Ericson M, Osika W, Meurling L. Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff-a mixed-methods study. BMJ Open Qual 2023; 12:e002009. [PMID: 36697055 PMCID: PMC9884924 DOI: 10.1136/bmjoq-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs. METHOD A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline. RESULTS Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported 'making a mistake' as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified 'lack of knowledge and large responsibility', 'workload and work environment', 'uncertainty', 'ethical stress' and 'organization and teamwork' as major causes of stress. CONCLUSION Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.
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Affiliation(s)
- Cecilia Escher
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Department of Anesthesia and Intensive Care, Norrtälje Hospital, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
| | - Elisabeth Nagy
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Creutzfeldt
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Oili Dahl
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mini Ruiz
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - Mats Ericson
- Division of Ergonomics, Royal Institute of Technology, Stockholm, Sweden
| | - Walter Osika
- Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Lisbet Meurling
- Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
- Center for Advanced Medical Simulation and Training (CAMST), Karolinska University Hospital, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Edwards KH, Franklin RC, Edwards MT, Stewart RA. Requesting air ambulance transport of patients with suspected appendicitis: The decision‐making process through the eyes of the rural clinician. Aust J Rural Health 2022. [DOI: 10.1111/ajr.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/23/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kristin H. Edwards
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Richard C. Franklin
- College of Public Health, Medical and Veterinary Sciences James Cook University Townsville Queensland Australia
| | - Mark T. Edwards
- LifeFlight Retrieval Medicine Australia Brisbane Queensland Australia
| | - Ruth A. Stewart
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
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Competency in ECG Interpretation and Arrhythmias Management among Critical Care Nurses in Saudi Arabia: A Cross Sectional Study. Healthcare (Basel) 2022; 10:healthcare10122576. [PMID: 36554100 PMCID: PMC9777912 DOI: 10.3390/healthcare10122576] [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: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Electrographic interpretation skills are important for healthcare practitioners caring for patients in need of cardiac assessment. Competency in ECG interpretation skills is critical to determine any abnormalities and initiate the appropriate care required. The purpose of the study was to determine the level of competence in electrocardiographic interpretation and knowledge in arrhythmia management of nurses in critical care settings. Methods: A descriptive cross-sectional design was used. A convenience sample of 255 critical care nurses from 4 hospitals in the Al-Madinah Region in Saudi Arabia was used. A questionnaire was designed containing a participant’s characteristics and 10 questions with electrocardiographic strips. A pilot test was carried out to evaluate the validity and reliability of the questionnaire. Descriptive and bivariate analyses were conducted using an independent t-test, one-way ANOVA, or bi-variate correlation tests, as appropriate. A statistical significance of p < 0.05 was assumed. Results: Females comprised 87.5% of the sample, and the mean age of the sample was 32.1 (SD = 5.37) years. The majority of the participants (94.9%) had taken electrocardiographic interpretation training courses. The mean total score of correct answers of all 10 ECG strips was 6.45 (±2.54) for ECG interpretation and 4.76 (±2.52) for arrhythmia management. No significant differences were observed between ECG competency level and nursing experience or previous training. Nurses working in the ICU and CCU scored significantly higher than those working in ED. Conclusions: The electrocardiographic knowledge in ECG interpretation and arrhythmia management of critical care nurses is low. Therefore, improving critical care nurses’ knowledge of ECGs, identification, and management of cardiac arrhythmias is essential.
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