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Harorani M, Garshasbi M, Sediqi M, Farahani Z, Habibi D, Farahani M, Amini N, Velashjerdi Z. The effect of Shiatsu massage on agitation in mechanically ventilated patients: A randomized controlled trial. Heart Lung 2021; 50:893-897. [PMID: 34403892 DOI: 10.1016/j.hrtlng.2021.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/14/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients admitted to the intensive care units encounter many complications due to the nature of the disease and invasive medical procedures such as intubation and mechanical ventilation. Among these complications, agitation is a frequently-observed and serious problem. OBJECTIVES This study aimed to investigate the effect of Shiatsu massage on agitation in mechanically ventilated patients. METHODS In this randomized controlled trial, a total of 68 mechanically ventilated patients were selected and then randomly assigned to two groups of intervention and control. Patients in the intervention group received three 5-minute periods of Shiatsu massage with a 2-minute break between them, while patients in the control group only received a touch on the area considered for the message. Data were collected before and after the intervention using the Richmond Agitation-Sedation Scale (RASS) and then analyzed using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk, N.Y., USA). RESULTS The results showed that the level of agitation significantly decreased in the intervention group compared to the control group (p=.001). CONCLUSION Application of shiatsu massage seems to be effective in managing agitation in mechanically ventilated patients. Further studies with greater sample size and longer follow-up period are needed to confirm the current findings.
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Affiliation(s)
- Mehdi Harorani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran; Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
| | - Masoumeh Garshasbi
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Mohamad Sediqi
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Zohreh Farahani
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Danial Habibi
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahtab Farahani
- Student Research Committee, Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Nazanin Amini
- Department of paramedicine, Arak University of Medical Sciences, Arak, Iran
| | - Zahra Velashjerdi
- Master of Nursing, Valiasr Arak Hospital, Arak University of Medical Sciences, Arak, Iran
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Momeni M, Arab M, Dehghan M, Ahmadinejad M. Assessment of Leg Massage on Hemodynamic Parameters of Intensive Care Patients: A Parallel Single-Blinded Randomized Controlled Trial. J Chiropr Med 2020; 19:111-118. [PMID: 33318729 DOI: 10.1016/j.jcm.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Objective We aimed to determine the effectiveness of leg massage by a nurse and patients' families on hemodynamic parameters in patients admitted to intensive care units. Methods This parallel single-blinded randomized clinical trial involved 75 patients admitted to the intensive care units at Shahid Bahonar Hospital in Kerman, Iran. Patients were assigned to 3 groups by the minimization method (massage by a nurse, massage by the patient's family, and the control group). Swedish massage was used on both legs (each leg for 5 minutes) once a day for 6 days, and the hemodynamic parameters of patients were measured before intervention, at the end of intervention, and 1 week later. Results The results showed that mean arterial pressure decreased in all 3 groups 1 week after intervention, which was not statistically significant. Mean heart rate also decreased in all 3 groups 1 week after intervention, which was statistically significant except for massage by family. Mean arterial oxygen saturation significantly decreased in all 3 groups 1 week after intervention but remained normal. The 3 hemodynamic parameters did not differ significantly among the 3 groups. Conclusion According to the results of this study, the use of massage has no effect on hemodynamic parameters.
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Affiliation(s)
- Masoumeh Momeni
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansour Arab
- Faculty of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Mahlagha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ahmadinejad
- Medicine School, Kerman University of Medical Sciences, Kerman, Iran
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Abstract
Purpose- To evaluate whether spontaneous breathing trials (SBTs) are necessary when extubating critical care patients. Methods- A prospective, randomized, double-blind study was performed in adult patients supported by mechanical ventilation for at least 48 hours in the general intensive care unit of a teaching hospital. Patients ready for weaning were randomly assigned to either the SBT group (extubation with an SBT) or the no-SBT group (extubation without an SBT). Patients in the SBT group who tolerated SBT underwent immediate extubation. Patients in the no-SBT group who met the weaning readiness criteria underwent extubation without an SBT. The primary outcome measure was a successful extubation or the ability to maintain spontaneous breathing for 48 hours after extubation. Results- A total of 139 adult patients were enrolled. No significant difference in the demographic, respiratory, and hemodynamic characteristics was indicated between the groups at the end of weaning readiness assessment. Successful extubation was achieved in 56 of 61 patients (91.8%) in the SBT group and 54 of 60 patients (90.0%) in the no-SBT group. In the SBT and no-SBT groups, 5 (8.2%) and 6 (10.0%) patients, respectively, needed reintubation; 7 (11.5%) and 9 (15.0%) patients, respectively, required noninvasive ventilation after extubation. In-hospital mortality did not differ significantly between the groups. Conclusion- Intensive care patients can be extubated successfully without an SBT.
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Cederwall CJ, Plos K, Rose L, Dübeck A, Ringdal M. Critical care nurses management of prolonged weaning: an interview study. Nurs Crit Care 2014; 19:236-42. [PMID: 24809683 DOI: 10.1111/nicc.12092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/14/2014] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND For most critically ill patients requiring mechanical ventilation in the intensive care unit (ICU) weaning is uncomplicated. For the remainder, weaning is a challenge and may result in further complications and increased risk of mortality. Critical care nurses (CCNs) require substantial knowledge and experience to manage patients experiencing prolonged weaning. AIM The aim of this study was to explore CCNs approach for management of patients experiencing prolonged weaning in the ICU. DESIGN A descriptive qualitative design. METHODS Semi-structured interviews with 19 experienced CCNs were conducted. Data were analysed using content analysis. RESULTS Participants used various strategies for weaning that were grouped into four categories: individualized planning for the weaning process, assessing patient's capacity, managing the process and team interaction. The overall theme that emerged was: CCNs drive the weaning process using both a patient centred and targeted approach. CONCLUSION CCNs in these ICUs performed weaning using a patient centred approach to plan, initiate, assess and establish a holistic weaning process. Team collaboration among all health care practitioners was important. CCNs have a key role in prioritizing weaning and driving the process forward. RELEVANCE TO CLINICAL PRACTICE Closeness to the patient and a key role in management of the mechanical ventilated patient in ICU gives the CCN unique potential to develop and create models and tools for prolonged weaning. These tools, specially designed for patients undergoing prolonged weaning, would give focus on continuous planning, collaborating, managing and evaluation in the process of liberating patients from mechanical ventilation.
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Affiliation(s)
- Carl-Johan Cederwall
- C.-J. Cederwall, Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Intensive care unit, Sahlgrenska University Hospital, CIVA, Gröna stråket 2, 413 45 Gothenburg, Sweden
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Tume LN, Scally A, Carter B. Paediatric intensive care nurses' and doctors' perceptions on nurse-led protocol-directed ventilation weaning and extubation. Nurs Crit Care 2013; 19:292-303. [PMID: 24279710 DOI: 10.1111/nicc.12055] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/16/2013] [Accepted: 09/03/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Nurse-led (protocol-directed) ventilation weaning (NLVW) is utilized in adult intensive care and has shown to be safe and reduce ventilation times. Our paediatric intensive care unit (PICU) implemented a NLVW (and extubation) protocol in 2004, yet it was observed that some NLVW-trained nurses were not undertaking the role in practice. AIMS To explore PICU nurses' and doctors' perceptions of and barriers to NLVW on a UK PICU, with the aim of facilitating more NLVW on our PICU by reducing these barriers. METHODS A cross-sectional electronic survey was used to collect data from both nurse ventilation weaners and all medical staff and advanced nurse practitioners (ANPs) on one PICU. RESULTS Our survey response rates were 90% (36/40) nursing and 54% (20/37) medical. The four top reasons cited for nurses not being able to wean by protocol were not being allocated to a 'weanable' patient, being in an in-charge or runner role, high clinical workload and a perceived lack of support from medical staff/ANPs. The restrictive nature of our protocol also emerged as a key issue by all staff. The medical survey revealed an overwhelming positive response to NLVW with 90% believing that experienced PICU nurses should be allowed to wean ventilation. In contrast to the nurses perceived lack of support or encouragement for NLVW, medical staff rated their encouragement for the nurses to undertake this role as high. CONCLUSIONS NLVW is a complex process, and factors that impair or facilitate this process relate not only to the weaning protocol itself, but also organizational processes and structural factors in a PICU. RELEVANCE TO CLINICAL PRACTICE This paper highlights the complexities involved in instituting and establishing a nurse-led, protocol-driven ventilation weaning process within a PICU. Further, in depth research is required to examine both PICU nurses and doctors attitudes to NLVW both in the UK and across Europe.
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Affiliation(s)
- Lyvonne N Tume
- Alder Hey Children's NHS Foundation Trust and University of Central Lancashire, Liverpool L12 2AP, UK
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Haugdahl HS, Storli S, Rose L, Romild U, Egerod I. Perceived decisional responsibility for mechanical ventilation and weaning: a Norwegian survey. Nurs Crit Care 2013; 19:18-25. [PMID: 24131532 DOI: 10.1111/nicc.12051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/20/2013] [Accepted: 08/02/2013] [Indexed: 12/31/2022]
Abstract
AIM To explore variability in perceptions of nurse managers and physician directors regarding roles, responsibilities and clinical-decision making related to mechanical ventilator weaning in Norwegian intensive care units (ICUs). BACKGROUND Effective teamwork is crucial for providing optimal patient care in ICU. More knowledge on nurses' and physicians' perceptions of responsibility in clinical decision-making for mechanical ventilation is needed. METHODS Self-administered survey of mechanical ventilation and weaning responsibilities was sent to nurse managers and physician directors of Norwegian adult ICUs. Nurses' decisional influence and autonomy were estimated on a numeric rating scale (NRS) from 0 to 10 (least to most). RESULTS Response rate was 38/60 (63%) nurses and 38/52 (73%) physicians. On the NRS nurse managers perceived the autonomy and influence of nurses' ventilator decisions higher than physician directors: median of 7 (IQR 5-8) (nurses) versus 5 (3-6) (physicians), (p < 0·01), and 8 (7-9) (nurses) versus 7 (5-8) (physicians), (p < 0·01) respectively. Respondents agreed that nurses collaborated in assessment of patient response to ventilator changes and titrating ventilator settings: 92% of nurses and 87% of physicians, (p = 0·46), and recognizing weaning failure 84% of nurses and 84% of physicians, (p = 0·96). Physician directors perceived significantly less collaborative decision-making on weaning method (p = 0·01), weaning readiness (p = 0·04) and readiness to extubate (p < 0·01) than nurse managers. Both groups acknowledged the importance of 'knowing the patient' for weaning success, and agreed that the assessment of work of breathing, well-being, and clinical deterioration were important for determining weaning tolerance. CONCLUSIONS Nurse managers perceived nurses to have greater autonomy, influence and collaborative interaction regarding decisions on mechanical ventilation than physician directors. Greater awareness and acknowledgment of nurses' role may promote interprofessional collaboration and improve patient care.
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Affiliation(s)
- Hege S Haugdahl
- HS Haugdahl, PhD student, MSc, RN, Department for Research and Development, Levanger Hospital, Nord-Trøndelag Health Trust and Nord Trøndelag University College, Levanger, Levanger, Norway, and Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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Zetterlund P, Plos K, Bergbom I, Ringdal M. Memories from intensive care unit persist for several years--a longitudinal prospective multi-centre study. Intensive Crit Care Nurs 2012; 28:159-67. [PMID: 22579396 DOI: 10.1016/j.iccn.2011.11.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 11/23/2011] [Accepted: 11/28/2011] [Indexed: 01/22/2023]
Abstract
INTRODUCTION In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients' delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective. AIM The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL). METHODS In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU. RESULTS The patients' memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury. CONCLUSIONS Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.
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Affiliation(s)
- Per Zetterlund
- Operation Norr, AN/OP/IVA, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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A Delphi study on National PICU nursing research priorities in Australia and New Zealand. Aust Crit Care 2012; 25:41-57. [DOI: 10.1016/j.aucc.2011.08.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 01/28/2023] Open
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Rose L, Blackwood B, Egerod I, Haugdahl HS, Hofhuis J, Isfort M, Kydonaki K, Schubert M, Sperlinga R, Spronk P, Storli S, McAuley DF, Schultz MJ. Decisional responsibility for mechanical ventilation and weaning: an international survey. Crit Care 2011; 15:R295. [PMID: 22169094 PMCID: PMC3388643 DOI: 10.1186/cc10588] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/14/2011] [Accepted: 12/14/2011] [Indexed: 11/30/2022] Open
Abstract
Introduction Optimal management of mechanical ventilation and weaning requires dynamic and collaborative decision making to minimize complications and avoid delays in the transition to extubation. In the absence of collaboration, ventilation decision making may be fragmented, inconsistent, and delayed. Our objective was to describe the professional group with responsibility for key ventilation and weaning decisions and to examine organizational characteristics associated with nurse involvement. Methods A multi-center, cross-sectional, self-administered survey was sent to nurse managers of adult intensive care units (ICUs) in Denmark, Germany, Greece, Italy, Norway, Switzerland, Netherlands and United Kingdom (UK). We summarized data as proportions (95% confidence intervals (CIs)) and calculated odds ratios (OR) to examine ICU organizational variables associated with collaborative decision making. Results Response rates ranged from 39% (UK) to 92% (Switzerland), providing surveys from 586 ICUs. Interprofessional collaboration (nurses and physicians) was the most common approach to initial selection of ventilator settings (63% (95% CI 59 to 66)), determination of extubation readiness (71% (67 to 75)), weaning method (73% (69 to 76)), recognition of weaning failure (84% (81 to 87)) and weaning readiness (85% (82 to 87)), and titration of ventilator settings (88% (86 to 91)). A nurse-to-patient ratio other than 1:1 was associated with decreased interprofessional collaboration during titration of ventilator settings (OR 0.2, 95% CI 0.1 to 0.6), weaning method (0.4 (0.2 to 0.9)), determination of extubation readiness (0.5 (0.2 to 0.9)) and weaning failure (0.4 (0.1 to 1.0)). Use of a weaning protocol was associated with increased collaborative decision making for determining weaning (1.8 (1.0 to 3.3)) and extubation readiness (1.9 (1.2 to 3.0)), and weaning method (1.8 (1.1 to 3.0). Country of ICU location influenced the profile of responsibility for all decisions. Automated weaning modes were used in 55% of ICUs. Conclusions Collaborative decision making for ventilation and weaning was employed in most ICUs in all countries although this was influenced by nurse-to-patient ratio, presence of a protocol, and varied across countries. Potential clinical implications of a lack of collaboration include delayed adaptation of ventilation to changing physiological parameters, and delayed recognition of weaning and extubation readiness resulting in unnecessary prolongation of ventilation.
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Affiliation(s)
- Louise Rose
- Lawrence S, Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, M5T 1P8, Canada.
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Hansen BS, Severinsson E. Dissemination of research-based knowledge in an intensive care unit-a qualitative study. Intensive Crit Care Nurs 2009; 25:147-54. [PMID: 19362841 DOI: 10.1016/j.iccn.2009.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Revised: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND A gap exists between best evidence and best practice in intensive care units. The aim of this study was to investigate different aspects of intensive care nurses' and physicians' inter- and intraprofessional collaboration, with focus on factors associated with standardised weaning from mechanical ventilation. METHODS A qualitative design was used for implementing research-based knowledge into multistage focus group discussions. Data were analysed by means of qualitative content analysis. RESULTS One main theme emerged: The need for strategies aimed at improving quality control of care, and three sub-themes: 'Interprofessional learning', 'Quality control of care', and 'Teamwork and communication'. The multistage focus groups were perceived as an important interprofessional arena for improving quality of care. Improvement projects and research dissemination must be regarded as vital parts of the organisation's ongoing development work. Management was perceived as crucial for success. CONCLUSION Interprofessional research dissemination was perceived as important both in the creation of a common understanding and in knowledge development. Managers should make use of the valuable knowledge possessed by bedside professionals in their strategic planning. There is a need to allocate time for learning and reflection to provide a safe practice environment.
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