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Erbay Dalli Ö, Akça Doğan D, Bayram R, Pehlivan S, Yildiz H. Practices of the ABCDEF care bundle in intensive care units as reported by nurses: A cross-sectional study from Turkey. Nurs Crit Care 2024; 29:974-986. [PMID: 37581265 DOI: 10.1111/nicc.12963] [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: 01/14/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs. AIM To assess the current practices of the ABCDEF care bundle as reported by ICU nurses. STUDY DESIGN A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members. RESULTS A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits. CONCLUSIONS While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation. RELEVANCE TO CLINICAL PRACTICE Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs.
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Affiliation(s)
- Öznur Erbay Dalli
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Derya Akça Doğan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Rıdvan Bayram
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Seda Pehlivan
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Hicran Yildiz
- Department of Internal Medicine Nursing, Bursa Uludag University Faculty of Health Sciences, Bursa, Turkey
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Papathanassoglou E, Park T, Punjani N, Pokharel B, Taha M, Hegadoren K. Implementing integrative therapies in adult critical care: Barriers and strategies. Aust Crit Care 2024; 37:563-570. [PMID: 38218673 DOI: 10.1016/j.aucc.2023.11.002] [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: 09/05/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Critically ill patients experience intense physical and psychological stressors in the intensive care unit (ICU). More than half of ICU survivors report overwhelming mental health symptoms after ICU discharge, such as post-traumatic stress symptoms, anxiety, and depression. Relaxation-inducing integrative therapies such as guided imagery, massage, therapeutic touch, music therapy, and spirituality-based healing practices have the potential to promote comfort and relaxation and improve patient outcomes. OBJECTIVES The aim of this study was to explore the attitudes of healthcare professionals towards the implementation of relaxation-inducing integrative therapies in critical care, barriers to implementation, and potential strategies to overcome them. METHODS We conducted seven focus group interviews with 23 critical care clinicians (70% nurses, 17% allied health professionals, 13% physicians). Interviews were audiotaped and transcribed verbatim. Data were thematically analysed using an inductive content analysis approach. FINDINGS Results reveal a constant interplay between mostly positive personal attitudes towards implementation of integrative therapies and the perceived culture and priorities of the unit. The main benefits for critically ill patients as perceived by participants were promotion of comfort, sleep, and coping, increase of trust, and decrease of pain and stress. As for barriers, dominant themes were a perceived lack of evidence, cost, and time constraints and the fear of loss of professional credibility. Participants related nurses' education and training, family involvement, and leadership were seen as main strategies for implementation. CONCLUSIONS The dominant ICU culture needs to be considered when implementing integrative therapies. Education, access to evidence, and role modelling are proposed as means to shift the ICU culture towards utilisation of integrative therapies in critical care.
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Kim CM, van der Heide EM, van Rompay TJL, Ludden GDS. Reimagine the ICU: Healthcare Professionals' Perspectives on How Environments (Can) Promote Patient Well-Being. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:97-114. [PMID: 38293825 PMCID: PMC11080390 DOI: 10.1177/19375867231219029] [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] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology. BACKGROUND Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored. METHOD This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being. RESULTS The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients. CONCLUSION Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology.
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Affiliation(s)
- Chan Mi Kim
- Department of Design, Production, and Management, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
| | | | - Thomas J. L. van Rompay
- Department of Communication Science, Faculty of Behavioral, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Geke D. S. Ludden
- Department of Design, Production, and Management, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
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Spies C, Piazena H, Deja M, Wernecke KD, Willemeit T, Luetz A. Modification in ICU Design May Affect Delirium and Circadian Melatonin: A Proof of Concept Pilot Study. Crit Care Med 2024; 52:e182-e192. [PMID: 38112493 PMCID: PMC10930376 DOI: 10.1097/ccm.0000000000006152] [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] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Nonpharmacologic delirium management is recommended by current guidelines, but studies on the impact of ICU design are still limited. The study's primary purpose was to determine if a multicomponent change in room design prevents ICU delirium. Second, the influence of lighting conditions on serum melatonin was assessed. DESIGN Prospective observational cohort pilot study. SETTING The new design concept was established in two two-bed ICU rooms of a university hospital. Besides modifications aimed at stress relief, it includes a new dynamic lighting system. PATIENTS Seventy-four adult critically ill patients on mechanical ventilation with an expected ICU length of stay of at least 48 hours, treated in modified or standard rooms. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The clinical examination included a prospective assessment for depth of sedation, delirium, and pain every 8 hours using validated scores. Blood samples for serum melatonin profiles were collected every 4 hours for a maximum of three 24-hour periods. Seventy-four patients were included in the analysis. Seventy-six percent ( n = 28) of patients in the standard rooms developed delirium compared with 46% of patients ( n = 17) in the modified rooms ( p = 0.017). Patients in standard rooms (vs. modified rooms) had a 2.3-fold higher delirium severity (odds ratio = 2.292; 95% CI, 1.582-3.321; p < 0.0001). Light intensity, calculated using the measure of circadian effective irradiance, significantly influenced the course of serum melatonin ( p < 0.0001). Significant interactions ( p < 0.001) revealed that differences in serum melatonin between patients in standard and modified rooms were not the same over time but varied in specific periods of time. CONCLUSIONS Modifications in ICU room design may influence the incidence and severity of delirium. Dedicated light therapy could potentially influence delirium outcomes by modulating circadian melatonin levels.
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Affiliation(s)
- Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Helmut Piazena
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Maria Deja
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Berlin, Lübeck, Germany
| | - Klaus-Dieter Wernecke
- Institute Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Willemeit
- Department of Architectural Research, GRAFT Architects Berlin, Berlin, Germany
| | - Alawi Luetz
- Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
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Denke C, Voigt B, Krampe H, Spies C, Rose M. [Psychosocial Care in the Intensive Care Unit]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:666-674. [PMID: 38056446 DOI: 10.1055/a-2081-3521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.
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Leong EL, Chew CC, Ang JY, Lojikip SL, Devesahayam PR, Foong KW. The needs and experiences of critically ill patients and family members in intensive care unit of a tertiary hospital in Malaysia: a qualitative study. BMC Health Serv Res 2023; 23:627. [PMID: 37312146 DOI: 10.1186/s12913-023-09660-9] [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: 01/03/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Admission to an intensive care unit (ICU) is a stressful experience for patients and their family members. While the focus of management is primarily on medical care, there can be other areas which are overlooked. The purpose of this study was to investigate the needs and experiences of ICU patients and family members. METHOD This qualitative study involved four trained researchers conducting in-depth interviews (IDI) based on a semi-structured interview guide. The participants were ICU patients and family members. All IDIs were audio-recorded and transcribed verbatim. Four researchers independently analyzed the data via thematic analysis with the aid of QDA Miner Lite®. The themes and subthemes were generated and confirmed by literature and expert opinion. RESULTS Six IDIs were conducted with three patients and three family members, whose ages ranged from 31 to 64 years old. One pair of participants consisted of a patient and his respective family member, while the other four participants did not have a familial relationship with each other. Three main themes emerged from the analysis: (I) critical care services; (II) physical spaces; and (III) monitoring technology. Medical, psychological, physical, and social needs for critical care services were expressed by both patients and family members. Patients' needs in clinical spaces were highlighted as a conducive ICU environment with ambient temperature and controlled noise levels. In non-clinical spaces, family members expressed a need for more chairs in the waiting area. Participants expressed the need for call bells as well as patients' negative perceptions of medical equipment alarms in the ICU when it pertained to monitoring technology. CONCLUSION This study provides an in-depth view at the needs and experiences of ICU patients and family members who have a variety of unmet needs. This understanding is critical for guiding ICU personnel and stakeholders in their efforts to humanize ICU care.
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Affiliation(s)
- E-Li Leong
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia.
| | - Chii-Chii Chew
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Ju-Ying Ang
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Sharon-Linus Lojikip
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
| | - Philip-Rajan Devesahayam
- Clinical Research Centre, Hospital Raja Permaisuri Bainun, Ministry of Health, 30450, Ipoh, Perak, Malaysia
- Otolaryngology Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
| | - Kit-Weng Foong
- Anaesthesiology and Intensive Care Department, Hospital Raja Permaisuri Bainun, Ministry of Health, Ipoh, Malaysia
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Paul N, Weiss B. Post-Intensive Care Syndrome after Critical Illness: An Imperative for Effective Prevention. J Clin Med 2022; 11:6203. [PMID: 36294524 PMCID: PMC9604815 DOI: 10.3390/jcm11206203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Over the last decades, the importance of intensive care has considerably increased [...].
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Affiliation(s)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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Xianjiao D, Fenfang L, Shihao C, Chenxi Z, Chuxia T, Ranran M, Wei L, Man Y. How to achieve self-growth as an intern nursing student in Intensive Care Unit: A qualitative study. Nurse Educ Pract 2022; 65:103490. [DOI: 10.1016/j.nepr.2022.103490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
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Naef AC, Erne K, Exl MT, Nef T, Jeitziner MM. Visual and auditory stimulation for patients in the intensive care unit: A mixed-method study. Intensive Crit Care Nurs 2022; 73:103306. [PMID: 35931597 DOI: 10.1016/j.iccn.2022.103306] [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: 12/15/2021] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine what type (e.g., television, photographs, music, etc), content (e.g., nature scenes, family members, etc), and duration of visual and auditory stimuli should be provided to intensive care unit patients during their hospitalisation. RESEARCH METHODOLOGY AND DESIGN This mixed-methods study followed an exploratory-descriptive design. In total, 31 participants were interviewed: 19 were former critically ill patients in the intensive care unit and 12 were nursing experts, all from a university hospital in Switzerland. Based on current practice, patients and nurses were familiar with receiving and providing television, photographs, radio, and musical stimuli, with no specific exposure to virtual reality, aside from that in their personal lives. Data were collected from the former patients using structured interviews, whereas semi-structured interviews were used for the nursing experts. FINDINGS Overall, patient and expert opinions aligned well; both groups agreed that receiving visual and/or auditory stimuli would benefit patients. Photographs, television, and virtual reality were the visual stimuli most chosen by the patients, with an emphasis on nature-focused content. When appropriate, audio matching the content should be provided alongside the visual stimuli to act as a distraction from the hospital environment. Visual stimuli should not exceed 10-15 min, while auditory stimuli should not exceed one hour. CONCLUSION Sensory overload and deprivation are common problems in the intensive care unit with negative effects on patient outcomes. Based on patient and expert opinions, visual and auditory stimuli are desired by patients and could help address these issues.
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Affiliation(s)
- Aileen C Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland.
| | - Katja Erne
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.
| | - Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008 Bern, Switzerland; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 16, 3010 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
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Denke C, Eitner B, Falk K, Spies C. Self-healing Environment. Anasthesiol Intensivmed Notfallmed Schmerzther 2022; 57:10-13. [PMID: 35021236 DOI: 10.1055/a-1644-8605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Decio V, Pirard P, Pignon B, Bouaziz O, Perduca V, Chin F, Le Strat Y, Messika J, Kovess-Masfety V, Corruble E, Regnault N, Tebeka S. Hospitalization for COVID-19 is associated with a higher risk of subsequent hospitalization for psychiatric disorders: A French nationwide longitudinal study comparing hospitalizations for COVID-19 and for other reasons. Eur Psychiatry 2022; 65:e70. [DOI: 10.1192/j.eurpsy.2022.2331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Introduction
Although COVID-19 has been associated with psychiatric symptoms in patients, no study to date has examined the risk of hospitalization for psychiatric disorders after hospitalization for this disease.
Objective
We aimed to compare the proportions of hospitalizations for psychiatric disorders in the 12 months following either hospitalization for COVID-19 or hospitalization for another reason in the adult general population in France during the first wave of the current pandemic.
Methods
We conducted a retrospective longitudinal nationwide study based on the national French administrative healthcare database.
Results
Among the 2,894,088 adults hospitalized, 96,313 (3.32%) were admitted for COVID-19. The proportion of patients subsequently hospitalized for a psychiatric disorder was higher for COVID-19 patients (11.09 vs. 9.24%, OR = 1.20 95%CI 1.18–1.23). Multivariable analyses provided similar results for a psychiatric disorder of any type and for psychotic and anxiety disorders (respectively, aOR = 1.06 95%CI 1.04–1.09, aOR = 1.09 95%CI 1.02–1.17, and aOR = 1.11 95%CI 1.08–1.14). Initial hospitalization for COVID-19 in intensive care units and psychiatric history were associated with a greater risk of subsequent hospitalization for any psychiatric disorder than initial hospitalization for another reason.
Discussion
Compared with hospitalizations for other reasons, hospitalizations for COVID-19 during the first wave of the pandemic in France were associated with a higher risk of hospitalization for a psychiatric disorder during the 12 months following initial discharge. This finding should encourage clinicians to increase the monitoring and assessment of psychiatric symptoms after hospital discharge for COVID-19, and to propose post-hospital care, especially for those treated in intensive care.
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