Critical Care Nursing Quarterly最新文献

Background: Nurses working night shifts face the risk of sleep deprivation, posing threats to patient and nurse safety. There has been limited nursing research on napping, which is recognized as an effective strategy to enhance performance, reduce fatigue, and increase alertness.

Objectives: This study aims to investigate nurses' practices and perceptions regarding the benefits and drawbacks associated with napping during night shifts.

Methods: Qualitative research methods were utilized with a targeted sample of critical care nurses working in intensive care units or emergency departments at Assiut University Hospitals in Egypt. Nurses participated in semi-structured interviews using a questionnaire. Analysis involved constant comparison of transcripts to identify categories and themes.

Results: Most participants (65.6%) acknowledged the benefits of napping. Reported positive effects included clearer communication (98.09%), enhanced efficiency during shift changes (59.04%), wakefulness during charting (89.52%), increased energy levels (95.23%), and confidence in task completion (87.61%). Additionally, napping was found to improve nurses' psychological adjustment (100%) and enhance safety for both nurses and patients (100%). However, a minority of respondents (34.4%) cited drawbacks such as understaffing associated with napping and patients worry.

Conclusion: This study provides evidence of the positive impact of napping on various aspects of nursing care and safety for patients and nurses.

Sleep disturbances and fatigue are significant concerns among critical care nurses due to the demanding nature of their work, which includes long shifts, high patient acuity, and constant exposure to stress. This study explores the prevalence and correlation between sleep disturbances and fatigue among critical care nurses. Using a cross-sectional design, data were collected from 104 nurses across 6 government hospitals through validated self-reported measures, including the Richards-Campbell Sleep Scale and the Fatigue Assessment Scale. Findings revealed moderate sleep disturbance, with an average sleep quality (SQ) score of 57.57 (SD = 23.90). Fatigue levels were also notable, particularly physical exhaustion. While demographic factors such as experience and work shifts showed no significant effect on SQ, age and gender were significantly associated with fatigue levels. Additionally, a negative correlation (R = -0.234, P = .017) was found between SQ and fatigue, indicating that poorer SQ was linked to higher fatigue levels. These results highlight the urgent need for targeted interventions to improve sleep hygiene and reduce fatigue among critical care nurses. Implementing structured shift schedules and fatigue management strategies could enhance nurses' well-being and ultimately improve patient safety and health care outcomes.

Extracorporeal membrane oxygenation (ECMO) is a critical life-support therapy for patients with severe cardiac and/or respiratory failure, but it carries a significant risk of neurological complications. This narrative review evaluates neuromonitoring techniques, including electroencephalography, near-infrared spectroscopy, transcranial Doppler, somatosensory evoked potentials, and pupillometry, highlighting their clinical utility, limitations, and relevance for nursing practice. Findings indicate that a multimodal neuromonitoring approach improves early detection and management of neurological deterioration, ultimately enhancing patient outcomes. Standardized protocols and specialized nursing training are essential to optimizing neuromonitoring in ECMO patients.

Decompensated cirrhosis is a critical stage of liver disease associated with high morbidity and mortality. Significant variability in care exists, potentially impacting patient outcomes. This study aimed to evaluate the effectiveness of a standardized admission care bundle in improving outcomes for patients with decompensated cirrhosis. Quasi-experimental research design was utilized in the study. Gastroenterology intensive care unit (ICU) at Al-Rajhy Liver Hospital at Assiut University, Assiut, Egypt. The study included 180 patients with decompensated cirrhosis, comparing outcomes between a control group (received routine hospital care, n = 90) and study group (received admission care bundle, n = 90) of a standardized admission care bundle. The bundle comprised early risk stratification, timely antibiotics administration, prompt fluid assessment, variceal bleeding prophylaxis, and hepatic encephalopathy management. Primary outcomes included mortality rate and length of gastroenterology ICU stay. Secondary outcomes included the occurrence of specific complications. Compared to the control group, the post-implementation cohort demonstrated a significant reduction in mortality (38% vs. 18.9% respectively) (P < .05). Also observed was a statistically significant decrease in the average length of hospital stay and occurrence of complication (P < .01). Implementation of a standardized admission care bundle for decompensated cirrhosis is associated with improved patient outcomes, specifically a reduction in 90-day mortality and length of stay, highlighting the potential of standardized care to enhance the management of this complex condition.

This study aimed to assess nurses' experiences in preventing or reducing sensory deprivation and sensory overload in intensive care unit (ICU) patients, utilizing a phenomenological approach. The qualitative research involved face-to-face, semi-structured, in-depth interviews with 15 nurses working in a general ICU in the southern region of our country. Data collection continued until data saturation was achieved, and all interviews were audio recorded and transcribed. Colaizzi's phenomenological analysis method was employed for data analysis, and adherence to the COREQ checklist was ensured throughout the study. The data analysis revealed 2 main categories (reflection on situations that may cause sensory deprivation and sensory overload in intensive care units and practices and coping experiences of nurses to avoid sensory deprivation and overload) and 6 themes (environment, disease, and its effects, being separated from the family environment and loved ones, challenges encountered, coping, and psychosocial applications). The results indicated that patients undergo sensory deprivation or sensory overload in the intensive care environment, with nurses playing a pivotal role in addressing these situations. It was observed that nurses encountered challenges in coping with sensory deprivation or sensory overload issues in patients. Nurses are advised to regularly assess training programs to ensure the ongoing promotion of safe nursing practices aimed at minimizing sensory deprivation or sensory overload in patients.

Intra-abdominal pressure (IAP) is a physiological measure of great importance that can have profound clinical consequences in a range of medical diseases particularly trauma patients who are requiring fluid resuscitation. This study examines the changes in intra-abdominal pressure at 3 distinct body positions-0°, 15°, and 30° of head of bed elevation in a supine position-and its impact on trauma patients. A prospective, non-randomized comparative study involving 63 trauma patients in intensive care was carried out. Every patient's IAP was measured in 3 positions, and the mean values-and a grading system for categorizing IAP levels-were examined. IAP grades were divided into 5 levels. IAP rose as the angle of body inclination increased, reaching a maximum at 30° (21.61 ± 2.93 mm Hg). At 0° (16.17 ± 3.12 mm Hg), the lowest IAP was observed (P < .001). The grading of IAP displayed notable trends at 0° and 30°head of bed positions as grades 2, 3, and 4 were specific to abdominal trauma, showing substantially higher IAP compared to others. This study demonstrates a statistically significant correlation between head of bed elevation and intra-abdominal pressure in trauma patients. A progressive increase in IAP as the head of bed was elevated from 0° to 30°, with the highest mean IAP recorded at 30°. Furthermore, the IAP grading system highlighted that patients with abdominal trauma exhibited substantially higher IAP, particularly at 0° and 30°, falling into grades 2, 3, and 4, which are indicative of clinically significant intra-abdominal hypertension.

Cardiopulmonary resuscitation (CPR) is a critical emergency technique used in cases of cardiac arrest or respiratory failure. This study aims to assess the knowledge, attitudes, and practices related to CPR among nurses working in hospitals in southern Palestine. A cross-sectional study was conducted on 157 nurses across 6 hospitals. Data were collected using a self-administered questionnaire composed of 4 sections: sociodemographic information, knowledge, attitudes, and practices of nurses toward CPR. The analysis revealed that 49% of the participants have moderate knowledge, while 29.9% had low knowledge. Also, 54.8% of the participants demonstrated positive attitudes, while 36.9% had fair attitudes. In terms of practice, 42.0% exhibited fair practice, and 38.9% had good practice. The results also showed no statistically significant differences between nurses' sociodemographic characteristics and their levels of knowledge, attitudes, and practice regarding CPR. The findings indicate that while nurses generally exhibit positive attitudes toward CPR, their levels of knowledge and practice vary. This article highlights the need for enhanced training programs to improve CPR competency.

The purpose of this article is to assess the effect of implementing oral care with betadine wash on the occurrence of ventilator-associated pneumonia (VAP) and oral health problems in mechanically ventilated patients. A quasi-experimental research design with a nonequivalent control group pretest-posttest approach was employed. The study utilized a VAP diagnostic criteria sheet and Oral Assessment Scale. A convenience sample of 90 ventilated patients admitted to intensive care units with patients assigned to either an intervention group or a control group (45 patients in each). On day 3 and day 6, the intervention group showed significantly better outcomes than the control group (P < .001). The intervention had lower VAP occurrence, though not statistically significant. Regarding mouth alterations, on day 3 and day 6, these were significantly more common in the control group (4.4% and 35.6%) compared to the intervention group (64.4% and 82.2%) (P < .001). For VAP, 6.7% of the control group developed VAP on day 3, increasing to 11.1% by day 6, compared to 0% and 4.4% in the intervention group. However, these differences were not statistically significant. Comprehensive oral care intervention with betadine wash is effective in improving oral health status and reducing the occurrence of ventilator-associated pneumonia.