Critical Care Nursing Quarterly最新文献

Introduction: Neurological assessments are vital in managing critically ill patients, with tools like the Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score aiding decision-making and predicting outcomes. This study compared the predictive accuracy of the GCS and FOUR scores for mortality in ICU patients with neurological disorders across eight hospitals in the South West Bank with a total of 76 ICU beds.

Methods: A prospective cross-sectional study included 243 ICU patients. GCS and FOUR scores were recorded at admission, 48 hours, and discharge. Predictive accuracy for mortality was assessed using ROC curves and AUC values, alongside sensitivity and specificity evaluations.

Results: The FOUR score outperformed the GCS, especially in intubated or sedated patients, with an AUC of 0.821 (95% CI: 0.766-0.876) versus 0.729 (95% CI: 0.666-0.739). The FOUR score achieved 100% sensitivity and specificity at admission and after 48 hours, while the GCS showed moderate sensitivity (74.6%) and specificity (50.0%). Both scales demonstrated high sensitivity at discharge, with the FOUR score maintaining superior accuracy.

Discussion: The FOUR score offers enhanced neurological assessment, particularly in resource-limited settings, outperforming the GCS in intubated or sedated patients. Its adoption in ICUs could improve patient outcomes by enabling more precise and timely evaluations.

Obsessive-compulsive disorder (OCD) is a prevalent psychiatric issue, particularly among critical care nurses who face intense emotional demands. This descriptive correlational study employed a cross-sectional design to assess the prevalence and characteristics of OCD among 175 registered critical care nurses in Oman, utilizing the Obsessive-Compulsive Inventory-Revised (OCI-R) for data collection. Recruitment occurred via online surveys distributed through social media in May-June 2023. The findings indicated that 88% of participants reported OCD, with the majority at low levels (45.45%). Significant differences in OCD were associated with marital status (t = 10.108, P = .002) and clinical experience (F = 3.275, P = .022), while age, gender, nationality, and education showed no significant differences. The high prevalence of OCD among critical care nurses underscores the psychological toll of their work environment. Factors, including single marital status and less clinical experience, contribute to the increase in OCD. This study emphasizes the urgent need for targeted mental health interventions to support critical care nurses in Oman. Establishing supportive resources and policies can improve their mental well-being and enhance patient care quality.

Unique scientific contributions are made by the discipline of nursing every year. There is a growing call to action among professional nursing organizations to recognize nursing as a science, technology, engineering, and mathematics (STEM)-designated discipline. To elevate the practice of nursing to the accepted disciplines of STEM, nurse scientists must curate a body of scientific knowledge exploring and amplifying aspects of care that no other discipline can have command over. With an abundance of literature to support it, this article aims to define clinical surveillance, as an aspect of science that no discipline outside of nursing has absolute command of Clinical surveillance is known to be a concept within the discipline of nursing. This article argues that it is not only a concept but also that the discipline of nursing holds a distinct command of clinical surveillance science over any other discipline.

Neonatal pain management is critical in the neonatal intensive care unit (NICU) and mothers play a significant role in alleviating pain. This study investigates mothers' participation in managing neonatal pain based on Barnard's interaction model. A descriptive study was conducted in NICU from September 2022 to May 2023. The study involved 100 mothers of hospitalized infants, utilizing convenience sampling. Data were collected through a two-part questionnaire assessing demographic characteristics and mothers' perceptions of their infants' pain experiences and management strategies. The mean age of mothers was 27.77 years, with a mean neonatal hospitalization duration of 13.12 days. A majority (84%) believed their infants experienced pain. Mothers reported limited verbal (52%) and written (91%) information regarding pain management. They identified crying as the primary behavioral sign of pain and predominantly used their voice and breastfeeding as non-pharmacological pain relief methods, with 77% believing these methods effectively reduced pain. The findings underscore the critical importance of maternal involvement in managing neonatal pain. According to Barnard's model, the mother-neonate interaction is essential for recognizing pain signs and employing effective non-pharmacological pain relief strategies. This study emphasizes the necessity for healthcare providers to enhance and support these interactions in the context of pain management.

Reflexology is an alternative treatment method that has been increasingly used in recent years. This study aimed to determine the effect of reflexology intervention on stress levels, sleep duration, sucking frequency, and crying episodes in newborn infants. This study was designed as a randomized controlled trial. Using the block randomization method, 72 infants were included in the study (control = 36, experimental = 36). A demographic characteristics form, the Neonatal Stress Scale, and neonatal sleep duration, sucking frequency, and crying episodes form were used. Reflexology was applied to the left and right feet twice on the second day of the study, once in the morning and once in the evening. Within-group comparisons showed that the stress scale scores of infants in the experimental group decreased statistically significantly compared to the control group. One day before the intervention, sleep duration, sucking frequency, and crying episodes of the control and experimental group infants were similar. On the second and third days, when the intervention was applied twice, the sleep duration and sucking frequency increased, and the crying episodes decreased. Reflexology was found to decrease stress, crying episodes and increase sleep duration and sucking frequency in newborn infants.

Central line-associated bloodstream infections (CLABSIs) are common types of hospital acquired infections (HAIs) that can place heavy financial and medical burdens on healthcare practices and facilities. In the medical intensive care unit (ICU) of a medical center, the CLABSI rate rose to 6.60.

Purpose: The purpose of this project was to develop and implement an evidence-based central line clinical protocol (paper checklist) to prevent CLABSIs in the ICU.

Methods: A quality improvement project was implemented in a 16-bed medical ICU. The project focused on the use of a nine-question checklist and education on the use of the checklist to decrease the occurrence of CLABSIs in ICU patients.

Results: During the eight weeks of the pre-intervention period, the CLABSI rates were 6.13 and 5.68. During the eight weeks of the post-intervention period, the CLABSI rates were 4.41 and 0.0.

Conclusions: Implementation of this intervention showed a decrease in CLABSI rates.

Night shift work is a critical component of healthcare delivery, yet it poses significant challenges to the well-being and performance of healthcare professionals. This qualitative study explores the perceptions of medical managers regarding night shift napping, a potential strategy to mitigate fatigue and enhance patient safety. Using semi-structured interviews with 20 medical managers from various intensive care units at Assiut University Hospital in Egypt, we examined views on the benefits, challenges, and institutional support for sanctioned napping during night shifts. Thematic analysis revealed 3 key themes: (1) perceived benefits of napping; (2) barriers to implementation-such as concerns about professional image, staffing inadequacies, and operational disruptions; and (3) institutional support and policy gaps-highlighting a lack of formal guidelines, inconsistent leadership attitudes, and logistical challenges in creating designated nap areas. While many managers acknowledged the potential benefits of night shift napping, concerns about its practical implementation and impact on workflow persist. The findings suggest that developing clear policies, fostering a culture of safety, and addressing logistical constraints could enhance support for strategic napping as a fatigue management tool in healthcare settings. This study underscores the need for further research and policy development to balance staff well-being with continuous, high-quality patient care.

Respiratory complications are among the most common issues post coronary artery bypass grafting (CABG), with atelectasis being one of the most serious respiratory consequences. This study aims to evaluate the association between positive end-expiratory pressure (PEEP) levels and post-CABG atelectasis, investigate demographic risk factors associated with atelectasis, and determine the timing pattern of atelectasis development. A retrospective analysis was conducted on data from 268 CABG patients. Three PEEP levels-5, 8, and 10 cm H2O were considered. Demographic information and postoperative outcomes were collected using a self-developed data collection tool. The study took place at a tertiary care hospital in Nablus, West Bank. Higher PEEP levels, especially at 10 cm H2O, were associated with a reduction in pulmonary atelectasis. Smoking emerged as a significant factor influencing atelectasis, while interventions such as spirometry and early thoracic drainage showed positive effects in reducing the incidence of atelectasis. Furthermore, higher PEEP levels were associated with a shorter hospital stay after CABG. This study has highlighted the importance of optimal PEEP adjustment in improving respiratory outcomes and reducing recovery time post-CABG.

Stroke is a leading global health concern and a primary cause of death and disability. Nurses play an essential role in stroke care, significantly influencing patient outcomes. This study aimed to assess the predictors of nurses' practice in caring for patients with stroke. A cross-sectional study was conducted among 167 nurses working in medical departments between January 1, 2023 and March 15, 2024. Data were collected using a structured questionnaire evaluating nurses' knowledge, attitudes, and practices. The study revealed that 138 (82.6%) nurses had moderate knowledge, 77 (46.1%) displayed positive attitudes, and 91 (54.4%) demonstrated good practice levels regarding stroke care. Multivariable regression analysis showed that education level (bachelor's degree), stroke care training, and knowledge were significant predictors of effective nursing practice (P < .01). This study highlights that while nurses generally have moderate knowledge and positive attitudes, only half exhibit good practices in stroke care. Tailored educational and training programs focusing on evidence-based stroke care can significantly enhance nursing practices, ultimately improving patient outcomes. Prioritizing ongoing professional development and structured stroke care protocols in resource-constrained settings like Palestine is essential to address these gaps effectively.

Interdisciplinary collaboration is a vital part of patient care. One of the most important aspects of care in the intensive care unit is the handoff process. Guided by the principles of High-Reliability Organizations, this process allows intra-professional and inter-professional sharing of critical patient information that can influence patient outcomes. The purpose of this project was to develop, implement, and evaluate the impact of a structured handoff process in the immediate postoperative recovery phase in the adult cardiothoracic intensive care unit (CTICU) in an academic medical center (AMC). The project focused on patients being transferred directly from the operating room (OR) to the CTICU with the goal of promoting efficiency, effectiveness, and optimizing the work environment. This was a nurse-led quality improvement project that took place over a 5-month period in a CTICU in an AMC. The project utilized the development of a comprehensive handoff process that included a staff position map and a handoff tool. Pre-post implementation unit-specific data were analyzed that includes staff workflow satisfaction surveys and financial savings to evaluate the outcomes of the handoff process. The CTICU handoff process helped reduce perceived OR patient turnover times and improved handoff efficiency, effectiveness, and readiness of providers at the point of care. The department will save a projected $25.5 K/annually by not interrupting the patient's arterial pressure monitoring system that was utilized in the OR. This CTICU handoff process has been shown to provide a seamless transition for the adult immediate postoperative patient. By providing standardized guidelines on communication, clarity of individual roles, and elimination of waste there is greater team member confidence in safety, completeness, and adaptability during handoff. Maintaining these improvements has required ongoing re-evaluation of the process including ongoing multidisciplinary education during the onboarding process. Overall, the implementation of this nurse-driven handoff process has proven to help efficiency, effectiveness and optimize the work environment and patient outcomes in a CTICU.