Critical Care Nursing Quarterly最新文献

Peripheral nerve stimulation (PNS) Train of Four (TOF) monitoring is indicated for use in patients receiving neuromuscular blockade (NMBA). Nurses are responsible for TOF monitoring, yet little is known about barriers to use. NMBA guidelines recommend quantitative electromyography (Q-EMG) monitoring not yet used in ICUs. The aim of this study was to explore ICU nurses' experiences with TOF and perceived barriers to use. This qualitative study explored ICU nurses' perspectives and perceived barriers to use of TOF. Semi-structured interviews were analyzed using thematic analysis. Thirty nurses from 6 ICUs participated. Two main themes emerged: (1) lack of confidence in visually monitoring TOF and (2) inconsistent procedures. Lack of confidence was related to device concerns, difficulty visualizing twitches, absence of baseline data, TOF not aligned with clinical presentation, and provider preference for ventilator synchrony vs. TOF. Barriers to skin access were reported. Objective measurement of Q-EMG twitch ratio may improve confidence. Nerve stimulation reported as minor discomfort (mean = 2, scale 0-10). Current barriers have led to misuse or disuse. Use of Q-EMG TOF may increase confidence in TOF monitoring and overcome current barriers. Further research is indicated to test Q-EMG in the ICU setting.

Sternal wound infections (SWIs) are a serious risk following medial sternotomy, occurring in 3-8% of cases. Despite stringent infection control measures, these infections can lead to extended hospital stays and frequent readmissions. Early SWI detection is essential, underscoring the need for nurses to understand SWI risk factors and management. To evaluate knowledge of SWIs, including associated risk factors and evidence-based management practices, among nurses with varying levels of experience in a cardiothoracic step-down unit (CTSDU). An anonymous survey, including case-based questions and open-ended responses, was distributed to CTSDU nurses from April to May 2023. Nurses were grouped based on experience (≤3 years or ≥4 years), and data were analyzed using descriptive and inferential statistics. Out of 61 nurses, 33 completed the survey. Correct SWI risk identification rates were 77%, 21%, and 46%, while correct identification of individual risk factors was 63%, 54%, and 62% across 3 case studies. Cohen's d values were 0.809, 0.296, and 0.07. No significant confidence difference was found between experience levels (P = 0.065). Variability in SWI knowledge across experience levels highlights the need for standardized training to enhance SWI detection and patient outcomes.

A 341 bed Magnet® designated hospital with a 20-bed Silver AACN Beacon awarded medical surgical Intensive Care Unit (ICU) began to see a rise in their catheter associated urinary tract infections (CAUTI) in the last two quarters of 2021. Through a quality improvement project, the unit utilized operational excellence to redefine the roles and responsibilities of team members, a defined process for patients with Foley catheters, new visual management cues, and a checking phase to ensure the new process was working. After implementing the new process, the unit has reduced and remained at zero CAUTIs for over 3 years.

This study was conducted with a descriptive qualitative design to reveal the opinions and experiences of intensive care nurses who care for bariatric surgery patients. The study was conducted with 11 nurses working in hospitals' general surgery intensive care units caring for bariatric surgery patients. The data were collected using the interview method, which is one of the qualitative data collection methods. In the study, intensive care nurses expressed both positive and negative perspectives on bariatric surgery. They also reported challenges in patient care, particularly related to high-weight patients, in-pain patients, and fearful patients. Additionally, hospital-related difficulties, such as lack of staff and lack of equipment, were highlighted as key barriers to providing care. However, nurses identified facilitating factors, including patient characteristics and procedural aspects which contributed to more manageable care experiences. The findings of this study illuminate the diverse views and experiences of intensive care nurses caring for bariatric surgery patients.

This article reports the results of a cross-sectional study aiming to assess how critical care nurses evaluate and support their patients' individuality and to determine how it changes in relation to different predictors. Data were obtained through an online survey with the ICN-Nurse questionnaire which was administered to a sample of Polish nurses working in a critical care setting. Data analysis included factor analysis, descriptive statistics, and linear model building. The levels of nurses' views on how they support their patients' individuality and for the way nurses perceive the maintenance of patients' individuality were moderate. The significant predictors for higher scores in both outcome measures included fewer years of experience in current unit, higher evaluations of care quality, and greater job satisfaction. Even though individualized care in critical care has been globally recommended, there are still places where it has not been implemented. This study several factors related to work organization and nurse characteristics that may explain why this approach to care remains underutilized. Based on the results, nurses can reflect on how they support the individuality of their patient, as well as acknowledge and address possible barriers to this approach.

This paper examines the relevance of Roy's Adaptation Theory within the modern healthcare landscape, particularly in intensive care units (ICUs), where the integration of AI and telemedicine presents both opportunities and challenges. Roy's framework categorizes adaptation into four modes: physiological, self-concept, role function, and interdependence, which remain critical in navigating the complexities of critical care. This study emphasizes that while AI technologies can enhance patient monitoring and proactive interventions, they may also contribute to increased anxiety and a potential loss of personal connections essential for emotional support. To address these challenges, this paper advocates for tailored communication strategies that simplify complex medical information and provide training for patients in technology use. Additionally, fostering interdependent relationships through trust-building measures and family involvement is highlighted as essential for improving patient engagement. By integrating robust measurement systems and evaluating the cost-effectiveness of technological implementations, this exploration seeks to reaffirm the importance of Roy's Adaptation Theory, ultimately paving the way for improved health outcomes in an increasingly digital healthcare environment.

Objective: This systematic review evaluates the clinical effectiveness of the spontaneous awakening trial (SAT)-spontaneous breathing trial (SBT) protocol in mechanically ventilated sedated patients (MVSPs) within intensive care units (ICUs). Methods: A comprehensive search identified 18 studies involving 12 284 patients from 11 countries. Outcomes included weaning success, mechanical ventilation (MV) duration, sedation time, complications, cognitive impairment, ICU stay length, and mortality. Results: Implementing the ABCDE bundle, particularly the paired SAT-SBT protocol, significantly reduced ventilation and sedation time by nearly 50%. The intervention was associated with decreased medication use, improved patient wakefulness, and higher extubation success rates. The intervention group showed shorter durations of MV, ICU, and hospital stays. Cognitive impairment was less frequent in the intervention group at the 3-month follow-up. Nurse workload was unaffected, and 1-year mortality was lower in the SAT-SBT group. Conclusion: The systematic review supports the clinical effectiveness of the paired SAT-SBT protocol within the ABCDE bundle for MVSPs in ICUs. The protocol improved weaning outcomes, reduced ventilation and sedation time, decreased complications, and shortened durations of MV and ICU stay. The findings underscore the benefits of a comprehensive approach integrating SAT and SBT in managing MVSPs. Further research is needed to optimize intervention timing, address implementation challenges, assess cost-effectiveness, and determine generalizability across diverse patient populations and healthcare settings.

Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. It is a major global health concern due to its high morbidity and mortality. This article provides a comprehensive overview of sepsis, focusing on its epidemiology, definitions, scoring systems, and diagnostic markers. The epidemiology section highlights the global burden of sepsis, noting variations in incidence and mortality across different regions and populations. It also discusses the risk factors associated with sepsis, including age, comorbidities, and healthcare-associated exposures. The definitions section traces the evolution of sepsis definitions, emphasizing the current sepsis-3 criteria, which focus on organ dysfunction as a key diagnostic feature. Scoring systems, such as the Sequential Organ Failure Assessment (SOFA) score and the Quick SOFA (qSOFA) score, are discussed in terms of their components, calculation, and interpretation. The diagnostic markers section details the clinical, laboratory, and microbiological parameters used in sepsis diagnosis, highlighting traditional markers and emerging technologies. The conclusion summarizes the key points and emphasizes the importance of early recognition and adherence to evidence-based guidelines for improving sepsis outcomes.

The knowledge level of nurses' endotracheal tube (ETT) cuff pressure control management is important for patient safety. The aim of this study is to assess how the knowledge level of intensive care (ICU) nurses is affected by ETT cuff pressure control training delivered using 2 alternative teaching techniques. The research was conducted with 88 medical and surgical nurses working in ICUs. The nurses in the groups were given education with presentation techniques in line with evidence-based guidelines on ETT cuff pressure control management. In addition to the nurses in the experimental group, 4 one-on-one follow-up visits were made using the demonstration technique. A statistically significant difference was found between the total scores of the knowledge level of ETT cuff pressure control after training in the experimental group and control group (P < .001). It was determined that presentation and demonstration teaching techniques increased the knowledge level of nurses on ETT cuff pressure control management, and the use of demonstration and one-to-one follow-up strategies were most effective.