Dimensions of Critical Care Nursing最新文献

Objective: To map the applications and impacts of virtual reality in the care of critically ill patients in intensive care units.

Methods: This scoping review followed the Joanna Briggs Institute guidelines and the PRISMA-ScR guidelines, where, according to the criteria during the selection stages, it was carried out by 2 independent evaluators. The search was carried out between February and March 2025, in the MEDLINE, Embase, LILACS, RCAAP, and HAL databases, initially resulting in 2803 articles, 28 of which were included in the final analysis after applying the inclusion criteria and excluding nonoriginal or non-peer-reviewed materials.

Results: The results indicated that virtual reality therapy had a high acceptance rate among patients and was considered safe and effective. However, technical difficulties in using the technology were also identified, as well as the need for more extensive and rigorous studies to assess its impact comprehensively.

Conclusions: The mapped studies suggest that virtual reality has potential as a complementary tool in intensive care, especially in terms of promoting the well-being of patients and professionals, as well as opening up avenues for therapeutic and educational applications. However, there is a need for research with greater methodological rigor, to ensure the robustness of the results and enable replication in different contexts, as well as adaptations that consider diverse cultural, socioeconomic and regional contexts, such as those in Latin America, to ensure that interventions are effective and accessible in different realities.

Background: Pediatric delirium is a significant disorder which affects a child's psychomotor activity, sleep, emotions, perception, attention, and consciousness. It is commonly observed in pediatric intensive care units.

Objectives: The aim of this study is to investigate the knowledge, monitoring, and assessment practices related to delirium among nurses working in pediatric intensive care units.

Methods: This descriptive and cross-sectional study was conducted between January 30, 2022, and April 15, 2024, with 71 nurses working in public hospitals in Ankara, Turkey. Data were collected using an online survey method with a "Descriptive Information Form" and a "Pediatric Delirium Knowledge Assessment Questionnaire."

Results: The majority of nurses had not received training on delirium (80.3%) and did not assess delirium in their clinical practice (88.3%). In all, 85.9% considered urinary catheters, 73.2% considered mechanical ventilators, and 53.5% considered congenital heart disease not to be risk factors for delirium. The majority believed that delirium is always hyperactive (90.1%), lasts for a few hours (77.5%), and that changes in the sleep-wake cycle are not a sign of delirium (50.7%). They thought that some nursing interventions that could be used to prevent delirium; such as wearing glasses (54.9%), early mobilization (77.5%), regularly assessing pain (54.9%), and not leaving the lights on for 24 hours.

Discussion: This study has revealed that nurses working in pediatric intensive care units in central Türkiye have significant knowledge gaps regarding the risk factors, symptoms, and management of delirium. It is recommended to organize training programs for intensive care nurses to facilitate the early detection and proper management of pediatric delirium, use validated and reliable pediatric delirium assessment tools in pediatric intensive care units, and develop evidence-based care guidelines.

Objective: This study aimed to examine the effectiveness of the care intervention, which consists of the combination of cold water spray, cold water application with swap, and menthol moisturizer application in reducing dry mouth and thirst in intensive care (ICU) patients.

Design: The population of this quasi-experimental study consisted of patients hospitalized in the level 3 ICU of a university hospital between October 2019 and March 2021.

Research methodology: The care intervention consisting of cold water spray, cold water application with swap, and menthol moisturizer application was applied to the experimental group 3 times a day for 2 days. The control group underwent routine oral care in the clinic. The population of this quasi-experimental study: main outcome measures: The study data were collected using the Thirst Severity Assessment Scale (TSAS), Thirst Distress Assessment Scale (TDAS), and Eilers Oral Assessment Guide.

Results: No statistical difference was found between the groups when the mean score differences of dry mouth on day 1 and day 2 after the intervention compared with before the intervention (P>0.05). However, when the mean differences of Thirst Severity and Thirst Distress scores on both day 1 and day 2 were compared, it was observed that the mean scores of the experimental group patients decreased significantly more (P<0.05).

Conclusions: It was concluded that the care intervention consisting of cold water spray, cold water application with swap, and menthol moisturizer application was not effective in eliminating dry mouth, but it was effective in reducing the feeling of thirst.

Implications for clinical practice: This care practice can be used to reduce the feeling of thirst, which is one of the most common symptoms in the ICU.

Background: Nurses are the caretakers who have the most contact with patients and families above any other member of the health care team. Nurses provide care to dying patients as part of professional and occupational responsibilities. Caring for the dying can create a stressful environment. It is important to understand how nurses psychologically adapt while providing care and support.

Purpose: The purpose of this descriptive qualitative research study was to explore, describe, and understand the experiences of nurses caring for dying patients in critical care.

Methods: A qualitative descriptive study was conducted employing semistructured face-to-face interviews utilizing naturalistic inquiry and a content analysis approach linking generalizations to theory. A purposeful sampling of 9 critical care nurses, interviewed between July 2024 and October 2024, were selected and participated in this study.

Results: Eight themes were illuminated from the content analysis: empathy, feelings of ambivalence, inevitability, inspiration, relationship, responsibility, self-preservation, and sorrow, all in the context of 3 subthemes: the patient, family, and health care team. The themes uncovered mediating behaviors by the nurse to overcome reactions and responses to critical care patient deaths.

Conclusion: The 8 themes, and subthemes, described the way in which critical care nurses create the ability to psychologically adapt to the dying patient. The central meaning of these findings concludes that nurses function as an adaptive system when faced with the stimuli of a dying patient. It is important that nurses who care for dying patients are informed by this research so they can enhance their functioning within the profession.

Background: The ICU often provides aggressive treatments that may be futile for critically ill patients. Palliative care (PC) aims to enhance the quality of life for patients with life-threatening illnesses. Despite recommendations for early PC consultations, delays remain prevalent worldwide.

Objective: This project aimed to improve the timeliness of PC referrals in a New York City hospital ICU through the implementation of a nurse-driven PC screening tool.

Methods: Using the Model for Improvement, this quality improvement project was conducted over 7 months, including a 4-month baseline phase and a 3-month implementation phase. ICU nurses used a PC screening tool to evaluate patients within 48 hours of admission. The project aimed to increase PC screenings to 75% and ensure PC referrals within 48 hours.

Results: The implementation phase saw a significant increase in PC screenings, with compliance reaching 90.9% after process adjustments. The average time to PC referral decreased from 8.9 days pre-intervention to <2 days in the 3-month implementation phase. Of the patients receiving PC consultations, 46.6% had do not resuscitate and/or intubate status established, and 20% transitioned to hospice or comfort care.

Conclusions: The nurse-driven PC screening tool effectively improved the timeliness of PC referrals, demonstrating the importance of standardized screening processes in the ICU.

Background: Although securing an endotracheal tube with medical adhesive tape has been shown to be associated with medical adhesive-related skin injury (MARSI) and medical device-related pressure injuries (MDRPIs), their incidence has been studied separately.

Objectives: To compare the incidence of MARSI and MDRPI after endotracheal tube fixation using medical adhesive tape. In addition, the risk factors for occurrence were identified.

Methods: Data collection started when the endotracheal tube was secured with medical adhesive tape and was followed until extubation or change to another fixation method. The incidence of MARSI and MDRPI was calculated, and the risk factors were examined using a generalized estimating equation.

Results: During the study period, 20 of 153 patients had MARSI or MDRPI, with an incidence of 13%. Eleven patients had MARSI with an incidence rate of 7.2%, and 9 patients had MDRPI with an incidence rate of 5.9%. The factors associated with the occurrence of MARSI were fixation time with medical adhesive tape (P=0.003), analgesics (P=0.015), and fraction of inspired oxygen (P=0.038). The factors associated with the occurrence of MDRPI were fixation time with medical adhesive tape (P<0.001) and analgesics (P=0.017).

Conclusion: The incidence of MDRPI was higher than that of MARSI when the endotracheal tube was secured with medical adhesive tape. The results showed that there are common factors in the association between MARSI and MDRPI, suggesting the importance of a prevention strategy that considers both factors as a single entity.

Background: According to the Affordable Care Act of 2010, any health program that receives federal funding must take reasonable steps to provide oral or written language assistance to individuals with limited English proficiency (LEP).

Local problem: After conducting a needs assessment, a disconnect between nursing knowledge and hospital policy was discovered.

Objectives: The purpose of this quality improvement initiative was to improve communication for individuals with LEP.

Methods/interventions: This initiative occurred in 2 medical intensive care units in a tertiary academic medical center. An audit was performed to identify the number of LEP patients, assess if nurses were documenting medical interpreter use, and identify areas for improvement. A needs assessment and an educational intervention were developed. A post-education questionnaire was used to evaluate the effectiveness of the interventions.

Results: All nurses (45/61%) responded that they were aware of their legal and ethical responsibilities to use a medical interpreter when communicating with LEP patients and 35% responded that they hardly ever document medical interpreter use. Barriers faced when accessing interpreters included: not knowing how and not enough time to call.

Conclusions: Education and audits continue to improve interpreter use and research should continue in this area to improve outcomes for this patient population.