Dimensions of Critical Care Nursing最新文献

Background: Postoperative delirium (POD) is a neurobehavioral disorder that occurs during intensive care unit (ICU) admission. There is a lack of knowledge about POD and cognitive functions in cardiac surgery (CS) patients.

Objectives: To describe the impact of POD on cognitive function in patients undergoing CS after discharge from the ICU.

Methods: A systematic review followed the PRISMA guidelines. The inclusion criteria were studies explaining the relationship between POD and cognitive functions, while we excluded secondary studies, studies on dementia, and studies using languages other than English. This review was registered in the PROSPERO database (ID: CRD42024560306).

Results: A total of 2540 records were screened. We included 10 studies. Eight studies reported evidence of level 3 (OCEBM level), and 4 had high methodological quality (JBI score). Four studies reported POD as a significant independent risk factor for cognitive impairment after CS. Four studies reported a positive association between POD and cognitive function 1 month after discharge, 3 studies reported it at 6 and 12 months after discharge, and 2 studies showed the effects on cognitive function at 36 months. The cognitive functions most affected in the patients who developed POD were memory, orientation, concentration, visual construction, language, and attention.

Conclusions: POD in patients with CS is a widespread problem that negatively affects cognitive function after ICU discharge. Patients undergoing CS and caregivers shared vital data on cognitive impairments after ICU admission. Their long-term participation highlighted postoperative delirium's impact, stressing the need for improved care.

Objective: Empathy is fundamental to patient-centered care and central to nurse-patient interactions in the ICU. Empathy has been studied as an intrapersonal process, with much less emphasis on its interpersonal processes. This article reports findings from a larger ethnographic study to 'explain the culture of empathic care among intensive care nurses,' with a focus on the significant themes of intrapersonal and interpersonal consequences of empathy.

Methods: This focused ethnographic study was conducted in the cardiac surgical intensive care unit of a hospital in Tehran. Purposive sampling was used to select nurses, patients, companions, and others involved in service delivery. Three methods were used to collect data: observation, interviews, and review of existing literature to supplement the information. Qualitative data analysis software, MAXQDA version 11, was used for data coding and the Roper and Shapira (2000) framework for analysis.

Results: The cultural model "empathy, an interactive and reciprocal process" was extracted from the data analysis, which had 2 contents: "intrapersonal consequences of empathy in nurses" and "interpersonal consequences of empathy".

Conclusions: Empathy is important for both patients and caregivers. It is a 2-way process and the study of empathy needs to take into account the experiences and perceptions of both caregivers and patients. The results showed that empathy grows over time. This leads to patient/caregiver satisfaction and improved clinical outcomes. It provides a framework for managers and decision makers.

Background: Delirium and intra-abdominal hypertension are dangerous and prevalent consequences seen in patients in the intensive care unit.

Objectives: This nonrandomized, observational, prospective study was carried out to assess the role of intra-abdominal hypertension in the occurrence of delirium in mechanically ventilated patients.

Methods: This study included 64 patients admitted to 2 intensive care units of our organization served as the study's sites of observation. All patients were assessed for delirium symptoms on the third day of mechanical ventilation by the NEECHAM confusion scale. Intra-abdominal pressure was measured in those patients and the possibility of a relationship between intra-abdominal hypertension and delirium in patients on mechanical ventilation was then assessed.

Results: Of the 64 patients, 84.4% experienced intra-abdominal hypertension, and 75.9% experienced delirium. Delirium worsened clinical outcomes in these patients, leading to longer ventilatory support duration (P=0.001) and longer intensive care unit stay (P=0.003).

Conclusions: Intra-abdominal hypertension is a common complication in mechanically ventilated patients in the intensive care unit and is significantly associated with higher risk of delirium than similar patients with normal intra-abdominal pressure.

Background: Optimal nutritional support is a fundamental element of treatment for critically ill patients. Adherence to evidence-based enteral nutrition guidelines is essential to promote patient care and prevent potential complications.

Objectives: To assess the effectiveness of enteral nutrition guidelines in improving critically ill patients' outcomes.

Method: A quasiexperimental study evaluated 68 critically ill patients divided into 2 groups. The intervention group received their nutrition based on the evidence-based enteral nutrition guidelines, while the control group received their nutrition based on the unit's routine care. The study was conducted in the surgical intensive care units of Mansoura Emergency Hospital in Egypt. Data were collected using the critically ill patients' assessment tool and the enteral nutrition complications evaluation tool. The main measured outcomes included nutritional complications, mechanical ventilation duration, and length of stay in the intensive care units.

Results: There were statistically significant differences in the occurrence of nutritional complications. Vomiting, diarrhea, abdominal distension, and gastric residual volume decreased in the intervention group versus the control group (P≤.05). A notable reduction was observed in the duration of mechanical ventilation and the length of stay in the intensive care unit for the intervention group (P≤.05).

Discussion: Implementing enteral nutrition guidelines for critically ill patients can significantly improve their clinical outcomes through reducing nutritional complications and lowering the time spent on mechanical ventilation and staying in the intensive care unit.

Background: Nursing care complexity is a critical determinant of safety and quality of care in stroke management.

Objectives: This retrospective cross-sectional study evaluated the care complexity and its association with neurological impairment among patients admitted to a comprehensive stroke unit.

Methods: This study analyzed a database of patients with stroke. Care complexity was assessed using the Fugulin scale. Occupancy rate and required nursing staff were calculated according to the Fugulin scale care profile. Neurological impairment was measured at admission using the National Institutes of Health Stroke Scale (NIHSS). A multiple regression model was used to test the association between Fugulin and NIHSS scores across 3 models: model 1 (NIHSS only), model 2 (NIHSS, age, sex, and treatment), and model 3 (NIHSS, age, sex, stroke type, and treatment).

Results: Most patients required high-dependency care. Optimal care delivery demanded 5 nurses and 8 nursing technicians. NIHSS score was positively associated with Fugulin score in all models (P<.001). Age was also positively associated with care complexity (P<.001). In contrast, reperfusion therapy with combined thrombolysis and thrombectomy was negatively associated with Fugulin score (model 2: P=.016; model 3: P=.035).

Conclusions: Nursing care complexity exceeded national recommendations. Stroke severity and older age increased demands, whereas cerebral reperfusion reduced them.

Background: Pain is a leading reason for emergency department (ED) visits among patients with critical illness (PWCIs), yet pain management remains inconsistent and often suboptimal. The lack of standardized protocols and documentation gaps further complicates effective care.

Objectives: This study aimed to characterize pain assessment and management practices for PWCIs in the ED and basic emergency service (BES) and identify improvement opportunities.

Methods: A retrospective analysis was performed on 10,802 patient records from a major hospital in northern Portugal. Adults with moderate or severe pain, triaged as yellow, orange, or red, were included over a 90-day period. Data on pain assessment, interventions, and reassessment were analyzed using descriptive statistics.

Results: Of 27,212 episodes, 96.3% involved pain as the primary complaint. Physicians were the main prescribers of pharmacological measures, especially in higher-priority cases, while nonpharmacological interventions were underutilized. Documentation of pain reassessment was incomplete, with significant gaps in both physician and nursing records. No nurse-initiated analgesia protocol was in place during the study period.

Conclusions: This study highlights persistent gaps in pain management for PWCIs in the ED and BES. The implementation of targeted protocols, ongoing training, and regular audits has the potential to significantly improve pain management practices and patient outcomes. Continued focus on multidisciplinary collaboration and evidence-based protocols is essential for advancing emergency care quality.

Background: Many barriers exist in the literature related to the implementation of the Clinical Practice Guidelines for the Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in the intensive care unit (ICU).

Objectives: The objective of this integrative review was to identify barriers to and facilitators of nurses' PADIS delirium guideline implementation in adult ICU settings.

Methods: We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines as a framework for this review and the Joanna Briggs Institute quality appraisal guidelines. The inclusion criteria led to the identification of quantitative and qualitative studies, quality improvement projects, and review studies published in English between 2013 and 2023 that addressed adult ICU patients and explored facilitators and barriers regarding nurses' delirium guideline implementation in a variety of countries.

Results: The 15 selected studies were 5 cross-sectional studies, 2 mixed-methods studies, 1 cohort report, 3 qualitative studies, 3 quality improvement projects, and 1 systematic review. The most commonly reported barriers concerned a lack of interdisciplinary collaboration and support, a workload burden, and knowledge deficits among nurses. The most commonly reported facilitators were related to interdisciplinary collaboration and education on delirium, PADIS guideline, and ABCDE bundle.

Discussion: Delirium is crucial to address in critically ill patients, and nurses' implementation of PADIS guidelines is vital for better outcomes. This review identified barriers and facilitators at individual, educational, and institutional levels. The review findings emphasize the need for routine and structured education for nurses on delirium risk factors, prevalence, outcomes, complications, management, and assessment to combat the educational deficits that inhibit guideline implementation. The review findings also highlight the need for interdisciplinary collaboration and education to effectively support nurses. Hospitals and other institutions can leverage these insights to develop strategic interdisciplinary education planning, including delirium-focused rounds and routine interdisciplinary discussions about incorporating delirium guidelines into the care of ICU patients.