Dimensions of Critical Care Nursing最新文献

Background: Enteral feeding intolerance (EFI) occurs in more than one-third of mechanically ventilated patients, yet the cause of this gastrointestinal dysfunction remains unclear. Assessment and diagnostic criteria are often vague and subjective leading to inaccurate recognition or diagnosis of EFI. Nurses are often unsure or unaware of appropriate assessment methods.

Objectives: The objective of this descriptive study was to determine current practice for assessment of EFI among critical care nurses.

Methods: A national survey to explore EFI assessment practices was conducted with critical care nurses at the American Association of Critical-Care Nurses National Teaching Institute conference in 2022. Nurses completed a 19-item survey to determine assessment practices for EFI among critical care nurses.

Results: A total of 344 nurses completed the survey. The majority of nurses practiced direct care at the bedside for adult critical care patients, held a bachelor's degree, had 6 to 15 years of nursing experience, and held specialty certification. There was variability among responses to the practice questions in the survey. Seventy-eight percent of the nurses were aware of and had cared for patients with EFI. EFI was assessed by 84% of participants. The most common assessment criterion for EFI was nausea and vomiting. The majority (81%) of respondents measured gastric residual volume routinely or sometimes.

Discussion: This study shows assessment of EFI is not standardized among nurses. This study identifies a need for education about EFI given the lack of understanding of EFI. Findings from this study can be used to inform future research to develop best methods for assessing the presence of EFI.

Background: Infection control in intensive care units is important for both patients' quality of life and institutions.

Aim: This study was conducted to evaluate the effect of a nurse-driven algorithm in preventing central catheter-related bloodstream infections in intensive care units.

Methods: This intervention research was implemented in a training and research hospital in Turkey between July 1, 2021, and December 31, 2021. The research was carried out in 3 stages after the creation of the algorithm. The data were collected using the Descriptive Characteristics Form for Nurses, the Descriptive and Medical Characteristics Form for Patients, the algorithm knowledge test, and the Algorithm Parameters Follow-up form. After obtaining the necessary permissions for the study, consent was obtained from the nurses participating in the study. Number, percentage, Wilcoxon, Kruskal-Wallis, and Mann-Whitney U test values were used in the study.

Results: With the algorithm, a decrease was found in the rate of infections in the intensive care units.

Conclusion: As a result, it was observed that the nurse-driven, central catheter-related bloodstream infection prevention algorithm, prepared using evidence-based clinical guidelines, reduced the rates of infection. Therefore, it is recommended to use algorithm studies as a long-term guide in intensive care units.

Background: Intensive care unit (ICU) admissions can be traumatic for critically ill, ventilated acute respiratory distress syndrome (ARDS) patients due to fear of death, an inability to verbally communicate, reliance on health care professionals, and invasive medical interventions. Adult ARDS patients hospitalized during the COVID-19 pandemic were strictly isolated and had limited to no visitation from loved ones, impacting their access to support systems.

Objective: To explore the memories and sensory triggers for them (if applicable) of adult ARDS survivors hospitalized during the COVID-19 pandemic.

Methods: This study used a phenomenological design with an interpretative descriptive approach. Semistructured interviews with open-ended questions were conducted with survivors. Thematic analysis of 16 ARDS survivors' responses to ICU memories and sensory triggers questions was completed to identify the most prevalent themes.

Results: Major themes for vivid memories included (1) altered reality, (2) vivid nonsense dreams, (3) medical treatment/procedures, and (4) feeling lonely/isolated. Themes for triggers included (1) seeing doctors/nurses/hospitals and medical equipment or seeing/hearing media depictions of them, (2) hearing ringtones and beeping/alarms, (3) seeing/hearing helicopters, (4) smelling cleaning products, and (5) seeing/touching scars.

Discussion/conclusions: Fifteen of the 16 ARDS survivors reported traumatic vivid memories, often triggered by sensory stimuli they encountered in their everyday lives. It is important for acute care and outpatient nurses to understand the impact of an ICU admission on ARDS survivors' mental health, so they can adopt evidence-based interventions to prevent or limit these effects.

Background: Recurrent episodes of infection and subsequent sepsis are a frequent cause of readmission after sepsis hospitalization. Although persistent immune dysregulation initiated during the sepsis episode may play a role, the impact of preexisting immune suppression (including HIV, organ transplantation, and cancer) and common chronic diseases associated with immune suppression (diabetes and chronic kidney disease) on the risk of recurrent infections after sepsis is unknown.

Objectives: To investigate the role of preexisting immune-suppressive conditions (PISCs) and other common chronic diseases on infection-related readmissions after a sepsis admission.

Methods: Using the US 2015 Nationwide Readmissions Database, we identified a retrospective cohort of adult patients with an unplanned sepsis index admission from April to September, excluding patients with sepsis during the preceding 90 days. We followed all sepsis survivors for subsequent infection-related admissions for 90 days. We identified clinical conditions using International Classification of Diseases coding.

Results: We identified 649 029 unique unplanned sepsis admissions over 6 months; 189 604 (29.2%) had sepsis with PISC, and 459 425 (70.8%) had sepsis without PISC. Overall, sepsis survivors were older (median age, 70 years), and 145 156 (22.4%) experienced at least 1 infection-related readmission within 90 days. The incidence of infection-related readmission among sepsis survivors with PISC was 26.1%, whereas it was 20.8% for those without PISC. The excess risk of infection-related readmissions attributed to PISC was 5.3%, whereas the excess risk attributed to diabetes and chronic kidney disease was 3.7% and 4.7%, respectively. The background risk attributed to new-onset sepsis among participants with none of these conditions was 16.3%. Multivariable regression analysis adjusting for age, gender, and acute illness factors indicated that odds of infection-related readmission were strongly associated with PISC (odds ratio 1.30; 95% confidence interval, 1.29-1.32), closely followed by chronic kidney disease (1.28 [1.27-1.32]) and diabetes (1.17 [1.16-1.19]).

Conclusion: The risk of subsequent infection is higher among patients with PISC, although chronic kidney disease and diabetes are also important risk factors for subsequent infection and sepsis readmissions.

Objective: To map nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in the context of intensive care.

Design: Scoping review according to the Joanne Briggs Institute methodology.

Methods: The search was carried out in the databases PubMed, CINAHL via EBSCO, Joanna Briggs Institute Database of Systematic Reviews, COCHRANE Database of Systematic Reviews, Repositório Científico de Acesso Aberto de Portugal, Dans Easy, and Dart-Europe. Published and unpublished studies (gray literature) were considered. This review integrates articles focused on nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in intensive care in English, Portuguese, and Spanish. Studies with quantitative, qualitative, or mixed designs are covered, as well as systematic reviews and guidelines. The research has 3 eligibility criteria, following the PPC mnemonic: participants (studies involving adults hospitalized in intensive care), concept (studies that address nursing interventions that prevent posttraumatic stress), and context (studies developed in any contextual settings).

Results: The present scoping review included 11 articles. Autonomous, nonpharmacologic, pharmacologic, and interdependent nursing interventions were identified, capable of contributing to prevent posttraumatic stress in people hospitalized in intensive care.

Conclusion: Identifying nursing interventions that prevent posttraumatic stress in people hospitalized in intensive care allows nurses to develop care plans that include these interventions in the context of intensive care, with a view to improving the quality of nursing care provided.

Implications for clinical practice: This scoping review demonstrated that nurses have a crucial role in the prevention of posttraumatic stress in the context of intensive care. It is intended to make nurses aware of this issue, specifically to obtain highly significant and clinically relevant results, sensitive to nursing interventions. It is hoped that this review will be the precursor of research studies, centered on evaluating the degree of effectiveness of the nursing interventions mapped in this review.

Background: Delirium leads to prolongation in intensive care unit (ICU) and hospital length of stay and an increase in ICU costs and mortality. As a result of this, the number of studies on delirium in ICUs has recently increased significantly, and many articles have been published.

Objectives: The aim of this study was to evaluate the articles related to "delirium" in "critical care" field in the Web of Science database and the first hundred most cited articles on this subject.

Methods: The Web of Science database was searched for articles relevant to "delirium" in the critical care medicine field published between 1980 and 2024. Text analytics and network models used in bibliometric mapping were used for prolific authors, annual trend, citation, and countries.

Results: In our study, it was determined that a total of 1834 articles in the field of delirium in critical care medicine were included. It was determined that the annual citation average was 42.79 and the H-index value was 134. There is a general upward trend over the years, and it was observed that it has intensified in the last 5 to 6 years. With the Reference Spectroscopy analysis, it was determined that the most intensively cited studies on delirium were the studies of 2013 and 2010. The distribution of keywords in recent years has focused on analgosedation, acute brain injury, older patient, COVID-19, and fragility. When examined for the top 100 cited articles, it was seen that mobilization, guidelines, pain, activities of daily living, anesthesia, sedation, and haloperidol have become prominent in recent years.

Conclusion: In recent years, there has been a noticeable increase in the volume of research focusing on delirium studies within the field of critical care medicine. Staying current with trends, incorporating findings from frequently cited studies, and customizing interventions to suit modern difficulties can all improve the quality of care offered to critically ill patients and lead to better outcomes.

Introduction: During the COVID-19 pandemic, many health care workers were involved and suffered significant physical and psychological strain, and nursing was one of the main players. Clearly and objectively establishing the psychological impact on nurses during the pandemic is necessary for long-term recovery and to be prepared for new outbreaks in the future.

Aim: The aims of this study were to evaluate the perceived impact on nurses at risk of psychological stress at work during a major health care crisis and determine the psychological impact and its influencing factors.

Methods: An online questionnaire was designed and distributed between April 9 and April 19, 2020, in Spain. The comprehensive self-conducted questionnaire included demographic information and the Psychological Stress and Adaptation at work Score. For the analysis, descriptive statistics, logistic regressions, and receiver operating characteristic curves were determined.

Results: A total of 825 nurses (33% working in intensive care units and emergency departments) answered the questionnaire. A logistic regression analysis revealed that nurses with higher psychological stress scores experienced more physical overload (P = .02), higher psychological overload (P < .01), poor teamwork (P = .02), more distress due to new circumstances (P < .01), more personal impact of how society responded to COVID-19 (P < .01), anticipation of negative future consequences (P < .01), and worse balance between family and work (P < .01). The area under the curve for the cutoff point of Psychological Stress and Adaptation at work Score 40 was 0.82 (95% confidence interval, 0.79-0.91), with 70% sensitivity and 81% specificity. The positive predictive value was 72%, and the negative predictive value was 80%.

Conclusion: Psychological Stress and Adaptation at work Score is a rapid and accurate test for evaluating the psychological well-being of health care staff that can be used when crisis prevents the use of conventional stress diagnosis methods. Higher psychological impact was observed in nurses who worked in the intensive care unit and in the hospital ward.

Background: Delirium is a state of altered level of consciousness often leading to confusion, inattention, and changes to levels of cognition. Delirium increases average length of stay in the hospital and costs the US health care system approximately $148 billion each year in associated medical costs. Sleep hygiene is an important factor in delirium prevention for all hospitalized patients.

Objectives: This quality improvement project was designed to increase implementation of an evidence-based sleep hygiene bundle in the neurocritical care population in order to decrease rates of hospital-acquired delirium.

Methods: This project followed the Plan, Do, Study, Act (PDSA) framework to facilitate a continuous quality improvement intervention at a mid-Atlantic academic medical center in the neurocritical care population. The continuous quality improvement included the incorporation of "sleep" as a topic into the daily rounding checklist, thus optimizing the ability to improve adherence to a multicomponent sleep hygiene bundle. The intervention includes the preintervention-postintervention occurrences of delirium and use of the daily rounding checklist.

Results: Nursing adherence to documentation of delirium assessments was high at approximately 99%. Following the intervention, there was a 41% decrease in the number of patients who screened positive for hospital-acquired delirium.

Discussion: The improvement in cases of hospital-acquired delirium may be attributed to the project intervention. Recommendations for future interventions include analysis of training on sleep plans, focus on nursing education regarding delirium assessment tools, or a measure of staff and/or patient satisfaction related to the intervention.

Abstract: Pulmonary thromboembolism is a common cardiovascular disease, with high morbidity and mortality rates in hospitalized patients. Because of clotting disorders and hypoxemia caused by COVID-19, critically ill patients are highly susceptible to thrombotic complications. A study published in the Journal of the American Medical Association in 2022 showed that the incidence of venous thromboembolism (VTE) in critically ill COVID-19 patients was approximately 10% to 35%, whereas the incidence of VTE in autopsy cases was as high as 60% (JAMA Intern Med 182:1063-1070). Clinicians need increased awareness of VTE in COVID-19 patients, to reduce the risk of deep vein thrombosis and pulmonary thromboembolism and to be alert to life-threatening complications.