Medizinische Klinik-Intensivmedizin Und Notfallmedizin最新文献

Background: Due to an increasing workload and the resulting moral distress, many intensive care nurses have left their profession. Much of the literature on this topic deals with extrinsic reasons for leaving the profession and the occurrence of burnout syndrome.

Objective: This article asks positive questions about the reasons why intensive care nurses remain loyal to their profession and about finding meaning and intrinsic motivation in intensive care.

Materials and methods: The article builds upon a scoping review of the intrinsic motivation of intensive care nurses and links the findings with current literature and ongoing projects.

Results: The previous scoping review describes one overarching theme (meaning) and five sub-themes: spirituality, sense of pride and joy, personal relationships, moral responsibility, and thriving. The five sub-themes correlate with each other and enable meaning to be found in work.

Conclusion: When intensive care nurses can realise their values in their work, this triggers emotions such as joy and pride and enables them to remain intrinsically motivated. Emotions are also the medium through which meaning can be experienced as emotionally reflected insight. For these mechanisms to work, the three basic needs for autonomy, competence and connectedness must be fulfilled by the institution, with suitable organisational and structural framework conditions. The Magnet® concept of the American Nurses Credentialing Center (ANCC; Oakbrook Terrace, IL, USA) is a good example of how this can be achieved.

Background: Overcrowding is common in emergency departments (EDs). However, the effects on moral distress among personnel are not well understood. There is a lack of suitable empirical studies, particularly for work in EDs in Germany.

Aim: Exploratory investigation into the reported frequency and correlations of adverse moral consequences of overcrowding among ED staff.

Materials and methods: Combined survey study of physicians and nurses at an interdisciplinary ED at a university hospital and use of clinical process data. Standardized survey assessed overcrowding, including a list of undesirable moral consequences, as well as sick days and burnout symptoms. Descriptive and correlation analysis of survey data and Community Emergency Department Overcrowding Scale (CEDOCS) data.

Results: The subjectively assessed and objectively collected frequencies of overcrowding were not entirely consistent. The most frequently experienced undesirable moral consequences of overcrowding were prolonged patient stays, higher workloads for staff, and insufficient privacy and care control for patients. This was similar for both professional groups. Correlations with sick days and burnout were inconsistent.

Conclusion: For the first time, undesirable moral consequences associated with ED overcrowding have been empirically identified. The results also provide insights into the methodological challenges that future studies on the subjective consequences of overcrowding for ED personnel should take into consideration.

Background: The organisation and deployment of leading emergency physician groups (LNA) in Germany show considerable regional differences. To date, reliable nationwide data on structures, training, and operational implementation have been lacking. The aim of this study was to assess the current status of LNA deployment and to identify optimisation potential for uniform standards.

Methods: During the 2024 annual meeting of the Federal Associations of Medical Directors of Emergency Services (BV-ÄLRD), an anonymised online survey was conducted. Structural, organisational, training, and operational parameters of LNA groups were collected. Data analysis was descriptive.

Results: A total of 59 datasets from 13 federal states were evaluated. Most LNA groups cover counties (47%) or combined urban-rural areas (15%) with 100,000-500,000 inhabitants (81%). Seventy-six per cent maintain a fixed group, 17% two groups. Furthermore, 51% of LNA services are scheduled on a rotating basis, and financial compensation is predominantly provided as fixed allowances (80%). Most LNA are specialists (93%) and hold the additional qualification in emergency medicine (84%). An LNA course according to German Medical Association (BÄK) specifications is established in 100% of cases. In addition, 91% receive complete protective equipment. Deployment is mostly defined in special alarm plans (97%). Only 58% document deployments using structured protocols. Digital applications are used to a limited extent (15%). Personnel and structural challenges were repeatedly reported in the free-text responses.

Conclusion: The study demonstrates a heterogeneous implementation of LNA structures in Germany. There is optimisation potential particularly regarding standardisation of digital integration and securing personnel resources. The results provide a basis for further development of national standards.

Background: Spirituality in the field of neonatology begins with the care of pregnant women at risk of premature birth. This existential threat at the very beginning of life inevitably leads to a need for spiritual support. One major focus of care in prematurity is on building a bond between parents and child, which is fundamental for the child's further development.

Objectives: To identify the spiritual needs of parents in perinatal care and to demonstrate a possible way to meeting these needs.

Methods: This work is based on case reports, identification of topics, and a systematic literature search.

Results: The identified studies show considerable heterogeneity, e.g., regarding research questions and neonatal care settings. Across studies, spirituality was consistently found to play a significant role in perinatology, closely associated with parents' existential anxiety, which can interfere with the development of the parent-infant relationship. Parents consistently expressed the expectation that their spiritual needs are recognized; however, these needs were often inadequately addressed by the perinatal care team.

Conclusion: Spirituality is among the essential needs of parents of preterm infants in the intensive care unit. It enables parents to reduce stressors and thereby facilitates the establishment of a parent-infant relationship.

Background and objectives: Transfer of critically ill, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients to a tertiary care center in combination with mortality prediction using the Simplified Acute Physiology Score (SAPS II) score has not been investigated in detail so far, in Germany.

Materials and methods: A retrospective analysis of SARS-CoV-2 patients receiving intensive care unit (ICU) treatment at a tertiary care center between 1 March 2020 and 31 December 2021 was performed. Patients directly admitted through the emergency room (PA) and patients admitted later-on from hospitals with lower level of care (SA) were compared.

Results: In all, 165 SARS-CoV-2 patients with a SAPS II score received intensive care during the period described. SA patients were significantly younger (SA 62.2 years [IQR 51.9-72.4] vs. PA 70.8 years [IQR 58.3-79.9], p = 0.002), were ventilated longer (SA 16.5 days [IQR 7-31] vs. PA 7 days [IQR 4-11], p < 0.001) but had the same hospital mortality (SA 53.3% vs. PA 45.7%, p = 0.41). Predicted mortality through SAPS II score underestimated true mortality in both patient collectives (SA 15.2% [IQR 7.9-26.6] vs. PA 19.6% [IQR 9.2-34.7], p = 0.17).

Conclusion: The prognostic value of SAPS II is limited for patients suffering from SARS-CoV‑2. Interhospital transfer of critically ill patients seems reasonable since mortality is not different between patients primarily admitted to a tertiary center and patients admitted later-on during disease course.

The concurrent delivery of multiple infusion solutions (Y-site administration) through a single catheter lumen in intensive care patients is often unavoidable. This may lead to physicochemical incompatibilities, significantly affecting the efficacy and safety of drug therapy. The objective of this study is to develop and formulate an infusion regimen that considers the number of access points and avoids incompatibilities for adult intensive care patients. A comprehensive literature search was conducted following the ADKA-DIVI standard concentration list for continuous infusions. Manufacturer information and databases, such as STABILIS, Kingguide, and Trissel's TM 2 IV Compatibility, were used to evaluate compatibility. For frequently used combinations for which no compatibility data were available, stability data on physical compatibility were compiled. Based on this, considering 34 common active ingredients and their standard concentrations, a 4-lumen central venous catheter (CVC) infusion regimen was developed to help avoid incompatibilities in the adult intensive care unit.

Animal-assisted interventions (AAI) are increasingly recognized as nonpharmacological adjuncts to intensive care medicine. The aim of this paper by the German Society of Internal Intensive Care and Emergency Medicine (DGIIN) is to summarize the scientific rationale, safety considerations, and implementation recommendations for the use of AAI in intensive care units. Therapeutic effects are attributed to neuroendocrine mechanisms, particularly activation of the oxytocin system and reduction of cortisol levels, which can alleviate anxiety, pain perception, and psychological stress in critically ill patients. Early studies have reported significant reductions in anxiety without an associated increase in nosocomial infections. However, clinical implementation requires well-defined structural, hygienic, and ethical frameworks, including standardized risk analyses, binding hygiene and animal welfare standards, and multiprofessional collaboration integrating intensive care, nursing, infection control, and animal therapy. This paper presents the first systematic recommendations in Germany for the safe and quality-assured integration of animal-assisted interventions into intensive care practice and calls for scientifically accompanied implementation focusing on patient safety, animal welfare, and team well-being.

Dealing with dying and death is an integral part of working in an intensive care unit, yet time pressure and workload often leave little room for emotional processing. A shared moment of silence offers intensive care staff the opportunity to pause after a patient's death, to uphold dignity, and to foster team reflection. This article explores the origin and significance of the ritual, summarizes the current evidence, and provides practical recommendations for its implementation-including appropriate language, involvement of relatives, framework conditions, and evaluation. The moment of silence does not replace structural support measures (e.g., supervision or ethical consultations) but can serve as a meaningful complement to them.