Clinical Nursing Research最新文献

The purpose of this study was to investigate the prevalence and risk factors of delirium in children receiving mechanical ventilation (MV) admitted to the pediatric intensive care unit. A prospective observational study was conducted, enrolling 160 critically ill children aged 29 days to 18 years who received MV for more than 24 hr between August 2021 and August 2023. Delirium was assessed using the Cornell Assessment of Pediatric Delirium. Demographic, disease-related, and treatment-related characteristics were collected from electronic medical records by staff nurses. The incidence of delirium in children with MV was 83.8%. The median duration of MV at the onset of delirium was 1.5 (interquartile range: 0.5, 3.0) days, and according to the day of extubation, 74.6% of delirium cases first occurred ≥ 24 hr before extubation. Binary logistic regression analyses revealed that the independent risk factors of delirium in critically ill children with MV included age ≤ 5 years, physical restraints, pediatric sequential organ failure assessment score, and lower pulse oximetry oxygen saturation (SpO₂). This study may help develop intervention strategies to reduce the incidence of delirium in critically ill children with MV by targeting related risk factors.

Social drivers of health (SDOH) play a critical role in influencing health outcomes, including those related to cognitive dysfunction in patients with cirrhosis. Cognitive dysfunction, which can significantly impact the quality of life and health outcomes in patients with cirrhosis, may be influenced by various SDOH factors. This scoping review aims to synthesize current evidence on the association between SDOH and cognition among patients with cirrhosis. A systematic search of the literature was conducted from inception through March 2024 using PubMed, Cochrane Library, and Embase databases. Studies that examined the relationship between SDOH and cognition, as measured by neuropsychological tests, were identified. SDOH were categorized into the five Healthy People 2030 SDOH domains. A total of 31 studies were included in the review; however, many of the studies did not primarily focus on examining the relationship between SDOH and cognition. Cognition was primarily assessed using the Psychometric Hepatic Encephalopathy Score. Education was the most frequently investigated SDOH, followed by employment. Higher levels of education and employment were generally associated with better cognitive performance. The SDOH domains of social and community context and healthcare access and quality were not addressed in the included studies. This review highlights the potential link between SDOH and cognition among patients with cirrhosis but also reveals that existing research is limited, especially beyond education. Future research should address these understudied SDOH factors to inform strategies to identify at-risk patients and improve health outcomes in patients with cirrhosis.

COVID-19 can create a viral-induced myopathy resulting in dyspnea. Respiratory muscle strength training has recently been reported to reduce persistent dyspnea in individuals with post-COVID-19 symptomology. This study aimed to determine the effectiveness of a 12-week home-based, respiratory muscle strength training program in reducing dyspnea and to determine its feasibility and acceptability. This single-group trial included adults > 4 weeks beyond the acute COVID illness. Participants were assessed in person at baseline, 6, and 12 weeks for dyspnea, pulmonary symptoms, quality of life, pulmonary function, and functional capacity. Participants received inspiratory and expiratory respiratory muscle strength trainers, diaries, weekly phone calls, and were shown how to perform the exercises using a return demonstration during the baseline appointment. Statistical analyses included descriptive statistics and the Friedman test to evaluate changes over time. There was a significant reduction in dyspnea (2.04-1.39, p = .005), pulmonary symptoms (17.6-11.7, p < .001), and a significant increase in the quality-of-life index score (0.682-0.752, p = .013) and visual analog scale (63.1-71.57, p = .004). Significant improvements in peak inspiratory flow (111.24-195.77 l, p < .001), forced expiratory volume over 1 s (291.29-345.42 l, p < .001), thoracic expansion (2.71-3.88 cm, p < .001) and the 6 min walk test (300.22-391.57 m, p < .001) were also found. Study adherence was >95% and feasibility and acceptability scores were high. Home-based respiratory muscle strength training may be an effective, acceptable strategy that can be used as a standalone treatment to reduce persistent dyspnea in post-COVID-19 survivors. This study was pre-registered with Clinical Trials.gov [NCT06091280]. Clinical Trial URL/ClinicalTrials.gov PRS: Record Summary NCT06091280. IRB approval was provided by the University of South Florida (006272).

The readiness of essential equipment like airway trolleys is critical in pediatric cardiac intensive care units (PCICUs). Kaizen, a Lean management principle, has been increasingly applied in healthcare to enhance efficiency and patient care. This study investigates the transformative impact of Kaizen principles on airway trolley preparation in a 10-bedded PCICU. A 12-month prospective observational study was conducted between January 1, 2024 and December 31, 2024. Kaizen was introduced in the system on July 1, 2024. Pre-and post-Kaizen data were compared to evaluate its impact on response times, preparation efficiency, error reduction, resource utilization, and nursing satisfaction. We demonstrated remarkable reduction in response times during pediatric cardiac emergencies, from 4.82 to 2.14 min, post-Kaizen (p < .001). Time spent on airway trolley preparation decreased significantly from 12.5 to 7.3 min (p < .001). The frequency of errors in preparation decreased significantly from 4.2 to 1.1 errors per month. Waste reduction was achieved through streamlined processes, with nurses reporting a 30% reduction in preparation time. Nursing staff expressed heightened confidence and preparedness during high-stress situations. The application of Kaizen principles significantly optimized airway trolley preparation processes, highlighting their potential for broader healthcare applications.

Pulse oximetry is a widely used, noninvasive method for estimating arterial oxygen saturation (SaO2). However, emerging evidence suggests that skin pigmentation may affect its accuracy, potentially leading to occult hypoxemia in individuals with darker skin tones. This systematic review examines the impact of skin pigmentation on pulse oximeter accuracy by comparing pulse oximetry (SpO2) readings with arterial blood gas-measured SaO2 across diverse populations. A systematic search of PubMed and Embase was conducted following PRISMA 2020 guidelines. Eligible studies included those comparing SpO2 to SaO2 while stratifying results by skin pigmentation or race/ethnicity. Data extraction focused on bias in SpO2 readings, study design, and population characteristics. Risk of bias was assessed using the QUADAS-2 tool. Forty-two studies met the inclusion criteria. Consistent evidence indicated that pulse oximeters overestimate SaO2 in individuals with darker skin tones, particularly at lower oxygen saturations. This overestimation may delay recognition of hypoxemia and critical interventions. Methodological variability was noted, including inconsistent racial classifications and skin tone assessment methods. Pulse oximeters exhibit a systematic bias in individuals with darker skin tones. Standardized skin pigmentation assessment and improved device calibration are needed to enhance accuracy and ensure equitable patient care.

Severe illness and intensive care treatment pose significant challenges not only for the patients but also for their relatives, known as post-intensive care syndrome in family members (PICS-F). Not much is known about psychosocial outcomes in relatives of former severely ill COVID-19 patients who were hospitalized under pandemic-related challenges. This study aimed to investigate long-term psychosocial outcomes of relatives of formerly hospitalized COVID-19 patients in relation to patient and relative characteristics. Longitudinal data on psychosocial outcomes of relatives of COVID-19 patients, admitted to the general ward or intensive care unit (ICU) in 2020 and enrolled in the multicenter prospective cohort NeNeSCo study, were collected via questionnaires, 9 and 15 months post-hospital discharge of the patient. Outcomes of interest were anxiety, depression, post-traumatic stress symptoms (PTSS), caregiver burden, and quality of life. In general, relatives scored high on PTSS, especially in the ICU group (22.5%). Relatives of ICU patients had higher levels of anxiety and caregiver burden than those of general ward patients. Over time, anxiety decreased while caregiver burden increased in the total group. Factors associated with less favorable outcomes in terms of anxiety, depression, PTSS, and caregiver burden were associated with both relative and patient variables, with relatives' passive coping showing the strongest association across all outcome variables and time. Admission to the ICU increased the level of anxiety in relatives, while patient cognitive complaints were predictive of more severe symptoms in relatives (anxiety, depression, and caregiver burden). In conclusion, nurses providing follow-up care should be aware of the impact of severe COVID-19 on the psychosocial outcomes of relatives, comparable to other severe conditions, and offer guidance, especially to those who will not seek help themselves. Early screening for and psychoeducation on the emotional consequences of severely ill patients can guide nurses in their supportive care.

Intensive care unit (ICU) survivors increasingly report new or worsening functional impairment at hospital discharge. Early risk identification models that include high-dimensional nursing data may improve the delivery of preventive interventions. This study aims to develop and validate models predicting functional impairment at hospital discharge (Activity Measure for Post Acute Care [AMPAC] score <18) using electronic health record (EHR) data from the first 48 h of ICU admission. We identified 799 sepsis survivors hospitalized in the ICU (April 2016-May 2020) from a Midwestern health system's data warehouse. We extracted demographics, illness severity, nursing assessments, and ICU interventions. Given the limited availability of real-world EHR data, we employed CTAB-GAN, a generative adversarial network, to synthesize training data, enabling more robust model development. After feature engineering, 53 of 99 features were selected. We trained an eXtreme Gradient Boosting (XGBoost) classification model and used SHapley Additive exPlanations (SHAP) analysis to identify key predictors. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC). For the 24-h model, the most critical features were first documented AMPAC score, age, mobility level, Braden Scale score, and walking device, while the 48-h model added body mass index and sequential organ failure assessment (SOFA) score as key predictors. Leveraging these findings, lightweight models were constructed using only the most important (top 5/10) predictors, which achieved results comparable to the full predictor model, with AUCs of 0.83 (24 h) and 0.83 (48 h), respectively. Our model, which includes patient characteristics and nurse assessments, can identify patients during early ICU admission who are at high risk for functional impairment at hospital discharge. Our streamlined modeling approach highlights the potential for integration into EHR systems, providing a practical and efficient tool for clinical decision support while maintaining predictive accuracy.

With aging, female older adults experience biochemical changes such as drop in their sex hormones and biomarkers and often encounter stress, which can be manifested in psychological symptoms. Previous literature has confirmed that racial/ethnic differences exist in the interactive relationship between sex hormones, biomarkers, and psychological symptoms. Yet, the racial/ethnic differences in their interactive relationship have not yet been examined. This is a secondary data analysis using the cross-sectional data of Wave II (2010-2011) from the National Social Life, Health, and Aging Project (NSHAP), and included 1,228 female older adults without moderate to severe cognitive impairment. Moderated network analysis was conducted with race as a moderator to examine the interactive relationship among sex hormones, biomarkers, and psychological symptoms and to compare the differences between the White and non-White group. The White group had a more positive relationship between total hemoglobin and cognition (edge weight = 0.18; moderated edge weight = 0.22). The non-White group had a positive relationship between progesterone and anxiety (edge weight = 0.05; moderated edge weight = 0.04) and between estradiol and cognition (edge weight = 0.03; moderated edge weight = 0.03), both of which were not present in the White group. We found a small moderated effect of race, and the strength of relationship among sex hormones, biomarkers, and psychological symptoms was different between the White and non-White group. Our study offers important preliminary findings to understand the potential racial/ethnic disparities that exist among sex hormones, biomarkers, and psychological symptoms in female older adults and the need to take an interactive approach.

Advance care planning, involving goals-of-care and surrogate-designation conversations, is crucial for patient-centered care. However, determining the optimal timing and participants for these conversations remains challenging. This study explored the frequency, timing, and predictors of documenting two advance care planning elements, goals-of-care and surrogate-designation conversations, in clinical notes for patients with advanced illness. In this retrospective observational study, we leveraged high-dimensional data and natural language processing (NLP) to analyze clinical notes and predict the presence or absence of advance care planning conversations. We included notes for patients treated at a Midwestern United States hospital who had advanced chronic conditions and eventually passed away. We manually labeled a gold-standard dataset (n = 913 notes) for the presence or absence of advance care planning conversations at the note level, achieving excellent inter-annotator agreement (90.5%). Training and testing four NLP models to detect goals-of-care and surrogate-designation conversations revealed that a transformer-based model (Bidirectional Encoder Representations from Transformers [BERT]) achieved the highest accuracy, with an F1 score of 93.6. We then deployed the BERT model to a high-dimensional corpus of 247,241 notes for 4,341 patients and detected goals-of-care and surrogate-designation conversations in the records of 85% and 60% of patients, respectively. Temporal analysis revealed that goals-of-care and surrogate-designation conversations were first documented at medians 28 and 8 days before death, respectively. Patient characteristics and referral to specialty palliative care emerged as significant factors associated with documenting these conversations. Our findings demonstrate the potential of NLP, particularly Transformer-based models like BERT, to accurately detect goals-of-care and surrogate-designation conversations in clinical narratives. This study identified significant temporal patterns, including late documentation, and patient characteristics associated with these conversations. It highlights the value of high-dimensional data in enhancing our understanding of advance care planning and offers insights for improving patient-centered care in clinical settings. Future research should explore the integration of these models into clinical workflows to facilitate timely and effective advance care planning discussions.

Previous studies have focused on identifying risk factors for older adults receiving home healthcare services without considering vital signs. This may provide important information on deteriorating health conditions that may lead to hospitalization and/or emergency department (ED) visits. Thus, it is important to understand the relationship between vital signs and hospitalization and/or ED visits and critical vital sign points for mitigating the higher risks of hospitalization and/or ED visits. This secondary data analysis uses cross-sectional data from a large, urban home healthcare organization (n = 61,615). A generalized additive model was used to understand the nonlinear relationship between each vital sign and hospitalization and/or ED visits through three unadjusted and adjusted models, and to identify a critical vital sign point related to a higher risk of hospitalization and/or ED visits. A significant nonlinear relationship (effective degree of freedom >2.0) was found between systolic, diastolic blood pressure, heart rate, hospitalization, and/or ED visits. The critical inflection point for systolic blood pressure was 120.36 (SE 3.625, p < .001), diastolic blood pressure was 72.00 (SE 3.108, p < .001), and heart rate was 83.24 (SE 1.994, p = .052). Among all vital signs, the risk of hospitalization and/or ED visits sharply increased when an older adult's heart rate surpassed 83.24 bpm. Our findings reveal that vital signs may serve as a critical indicator of a patient's clinical condition, especially related to hospitalization and/or ED visit. Clinicians need to be cognizant of these critical thresholds for each vital sign and monitor any deviations from baseline to preempt adverse outcomes.