Australian Critical Care最新文献

{"title":"Accuracy of a visual analogue scale for screening anxiety and depression in patients admitted to an intensive care unit: A comparison with the Hospital Anxiety and Depression Scale","authors":"Anil P. Ramnani FCICM ,&nbsp;Lillian Armellin FCICM ,&nbsp;Sumeet Rai FCICM ,&nbsp;Misty Purdy BSW MCouns ,&nbsp;Elissa Jacobs MClinPsch ,&nbsp;Kush Deshpande FCICM","doi":"10.1016/j.aucc.2025.101526","DOIUrl":"10.1016/j.aucc.2025.101526","url":null,"abstract":"<div><h3>Background</h3><div>Survivors of intensive care unit (ICU) admissions frequently experience psychological distress, with anxiety and depression being particularly prevalent. While the Hospital Anxiety and Depression Scale (HADS) is a commonly used instrument for assessing these conditions, there is limited evidence comparing its effectiveness with simpler tools like the Visual Analogue Scale (VAS) in ICU settings.</div></div><div><h3>Objective</h3><div>The objective of this study was to compare the accuracy of the VAS with the HADS for screening anxiety and depression in ICU patients.</div></div><div><h3>Methods</h3><div>A prospective, single-centre observational cohort study was conducted in a tertiary ICU. Adult patients with an ICU length of stay exceeding 48 h were enrolled. Anxiety and depression symptoms were self-reported using both the VAS (0–10 scale) for pre-ICU and ICU stay and HADS (0–21 scale). Borderline and probable anxiety/depression were defined by HADS scores ≥8 and ≥ 11, respectively. Paired t-tests compared VAS scores before and during ICU stay. Receiver operating characteristic curve analysis assessed the accuracy of the VAS against that of the HADS, with optimal cut-off values determined using the nearest method and bootstrapped confidence intervals.</div></div><div><h3>Results</h3><div>Of 135 participants (response rate: 93.8%, mean age: 63 ± 16 years; 42% female, median Acute physiology and Chronic Health Evaluation II score: 15), 48.2% and 47.4% met criteria for anxiety and depression, respectively. No significant differences were observed in pre-ICU versus in-ICU VAS scores. The area under the receiver operating characteristic curve for in-ICU VAS was 0.77 and 0.79 for borderline and probable anxiety and 0.73 and 0.76 for borderline and probable depression, respectively. Optimal VAS cut-offs were 4 and 3 for borderline and probable anxiety and 4 and 2 for borderline and probable depression, respectively.</div></div><div><h3>Conclusion</h3><div>The VAS demonstrated acceptable discriminatory capability compared to the HADS and may serve as a rapid, effective screening tool for anxiety and depression in ICU patients. Given the high prevalence of these conditions, further research is warranted to validate these findings and explore clinical integration.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101526"},"PeriodicalIF":2.7,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146039876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do clinicians know how to use pulse oximetry? A scoping review","authors":"Malcolm Elliott RN, PhD ,&nbsp;Jessica Allardice RN, MNP, BBiomedSc","doi":"10.1016/j.aucc.2025.101521","DOIUrl":"10.1016/j.aucc.2025.101521","url":null,"abstract":"<div><h3>Aim</h3><div>The aim of this study was to scope published evidence on clinicians’ knowledge of pulse oximetry.</div></div><div><h3>Background</h3><div>Vital signs’ assessment is critical for the early detection of acute clinical deterioration. Oxygen saturation, measured using a pulse oximeter, is one of these signs. To use a pulse oximeter correctly, clinicians must have a thorough understanding of the principles underpinning this technology. Previous research has shown that clinicians often do not understand pulse oximetry at depth.</div></div><div><h3>Design</h3><div>A scoping review was conducted.</div></div><div><h3>Method</h3><div>A review of contemporary research was conducted to determine clinicians’ understanding of how to use a pulse oximeter. Eligibility criteria included studies published in English from 2019 onwards which examined clinicians’ knowledge of pulse oximetry. A search of CINAHL, MEDLINE, and PubMed databases identified 11 studies that met the inclusion criteria.</div></div><div><h3>Results</h3><div>Eleven relevant studies were identified. The findings of this review indicated that despite pulse oximeters being a commonly used clinical tool, clinicians using it often have little or no education regarding its use and therefore poor understanding of how to use it correctly.</div></div><div><h3>Discussion</h3><div>Clinicians’ knowledge of pulse oximetry continues to be poor. Undergraduate and clinical education focused on pulse oximetry is therefore needed to address this significant knowledge gap. Clinicians using pulse oximetry should reflect on their knowledge of this technology and not just basic user functions and address any gaps in their clinical knowledge.</div></div><div><h3>Conclusion</h3><div>Despite pulse oximetry being important for patient assessment, research indicates clinicians’ understanding of this technology remains poor. It is time for educators to address this significant knowledge gap.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101521"},"PeriodicalIF":2.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and influencing factors of medical adhesive–related skin injury in critically ill patients: A systematic review and meta-analysis","authors":"Jialin Chen MN, RN ,&nbsp;Ping Yu MN, CNS ,&nbsp;Lan Liu MN, RN ,&nbsp;Meiqing Chen BN, NP ,&nbsp;Xujun Yuan BN, CNS ,&nbsp;Yang Xu MN, RN ,&nbsp;Nina Wang BN, NP ,&nbsp;Min Zhu BN, NP","doi":"10.1016/j.aucc.2025.101524","DOIUrl":"10.1016/j.aucc.2025.101524","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to systematically analyse the incidence and influencing factors of medical adhesive–related skin injury (MARSI) in critically ill patients.</div></div><div><h3>Methods</h3><div>A systematic search of eight databases was conducted from their inception to October 10, 2025. Two trained researchers independently performed study screening, data extraction, and quality assessment. Statistical analyses were performed using R software. We performed meta-analyses to pool the incidence of MARSI and its influencing factors using a random-effect model. Subgroup and sensitivity analyses were conducted to explore heterogeneity and verify robustness.</div></div><div><h3>Results</h3><div>A total of 20 studies involving 4337 patients were included in this review. The pooled incidence of MARSI among intensive care unit patients was 25.21% (95% confidence interval [CI] = [17.99, 34.12]). Of all subtypes, skin stripping had the highest incidence, at 52.19% (95% CI = [39.69, 64.42]). This analysis identified eight factors significantly associated with MARSI: length of hospital stay (standardised mean difference = 0.562, 95% CI = [0.290, 0.835]), fever (odds ratio [OR] = 2.306, 95% CI = [1.540, 3.454]), skin oedema (OR = 5.739, 95% CI = [3.502, 9.405]), intravenous fluids (OR = 2.899, 95% CI = [1.550, 5.423]), mechanical ventilation (OR = 3.519, 95% CI = [2.128, 5.819]), sedatives (OR = 4.807, 95% CI = [1.798, 12.852]), antibiotics (OR = 2.427, 95% CI = [1.448, 4.066]), and Braden score (standardised mean difference = −0.424, 95% CI = [-0.635, −0.212]).</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis demonstrates a substantial incidence of MARSI in intensive care unit patients, with considerable variation in incidence rates across different MARSI subtypes. To mitigate the occurrence of MARSI, healthcare providers should prioritise early identification of at-risk patients based on established influencing factors.</div></div><div><h3>Registration</h3><div>This review protocol has been prospectively registered in the International Prospective Register of Systematic Reviews (CRD42024566852).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 2","pages":"Article 101524"},"PeriodicalIF":2.7,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors’ response to the letter “Prepared but stressed: Reconciling the paradox of caring for healthcare professional-patients”","authors":"Lynne Hunt RN, BN(Hons),&nbsp;Melissa Riegel RN, PhD,&nbsp;Robyn Gallagher RN, PhD,&nbsp;Thomas Buckley RN, PhD","doi":"10.1016/j.aucc.2025.101520","DOIUrl":"10.1016/j.aucc.2025.101520","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101520"},"PeriodicalIF":2.7,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of medical device alarms in intensive care units: A scoping review","authors":"Vivienne Leigh RN, MClinSc ,&nbsp;Carol Grech RN, PhD ,&nbsp;Allison Roderick RN, PhD ,&nbsp;Michelle A. Kelly RN, PhD ,&nbsp;Lemuel Pelentsov RN, PhD","doi":"10.1016/j.aucc.2025.101511","DOIUrl":"10.1016/j.aucc.2025.101511","url":null,"abstract":"<div><h3>Background</h3><div>The presence of medical device alarms in the intensive care unit (ICU) has increased significantly over the past decade due to technological advancements. A troubling paradox is that while alarms are designed to keep patients safe, the overabundance of noise and frequency of nonactionable alarms is associated with alarm fatigue in nurses.</div></div><div><h3>Objective</h3><div>The objectives of this study were to explore and describe the interventions and recommendations for alarm management of medical devices in the ICU environment.</div></div><div><h3>Methods</h3><div>This scoping review was conducted using the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.</div></div><div><h3>Data sources</h3><div>Data sources included APA PsycINFO (Ovid), EBSCO CINAHL, Elsevier Embase, Emcare (Ovid), Epistemonikos, MEDLINE (Ovid), PROSPERO, Elsevier Scopus (Ovid), and Clarivate Analytics Web of Science Core Collection from 1st January 2014 to 31st December 2024 and supplemented with hand searching of references from included studies.</div></div><div><h3>Results</h3><div>A total of 44 studies met the inclusion criteria: 28 were quantitative, 12 were qualitative, and four were mixed-method studies. The most common intervention utilised for the management of medical device alarms was clinical education followed by alarm customisation. A total of 150 recommendations to manage medical device alarms were made that were themed into a collaborative framework to guide improvements.</div></div><div><h3>Conclusions</h3><div>There is no single or easy intervention that will address the management of clinical alarms in the ICU. There is a strong need for shared responsibility across the critical care faculty that requires effective collaboration, ongoing involvement, and vigilance across whole multidisciplinary ICU team.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101511"},"PeriodicalIF":2.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145976471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of family resilience in intensive care unit settings: A grounded theory study integrating perspectives of healthcare professionals and families","authors":"Shunxia Sun Ph.D ,&nbsp;Caiping Song MD ,&nbsp;Li Guan MD ,&nbsp;Jin Yang PhD ,&nbsp;Jun Lan B.S.","doi":"10.1016/j.aucc.2025.101517","DOIUrl":"10.1016/j.aucc.2025.101517","url":null,"abstract":"<div><h3>Background</h3><div>Families of intensive care unit (ICU) patients face significant crises during their relatives’ critical illness. Family resilience plays a vital role in overcoming these challenges, yet theoretical frameworks for ICU family resilience remain understudied, limiting clinical interventions.</div></div><div><h3>Objectives</h3><div>The objectives of this study were to explore the development of family resilience in ICU settings from the perspectives of healthcare professionals and families and to construct a theoretical framework.</div></div><div><h3>Design</h3><div>A grounded theory study was conducted using Glaser and Strauss’ traditional approach.</div></div><div><h3>Settings</h3><div>The study was conducted in 10 ICUs across nine provinces/municipalities in China, including Beijing, Liaoning, Shandong, Zhejiang, Sichuan, Chongqing, Xizang, Hainan, and Guangdong, representing diverse geographical and cultural regions.</div></div><div><h3>Participants</h3><div>Data were collected from 21 ICU healthcare professionals (seven physicians and 14 nurses) and 36 members of 14 patient families. Healthcare professionals had 3–25 y of ICU experience.</div></div><div><h3>Methods</h3><div>Data were collected via in-depth or focus group interviews (both face-to-face and telephone). The constant comparative method was applied simultaneously to data from both groups to develop an integrated theoretical framework.</div></div><div><h3>Results</h3><div>The core issue identified was <em>the development of ICU family resilience</em>. There were nine conceptual codes and nine subconceptual codes. The theoretical framework integrates five theoretical codings: <em>conditions</em> (patient illness severity and family characteristics), <em>processes</em> (adaptive behaviour, interactive behaviour, and cultural factors), <em>covariance</em> (disease duration and economic burden), and <em>consequences</em> (adaptation vs. breakdown). Key adaptive behaviours included environmental, psychological, and functional adjustments. Interaction with professionals, patients, and social resources facilitated resilience. Cultural values and regional norms significantly influenced decision-making.</div></div><div><h3>Conclusion</h3><div>This study constructs a theoretical framework of ICU family resilience by integrating the complementary perspectives of healthcare professionals and families, modelling the roles of adaptive processes, professional–family interaction, and cultural context. The framework offers a holistic understanding of the phenomenon and has global applicability for guiding family-centred interventions in critical care.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101517"},"PeriodicalIF":2.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of family-involved sensory stimulation interventions on delirium outcomes: A systematic review and meta-analysis","authors":"Yuanyuan Jiang RN, MM ,&nbsp;Ruile Shen CP, PhD ,&nbsp;Yahan Song RN, BSc ,&nbsp;Jie Li RN, MM","doi":"10.1016/j.aucc.2025.101513","DOIUrl":"10.1016/j.aucc.2025.101513","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a severe neuropsychiatric syndrome characterised by a transient, fluctuating, altered mental state. Currently, family-involved sensory stimulation interventions have been explored for their effects on delirium outcomes. However, the existing evidence remains fragmented and has not been synthesised through a systematic and quantitative method.</div></div><div><h3>Objectives</h3><div>The aims of this review are to synthesise the current studies on family-involved sensory stimulation interventions and to determine their effects on delirium outcomes.</div></div><div><h3>Methods</h3><div>We comprehensively searched 11 electronic databases and reference lists until February 23, 2025. The Cochrane Collaboration’s tool was used to assess the risk of bias. Review Manager 5.4.1 (The Cochrane Collaboration, London, UK) was used to perform the quantitative analysis.</div></div><div><h3>Results</h3><div>In total, five randomised controlled trials involving 496 participants were included. Family-involved sensory stimulation interventions may reduce delirium incidence (odds ratio [OR] = 0.24; 95% confidence interval [CI]: 0.13 to 0.46; <em>P</em> &lt; 0.0001) and duration (standardised mean difference [SMD] = −2.68; 95% CI: −4.22 to −1.15; <em>P</em> = 0.0006). Both unisensory stimulation (incidence: OR = 0.28; 95% CI: 0.14 to 0.54; <em>P</em> = 0.0001; duration: SMD = −1.64; 95% CI: −1.90 to −1.38; <em>P</em> &lt; 0.00001) and multisensory stimulation (incidence: OR = 0.22; 95% CI: 0.07 to 0.67; <em>P</em> = 0.008; duration: SMD = −3.12; 95% CI: −5.80 to −0.43; <em>P =</em> 0.02) were associated with decreased delirium incidence and duration. Interventions lasting up to 3 days (OR = 0.18; 95% CI: 0.04 to 0.93; P = 0.04), as well as those lasting more than 3 days (OR = 0.35; 95% CI: 0.22 to 0.56; <em>P</em> &lt; 0.0001), were associated with decreased delirium incidence.</div></div><div><h3>Conclusions</h3><div>Family-involved sensory stimulation interventions may improve delirium outcomes in decreasing delirium incidence and duration. High-quality randomised controlled trials should further clarify their efficacy as well as assess the optimal dosage, feasibility, acceptability, and cost-effectiveness of these interventions in critical care.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101513"},"PeriodicalIF":2.7,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Being broken: A qualitative study exploring unexpected death in the Paediatric Intensive Care Unit and the family experience of care","authors":"Arielle Jolly RN, GradCert ClinNurs PICU ,&nbsp;Ashleigh E. Butler RN, PhD ,&nbsp;Simon Erickson MBBS, FRACP, FFICANZA, FCICM ,&nbsp;Kristen Gibbons PhD ,&nbsp;Kylie Davies RN, PhD ,&nbsp;Nick Williams MD, MBChB ,&nbsp;Yetunde Odutolu MBChB, FCICM ,&nbsp;Jacqueline Reid BscPsych, MEd ,&nbsp;Kelly Higgins RN, BSN ,&nbsp;Linda Thomas RN, GradCert ClinNurs Crit Care ,&nbsp;Fenella J. Gill RN, PhD, FACCCN ,&nbsp;The ANZICS Paediatric Study Group","doi":"10.1016/j.aucc.2025.101515","DOIUrl":"10.1016/j.aucc.2025.101515","url":null,"abstract":"<div><h3>Background</h3><div>The death of a child is a catastrophic event, and to experience this loss within the complex environment of a paediatric intensive care unit (PICU) can be highly traumatic for parents. With current bereavement literature heavily focused on children with known life-limiting conditions, the unique grief experience of unexpected child death is poorly understood.</div></div><div><h3>Aim</h3><div>The aim of this study was to increase understanding of bereaved family members’ experience of care in a PICU after the unexpected death of their child.</div></div><div><h3>Methods</h3><div>Two focus groups and two interviews were conducted with adult family members of children who had died unexpectedly in a tertiary PICU 6 months to 5 years prior. A qualitative, constructivist approach was adopted, utilising semistructured discussions following a facilitation guide underpinned by meaning reconstruction framework as the guiding grief theory. Data were analysed thematically.</div></div><div><h3>Results</h3><div>There were 15 participants, including four fathers, 10 mothers, and one family friend. Participants shared vivid and emotional recollections of the death of their child, with a central concept of <em>being broken.</em> Five key themes captured participants’ experience of care in the PICU including <em>respectful communication, meaningful time, memories we can live with, face(s) of</em> <em>support</em><em>,</em> and <em>involving the whole family.</em> Participants described well-delivered elements of care that supported their bereavement needs, as well as poorly delivered care that contributed to their feelings of <em>being broken.</em></div></div><div><h3>Conclusion</h3><div>Family members valued care that was respectfully communicated by a trusted clinician, provided choice over significant time periods and meaning-making opportunities at the end of life, and was inclusive of all family members. These insights offer guidance to improve PICU bereavement practices for unexpected deaths.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101515"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From nurse concerns to standardised nursing statements: Mapping intensive care unit intervention notes with clinical care classification","authors":"Yeonju Kim RN, MPH ,&nbsp;Yesol Kim RN, PhD ,&nbsp;Mona Choi RN, PhD","doi":"10.1016/j.aucc.2025.101518","DOIUrl":"10.1016/j.aucc.2025.101518","url":null,"abstract":"<div><h3>Background</h3><div>Patients in intensive care units (ICUs) are at high risk of clinical deterioration, and ICU nurses document their clinical judgements in the electronic medical record system, where documentation patterns can be operationalised as indirect indicators of nurses’ concerns. Despite their clinical importance, unstructured documentation hinders the representation of nurses’ concerns, underscoring the need for systematic approaches.</div></div><div><h3>Aim</h3><div>The aim of this study was to map unstructured intervention notes reflecting ICU nurses’ concerns into standardised nursing terminology such as the Clinical Care Classification (CCC) system.</div></div><div><h3>Methods</h3><div>This study utilised the Medical Information Mart for Intensive Care IV database. Intervention notes were defined as sentence-level documentation related to nursing interventions recorded during ICU stays. Nurses’ concern categories were defined based on the comprehensive literature review. The mapping process comprised (i) extraction of intervention notes; (ii) review of these notes based on nurses’ concerns; (iii) validation of the matched intervention notes and nurses’ concerns; and (iv) mapping of the validated notes to the CCC.</div></div><div><h3>Results</h3><div>Among 17 587 757 note entries from 39 904 ICU admissions, a total of 9 614 214 intervention-note entries from 39 711 ICU admissions were obtained. Given the data characteristic that notes were often repeated, 269 unique intervention notes, obtained after removing duplicates, were selected. Of the 269, 107 notes were matched with 15 concern categories and were then mapped into the CCC terms. A total of 63 CCC intervention codes were finalised, reflecting ICU nurses’ primary concerns with respiratory- and fluid-related clinical deterioration and predominantly addressed through direct nursing care.</div></div><div><h3>Conclusions</h3><div>Nurses’ concerns were successfully mapped to standardised terms. Based on theoretical knowledge and practical clinical insights, this study can contribute to transforming nurses’ concerns into quantifiable nursing data for decision support and strengthening the infrastructure for interoperable nursing data across healthcare settings.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101518"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and testing of implementation strategies to increase the use of midline catheters in a paediatric intensive care unit","authors":"Mark D. Weber MSN, RN, CRNP-AC, FCCM ,&nbsp;Warren Frankenberger PhD, RN ,&nbsp;Amanda J. Ullman PhD, RN ,&nbsp;Bingqing Zhang MPH ,&nbsp;Danielle Traynor MSN, RN ,&nbsp;Taylor Slocumb BA ,&nbsp;Kim Perry MS ,&nbsp;Eileen Nelson BSN, RN ,&nbsp;Amanda Watson BSN, RN ,&nbsp;Thomas W. Conlon MD ,&nbsp;Amanda Bettencourt PhD, RN","doi":"10.1016/j.aucc.2025.101514","DOIUrl":"10.1016/j.aucc.2025.101514","url":null,"abstract":"<div><h3>Background</h3><div>Paediatric critically ill patients are at risk of harm from central venous catheter overuse. We applied an implementation science approach to promote appropriate use of midline catheters. The aim of this study was to evaluate changes in clinician perceptions of midline catheters following the implementation of tailored intervention strategies and the effectiveness of implementation on midline use in the care of critically ill children.</div></div><div><h3>Methods</h3><div>We used a mixed-method, prehybrid/posthybrid implementation–effectiveness design in a 75-bed paediatric intensive care unit. The study included three phases: pre-implementation (July–August 2023), implementation (September 2023), and post-implementation (October–November 2023). Focus groups informed barrier/facilitator mapping using implementation frameworks to develop intervention strategies. Pre-implementation/post-implementation surveys included 36 items assessing clinician perceptions of midline acceptability, feasibility, and appropriateness domains. Midline catheter utilisation rates assessed clinical effectiveness, and balancing metrics included vascular access harm and midline failure rates.</div></div><div><h3>Findings</h3><div>Pre-implementation/post-implementation survey scores increased across all 36 items measuring midline perception (two items statistically significant in feasibility domain; <em>p</em> &lt; 0.05). Midline use increased, from 3% to 7.2% during implementation and to 4.3% post implementation, though increases were not statistically significant. No increase in vascular access harm occurred, and midline failure rates decreased from 57.1% during the preimplementation phase to 14.3% during the postimplementation phase.</div></div><div><h3>Conclusions</h3><div>A suite of tailored, theory-informed implementation intervention strategies supported and improved positive clinician perceptions of midline catheter utilisation. Clinical utilisation of midlines across implementation phases did not increase overall vascular access harm. The decrease in midline catheter device selection post-implementation highlights the need for sustained strategies. These findings offer a replicable framework for other paediatric settings to optimise vascular access device selection.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101514"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}