Pub Date : 2026-01-08DOI: 10.1016/j.aucc.2025.101512
Duncan Smith PhD, RN , Stephen McIntyre DClinPsy , Mandeep Sekhon PhD
Introduction
Patients who clinically deteriorate in acute hospital wards who do not receive optimal care are at risk of harm. Track-and-trigger tools have been implemented internationally to facilitate the detection of clinical deterioration and prompt a response. Despite these tools, patients continue to deteriorate without optimal care. To address this, a theory-based behaviour change intervention (the Promoting Recognition Of deterioraTion and EsCalaTion of care [PROTECT] intervention) was developed to promote detection and response behaviours from nursing staff. While the PROTECT intervention followed a robust development process, its acceptability to end-users (those who could receive or deliver it) was unknown.
Aim
The aim of this study was to prospectively evaluate the acceptability of the PROTECT intervention to end users in a research context.
Design
A mixed-method study was conducted with a sequential explanatory design underpinned by the theoretical framework of acceptability.
Methods
Ward-based nursing staff members and critical care outreach nurses from three hospitals were recruited. Research materials were developed using theoretical framework of acceptability constructs. Participants received a presentation about the PROTECT intervention before completing a questionnaire using a live poll. Questionnaire results, displayed in real time, guided which acceptability constructs were explored in a subsequent focus group. Participant’s demographics and questionnaire data were reported descriptively. Qualitative data were analysed using Framework Method.
Results
Research was conducted with 19 participants. The PROTECT intervention was rated as (highly) acceptable for four constructs (Affective Attitude, Perceived Effectiveness, Intervention Coherence, and Self-efficacy) and less acceptable for three constructs (Opportunity Costs [and Gains], Burden, and Ethicality). Participants praised the intervention’s multifaceted nature and the familiarity of components that aligned with the existing strategies. Concerns were raised about its potential for components to induce psychological harm and the burden of engaging with the intervention.
Conclusion
The PROTECT intervention was broadly rated as (very) acceptable, suggesting progression to delivery and piloting in acute hospitals is appropriate. Findings from this work will be used to refine the PROTECT intervention and inform development of the implementation package.
{"title":"Acceptability of a behaviour change intervention to improve care of clinically deteriorating patients on acute hospital wards: A theory-based mixed-methods study","authors":"Duncan Smith PhD, RN , Stephen McIntyre DClinPsy , Mandeep Sekhon PhD","doi":"10.1016/j.aucc.2025.101512","DOIUrl":"10.1016/j.aucc.2025.101512","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients who clinically deteriorate in acute hospital wards who do not receive optimal care are at risk of harm. Track-and-trigger tools have been implemented internationally to facilitate the detection of clinical deterioration and prompt a response. Despite these tools, patients continue to deteriorate without optimal care. To address this, a theory-based behaviour change intervention (the Promoting Recognition Of deterioraTion and EsCalaTion of care [PROTECT] intervention) was developed to promote detection and response behaviours from nursing staff. While the PROTECT intervention followed a robust development process, its acceptability to end-users (those who could receive or deliver it) was unknown.</div></div><div><h3>Aim</h3><div>The aim of this study was to prospectively evaluate the acceptability of the PROTECT intervention to end users in a research context.</div></div><div><h3>Design</h3><div>A mixed-method study was conducted with a sequential explanatory design underpinned by the theoretical framework of acceptability.</div></div><div><h3>Methods</h3><div>Ward-based nursing staff members and critical care outreach nurses from three hospitals were recruited. Research materials were developed using theoretical framework of acceptability constructs. Participants received a presentation about the PROTECT intervention before completing a questionnaire using a live poll. Questionnaire results, displayed in real time, guided which acceptability constructs were explored in a subsequent focus group. Participant’s demographics and questionnaire data were reported descriptively. Qualitative data were analysed using Framework Method.</div></div><div><h3>Results</h3><div>Research was conducted with 19 participants. The PROTECT intervention was rated as (highly) acceptable for four constructs (<em>Affective Attitude, Perceived Effectiveness, Intervention Coherence,</em> and <em>Self-efficacy</em>) and less acceptable for three constructs (<em>Opportunity Costs [and Gains], Burden,</em> and <em>Ethicality</em>)<em>.</em> Participants praised the intervention’s multifaceted nature and the familiarity of components that aligned with the existing strategies. Concerns were raised about its potential for components to induce psychological harm and the burden of engaging with the intervention.</div></div><div><h3>Conclusion</h3><div>The PROTECT intervention was broadly rated as (very) acceptable, suggesting progression to delivery and piloting in acute hospitals is appropriate. Findings from this work will be used to refine the PROTECT intervention and inform development of the implementation package.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101512"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924537","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}
Patients with high respiratory drive during mechanical ventilation (MV) may be at risk for ventilator-induced lung injury, making control crucial. While high respiratory drive is often associated with dyspnoea, the relationship remains unclear.
Objectives
We examined the relationship between three dyspnoea-rating scales and respiratory drive, as measured by airway occlusion pressure (P0.1), in patients receiving MV.
Methods
A prospective observational study was conducted in the intensive care unit between February 2020 and March 2022. Adults (aged ≥20 years) expected to require MV for over 24 h were included. Dyspnoea was assessed using the Respiratory Distress Observation Scale, Intensive Care-Respiratory Distress Observation Scale, and Mechanical Ventilation-Respiratory Distress Observation Scale. Respiratory drive was measured using P0.1. Measurements were taken at up to two time points between intensive care unit admission and day 4 by two independent investigators blinded to each other’s data. Pearson’s correlation coefficients were used to assess relationships between dyspnoea scales and P0.1.
Results
Of the 253 eligible patients, 131 were included, and 69 underwent P0.1 measurement. A total of 105 observation points were analysed. Weak negative correlations were found between the Respiratory Distress Observation Scale, Intensive Care-Respiratory Distress Observation Scale, and Mechanical Ventilation-Respiratory Distress Observation Scale and P0.1 (r = −0.293, p = 0.003; r = −0.240, p = 0.014; and r = −0.260, p = 0.008, respectively). Stratified analysis by baseline disease, severity, and sedation showed weak negative correlations only in the deep sedation group (r = −0.347, p = 0.020; r = −0.325, p = 0.029; and r = −0.352, p = 0.018, respectively), stronger than in the overall cohort. No significant correlations were found among groups stratified by disease or severity.
Conclusions
In patients with MV, weak negative correlations were observed between dyspnoea assessed with the three scales and respiratory drive measured by P0.1.
背景：机械通气（MV）期间高呼吸驱动的患者可能存在呼吸机诱发肺损伤的风险，因此控制至关重要。虽然高呼吸驱动常与呼吸困难有关，但两者之间的关系尚不清楚。目的：研究三个呼吸困难评分量表与呼吸驱动之间的关系，通过气道闭塞压（P0.1）来测量。方法于2020年2月至2022年3月在重症监护病房进行前瞻性观察研究。成人（年龄≥20岁）预计需要MV超过24小时。采用呼吸窘迫观察量表、重症监护-呼吸窘迫观察量表和机械通气-呼吸窘迫观察量表评估呼吸困难。采用P0.1测量呼吸驱动。在重症监护病房入院和第4天之间的两个时间点，由两名互不知情的独立调查人员进行测量。使用Pearson相关系数评估呼吸困难量表与P0.1之间的关系。结果253例符合条件的患者中，131例纳入，69例接受P0.1测量。共分析了105个观测点。呼吸窘迫观察量表、重症监护-呼吸窘迫观察量表和机械通气-呼吸窘迫观察量表之间呈弱负相关，p < 0.01 （r = - 0.293, p = 0.003; r = - 0.240, p = 0.014; r = - 0.260, p = 0.008）。基线疾病、严重程度和镇静的分层分析显示，只有深度镇静组存在弱负相关（r = - 0.347, p = 0.020; r = - 0.325, p = 0.029; r = - 0.352, p = 0.018），强于整个队列。按疾病或严重程度分层的组间未发现显著相关性。结论在MV患者中，用3种量表评估的呼吸困难与用P0.1测量的呼吸驱动呈弱负相关。
{"title":"Relationship between dyspnoea and respiratory drive in mechanically ventilated patients: A prospective observational study","authors":"Chie Hatozaki RN, MSN , Hideaki Sakuramoto RN, PhD , Gen Aikawa RN, PhD , Shunsuke Kobayashi RN, MSN , Tetsuya Hoshino MD, PhD , Yoshiaki Inoue MD, PhD","doi":"10.1016/j.aucc.2025.101508","DOIUrl":"10.1016/j.aucc.2025.101508","url":null,"abstract":"<div><h3>Background</h3><div>Patients with high respiratory drive during mechanical ventilation (MV) may be at risk for ventilator-induced lung injury, making control crucial. While high respiratory drive is often associated with dyspnoea, the relationship remains unclear.</div></div><div><h3>Objectives</h3><div>We examined the relationship between three dyspnoea-rating scales and respiratory drive, as measured by airway occlusion pressure (P0.1), in patients receiving MV.</div></div><div><h3>Methods</h3><div>A prospective observational study was conducted in the intensive care unit between February 2020 and March 2022. Adults (aged ≥20 years) expected to require MV for over 24 h were included. Dyspnoea was assessed using the Respiratory Distress Observation Scale, Intensive Care-Respiratory Distress Observation Scale, and Mechanical Ventilation-Respiratory Distress Observation Scale. Respiratory drive was measured using P0.1. Measurements were taken at up to two time points between intensive care unit admission and day 4 by two independent investigators blinded to each other’s data. Pearson’s correlation coefficients were used to assess relationships between dyspnoea scales and P0.1.</div></div><div><h3>Results</h3><div>Of the 253 eligible patients, 131 were included, and 69 underwent P0.1 measurement. A total of 105 observation points were analysed. Weak negative correlations were found between the Respiratory Distress Observation Scale, Intensive Care-Respiratory Distress Observation Scale, and Mechanical Ventilation-Respiratory Distress Observation Scale and P0.1 (<em>r</em> = −0.293, <em>p</em> = 0.003; r = −0.240, <em>p</em> = 0.014; and r = −0.260, <em>p</em> = 0.008, respectively). Stratified analysis by baseline disease, severity, and sedation showed weak negative correlations only in the deep sedation group (r = −0.347, <em>p</em> = 0.020; r = −0.325, <em>p</em> = 0.029; and <em>r</em> = −0.352, <em>p</em> = 0.018, respectively), stronger than in the overall cohort. No significant correlations were found among groups stratified by disease or severity.</div></div><div><h3>Conclusions</h3><div>In patients with MV, weak negative correlations were observed between dyspnoea assessed with the three scales and respiratory drive measured by P0.1.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101508"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924110","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}
Intensive care units (ICUs) are major contributors to waste production within the healthcare sector; however, implementing recycling initiatives in the ICU has several logistical barriers. The aim of this study was to assess the total amount of waste produced by the Flinders Medical Centre (FMC) ICU and the proportion of that waste suitable for alternative waste streams as well as staff perspectives before and after introduction of the waste diversion initiative.
Materials and methods
A waste audit was performed within the FMC ICU to quantify waste output and determine the suitability for individual items to be diverted from landfill to more sustainable streams. A survey was distributed to staff within the unit before and after implementation of the initiative to assess staff attitudes towards waste management practices.
Results
The audit demonstrated that the unit produces approximately 2000 kg of waste per week and that 92% (269/290) of the individual waste items produced were suitable for diversion from landfill to an alternative waste stream. In the pre-implementation survey, 95% (56/82) of respondents demonstrated an interest in increasing recycling within the unit and the most often reported barriers were lack of recycling facilities and inadequate information. In the post-implementation survey, 92% (49/53) of participants demonstrated an interest in continuing to increase recycling within the unit, 83% (44/53) of respondents reported improvements in the handling of waste within the unit, and 72% (38/53) felt the education was appropriate, while 79% (42/53) were confident in their ability to accurately dispose of waste in the correct stream.
Conclusions
The FMC ICU has the capacity to significantly reduce landfill waste via alternative waste streams. It was demonstrated that effective waste diversion is possible, and staff showed an ongoing interest in improving waste management practices before and after implementation of the changes.
{"title":"Assessing waste management, recycling practices, and staff attitudes towards recycling in a single-centre tertiary-level intensive care unit","authors":"Nicholas Brummer MD , Joanne McIntyre RN, MNSc , Ubbo Wiersema MBBS, FCICM , Xia Jin RN, MHlthAdmin , Shailesh Bihari PhD, FCICM","doi":"10.1016/j.aucc.2025.101509","DOIUrl":"10.1016/j.aucc.2025.101509","url":null,"abstract":"<div><h3>Introduction</h3><div>Intensive care units (ICUs) are major contributors to waste production within the healthcare sector; however, implementing recycling initiatives in the ICU has several logistical barriers. The aim of this study was to assess the total amount of waste produced by the Flinders Medical Centre (FMC) ICU and the proportion of that waste suitable for alternative waste streams as well as staff perspectives before and after introduction of the waste diversion initiative.</div></div><div><h3>Materials and methods</h3><div>A waste audit was performed within the FMC ICU to quantify waste output and determine the suitability for individual items to be diverted from landfill to more sustainable streams. A survey was distributed to staff within the unit before and after implementation of the initiative to assess staff attitudes towards waste management practices.</div></div><div><h3>Results</h3><div>The audit demonstrated that the unit produces approximately 2000 kg of waste per week and that 92% (269/290) of the individual waste items produced were suitable for diversion from landfill to an alternative waste stream. In the pre-implementation survey, 95% (56/82) of respondents demonstrated an interest in increasing recycling within the unit and the most often reported barriers were lack of recycling facilities and inadequate information. In the post-implementation survey, 92% (49/53) of participants demonstrated an interest in continuing to increase recycling within the unit, 83% (44/53) of respondents reported improvements in the handling of waste within the unit, and 72% (38/53) felt the education was appropriate, while 79% (42/53) were confident in their ability to accurately dispose of waste in the correct stream.</div></div><div><h3>Conclusions</h3><div>The FMC ICU has the capacity to significantly reduce landfill waste via alternative waste streams. It was demonstrated that effective waste diversion is possible, and staff showed an ongoing interest in improving waste management practices before and after implementation of the changes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101509"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924539","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}
Appropriate assessment of pain is essential to ensure effective treatment.
Objectives
The objective of this study was to determine the discriminative ability of the Behavioural Indicators of Pain Scale-Brain Injury (Escala de Conductas Indicadoras de Dolor-Daño Cerebral [ESCID-DC]) under different sedation levels (deep vs. light-to-moderate) and procedures in critically ill patients with acquired brain injury and disorders of consciousness.
Methods
A multicentre, observational study was conducted involving critically ill patients with acquired brain injury and an artificial airway unable to self-report. Patients with prior brain injuries, cognitive impairment, or any condition (clinical or pharmacological) affecting motor response were excluded. The ESCID-DC was administered 5 min before, during, and 15 min after performing painful procedures (tracheal suctioning, right/left nail bed pressure) and a nonpainful procedure (gauze pad rubbing). All assessments were repeated under deep and light-to-moderate sedation.
Results
A total of 418 patients (284 men; 68%) were enrolled. The mean (standard deviation) age was 56.2 (16.3) years. Pain was assessed in 369 patients under deep sedation and in 346 under light-to-moderate sedation. Median (interquartile range) Glasgow Coma Scale scores were 6 (4–7) and 8.5 (7–9) in the deep and light-to-moderate sedation groups, respectively. Under deep sedation, median pain scores during the suctioning and pressure procedures were, respectively, 3 (2–5) and 0 (0–2). Median ESCID-DC scores under light-to-moderate sedation during suctioning and right and left nail bed pressure were 6 (4–7), 3 (1–4), and 3 (1–5), respectively. The ESCID-DC score during the nonpainful procedure was 0. During tracheal suctioning, the discriminative ability of the ESCID-DC was adequate (area under the curve = 0.88; 95% confidence interval: 0.84–0.93), even in patients with very low levels of consciousness. For the pressure procedures, discriminative ability was adequate only when the Glasgow Coma Scale score was ≥5.
Conclusions
The discriminative ability of the ESCID-DC depends on the level of consciousness and type of procedure. In patients with a low level of consciousness, the scale has a limited capacity to detect pain during less painful procedures.
背景：适当的疼痛评估是确保有效治疗的必要条件。目的探讨获得性脑损伤及意识障碍危重患者在不同镇静水平（深度镇静与轻、中度镇静）和不同镇静程序下疼痛量表-脑损伤行为指标（Escala de传导指标Indicadoras de Dolor-Daño Cerebral [ESCID-DC]）的判别能力。方法采用多中心观察性研究方法，对无法自我报告的获得性脑损伤人工气道危重患者进行研究。既往有脑损伤、认知障碍或任何影响运动反应的情况（临床或药理学）的患者被排除在外。ESCID-DC分别在进行疼痛操作（气管吸引，右/左甲床压力）和无痛操作（纱布垫摩擦）前5分钟、中5分钟和15分钟后使用。在深度和轻度至中度镇静下重复所有评估。结果共纳入418例患者，其中男性284例，占68%。平均（标准差）年龄为56.2（16.3）岁。对369例深度镇静患者和346例轻度至中度镇静患者的疼痛进行了评估。深度镇静组和轻度至中度镇静组的格拉斯哥昏迷评分中位数（四分位数范围）分别为6（4-7）和8.5（7-9）。深度镇静下，抽吸和按压过程中疼痛评分中位数分别为3（2-5）和0（0 - 2）。抽吸时轻至中度镇静、左右甲床压力下ESCID-DC评分中位数分别为6（4-7）、3（1-4）、3（1-5）。无疼痛过程中ESCID-DC评分为0。在气管吸引过程中，即使在意识水平非常低的患者中，ESCID-DC的鉴别能力也是足够的（曲线下面积= 0.88；95%可信区间：0.84-0.93）。对于压力手术，只有当格拉斯哥昏迷量表评分≥5分时，判别能力才足够。结论ESCID-DC的识别能力与意识水平和手术类型有关。在意识水平较低的患者中，该量表在不那么痛苦的过程中检测疼痛的能力有限。
{"title":"Discriminative ability of the Behavioural Indicators of Pain Scale-Brain Injury (Escala de Conductas Indicadoras de Dolor-Daño Cerebral) according to level of sedation in critically ill patients with acquired brain injury and disorders of consciousness: A multicentre observational study","authors":"Candelas López-López RN, PhD , Gemma Robleda-Font RN, PhD , Ignacio Latorre-Marco RN , Montserrat Solís-Muñoz RN, PhD , María Carmen Sarabia-Cobo RN, PhD , Antonio Arranz-Esteban RN , Francisco Paredes-Garza RN, MSc , Aaron Castanera-Duro RN, PhD , Mónica Bragado-León RN , Emilia Romero de-San-Pío RN , Isabel Gil-Saaf RN , David Alonso-Crespo RN, MSc , Carolina Rojas-Ballines RN , María Teresa Pulido-Martos RN , Isabel Martínez-Yegles RN , Teresa Pérez-Pérez B.Sc, PhD","doi":"10.1016/j.aucc.2025.101510","DOIUrl":"10.1016/j.aucc.2025.101510","url":null,"abstract":"<div><h3>Background</h3><div>Appropriate assessment of pain is essential to ensure effective treatment.</div></div><div><h3>Objectives</h3><div>The objective of this study was to determine the discriminative ability of the Behavioural Indicators of Pain Scale-Brain Injury (Escala de Conductas Indicadoras de Dolor-Daño Cerebral [ESCID-DC]) under different sedation levels (deep vs. light-to-moderate) and procedures in critically ill patients with acquired brain injury and disorders of consciousness.</div></div><div><h3>Methods</h3><div>A multicentre, observational study was conducted involving critically ill patients with acquired brain injury and an artificial airway unable to self-report. Patients with prior brain injuries, cognitive impairment, or any condition (clinical or pharmacological) affecting motor response were excluded. The ESCID-DC was administered 5 min before, during, and 15 min after performing painful procedures (tracheal suctioning, right/left nail bed pressure) and a nonpainful procedure (gauze pad rubbing). All assessments were repeated under deep and light-to-moderate sedation.</div></div><div><h3>Results</h3><div>A total of 418 patients (284 men; 68%) were enrolled. The mean (standard deviation) age was 56.2 (16.3) years. Pain was assessed in 369 patients under deep sedation and in 346 under light-to-moderate sedation. Median (interquartile range) Glasgow Coma Scale scores were 6 (4–7) and 8.5 (7–9) in the deep and light-to-moderate sedation groups, respectively. Under deep sedation, median pain scores during the suctioning and pressure procedures were, respectively, 3 (2–5) and 0 (0–2). Median ESCID-DC scores under light-to-moderate sedation during suctioning and right and left nail bed pressure were 6 (4–7), 3 (1–4), and 3 (1–5), respectively. The ESCID-DC score during the nonpainful procedure was 0. During tracheal suctioning, the discriminative ability of the ESCID-DC was adequate (area under the curve = 0.88; 95% confidence interval: 0.84–0.93), even in patients with very low levels of consciousness. For the pressure procedures, discriminative ability was adequate only when the Glasgow Coma Scale score was ≥5.</div></div><div><h3>Conclusions</h3><div>The discriminative ability of the ESCID-DC depends on the level of consciousness and type of procedure. In patients with a low level of consciousness, the scale has a limited capacity to detect pain during less painful procedures.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101510"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924109","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}
Pub Date : 2026-01-08DOI: 10.1016/j.aucc.2025.101506
Ian Paul Hughes BVSc, BSc(Vet.), PhD, M.Biostats, Madeleen van der Merwe M.Biostats, Mark Jones BSc, PhD
{"title":"Response to methodological series: Advancing statistical rigour in critical care research—a call for quantified collaboration and precision-based sample rationale","authors":"Ian Paul Hughes BVSc, BSc(Vet.), PhD, M.Biostats, Madeleen van der Merwe M.Biostats, Mark Jones BSc, PhD","doi":"10.1016/j.aucc.2025.101506","DOIUrl":"10.1016/j.aucc.2025.101506","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101506"},"PeriodicalIF":2.7,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924103","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}
Pub Date : 2026-01-07DOI: 10.1016/j.aucc.2025.101507
Shyam Sundar Sah MD, Abhishek Kumbhalwar PhD
{"title":"Comment on “Critical care nurses’ lived experience of compassion fatigue in the intensive care unit: A phenomenological study”","authors":"Shyam Sundar Sah MD, Abhishek Kumbhalwar PhD","doi":"10.1016/j.aucc.2025.101507","DOIUrl":"10.1016/j.aucc.2025.101507","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101507"},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924104","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}
The objectives of this study were to explore nurses’ experiences and needs in implementing early mobilisation (EM) in adult intensive care units and also to provide recommendations to enhance the implementation of EM.
Methods
This meta-synthesis followed the Thomas and Harden approach. A systematic search was conducted in Web of Science, PubMed, Embase, and Scopus for studies published between March 1, 2015, and March 1, 2025. Qualitative studies published in peer-reviewed journals that examined nurses’ experiences and needs related to EM in adult intensive care units were eligible and included. Two reviewers independently screened and extracted data. All included studies were critically appraised using the Critical Appraisal Skills Programme tool.
Results
A total of 10 studies with 87 nurses were included. Three analytical themes and nine descriptive themes were identified. The first analytical theme, Systemic and Institutional Experiences, encompassed four descriptive themes: lack of institutional policies and adequate staffing, role ambiguity, time constraint due to workload, and lack of a standardised risk assessment tool. The second analytical theme, Interpersonal and Professional Experiences, included difficulties with patient engagement, lack of interdisciplinary teamwork, and insufficient leadership. The final analytical theme, Expressed Needs for Effective Implementation, reflected the need for training and the need for support and motivation.
Conclusions
This thematic synthesis reveals that nurses mostly encounter negative experiences when implementing EM, highlighting significant gaps and opportunities for improvement. To strengthen EM practices and optimise patient outcomes, it is crucial to equip nurses with structured, evidence-based education, clearly defined roles, sufficient resources, and a collaborative environment supported by hospital policymakers and administrators.
Registration
The review was registered on the International Prospective Register of Systematic Reviews with the number CRD420251006731.
目的探讨护士在成人重症监护病房实施早期动员（EM）的经验和需求，并为加强EM的实施提供建议。方法采用Thomas和Harden方法。在Web of Science、PubMed、Embase和Scopus中系统检索了2015年3月1日至2025年3月1日之间发表的研究。发表在同行评议期刊上的定性研究，检查了成人重症监护病房护士的经验和需求。两名审稿人独立筛选和提取数据。所有纳入的研究都使用批判性评估技能计划工具进行了批判性评估。结果共纳入10项研究，87名护士。确定了三个分析性主题和九个描述性主题。第一个分析主题“系统和机构经验”包括四个描述性主题：缺乏机构政策和适当的工作人员、作用不明确、工作量造成的时间限制和缺乏标准化的风险评估工具。第二个分析主题，人际和专业经验，包括病人参与的困难，缺乏跨学科的团队合作，和领导能力不足。最后的分析性主题“表示需要有效执行”反映了培训的需要以及支持和激励的需要。这一主题综合揭示了护士在实施电子病历时大多遇到负面经历，突出了显著的差距和改进机会。为了加强急诊实践并优化患者治疗效果，为护士提供结构化的循证教育、明确定义的角色、充足的资源以及由医院决策者和管理者支持的协作环境至关重要。该综述已在国际前瞻性系统综述注册中注册，注册号为CRD420251006731。
{"title":"Nurses’ experiences and needs in implementing early mobilisation in the adult intensive care unit: A qualitative meta-synthesis","authors":"Ewa Zuzanna Krzyż RN, PhD , Kai-Mei Chang RN , Iftitakhur Rohmah RN, PhD , Kath Peters RN, PhD , Lucie Ramjan RN, PhD , Hsiao-Yean Chiu RN, PhD","doi":"10.1016/j.aucc.2025.101516","DOIUrl":"10.1016/j.aucc.2025.101516","url":null,"abstract":"<div><h3>Objectives</h3><div>The objectives of this study were to explore nurses’ experiences and needs in implementing early mobilisation (EM) in adult intensive care units and also to provide recommendations to enhance the implementation of EM.</div></div><div><h3>Methods</h3><div>This meta-synthesis followed the Thomas and Harden approach. A systematic search was conducted in Web of Science, PubMed, Embase, and Scopus for studies published between March 1, 2015, and March 1, 2025. Qualitative studies published in peer-reviewed journals that examined nurses’ experiences and needs related to EM in adult intensive care units were eligible and included. Two reviewers independently screened and extracted data. All included studies were critically appraised using the Critical Appraisal Skills Programme tool.</div></div><div><h3>Results</h3><div>A total of 10 studies with 87 nurses were included. Three analytical themes and nine descriptive themes were identified. The first analytical theme, <em>Systemic and Institutional Experiences,</em> encompassed four descriptive themes: lack of institutional policies and adequate staffing, role ambiguity, time constraint due to workload, and lack of a standardised risk assessment tool. The second analytical theme, <em>Interpersonal and Professional Experiences</em>, included difficulties with patient engagement, lack of interdisciplinary teamwork, and insufficient leadership. The final analytical theme, <em>Expressed Needs for Effective Implementation</em>, reflected the need for training and the need for support and motivation.</div></div><div><h3>Conclusions</h3><div>This thematic synthesis reveals that nurses mostly encounter negative experiences when implementing EM, highlighting significant gaps and opportunities for improvement. To strengthen EM practices and optimise patient outcomes, it is crucial to equip nurses with structured, evidence-based education, clearly defined roles, sufficient resources, and a collaborative environment supported by hospital policymakers and administrators.</div></div><div><h3>Registration</h3><div>The review was registered on the International Prospective Register of Systematic Reviews with the number CRD420251006731.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101516"},"PeriodicalIF":2.7,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924107","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}
Pub Date : 2025-12-26DOI: 10.1016/j.aucc.2025.101500
Julie C. Reid PT, PhD , Joanna S. Semrau PhD , Heather K. O'Grady PhD , Jen Hoogenes MPH, MSc, MS, PhD , Jeniszka Gill MSc , Hibaa Hasan BSc , Sophie von Teichman MMedSc , Yelena Bogdanova PhD , Shannon McKenney , Olivia Sokol MA , Tania J. Pereira PhD , Vanessa Campes Dannenberg BScPT, MSc, PhD , Christopher Farley PT, MSc , Jose Colleti Junior MD PhD , Amal Deis MScA , David Williamson BPharm, MSc, PhD , Margaret Herridge MD , Michelle Kho PT, PhD
<div><h3>Introduction</h3><div>Before the pandemic, intensive care unit rehabilitation was common. However, for critically ill patients with COVID-19 infection, rehabilitation became secondary to lifesaving measures and managing scarce resources.</div></div><div><h3>Objective</h3><div>In this systematic review, we investigated the impact of rehabilitation for critically ill adults with COVID-19 infection on outcomes.</div></div><div><h3>Data sources</h3><div>Five electronic databases from 2020 to 2024 were searched for this study.</div></div><div><h3>Study selection</h3><div>Randomised controlled trials (RCTs) and nonrandomised studies of critically ill adults with COVID-19 infection receiving in-hospital rehabilitation interventions were included in this study.</div></div><div><h3>Data extraction and synthesis</h3><div>Two independent reviewers screened titles/abstracts and full texts. Intervention types were organised into 13 categories. We assessed completeness of study reporting using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and intervention reporting using the Consensus on Exercise Reporting Template. For RCTs, we assessed risk of bias, conducted meta-analyses using random-effect models, and evaluated certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.</div></div><div><h3>Main outcomes and measures</h3><div>There were 11 prespecified outcomes including physical function and resource utilisation.</div></div><div><h3>Results</h3><div>Sixty-eight studies (n = 50 observational, 8 RCTs, 4 experimental non-RCTs, and 6 other designs) enrolling 23,630 participants met inclusion criteria. Thirty-one reported interventions; mobility was the most common activity (74% of studies). Authors used 87 outcome measures at 57 reported time points. Strengthening the Reporting of Observational Studies in Epidemiology scores were adequate with >75% items reported. Mean Consensus on Exercise Reporting Template reporting for intervention (n = 45) was moderate (54% [23%]), and that for control groups (n = 11) was poor (48% [20%]). Risk of bias was low; very-low-certainty evidence showed that multidisciplinary functional and respiratory rehabilitation and bed cycling + tilt table may result in shorter duration of mechanical ventilation (2 RCTs, n = 116, intervention = 9.1 days, control = 11.7 days; standardised mean difference: 0.44 days [95% confidence interval: −0.81 to-0.07]) and shorter hospital length of stay (three RCTs, n = 116, intervention = 17.6-days, control = 26.2-days; standardised mean difference: 2 days [95% confidence interval: –4.22 to 0.04]).</div></div><div><h3>Conclusions and relevance</h3><div>Based on very-low-certainty evidence, rehabilitation may lead to shorter mechanical ventilation duration and hospital length of stay. Substantial heterogeneity across interventions, outcomes, and time points limited evidence synthesis. This review may aid
{"title":"Rehabilitation in critically ill patients with COVID-19 infection: A systematic review and meta-analysis","authors":"Julie C. Reid PT, PhD , Joanna S. Semrau PhD , Heather K. O'Grady PhD , Jen Hoogenes MPH, MSc, MS, PhD , Jeniszka Gill MSc , Hibaa Hasan BSc , Sophie von Teichman MMedSc , Yelena Bogdanova PhD , Shannon McKenney , Olivia Sokol MA , Tania J. Pereira PhD , Vanessa Campes Dannenberg BScPT, MSc, PhD , Christopher Farley PT, MSc , Jose Colleti Junior MD PhD , Amal Deis MScA , David Williamson BPharm, MSc, PhD , Margaret Herridge MD , Michelle Kho PT, PhD","doi":"10.1016/j.aucc.2025.101500","DOIUrl":"10.1016/j.aucc.2025.101500","url":null,"abstract":"<div><h3>Introduction</h3><div>Before the pandemic, intensive care unit rehabilitation was common. However, for critically ill patients with COVID-19 infection, rehabilitation became secondary to lifesaving measures and managing scarce resources.</div></div><div><h3>Objective</h3><div>In this systematic review, we investigated the impact of rehabilitation for critically ill adults with COVID-19 infection on outcomes.</div></div><div><h3>Data sources</h3><div>Five electronic databases from 2020 to 2024 were searched for this study.</div></div><div><h3>Study selection</h3><div>Randomised controlled trials (RCTs) and nonrandomised studies of critically ill adults with COVID-19 infection receiving in-hospital rehabilitation interventions were included in this study.</div></div><div><h3>Data extraction and synthesis</h3><div>Two independent reviewers screened titles/abstracts and full texts. Intervention types were organised into 13 categories. We assessed completeness of study reporting using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and intervention reporting using the Consensus on Exercise Reporting Template. For RCTs, we assessed risk of bias, conducted meta-analyses using random-effect models, and evaluated certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.</div></div><div><h3>Main outcomes and measures</h3><div>There were 11 prespecified outcomes including physical function and resource utilisation.</div></div><div><h3>Results</h3><div>Sixty-eight studies (n = 50 observational, 8 RCTs, 4 experimental non-RCTs, and 6 other designs) enrolling 23,630 participants met inclusion criteria. Thirty-one reported interventions; mobility was the most common activity (74% of studies). Authors used 87 outcome measures at 57 reported time points. Strengthening the Reporting of Observational Studies in Epidemiology scores were adequate with >75% items reported. Mean Consensus on Exercise Reporting Template reporting for intervention (n = 45) was moderate (54% [23%]), and that for control groups (n = 11) was poor (48% [20%]). Risk of bias was low; very-low-certainty evidence showed that multidisciplinary functional and respiratory rehabilitation and bed cycling + tilt table may result in shorter duration of mechanical ventilation (2 RCTs, n = 116, intervention = 9.1 days, control = 11.7 days; standardised mean difference: 0.44 days [95% confidence interval: −0.81 to-0.07]) and shorter hospital length of stay (three RCTs, n = 116, intervention = 17.6-days, control = 26.2-days; standardised mean difference: 2 days [95% confidence interval: –4.22 to 0.04]).</div></div><div><h3>Conclusions and relevance</h3><div>Based on very-low-certainty evidence, rehabilitation may lead to shorter mechanical ventilation duration and hospital length of stay. Substantial heterogeneity across interventions, outcomes, and time points limited evidence synthesis. This review may aid ","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"39 1","pages":"Article 101500"},"PeriodicalIF":2.7,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839376","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}
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