Pub Date : 2025-01-01DOI: 10.1016/j.aucc.2024.05.010
Melissa J. Bloomer RN, PhD , Laura A. Brooks RN, MN , Alysia Coventry RN, MPhil , Kristen Ranse RN, PhD , Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Car) , Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care)
Introduction
Australian organ and tissue donation rates are low compared to other countries. Acknowledging that donation practices vary across Australia, the Australian College of Critical Care Nurses supported the development of a position statement to explicate critical care nurses’ role in supporting organ and tissue donation. Several Australian peak professional organisations provide guidance to inform and support organ and tissue donation.
Aim
The aim of this study was to develop a position statement using contemporary Australian research evidence to build upon and complement existing guidance, focussing on the role of critical care nurses in organ and tissue donation in Australian critical care.
Method
An approach similar to a rapid review was used, providing a streamlined approach to synthesising evidence. A comprehensive search using Medical Subject Headings, keywords, and synonyms was undertaken using Medline and CINAHL Complete via EBSCOhost to identify peer-reviewed Australian research evidence about critical care nurses’ role, obligations, expectations, and scope of practice during organ and tissue donation. Narrative synthesis was used to synthesise the research evidence.
Findings
The importance of separating death from organ donation in discussions with family, the timing and the approach to organ donation conversations, and working in collaboration with the DonateLife Donation Specialist Nurses were identified. The importance of understanding family perspectives, caring for families, and collegial support for critical care clinicians were also identified. With the guidance of peak professional organisations, the research evidence was then used to develop practice recommendations for critical care units, leaders, and critical care nurses.
Discussion and conclusion
The recommendations explicate the important contribution critical care nurses can make to ensuring timely, sensitive communication, providing high-quality end-of-life care, supporting families irrespective of the donation decision and supporting colleagues from the wider critical care team, thereby optimising the processes related to organ and tissue donation in Australian critical care settings.
导言：与其他国家相比，澳大利亚的器官和组织捐献率较低。澳大利亚重症监护护士学院（Australian College of Critical Care Nurses）认识到澳大利亚各地的捐献实践各不相同，因此支持制定一份立场声明，阐述重症监护护士在支持器官和组织捐献中的作用。目的：本研究的目的是利用澳大利亚当代的研究证据制定一份立场声明，以现有指南为基础并加以补充，重点关注重症监护护士在澳大利亚重症监护的器官和组织捐献中的作用：方法：采用了类似于快速审查的方法，提供了一种简化的证据综合方法。通过EBSCOhost使用Medline和CINAHL Complete对医学主题词、关键词和同义词进行了全面检索，以确定经同行评审的澳大利亚研究证据，这些证据涉及重症监护护士在器官和组织捐献过程中的角色、义务、期望和实践范围。对研究证据进行了叙事综合：确定了在与家属讨论时将死亡与器官捐献分开的重要性、器官捐献对话的时机和方法，以及与捐献生命捐献专科护士合作的重要性。此外，还确定了了解家属观点、关爱家属以及为重症监护临床医生提供同事支持的重要性。在高峰专业组织的指导下，研究证据被用于为重症监护病房、领导者和重症监护护士制定实践建议：这些建议阐述了重症监护护士在确保及时、敏感的沟通，提供高质量的临终关怀，无论捐赠决定如何都为家属提供支持，以及为更广泛的重症监护团队的同事提供支持方面可以做出的重要贡献，从而优化澳大利亚重症监护环境中与器官和组织捐赠相关的流程。
{"title":"The role of critical care nurses in organ and tissue donation: A position statement of the Australian College of Critical Care Nurses","authors":"Melissa J. Bloomer RN, PhD , Laura A. Brooks RN, MN , Alysia Coventry RN, MPhil , Kristen Ranse RN, PhD , Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Car) , Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care)","doi":"10.1016/j.aucc.2024.05.010","DOIUrl":"10.1016/j.aucc.2024.05.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Australian organ and tissue donation rates are low compared to other countries. Acknowledging that donation practices vary across Australia, the Australian College of Critical Care Nurses supported the development of a position statement to explicate critical care nurses’ role in supporting organ and tissue donation. Several Australian peak professional organisations provide guidance to inform and support organ and tissue donation.</div></div><div><h3>Aim</h3><div>The aim of this study was to develop a position statement using contemporary Australian research evidence to build upon and complement existing guidance, focussing on the role of critical care nurses in organ and tissue donation in Australian critical care.</div></div><div><h3>Method</h3><div><span>An approach similar to a rapid review was used, providing a streamlined approach to synthesising evidence. A comprehensive search using Medical Subject Headings, keywords, and synonyms was undertaken using Medline and CINAHL Complete via EBSCOhost to identify peer-reviewed Australian research evidence about critical care nurses’ role, obligations, expectations, and </span>scope of practice during organ and tissue donation. Narrative synthesis was used to synthesise the research evidence.</div></div><div><h3>Findings</h3><div>The importance of separating death from organ donation in discussions with family, the timing and the approach to organ donation conversations, and working in collaboration with the DonateLife Donation Specialist Nurses were identified. The importance of understanding family perspectives, caring for families, and collegial support for critical care clinicians were also identified. With the guidance of peak professional organisations, the research evidence was then used to develop practice recommendations for critical care units, leaders, and critical care nurses.</div></div><div><h3>Discussion and conclusion</h3><div>The recommendations explicate the important contribution critical care nurses can make to ensuring timely, sensitive communication, providing high-quality end-of-life care, supporting families irrespective of the donation decision and supporting colleagues from the wider critical care team, thereby optimising the processes related to organ and tissue donation in Australian critical care settings.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101073"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141328064","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}
Early mobilisation interventions play a role in preventing intensive care unit–acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions.
Objectives
The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients.
Methods
A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.
Results
Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted.
Conclusions
Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.
{"title":"Exploring critically ill patients’ functional recovery through family partnerships: A descriptive qualitative study","authors":"Julie Cussen MN, BN , Sasithorn Mukpradab RN, PhD , Georgia Tobiano RN, PhD , Kimberley J. Haines BHSc, PhD , Lauren O’Connor MPhil, BPhty , Andrea P. Marshall RN, PhD","doi":"10.1016/j.aucc.2024.06.007","DOIUrl":"10.1016/j.aucc.2024.06.007","url":null,"abstract":"<div><h3>Background</h3><div>Early mobilisation interventions play a role in preventing intensive care unit–acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions.</div></div><div><h3>Objectives</h3><div>The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients.</div></div><div><h3>Methods</h3><div>A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines.</div></div><div><h3>Results</h3><div>Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted.</div></div><div><h3>Conclusions</h3><div>Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101084"},"PeriodicalIF":2.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898933","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}
Despite syntheses of evidence showing efficacy of music intervention for improving psychological and physiological outcomes in critically ill patients, interventions that include nonmusic sounds have not been addressed in reviews of evidence. It is unclear if nonmusic sounds in the intensive care unit (ICU) can confer benefits similar to those of music.
Objective
The aim of this study was to summarise and contrast available evidence on the effect of music and nonmusic sound interventions for the physiological and psychological outcomes of ICU patients based on the results of randomised controlled trials.
Methods
This systematic review was directed by a protocol based on the Methodological Expectations of Cochrane Intervention Reviews. Quality of studies was assessed with the Cochrane risk of bias assessment tool. Searches were performed in the following databases: MEDLINE, Embase, APA PsycInfo, CINAHL Plus with Full Text, Academic Search Complete, RILM Abstracts of Music Literature, Web of Science, and Scopus.
Results
We identified 59 articles meeting the inclusion criteria, 37 involving music and 22 involving nonmusic sound interventions, with one study comparing music and sound. The identified studies were representative of a general ICU population, regardless of patients’ ability to communicate. Our review demonstrated that both slow-tempo music and sound interventions can significantly (i) decrease pain; (ii) improve sleep; (iii) regulate cortisol levels; (iv) reduce sedative and analgesic need; and (v) reduce stress/anxiety and improve relaxation when compared with standard care and noise reduction. Moreover, compared to nonmusic sound interventions, there is more evidence that music interventions have an effect on stress biomarkers, vital signs, and haemodynamic measures.
Conclusion
These results raise the possibility that different auditory interventions may have varying degrees of effectiveness for specific patient outcomes in the ICU. More investigation is needed to clarify if nonmusic sound interventions may be equivalent or not to music interventions for the management of discrete symptoms in ICU patients.
Registration of reviews
The protocol was registered on Open Science Framework in November 6 2023 (https://doi.org/10.17605/OSF.IO/45F6E).
背景：尽管综合证据表明音乐干预对改善危重患者心理和生理结果的有效性，但包括非音乐声音在内的干预措施尚未在证据综述中得到解决。目前尚不清楚重症监护病房（ICU）的非音乐声音是否能带来与音乐类似的好处。目的：本研究的目的是总结和对比基于随机对照试验结果的音乐和非音乐声音干预对ICU患者生理和心理结局的影响的现有证据。方法：本系统评价采用基于Cochrane干预评价方法学期望的方案。采用Cochrane偏倚风险评估工具评估研究质量。在以下数据库中进行检索：MEDLINE， Embase, APA PsycInfo, CINAHL Plus with Full Text, Academic Search Complete, RILM Abstracts of Music Literature， Web of Science和Scopus。结果：我们确定了59篇符合纳入标准的文章，其中37篇涉及音乐，22篇涉及非音乐声音干预，其中一项研究比较了音乐和声音。所确定的研究代表了普通ICU人群，而不考虑患者的沟通能力。我们的回顾表明，慢节奏音乐和声音干预都可以显著地(1)减轻疼痛；（ii）改善睡眠；（iii）调节皮质醇水平；（iv）减少镇静和镇痛的需要；(v)与标准护理和降噪相比，减少压力/焦虑，改善放松。此外，与非音乐声音干预相比，有更多证据表明音乐干预对压力生物标志物、生命体征和血流动力学指标有影响。结论：这些结果提出了不同的听觉干预可能对ICU特定患者结局有不同程度的有效性的可能性。需要更多的研究来澄清非音乐声音干预是否等同于音乐干预对ICU患者离散症状的管理。审查注册：该方案于2023年11月6日在开放科学框架（https://doi.org/10.17605/OSF.IO/45F6E）上注册。
{"title":"A systematic review of the comparative effects of sound and music interventions for intensive care unit patients’ outcomes","authors":"Elizabeth Papathanassoglou RN, PhD , Usha Pant RN, MN , Shaista Meghani RN, PhD , Neelam Saleem Punjani RN, PhD , Yuluan Wang MSc Rehabilitation Science, MLT, CCW , Tiffany Brulotte MTA, MA , Krooti Vyas RN, BScN (Hons) , Liz Dennett MLIS , Lucinda Johnston MTA, MLIS , Demetrios James Kutsogiannis MD, PhD , Stephanie Plamondon MD FRCPC , Michael Frishkopf PhD","doi":"10.1016/j.aucc.2024.101148","DOIUrl":"10.1016/j.aucc.2024.101148","url":null,"abstract":"<div><h3>Background</h3><div>Despite syntheses of evidence showing efficacy of music intervention for improving psychological and physiological outcomes in critically ill patients, interventions that include nonmusic sounds have not been addressed in reviews of evidence. It is unclear if nonmusic sounds in the intensive care unit (ICU) can confer benefits similar to those of music.</div></div><div><h3>Objective</h3><div>The aim of this study was to summarise and contrast available evidence on the effect of music and nonmusic sound interventions for the physiological and psychological outcomes of ICU patients based on the results of randomised controlled trials.</div></div><div><h3>Methods</h3><div>This systematic review was directed by a protocol based on the Methodological Expectations of Cochrane Intervention Reviews. Quality of studies was assessed with the Cochrane risk of bias assessment tool. Searches were performed in the following databases: MEDLINE, Embase, APA PsycInfo, CINAHL Plus with Full Text, Academic Search Complete, RILM Abstracts of Music Literature, Web of Science, and Scopus.</div></div><div><h3>Results</h3><div>We identified 59 articles meeting the inclusion criteria, 37 involving music and 22 involving nonmusic sound interventions, with one study comparing music and sound. The identified studies were representative of a general ICU population, regardless of patients’ ability to communicate. Our review demonstrated that both slow-tempo music and sound interventions can significantly (i) decrease pain; (ii) improve sleep; (iii) regulate cortisol levels; (iv) reduce sedative and analgesic need; and (v) reduce stress/anxiety and improve relaxation when compared with standard care and noise reduction. Moreover, compared to nonmusic sound interventions, there is more evidence that music interventions have an effect on stress biomarkers, vital signs, and haemodynamic measures.</div></div><div><h3>Conclusion</h3><div>These results raise the possibility that different auditory interventions may have varying degrees of effectiveness for specific patient outcomes in the ICU. More investigation is needed to clarify if nonmusic sound interventions may be equivalent or not to music interventions for the management of discrete symptoms in ICU patients.</div></div><div><h3>Registration of reviews</h3><div>The protocol was registered on Open Science Framework in November 6 2023 (<span><span>https://doi.org/10.17605/OSF.IO/45F6E</span><svg><path></path></svg></span>).</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101148"},"PeriodicalIF":2.6,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-16DOI: 10.1016/j.aucc.2024.101147
Tania Lovell RN, MPH/HM , Marion Mitchell RN, PhD , Madeleine Powell RN, MPH/HM , Petra Strube RN, MN , Angela Tonge BSW, Grad Cert Hlth Studies (Loss & Grief) , Kylie O’Neill RN, MN , Elspeth Dunstan RN, MN , Amity Bonnin-Trickett RN, Grad Cert (Critical Care) , Elizabeth Miller B BEH SC (Hons Psych) , Adam Suliman MB , Tamara Ownsworth PhD , Kristen Ranse RN, PhD
Background
The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period.
Objectives
This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians’ perceptions of EOLC.
Methods
A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Mann–Whitney U tests for non-normally distributed data.
Findings
A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t282 = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians’ work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement.
Conclusions
The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high-quality EOLC for patients, families, and clinicians in the ICU.
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Pub Date : 2024-12-16DOI: 10.1016/j.aucc.2024.101150
Hasan M. Al-Dorzi MD , Yasser A. AlRumih MBBS , Mohammed Alqahtani MBBS , Mutaz H. Althobaiti MBBS , Thamer T. Alanazi MD , Kenana Owaidah MBBS , Saud N. Alotaibi MBBS , Monirah Alnasser MBBS, MPH , Abdulaziz M. Abdulaal MBBS , Turki Z. Al Harbi MBBS , Ahmad O. AlBalbisi MBBS , Saad Al-Qahtani MD , Yaseen M. Arabi MD, FCCP, FCCM, ATSF
Background
The systolic shock index (SSI) is used to direct management and predict outcomes, but its utility in patients requiring rapid response team (RRT) activation is unclear.
Objectives
We explored whether SSI can predict the outcomes of ward patients experiencing clinical deterioration and compared its performance with other parameters.
Methods
This retrospective study included adult patients in medical/surgical wards who required RRT activation. We calculated SSI (heart rate/systolic blood pressure [BP]), diastolic shock index (DSI, heart rate/diastolic BP), modified shock index (heart rate/mean BP), and quick Sequential Organ Failure Assessment (qSOFA) score at activation. We categorised patients into two groups (SSI: ≥1.0 and <1.0). We performed univariate and multivariable logistic regression analyses to evaluate the association of SSI with intensive care unit (ICU) admission, vasopressor therapy, and in-hospital mortality. The covariates included demographics, comorbidities, and reasons for RRT activation.
Results
Among the 837 study patients, 297 (35.5%) had an SSI ≥1.0. On univariate analysis, SSI was associated with vasopressor therapy (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.40–2.99) but not ICU admission or in-hospital mortality. On multivariable logistic regression analysis, an SSI ≥1.0 was associated with ICU admission (adjusted OR: 1.55, 95% CI: 1.05–2.28), vasopressor therapy (adjusted OR: 3.05, 95% CI: 1.86–5.00), and in-hospital mortality (adjusted OR: 2.18, 95% CI: 1.42–3.33). A systolic BP <90 mmHg, mean BP < 65 mmHg, and qSOFA score ≥2 were associated with these outcomes in univariate and multivariable regression analyses (adjusted ORs close to those of SSI). Separate receiver operating characteristic curve analysis found that SSI, diastolic shock index, and modified shock index poorly discriminated between survivors and nonsurvivors (area under the curve: <0.60 for all).
Conclusions
In ward patients experiencing clinical deterioration, an SSI ≥1.0 was associated with adverse outcomes but did not perform better than systolic and mean BP and qSOFA. This limits its standalone clinical utility in these patients.
{"title":"The clinical utility of shock index in hospitalised patients requiring activation of the rapid response team","authors":"Hasan M. Al-Dorzi MD , Yasser A. AlRumih MBBS , Mohammed Alqahtani MBBS , Mutaz H. Althobaiti MBBS , Thamer T. Alanazi MD , Kenana Owaidah MBBS , Saud N. Alotaibi MBBS , Monirah Alnasser MBBS, MPH , Abdulaziz M. Abdulaal MBBS , Turki Z. Al Harbi MBBS , Ahmad O. AlBalbisi MBBS , Saad Al-Qahtani MD , Yaseen M. Arabi MD, FCCP, FCCM, ATSF","doi":"10.1016/j.aucc.2024.101150","DOIUrl":"10.1016/j.aucc.2024.101150","url":null,"abstract":"<div><h3>Background</h3><div>The systolic shock index (SSI) is used to direct management and predict outcomes, but its utility in patients requiring rapid response team (RRT) activation is unclear.</div></div><div><h3>Objectives</h3><div>We explored whether SSI can predict the outcomes of ward patients experiencing clinical deterioration and compared its performance with other parameters.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients in medical/surgical wards who required RRT activation. We calculated SSI (heart rate/systolic blood pressure [BP]), diastolic shock index (DSI, heart rate/diastolic BP), modified shock index (heart rate/mean BP), and quick Sequential Organ Failure Assessment (qSOFA) score at activation. We categorised patients into two groups (SSI: ≥1.0 and <1.0). We performed univariate and multivariable logistic regression analyses to evaluate the association of SSI with intensive care unit (ICU) admission, vasopressor therapy, and in-hospital mortality. The covariates included demographics, comorbidities, and reasons for RRT activation.</div></div><div><h3>Results</h3><div>Among the 837 study patients, 297 (35.5%) had an SSI ≥1.0. On univariate analysis, SSI was associated with vasopressor therapy (odds ratio [OR]: 2.04, 95% confidence interval [CI]: 1.40–2.99) but not ICU admission or in-hospital mortality. On multivariable logistic regression analysis, an SSI ≥1.0 was associated with ICU admission (adjusted OR: 1.55, 95% CI: 1.05–2.28), vasopressor therapy (adjusted OR: 3.05, 95% CI: 1.86–5.00), and in-hospital mortality (adjusted OR: 2.18, 95% CI: 1.42–3.33). A systolic BP <90 mmHg, mean BP < 65 mmHg, and qSOFA score ≥2 were associated with these outcomes in univariate and multivariable regression analyses (adjusted ORs close to those of SSI). Separate receiver operating characteristic curve analysis found that SSI, diastolic shock index, and modified shock index poorly discriminated between survivors and nonsurvivors (area under the curve: <0.60 for all).</div></div><div><h3>Conclusions</h3><div>In ward patients experiencing clinical deterioration, an SSI ≥1.0 was associated with adverse outcomes but did not perform better than systolic and mean BP and qSOFA. This limits its standalone clinical utility in these patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101150"},"PeriodicalIF":2.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-11DOI: 10.1016/j.aucc.2024.09.012
Deanne August RN, PhD , Isabel Byram BBus, BFA , David Forrestal BEng, PhD , Mathilde Desselle MEng, PhD , Nathan Stevenson BEng, PhD , Kartik Iyer BEng, PhD , Mark W. Davies MBBS, PhD , Katherine White MBBS , Linda Cobbald BN, PGCertNg , Lynette Chapple BN, GradDipNg , Kellie McGrory CN, CertAdvNg , Margaret McLean BN , Stephanie Hall Bn, MNursPrac , Brittany Schoenmaker BN, MClinNurs , Jackie Clement BN, GradDipNg , Melissa M. Lai MBBS, PhD
Background
Nasal continuous positive airway pressure (CPAP) injuries are common for premature infants. Clinical use of three-dimensional (3D) scanning is established in adult medicine, but the possibilities in neonatal care are still emerging. Custom printed CPAP devices have the potential to reduce injuries and disfigurement in this vulnerable population.
Aim
We sought to identify the most feasible portable 3D scanner for use in the neonatal intensive care environment towards the development of custom-fitting CPAP devices for premature infants.
Methods
Four handheld 3D scanners were assessed and compared, Artec Leo, Revopoint POP 2, iPad Pro/Metascan, and iPhone/Scandy Pro. Trained neonatal clinicians (medical and nursing) undertook mock scans in a simulated neonatal intensive care environment.
Results
Sixty scans were performed by 13 neonatal clinicians (four medical/nurse practitioners and nine nurses). The median mean absolute error was 0.21 mm (interquartile range [IQR]: 0.19–0.26), 0.17 mm (IQR: 0.15–0.21), and 1.08 mm (IQR: 1.0–1.63) for Artec Leo, Revopoint POP 2, and Scandy Pro, respectively. Scan times were the quickest for Artec Leo at 22.9 sec (IQR: 18.5–27), followed by Revopoint POP 2 at 25.2 sec (IQR: 22–34.4). Artec Leo was rated most expensive, but Revopoint POP 2 was rated more ergonomic. Both app-based 3D scanners (Metascan and Scandy Pro) presented data security issues.
Conclusions
Artec Leo and Revopoint POP 2 were identified as most feasible for use to perform 3D scans on premature infants in the neonatal intensive care environment.
背景：鼻腔持续气道正压通气（CPAP）损伤在早产儿中很常见。临床使用三维（3D）扫描是建立在成人医学，但在新生儿护理的可能性仍在出现。定制打印CPAP设备有可能减少这一弱势群体的伤害和毁容。目的：我们试图确定最可行的便携式3D扫描仪用于新生儿重症监护环境，以开发适合早产儿的定制CPAP设备。方法：对Artec Leo、revpoint POP 2、iPad Pro/Metascan和iPhone/ scany Pro四种手持式3D扫描仪进行评估和比较。训练有素的新生儿临床医生（医疗和护理）在模拟的新生儿重症监护环境中进行模拟扫描。结果：由13名新生儿临床医生（4名医疗/护士从业人员和9名护士）进行了60次扫描。Artec Leo、Revopoint POP 2和scany Pro的平均绝对误差中位数分别为0.21 mm（四分位间距[IQR]: 0.19-0.26）、0.17 mm（四分位间距[IQR]: 0.15-0.21）和1.08 mm（四分位间距[IQR]: 1.0-1.63）。扫描时间最快的是Artec Leo，为22.9秒（IQR: 18.5-27），其次是revpoint POP 2，为25.2秒（IQR: 22-34.4）。Artec Leo被评为最昂贵的，但revpoint POP 2被评为更符合人体工程学。基于应用程序的3D扫描仪（Metascan和scany Pro）都存在数据安全问题。结论：在新生儿重症监护环境下，Artec Leo和revpoint POP 2被认为是对早产儿进行3D扫描最可行的。
{"title":"Assessing the feasibility of handheld scanning technologies in neonatal intensive care: Trueness, acceptability, and suitability for personalised medical devices","authors":"Deanne August RN, PhD , Isabel Byram BBus, BFA , David Forrestal BEng, PhD , Mathilde Desselle MEng, PhD , Nathan Stevenson BEng, PhD , Kartik Iyer BEng, PhD , Mark W. Davies MBBS, PhD , Katherine White MBBS , Linda Cobbald BN, PGCertNg , Lynette Chapple BN, GradDipNg , Kellie McGrory CN, CertAdvNg , Margaret McLean BN , Stephanie Hall Bn, MNursPrac , Brittany Schoenmaker BN, MClinNurs , Jackie Clement BN, GradDipNg , Melissa M. Lai MBBS, PhD","doi":"10.1016/j.aucc.2024.09.012","DOIUrl":"10.1016/j.aucc.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>Nasal continuous positive airway pressure (CPAP) injuries are common for premature infants. Clinical use of three-dimensional (3D) scanning is established in adult medicine, but the possibilities in neonatal care are still emerging. Custom printed CPAP devices have the potential to reduce injuries and disfigurement in this vulnerable population.</div></div><div><h3>Aim</h3><div>We sought to identify the most feasible portable 3D scanner for use in the neonatal intensive care environment towards the development of custom-fitting CPAP devices for premature infants.</div></div><div><h3>Methods</h3><div>Four handheld 3D scanners were assessed and compared, Artec Leo, Revopoint POP 2, iPad Pro/Metascan, and iPhone/Scandy Pro. Trained neonatal clinicians (medical and nursing) undertook mock scans in a simulated neonatal intensive care environment.</div></div><div><h3>Results</h3><div>Sixty scans were performed by 13 neonatal clinicians (four medical/nurse practitioners and nine nurses). The median mean absolute error was 0.21 mm (interquartile range [IQR]: 0.19–0.26), 0.17 mm (IQR: 0.15–0.21), and 1.08 mm (IQR: 1.0–1.63) for Artec Leo, Revopoint POP 2, and Scandy Pro, respectively. Scan times were the quickest for Artec Leo at 22.9 sec (IQR: 18.5–27), followed by Revopoint POP 2 at 25.2 sec (IQR: 22–34.4). Artec Leo was rated most expensive, but Revopoint POP 2 was rated more ergonomic. Both app-based 3D scanners (Metascan and Scandy Pro) presented data security issues.</div></div><div><h3>Conclusions</h3><div>Artec Leo and Revopoint POP 2 were identified as most feasible for use to perform 3D scans on premature infants in the neonatal intensive care environment.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101127"},"PeriodicalIF":2.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814972","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 : 2024-12-05DOI: 10.1016/j.aucc.2024.101139
Barbara M. Geven RN, MSc , Erwin Ista RN, PhD , Job B.M. van Woensel MD, PhD , Sascha C.A.T. Verbruggen MD, PhD , Faridi S. van Etten-Jamaludin BSc , Jolanda M. Maaskant RN, PhD
Objective
Early mobilisation in critically ill children is safe and feasible. However, the effectiveness of early mobilisation on short- and long-term outcomes is understudied. The aim of this scoping review was to generate an overview of outcomes used in previous research regarding early mobilisation in critically ill children.
Data sources
A systematic search was performed in Medline, Embase, Cochrane library, and CINAHL, without restricting on design, on April 3rd, 2023.
Study selection
Two independent reviewers assessed titles, abstracts, and full texts. Studies were included if they described any outcomes related to early mobilisation in critically ill children.
Data charting process
One reviewer performed data extraction, which was subsequently verified by another reviewer. Seven domains were used to categorise the outcomes: mortality, physiological, life impact, resource use, adverse events, process indicators, and perception of early mobilisation.
Data synthesis
Out of 3380 screened titles, 25 studies were included. Data extraction yielded 148 unique outcomes, which were clustered into 40 outcomes. Outcomes spanned in all seven domains, with “length of paediatric intensive care unit stay” (resource use) and “adverse events involving unintentional removal of catheters, tubes, and/or lines” (adverse events) being the most frequently reported. Process indicators such as mobilisation activities were well documented. Mortality and functionality outcomes were chosen the least.
Conclusions
This scoping review provides a categorised overview of outcomes that have been used to assess the effectiveness of early mobilisation in critically ill children. The findings show a great heterogeneity in used outcomes and are input for paediatric intensive care unit experts and parents to prioritise outcomes developing a Core Outcome Set.
{"title":"Outcomes in early mobilisation research in critically ill children: A scoping review","authors":"Barbara M. Geven RN, MSc , Erwin Ista RN, PhD , Job B.M. van Woensel MD, PhD , Sascha C.A.T. Verbruggen MD, PhD , Faridi S. van Etten-Jamaludin BSc , Jolanda M. Maaskant RN, PhD","doi":"10.1016/j.aucc.2024.101139","DOIUrl":"10.1016/j.aucc.2024.101139","url":null,"abstract":"<div><h3>Objective</h3><div>Early mobilisation in critically ill children is safe and feasible. However, the effectiveness of early mobilisation on short- and long-term outcomes is understudied. The aim of this scoping review was to generate an overview of outcomes used in previous research regarding early mobilisation in critically ill children.</div></div><div><h3>Data sources</h3><div>A systematic search was performed in Medline, Embase, Cochrane library, and CINAHL, without restricting on design, on April 3rd, 2023.</div></div><div><h3>Study selection</h3><div>Two independent reviewers assessed titles, abstracts, and full texts. Studies were included if they described any outcomes related to early mobilisation in critically ill children.</div></div><div><h3>Data charting process</h3><div>One reviewer performed data extraction, which was subsequently verified by another reviewer. Seven domains were used to categorise the outcomes: mortality, physiological, life impact, resource use, adverse events, process indicators, and perception of early mobilisation.</div></div><div><h3>Data synthesis</h3><div>Out of 3380 screened titles, 25 studies were included. Data extraction yielded 148 unique outcomes, which were clustered into 40 outcomes. Outcomes spanned in all seven domains, with “length of paediatric intensive care unit stay” (resource use) and “adverse events involving unintentional removal of catheters, tubes, and/or lines” (adverse events) being the most frequently reported. Process indicators such as mobilisation activities were well documented. Mortality and functionality outcomes were chosen the least.</div></div><div><h3>Conclusions</h3><div>This scoping review provides a categorised overview of outcomes that have been used to assess the effectiveness of early mobilisation in critically ill children. The findings show a great heterogeneity in used outcomes and are input for paediatric intensive care unit experts and parents to prioritise outcomes developing a Core Outcome Set.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101139"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The timely identification and transfer of critically ill patients from the emergency department (ED) to the intensive care unit (ICU) is important for patient care and ED workflow practices.
Objective
We aimed to develop a predictive model for ICU admission early in the course of an ED presentation.
Methods
We extracted retrospective data from the electronic medical record and applied natural language processing and machine learning to information available early in the course of an ED presentation to develop a predictive model for ICU admission.
Results
We studied 484 094 adult (≥18 years old) ED presentations, amongst which direct admission to the ICU occurred in 3955 (0.82%) instances. We trained machine learning in 323 678 ED presentations and performed testing/validation in 160 416 (70 546 for testing and 89 870 for validation). Although the area under the receiver operating characteristics curve was 0.92, the F1 score (0.177) and Matthews correlation coefficient (0.257) suggested substantial imbalance in the dataset. The strongest weighted variables in the predictive model at the 30-min timepoint were ED triage category, arrival via ambulance, quick Sequential Organ Failure Assessment score, baseline heart rate, and the number of inpatient presentations in the prior 12 months. Using a likelihood of ICU admission of more than 75%, for activation of automated ICU referral, we estimated the model would generate 2.7 triggers per day.
Conclusions
The infrequency of ICU admissions as a proportion of ED presentations makes accurate early prediction of admissions challenging. Such triggers are likely to generate a moderate number of false positives.
{"title":"Early prediction of intensive care unit admission in emergency department patients using machine learning","authors":"Dinesh Pandey BEng, MSc, PhD , Hossein Jahanabadi BSc, MEng, PhD , Jack D'Arcy MB BCh, BAO(Hons), FCICM, FACEM , Suzanne Doherty MB BCh, BAO(Hons), FACEM , Hung Vo GradDipPsych , Daryl Jones BSc(Hons), MB BS, FRACP, FCICM, MD, PhD , Rinaldo Bellomo MB BS(Hons), MD, PhD, FRACP, FCICM","doi":"10.1016/j.aucc.2024.101143","DOIUrl":"10.1016/j.aucc.2024.101143","url":null,"abstract":"<div><h3>Background</h3><div>The timely identification and transfer of critically ill patients from the emergency department (ED) to the intensive care unit (ICU) is important for patient care and ED workflow practices.</div></div><div><h3>Objective</h3><div>We aimed to develop a predictive model for ICU admission early in the course of an ED presentation.</div></div><div><h3>Methods</h3><div>We extracted retrospective data from the electronic medical record and applied natural language processing and machine learning to information available early in the course of an ED presentation to develop a predictive model for ICU admission.</div></div><div><h3>Results</h3><div>We studied 484 094 adult (≥18 years old) ED presentations, amongst which direct admission to the ICU occurred in 3955 (0.82%) instances. We trained machine learning in 323 678 ED presentations and performed testing/validation in 160 416 (70 546 for testing and 89 870 for validation). Although the area under the receiver operating characteristics curve was 0.92, the F1 score (0.177) and Matthews correlation coefficient (0.257) suggested substantial imbalance in the dataset. The strongest weighted variables in the predictive model at the 30-min timepoint were ED triage category, arrival via ambulance, quick Sequential Organ Failure Assessment score, baseline heart rate, and the number of inpatient presentations in the prior 12 months. Using a likelihood of ICU admission of more than 75%, for activation of automated ICU referral, we estimated the model would generate 2.7 triggers per day.</div></div><div><h3>Conclusions</h3><div>The infrequency of ICU admissions as a proportion of ED presentations makes accurate early prediction of admissions challenging. Such triggers are likely to generate a moderate number of false positives.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 2","pages":"Article 101143"},"PeriodicalIF":2.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792811","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 : 2024-12-04DOI: 10.1016/j.aucc.2024.101145
David Golding MBChB , Anis Chaba MD, MSc , Anthony Delaney PhD, FCICM , Valery L. Feigin MD, PhD , Edward Litton PhD, FCICM , Champ Mendis PhD , Alex Poole RN, PhD , Andrew Udy PhD, FCICM , Paul J. Young PhD, FCICM , the Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE)
Background
The characteristics and outcomes of patients with acute brain injuries admitted to the intensive care unit (ICU) in Australia and New Zealand (ANZ) are insufficiently described.
Objective
This study aimed to describe the epidemiology of acute brain injury in ICU patients in ANZ.
Methods
A binational retrospective cohort study was conducted using the ANZ Intensive Care Society Adult Patient Database. Adult unplanned admissions from 2013 to 2022 were eligible unless the presence of acute brain injury could not be determined or the admission was for end-of-life care. In cases where a patient had multiple admissions, only the first was included. The population was divided into two cohorts: acute brain injury diagnoses and other diagnoses. The primary outcome was in-hospital mortality. Secondary outcomes included 90- and 180-day mortality, ICU and hospital lengths of stay, duration of invasive ventilation, and the proportion discharged home.
Results
Acute brain injuries accounted for 92 948 of 684 981 unplanned ICU admissions (14%). Hypoxic ischaemic encephalopathy, traumatic brain injury, and seizures were the most common diagnoses. A total of 24 568 of 92 948 (26%) and 62 603 of 592 033 (10%) patients with acute brain injuries and other diagnoses, respectively, died in hospital. Among the patients with brain injury the highest hospital mortality was in hypoxic ischaemic encephalopathy (53%), intracerebral haemorrhage (36%), subarachnoid haemorrhage (22%), and ischaemic stroke (22%); the lowest mortality was in traumatic brain injury (14%), central nervous system infection (10%), and seizures (4%). Acute brain injury patients were more likely to receive invasive mechanical ventilation, had longer ICU and hospital lengths of stay, had higher 90- and 180-day mortality, and were more likely to be discharged to chronic care than other patients.
Conclusions
Acute brain injuries accounted for a disproportionally high number of in-hospital deaths occurring in our cohort of adults who received unplanned ICU care; however, the mortality rates varied, and patients with central nervous system infections and seizures had similar or lower mortality compared to patients without brain injury.
{"title":"Characteristics and outcomes of adults with acute brain injuries admitted to intensive care units in Australia and New Zealand from 2013 to 2022","authors":"David Golding MBChB , Anis Chaba MD, MSc , Anthony Delaney PhD, FCICM , Valery L. Feigin MD, PhD , Edward Litton PhD, FCICM , Champ Mendis PhD , Alex Poole RN, PhD , Andrew Udy PhD, FCICM , Paul J. Young PhD, FCICM , the Australian & New Zealand Intensive Care Society (ANZICS) Centre for Outcomes & Resource Evaluation (CORE)","doi":"10.1016/j.aucc.2024.101145","DOIUrl":"10.1016/j.aucc.2024.101145","url":null,"abstract":"<div><h3>Background</h3><div>The characteristics and outcomes of patients with acute brain injuries admitted to the intensive care unit (ICU) in Australia and New Zealand (ANZ) are insufficiently described.</div></div><div><h3>Objective</h3><div>This study aimed to describe the epidemiology of acute brain injury in ICU patients in ANZ.</div></div><div><h3>Methods</h3><div>A binational retrospective cohort study was conducted using the ANZ Intensive Care Society Adult Patient Database. Adult unplanned admissions from 2013 to 2022 were eligible unless the presence of acute brain injury could not be determined or the admission was for end-of-life care. In cases where a patient had multiple admissions, only the first was included. The population was divided into two cohorts: acute brain injury diagnoses and other diagnoses. The primary outcome was in-hospital mortality. Secondary outcomes included 90- and 180-day mortality, ICU and hospital lengths of stay, duration of invasive ventilation, and the proportion discharged home.</div></div><div><h3>Results</h3><div>Acute brain injuries accounted for 92 948 of 684 981 unplanned ICU admissions (14%). Hypoxic ischaemic encephalopathy, traumatic brain injury, and seizures were the most common diagnoses. A total of 24 568 of 92 948 (26%) and 62 603 of 592 033 (10%) patients with acute brain injuries and other diagnoses, respectively, died in hospital. Among the patients with brain injury the highest hospital mortality was in hypoxic ischaemic encephalopathy (53%), intracerebral haemorrhage (36%), subarachnoid haemorrhage (22%), and ischaemic stroke (22%); the lowest mortality was in traumatic brain injury (14%), central nervous system infection (10%), and seizures (4%). Acute brain injury patients were more likely to receive invasive mechanical ventilation, had longer ICU and hospital lengths of stay, had higher 90- and 180-day mortality, and were more likely to be discharged to chronic care than other patients.</div></div><div><h3>Conclusions</h3><div>Acute brain injuries accounted for a disproportionally high number of in-hospital deaths occurring in our cohort of adults who received unplanned ICU care; however, the mortality rates varied, and patients with central nervous system infections and seizures had similar or lower mortality compared to patients without brain injury.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101145"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786565","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 : 2024-12-04DOI: 10.1016/j.aucc.2024.101149
Melissa J. Bloomer RN, PhD, FACCCN , Laura A. Brooks RN, MN, MACCCN , Alysia Coventry RN, MPhil, MACCCN , Kristen Ranse RN, PhD, MACCCN , Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Care), MACCCN , Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care), MACCCN
Background
The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses’ experiences after death in neonatal and paediatric intensive care is poorly understood.
Research question
What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?
Method
Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.
Findings
From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses’ emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child–family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.
Conclusion
Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses’ preferences is key.
{"title":"“You need to be supported”: An integrative review of nurses’ experiences after death in neonatal and paediatric intensive care","authors":"Melissa J. Bloomer RN, PhD, FACCCN , Laura A. Brooks RN, MN, MACCCN , Alysia Coventry RN, MPhil, MACCCN , Kristen Ranse RN, PhD, MACCCN , Jessie Rowe RN, Grad Dip Nurs Pract (Paediatric Crit Care), MACCCN , Shontelle Thomas RN, Grad Cert Nurs Pract (Paediatric Intens Care), MACCCN","doi":"10.1016/j.aucc.2024.101149","DOIUrl":"10.1016/j.aucc.2024.101149","url":null,"abstract":"<div><h3>Background</h3><div>The death of a child can have a profound impact on critical care nurses, shaping their professional practice and personal lives in diverse, enduring ways. Whilst end-of-life care is recognised as a core component of critical care nursing practice and a research priority, evidence about nurses’ experiences after death in neonatal and paediatric intensive care is poorly understood.</div></div><div><h3>Research question</h3><div>What is the experience of the nurse after death of a patient in neonatal and/or paediatric intensive care?</div></div><div><h3>Method</h3><div>Following registration with Open Science Framework, an integrative review of the empirical literature was undertaken. A combination of keywords, synonyms, and Medical Subject Headings was used across the Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Medline, APA PsycInfo, Scopus, and Embase databases. Records were independently assessed against inclusion and exclusion criteria. All included papers were assessed for quality. Narrative synthesis was used to analyse and present the findings.</div></div><div><h3>Findings</h3><div>From 13,018 records screened, 32 papers reporting primary research, representing more than 1850 nurses from 15 countries, were included. Three themes were identified: (i) postmortem care; (ii) caring for bereaved families; and (iii) nurses’ emotional response, which includes support for nurses. Nurses simultaneously cared for the deceased child and family, honouring the child and child–family relationship. Nurses were expected to provide immediate grief and bereavement support to families. In response to their own emotions and grief, nurses described a range of strategies and supports to aid coping.</div></div><div><h3>Conclusion</h3><div>Recognising neonatal and paediatric critical care nurses' experience after death is key to comprehensively understanding the professional and personal impacts, including the shared grief of a young life lost. Enabling nurses to acknowledge and reflect upon their experiences of death and seek their preferred supports is critically important. Thus, ensuring organisational and system processes similarly align with nurses’ preferences is key.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 3","pages":"Article 101149"},"PeriodicalIF":2.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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