Nursing in Critical Care最新文献

Tea trolley teaching is a tried and tested method of providing bedside education to hospital staff. This project aimed to integrate the tea trolley teaching model, already established in our local critical care unit, with library services. The goal was to equip clinical staff with the necessary training to retrieve literature and support evidence-based practice. Our evaluation highlights the value of this combined intervention of teaching research skills to upskill staff working in our intensive care units. This paper describes a scalable model of critical care bedside education that integrates library-focused teaching to upskill nurses in some of the prerequisite skills needed for evidence-based practice (EBP).

The earlier a child with biliary atresia undergoes surgery after diagnosis, the better the prognosis. However, newborns often present with additional symptoms, most commonly pneumonia, which complicate in stabilizing the child's internal environment preoperatively, challenges anaesthetic management during surgery and hampers postoperative recovery. In current clinical practice, nursing care tends to focus more on symptomatic treatment rather than on a comprehensive pre- and postoperative assessment. This paper aimed to summarize the perioperative nursing experience of a neonate with biliary atresia and severe pneumonia. The study design of this article is a case report. After 17 days of intensive treatment and care, the child recovered and was discharged from the hospital, with ongoing progress noted during regular outpatient follow-ups. A thorough nursing assessment encompassing preoperative, intraoperative and postoperative care for children with biliary atresia, along with clearly defined nursing priorities at each stage, is essential for safeguarding the child's well-being throughout the perioperative period and supporting optimal postoperative recovery. This case study offers a comprehensive assessment of the child's condition throughout hospitalization. It highlights essential nursing interventions and monitoring strategies during the perioperative period, particularly preoperative and postoperative care. The insights gained can serve as a valuable reference for nursing practices in paediatric intensive care units, enhancing care for similar cases.

Background: Ventilator-associated events (VAE) are associated with higher mortality rates. Understanding the risk factors for VAE provides preventive strategies for reducing them. Several studies have been conducted on VAE risk factors. However, the findings were inconsistent.

Aim: This scoping review aimed to explore the existing evidence on risk factors of VAEs in intensive care unit (ICU) patients.

Study design: Searches were performed across eight databases including Pubmed, ProQuest, Scopus, ScienceDirect, BMJ, Web of Science, Taylor & Francis and Ebsco from 26 March to 5 April 2024, complemented by backward and forward citation tracking-eligible studies criteria: participants aged 18 years and older reporting on VAE risk factors. The publication must have occurred between 2013 and 2024, be available as full text and be written in English. A total of 19 studies met the inclusion criteria and were analysed.

Results: Forty-four risk factors were identified. Decreased level of consciousness, chronic lung diseases, invasive operation, duration of MV, trauma, fluid overload, reintubation, enteral feeding, administration of sedation and stress ulcer prophylaxis were the most frequently reported risk factors for VAE.

Conclusions: This review identified several potential risk factors for VAE; some factors have varying results or lack evidence. Further research is needed to confirm the role of these factors in reducing VAE or to clarify inconsistent findings.

Relevance to clinical practice: These findings provide information on the risk factors for VAE. Nurses must identify the presence of these risk factors in all adult ICU patients receiving invasive mechanical ventilation (IMV) and manage them to prevent the occurrence of VAE.

Background: As the backbone of the intensive care unit nursing team, young nurses' emotional and psychological well-being is related to the physiological health and life outcomes of critically ill patients.

Aim: Exploring the impact of access to and utilization of organizational resources on emotional exhaustion among intensive care unit nurses.

Study design: A cross-sectional survey. SPSS 27.0 was used for descriptive analysis and Pearson correlation analysis. AMOS 25.0 was used to construct the structural equation model and conduct the Bootstrap test.

Results: A total of 447 valid questionnaires were ultimately included, with a validity rate of 91.2%. The results showed that the turnover intention of young intensive care unit nurses was high (2.06 ± 0.67). Emotional exhaustion positively predicts nurses' turnover intentions (β = 0.30, p < .001). Inclusive leadership (β = 0.075, 95% CI: 0.04 to 0.116, p < .001) and distributive justice (β = 0.090, 95% CI: 0.059 to 0.132, p < .001), as organizational resources, respectively moderate the relationship between emotional exhaustion and turnover intention, and play a chain-mediated role in their relationship (β = 0.055, 95% CI: 0.036 to 0.081, p < .000). Additionally, the study did not show a direct effect of emotional exhaustion on work engagement (β = -0.07, p = .083). Instead, this relationship is mediated through distributive justice (but not inclusive leadership) (β = -0.203, 95% CI: -0.258 to -0.146, p < .001). At the same time, inclusive leadership and distributive justice serve as serial mediators in the mechanism by which emotional exhaustion affects work engagement (β = -0.125, 95% CI: -0.167 to -0.096, p < .000).

Conclusions: This study emphasizes that organizational resources can effectively alleviate the impact of emotional exhaustion among young intensive care unit nurses.

Relevance to clinical practice: Health care institutions and nursing managers need to recognize the importance of utilizing organizational resources and take necessary measures to alleviate emotional exhaustion among intensive care unit nurses. By implementing effective policies, they can enhance nurses' work engagement and retain nursing talent.

Background: Delirium is a common and severe condition among adult intensive care unit (ICU) patients. Music intervention, as a non-pharmacological approach, has the potential to reduce delirium, but the optimal dosage and type of intervention remain unclear.

Aim: To explore the effects of music intervention at different doses and types on reducing delirium in ICU patients.

Study design: This study was conducted as a systematic review and meta-analysis. Databases including Cochrane Library, EBSCO, Embase, PubMed, Web of Science, Airiti Library, China National Knowledge Infrastructure and Wanfang Data were searched until 29 February 2024. Study quality was assessed using the Cochrane Risk of Bias 2.0 criteria. Data were analysed using RevMan 5.4.1 and Comprehensive Meta-Analysis 3.0.

Results: Fourteen studies involving 1434 ICU patients were included. Four studies were of good quality (low risk of bias), seven were of moderate quality (unclear risk) and three were of low quality (high risk). Pooled analysis showed that music interventions significantly reduced the risk of delirium (12 studies, RR = .49, 95% confidence interval [CI] [.40, .61]). Slow-tempo music had the strongest effect (11 studies, RR = .46, 95% CI [.37, .57]). The optimal intervention dosage involves conducting music interventions twice daily (12 studies, RR = .46, 95% CI [.34, .63]), with each session lasting 30 min (12 studies, RR = .41, 95% CI [.30, .55]). Additionally, a pooled analysis showed that a 7-day music intervention (6 studies, RR = .43, 95% CI [.26, .71]) was the most effective in reducing the risk of delirium.

Conclusions: Music intervention reduces delirium in ICU patients, especially with two 30-min sessions daily for 7 days. However, the certainty of evidence is low, highlighting the need for further high-quality research.

Relevance to clinical practice: Music intervention is a simple, non-invasive method that may help reduce delirium in ICU patients. However, given the low certainty of the current evidence, it should be used cautiously, and further research is needed to validate its effectiveness before routine implementation.

Background: Coronary care unit (CCU) patients surviving to discharge still face significant mortality. Delirium is common in CCU patients and has been associated with poorer CCU and in-hospital outcomes.

Aim: To assess the association between delirium and mortality after hospital discharge in CCU survivors.

Study design: This was a retrospective observational study that included patients admitted to CCU. All data were extracted from the Medical Information Mart for Intensive Care IV database. The exposure was delirium during CCU stay. The primary outcome was mortality 180 days after hospital discharge. Secondary outcomes included post-hospital discharge mortality at 90 days, length of CCU and hospital stays, and hospital discharge disposition.

Results: Of the 3609 CCU patients included, 891 were considered delirium-positive during their CCU stay. Delirium was associated with an increased risk of mortality at 180 days after hospital discharge (adjusted hazard ratio [HR], 1.33; 95% confidence interval (CI), 1.08-1.64). Similar results were observed for 90-day post-discharge mortality (adjusted HR,1.43; 95% CI, 1.13-1.83). CCU patients who experienced delirium had longer stays in both the CCU and hospital (adjusted β, 2.11; 95% CI, 1.79-2.43 and 3.87; 95% CI, 3.06-4.69, respectively). They were also more likely to require nursing care after hospital discharge (adjusted odds ratio [OR], 1.65; 95% CI, 1.22-2.22).

Conclusion: Delirium during CCU stay was associated with an increased risk of all-cause mortality up to 180 days in CCU patients who survived hospital discharge.

Relevance to clinical practice: Delirium places CCU patients at a higher risk of post-discharge mortality and increased health care resource requirements. Given the high prevalence of delirium in CCU patients and its significantly deleterious impact on both short-term and long-term post-discharge mortality, nurses and physicians should enhance the post-discharge management of patients who experience delirium in order to improve prognosis. This also highlights the importance of preventing and managing delirium during hospitalization.

Background: Care bundles are evidence-based practices intended to improve patient outcomes and have become a significant focus in intensive care.

Aim: This study aims to identify research trends, key topics, leading researchers, and significant collaborations in care bundle research within ıntensive care units by mapping the conceptual and intellectual structure of the field.

Study design: Data were collected from the Web of Science database, covering publications from 2010 to 2024. The search terms included 'bundle*' or 'bundle* care' and 'intensive care unit' or 'critical care'. The analysis used tools like the Biblometrix package in R and VOSviewer, focusing on performance metrics, co-citation analysis, co-occurrence network analysis, and thematic mapping.

Results: The annual growth rate of publications on care bundles is 6.26%. The most prolific journals include Critical Care Medicine, the American Journal of Infection Control, and Infection Control and Hospital Epidemiology. Thematic mapping shows research is concentrated on critical areas such as infection control, patient safety, and quality improvement. While some themes, like 'intensive care units' and 'central line-associated bloodstream infection', are well-developed and central, others like 'maternal safety consensus' and 'safety consensus bundle' are highly developed but less central. Emerging themes like 'acute kidney injury' suggest potential areas for future research.

Conclusions: This bibliometric analysis offers a comprehensive overview of intensive care unit care bundle research, highlighting a strong focus on critical issues like infection control, patient safety, and care quality improvement.

Relevance to clinical practice: The study provides crucial insights for clinical practice by identifying key research trends and underexplored topics related to intensive care unit care bundles. These findings can guide the development of more effective care protocols, promote multidisciplinary collaboration, and enhance healthcare professional education, ultimately contributing to optimized patient care and high standards in the intensive care unit through improved care bundle implementation.

Background: Several predictive models have been developed for post-traumatic stress disorder (PTSD) in intensive care unit (ICU) family members. However, significant differences persist across related studies in terms of literature quality, model performance, predictor variables and scope of applicability.

Aim: This study aimed to systematically review risk prediction models for PTSD in family members of ICU patients, to make recommendations for health care professionals in selecting appropriate predictive models.

Study design: China National Knowledge Infrastructure, VIP database, Wanfang database, SinoMed, PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Embase and OVID were searched from inception to 1 May 2024. Two independent researchers conducted literature screening, data extraction and applied a risk of bias assessment tool for predictive models to evaluate included studies. The systematic review was registered on PROSPERO (registration number: CRD42024560815).

Results: Seventeen studies were included, with sample sizes ranging from 32 to 2734. Incidence rates of outcomes ranged from 1.6% to 63.6%. The most frequently used predictors were relative's female sex, longer duration of ICU stay, patient's death in the ICU and type of relationship with the patient. Two models reported area under the receiver operating characteristic curve (AUC) values ranging from 0.73 to 0.74; only three models reported calibration, and one study conducted internal validation. Overall, the 17 studies showed good applicability but exhibited a high risk of bias, particularly in data analysis.

Conclusions: Research on predictive models for PTSD risk in family members of ICU patients is in the developmental stage. Future studies should validate existing models or develop high-performance localized predictive models.

Relevance to clinical practice: PTSD can have a significant impact on the families of ICU patients, making early identification of high-risk populations essential for health care professionals to implement timely interventions.

Background: The process of discharging the critical patient to the ward (discharge from critical care to the general ward-DCCW) is often described as an experience involving uncertainty which may affect the patient's quality of life and ability to cope. Coping with uncertainty is an individual response not related to the course of the illness that is dependent on external and internal resources and the ability to utilize them. Mishel's theory of uncertainty identifies aspects of care that can shape the experience of uncertainty associated with the illness.

Aim: To understand the experiences of uncertainty of critical patients associated with discharge from the intensive care unit (ICU) to glean person-centred care strategies under such circumstances.

Study design: Qualitative study with a phenomenological approach. Between March 2017 and May 2018, 20 in-depth interviews were conducted on patients recently discharged from an ICU.

Results: The patients have been organized according to the following pre-established categories of Mishel's theory: stimulus framework, structure providers and uncertainty assessment. Based on these results, suggestions for the care of the critical patient upon discharge from the ICU are made in each of these categories.

Conclusions: Applying Mishel's theoretical perspective to care for the critical patient during the process of discharge to the ward can help identify areas for intervention and improvement. To succeed, there is a need to promote a cultural change in ICUs, empower nurses and provide the necessary resources.

Relevance to clinical practice: These findings are relevant and timely given the impact of the experience of critical patients discharge to the ward. Uncertainty management has been identified as an important element in the discharge experience of critically ill patients to the ward because, according to the informants' stories, it can make this transition a healthier process with less emotional impact.