Nursing in Critical Care最新文献

Background: Awake prone positioning (APP) is a promising strategy for enhancing ventilation and oxygenation in patients with acute respiratory distress syndrome (ARDS). However, its implementation is often hindered by issues related to patient comfort, which is crucial for its effectiveness.

Aim: This study aims to explore the factors influencing comfort during awake prone positioning in ARDS patients.

Study design: A purposive sampling method was employed to select ARDS patients for this qualitative study. An interview outline was developed based on a literature review, and semi-structured interviews were conducted to gain a comprehensive understanding of patients' comfort experiences during awake prone positioning. Qualitative content analysis (QCA) was utilised to organise and analyse the transcribed data.

Findings: The analysis of data from 18 patients revealed five themes and 14 subthemes. The themes include physiological experience, psychological and emotional experience, family and social relationships, communication and support from the medical team and environmental perception. The subthemes covered a wide range of factors influencing comfort across these domains.

Conclusion: This study highlights the diversity and complexity of factors influencing the comfort of ARDS patients during awake prone positioning, emphasising the need for tailored interventions to enhance patient experiences and improve outcomes.

Relevance to clinical practice: Understanding the multifaceted factors that influence comfort during awake prone positioning in ARDS patients is essential for improving adherence and clinical outcomes. This study provides valuable insights for critical care nurses to develop individualised care strategies that address both physical and psychosocial needs. Enhancing patient comfort through targeted communication, environmental adjustments and emotional support may facilitate longer and more effective prone sessions, ultimately contributing to better respiratory outcomes and patient satisfaction.

Background: As science and technology have progressed, human-computer tasks have become more common in intensive care units and nurses must interact frequently with human-computer systems.

Aim: To systematically evaluate ICU nurses' working experience related to human-computer interactions and to provide a reference for the integration of technology into clinical nursing practice.

Study design: The study design was a meta-synthesis.

Findings: Sixteen qualitative studies were included, and 116 codes were extracted, yielding four analytical themes: (1) A good environment is fundamental in the ICU nurse-computer interaction; (2) technology is a double-edged sword; (3) the adaptation trajectory of ICU nurses in human-computer interaction; (4) the hospital prioritises patient safety and fosters ICU alarm culture.

Conclusions: Nursing managers should attach great importance to ICU nurses' working experience related to human-computer interactions. To optimise these interactions, improve care quality and ensure patient safety, targeted training and psychological interventions should be implemented based on nurses' reported experience.

Relevance to clinical practice: Human-computer interaction in the ICU is complex and challenging for nurses. It is essential to explore the experience of ICU nurses and to enhance the efficiency of these interactions.

Background: Accumulation of secretions in the airways of patients on mechanical ventilation (MV) can lead to serious complications. Chest physiotherapy (CP) techniques can be used prior to endotracheal aspiration to facilitate the removal of secretions accumulated in the respiratory tract.

Aim: This study was carried out to determine the effect of CP techniques applied before aspiration on the vital signs, blood gas values and amount of secretion in patients on MV support.

Study design: This randomised controlled trial was conducted in a State Hospital critical care unit with patients on MV support. The study was designed to include three groups: a percussion vibration (PV) group (n = 26) an expiratory rib compression (ERCC) group (n = 26) and a control group (n = 26). All three groups underwent two aspirations, three hours apart. Three hours after the first aspiration, CP techniques were applied to the two experimental groups, but not to the control group. A second aspiration was then performed. Vital signs and blood gases were measured before and after both aspiration procedures, and the amount of secretion collected during the two aspiration procedures was weighed.

Results: The study was completed with 78 patients. During the second aspiration, ERCC patients showed significant increases in diastolic blood pressure (DBP: 69.38 ± 10.58 → 73.23 ± 11.84 mmHg; p = 0.004; 95% CI: -3.250, 3.327) and heart rate (81.35 ± 10.43 → 85.73 ± 11.39 bpm; p = 0.004; 95% CI: -3.250, 3.327). Respiratory rate and body temperature also increased significantly (p  = 0.006 and p  = 0.034). SpO_₂ increased in both PV (97.35 ± 1.67 → 97.81 ± 1.55%; p  = 0.014) and ERCC (96.01 ± 2.66 → 96.67 ± 2.58%; p  = 0.039) groups. No significant changes were observed in secretion weight or volume across groups, although PV and ERCC showed an increasing trend and the control group a decreasing trend (p  > 0.05).

Conclusions: It was determined that CP techniques had an effect on DBP, heart rate, respiratory rate and SpO2 in patients under MV support, but had no effect on other parameters.

Relevance to clinical practice: The use of CP techniques by critical care nurses before aspiration may facilitate the removal of secretions in patients receiving MV support, prevent complications related to secretions and positively improve vital signs and hemodynamic indices.

Trial registration: ClinicalTrials.gov. No: NCT06277817.

Background: Family members of critically ill patients encounter major emotional, psychological, and practical challenges, especially during ICU admissions, delays, or transfers. For Arabic families, whether Muslim or Christian, these experiences are strongly influenced by cultural, religious, and social norms.

Aim: To conduct a systematic review and synthesis on the stressors, needs, and satisfaction of families of critically ill Arabic patients, with the aim of informing culturally sensitive, family-centered care in the ICU.

Study design: A systematic literature review was conducted from 2005 to March 2025. Eligible studies were peer-reviewed English-language articles examining stressors, needs, or satisfaction among families of critically ill Arabic patients in critical care settings. Some studies used validated Arabic versions of standardized instruments (e.g., FS-ICU, CCFNI). Searches were performed in PubMed, CINAHL, Scopus, Web of Science, and the Saudi Digital Library. Study selection followed PRISMA 2020 guidelines, and data were narratively extracted and synthesized.

Results: A total of 52 studies met the inclusion criteria. Thirty (58%) were rated as high quality, 15 (29%) as moderate, and 7 (13%) as low quality. Families reported major stressors including uncertainty, restricted visitation, financial burdens, and cultural or linguistic barriers. Their key needs were emotional reassurance, spiritual guidance, clear communication, and involvement in decision-making. Family satisfaction improved when care was empathetic, culturally sensitive, and supported by spiritual and psychological resources. There is limited evidence on pediatric ICUs and settings affected by violence because most research was conducted in the Middle East and North Africa (MENA) region.

Conclusion: Families of critically ill Arabic patients face complex stressors and have distinct culture-related needs that must be addressed to ensure quality care in the ICU. Empathy, clear communication, and cultural competence from healthcare providers are central to meeting family expectations. However, gaps remain in longitudinal research, studies focusing on pediatric ICUs, and the use of culturally validated measurement tools.

Relevance to clinical practice: The lack of culturally competent family-centered care remains a significant challenge for practitioners. Enhancing healthcare professionals' cultural sensitivity, implementing spiritually inclusive care, and involving families in shared decision-making are essential steps to improving outcomes for Arabic families in intensive care settings.

Background: Agitation is a common and clinically significant phenomenon among patients admitted to intensive care units (ICUs), particularly those receiving mechanical ventilation or experiencing critical illness. Previous studies have shown inconsistent results regarding the prevalence and predictors of agitation in intensive care units.

Aim: To assess the pooled prevalence and associated factors of agitation among adults in the intensive care unit.

Study design: A systematic review and meta-analysis was conducted. The review protocol has been registered in the Prospero database under registration number CRD420251022240, following PRISMA guidelines.

Results: This systematic review and meta-analysis included 10 studies. The pooled prevalence of agitation in the intensive care unit was 55.65% (95% CI: 40.07, 71.24). The pooled analysis revealed a significant association between hyperthermia (≥ 37.5°C) and the prevalence of agitation in adult patients in the intensive care unit. The adjusted odds ratio (AOR) for hyperthermia was 3.24 (95% CI: 1.51-4.91, p < 0.0002).

Conclusion: This meta-analysis highlights the significant burden of agitation among adult patients in intensive care units, revealing that over half of critically ill individuals experience agitation during their ICU stay. Among the various contributing factors examined, elevated body temperature emerged as the only one with a statistically significant association with agitation.

Relevance to clinical practice: This study underscores the importance of vigilant temperature monitoring and timely management of fever in ICU patients. Hyperthermia was found to be associated with a higher likelihood of agitation, although a direct causal relationship cannot be established from the available data. Maintaining normothermia remains a reasonable clinical goal that may contribute to overall patient stability. Implementing structured temperature control protocols as part of routine ICU care could help reduce agitation-related complications such as unplanned extubation, increased sedation needs and prolonged ICU stays, thereby supporting improved patient safety and outcomes.

Background: Paediatric intensive care units (PICU) need to take measures to include the child and the parents in their care regarding the child's cognitive ability. Partnerships must be based on respect and understanding, starting from the child's perspective and collaborating with the child and parents towards a common care plan.

Aim: This study aimed to explore parents' experience of partnership with the child and the healthcare team in a paediatric intensive care unit to develop child-centred care further.

Study design: A qualitative explorative design was adopted as the study aimed to explore parents' own experiences. Ten mothers and ten fathers participated. Data was collected via narrative interviews. Data was analysed using inductive content analysis.

Findings: The Findings of this study uncovered one main category: Safety as a key component of partnership, three categories: Information transfer, Collaboration in the team, Challenges for partnerships. The main Finding of this study uncovers how the context and the child-centred approach are connected and intertwined. Safety is the foundation of partnership and trust; without it, true collaboration thus, partnership or child-centred care cannot exist. The data analysis resulted in eight subcategories, three categories and one main category.

Conclusions: It is when the context enables parents to be safe and trust their relations to the care team that they dare to have their child as the focus of the family context, dare to be involved in their child's care and develop a reciprocal relationship between carers, children and parents.

Relevance to clinical practise: The findings highlight the need to promote collaborative partnerships by inviting parents to engage in care activities, providing clear explanations of procedures, encouraging questions, and validating parental observations regarding the child.

Background: Neonatal intensive care unit (NICU) environments are characterised by a high prevalence of alarms. The majority of these alarms are non-actionable, meaning they do not require immediate clinical intervention by nurses leading to nurse desensitisation and alarm fatigue. Currently, there is no assessment of this problem from a technical in combination with the clinical perspectives.

Aim: This study aimed to evaluate alarm frequencies, the proportion of actionable alarms and nurses' perceptions to identify optimal improvement strategies.

Study design: A single-centre prospective cohort study was conducted at an open-bay Level III NICU in a teaching hospital in the Netherlands. Over 2 months (February-March 2024), alarm data from patient monitors were collected and categorised into high, medium priority and technical alarms. Clinical observations assessed the proportion of actionable alarms. Additionally, NICU nurses completed the Charité Alarm Fatigue Questionnaire to evaluate alarm fatigue and their perceptions of evidence-based improvement strategies. Data were analysed using descriptive statistics (mean and frequencies).

Results: A total of 678 212 alarms were recorded, with the majority being medium priority alarms (57.6%). Observations (n = 1467) showed that nurses did respond to 16.6% of alarms. Among the 39 nurses surveyed (response rate 66%), 48.7% experienced considerable alarm fatigue. For three out of five proposed interventions, the majority of nurses it feasible and useful.

Conclusion: This study highlights the important issue of high alarm rates and low responsiveness in the NICU, contributing to significant alarm fatigue among nurses. Implementing targeted improvement strategies to reduce alarm frequency and improve response rates, such as personalised alarm settings, is essential for enhancing nurse well-being and patient care.

Relevance to clinical practice: Enhancement of alarm management and mitigation of alarm fatigue should be addressed by both technical and human factors evidence-based strategies to improve nurse well-being and patient outcomes, optimising NICU safety and efficacy.

Background: Up to 24% of children admitted to the paediatric intensive care unit (PICU) experience moderate to severe pain. Nurses have the ethical responsibility to manage pain, which is often challenging due to a wide range of age, developmental ability, medical diseases and complex medical equipment. Limited research has been done, specifically in the PICU, related to pain management practices and barriers and facilitators.

Aim: The purpose of this study is to describe PICU nurses' current pain assessment and analgesic premedication practices, in addition to facilitators and barriers to pain management.

Study design: This study is a secondary analysis of a previous cross-sectional study. PICU nurses were asked to complete a survey regarding their pain assessment practices, premedication practices, perceptions of patient behaviours indicative of pain and barriers and facilitators.

Results: A total of 106 nurses responded. It was found that nurses more routinely use behavioural assessment scales compared to self-report and do not regularly attempt to obtain a self-report for those who are mechanically ventilated. The decision to premedicate prior to a painful procedure was variable. Nurses found only four patient behaviours as most commonly indicating pain. Lastly, facilitators were perceived more commonly present than barriers, with nurses valuing having a designated charting system and standardised assessment tools.

Conclusion: Overall, there is a need to leverage facilitators and minimise barriers to successfully implement evidence-based pain management practices. Future research in the creation of clinician support tools, following the principles of implementation science, is needed.

Relevance to clinical practice: Understanding current pain management practices better enables frontline nurses, educators and leaders to identify, implement and sustain evidence-based pain management improvements.

Background: Pain, agitation, delirium, immobility, and sleep disruption (PADIS) are prevalent and closely connected in the intensive care unit (ICU). Despite their significance, PADIS circumstances are managed separately in ICU settings, and nurses lack a comprehensive understanding of PADIS management.

Aim: To explore nurses' perceptions of PADIS, challenges encountered during the nursing process, and the need for PADIS training. Additionally, this study provides suggestions for establishing a PADIS training system.

Study design: A descriptive, qualitative design was used. Face-to-face semi-structured interviews were conducted with nine nurses at a tertiary general hospital in Shijiazhuang, Hebei province, China. The interview data were analysed using the Colaizzi 7-step analysis method.

Findings: Four major themes and nine subthemes emerged from interview data. The major themes were: (1) gaps in PADIS knowledge and clinical integration; (2) clinical settings and the influence of expertise; (3) PADIS management training attitude; (4) nurses' recommendations for PADIS training.

Conclusions: The training methods are limited, and the current system has flaws. Establishing a scientific, rational training system that incorporates diverse methods is recommended to encourage nurses' active participation in training.

Relevance to clinical practice: It is crucial to use appropriate, diverse training methods to strengthen nurses' comprehensive management of PADIS and enhance their capabilities.