Nursing in Critical Care最新文献

Background: The birth of a child is typically associated with joy and relief; however, when a newborn is admitted to the neonatal intensive care unit (NICU), parental stress often persists or intensifies. The duration of a newborn's stay in the NICU can have a significant effect on parental well-being.

Aim: This study explored the experiences of stress among mothers with hospitalised newborns in NICUs within the Accra Metropolis.

Study design: A qualitative, descriptive and exploratory design was used. Semi-structured interviews were conducted with 12 purposively selected parents in NICUs. The interviews were transcribed and analysed using thematic content analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ).

Results: Three main themes and eight subthemes support these findings. Maternal and perinatal stressors include complicated pregnancy experiences, challenges during labour and delivery and the stress associated with newborn admission to the NICU. Environmental and systemic burdens encompassed the strain of daily commute and physical exhaustion, discomfort within the NICU setting and the stressful nature of the NICU environment. Maternal coping and adaptation reflected emotional regulation through social withdrawal, alongside spiritual coping and faith-based practices that provided strength and hope.

Conclusions: Mothers of newborns admitted to the NICU face multiple stressors that affect their emotional well-being. This study highlights the need for anticipatory guidance and mental health support, particularly through pre-delivery counselling for expectant mothers at risk of NICU admissions.

Relevance to clinical practice: Emotional support of parents in the NICU is essential for holistic newborn care. Nurses and midwives should offer anticipatory guidance, psychosocial support and culturally appropriate interventions including spiritual care. Pre-delivery counselling and parental support systems can improve coping and overall outcomes for both parents and newborns.

Background: Family voice interventions have emerged as a non-pharmacological approach for delirium prevention; however, evidence regarding their effectiveness remains inconsistent.

Aim: The aim of this study was to evaluate the effectiveness of family voice interventions in reducing delirium among adult intensive care unit (ICU) patients.

Study design: We conducted a systematic review and meta-analysis. A comprehensive literature search was conducted across PubMed, EMBASE, CINAHL and the Cochrane Library from inception through 4 March 2025. Study quality was assessed using the Cochrane Risk of Bias II tool, with analyses performed using Comprehensive Meta-Analysis version 4.0.

Results: Six randomised controlled trials (reported across seven publications) involving 598 adult ICU patients were included. Family voice interventions significantly reduced delirium incidence (OR = 0.282, 95% CI: 0.126-0.630, p = 0.002) and duration (Hedges' g = -1.929, 95% CI: -2.980 to -0.879, p < 0.001). No significant effects were observed for mechanical ventilation duration (Hedges' g = -0.826, 95% CI: -1.696 to 0.044, p = 0.063) or ICU length of stay (Hedges' g = -0.534, 95% CI: -1.371 to 0.303, p = 0.211). Subgroup analysis showed multicomponent interventions significantly reduced both delirium incidence (OR = 0.178, 95% CI: 0.046-0.681, p = 0.012) and duration (Hedges' g = -1.888, 95% CI: -2.917 to -0.859, p < 0.001), while single-component interventions showed no significant effects.

Conclusions: Family voice interventions effectively reduce delirium incidence and duration in adult ICU patients, with multicomponent approaches demonstrating superior efficacy.

Relevance to clinical practice: Critical care nurses may incorporate family voice interventions as a practical alternative within delirium prevention strategies. Although direct family presence is generally regarded as the preferred form of engagement, recorded voice messages can provide a feasible and meaningful option to enhance patient orientation and emotional connection when families cannot always be present.

Protocol registration: The study protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42025628074).

Background: Delirium is a common neuropsychiatric complication in the intensive care unit (ICU), the occurrence of which is closely associated with patient prognoses.

Aim: To examine the associations between sleep quality and circadian rhythm stability measured by actigraphy and changes in delirium state in intensive care unit (ICU) patients, as well as their predictive power for mortality risk.

Study design: ICUs of a medical centre in Taiwan, from September 1, 2024, to January 31, 2025. A prospective observational study was conducted in adult ICU patients. Wrist-worn actigraphy was used to monitor total sleep time (TST, h), wake after sleep onset (WASO, h), and circadian rhythm stability (24-h autocorrelation coefficient, r24) for 72 consecutive hours. Delirium was assessed twice daily for three days using the Confusion Assessment Method for the ICU (CAM-ICU) and categorized as no delirium, prolonged delirium (lasting ≥ 3 days), or new-onset delirium (developed after enrollment).

Results: A total of 74 ICU patients were included. Among them, 30 had no delirium, 20 had prolonged delirium, and 24 developed new-onset delirium. Mortality rates in both the prolonged delirium and new-onset delirium groups were 45%, significantly higher than in the no-delirium group (13.3%, p = 0.015). The prolonged delirium group had higher Sequential Organ Failure Assessment (SOFA) scores, longer WASO and lower r24 than the no-delirium group, with r24 significantly associated with prolonged delirium (OR = 0.001, p = 0.012). The new-onset delirium group showed higher WASO, which was significantly associated with delirium (OR = 1.04, p = 0.046). Multivariate Cox analysis identified prolonged delirium (HR = 3.92, p = 0.049) and SOFA score (HR = 1.32, p = 0.027) as independent predictors of mortality.

Conclusions: WASO and r24 were closely linked to delirium state changes. Lower r24 was strongly associated with prolonged delirium and higher mortality, while higher WASO was related to new-onset delirium.

Relevance to clinical practice: Continuous monitoring of sleep continuity and circadian rhythms in ICU patients is recommended. Incorporating WASO into early delirium risk assessments may facilitate timely interventions, reduce delirium incidence and mortality and improve critical care quality.

Background: Delirium commonly occurs during prolonged intensive care unit (ICU) stays, yet the clinical benefit of escorted outdoor exposure for critically ill adults remains uncertain.

Aim: The aim of this study was to determine whether supervised outdoor therapy is associated with reduced delirium severity among adults with ICU stays ≥ 7 days.

Study design: We performed a single-centre, retrospective cohort study in Japan, including adults with an ICU length of stay ≥ 7 days from 1 January 2019 to 31 December 2022. Delirium was assessed twice-daily using the Intensive Care Delirium Screening Checklist (ICDSC). We evaluated (1) within-patient change from 16:00 on the day before to 16:00 on the day of the first outdoor-therapy session; (2) ICDSC score at ICU discharge comparing patients who did vs. did not receive outdoor therapy using multiple imputation integrated with propensity-score matching; and (3) dose-response using multivariable linear regression with session count, adjusting for prespecified covariates including the highest ICDSC score and psychotropics prescribed through the first session.

Results: Among patients (n = 391) receiving outdoor therapy, the median ICDSC score decreased from 4 to 2 on the day of the first session (p < 0.001). After propensity-score matching, the outdoor-therapy group had lower ICDSC scores at ICU discharge than matched controls (median: 3.0 [IQR 1.0-5.0] vs. 4.0 [2.0-6.0]; p = 0.013; Cliff's δ = -0.329). In the adjusted regression, a greater number of outdoor sessions was associated with a lower discharge ICDSC score (standardised β = -0.113; p = 0.025).

Conclusions: Supervised outdoor therapy was associated with lower delirium severity in adults with prolonged ICU stays. These findings support the integration of outdoor exposure within multimodal delirium management while prospective multicentre studies define standardised protocols and optimal dosing.

Relevance to clinical practice: Incorporating brief, supervised outdoor sessions into multidisciplinary ICU workflows may provide a practical, non-pharmacological adjunct for delirium care, pending confirmation in protocolised prospective trials.

Trial registration: University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR) (ID: UMIN000049057; registered on 1 October 2022; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055872).

Background: Sudden cardiac death remains a critical global health issue, with cardiopulmonary resuscitation serving as a vital life-saving intervention. However, ethical dilemmas emerge when cardiopulmonary resuscitation is unlikely to benefit the patient, particularly in settings lacking formal Do-Not-Resuscitate orders. This situation often leads to ambiguous practices such as 'slow codes', raising complex challenges for critical care nurses involved in end-of-life decision-making.

Aim: This study aims to explore the experiences of Iranian critical care nurses with slow code practices in the absence of formal Do-Not-Resuscitate orders.

Study design: This qualitative study employed semi-structured interviews with purposively sampled nurses from diverse intensive care units (medical, pulmonary, poisoning, surgical and cardiac) across three teaching hospitals. Data were analysed using Braun and Clarke's thematic analysis framework.

Results: Sixteen participants took part in the study. They had a mean age of 36.8 years (SD = 5.9) and professional experience ranging from 6 to 23 years (M = 13 years), with 2-15 years in intensive care (M = 8.5 years). Most were female (75%), married (75%) and held a bachelor's degree (68.8%). Six key themes emerged influencing slow code practices: fear of litigation and criticism, stretching and buying time, post-resuscitation care and quality of life, opportunities for gaining resuscitation expertise, emotional struggles and moral disengagement. These findings highlight the complex ethical and practical dilemmas nurses face, where legal ambiguities and resource constraints significantly affect end-of-life care decisions.

Conclusions: Nurses often initiate slow codes due to fear of litigation and the desire to support families, while confronting moral dilemmas and concerns about patient outcomes. These findings highlight the urgent need for formal legal frameworks on Do-Not-Resuscitate orders and enhanced nurse training to effectively address the ethical complexities of end-of-life care.

Relevance to clinical practice: Resuscitation decisions must align with updated clinical guidelines, underscoring the need for formal national and local frameworks on Do-Not-Resuscitate orders in Iran. Legislation that reduces nurses' fear of litigation is essential to promote confident, ethically grounded decision-making. Furthermore, enhancing healthcare professionals' communication skills is critical to improving patients' and families' understanding of cardiopulmonary resuscitation.

Background: Individuals with relatives in intensive care face high psychological distress. Religious coping styles and perceived stress may influence their attitudes towards death, yet the mechanisms of this relationship remain unclear.

Aim: The study was conducted to examine the relationship between the religious coping styles of individuals with relatives in intensive care, their perceived stress and their attitudes towards death and to investigate the mediating role of perceived stress in the relationship between religious coping styles and attitudes towards death.

Study design: This descriptive and cross-sectional study was conducted between March 1, 2023 and March 3, 2025 with individuals who had patients in the intensive care units of a city hospital located in eastern Turkey. Data collection tools included a Personal Information Form, Religious Coping Scale (RCS), Perceived Stress Scale (PSS) and Death Attitudes Profile-Revised (DAP-R).

Results: Of the 350 individuals invited to participate, 245 completed the study, yielding a response rate of 70.0%. In the study, the mean positive coping score was 18.26 ± 4.87, and the mean negative coping style score was 20.43 ± 4.65. The mean PSS score was 32.28 ± 12.02, the mean Perceived Insufficient Self-Efficacy Perception score was 15.03 ± 6.61, and the mean Perceived Stress/Distress score was 17.25 ± 6.85. The mean DAP-R score was 114.31 ± 22.79, the mean Neutral Acceptance-Approach Acceptance score was 51.32 ± 11.56, the mean Avoidance Acceptance score was 22.43 ± 4.71, and the mean Fear of Death and Death Avoidance score was 40.55 ± 10.34. Perceived stress was found to play a mediating role in the effect of positive coping on attitude towards death (β = 0.352; (-0.675X -0.522)), and the perceived stress scale was found to strengthen the positive effect on attitude towards death (β = 0.722). Perceived stress was found to play a mediating role in the effect of negative coping style on attitude towards death (β = 0.161; (-0.310X -0.522)), and the perceived stress scale was found to strengthen the positive effect on attitude towards death (β = 0.466).

Conclusion: It has been observed that participants use negative coping styles more frequently and have moderate levels of perceived stress and attitudes towards death. Positive coping styles increase attitudes towards death, but a significant part of this effect occurs through perceived stress. It can be concluded that individuals develop a healthier awareness of death despite stress or through stress and tend to accept death.

Relevance to clinical practice: Understanding how religious coping and stress affect death attitudes can help healthcare professionals provide more targeted psychological and spiritual support to families of intensive care patients.

Background: Privacy represents a fundamental aspect of healthcare ethics, critically influencing patient safety and dignity. In intensive care units (ICUs), protecting privacy becomes particularly challenging due to the complex clinical environment and vulnerable patient population.

Aim: This study aimed to systematically identify the dimensions, challenges and protective strategies related to patient privacy in intensive care settings.

Study design: An integrative review was conducted. Comprehensive searches were performed across multiple databases including Web of Science, PubMed, Cochrane, ProQuest and Magiran in December 2024, supplemented by grey literature screening.

Results: From 1327 initial records, 10 studies met inclusion criteria after rigorous evaluation. The synthesis revealed six fundamental privacy dimensions: physical, informational, psychological-social, familial, religious-spiritual and individual autonomy. Key protective strategies included environmental modifications for physical privacy, implementing strict information protocols, providing culturally competent care, facilitating family involvement, respecting spiritual needs and promoting patient autonomy through shared decision-making.

Conclusions: Privacy in ICU settings constitutes a multidimensional concept requiring comprehensive protection approaches. Effective privacy preservation necessitates both structural interventions and cultural changes within healthcare teams, emphasising respectful communication and patient participation in care decisions.

Relevance to clinical practice: The findings provide evidence-based guidance for developing privacy protection protocols, staff education programs and ICU design modifications. Implementing these strategies can significantly enhance patient dignity, improve care experiences and foster ethical practice in critical care settings.