Nursing in Critical Care最新文献

Background: Central venous catheters (CVCs) are placed where the vena cava meets the right atrium. Their common use raises the risk of catheter-related thrombosis (CRT), a potentially life-threatening complication.

Aim: This study leverages machine learning to develop a CRT predictive model for abdominal surgery patients, aiming to refine clinical decisions and elevate treatment quality.

Study design: The data were split into training and validation sets using the caret package in R. Decision Trees (DT), Extra Trees (ET), Ada Boost, Gradient Boosting (GB), Light Gradient Boosting Machine (LGBM), K Neighbours Classifier (KNN) and Random Forest (RF) algorithms were used for model construction. Receiver operating characteristic (ROC) curve, area under curve (AUC), accuracy, recall, precision, F1 score, sensitivity and specificity were used to evaluate the performance of the model. Decision curve analysis (DCA) was used to evaluate the clinical utility of each model.

Results: Among the 400 subjects, 184 had thrombosis, with an incidence of 46%. Basic characteristics analysis and univariate analysis showed that there were significant differences in the history of radiotherapy or chemotherapy, age, mobility score, retention time, D-dimer, fibrinogen and urea (p < .05). Among the models constructed by the seven algorithms, the performance of DT model was relatively balanced. The AUC of the validation set was 0.782, the sensitivity was 0.618, and the specificity was 0.781.

Conclusion: The predictive model for CRT developed using machine learning algorithms demonstrates good discrimination and clinical applicability among abdominal surgery patients, offering valuable guidance for CRT prevention strategies.

Relevance to clinical practice: By integrating risk prediction models into the Hospital Information System (HIS), nurses can assess catheter status in a timely and accurate manner, understand the risks of thrombosis for patients, and implement targeted preventive measures. This approach can enhance the efficiency and accuracy of nursing care, holding clinical significance in critical care practice.

Background: More self-efficacy leads to greater confidence in one's ability to perform actions to achieve treatment goals. Therefore, self-efficacy may affect patient recovery and health-related quality of life (HRQoL) after ICU discharge.

Aim: In a cohort of mechanically ventilated COVID-19 survivors, we examined the associations between self-efficacy at 3 months and HRQoL at 3, 12 and 24 months after discharge.

Study design: Mechanically ventilated survivors of the MaastrICCht cohort that completed a self-efficacy assessment with the General Self-Efficacy Scale (GSES) were included. HRQoL was measured using the EuroQol 5 Dimensions 5 Levels (EQ-5D-5L), subdivided into a health utility score (EQ-HUS) and visual analogue scale (EQ-VAS). Linear regression models were used to investigate associations between self-efficacy and HRQoL and were adjusted for age, sex, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ICU length of stay and hospital discharge location.

Results: In 87 ICU survivors, more self-efficacy at 3 months after ICU discharge was associated with longitudinally higher EQ-HUS (β = 0.01; 95% CI: 0.01-0.02; p < 0.001) and higher EQ-VAS (β = 1.00; 95% CI: 0.66-1.35; p < 0.001) up to 2 years after ICU discharge. After adjustment for age, sex, BMI, APACHE II score, ICU length of stay, and hospital discharge location, associations were similar.

Conclusions: More self-efficacy at 3 months after ICU discharge was associated with longitudinally higher HRQoL up to 2 years after ICU discharge in mechanically ventilated COVID-19 survivors.

Relevance to clinical practice: Screening for self-efficacy in patients post-ICU as well as developing interventions to improve self-efficacy are a target post-ICU to enhance HRQoL over the long term.

This is a prospective observational study designed to develop an echocardiography-guided tip location program for central venous catheter (CVC) implantation, and to assess the feasibility and the accuracy of the program. First, a multidisciplinary expert committee designed an echocardiography-guided tip location program; then, a pilot prospective observational study was conducted to assess the feasibility of the program in a vascular access clinic in a tertiary hospital. A total of 186 patients participated in the study. Successful echocardiography-guided tip placement was achieved in 172 (92.5%) patients. The accuracy of the program reached 99.4%. The program of echocardiography-guided tip location is feasible and accurate. Ultrasound images revealed notable discrepancies at various locations, allowing specialized nurses to conduct echocardiography-guided tip placement during CVC insertion through targeted training and practice.

Background: Research has demonstrated that staff working in Paediatric Critical Care (PCC) experience high levels of burnout, post-traumatic stress and moral distress. There is very little evidence of how this problem could be addressed.

Aim: To develop evidence-based, psychologically informed interventions designed to improve PCC staff well-being that can be feasibility tested on a large scale.

Study design: The Behaviour Change Wheel (BCW) framework guided systematic development of the interventions. This process was informed by a review of existing well-being initiatives and a survey of PCC staff's awareness and uptake of initiatives identified.

Results: Together with empirical evidence, the BCW process produced two bespoke 'SWell' (Staff Wellbeing) interventions tailored for delivery in UK PCC units. The two group-based interventions, Mad-Sad-Glad and Wellbeing Images involve the Behaviour Change Techniques (BCTs) of self-belief, social support, feedback and monitoring. These BCTs align closely with the psychological concepts of self-efficacy, self-regulation and the psychological theory of how to thrive.

Conclusions: Tailored, evidence-based, psychologically informed SWell (Staff Wellbeing) interventions are likely to be feasible and have the potential of making significant differences to individual staff members and the PCC workforce as a whole. Associated investments in the psychological health of the workforce and time to prioritize well-being interventions are required for change to occur and be maintained.

Relevance to clinical practice: The SWell (Staff Wellbeing) interventions could impact directly on the well-being of PCC staff and their ability to thrive in the workplace. Indirectly, they could reduce staff attrition, sickness absence and improve patients' and families' experiences of care.

Background: Upon discharge, very low birth weight infants pose significant caregiving challenges for families. Family resilience is vital for managing stress and adapting to this new situation. However, research focussing on the resilience of families with premature infants returning home has been limited. Understanding these factors is crucial for improving care quality.

Aim: To investigate the influence of family resilience on very low birth weight (VLBW) and extremely low birth weight (ELBW) infants, specifically examining social support, family functioning and parenting stress at 3 and 6 months of corrected age.

Study design: In this longitudinal study, we collected data from two medical centres in Northern Taiwan through convenience sampling. From December 2019 to September 2020, 51 mothers of VLBW or ELBW infants (birth weight = 540-1490 g) were included; they were assessed at 3 and 6 months of corrected age. The mothers completed questionnaires measuring family resilience, social support, family functioning and parenting stress. The data were analysed through multiple linear regression.

Results: At 3 and 6 months of corrected age, the mothers demonstrated moderate-to-high levels of family resilience. The family resilience levels demonstrated no significant differences between the two follow-ups. Social support and parenting stress strongly predicted family resilience levels at both follow-ups.

Conclusion: This study sheds light on the crucial role of family resilience in coping with challenges during this critical period.

Relevance to clinical practice: Nursing professionals' early recognition and support for family resilience can ensure post-discharge well-being for premature infants and their families.

Background: Endotracheal suction catheters are often used multiple times during endotracheal suctioning procedures in resource-limited intensive care units (ICU). The impact of this practice on mechanically ventilated patients' outcomes remains unclear.

Aim: The aim of this feasibility randomized controlled trial (fRCT) is to assess the feasibility and acceptability of single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients.

Design: This study is a three-armed fRCT with an embedded qualitative study.

Methods: The trial involves three groups. One group includes endotracheal suctioning using a single-use catheter; the second group includes a multiple-use endotracheal suction catheter flushed with chlorhexidine and the control group includes a multiple-use endotracheal suction catheter flushed with normal saline. Sixty adult ICU patients (20 in each group) will be recruited, along with 12-16 ICU nurses delivering the interventions, and 12-16 patients' next-of-kin for semi-structured interviews. The study protocol has been approved by two ethics committees. Study recruitment will be conducted over an 8-month period with an expected start date of 12 April 2024.

Outcome measures: The feasibility outcome measures will be recruitment, retention, and follow-up measures as well as the identification of clinical outcomes such as Ventilator-Associated Pneumonia (VAP) using the modified clinical pulmonary infection score, and ICU length-of-stay.

Relevance to clinical practice: This study will help ICU nurses to understand how different methods of endotracheal suctioning affects patients in ICUs with limited resources. The findings could influence clinical practice and improve patient outcomes.

Background: Nurses working in intensive care units experience insomnia and accompanying psychosocial problems due to working conditions.

Aim: This study explores with a phenomenological approach the psychosocial problems experienced by intensive care nurses regarding sleep patterns within the scope of working conditions.

Study design: In this phenomenological study, semi-structured in-depth interviews were conducted with 16 nurses working in the surgical intensive care unit of a state hospital in Türkiye. Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Researchers' interviews continued until they reached data saturation. All interviews were recorded on a voice recorder after obtaining the necessary permissions from the nurses and then transcribed. The study data were evaluated using thematic analysis. The current manuscript was reported following the COREQ checklist.

Results: Data analysis revealed three main themes (how working as an intensive care nurse changes sleep patterns, the relationship between shift work, work performance, patient care and how working as an intensive care nurse changes individual life and coping strategies) and nine subthemes (mental, physical, social, work performance, patient care, nutrition, family life, social life and coping).

Conclusion: The study's findings revealed that nurses working in intensive care experienced psychosocial difficulties related to sleep patterns and had trouble coping. In particular, it was determined that sleep problems of intensive care nurses cause difficulties in family life, nutrition and social life. It is recommended that the number of personnel in workplaces be increased, overtime hours should be limited, and professional development and training on the importance of sleep for all nurses should be provided.

Relevance to clinical practice: Nurses working in intensive care units may experience psychosocial problems due to working conditions, which may negatively change their coping skills. Therefore, organizing the working conditions of nurses positively changes their coping skills.

Background: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. Policies are only effective if people comply.

Aim: Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU).

Study design: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented.

Results: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage.

Conclusions: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment.

Relevance to clinical practice: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.