Nursing in Critical Care最新文献

Background: Medical sedation is a requirement for mechanical ventilation for most patients admitted to the intensive care unit (ICU). Sedation can help minimise patient discomfort, pain and distress, but can lead to hypotension, bradycardia, prolonged ventilation and delirium. Improving sedation practice is key to improving sedation-related patient outcomes.

Aim: This study aims to explore ICU staff experience with sedation practices and identify potential areas for improvement and innovation.

Study design: Semi-structured interview study exploring views, experiences and clinical decision-making of ICU medical and nursing staff from two NHS adult ICUs in Yorkshire, England. Interviews were recorded to enable anonymous transcript production. Transcripts were coded using reflexive thematic analysis guided by Braun and Clarke's six-stage method.

Findings: We interviewed 18 members of ICU medical and nursing staff and using thematic analysis four interrelated themes were identified. First, staff perception of sedation, including understanding and reasoning around sedation goals. Second, the impact that ICU culture has on sedation practices. Third, sedation education and training for clinical staff. Finally, motivation to change, aspects impacting the delivery of sedation practices on ICU and key considerations for innovating change.

Conclusions: Sedation practices in ICU are shaped by complex interactions between clinical framing, cultural norms, education and training and organisational pressures. Optimising sedation and implementing innovation require prioritisation of sedation as an active, goal-directed treatment, supported by structured education and leadership engagement.

Relevance to clinical practice: This analysis offers novel insights into barriers and facilitators to innovating sedation practices for mechanically ventilated patients, highlighting under-prioritisation in clinical practice and training, cultural barriers and external influencers like staff retention and workload.

Background: Involving mothers in their infant's pain management is an essential part of family-centred care in a neonatal intensive care unit (NICU). Healthcare professionals commonly use sweet solutions, such as oral glucose, to relieve pain in infants during heel lances and other procedures. However, there is a lack of knowledge about how mothers perceive the use of oral glucose for pain management.

Aim: To describe mothers' views on the use of oral glucose for neonatal pain relief.

Study design: A qualitative descriptive study was conducted in a neonatal intensive care unit in Finland between May 2023 and May 2024. The participants were mothers (n = 25), recruited from a randomised controlled trial (RCT) involving newborns. Data were collected through semi-structured interviews based on an interview guide, and analysed using content analysis.

Findings: Mothers' views on the use of glucose for neonatal pain relief consisted of four main categories: 'Varying perceptions of acceptability', 'An easy-to-implement method', 'Contradictory opinions on effectiveness' and 'Another method would be better'.

Conclusions: Mothers found glucose to be an easy-to-use method for neonatal pain relief, but their opinions on its effectiveness varied. They recommended combining glucose with another method or adopting a mother-led approach to improve pain management.

Relevance to clinical practice: Healthcare professionals should recognise the individual nature of each mother's perception of glucose as a method of newborn pain management and consider this perspective when providing counselling and planning pain relief methods.

Background: Admission of a child to a paediatric intensive care unit (PICU) is a highly stressful experience for parents and may trigger acute stress disorder (ASD), posing a risk for long-term post-traumatic stress disorder (PTSD) and depression. Despite this vulnerability, structured follow-up care is rarely offered.

Aim: This study examined (1) acute stress, post-traumatic adjustment and the perceived need for psychological follow-up care among parents of PICU patients, (2) variables associated with ASD symptoms and the need for follow-up care, and (3) dyadic associations between mothers' and fathers' distress.

Study design: An observational study was conducted at the PICU of a University Hospital in Germany between December 2022 and February 2024. Parents of children admitted for ≥ 48 h completed standardised self-report instruments, including the Acute Stress Disorder Scale (ASDS) and the Post-traumatic Adjustment Scale (PAS). Logistic regression analyses identified predictors of ASD and the need for follow-up care; dyadic associations were explored with correlation and intraclass correlation analyses.

Results: Seventy-seven parents of 52 children participated (58% mothers, median age 38 years). Nearly two-thirds met diagnostic criteria for ASD, with mothers reporting higher symptom severity. Forty-two percent screened positive for PTSD risk, and 68% for depression risk. One-third (34%) expressed a need for psychological follow-up care, which was strongly associated with PTSD risk (OR = 8.42, 95% CI [2.79-25.38]). Dyadic analyses showed significant correlations of ASD symptoms between mothers and fathers (r = 0.42), but not for PTSD or depression risk.

Conclusions: Parents of PICU patients experience high rates of acute stress and are at considerable risk for subsequent psychopathology. The need for psychological support is strongly linked to PTSD risk, and parental distress shows dyadic associations.

Relevance to clinical practice: Routine psychosocial screening and structured follow-up care should be integrated into PICU services. Family-centred interventions targeting both parents may help mitigate long-term psychological consequences.

Background: In resource-limited settings, single-use open endotracheal suction catheters are commonly used multiple times. The current evidence of this practice on ventilator-associated pneumonia (VAP) among mechanically ventilated patients remains unclear.

Aim: The aim of this study was to test the feasibility of single-use and multiple-use endotracheal suction catheters flushed with chlorhexidine versus standard care (multiple-use endotracheal suction catheters flushed with normal saline) to reduce VAP in resource-limited intensive care units (ICUs) and evaluate study methods for designing a future definitive randomised controlled trial (RCT).

Study design: A three-armed feasibility RCT was conducted in three ICUs at a university hospital in Egypt.

Results: Sixty mechanically ventilated patients were randomized into three groups: Intervention I group, single-use catheters, Intervention II group, multiple-use catheters flushed with chlorhexidine, and Control group (standard care) multiple-use catheters flushed with normal saline. Data on feasibility parameters, intervention adherence, and patient outcomes were collected. Recruitment and retention rates were high across all groups, with 96.7% (n = 58) of participants completing the 3-day follow-up and 93.3% (n = 56) completing the 6-day follow-up. Adherence to intervention protocols was excellent, with 100% of participants receiving the designed interventions. No adverse events were reported. Chlorhexidine flushing and single-use catheters were practical and successfully implemented. Challenges of budget constraints, supply shortages and the need for staff training were observed. The incidence of VAP was 31.6% in the Intervention I group, 26.3% in the Intervention II group, and 40% in the standard care group. The relative risk of developing VAP compared with the control group was 0.79 (95% CI: 0.51-1.23) for Intervention I and 0.66 (95% CI: 0.42-1.03) for Intervention II.

Conclusions: A full-scale RCT comparing single-use and multiple-use catheters with chlorhexidine flushing is feasible in resource-limited ICUs. Further investigation into the effectiveness of interventions on VAP prevention is needed in future definitive RCTs.

Relevance to clinical practice: This study highlights the practical implementation of endotracheal suctioning strategies, such as chlorhexidine flushing and single-use suction catheters, to potentially reduce VAP in resource-limited ICUs. These findings can inform clinical decision-making and infection control.

Trial registration: ClinicalTrials.gov, identifier NCT06207513.

Background: Post-extubation dysphagia (PED) is a common complication in neurosurgical ICU (NICU) patients, increasing the risks of aspiration, pneumonia and malnutrition. Limited research has examined how PED prevalence and recovery vary across different neurological disease types.

Aim: This study aimed to investigate the prevalence and recovery rates of post-extubation dysphagia in neurosurgical ICU patients with intracerebral haemorrhage, cerebral ischaemia, or intracranial tumours. It further sought to identify disease-specific differences and contributing factors to inform the development of individualised swallowing rehabilitation strategies.

Study design: This cross-sectional study consecutively enrolled eligible patients. Swallowing function was assessed using the Gugging Swallowing Screen for ICU (GuSS-ICU) at 24 h post-extubation and at discharge (score < 15 = dysphagia). Prevalence, improvement rates and associated factors (via multivariate logistic regression) were analysed.

Results: A total of 341 participants were included. The overall prevalence of dysphagia was 85.3%. Patients with intracerebral haemorrhage exhibited the highest prevalence (OR = 1.774, p = 0.008) and a relatively lower improvement rate (OR = 1.992, p = 0.006). Compared to haemorrhagic stroke, patients with cerebral ischaemia showed a slightly better recovery trend (OR = 1.408, p = 0.111), although overall improvement remained limited (OR = 0.659, p = 0.040). The poorest recovery was observed in patients with intracranial tumours (OR = 0.374, p = 0.002).

Conclusions: The prevalence and recovery of PED varied significantly depending on the neurological disorder. Patients with ICH were at the highest risk, while those with intracranial tumours faced the poorest prognosis for recovery.

Relevance to clinical practice: These findings highlight the critical need for early and routine dysphagia screening in this vulnerable population. Understanding these disease-specific patterns allows clinicians to identify high-risk patients earlier and provides an evidence-based foundation for creating personalised swallowing rehabilitation strategies.

Background: Family Integrated Care (FICare) is a structured model of parental participation in NICUs designed to improve infant outcomes and promote parental well-being. While some trials have shown benefits, effectiveness across clinical and psychosocial outcomes remains uncertain.

Aim: To evaluate the effectiveness of FICare compared with standard neonatal intensive care unit (NICU) care in preterm infants and their parents.

Study design: PubMed, Embase, PsycINFO, Web of Science, Medline, CINAHL Complete and ClinicalTrials.gov were searched from inception to May 5, 2025. Eligible studies were randomised controlled trials (RCTs) comparing FICare with standard NICU care. Pooled relative risks (RRs) were calculated for categorical outcomes, and standardised mean differences (SMDs) or mean differences (MDs) for continuous outcomes. Risk of bias was assessed with the Cochrane RoB 2.0 tool, and sensitivity analyses tested the robustness of findings.

Results: Eight trials were included. FICare was associated with greater weight gain (three studies; SMD = 1.07; 95% CI: 0.15-1.99; I² = 98.9%) and reductions in parental stress (three studies; MD = -0.30; 95% CI: -0.53 to -0.07; I² = 90.6%) and anxiety (two studies; MD = -2.36; 95% CI: -4.36 to -0.37; I² = 58.4%). No significant differences were observed for breastfeeding, time to full enteral feeding, hospital stay, or readmission. Most studies had some concerns regarding bias, and sensitivity analyses confirmed robustness.

Conclusions: FICare improves neonatal growth and parental psychological outcomes; however, the low certainty of evidence warrants cautious interpretation and highlights the need for further high-quality trials.

Relevance to clinical practice: Implementing FICare in NICUs may improve infant growth and parental well-being, supporting broader adoption in neonatal care.

Trial registration: PROSPERO Registration number: CRD420251004003.

Background: On 6 February 2023, two major earthquakes of magnitude 7.7 and 7.6 occurred in Turkey. The earthquakes caused severe damage and loss of life in 11 provinces, and the injured were transferred to other provinces for treatment and care.

Aim: This study was conducted to investigate the nursing experiences of nurses who cared for people affected by the two major earthquakes in Kahramanmaraş.

Study design: A phenomenological research design was used in this study. The study sample consisted of 24 nurses who provided care to earthquake victims in the intensive care unit (n = 20) and the emergency service (n = 4). Nurses were included in the study using the purposive sampling method. Interviews were conducted face-to-face and continued until data saturation was reached. The research data was collected between June and August 2024 using a semi-structured interview form. The data were analysed using the inductive content analysis technique. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were used as a guide when reporting this study.

Findings: Four main themes were identified in the in-depth interviews conducted with the nurses. These were: (1) Psychosocial impact of caring for earthquake victims, (2) Difficulties experienced in caring for them, (3) Experiencing personal and professional resilience during care and (4) Reflections shaped by their lived experience for future disasters.

Conclusions: The results of this study show that the nurses showed great dedication in the face of the disaster they experienced and encountered various difficulties in caring for the earthquake victims.

Relevance to clinical practice: The unexpected and sudden nature of disasters requires effective planning, coordination and implementation of health services. In this context, health institutions, universities and policymakers should take strategic measures to reduce the difficulties faced by nurses in disaster situations such as earthquakes and to increase the effectiveness of health services.

Background: Research on gender and racial disparities in intensive care is emerging. Women experience less intensity of care, less utilisation of critical care resources and poorer overall health outcomes. These disparities may become more pronounced when race is considered. Black women experience more barriers in accessing care, yet their unique needs, critical care experiences and illness trajectories are understudied. Intersectionality theory can help explore how overlapping systems of oppression contribute to greater health disparities and poorer health outcomes in Black women.

Aim: To summarise evidence on the experiences of Black women receiving critical and acute care in high-income countries.

Study design: A narrative review using an intersectionality of gender and race lens. Given the scarcity of studies in critical care, we included evidence from other acute care settings to emphasise the importance of intersectionality in understanding health disparities in critical care. Databases used included CINAHL, Cochrane, Embase, Medline, PsycINFO, Scopus, ProQuest Dissertations and Theses. The Scale for the Assessment of Narrative Review Articles guided reporting.

Findings: Ten studies, all conducted in the United States, were analysed. Four themes present the findings, including critical care outcomes in Black women through an intersectional lens, structural vulnerability of Black women, micro-aggressions and intersections of race and gender stress in Black women.

Conclusions: The paucity of literature on Black women's critical care experiences may cause further marginalisation in their care.

Relevance for clinical practice: Critical care systems should collect data on patients' identities (i.e., race, gender, socio-economic status) to assist in analyzing health disparities across populations.

Background: Intra-hospital transport of critically ill patients may be associated with a significant risk of adverse events. Critically ill patients inadequately responding to therapy on general wards need to be transferred to the intensive care unit for immediate intervention and organ support. However, the focus on the safety of transportation from the general ward to the intensive care unit has seldom been addressed.

Aim: To investigate the current challenges of transportation of critically ill patients from general wards to intensive care units from nurses' perspectives.

Study design: A qualitative descriptive design. In-depth and semi-structured interviews were performed. Data were collected at a single tertiary university hospital in Hunan province, China. Sixteen nurses participated in this study. Qualitative data were analysed using content analysis.

Findings: Four themes were identified: practical barriers in initiating transport (e.g., gaps in early recognition and management), preparation under strong pressure: challenges of covering everything (e.g., juggling multiple roles in the preparation phase), every minute counts: an unexpected journey (e.g., concerns about patient conditions deteriorating in the blink of an eye during the transfer phase), difficulties in multilateral cooperation (e.g., unsynchronised interdepartmental handover).

Conclusions: From the perspective of the participants, nurses underwent a difficult experience in transporting critically ill patients from the general ward to the intensive care unit, and challenges were encountered throughout the entire transport process.

Relevance to clinical practice: Our findings highlighted that managers should clarify criteria for initiating transfers and team member qualification, establish standardised protocols, improve interdisciplinary teamwork and apply constant training programs. The findings underscored the urgent need for high-fidelity-based interdisciplinary training and joint education programs.

Background: Postoperative delirium of cardiovascular surgery (PODOCVS) is an acute brain dysfunction, which will lead to increased postoperative complications and high mortality rates. Using prediction models for early identification and intervention could improve outcomes and resource utilisation. However, the quality and applicability of existing models remain unclear, and healthcare professionals are often unsure which model should be recommended to cardiovascular surgery (CS) patients in a specific setting.

Aim: To systematically review and critically evaluate the development, performance and applicability of available prediction models for PODOCVS.

Study design: We searched multiple databases from inception to 12 August 2024, to identify multivariate predictive models for PODOCVS. Prospective or retrospective cohort studies were eligible if they created and validated delirium prediction models or scoring systems. We included studies involving adults undergoing CS, excluding studies that externally validated existing models or did not validate the models. Data extraction used the CHARMS checklist, and model quality was assessed with the PROBAST.

Results: Of 3967 screened studies, 24 described 67 prediction models. The incidence of postoperative delirium following CS ranged between 3.6% and 36%. Logistic regression was the most commonly used modelling technique. Internal model validation was carried out in 17 studies (70.38%), with the bootstrap and random split methods being the most commonly used. The most commonly used predictors were age, EF value, extracorporeal bypass time and ICU stay duration.

Conclusions: While existing prediction models for PODOCVS demonstrated good discriminatory ability, they were found to have a high risk of bias according to PROBAST. All studies had a low risk of bias in predictor and outcome domains, but analysis domains were at high or unclear risk due to underreporting. The utility and generalisability of these models are uncertain due to this bias, heterogeneity in predictors and a lack of clinical application studies. Therefore, current models are not recommended for clinical use.

Relevance to clinical practice: Early delirium prediction is crucial for timely intervention and can provide actionable information to nurses. However, the current models are not sufficiently reliable for clinical application. Future work should focus on improving methodological rigour and performing robust internal and external validation.