Nursing in Critical Care最新文献

Background: Prone positioning (PP) is widely used to improve oxygenation in acute respiratory distress syndrome (ARDS), but evidence in mechanically ventilated COVID-19 ARDS is heterogeneous.

Aim: To evaluate the effect of 16-h daily PP on oxygenation, ventilation, laboratory and radiological parameters in intubated patients with COVID-19-related ARDS.

Study design: In this prospective cohort, 40 intubated patients were followed for 3 days: PP group (n = 20; PaO₂/FiO₂ ≤ 100) and supine position (SP) group (n = 20; PaO₂/FiO₂ ≤ 200). Ventilator settings, oxygenation/ventilation parameters (PaO₂, PaCO₂, HCO₃, lactate, pH and SaO₂), PaO₂/FiO₂ ratio, haematologic/biochemical markers (C-reactive protein (CRP), fibrinogen, D-dimer, ferritin, lymphocyte count, procalcitonin, platelet count and LDH) and daily chest radiographs were recorded.

Results: Within-group analyses in the PP group showed significant changes over time in PaO₂ (p = 0.024), PaCO₂ (p = 0.035), PaO₂/FiO₂ (p < 0.001), pH (p = 0.004), fibrinogen (F = 7.600; p = 0.002), procalcitonin (F = 3.828; p = 0.043), platelet count (F = 6.486; p = 0.013), and LDH (F = 8.862; p = 0.002) no significant within group changes were observed in the SP group (fibrinogen, p = 0.068; procalcitonin p = 0.093; platelet p = 0.068; LDH p = 0.227). SaO₂ was higher in the PP group than in the SP group at M3 on Day 2: PP: 92.13 ± 5.5 vs. SP: 88.24 ± 6.02%; t = 2.131; mean difference +3.89 (95% CI 0.19 to 7.57; p = 0.040). CRP decreased over time in both groups (PP: p = 0.008; SP: p = 0.001). Radiographically, ground-glass opacities decreased in 70% of PP vs. 25% of SP patients (p = 0.001).

Conclusions: This study suggests that the prone position may be more effective in improving clinical and oxygenation parameters in intubated COVID-19 patients with severe ARDS.

Relevance to clinical practice: This study provides evidence to guide the management of COVID-19-related ARDS. The findings may support ICU nurses' clinical decisions and improve care protocols for similar patients. Clinically, maintaining ARDS patients in the prone position (PP) aids recovery. In intensive care units, experienced nurses should ensure correct patient positioning and provide continuous monitoring.

Background: Surgical intensive care unit (SICU) nurses undertake multidimensional and complex responsibilities in the process of postoperative patient care and monitoring. Understanding the challenges encountered within these responsibilities is crucial for improving care quality. Additionally, recognising nurses' coping strategies helps to identify their professional support needs.

Aim: This study aimed to identify the difficulties encountered by nurses working in SICUs in the management of postoperative patients, as well as the strategies they use to cope with these difficulties.

Study design: This qualitative study was structured using a phenomenological design. Individual in-depth interviews were conducted with nurses working in SICUs in various provinces across Turkey between 15 October and 15 November 2024. The interviews were carried out using a 'Semi-Structured Interview Form' During the reporting process, the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed, and the data were analysed using the conventional content analysis method.

Findings: The study was conducted with 20 nurses. Two main themes and eight subthemes were identified. The first main theme was the difficulties encountered in postoperative patient care; under this theme, the subthemes were defined as difficulties related to the surgical process, communication, workload, time management and psychological factors. The second main theme was the strategies used by nurses to cope with difficulties; within this theme, the subthemes included teamwork and collaboration, time management, stress management methods, professional development and knowledge updating.

Conclusions: Surgical intensive care unit nurses encounter multidimensional difficulties during the postoperative patient care process, which can negatively impact both the quality of care and professional well-being. Establishing supportive mechanisms at the institutional level is essential for maintaining high-quality patient outcomes and promoting the well-being of nurses in coping with these difficulties.

Relevance to clinical practice: Effective coping strategies such as interdisciplinary collaboration, prioritisation of care, emotional regulation and continuous professional education enhance nurses' resilience and strengthen the quality of nursing care.

Background: Work in intensive care unit (ICU) is associated with different but often-neglected problems for nurses. Exploring nurses' experiences of these problems helps managers better understand them. However, there are limited qualitative data about these problems.

Aim: The aim of this study was to explore the potential threats to nurses' health in ICU.

Study design: This conventional qualitative content analysis was undertaken in September-December 2023. Sixteen in-depth interviews were conducted with 14 nurses and nursing managers who were purposively selected from five public, six military, and three private hospitals in Tehran, Iran. The data were analysed using Elo and Kyngas' conventional qualitative content analysis.

Findings: Sixteen interviews with 14 participants were conducted. Participants' experiences of health threats in ICUs revealed six main themes: social health threats stem from challenges in maintaining effective interpersonal relationships; mental health threats arise from psychological stressors and disorders linked to the high-pressure ICU environment; ethical-spiritual health threats emerge from morally distressing situations and spiritual conflicts; physical health threats result from the physical demands and health risks inherent in ICU work; technological health threats are associated with difficulties in adapting to and using complex medical technologies and environmental health threats are caused by unfavourable workplace conditions such as noise, lighting and physical structure.

Conclusions: Nurses in ICU are exposed to many different threats to their social, mental, ethical-spiritual, physical, technological and environmental health which can be considered a work-related syndrome, called 'nurse ICU syndrome (NICUS)'. These problems highlight the necessity of serious interventions by healthcare policy-makers and hospital managers.

Relevance to clinical practice: The results of this study help hospital managers and nursing authorities determine and manage the threats to nurses' health. Educational and supportive programs are necessary for ICU nurses to improve their stress management skills, their work conditions and their welfare facilities.

Background: Nurse fatigue has become an escalating global concern due to chronic nursing shortages, especially among ICU nurses. Scientific and effective assessment of fatigue is beneficial for strengthening nurse occupational health management and reducing the turnover rate. Yet previous studies mainly relied on subjective self-reports, with limited integration of objective physiological measures in the nursing population.

Aim: To investigate the fatigue status of ICU nurses and analyse related influencing factors, so as to provide a reference for formulating targeted intervention measures.

Study design: From March 2025 to June 2025, a convenience sample was recruited from 9 intensive care units across two teaching hospitals in Beijing, China. Participation in the study was entirely voluntary, and only those who completed both the questionnaire and monitoring procedures were included. Data collected included demographic characteristics, fatigue levels, sleep-wake index, heart rate variability and salivary cortisol levels.

Results: In total, 140 nurses participated in the study. The average fatigue severity score among intensive care unit nurses exceeded the established clinical cut-off, and 92.9% of participants reported clinically significant fatigue. Among nurses working 8-h shifts, factors associated with fatigue included heart rate, low-frequency heart rate variability, total sleep time, circadian activity rhythm and cortisol levels after the shift. For nurses on 12-h shifts, predictors included the balance of sympathetic and parasympathetic nervous activity, total sleep time, circadian activity rhythm, cortisol levels before the shift and years of experience in the intensive care unit.

Conclusions: Fatigue among nurses in intensive care units is high and is associated with disrupted sleep, reduced self-regulation ability and occupational stress. Interventions should be tailored according to shift type to effectively reduce fatigue.

Relevance to clinical practice: Recognising fatigue predictors enables the development of targeted interventions to mitigate fatigue, optimise work schedules and improve quality of care.

Background: Medical device-related pressure injury (MDRPI) is a major patient safety issue in intensive care units (ICUs), where invasive devices, impaired consciousness and fragile skin tolerance increase risk. Generic risk scales such as Braden and Norton do not account for device-skin interface mechanisms, leading to the underestimation of MDRPI risk. No ICU-specific validated MDRPI risk assessment instrument has been reported in Indonesia.

Aim: To develop and preliminarily validate a concise, ICU-specific, mechanism-based risk assessment instrument for MDRPI.

Study design: Methodological instrument development and validation study guided by the COSMIN framework, comprising three phases: literature review and item generation, three-round Delphi consensus with wound care experts, and pilot testing among ICU patients.

Results: Delphi consensus reduced 31 candidate items to six domains: nutrition, moisture/microclimate, sensory perception, friction/shear, external device and consciousness. Content validity was excellent (I-CVI = 1.00 S-CVI/Ave = 1.00). Internal consistency was acceptable (Cronbach's α = 0.81-0.85). Receiver operating characteristic analysis demonstrated excellent discriminative performance (AUC = 0.96), with an optimal cut-off score of ≥ 14 for identifying patients at high risk of MDRPI.

Conclusions: The 6-item ICU-specific MDRPI risk assessment instrument demonstrated robust preliminary validity and reliability. It addresses key limitations of generic scales and provides a feasible framework for MDRPI risk stratification in critical care settings.

Relevance to clinical practice: The instrument supports early identification of high-risk ICU patients, facilitates targeted preventive interventions and is suitable for integration into routine bedside assessment and electronic health record systems.

Background: Intensive care units (ICUs) are among the most resource-intensive hospital settings, generating substantial greenhouse gas emissions and waste. While ICU nurses play a central role in advancing sustainability, how clinical context shapes their understanding and enactment of sustainable practices remains unclear.

Aim: To explore how nurses frame and integrate environmental sustainability across different intensive care settings.

Study design: A qualitative exploratory design was adopted using semi-structured interviews with ICU nurses from Trauma, General, Cardiac and General Surgery ICUs in Italy. Textual data were analysed through Automatic Analysis of Textual Data within the framework of Exploratory Multidimensional Data Analysis. Correspondence analysis identified lexical associations and latent semantic dimensions differentiating sustainability discourses across settings.

Findings: A total of 29 ICU nurses participated in the study. Discourses varied markedly by clinical context. Trauma ICUs emphasised cultural awareness and collective responsibility. General ICUs reflected institutional coordination and procedural integration. Cardiac ICUs described systemic barriers and operational strain, while Surgical ICUs highlighted pragmatic alignment with infection prevention. Two latent dimensions, cultural promotion versus institutional coordination and integration versus operational strain, captured how sustainability transitions from value-driven awareness to structured policy practice.

Conclusions: Environmental sustainability in intensive care is not a universal construct, but a negotiated, context-dependent practice shaped by cultural, organisational and material factors.

Relevance to clinical practice: Promoting sustainability in critical care requires setting-specific strategies that align ecological principles with clinical priorities. Nursing education and leadership should foster both bottom-up engagement and top-down institutional support to embed sustainability into the culture and operations of intensive care.

Background: A palliative care unit is a place where intensive treatment and care are provided for both patients and caregivers. In addition, some invasive interventions are needed to reduce the symptoms seen in end-stage patients.

Aim: In this study, the relationship between the care burden experienced by caregivers of patients hospitalised in a palliative care unit and invasive procedures (intravenous applications were excluded from invasive procedures because they are routinely applied to all patients) was evaluated.

Study design: This cross-sectional study was conducted in Turkey. The following tools were used to collect data: the 'Caregiver Information Form', 'Palliative Performance Scale (PPS)' and the 'Zarit Care Burden Scale'.

Results: Although data were collected from 123 patients, informal caregivers and those who declined to answer certain questions were excluded from the final sample, ensuring that the target sample size was met. The final sample consisted of 107 caregivers. Results showed that the median care burden score was significantly higher among caregivers with low income (49 (14-72); p = 0.034), those caring for patients diagnosed with cerebrovascular events (58.5(19-70); p = 0.029), and those who underwent invasive interventions for various reasons (34 (10-73); p = 0.006). Additionally, 68.2% (n = 73) of caregivers reported feelings of distress for their patients and 57% (n = 61) experienced insomnia while providing care. The mean PPS score of the patients was 32.0 ± 20.0, and the median score of the Zarit Burden of Care Scale was 30 (10-73). The combined variables of caregiver age, days spent with the patient, and PPS score accounted for 17% of the variance in the Care Burden Scale (R = 0.444, R² = 0.174, p < 0.05).

Conclusions: Based on these findings, it is recommended that caregivers of patients receiving invasive interventions and those with low PPS scores receive both physiological and psychological support.

Relevance to clinical practice: These findings highlight the need for targeted physiological and psychological support for caregivers of palliative care patients undergoing invasive interventions to reduce care burden and improve overall care quality.

Background: The number of children with long-term home mechanical ventilation (LTV) is increasing globally. Parents become experts on their children's needs and sometimes know more about LTV treatment than non-specialist healthcare professionals. Nurses caring for LTV-dependent children in intensive care settings adjust to a collaborative caregiving role; however, this interaction has not been described in general paediatric wards.

Aim: To describe nurses' experiences of caring for children and adolescents with established LTV at general paediatric wards.

Study design: We conducted individual semi-structured interviews with 15 participants and analysed the data using qualitative content analysis.

Findings: The study resulted in three categories: 'Building a relationship', 'Working hand in hand with the family', and 'Doing one's best despite the LTV', interpreted into the theme 'Working for reciprocal trust despite frail confidence', which can be seen as foundational to nursing both the child and the family.

Conclusions and relevance to clinical practice: Reciprocal trust between families, nurses and the respiratory team could and should be established swiftly after admission with a discussion of each party's immediate responsibilities and back-up roles.

Background: Intranasal breast milk administration is perceived as a promising intervention in preterm infants.

Aim: The aim of this paper is to present a protocol for a study whose aim is to evaluate the effects of intranasal breast milk administration in preterm infants.

Study design: The study was planned as a randomized controlled experimental design. The study will be conducted with preterm infants between 28⁰-36⁺⁶ gestational age in the NICU of Selçuk University Faculty of Medicine Hospital in Konya, Türkiye. The study sample will consist of 40 preterm infants. Intranasal breast milk administration will be administered to the infants in the intervention group three times a day for three days. Intervention group will receive a total of 0.2 ml of breast milk intranasally in each application. Control group will not receive any intervention, including placebo. Cerebral oxygenation levels and vital signs will be recorded at four time points during each intervention session: before the intervention, and at the 5th, 15th, and 30th minutes after the intervention. Time to full oral feeding of preterm infants will continue to be monitored after the intervention period.

Results: The measurements of the study outcomes will be evaluated using the "Infant Information Form", "Physiologic Parameter Follow-up Form" and "Nutrition Follow-up Form" developed by the researchers.

Conclusions: This study is expected to provide findings on the potential effects of intranasal breast milk administration on physiological stability, cerebral oxygenation, time to full oral feeding in preterm infants.

Relevance to clinical practice: This study is expected to contribute to the literature by determining the effect of intranasal breast milk administration in preterm infants and provide valuable findings for future studies.

Trial registration: The study protocol was registered on ClinicalTrials.gov (NCT06706115).

Background: Parents of infants hospitalised in neonatal intensive care units (NICU) experience significant stress and require clear, consistent communication. Involving them in family-centred rounds (FCR), a key component of family-centred care (FCC), may help meet these needs.

Aim: To assess the feasibility of implementing FCR in a NICU setting in Switzerland.

Study design: This one-group pre-post feasibility study was conducted from June to September 2022. Feasibility was evaluated using three dimensions: acceptability (participation rate and duration), implementation (fidelity of the intervention and open-ended questions), as well as limited efficacy. Efficacy was assessed through parent-reported stress and satisfaction (PSS, EMPATHIC-N) before and after participation in FCR and healthcare professional (HCP) reported interprofessional collaboration (AITCS-II) before and after implementation.

Results: A total of 37 rounds were conducted with seven parents (24% participation). FCRs lasted on average 12m13s, compared to 8m49s for traditional rounds (mean difference: 3m24s). Fidelity, observed in 18 FCRs during the study period, showed some variability. Open-ended survey questions from both parents and HCP provided qualitative insights on implementation determinants. Parents reported reduced stress after FCR and increased satisfaction in the 'parental involvement' subscale. Among professionals, only the 'coordination of care' subscale showed significant improvement.

Conclusions: FCR implementation was feasible and showed potential to improve parental stress, satisfaction and interprofessional collaboration. Further evaluation of whether FCRs can be sustained over time is warranted.

Relevance to clinical practice: FCR may enhance family partnerships in NICUs and improve care experiences for both families and healthcare teams, and promote a family-centred care environment.