Nursing in Critical Care最新文献

This article describes the reallocation of space and construction of a new adult shock trauma intensive care unit implementing methods to mitigate the environmental impact. The environmental burden was reduced through innovative reallocation of space and diversity of lighting sources. Circular economy principles were implemented which enabled much of the infrastructure materials to be reused. Collaboration among interdisciplinary health care teams, such as described in this article, helped to ensure expertise was shared so that the environmental impact was lessened. This article provides insight into innovative methods to mitigate the carbon footprint of a critical care renovation project.

Background: Frailty, a geriatric syndrome characterized by decreased resilience, is a known risk factor for mortality in critical care settings and can significantly impact a patient's perception of their own health and prognosis.

Aim: To explore the relationship between frailty and fear of death in geriatric patients admitted to critical care units.

Study design: A convergent parallel mixed methods design was applied.

Methods: Data were collected from 247 geriatric patients in critical care units from March 2023 to February 2024. Quantitative data included clinical frailty score and death anxiety questionnaire. Qualitative data were gathered through semi-structured interviews with a subset of 34 participants. Quantitative analysis involved descriptive statistics, correlation analysis and multiple linear regression. Qualitative data were analysed thematically using Braun and Clarke's approach.

Results: Quantitative analysis revealed a positive significant correlation between frailty and death anxiety (r = 0.19, p = 0.003). Additionally, regression analysis identified age (B = 0.69, 95% CI [0.22, 1.15], p = 0.004), lack of social support (B = 2.88, 95% CI [0.28, 5.47], p = 0.030), lower income (B = -5.33, 95% CI [-9.03, -1.63], p = 0.005) and higher frailty scores (B = 0.83, 95% CI [0.10, 1.56], p = 0.025) as significant predictors of increased death anxiety. Qualitative findings yielded four key themes: the impact of frailty on perception of mortality, the psychological and emotional dimensions of fear of death, the role of the critical care unit environment on fear of death and coping mechanisms and support.

Conclusion: Frailty in geriatric critically ill patients heightened death anxiety due to physical decline, existential worries and the overwhelming critical care environment.

Relevance to clinical practice: This study can help nurses provide more personalized care to geriatric patients by addressing both their physical frailty and psychological needs related to fear of death. This, in turn, can improve the quality of care and enhance patient satisfaction.

Background: Re-deployment of medical, nursing and Allied Health Professional workforce became a more prevalent feature in filling workforce gaps during the Covid-19 pandemic; however, very little evidence exists surrounding the impact of this re-deployment of registered nursing workforce. Prior to the Covid-19 pandemic and subsequently in an attempt to address nursing shortages across paediatric ward areas, there is a growing trend to utilize registered nursing staff more flexibly to meet the demands of the whole organization.

Aim: The aim of this study was to explore the incidence impact of re-deployment to cover workforce shortages in the registered paediatric critical care nursing workforce.

Study design: This is a cross-sectional electronic survey of paediatric critical care nurses registered with the Paediatric Critical Care Society as nursing members (n = 688). Anonymous quantitative and qualitative data were collected between January and March 2023. Quantitative data were analysed using descriptive statistics and qualitative data were analysed thematically.

Results: There were 225 participant responses representing 21 of the 26 paediatric critical care units within the United Kingdom. This represents a response rate of 33%. The frequency of re-deployment ranged from zero to two occurrences per month (n = 195; 87%). Thirty percent (n = 67) of respondents felt that re-deployment to other wards to cover staffing shortfalls impacted the safety of care delivered to the patients. Five themes were identified: Quality of Care, Wellbeing, Teamwork, Training and Support and Leadership.

Conclusions: This study demonstrates the significant impact that re-deployment has on the paediatric critical care nurse population. With retention of experienced critical care nurses at crisis point, it is essential that we identify factors that contribute to this poor retention and address these factors accordingly. Re-deployment is a significant factor.

Relevance to clinical practice: This study has provided a greater understanding of the impact of re-deploying paediatric critical care to cover workforce shortages throughout acute hospital settings.

Background: The World Health Organization (WHO) emphasizes the need for radical approaches in its Global Patient Safety Action Plan, particularly in terms of interprofessional and multidisciplinary approaches. The plan highlights the importance of providing training on patient safety for all professionals, focusing on team and task-based strategies that include bedside and simulation education. TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) is an educational programme developed to teach health care professionals on specific tools and strategies to enhance basic teamwork skills. Mutual support, one of the teamwork skills described in TeamSTEPPS®, involves team members assisting one another, providing and receiving feedback on performance, and advocating assertively when patient safety is threatened.

Aim: The aim of this study was to explore the experiences of cardiovascular surgeons and nurses with mutual support through interprofessional collaboration in the intensive care unit (ICU) at Hacettepe University.

Study design: The study employed a basic qualitative research design. The data were gathered through in-depth interviews and analysed with inductive content analysis in accordance with Elo and Kyngäs. We used the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to describe and report the components of study design.

Results: We interviewed 13 participants: 6 surgeons and 7 nurses. Six themes were identified: mutual support, positiveness of working in a supportive environment, feedback, effective communication, patient safety and conflict resolution.

Conclusion: The results of our study revealed that intra/inter-professional collaboration and mutual trust based on the variety of individual and workplace-related factors improved patient safety through individual motivation while monitoring and supporting each other in a positive environment, providing feedback and encouraging effective communication, patient advocacy and conflict resolution.

Relevance to clinical practice: Exploring the experiences, challenges and successes of health care workers in interprofessional collaboration is crucial. Understanding team dynamics, communication barriers and collaboration strategies can help promote more effective teamwork and contribute to the development of plans to improve the quality of patient care.

Background: Intensive care unit-acquired weakness (ICU-AW) is prevalent and adversely affects patient outcomes. Muscle strength progression and response to rehabilitation differ across ICU populations. However, the trajectories, determinants and prognoses of muscle strength changes remain unclear.

Aim: This study aimed to investigate the trajectory and determinants of ICU-AW in critical illness and its impact on 60-day postadmission mortality.

Study design: A multicentre prospective cohort study was conducted, involving critically ill patients from 10 ICUs across five tertiary hospitals in Fujian Province, China. Patients were evaluated using the Medical Research Council (MRC) scale at three time points: within 48 h of ICU admission or within 24 h of regaining consciousness (T1), within 24 h of ICU discharge (T2) and at the time of hospital discharge (T3). The latent class growth mixed model was utilized for data analysis, and multivariable logistic regression was employed to examine the determinants of muscle strength trajectories.

Results: This study encompassed 343 patients from five tertiary hospitals. Three latent trajectory groups were identified: a low-level decline group (5.83%), a medium-level stability group (25.36%) and a high-level recovery group (68.81%). Multivariable logistic regression revealed that Charlson comorbidity index (CCI) and alcohol consumption significantly influenced the trajectory of muscle strength development in ICU patients (p < .05). The mortality rate at 60 days was significantly higher in both the low-level decline and medium-level stability groups compared with the high-level recovery groups (p < .05).

Conclusions: This study identified three muscle strength trajectories in ICU patients: low-level decline, medium-level stability and high-level recovery. CCI and alcohol consumption significantly influenced these trajectories. The lower 60-day mortality rate in the high-level recovery group underscores the need for early intervention and tailored care.

Relevance to clinical practice: Developing targeted rehabilitation strategies for those at risk of low-level decline or medium-level stability group is challenging and may potentially improve recovery and outcomes.

Background: Family-led interventions have been identified as effective in many areas of care including the management of delirium. However, because of the heterogeneity and ambiguity of family-led interventions, they are not consistently applied within intensive care units. A user-friendly digital intervention may therefore support consistent family integration into delirium management.

Aim: To explore the feasibility and acceptability of a family member's voice reorientation intervention for delirium prevention and management in an adult intensive care unit.

Study design: Parallel, convergent mixed-methods pilot study was conducted in a general adult intensive care unit in the United Kingdom. Thirty participants (15 patients and 15 family members) were enrolled in the study. For the qualitative component, 17 participants (three patients, six family members and eight nurses) contributed to the evaluation.

Results: The median frequency of the family member's voice reorientation intervention was 2.3 times per day (range 3.3), and the median Richmond Agitation-Sedation Scale score was -1 (range 2.5). Qualitative data revealed seven themes: acceptance of the intervention, communication, delirium awareness, reactions to the intervention, cognitive state, perception of the intensive care unit and psychological well-being.

Conclusion: Nurses can involve family members in person-centred care within the intensive care unit. Results from this study indicate that the family member's voice reorientation programme is feasible and acceptable and may be an effective strategy for providing ongoing orientation, reassurance and comfort to critically ill adult patients to prevent or manage delirium. A larger study is needed to evaluate its impact on delirium.

Relevance for clinical practice: The family member's voice reorientation intervention offers critical care nurses a feasible, family-centred approach to support delirium care in the intensive care unit. Integrating this non-invasive tool into practice may enable nurses to enhance patient outcomes, reduce anxiety and strengthen collaboration between patients, families and health care professionals.