Nursing in Critical Care最新文献

Background: Psychological factors such as anxiety, depression and Type D (distressed) personality have been associated with poor prognosis and slower emotional recovery in patients with coronary heart disease. Despite this evidence, systematic psychosocial screening remains limited in cardiac nursing practice.

Aim: The aim of this study was to evaluate the feasibility of nurse-led Type D personality (TDP) screening and its potential role in predicting emotional recovery among patients hospitalised in a coronary care unit (CCU).

Study design: A cross-sectional observational study was conducted. Data were collected through validated self-report questionnaires assessing TDP, coping strategies, anxiety and depression. Statistical analyses included descriptive statistics, correlation analyses and multiple linear regression.

Results: 110 CCU patients took part in the study. Type D personality was identified in (n = 32.5%) of participants. Patients with TDP demonstrated significantly higher levels of anxiety and depression and more frequent use of maladaptive coping strategies. Regression analyses revealed that TDP and avoidant coping were independent predictors of anxiety and depression scores, explaining a significant proportion of variance in emotional outcomes.

Conclusions: Nurse-led psychosocial screening for TDP is feasible in the CCU setting and provides valuable information for identifying patients at risk of poor emotional recovery. Integrating this assessment into nursing care may promote holistic management and improve psychological support during cardiac rehabilitation.

Relevance to clinical practice: Routine psychosocial screening by nurses can facilitate early detection of distressed cardiac patients and guide targeted interventions. Incorporating Type D personality assessment into standard nursing procedures may enhance emotional recovery, reduce psychological morbidity and contribute to comprehensive cardiac care.

Background: Pressure ulcers (PUs) remain a major clinical challenge, particularly among immobilized and critically ill patients. Accumulating evidence suggests that alterations in gut microbiota composition and diversity are associated with PUs. But until now, the causal association between them has been unclear.

Aim: We conducted a two-sample Mendelian randomisation (MR) study to investigate the causal effect of gut microbiota on PUs.

Study design: Gut microbiota summary statistics were obtained from the MiBioGen Consortium (18,340 individuals, 24 cohorts, 211 taxa), and PU data were derived from the FinnGen biobank (354,567 Europeans; 1479 PU cases, 353,088 controls). Causal estimates were calculated using inverse variance weighted (IVW), weighted median, simple mode, weighted mode and MR-Egger methods, with sensitivity analyses including pleiotropy tests, Cochran's Q and leave-one-out analysis. MR Steiger's test was applied to infer directionality.

Results: IVW analysis indicated protective effects of Clostridiaceae 1 (odds ratio, OR = 0.668, 95% confidence intervals (CI) = 0.455-0.982, p = 0.040), genus Coprococcus2 (OR = 0.508, 95% CI = 0.344-0.751, p = 0.001) and genus Gordonibacter (OR = 0.812, 95% CI = 0.676-0.976, p = 0.027) against PUs. While genus Anaerotruncus (OR = 1.729, 95% CI = 1.189-2.513, p = 0.004) and genus Christensenellaceae R7 (OR = 1.953, 95% CI = 1.087-3.508, p = 0.025) increased PUs' risk. Reverse MR suggested causal effects of PUs on five genera, including Butyrivibrio (OR = 0.887, 95% CI = 0.798-0.985, p = 0.026), Erysipelotrichaceae UCG003 (OR = 1.057, 95% CI = 1.004-1.113, p = 0.035), Eubacterium fissicatena group (OR = 0.898, 95% CI = 0.811-0.995, p = 0.040), Faecalibacterium (OR = 0.952, 95% CI = 0.908-0.999, p = 0.046) and Eubacterium oxidoreducens group (OR = 1.093, 95% CI = 1.001-1.194, p = 0.047). Sensitivity analysis supported the robustness of the findings, and Steiger's test confirmed directionality from gut microbiota to PUs.

Conclusion: This MR study provides genetic evidence for a causal role of gut microbiota in PU risk, supporting the potential of microbiota-targeted interventions and offering new insights into PU pathogenesis and highlighting their particular relevance for prevention strategies in immobilized critical care patients.

Relevance to clinical practice: The study provides epidemiological evidence for a gut-skin link in PUs and suggests personalised microbiota-based intervention strategies for critically bedridden patients.

Background: Patients admitted to intensive care units are frequently exposed to environmental stressors such as noise, excessive lighting and lack of privacy. These stressors are known to negatively affect both sleep quality and the overall intensive care experience, yet limited studies have examined both outcomes simultaneously in the same model.

Aim: To examine the effects of perceived environmental stressors on sleep quality and intensive care units experience among intensive care patients.

Study design: A cross-sectional, correlational study was conducted in the intensive care units of a tertiary hospital in southeastern Türkiye between February and August 2025. Data were collected using the Intensive Care Unit Environmental Stressors Scale (ICUESS), Richard-Campbell Sleep Questionnaire (RCSQ) and Intensive Care Experience Scale (ICES). Multiple linear regression analyses were conducted to identify significant predictors of sleep quality and ICU experience.

Results: A total of 156 patients were included using convenience sampling. Perceived environmental stressors were significantly and negatively associated with both sleep quality (β = -0.335, p < 0.001) and intensive care units experience (β = -0.603, p < 0.001). Additionally, poor sleep quality was a significant negative predictor of ICU experience (β = -0.196, p = 0.007). Demographic and clinical characteristics were not significant predictors in either model.

Conclusions: This study highlights the dual impact of environmental stressors on critical patient outcomes and demonstrates that both direct and indirect pathways-via sleep disturbance-contribute to negative ICU experiences.

Relevance to clinical practice: Nursing interventions that aim to reduce environmental stressors, such as noise and light control or promotion of restful sleep, may improve both sleep quality and patient experience in the ICU. These findings support the need for environmental redesign and nurse-led strategies in the delivery of patient-centred critical care.

Background: Parents in the neonatal intensive care unit (NICU) face stress, anxiety and isolation, which affect their mental health and involvement in the care of their infants.

Aim: To analyse, summarise and compare the most recent scientific evidence on interventions in NICU aimed at parents in order to improve their emotional state.

Study design: A scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Methodological quality was assessed using the Critical Appraisal Skills Programme (CASP) for Randomised Controlled Trials (RCTs), cohort and qualitative studies and the Joanna Briggs Institute (JBI) for quasi-experimental studies. PubMed, CINAHL Plus and Scopus (2022-2024) were searched for studies according to predefined criteria.

Results: A total of 27 studies were selected, the majority of which were RCTs, quasi-experimental and qualitative. It was shown that low-complexity family-centred interventions, alternative therapies and communication and training strategies for parents are effective in improving emotional health and family well-being, increasing parental self-efficacy, strengthening family cohesion and facilitating adaptation to NICU.

Conclusions: During hospitalisation in NICU, it is essential to address the emotional health of the family. It is key to apply individualised interventions that integrate psychological support, care education and effective communication. Involving all family members strengthens their emotional well-being and improves their ability to cope.

Relevance to clinical practice: Interventions to improve neonatal health are highlighted, focusing on humanised care, family involvement and communication. Nursing, with its holistic approach, is key, so managers should promote strategies that strengthen the emotional health of families and the quality of care in the NICU.

Background: As a patient-centred model of nursing care, primary nursing (PN) ensures continuity of care while promoting systematic involvement of patients and family members in the therapeutic process. To date, comprehensive published research projects that address the implementation of PN on intensive care units (ICUs) are rare.

Aims: Primary aim was to evaluate the overall process of development and implementation of PN in two German ICUs of a university hospital. Secondary aims were to identify changes on ICU, as well as nursing performance indicators.

Study design: Quantitative design on a surgical (ICU 1) and medical (ICU 2) ICU. We used the validated German Instrument zur Erfassung von Pflegesystemen (IzEP(c)) with separate questionnaires for patients, relatives and medical staff at three data collection points as an as-is analysis before (t₀), after six (t₁) and 12 months (t₂) of implementation of PN in practice. IzEP(c) enables a percentage calculation of the practiced nursing organisation model (overall ICU profile; PN at > 75%), information of the ICU profile (e.g., communication) and nursing performance indicators (e.g., patient participation). For descriptive statistics, a programmed Microsoft Excel spreadsheet with built-in percentage calculations, developed by the IzEP(c) development team, was used.

Results: Data collection took place between September 2023 and March 2025, and 264 questionnaires were analysed. The overall profile on ICU 1 started with individual nursing (44.5%, t₀) up to PN in t₂ (83.0%). ICU 2 reached individual nursing between t₀-t₂ with characteristics toward PN (t₀: 51.0%; t₂: 69.0%). Between t₀-t₂, ICU profile showed good development in communication in ICU 1 (36.0%; 77.0%) and necessary change in ICU 2 (38.5%; 46.5%). Nursing performance indicators reached good development in both ICUs with development potential in, for example, patient participation in ICU 2 (54.0%; 49.5%).

Conclusions: PN was practiced in all included patients in both ICUs, but implementation was not fully achieved in ICU 2. Nevertheless, PN was practiced in included patients on ICU 2. Another evaluation on ICU 2 should be planned.

Relevance to clinical practice: PN on ICU is feasible and needs continuous support from nursing managers for successful implementation. An accompanying evaluation is mandatory for this purpose.

Trial registration: This study is registered at the German Clinical Trials Register as DRKS00030966.

Background: Family members of Intensive Care Unit survivors face profound challenges following discharge. This early post-discharge phase represents a critical period, as caregiving responsibilities often intensify, placing a substantial emotional and practical burden on family members who are still processing the ICU experience. Despite its importance, this period remains poorly investigated in terms of how families interpret and integrate this transition into their broader illness experience.

Aim: To explore the lived experiences of family members of ICU survivors 1 month after hospital discharge.

Study design: This study applied Cohen's phenomenological method, integrating descriptive and interpretive analyses to explore the meaning of lived experiences. Data were collected through semi-structured interviews and analysed following a rigorous, iterative process. The Standards for Reporting Qualitative Research (SRQR) guided reporting.

Findings: A total of 21 family members were interviewed through semi-structured interviews. A total of five key themes emerged from the interviews. Lack of control: participants experienced fear, loneliness and emotional pain. The unseen: uncertainty about the future and the patient's recovery process led to anxiety and stress, exacerbated by inadequate and incomplete communication. Unexpected life disruption: family members faced isolation and a shift in life perspective. Family burden: participants reported physical and emotional distress, including fatigue and sleep disorders. Finding strength in affection: many found resilience through the support of family, friends and colleagues.

Conclusion: The experiences of ICU survivors' family members were significantly shaped by communication, which played a central role in their anxiety, stress and sleep disturbances. These emotional burdens also affected their social relationships, family dynamics and overall quality of life.

Relevance to clinical practice: Recognising the challenges faced by family members of Intensive Care Unit survivors highlights the need for structured transitional support, which can inform family-centred care communication strategies throughout the recovery journey.

Background: Downtime refers to the period during CRRT treatment when the filter is not performing solute clearance or ultrafiltration. It is an important component of continuous renal replacement therapy (CRRT) nursing quality indicators. To improve CRRT nursing quality, it is crucial to assess the level of intensive care unit (ICU) nurses' management of CRRT downtime.

Aim: To develop a questionnaire to assess knowledge, attitude and practice (KAP) regarding downtime management in continuous renal replacement therapy among ICU nurses and test the validity and reliability of the scale.

Study design and methods: Based on the knowledge-attitude-practice (KAP) theory, a preliminary scale was formed through a literature review, expert consultation, group discussion and pre-surveys. From August to September 2024, a survey was conducted with nurses from 14 ICUs across 12 provinces and cities, including Hubei Province, Guangxi Province and Chongqing City, to analyse the reliability and construct validity of the scale. From September to October 2024, a questionnaire survey was conducted with nurses from 16 ICUs across six provinces and cities, including Hubei Province, Henan Province and Shanxi Province, for confirmatory factors.

Results: A total of 255 and 320 nurses participated in the first and second phase of the study. The KAP scale for ICU nurses' CRRT downtime management consists of 37 items, including knowledge (9 items), attitudes (15 items) and practices (13 items) across three dimensions. The item-content validity index (I-CVI) of the scale ranged from 0.820 to 1.000, with the average scale-level content validity index (S-CVI/Ave) being 0.902. Exploratory factor analysis extracted three common factors, with a cumulative variance contribution rate of 70.331%. Confirmatory factor analysis showed good model fit. The overall scale's Cronbach's α coefficient was 0.971, and the test-retest reliability was 0.931.

Conclusion: The developed KAP scale for ICU nurses' CRRT downtime management demonstrates good reliability and validity and can be used to measure the KAP levels of ICU nurses in managing CRRT downtime.

Relevance to clinical practice: This scale provides a standardised tool for assessing ICU nurses' competence in CRRT downtime management. It helps nursing managers identify specific weaknesses in nurses' knowledge, attitudes and practice, enabling targeted training and guidance. This, in turn, can enhance nurses' practical skills in managing downtime, reduce the duration of CRRT treatment interruptions and ultimately improve patient clinical outcomes.

Background: Critical care and critical illness are key concepts that have been defined in various publications. A common understanding of the concepts is of great importance, but an up-to-date overview and discussion are lacking in the literature.

Aim: The aim of this study was to identify and discuss current definitions of critical care, critical illness and chronic critical illness.

Study design: We conducted a narrative review and performed literature searches in Medline, Cochrane Library, CINAHL, Embase, LIVIVO, Google Scholar, OpenGrey, Epistemonikos and Science Open as well as citation searching from July 2024 to September 2025. Reports on definitions were included if they dealt thematically with critical care, critical illness or chronic critical illness, were published within the last 10 years and were available in German or English. Data synthesis followed an inductive approach. We thematically analysed the core concepts of identified definitions, formed thematic clusters and finally approved them in multiple group discussions.

Results: In total, 13 definitions of critical care, eight definitions of critical illness and 12 definitions of chronic critical illness were identified. Key components of critical care are the population, interventions, timing, professionals, aim, location and complexity. Critical illness is mainly characterised by future aspects and prevention, underlying causes and treatment. Chronic critical illness is determined by its duration, several complications and frailty. All three terms share the temporality and severity of a disease. Included definitions have a pronounced pathophysiological focus; they point to highly complex and technologised treatment pathways.

Conclusion: Current definitions show a generally homogeneous understanding of the care for critically ill patients. To ensure a comprehensive representation, definitions need to be adapted and consider the experiences of those involved.

Relevance to clinical practice: The analysed clusters of the definitions of critical care, critical illness and chronic critical illness help professionals to develop their terminology and reflect on their clinical approaches.

Background: Delirium is common in intensive care unit (ICU) patients and is associated with adverse outcomes. Subsyndromal delirium (SSD) represents a milder form of this spectrum, which frequently goes unnoticed. It is important to clarify its incidence and risk factors to guide early detection and prevention.

Aim: To determine the incidence and risk factors of delirium and SSD in ICU patients.

Study design: This prospective observational study was conducted in a medical-surgical ICU in Izmir/Turkiye. Adult patients ≥ 18 years and admitted for ≥ 24 h were assessed twice daily using the Intensive Care Delirium Screening Checklist (ICDSC) and the Richmond Agitation-Sedation Scale (RASS) to identify delirium and SSD. Demographic and clinical data were recorded for potential risk factors, and associations with delirium and SSD were analysed using univariate tests and multinomial logistic regression.

Results: Among 233 patients, delirium occurred in 37.8% and SSD in 33.0%. Significant risk factors for both conditions were higher pain score (delirium: OR = 2.35, 95% CI: 1.59-3.46; SSD: OR = 2.83, 95% CI: 1.80-4.46), midazolam use (delirium: OR = 7.93, 95% CI: 1.97-17.64; SSD: OR = 4.12, 95% CI: 1.82-8.55) and physical restraint (delirium: OR = 1.60, 95% CI: 1.22-3.83; SSD: OR = 2.02, 95% CI: 1.86-4.72). Mechanical ventilation (OR = 1.67, 95% CI: 1.13-3.69) and vasopressor use (OR = 0.83, 95% CI: 1.06-2.14) were associated only with delirium, while longer ICU stay (OR = 1.55, 95% CI: 1.12-3.17) was associated only with SSD.

Conclusion: SSD is a frequent and early-occurring condition in ICU patients, with both shared and unique risk factors compared to fully manifest delirium, underscoring the need for vigilant monitoring and timely intervention.

Relevance to clinical practice: Implementing routine screening and addressing modifiable risk factors may prevent SSD progression to delirium and enhance ICU patient outcomes.