Nursing in Critical Care最新文献

Background: Patients in the intensive care unit (ICU) face severe psychological and spiritual stress, along with tough physical challenges. While the significance of spiritual care is widely acknowledged, systematic research on ICU nurses' practical experiences and perceptions in spiritual care is still lacking.

Aim: To examine and synthesise qualitative evidence about the ICU nurses' perspectives and experiences in providing spiritual care.

Study design: Databases including PubMed, Embase, Web of Science, Scopus, CINAHL, PsycINFO, ProQuest, Airiti Library and CNKI were searched up to December 2024. Additionally, grey literature and backward reference searches were also performed. Two independent reviewers assessed the methodological quality and extracted data; meta-aggregation was performed to synthesise the findings.

Results: Ten studies were selected for inclusion, resulting in four synthesised findings: Developing an understanding of spiritual care, spiritual care has no fixed form, challenges in spiritual care practice among ICU nurses and spiritual care as a double-edged sword for ICU nurses.

Conclusion: ICU nurses' spiritual care experiences fall into four themes. Based on the ConQual certainty assessment, the synthesised finding 'challenges in spiritual care practice among ICU nurses' was rated as moderate certainty, the highest level achieved. Spiritual care is crucial in critical care. Effective implementation in intensive care medicine requires collaboration and support from policymakers, the medical community and society. Translating spiritual care from theory to practice can be facilitated through policy support, resource integration and capacity building.

Relevance to clinical practice: Despite cultural differences, ICU nurses' practices in spiritual care reveal cross-cultural commonalities. The review gives specific advice for future ICU spiritual care, including creating standardised tools for spiritual needs assessment, forming multidisciplinary collaboration mechanisms and increasing ICU nurses' spiritual care training.

Trial registration: The protocol of this qualitative meta-synthesis has been registered at PROSPERO with the identifier CRD42025633933.

Background: Postoperative delirium remains a frequent and serious complication following open heart surgery, often linked with prolonged hospital stays and increased morbidity. Since the causes are multifactorial, non-pharmacological strategies such as psychosocial nursing interventions are being explored for their preventive potential.

Aim: This randomised controlled trial aimed to evaluate the effectiveness of psychosocial nursing interventions on sleep quality, anxiety levels and the occurrence of delirium in patients undergoing open heart surgery.

Study design: A prospective, two-arm randomised controlled trial. Sixty patients scheduled for elective open heart surgery at a university hospital in southern Türkiye were randomly assigned to the intervention group (n = 30) or the control group (n = 30). The control group received standard nursing care. The intervention group received structured psychosocial care including eye masks, earplugs and brief 45-min cognitive behavioural therapy (CBT) sessions before and after surgery. Anxiety was assessed before surgery and on day 2 after surgery, while sleep quality was assessed before surgery and on days 1 and 2 after surgery. Patients' anxiety and sleep quality were assessed before and after surgery using the Richard Campbell Sleep Questionnaire and the State Anxiety Inventory. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used to assess delirium after surgery. Adherence to sensory aids was monitored via nursing checklists. Outcome assessors for delirium were blinded to group assignment.

Results: Groups were demographically and clinically comparable at baseline (p > 0.05). Post-intervention, anxiety and pain levels significantly declined in the intervention group, with improved sleep scores (p < 0.001). Delirium incidence was 0% in the intervention group versus 30% in controls (p < 0.05). Duration of mechanical ventilation and hospital stay was significantly reduced in the intervention group. Effect sizes (Cohen's d) and 95% confidence intervals were reported for major outcomes.

Conclusions: Psychosocial nursing interventions combining cognitive and sensory strategies effectively enhance postoperative outcomes by reducing anxiety, improving sleep quality and preventing delirium. These findings support integrating such non-invasive, low-cost strategies into routine nursing care for patients undergoing cardiac surgery.

Relevance to clinical practice: Delirium is a critical postoperative complication after open heart surgery. Psychosocial interventions can be incorporated into nursing care to prevent delirium in intensive care units.

Background: Family members of frail elderly intensive care unit (ICU) patients shoulder complex surrogate decisions under prognostic uncertainty, cultural expectations and moral strain-particularly in Middle Eastern settings where collective responsibility and religion shape choices.

Aim: To explore how families experience and navigate ICU decision-making for frail elderly relatives and to identify culturally distinctive mechanisms.

Study design: Qualitative descriptive study using reflexive thematic analysis.

Results: Fifteen Arabic-language, in-depth interviews (45-90 min) with family decision-makers in Saudi Arabia were audio-recorded, transcribed, translated and analysed following Braun and Clarke's six phases. Rigour was supported by memoing, interpretive meetings and an audit trail. Sample adequacy was justified via information power (sufficiency at n = 13 with two confirming interviews). Three themes emerged: (1) Burden of Decision-emotional paralysis, moral ambivalence about withholding/withdrawing life-sustaining treatment and episodic isolation within surrogate roles; (2) Consultative Family Deliberation (shūrā)-distributed roles, intergenerational negotiation and prioritisation of family harmony; and (3) Faith-Driven Acceptance-tawakkul (trust in divine will), prayer/ritual as anchors and reframing death as a spiritual transition rather than treatment failure. Frailty (Clinical Frailty Scale ≥ 5) heightened uncertainty and, for some, oriented preferences towards comfort-focused care.

Conclusions: Family decision-making for frail elderly ICU patients is culturally embedded, relational and spiritually mediated.

Relevance to clinical practice: Nurse-led, culturally responsive supports-structured inclusive family meetings, Arabic values-clarification aids and facilitation of spiritual needs-may reduce decisional burden, enhance trust and align care with family values.

Background: Anxiety and unstable vital signs are frequently observed in patients undergoing non-invasive mechanical ventilation (NIMV), which can negatively affect treatment outcomes.

Aim: This study assessed the impact of audiobook use on anxiety levels and vital signs in patients receiving NIMV support.

Study design: This study was carried out as a randomised controlled trial with 60 patients in the Department of Chest Diseases, ICU of a university hospital. Patients were assigned to an audiobook group (n = 30) or a control group (n = 30). The audiobook group selected a book of their choice, which was played through headphones. Anxiety levels and vital signs were assessed before, during and after the intervention. Only routine care was administered to the control group.

Results: The audiobook group demonstrated significant reductions in anxiety (Cohen's d=2.306, 95% CI [1.643, 2.957]) and improvements in systolic and diastolic blood pressure (Cohen's d=0.972, 95% CI [0.432, 1.504]) and Cohen's d=0.351, 95% CI [0.160, 0.860]), pulse rate (Cohen's d=0.856, 95% CI [0.323, 1.382]), respiratory rate (Cohen's d=1,060, 95% CI [0.515, 1.598]), and SpO₂ (Cohen's d=0.772, 95% CI [0.243, 1.294]) compared with the control group at the final measurements, consistent with the within-group evaluations. The control group did not exhibit any notable changes (p > 0.05).

Conclusion: The calming effect of audiobooks may help distract patients from the discomfort associated with NIMV, thereby improving their physiological and psychological well-being. However, the study is limited by the single application of the intervention and the exclusive use of oro-nasal masks, which may restrict the generalisability of the results. The use of audiobooks positively impacts anxiety and vital signs in patients receiving NIMV support, suggesting its potential as a supportive, non-invasive therapy. Further research should explore long-term effects and broader patient populations.

Relevance to clinical practice: This study highlights that critical care nurses can use audiobook interventions as a non-pharmacological approach to reduce anxiety and stabilise vital signs in patients receiving NIMV, thereby improving comfort and patient cooperation during treatment.

Background: Medical adhesive-related skin injuries (MARSI) are a common complication in paediatric critical care, especially in patients with central venous catheters (CVCs). Despite the frequent use of medical adhesives, they are often underrecognised but are a preventable complication.

Aim: The aim of this study is to assess the effectiveness of the SECURE Care Bundle in preventing MARSI associated with CVC fixation in paediatric patients and its impact on the time to MARSI onset.

Study design: This study is designed as a quasi-experimental, pre-test and post-test control group study conducted in a Paediatric Cardiac Intensive Care Unit. A total of 92 neonatal and paediatric patients will be included. After obtaining consent from parents or legal guardians and assent from the children aged 7 years and older when applicable, patients will be assigned to the pre-test (control) group (n = 46) and the post-test (intervention) group (n = 46). During the pre-test phase, standard care will be provided according to the clinic's routine CVC procedures. In the post-test phase, the SECURE Care Bundle will be implemented in addition to standard care. The bundle includes skin assessment, ensuring secure fixation without causing skin injury, adhesive selection, correct application and removal techniques, use of a silicone-based adhesive remover and documentation of MARSI. Data will be collected using the descriptive information form, Braden QD Scale, skin observation form and SECURE Care Bundle checklist.

Results: The study will report the incidence of MARSI associated with CVC fixation and the time to onset of MARSI in paediatric patients by comparing the pre-test (control) and post-test (intervention) groups.

Conclusions: The study is designed to evaluate the effectiveness of the SECURE Care Bundle in preventing MARSI in paediatric critical care. The proposed research may contribute to the development of a standardised approach to CVC fixation and protection of skin integrity.

Relevance to clinical practice: This planned study will explore a structured approach to MARSI prevention in paediatric critical care units (PCCUs). The findings are intended to inform the development of standardised practices that support patient care and reduce the risk of MARSI. The SECURE Care Bundle may provide a framework to guide future efforts to protect skin integrity and minimise complications.

Trial registration: The study is designed as a quasi-experimental study with a pre-test and post-test control group design. This study has been registered at ClinicalTrials.gov (NCT06122402).

Background: Low-value care, is care that is ineffective, inefficiently delivered or unwanted and is common in high income settings. The United Kingdom (UK) Paediatric Critical Care Society (PCCS) established a de-implementation working group in October 2024.

Aim: The aim of the study was to identify and then prioritise low-value care practices for de-implementation across UK Paediatric Intensive Care Units (PICUs) over the next 5 years and to ascertain which practices staff would be prepared to de-implement based on current evidence, and for which further evidence is required.

Study design: A modified three round Delphi study was undertaken between December 2024 and May 2025. In Round 1, PICUs submitted their top low-value care practices. These were entered into an electronic survey (Round 2) for prioritisation. These were analysed according to a predefined consensus definition. The final survey (Round 3), including these items, plus any new items suggested at Round 2, were re-ranked considering the group mean score.

Results: Thirty-seven items were submitted from 16 PICUs (these were unit responses) in Round 1. One hundred thirty-five staff completed Round 2, and 14 of these 37 items met the criteria for inclusion in Round 3. Five new items were added to Round 3. One hundred eighteen staff voted on 19 items in Round 3. The top five practices ranked by mean score were (1) overprescribing of medications and not deprescribing them once not required, (2) fasting children for prolonged periods after extubation, (3) unnecessary use of non-sterile gloves, (4) continuing hourly observations in ward-ready patients and (5) taking routine blood tests.

Conclusions: This is the first study to gain consensus on low-value care practices to be de-implemented in UK PICUs.

Relevance to clinical practice: Low-value care practices are wasteful, both financially and environmentally, and impact on healthcare professionals' workload. Identification of these practices will enable future work to de-implement them.

Background: Alarm fatigue in ICU settings contributes to desensitisation, emotional exhaustion and job burnout, threatening nurse well-being and patient safety.

Aim: To measure alarm fatigue and burnout levels among ICU nurses and assess their correlation.

Study design: A cross-sectional survey study. Between February and March 2022, 140 ICU nurses in a tertiary hospital in Baoding were surveyed using a general information questionnaire, the Clinical Alarm Fatigue Scale and the Maslach Burnout Inventory. Correlation and subgroup analyses stratified by working years and professional title were performed to examine the relationship between alarm fatigue and the three dimensions of job burnout: emotional exhaustion, depersonalisation and personal achievement.

Results: Intensive care unit nurses exhibited moderate alarm fatigue and severe burnout, highlighting the urgent need for interventions such as alarm management systems and mental health support programs. The three dimensions of burnout-emotional exhaustion, depersonalisation and reduced personal achievement-were scored as severe. Alarm fatigue and depersonalisation among ICU nurses were positively correlated (r = 0.288, p < 0.001), indicating that higher alarm fatigue exacerbates these dimensions of burnout. A negative correlation with personal accomplishment was observed (r = -0.218, p = 0.022), suggesting a reduction in the sense of achievement. Subgroup analyses revealed differential impacts: alarm fatigue correlated more strongly with depersonalisation in junior nurses (≤ 10 years) but showed stronger associations with emotional exhaustion and reduced accomplishment in senior nurses (> 10 years).

Conclusions: Alarm fatigue is closely linked to burnout dimensions in ICU nurses, with effects varying significantly by professional seniority, emphasising the need for tailored strategies to mitigate these effects and improve nurse and patient outcomes.

Relevance to clinical practice: The findings emphasise implementing alarm management training, optimised shift scheduling and emotional support programs to mitigate fatigue, enhance well-being and improve patient safety.

Background: Despite limited evidence on nursing interventions for cardiogenic shock (CS) patients with mechanical circulatory support (MCS), nurses play a key role in ensuring device function, monitoring and preventing complications.

Aim: This scoping review aimed to map the nursing role in patients with CS supported by MCS, including extracorporeal membrane oxygenation (ECMO).

Study design: A comprehensive search was conducted in PubMed, CINAHL, Scopus and Web of Science from database inception to May 2025. Eligible sources included primary studies and relevant grey literature reporting nursing care for patients treated with MCS. Eligible studies focused on adult individuals with CS receiving MCS and explored nursing aspects within intensive or critical care environments.

Results: Ten studies met the inclusion criteria, encompassing various geographic and clinical contexts. Thematic analysis identified four primary domains of nursing intervention: (1) continuous monitoring of haemodynamic and device-specific parameters; (2) complication prevention and management, including haemorrhage, thromboembolism, and infection; (3) delivery of supportive care such as sedation, ventilation, nutrition and fluid balance; and (4) application of protocol-guided care to standardise interventions and ensure safety CONCLUSIONS: Nurses play an essential role in managing patients with CS supported by MCS, with critical contributions across all phases of care. However, variability in practice and lack of standardised models persist.

Relevance to clinical practice: Reinforcing nurse training, using evidence-based protocols and ensuring adequate staffing are key to improving care quality, while structured competencies and standardised documentation enhance continuity and patient safety.

Background: Delirium is a common and serious complication in ICU patients, leading to prolonged ICU length of stay (LOS), increased mechanical ventilation (MV) duration and higher mortality. The ABCDEF bundle has been proposed to prevent or reduce ICU delirium, but the strength and consistency of evidence across existing meta-analyses remain unclear.

Aim: This umbrella meta-analysis aimed to evaluate the pooled effects of ABCDEF bundle interventions on ICU delirium incidence and duration, with secondary objectives assessing their impact on ICU LOS, MV duration, ICU mortality and in-hospital mortality.

Study design: A comprehensive search was conducted across Web of Science, PubMed, EMBASE, Cochrane Reviews, Google Scholar, CNKI, Weipu and Wanfang up to May 2025. Meta-analyses of RCTs and cohort studies were included if they assessed interventions incorporating at least three components of the ABCDEF bundle and reported ICU-related outcomes. Methodological quality was assessed using the AMSTAR 2 tool; four meta-analyses rated as critically low quality were excluded. Six meta-analyses were included in the final synthesis. The certainty of evidence for each outcome was evaluated using the GRADE approach.

Results: A total of 4534 records were identified, of which six meta-analyses met the inclusion criteria, encompassing 62,949 participants. Three meta-analyses demonstrated a significant 50% reduction in ICU delirium incidence (OR = 0.50; 95% CI: 0.39-0.65; p < 0.001; I² = 0%). Two meta-analyses showed a significant reduction in delirium duration (SMD = -1.39; 95% CI: -2.38 to -0.40; p = 0.006; I² = 0%). ICU mortality was not significantly reduced (OR = 0.71; 95% CI: 0.33-1.53; p = 0.384; I² = 64.2%), but a 19% reduction in in-hospital mortality was observed in three meta-analyses (OR = 0.81; 95% CI: 0.71-0.93; p < 0.01; I² = 23.4%). Four meta-analyses reported shorter ICU LOS (SMD = -0.89; 95% CI: -1.65 to -0.13; p = 0.021; I² = 81.8%), and three reported reduced MV duration (SMD = -0.55; 95% CI: -1.08 to -0.02; p = 0.043; I² = 65.4%).

Conclusions: This umbrella meta-analysis provides moderate to high-certainty evidence supporting the efficacy of bundle interventions in reducing ICU delirium incidence and improving clinical outcomes, including ICU LOS and MV duration. While heterogeneity was noted in some outcomes, ABCDEF bundled approaches remain a promising strategy for improving the care of critically ill patients.

Relevance to clinical practice: This umbrella review highlights the importance for critical care nurses to select and implement at least three ABCDEF bundle components, based on individual patient needs, to reduce ICU delirium and improve recovery outcomes.