Intensive and Critical Care Nursing最新文献

{"title":"ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates","authors":"Ezekwesiri Nwanosike ,&nbsp;Peter Griffiths ,&nbsp;Chiara Dall’Ora ,&nbsp;Thomas Monks ,&nbsp;Natalie Pattison ,&nbsp;Tolusha Dahanayake Yapa ,&nbsp;Christina Saville ,&nbsp;on behalf of the SEISMIC-R study group","doi":"10.1016/j.iccn.2025.104314","DOIUrl":"10.1016/j.iccn.2025.104314","url":null,"abstract":"<div><h3>Aims</h3><div>This study examines the association between registered nurse (RN) staffing configurations and potentially nurse-sensitive patient outcomes in English Intensive Care Units (ICU) and to assess changes as the COVID-19 pandemic unfolded.</div></div><div><h3>Methods</h3><div>This was a longitudinal retrospective study analysing routinely collected patient and electronic roster data from 12 ICUs in NHS hospital trusts (January 2019–December 2022). The variables of interest were RN staffing levels and staff mix factors. The outcomes considered were unit-acquired infections, length of stay and readmissions. The relationships were analysed using covariate-adjusted generalised linear mixed models over the entire period and separately for pre-pandemic, pandemic and post-pandemic periods.</div></div><div><h3>Results</h3><div>Data from 12 ICUs included 52,267 admissions, with RN staffing levels (mean) peaking during the later pandemic period (34.2 h per patient day [HPPD], Standard Deviation (SD) = 12.1) compared to pre-pandemic levels (27.0 HPPD, SD = 8.5). Higher RN HPPD were associated with reduced readmission risk overall, with the strongest protective effect during early pandemic periods. No statistically significant association was found between RN staffing and length of stay overall, though a 5 % reduction occurred during the late pandemic period (p = 0.035). The presence of low levels of nurse managers (band 7 + ) was associated with significantly reduced readmission risk (1.3 %-point decrease, p = 0.011), which arose from an association during the pandemic, but increased length of stay across all periods.</div></div><div><h3>Conclusions</h3><div>Higher RN staffing levels were consistently associated with reduced ICU readmissions, demonstrating the protective effect of adequate nursing resources. However, the impact of senior nursing staff on other patient outcomes was complex and context-dependent, varying across pandemic periods.</div></div><div><h3>Implications for Clinical Practice</h3><div>The findings emphasise the importance of evidence-based staffing policies that optimise skill mix and leadership deployment to improve ICU patient outcomes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104314"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining the ICU E-Diary: Integration, Intelligence, and Impact – Letter on Rose et al.","authors":"Xia Luo ,&nbsp;Jie Peng","doi":"10.1016/j.iccn.2025.104310","DOIUrl":"10.1016/j.iccn.2025.104310","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104310"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and barriers to optimizing sedation practices in critically ill adult patients: A qualitative study","authors":"Theophany Eystathioy ,&nbsp;Claudia Singh ,&nbsp;Daniel J. Niven ,&nbsp;Jeanna Parsons-Leigh ,&nbsp;Lisa D. Burry ,&nbsp;Andrea Petkovic-Wintemute ,&nbsp;Kirsten M. Fiest ,&nbsp;Natalia Jaworska","doi":"10.1016/j.iccn.2026.104351","DOIUrl":"10.1016/j.iccn.2026.104351","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify priority domains that influence healthcare provider sedation practices and to describe key sedation protocol elements reported by participants that serve as facilitators and barriers to sedation practice change.</div></div><div><h3>Methods</h3><div>We conducted qualitative individual semi-structured interviews with critical care healthcare providers, including physicians/nurse practitioners, nurses, pharmacists, respiratory therapists, and physiotherapists, to understand sedation practices and define key factors that limit the opportunity for optimization of ICU sedation practices. We analyzed responses with deductive content analysis using the Theoretical Domains Framework (TDF) to identify priority domains related to sedation practices and describe constructs within the priority domains.</div></div><div><h3>Results</h3><div>We conducted 29 semi-structured interviews virtually from April 29 to December 10, 2024, consisting of 12 physicians/nurse practitioners, 5 respiratory therapists, 8 nurses, 3 pharmacists, and 1 physiotherapist. We identified seven priority TDF domains across healthcare provider groups including: <em>Beliefs about consequences, Beliefs about capabilities, Reinforcement, Memory, attention, and decision processes, Environmental context and resources, Social influence, and Social/professional roles</em>. Participants reported sedation use for multiple purposes including patient and staff safety, unit culture, and to address environmental and organizational challenges (e.g., patient care efficiency). Participants reported several recommendations for optimizing sedation delivery including available nursing-driven sedation protocols for specific patient populations (e.g., alcohol withdrawal) and specific sedation weaning recommendations.</div></div><div><h3>Conclusions</h3><div>Critical care healthcare providers identified several domains relevant to sedation practices, underpinned by patient and staff safety, key patient-specific factors, and socioenvironmental factors. In understanding priority domains and underlying factors that influence sedation practice, implementation strategies using protocol-driven sedation as a tool to improve guideline adherence should be designed targeting the identified priority domains and underlying driving factors.</div></div><div><h3>Implications for clinical practice</h3><div>Protocol-driven sedation strategies are more likely to succeed when interventions intentionally address the priority domains and driving factors that influence adherence to clinical practice guidelines during implementation processes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104351"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146145119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Pre–ICU benzodiazepine and Z–Drug exposure on mortality in critically ill Adults: A nationwide retrospective cohort study","authors":"Tak Kyu Oh ,&nbsp;In-Ae Song","doi":"10.1016/j.iccn.2025.104322","DOIUrl":"10.1016/j.iccn.2025.104322","url":null,"abstract":"<div><h3>Objectives</h3><div>Outpatient use of benzodiazepines and Z-drugs (BZRA) is common, yet its impact on mortality after intensive care unit (ICU) admission remains unclear. We therefore aimed to determine whether outpatient BZRA use within 30 days before ICU admission is independently associated with 30- and 90-day mortality.</div></div><div><h3>Methods</h3><div>Using South Korea’s National Health Insurance Service database, we retrospectively identified adults (≥18 years) with first ICU admissions from 2020 to 2023 and defined pre-ICU BZRA exposure as ≥ 1 prescription within 30 days before admission. We performed 1:1 propensity-score matching on demographic, clinical (including Charlson Comorbidity Index and acute organ dysfunction), socioeconomic, functional, institutional, and temporal variables, then estimated 30- and 90-day mortality associations via conditional logistic regression and Kaplan–Meier survival analysis.</div></div><div><h3>Results</h3><div>Among 1,189,042 unique adult ICU admissions, 115,821 (9.7 %) had pre-ICU BZRA exposure. After matching, 115,820 exposed and 115,820 unexposed patients had excellent covariate balance (all ASDs &lt; 0.10). BZRA exposure was associated with higher 30-day mortality (23.8 % vs 16.6 %; odds ratio [OR] 1.57; 95 % confidence interval [CI] 1.54–1.60; <em>P</em> &lt; 0.001) and higher 90-day mortality (36.8 % vs 27.3 %; OR 1.56; 95 % CI 1.53–1.58; <em>P</em> &lt; 0.001). Kaplan–Meier analysis confirmed reduced cumulative survival (log-rank <em>P</em> &lt; 0.001). Notably, combined benzodiazepine + Z-drug users exhibited the greatest risk: OR 2.46 (95 % CI 2.35–2.58) for 30-day death and OR 2.61 (95 % CI 2.50–2.72) for 90-day death versus non-exposed patients.</div></div><div><h3>Conclusions</h3><div>Outpatient BZRA use within 30 days before ICU admission is independently associated with higher 30- and 90-day mortality, with combination exposure conferring an even greater risk.</div></div><div><h3>Implications for Clinical Practice</h3><div>Recent outpatient BZRA prescriptions are an easily obtainable risk marker that clinicians should incorporate into pre-ICU assessment and triage; where clinically appropriate, medication review and targeted deprescribing may reduce early ICU morbidity and mortality.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104322"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring barriers to patient safety and incident reporting in resource-limited intensive care units: A qualitative study","authors":"Gelana Fekadu ,&nbsp;Rachel Muir ,&nbsp;Georgia Tobiano ,&nbsp;Abera Kenay Tura ,&nbsp;Michael J. Ireland ,&nbsp;Andrea P. Marshall","doi":"10.1016/j.iccn.2025.104325","DOIUrl":"10.1016/j.iccn.2025.104325","url":null,"abstract":"<div><h3>Introduction</h3><div>The burden of patient harm from unsafe care is disproportionately high in low-income countries, particularly in intensive care units (ICUs). Despite this, there is limited empirical evidence explaining the underlying challenges that make patient safety difficult to achieve in resource-limited ICUs.</div></div><div><h3>Objectives</h3><div>To explore the barriers to patient safety and incident-reporting in ICUs at Ethiopian university hospital.</div></div><div><h3>Methods</h3><div>An exploratory qualitative descriptive study was conducted using in-depth interviews guided by a semi-structured protocol and informed by the Theoretical Domains Framework (TDF). Participants were purposively selected, and sample size was determined based on principles of data sufficiency. Reflexive thematic analysis with inductive orientation was employed following Braun and Clarke’s approach.</div></div><div><h3>Results</h3><div>Thirty-nine healthcare professionals participated: 23 (59 %) nurses, 13 (33 %) physicians, and 3 (8 %) clinical pharmacists. The mean age of participants was 32 ± 5 years. Three overarching themes captured the barriers to patient safety and incident reporting in ICUs: (i) Fragile systems: Governance failure and resource constraints; (ii) Normalisation of deviance: teaching-hospital dynamics and clinical oversight, normalised communication lapses, and weak teamwork and relational context; and (iii) Silence trap: Fear in punitive and blame-oriented culture and lack of incident-reporting systems.</div></div><div><h3>Conclusion</h3><div>Patient safety in Ethiopian ICUs is undermined by systemic, operational, and clinician-related obstacles. Structural and cultural barriers further hinder incident-reporting creating a vicious cycle where unsafe care remains hidden and opportunities for learning and improvements are lost. Breaking this cycle requires strong governance, coordinated resource investment, enhancing just culture, strengthening teamwork, establishing robust incident-reporting systems, and ongoing professional development focused on patient safety.</div></div><div><h3>Implications for clinical practice</h3><div>Identifying barriers to patient safety and incident reporting in ICUs may enables targeted interventions that reduce preventable harm, improve care quality, and promote incident reporting and learning to sustain safe clinical practice. <strong>Keywords</strong>: Patient safety, Incident-reporting; Barriers, Intensive care units, Resource-limited settings, Qualitative study, Ethiopian public hospitals.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104325"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A matter of perspective: How divergent professional logics shape perceptions of appropriate care in the ICU","authors":"Anna-Henrikje Seidlein","doi":"10.1016/j.iccn.2026.104339","DOIUrl":"10.1016/j.iccn.2026.104339","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104339"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of eye protection during prone positioning – Response to Marelli et al.","authors":"Xiaomeng Han ,&nbsp;Zhigang Zhang","doi":"10.1016/j.iccn.2026.104345","DOIUrl":"10.1016/j.iccn.2026.104345","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104345"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146115322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moral distress: The unmeasured catalyst in preventing catheter-associated bloodstream infections in neonatal ICUs − Letter on Berdida et al.","authors":"Peiyan Lin,&nbsp;Yuliu Huang","doi":"10.1016/j.iccn.2026.104341","DOIUrl":"10.1016/j.iccn.2026.104341","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104341"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties and structural validity of the traditional Chinese version of the FAMily engagement instrument in intensive care units","authors":"Kai-Mei Chang ,&nbsp;Kath Peters ,&nbsp;Lucie Ramjan ,&nbsp;Kevin Shu-Leung Lai ,&nbsp;An-Yi Wang ,&nbsp;Chen-I Lee ,&nbsp;Tzu-Hao Wang ,&nbsp;Hsiao-Yean Chiu","doi":"10.1016/j.iccn.2025.104316","DOIUrl":"10.1016/j.iccn.2025.104316","url":null,"abstract":"<div><h3>Objectives</h3><div>Family engagement, a key component of the ABCDEF bundle in the intensive care unit (ICU), is associated with improved clinical outcomes in patients and enhanced well-being of family members. The FAMily Engagement instrument is the only validated tool available for assessing family engagement in ICU care. However, it has not been evaluated in Chinese-speaking populations. The study aimed to translate and validate the Traditional Chinese version of the FAMily Engagement instrument (FAME-TC) among family members of ICU patients.</div></div><div><h3>Methods</h3><div>This prospective observational study included family members who were among the most frequent visitors or primary caregivers and had accompanied corresponding patients for at least 3 days after ICU admission. Data collection included demographic information, FAME-TC, the Depression, Anxiety, and Stress Scale-21 Items (DASS21), and the five-level version of EuroQoL–5 dimensions (EQ-5D-5L). Internal consistency, construct validity, and concurrent validity of the FAME-TC were evaluated to confirm the reliability and validity.</div></div><div><h3>Results</h3><div>A total of 200 participants were enrolled (mean age: 48.46 ± 14.52 years; female: 57.5 %). The FAME-TC showed excellent reliability (Cronbach’s α = 0.91). Exploratory factor analysis (EFA) confirmed a two-factor structure: <em>family engagement in care</em> and <em>family perceived support from the healthcare team</em>. No significant correlation was observed between the FAME-TC score and subscales of the DASS21 (<em>p</em> &gt; 0.05), while a statistically significant positive correlation was found between the FAME-TC score and the EQ-5D-5L visual analogue scale level (<em>r</em> = 0.26, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The FAME-TC exhibits satisfactory reliability and validity for assessing family engagement in critical care.</div></div><div><h3>Implications for clinical practice</h3><div>Healthcare providers can use the FAME-TC to evaluate family engagement degree and implement targeted interventions to strengthen family involvement in critical care, thereby improving patients’ clinical outcomes and improving family members’ quality of life.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104316"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining the ICU E-Diary: Integration, Intelligence, and Impact – Response to Luo et al.","authors":"Louise Rose ,&nbsp;Joel Meyer","doi":"10.1016/j.iccn.2026.104353","DOIUrl":"10.1016/j.iccn.2026.104353","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104353"},"PeriodicalIF":4.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}