To critically analyse and synthesise the literature describing the relationship between a debriefing intervention and wellbeing in the distinct population of registered nurses working in the adult Intensive Care Unit (ICU).
Methods
The JBI literature review methodology was used to analyse primary research exploring a clearly defined debriefing process with an aim to improving wellbeing in the setting and population of ICU nurses. A comprehensive search of primary research published between 1st January 2004 and 9th May 2024 was conducted. A systematic search was conducted across multiple scholarly databases: APA PsycInfo, CINAHL Complete, PubMed and Embase. Google Scholar and reference lists were also searched. Data from the included studies were extracted by one author, and then checked and verified by a second author. Included studies are summarised according to study details, debriefing characteristics and reported wellbeing results. Studies were appraised using the Mixed Methods Appraisal Tool.
Results
The search yielded 732 articles, with 12 articles screened in full-text format. Three primary research studies met the inclusion criteria. All included studies utilised a mixed methods design, there was significant heterogeneity between logistical components of the debriefing intervention as well as study instruments and reporting.
Conclusion
This systematic review illustrates a paucity of available research on the specificity of debriefing practices and the potential relationship to wellbeing in the ICU nursing population.
Implications for clinical practice
Further rigorous research is required surrounding the implementation and effectiveness of debriefing in the unique population of ICU nurses.
{"title":"The impact of clearly defined debriefing practices on nurses working within an adult intensive care: A systematic review","authors":"Annabel Levido , Fiona Coyer , Samantha Keogh , Natalie Barker , Liz Crowe","doi":"10.1016/j.iccn.2025.103997","DOIUrl":"10.1016/j.iccn.2025.103997","url":null,"abstract":"<div><h3>Objectives</h3><div>To critically analyse and synthesise the literature describing the relationship between a debriefing intervention and wellbeing in the distinct population of registered nurses working in the adult Intensive Care Unit (ICU).</div></div><div><h3>Methods</h3><div>The JBI literature review methodology was used to analyse primary research exploring a clearly defined debriefing process with an aim to improving wellbeing in the setting and population of ICU nurses. A comprehensive search of primary research published between 1st January 2004 and 9th May 2024 was conducted. A systematic search was conducted across multiple scholarly databases: APA PsycInfo, CINAHL Complete, PubMed and Embase. Google Scholar and reference lists were also searched. Data from the included studies were extracted by one author, and then checked and verified by a second author. Included studies are summarised according to study details, debriefing characteristics and reported wellbeing results. Studies were appraised using the Mixed Methods Appraisal Tool.</div></div><div><h3>Results</h3><div>The search yielded 732 articles, with 12 articles screened in full-text format. Three primary research studies met the inclusion criteria. All included studies utilised a mixed methods design, there was significant heterogeneity between logistical components of the debriefing intervention as well as study instruments and reporting.</div></div><div><h3>Conclusion</h3><div>This systematic review illustrates a paucity of available research on the specificity of debriefing practices and the potential relationship to wellbeing in the ICU nursing population.</div></div><div><h3>Implications for clinical practice</h3><div>Further rigorous research is required surrounding the implementation and effectiveness of debriefing in the unique population of ICU nurses.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103997"},"PeriodicalIF":4.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578366","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}
Pub Date : 2025-03-09DOI: 10.1016/j.iccn.2025.103998
Mireia Llaurado-Serra , Estel Curado Santos , Marina Perpiñán Grogues , Anca Constantinescu-Dobra , Madalina-Alexandra Coţiu , Beata Dobrowolska , Adriano Friganović , Aleksandra Gutysz-Wojnicka , Maria Hadjibalassi , Dorota Ozga , Slađana Režić , Adrian Sabou , Jelena Slijepčević , Evanthia Georgiou
Objectives
To determine the nursing intention to leave in critical care units and explore related factors along with work environment and sociodemographic variables.
Design and setting
Quantitative cross-sectional study in five European countries (Spain, Poland, Croatia, Cyprus and Romania) through a self-administered survey in 2021.
Methods
The “AACN Critical elements of a healthy work environment scale. National Survey of Critical-Care Nurse Work Environments” by the American Association of Critical Care Nurses was distributed to all nurses working in intensive care units through a convenience sampling method. The questionnaire included questions about healthy work environment, burnout, violence, intention to leave and sociodemographics.
Results
1033 responses were analysed. Participants from each country varied between 75 and 275 nurses. Mean age was 37.3 years old (SD 9.9) with a mean nursing experience in critical care of 10.8 (9.2) years. Despite 83.1 % of the nurses were satisfied with their current job, 22.8 % planned to leave their position. Intention to leave was independently associated with the country, gender, age, satisfaction with current job and frequency of moral distress (p < 0.05) along with several work-related variables, such as lower perception of a healthy work environment. Among the reasons to reconsider leaving the job, the most rated were higher salary and benefits (87.2 %), better staffing (85.3 %) and meaningful recognition (82 %). Conversely, the most relevant reasons that kept nurses working in their organisation, were salary and benefits and the people they work with.
Conclusion
Almost one out of three critical care nurses are considering leaving their job. Many aspects of the work environment that influence the intention to leave are modifiable.
Implications for clinical practice
Managers need to prioritise the retention of registered nurses, not only recruiting new personnel. Many aspects of the working environment need to be addressed in other to retain critical care nurses.
{"title":"Critical care nurses’ intention to leave and related factors: Survey results from 5 European countries","authors":"Mireia Llaurado-Serra , Estel Curado Santos , Marina Perpiñán Grogues , Anca Constantinescu-Dobra , Madalina-Alexandra Coţiu , Beata Dobrowolska , Adriano Friganović , Aleksandra Gutysz-Wojnicka , Maria Hadjibalassi , Dorota Ozga , Slađana Režić , Adrian Sabou , Jelena Slijepčević , Evanthia Georgiou","doi":"10.1016/j.iccn.2025.103998","DOIUrl":"10.1016/j.iccn.2025.103998","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the nursing intention to leave in critical care units and explore related factors along with work environment and sociodemographic variables.</div></div><div><h3>Design and setting</h3><div>Quantitative cross-sectional study in five European countries (Spain, Poland, Croatia, Cyprus and Romania) through a self-administered survey in 2021.</div></div><div><h3>Methods</h3><div>The “AACN Critical elements of a healthy work environment scale. National Survey of Critical-Care Nurse Work Environments” by the American Association of Critical Care Nurses was distributed to all nurses working in intensive care units through a convenience sampling method. The questionnaire included questions about healthy work environment, burnout, violence, intention to leave and sociodemographics.</div></div><div><h3>Results</h3><div>1033 responses were analysed. Participants from each country varied between 75 and 275 nurses. Mean age was 37.3 years old (SD 9.9) with a mean nursing experience in critical care of 10.8 (9.2) years. Despite 83.1 % of the nurses were satisfied with their current job, 22.8 % planned to leave their position. Intention to leave was independently associated with the country, gender, age, satisfaction with current job and frequency of moral distress (p < 0.05) along with several work-related variables, such as lower perception of a healthy work environment. Among the reasons to reconsider leaving the job, the most rated were higher salary and benefits (87.2 %), better staffing (85.3 %) and meaningful recognition (82 %). Conversely, the most relevant reasons that kept nurses working in their organisation, were salary and benefits and the people they work with.</div></div><div><h3>Conclusion</h3><div>Almost one out of three critical care nurses are considering leaving their job. Many aspects of the work environment that influence the intention to leave are modifiable.</div></div><div><h3>Implications for clinical practice</h3><div>Managers need to prioritise the retention of registered nurses, not only recruiting new personnel. Many aspects of the working environment need to be addressed in other to retain critical care nurses.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103998"},"PeriodicalIF":4.9,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578365","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}
Pub Date : 2025-03-09DOI: 10.1016/j.iccn.2025.104002
Risa Herlianita , Che-Jen Chang , Santa Maria Pangaribuan , Hsiao-Yean Chiu
Objectives
To summarize the occurrence rates and identified the risk factors for pain at rest and during procedures in critically ill patients.
Methods
This study conducted a systematic review and meta-analysis. The Embase, PubMed, CINAHL Plus, Web of Science Core Collection and ProQuest Dissertations & Theses A&I databases were searched from inception to January 10, 2025, for relevant studies. Two independent researchers screened the articles, reviewed them, and extracted data. The data were analyzed using a random-effects model.
Results
This meta-analysis included 23 observational studies with prospective, retrospective, and cross-sectional study designs encompassing 8,073 adult participants. The pooled occurrence rate of pain at rest among critically ill patients was 41 % (95 % confidence interval [CI] = 0.27 to 0.57), whereas that of pain during procedures was 68.4 % (95 % CI = 0.58 to 0.77). Most studies on intensive care unit (ICU)-related pain were conducted in the Asia Pacific region, the Americas, and Western Europe. Age was determined to be negatively associated with pain at rest, whereas opioid use percentage and percentage of male were positively associated with the occurrence of pain during procedures.
Conclusions
Pain at rest and during procedures is highly prevalent and often undertreated in ICU patients. Health-care providers should develop and implement effective pain management strategies to mitigate both pain at rest and procedural pain in critically ill patients.
Implications for Clinical Practice
Pain is a frequent and troubling experience for patients in the ICU, so healthcare providers need to assess and address it regularly. This study also pinpointed specific factors linked to pain at rest and during procedures, some of which can be changed or managed. These results offer ICU medical team valuable insights for identifying high-risk patients and delivering personalized interventions to minimize pain.
{"title":"Occurrence rate and risk factors for rest and procedural pain in critically ill patients: A systematic review and meta-analysis","authors":"Risa Herlianita , Che-Jen Chang , Santa Maria Pangaribuan , Hsiao-Yean Chiu","doi":"10.1016/j.iccn.2025.104002","DOIUrl":"10.1016/j.iccn.2025.104002","url":null,"abstract":"<div><h3>Objectives</h3><div>To summarize the occurrence rates and identified the risk factors for pain at rest and during procedures in critically ill patients.</div></div><div><h3>Methods</h3><div>This study conducted a systematic review and meta-analysis. The Embase, PubMed, CINAHL Plus, Web of Science Core Collection and ProQuest Dissertations & Theses A&I databases were searched from inception to January 10, 2025, for relevant studies. Two independent researchers screened the articles, reviewed them, and extracted data. The data were analyzed using a random-effects model.</div></div><div><h3>Results</h3><div>This meta-analysis included 23 observational studies with prospective, retrospective, and cross-sectional study designs encompassing 8,073 adult participants. The pooled occurrence rate of pain at rest among critically ill patients was 41 % (95 % confidence interval [CI] = 0.27 to 0.57), whereas that of pain during procedures was 68.4 % (95 % CI = 0.58 to 0.77). Most studies on intensive care unit (ICU)-related pain were conducted in the Asia Pacific region, the Americas, and Western Europe. Age was determined to be negatively associated with pain at rest, whereas opioid use percentage and percentage of male were positively associated with the occurrence of pain during procedures.</div></div><div><h3>Conclusions</h3><div>Pain at rest and during procedures is highly prevalent and often undertreated in ICU patients. Health-care providers should develop and implement effective pain management strategies to mitigate both pain at rest and procedural pain in critically ill patients.</div></div><div><h3>Implications for Clinical Practice</h3><div>Pain is a frequent and troubling experience for patients in the ICU, so healthcare providers need to assess and address it regularly. This study also pinpointed specific factors linked to pain at rest and during procedures, some of which can be changed or managed. These results offer ICU medical team valuable insights for identifying high-risk patients and delivering personalized interventions to minimize pain.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104002"},"PeriodicalIF":4.9,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578367","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}
Pub Date : 2025-03-08DOI: 10.1016/j.iccn.2025.103995
Oliver Coolens , Arnold Kaltwasser , Tobias Melms , Stefanie Monke , Peter Nydahl , Sabrina Pelz , Rebecca von Haken , Wolfgang Hasemann
Background
Delirium in patients on intensive care units (ICU) can lead to prolonged length of stay, cognitive decline and higher mortality. Implementing delirium management is a challenge for healthcare workers. Between 2016 and 2024, several quality improvement projects were performed in German speaking countries. These projects included founding a delirium society, distributing delirium related curricula, awards, surveys, webinars, public materials, and others. The aim was to assess the current state of delirium management in 2024 and identify changes in prevention, detection, and treatment since 2016.
Method
Repetition and comparison of a survey for delirium management from 2016 in 2024. Questions included items for hospital and ICU characteristics, present delirium structures, processes, assessment routines, barriers, and others. The survey was distributed in a snowball system in German speaking countries. Data were analysed statistically.
Results
Participating ICU in both surveys (2016: n = 559, 2024: n = 447) had similar basic characteristics and enabled comparison. Use of validated delirium assessment tools slightly increased from 56.8 % (n = 398) in 2016 to 74.4 % (n = 438) in 2024. Significant improvement rates were identified from 2016 to 2024 in use of validated assessments (56.8 % vs. 72.8 %), prevention programs (34.6 % vs. 44.7 %), information materials for patients and families (18.9 % vs. 33.8 %), and others. Conversely, there was decreased implementation in dementia screening (23.7 vs. 14.8), use of restraints (68.3 % vs. 58.4 %), and others. The top barrier, lack of time and staff, remained in first place.
Conclusions
The comparison of two large surveys in 2016 and 2024 indicate a slightly cultural shift in delirium management in German speaking countries. Open quality improvement projects might increase delirium awareness and contribute to an ongoing cultural change.
Implications for practice
Improvement projects addressing barriers and delirium-specific awareness are essential to improve and sustain delirium management practices in ICU settings.
{"title":"Delirium management in 2024: A status check and evolution in clinical practice since 2016","authors":"Oliver Coolens , Arnold Kaltwasser , Tobias Melms , Stefanie Monke , Peter Nydahl , Sabrina Pelz , Rebecca von Haken , Wolfgang Hasemann","doi":"10.1016/j.iccn.2025.103995","DOIUrl":"10.1016/j.iccn.2025.103995","url":null,"abstract":"<div><h3>Background</h3><div>Delirium in patients on intensive care units (ICU) can lead to prolonged length of stay, cognitive decline and higher mortality. Implementing delirium management is a challenge for healthcare workers. Between 2016 and 2024, several quality improvement projects were performed in German speaking countries. These projects included founding a delirium society, distributing delirium related curricula, awards, surveys, webinars, public materials, and others. The aim was to assess the current state of delirium management in 2024 and identify changes in prevention, detection, and treatment since 2016.</div></div><div><h3>Method</h3><div>Repetition and comparison of a survey for delirium management from 2016 in 2024. Questions included items for hospital and ICU characteristics, present delirium structures, processes, assessment routines, barriers, and others. The survey was distributed in a snowball system in German speaking countries. Data were analysed statistically.</div></div><div><h3>Results</h3><div>Participating ICU in both surveys (2016: n = 559, 2024: n = 447) had similar basic characteristics and enabled comparison. Use of validated delirium assessment tools slightly increased from 56.8 % (n = 398) in 2016 to 74.4 % (n = 438) in 2024. Significant improvement rates were identified from 2016 to 2024 in use of validated assessments (56.8 % vs. 72.8 %), prevention programs (34.6 % vs. 44.7 %), information materials for patients and families (18.9 % vs. 33.8 %), and others. Conversely, there was decreased implementation in dementia screening (23.7 vs. 14.8), use of restraints (68.3 % vs. 58.4 %), and others. The top barrier, lack of time and staff, remained in first place.</div></div><div><h3>Conclusions</h3><div>The comparison of two large surveys in 2016 and 2024 indicate a slightly cultural shift in delirium management in German speaking countries. Open quality improvement projects might increase delirium awareness and contribute to an ongoing cultural change.</div></div><div><h3>Implications for practice</h3><div>Improvement projects addressing barriers and delirium-specific awareness are essential to improve and sustain delirium management practices in ICU settings.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103995"},"PeriodicalIF":4.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-07DOI: 10.1016/j.iccn.2025.103991
Manu L.N.G. Malbrain
{"title":"“Do we still need central venous pressure monitoring in the ICU? No!”","authors":"Manu L.N.G. Malbrain","doi":"10.1016/j.iccn.2025.103991","DOIUrl":"10.1016/j.iccn.2025.103991","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103991"},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562456","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}
Pub Date : 2025-03-05DOI: 10.1016/j.iccn.2025.103943
Zhao Yingnan , Zhang Shulin , Lu Minxia , Zhen qiao , Shi Xiaoqing
Background
Heart failure management requires active participation in self-care by both patients and family caregivers as a dyad.
Objective
This systematic review and meta-analysis aimed to examine the impact of dyadic self-care interventions on patient outcomes in heart failure management.
Methods
We searched databases including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, and Wanfang through May 14, 2024. Following PRISMA guidelines, we used the Cochrane Risk of Bias tool for quality assessment and Review Manager 5.4 for data analysis.
Results
Twenty studies (18 Randomized Controlled Trials, 2 quasi-experimental) involving 3,266 patients and 3,091 family caregivers were included. Dyadic self-care interventions showed significant effects on patients’ self-care maintenance (MD: 9.07, 95 % CI: 6.17–11.98) and management (MD: 5.03, 95 % CI: 3.96–6.10) across all time periods. Self-care confidence improved only in short-term (MD: 6.32, 95 % CI: 5.32–7.32) and medium-term (MD: 4.23, 95 % CI: 0.26–8.20). Quality of life improved only in short-term. The interventions reduced readmission rates and healthcare costs but showed no effect on mortality, anxiety, or depression.
Conclusions
Dyadic interventions effectively reduced readmissions and improved quality of life in heart failure management. Future research should focus on sustainable, cost-effective strategies for long-term outcomes.
Implications for clinical practice
The findings support implementing dyadic interventions while emphasizing the need for continued focus on mental health and sustained support. Further research on caregiver outcomes is warranted.
{"title":"Patient and informal caregiver-centered nursing interventions for adults with heart failure: A systematic review and meta-analysis","authors":"Zhao Yingnan , Zhang Shulin , Lu Minxia , Zhen qiao , Shi Xiaoqing","doi":"10.1016/j.iccn.2025.103943","DOIUrl":"10.1016/j.iccn.2025.103943","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure management requires active participation in self-care by both patients and family caregivers as a dyad.</div></div><div><h3>Objective</h3><div>This systematic review and <em>meta</em>-analysis aimed to examine the impact of dyadic self-care interventions on patient outcomes in heart failure management.</div></div><div><h3>Methods</h3><div>We searched databases including PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, and Wanfang through May 14, 2024. Following PRISMA guidelines, we used the Cochrane Risk of Bias tool for quality assessment and Review Manager 5.4 for data analysis.</div></div><div><h3>Results</h3><div>Twenty studies (18 Randomized Controlled Trials, 2 quasi-experimental) involving 3,266 patients and 3,091 family caregivers were included. Dyadic self-care interventions showed significant effects on patients’ self-care maintenance (MD: 9.07, 95 % CI: 6.17–11.98) and management (MD: 5.03, 95 % CI: 3.96–6.10) across all time periods. Self-care confidence improved only in short-term (MD: 6.32, 95 % CI: 5.32–7.32) and medium-term (MD: 4.23, 95 % CI: 0.26–8.20). Quality of life improved only in short-term. The interventions reduced readmission rates and healthcare costs but showed no effect on mortality, anxiety, or depression.</div></div><div><h3>Conclusions</h3><div>Dyadic interventions effectively reduced readmissions and improved quality of life in heart failure management. Future research should focus on sustainable, cost-effective strategies for long-term outcomes.</div></div><div><h3>Implications for clinical practice</h3><div>The findings support implementing dyadic interventions while emphasizing the need for continued focus on mental health and sustained support. Further research on caregiver outcomes is warranted.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103943"},"PeriodicalIF":4.9,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552931","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}
Pub Date : 2025-03-02DOI: 10.1016/j.iccn.2025.103982
Sung-Hyun Cho , Shin-Ae Kim , Eunhye Kim
Objectives
To examine nurse staffing requirements in intensive care units (ICUs) for mechanical ventilation (MV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and their combinations, and analyze the effects of these procedures on staffing requirements across different types of ICU stay.
Methods
A cross-sectional study was conducted to analyze data from patients discharged from adult ICUs at a tertiary hospital in Seoul, South Korea, between 2022 and 2023. Staffing requirements were evaluated using nursing hours per patient day (NHPPD) and nurse-to-patient ratios. Each ICU day was categorized into one of eight procedure groups: none of three procedures, one-procedure (MV, CRRT, or ECMO), two-procedure (MV & CRRT, MV & ECMO, or CRRT & ECMO), and three-procedure (MV, CRRT, & ECMO) groups. The impacts of these groups on NHPPD were analyzed using multilevel regression models.
Results
Among a total of 51,226 ICU days from 8,541 patients, the MV group accounted for the largest proportion of ICU days (44.4%), followed by the no-procedure group (38.2%). The overall NHPPD was 14.8 h, with a nurse-to-patient ratio of 1:1.6. The no-procedure group had the lowest NHPPD (12.8 h), while the three-procedure group had the highest (18.9 h). The overall NHPPD was highest on continuing-stay days, whereas two- and three-procedure groups tended to have the highest NHPPD on admission days. In multiple regression analyses, the three-procedure group exhibited the greatest increase in NHPPD (4.94 h), followed by the MV & CRRT group (4.42 h) and the MV & ECMO group (3.28 h), compared to the no-procedure group.
Conclusions
Staffing requirements varied among procedure groups and types of ICU stay. The NHPPD for combined procedures exceeded the sum of the NHPPD for the individual procedures.
Implications for Clinical Practice
Staffing requirements should be tailored to meet the increasing patient needs resulting from procedural complexity.
{"title":"Comparisons of nursing hours and nurse-to-patient ratios required for patients with mechanical ventilation, CRRT, and ECMO in intensive care units: A cross-sectional study","authors":"Sung-Hyun Cho , Shin-Ae Kim , Eunhye Kim","doi":"10.1016/j.iccn.2025.103982","DOIUrl":"10.1016/j.iccn.2025.103982","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine nurse staffing requirements in intensive care units (ICUs) for mechanical ventilation (MV), continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), and their combinations, and analyze the effects of these procedures on staffing requirements across different types of ICU stay.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted to analyze data from patients discharged from adult ICUs at a tertiary hospital in Seoul, South Korea, between 2022 and 2023. Staffing requirements were evaluated using nursing hours per patient day (NHPPD) and nurse-to-patient ratios. Each ICU day was categorized into one of eight procedure groups: none of three procedures, one-procedure (MV, CRRT, or ECMO), two-procedure (MV & CRRT, MV & ECMO, or CRRT & ECMO), and three-procedure (MV, CRRT, & ECMO) groups. The impacts of these groups on NHPPD were analyzed using multilevel regression models.</div></div><div><h3>Results</h3><div>Among a total of 51,226 ICU days from 8,541 patients, the MV group accounted for the largest proportion of ICU days (44.4%), followed by the no-procedure group (38.2%). The overall NHPPD was 14.8 h, with a nurse-to-patient ratio of 1:1.6. The no-procedure group had the lowest NHPPD (12.8 h), while the three-procedure group had the highest (18.9 h). The overall NHPPD was highest on continuing-stay days, whereas two- and three-procedure groups tended to have the highest NHPPD on admission days. In multiple regression analyses, the three-procedure group exhibited the greatest increase in NHPPD (4.94 h), followed by the MV & CRRT group (4.42 h) and the MV & ECMO group (3.28 h), compared to the no-procedure group.</div></div><div><h3>Conclusions</h3><div>Staffing requirements varied among procedure groups and types of ICU stay. The NHPPD for combined procedures exceeded the sum of the NHPPD for the individual procedures.</div></div><div><h3>Implications for Clinical Practice</h3><div>Staffing requirements should be tailored to meet the increasing patient needs resulting from procedural complexity.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103982"},"PeriodicalIF":4.9,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143529690","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}
Pub Date : 2025-03-01DOI: 10.1016/j.iccn.2025.103980
Karla D Krewulak , Laurie A. Lee , Kathryn Strayer , Jennifer Armstrong , Nadia Baig , Judith Brouillette , Kirsten Deemer , Natalia Jaworska , Katherine A Kissel , Christine MacDonald , Tanya Mailhot , Oleska G. Rewa , Eric Sy , Peter Nydahl , Rebecca von Haken , Heidi Lindroth , Keibun Liu , Kirsten M. Fiest
Objective
This study aimed to evaluate the proportion of screened patients with delirium and the strategies used for its management in Canadian hospitals caring for critically ill children or adults.
Methods
This is a secondary analysis of a cross-sectional study completed on World Delirium Awareness Day (March 15, 2023). Respondents completed a 35-question survey on the proportion of screened patients with delirium (at 8:00 am and 8:00 pm), treatment, and management strategies employed.
Results
A total of 27 ICUs (22 adult and 5 pediatric) participated. Among adult ICU patients assessed for delirium, 18 % (n = 34/194) had delirium at 8:00 am and 18 % (32/181) had delirium at 8:00 pm. In pediatric ICUs, the proportion of screened patients with delirium was higher, with 50 % (n = 8/16) at 8:00 am and 44 % (n = 7/16) at 8:00 pm. Delirium management strategies varied: with non-pharmacological approaches such as multi-professional rounds (100 %), pain management (96 %), and mobilization (85 %) being most common. The most reported written delirium management protocols included spontaneous breathing trials in adult ICUs and physical restraint and sedation management in PICUs. Few ICUs reported written protocols for family engagement and empowerment.
Conclusions
Delirium remains a prevalent issue in Canadian ICUs, with variability in assessment and management strategies. Gaps in family engagement and pediatric-specific protocols persist. Addressing barriers like staff shortages and lack of training is critical to improving care.
Implications for Clinical Practice: Improving delirium management requires standardized protocols, especially in PICUs, and better integration of family engagement in care. Addressing workforce challenges (e.g., staff shortages and educating new staff on delirium) will be crucial for enhancing delirium prevention and treatment in Canadian ICUs. Further research should focus on pediatric-specific interventions and pharmacological management.
{"title":"The 2023 World delirium awareness and quality Survey: A Canadian substudy","authors":"Karla D Krewulak , Laurie A. Lee , Kathryn Strayer , Jennifer Armstrong , Nadia Baig , Judith Brouillette , Kirsten Deemer , Natalia Jaworska , Katherine A Kissel , Christine MacDonald , Tanya Mailhot , Oleska G. Rewa , Eric Sy , Peter Nydahl , Rebecca von Haken , Heidi Lindroth , Keibun Liu , Kirsten M. Fiest","doi":"10.1016/j.iccn.2025.103980","DOIUrl":"10.1016/j.iccn.2025.103980","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the proportion of screened patients with delirium and the strategies used for its management in Canadian hospitals caring for critically ill children or adults.</div></div><div><h3>Methods</h3><div>This is a secondary analysis of a cross-sectional study completed on World Delirium Awareness Day (March 15, 2023). Respondents completed a 35-question survey on the proportion of screened patients with delirium (at 8:00 am and 8:00 pm), treatment, and management strategies employed.</div></div><div><h3>Results</h3><div>A total of 27 ICUs (22 adult and 5 pediatric) participated. Among adult ICU patients assessed for delirium, 18 % (n = 34/194) had delirium at 8:00 am and 18 % (32/181) had delirium at 8:00 pm. In pediatric ICUs, the proportion of screened patients with delirium was higher, with 50 % (n = 8/16) at 8:00 am and 44 % (n = 7/16) at 8:00 pm. Delirium management strategies varied: with non-pharmacological approaches such as multi-professional rounds (100 %), pain management (96 %), and mobilization (85 %) being most common. The most reported written delirium management protocols included spontaneous breathing trials in adult ICUs and physical restraint and sedation management in PICUs. Few ICUs reported written protocols for family engagement and empowerment.</div></div><div><h3>Conclusions</h3><div>Delirium remains a prevalent issue in Canadian ICUs, with variability in assessment and management strategies. Gaps in family engagement and pediatric-specific protocols persist. Addressing barriers like staff shortages and lack of training is critical to improving care.</div><div><em>Implications for Clinical Practice:</em> Improving delirium management requires standardized protocols, especially in PICUs, and better integration of family engagement in care. Addressing workforce challenges (e.g., staff shortages and educating new staff on delirium) will be crucial for enhancing delirium prevention and treatment in Canadian ICUs. Further research should focus on pediatric-specific interventions and pharmacological management.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103980"},"PeriodicalIF":4.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To review the effect of family participation interventions in preventing delirium in Intensive Care Units (ICU).
Methods
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the “Synthesis Without Meta-analysis” guidelines. The search was performed using the MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases in April 2024. Eligibility criteria included patients admitted to Intensive Care Units, aged 18 or older exposed to risk factors for delirium, and with family members present; studies about family intervention to prevent delirium, that considered family as a partner in care and included interventions; studies that quantitatively assessed the effect of measures on the incidence and duration of delirium; interventional studies. Two authors independently applied these criteria using the Rayyan® application, assessing study quality with Critical Appraisal Skills Programme tools.
Results
Fourteen studies were included, involving 33,232 patients. A meta-analysis was not feasible due to the highly heterogeneous results, but we concluded that the family participation interventions for delirium prevention were grouped into single-component and multi-component interventions. The single-component interventions, such as familiar voice messages, flexible visitation, and family presence, showed a favorable response in reducing delirium. The multicomponent interventions suggesting a positive effect included family visitation with professional-guided orientation; familiar voice messages for reorientation, newspaper reading, and nighttime eye patch use; sensory stimulation program; the ABCDEF bundle; the DyDel program; family education, emotional support, orientation training, cognitive stimulation, and ICU life care participation.
Conclusions
Several family participation interventions, both single-component and multicomponent, have shown positive effects on outcomes in preventing delirium in ICU patients, particularly in reducing its incidence and duration.
Implications for Clinical Practice
Identifying the family participation interventions that can prevent delirium allows the development of measures to minimize its occurrence in ICU.
{"title":"The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review","authors":"Marli Lopo Vitorino , Adriana Henriques , Graça Melo , Helga Rafael Henriques","doi":"10.1016/j.iccn.2025.103976","DOIUrl":"10.1016/j.iccn.2025.103976","url":null,"abstract":"<div><h3>Aim</h3><div>To review the effect of family participation interventions in preventing delirium in Intensive Care Units (ICU).</div></div><div><h3>Methods</h3><div>The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the “Synthesis Without Meta-analysis” guidelines. The search was performed using the MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> databases in April 2024. Eligibility criteria included patients admitted to Intensive Care Units, aged 18 or older exposed to risk factors for delirium, and with family members present; studies about family intervention to prevent delirium, that considered family as a partner in care and included interventions; studies that quantitatively assessed the effect of measures on the incidence and duration of delirium; interventional studies. Two authors independently applied these criteria using the Rayyan® application, assessing study quality with Critical Appraisal Skills Programme tools.</div></div><div><h3>Results</h3><div>Fourteen studies were included, involving 33,232 patients. A <em>meta</em>-analysis was not feasible due to the highly heterogeneous results, but we concluded that the family participation interventions for delirium prevention were grouped into single-component and multi-component interventions. The single-component interventions, such as familiar voice messages, flexible visitation, and family presence, showed a favorable response in reducing delirium. The multicomponent interventions suggesting a positive effect included family visitation with professional-guided orientation; familiar voice messages for reorientation, newspaper reading, and nighttime eye patch use; sensory stimulation program; the ABCDEF bundle; the DyDel program; family education, emotional support, orientation training, cognitive stimulation, and ICU life care participation.</div></div><div><h3>Conclusions</h3><div>Several family participation interventions, both single-component and multicomponent, have shown positive effects on outcomes in preventing delirium in ICU patients, particularly in reducing its incidence and duration.</div></div><div><h3>Implications for Clinical Practice</h3><div>Identifying the family participation interventions that can prevent delirium allows the development of measures to minimize its occurrence in ICU.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103976"},"PeriodicalIF":4.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143519122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain during endotracheal aspiration (ETA) is frequent in critically ill patients. Managing pre-emptive analgesia before procedures remains a crucial aspect of care. We compared pupillometry to standard clinical practice for assessing preemptive-analgesia administration and pain before ETA according to Behavioural Pain Scale (BPS), the Behavioural Pain Indicator Scale (ESCID), and the Pupillary Dilation Reflex (PDR).
Trial design
A multicentre parallel-group, controlled trial with balanced (1:1) randomization.
Methods
Sedated, mechanically ventilated patients aged ≥ 18 with baseline BPS = 3, ESCID = 1, and RASS scores between −1 and −4 were included. Control group: preemptive-analgesia was administered according to nurse criteria. In the experimental group, preemptive analgesia was administered in patients with PDR ≥ 11.5 % after a 20 mA stimulus measured using AlgiScan®. The preemptive analgesia was fentanyl one µg/kg iv bolus. We used the Chi-square statistic to compare post-intervention pain according to BPS, ESCID, and PDR pain values. A multivariate logistic regression study adjusting for sex, BIS, RASS, APACHE II, remifentanil, and preemptive analgesia was conducted.
Results
Ninety-two patients were studied, 51 in control groups and 41 in intervention groups. Pain incidence was lower in the experimental group. Significantly, 43.9 % of patients in the experimental group were prescribed preemptive analgesia before ETA compared to 19.6 % in the control group (p = 0.03). Multivariate analysis showed significant reductions in pain in the group that received preemptive-analgesia before ETA guided by pupillometry across BPS [OR = 0.34 (95 % CI: 0.12–0.99), p = 0.048], ESCID [OR = 0.29 (95 % CI: 0.09–0.88), p = 0.030] and PDR [OR = 0.27 (95 % IC: 0.08–0.86), p = 0.027] compared to standard clinical practice.
Conclusions
Preemptive analgesia monitored with pupillometry group had a lower percentage of patients with pain than those who received analgesia based on standard clinical practice. This effect was independent of the sex, patient severity, BIS score, remifentanil use, or preemptive- analgesia.
Implications for clinical practice
The requirement for preemptive analgesia before aspiration, evaluated through routine clinical practice, was lower than detected by pupillometric monitoring of patients.
The use of pupillometry to monitor preemptive analgesia reduced pain after secretion aspiration. Pupillometry would be an effective tool to individualize the need for preemptive analgesia before potentially painful interventions, applicable to all patients regardless of sex, severity, or sedation level.
{"title":"The comparison of pupillometry to standard clinical practice for pain and preemptive analgesia before endotracheal suctioning: A randomized controlled trial","authors":"Yolanda López-de-Audícana-Jimenez-de-Aberasturi , Ana Vallejo-De-la-Cueva , Cristina Bermudez-Ampudia , Ines Perez-Francisco , Miren Begoña Bengoetxea-Ibarrondo , Naiara Parraza-Diez","doi":"10.1016/j.iccn.2025.103975","DOIUrl":"10.1016/j.iccn.2025.103975","url":null,"abstract":"<div><h3>Background</h3><div>Pain during endotracheal aspiration (ETA) is frequent in critically ill patients. Managing pre-emptive analgesia before procedures remains a crucial aspect of care. We compared pupillometry to standard clinical practice for assessing preemptive-analgesia administration and pain before ETA according to Behavioural Pain Scale (BPS), the Behavioural Pain Indicator Scale (ESCID), and the Pupillary Dilation Reflex (PDR).</div></div><div><h3>Trial design</h3><div>A multicentre parallel-group, controlled trial with balanced (1:1) randomization.</div></div><div><h3>Methods</h3><div>Sedated, mechanically ventilated patients aged ≥ 18 with baseline BPS = 3, ESCID = 1, and RASS scores between −1 and −4 were included. Control group: preemptive-analgesia was administered according to nurse criteria. In the experimental group, preemptive analgesia was administered in patients with PDR ≥ 11.5 % after a 20 mA stimulus measured using AlgiScan®. The preemptive analgesia was fentanyl one µg/kg iv bolus. We used the Chi-square statistic to compare post-intervention pain according to BPS, ESCID, and PDR pain values. A multivariate logistic regression study adjusting for sex, BIS, RASS, APACHE II, remifentanil, and preemptive analgesia was conducted.</div></div><div><h3>Results</h3><div>Ninety-two patients were studied, 51 in control groups and 41 in intervention groups. Pain incidence was lower in the experimental group. Significantly, 43.9 % of patients in the experimental group were prescribed preemptive analgesia before ETA compared to 19.6 % in the control group (p = 0.03). Multivariate analysis showed significant reductions in pain in the group that received preemptive-analgesia before ETA guided by pupillometry across BPS [OR = 0.34 (95 % CI: 0.12–0.99), p = 0.048], ESCID [OR = 0.29 (95 % CI: 0.09–0.88), p = 0.030] and PDR [OR = 0.27 (95 % IC: 0.08–0.86), p = 0.027] compared to standard clinical practice.</div></div><div><h3>Conclusions</h3><div>Preemptive analgesia monitored with pupillometry group had a lower percentage of patients with pain than those who received analgesia based on standard clinical practice. This effect was independent of the sex, patient severity, BIS score, remifentanil use, or preemptive- analgesia.</div></div><div><h3>Implications for clinical practice</h3><div>The requirement for preemptive analgesia before aspiration, evaluated through routine clinical practice, was lower than detected by pupillometric monitoring of patients.</div><div>The use of pupillometry to monitor preemptive analgesia reduced pain after secretion aspiration. Pupillometry would be an effective tool to individualize the need for preemptive analgesia before potentially painful interventions, applicable to all patients regardless of sex, severity, or sedation level.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103975"},"PeriodicalIF":4.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487292","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}
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