Pub Date : 2025-12-25DOI: 10.1016/j.iccn.2025.104322
Tak Kyu Oh , In-Ae Song
Objectives
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.
Methods
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.
Results
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 < 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; P < 0.001) and higher 90-day mortality (36.8 % vs 27.3 %; OR 1.56; 95 % CI 1.53–1.58; P < 0.001). Kaplan–Meier analysis confirmed reduced cumulative survival (log-rank P < 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.
Conclusions
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.
Implications for Clinical Practice
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.
目的门诊使用苯二氮卓类药物和z类药物（BZRA）是常见的，但其对重症监护病房（ICU）入院后死亡率的影响尚不清楚。因此，我们的目的是确定门诊患者在ICU入院前30天内使用BZRA是否与30天和90天死亡率独立相关。方法使用韩国国民健康保险服务数据库，回顾性地确定了2020年至2023年首次入住ICU的成年人（≥18岁），并将入院前30天内的BZRA暴露定义为≥1个处方。我们对人口学、临床（包括Charlson合并症指数和急性器官功能障碍）、社会经济、功能、制度和时间变量进行了1:1的倾向评分匹配，然后通过条件逻辑回归和Kaplan-Meier生存分析估计了30天和90天死亡率的关联。结果在1,189,042例单独入住ICU的成人中，115,821例（9.7%）在ICU前暴露于BZRA。匹配后，115,820例暴露患者和115,820例未暴露患者具有良好的协变量平衡（均为asd <； 0.10）。BZRA暴露与较高的30天死亡率（23.8% vs 16.6%；比值比[OR] 1.57； 95%可信区间[CI] 1.54-1.60; P < 0.001）和较高的90天死亡率（36.8% vs 27.3%; OR 1.56; 95% CI 1.53-1.58; P < 0.001）相关。Kaplan-Meier分析证实累积生存率降低（log-rank P < 0.001）。值得注意的是，苯二氮卓类药物+ z -药物联合使用者表现出最大的风险：与未暴露的患者相比，30天死亡的OR为2.46 (95% CI 2.35-2.58)， 90天死亡的OR为2.61 （95% CI 2.50-2.72）。结论在ICU入院前30天内使用BZRA与较高的30天和90天死亡率独立相关，联合使用会带来更大的风险。最近的门诊BZRA处方是一个容易获得的风险标志，临床医生应该将其纳入icu前评估和分诊；在临床上适当的情况下，药物审查和有针对性的去处方化可以降低ICU的早期发病率和死亡率。
{"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 , 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 < 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> < 0.001) and higher 90-day mortality (36.8 % vs 27.3 %; OR 1.56; 95 % CI 1.53–1.58; <em>P</em> < 0.001). Kaplan–Meier analysis confirmed reduced cumulative survival (log-rank <em>P</em> < 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":"2025-12-25","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}
Dyspnea is a prevalent and distressing symptom among critically ill patients, particularly in trauma intensive care units, and is often poorly managed in semi-conscious individuals. While guided imagery has shown benefits in various chronic and palliative contexts, its efficacy in ICU trauma patients remains understudied.
Methods
In this randomized controlled trial, 102 trauma ICU patients with Glasgow Coma Scale scores of 9–13 were randomly allocated to an intervention group (n = 51) or a control group (n = 51). The intervention group received nature-based guided imagery sessions twice daily for six consecutive days, in addition to standard ICU care. Respiratory distress was evaluated using the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). Secondary outcomes included PaO2, PaCO2, HCO3−, hemoglobin, and Behavioral Pain Scale (BPS) ratings.
Results
The intervention group experienced a greater reduction in respiratory distress (IC-RDOS) at Day 6 compared with controls (mean post-test IC-RDOS: 5.36 vs 6.22; between-group p < 0.001). Oxygenation improved in the intervention group (mean PaO2 at Day 6: 73.8 vs 63.9 mmHg; between-group p < 0.001), while PaCO2 showed a within-group decrease in the intervention arm but no significant between-group difference (mean post-test PaCO2: 42.1 vs 43.1 mmHg; between-group p = 0.35). Pain (BPS) decreased modestly in the intervention group compared with the control (mean post-test BPS: 3.68 vs 4.31; between-group p < 0.001). No intervention-related adverse events were reported.
Conclusion
Guided imagery may be a feasible adjunctive therapy for alleviating respiratory distress and promoting clinical stability in trauma ICU patients with impaired consciousness. Larger trials are needed to confirm safety and effectiveness before routine clinical implementation.
Implications for clinical practice
Incorporating guided imagery into routine ICU nursing care could provide a practical, non-invasive method to reduce respiratory distress in semi-conscious trauma patients, potentially enhancing patient comfort and supporting respiratory function.
研究背景：呼吸困难是危重病人，尤其是创伤重症监护病房中普遍存在的令人痛苦的症状，在半意识个体中往往管理不善。虽然引导成像在各种慢性和姑息性环境中显示出益处，但其在ICU创伤患者中的疗效仍有待研究。方法：将102例格拉斯哥昏迷评分为9 ~ 13分的外伤ICU患者随机分为干预组（n = 51）和对照组（n = 51）。除了标准的ICU护理外，干预组每天接受两次以自然为基础的引导成像课程，连续六天。采用重症监护呼吸窘迫观察量表（IC-RDOS）评估呼吸窘迫。次要结局包括PaO2、PaCO2、HCO3-、血红蛋白和行为疼痛量表（BPS）评分。结果：与对照组相比，干预组在第6天呼吸窘迫（IC-RDOS）的降低幅度更大(测试后平均IC-RDOS: 5.36 vs 6.22；第6天组间p2: 73.8 vs 63.9 mmHg；组间p2显示干预组内降低，但组间无显著差异（测试后平均PaCO2: 42.1 vs 43.1 mmHg；组间p = 0.35）。与对照组相比，干预组疼痛（BPS）略有下降（平均测试后BPS: 3.68 vs 4.31；组间p）。结论：引导成像可能是一种可行的辅助治疗，可减轻创伤ICU意识受损患者的呼吸窘迫，促进临床稳定性。在常规临床应用之前，需要更大规模的试验来确认安全性和有效性。对临床实践的启示：将引导成像纳入常规ICU护理可以提供一种实用的、无创的方法来减少半意识创伤患者的呼吸窘迫，潜在地提高患者的舒适度和支持呼吸功能。
{"title":"Effect of guided imagery on dyspnea in trauma ICU patients: a randomized controlled trial","authors":"Atena Shojaie , Naeimeh Naeimi Bafghi , Atefeh Ahmadi , Behnaz Bagherian","doi":"10.1016/j.iccn.2025.104280","DOIUrl":"10.1016/j.iccn.2025.104280","url":null,"abstract":"<div><h3>Background</h3><div>Dyspnea is a prevalent and distressing symptom among critically ill patients, particularly in trauma intensive care units, and is often poorly managed in semi-conscious individuals. While guided imagery has shown benefits in various chronic and palliative contexts, its efficacy in ICU trauma patients remains understudied.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, 102 trauma ICU patients with Glasgow Coma Scale scores of 9–13 were randomly allocated to an intervention group (n = 51) or a control group (n = 51). The intervention group received nature-based guided imagery sessions twice daily for six consecutive days, in addition to standard ICU care. Respiratory distress was evaluated using the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). Secondary outcomes included PaO<sub>2</sub>, PaCO<sub>2</sub>, HCO<sub>3</sub><sup>−</sup>, hemoglobin, and Behavioral Pain Scale (BPS) ratings.</div></div><div><h3>Results</h3><div>The intervention group experienced a greater reduction in respiratory distress (IC-RDOS) at Day 6 compared with controls (mean post-test IC-RDOS: 5.36 vs 6.22; between-group p < 0.001). Oxygenation improved in the intervention group (mean PaO<sub>2</sub> at Day 6: 73.8 vs 63.9 mmHg; between-group p < 0.001), while PaCO<sub>2</sub> showed a within-group decrease in the intervention arm but no significant between-group difference (mean post-test PaCO<sub>2</sub>: 42.1 vs 43.1 mmHg; between-group p = 0.35). Pain (BPS) decreased modestly in the intervention group compared with the control (mean post-test BPS: 3.68 vs 4.31; between-group p < 0.001). No intervention-related adverse events were reported.</div></div><div><h3>Conclusion</h3><div>Guided imagery may be a feasible adjunctive therapy for alleviating respiratory distress and promoting clinical stability in trauma ICU patients with impaired consciousness. Larger trials are needed to confirm safety and effectiveness before routine clinical implementation.</div></div><div><h3>Implications for clinical practice</h3><div>Incorporating guided imagery into routine ICU nursing care could provide a practical, non-invasive method to reduce respiratory distress in semi-conscious trauma patients, potentially enhancing patient comfort and supporting respiratory function.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104280"},"PeriodicalIF":4.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829408","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 : 2025-12-23DOI: 10.1016/j.iccn.2025.104317
Mariachiara Figura , Francesca Trotta , Luciano Midolo , Francesco Petrosino , Gianluca Pucciarelli , Davide Bartoli
Introduction
Intensive Care Units (ICUs) are among the most resource-intensive hospital environments, contributing substantially to healthcare’s environmental footprint. While sustainable practices are increasingly recognized as essential, little is known about how critical care nurses linguistically frame and make sense of sustainability within their professional culture and daily work.
Aim
To explore how critical care nurses construct and articulate meanings of environmental sustainability in their professional discourse.
Methods
Semi-structured interviews were conducted with 29 critical care nurses across diverse hospital settings. Narratives were analyzed using Automatic Analysis of Textual Data (IRaMuTeQ) with similarity analysis to map term relationships and uncover semantic clusters. Statistical associations (χ2 ≥ 3.84; p < 0.05) guided identification of lexical hubs and thematic subnetworks. Computational findings were integrated with qualitative interpretation to ensure contextual depth and rigor.
Results
The central lexical hub, sustainability, connected clusters reflecting reflective engagement, collaborative responsibility, organizational structures, and systemic gaps. Secondary hubs included environment (ecological impact and cost considerations), practice (behavioral integration), patient (embedded in bedside care), and waste (material handling, energy use, lifecycle awareness). Nurses framed sustainability as both a professional duty and systemic challenge, mediated by organizational support, personal commitment, and environmental constraints.
Conclusions
ICU nurses’ discourse reveals sustainability as a multidimensional construct bridging ethics, operational practice, and systemic limitations. Lexicometric mapping provides a structured view of how sustainability is embedded in professional narratives, offering insights to inform targeted educational and organizational strategies.
Implications for clinical practice
Integrating sustainability into professional identity enhances patient care and environmental responsibility. These findings deepen understanding of which dimensions of environmental sustainability can be meaningfully enacted through professional culture and organizational alignment, rather than through the direct imposition of fixed behavioural routines.
重症监护室（icu）是医院中资源最密集的环境之一，对医疗保健的环境足迹做出了重大贡献。虽然可持续实践越来越被认为是必不可少的，但人们对重症监护护士如何在其专业文化和日常工作中构建和理解可持续发展知之甚少。目的：探讨重症护理护士如何在其专业话语中构建和表达环境可持续性的含义。方法：对不同医院的29名重症护理护士进行半结构化访谈。使用IRaMuTeQ （Automatic Analysis of Textual Data）对叙述进行分析，并结合相似度分析来映射术语关系和揭示语义聚类。统计关联（χ2≥3.84;p）结果：中心词汇枢纽、可持续性、反映反思参与、协作责任、组织结构和系统差距的连接集群。次要中心包括环境（生态影响和成本考虑）、实践（行为整合）、患者（嵌入床边护理）和废物（材料处理、能源使用、生命周期意识）。护士将可持续发展定义为专业责任和系统挑战，由组织支持、个人承诺和环境约束作为中介。结论：ICU护士的话语揭示了可持续性作为一个多维结构，连接伦理、操作实践和系统限制。词典计量学映射提供了一个结构化的视角，说明可持续发展如何嵌入到专业叙事中，为有针对性的教育和组织战略提供了见解。对临床实践的启示：将可持续性纳入职业身份，提高患者护理和环境责任。这些发现加深了对环境可持续性的哪些方面可以通过专业文化和组织协调而不是通过直接强加固定的行为惯例来有意义地制定的理解。
{"title":"Mapping the discourse of environmental sustainability in intensive care nursing: a lexicometric exploration of professional meaning-making","authors":"Mariachiara Figura , Francesca Trotta , Luciano Midolo , Francesco Petrosino , Gianluca Pucciarelli , Davide Bartoli","doi":"10.1016/j.iccn.2025.104317","DOIUrl":"10.1016/j.iccn.2025.104317","url":null,"abstract":"<div><h3>Introduction</h3><div>Intensive Care Units (ICUs) are among the most resource-intensive hospital environments, contributing substantially to healthcare’s environmental footprint. While sustainable practices are increasingly recognized as essential, little is known about how critical care nurses linguistically frame and make sense of sustainability within their professional culture and daily work.</div></div><div><h3>Aim</h3><div>To explore how critical care nurses construct and articulate meanings of environmental sustainability in their professional discourse.</div></div><div><h3>Methods</h3><div>Semi-structured interviews were conducted with 29 critical care nurses across diverse hospital settings. Narratives were analyzed using Automatic Analysis of Textual Data (IRaMuTeQ) with similarity analysis to map term relationships and uncover semantic clusters. Statistical associations (χ<sup>2</sup> ≥ 3.84; p < 0.05) guided identification of lexical hubs and thematic subnetworks. Computational findings were integrated with qualitative interpretation to ensure contextual depth and rigor.</div></div><div><h3>Results</h3><div>The central lexical hub, <em>sustainability</em>, connected clusters reflecting reflective engagement, collaborative responsibility, organizational structures, and systemic gaps. Secondary hubs included <em>environment</em> (ecological impact and cost considerations), <em>practice</em> (behavioral integration), <em>patient</em> (embedded in bedside care), and <em>waste</em> (material handling, energy use, lifecycle awareness). Nurses framed sustainability as both a professional duty and systemic challenge, mediated by organizational support, personal commitment, and environmental constraints.</div></div><div><h3>Conclusions</h3><div>ICU nurses’ discourse reveals sustainability as a multidimensional construct bridging ethics, operational practice, and systemic limitations. Lexicometric mapping provides a structured view of how sustainability is embedded in professional narratives, offering insights to inform targeted educational and organizational strategies.</div></div><div><h3>Implications for clinical practice</h3><div>Integrating sustainability into professional identity enhances patient care and environmental responsibility. These findings deepen understanding of which dimensions of environmental sustainability can be meaningfully enacted through professional culture and organizational alignment, rather than through the direct imposition of fixed behavioural routines.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"94 ","pages":"Article 104317"},"PeriodicalIF":4.7,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145829379","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 : 2025-12-22DOI: 10.1016/j.iccn.2025.104308
Ashwin Subramaniam , Melissa J. Bloomer , Daryl Jones
{"title":"Time-limited ICU trials: A method for value-based rapid response team decision-making","authors":"Ashwin Subramaniam , Melissa J. Bloomer , Daryl Jones","doi":"10.1016/j.iccn.2025.104308","DOIUrl":"10.1016/j.iccn.2025.104308","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104308"},"PeriodicalIF":4.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822489","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 : 2025-12-20DOI: 10.1016/j.iccn.2025.104321
Pei-Fen Poh , Ying Gu , Jos M. Latour
{"title":"From family-centred care to humanisation of ICUs: A paediatric lens on future directions","authors":"Pei-Fen Poh , Ying Gu , Jos M. Latour","doi":"10.1016/j.iccn.2025.104321","DOIUrl":"10.1016/j.iccn.2025.104321","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104321"},"PeriodicalIF":4.7,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797022","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 : 2025-12-20DOI: 10.1016/j.iccn.2025.104316
Kai-Mei Chang , Kath Peters , Lucie Ramjan , Kevin Shu-Leung Lai , An-Yi Wang , Chen-I Lee , Tzu-Hao Wang , Hsiao-Yean Chiu
Objectives
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.
Methods
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.
Results
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: family engagement in care and family perceived support from the healthcare team. No significant correlation was observed between the FAME-TC score and subscales of the DASS21 (p > 0.05), while a statistically significant positive correlation was found between the FAME-TC score and the EQ-5D-5L visual analogue scale level (r = 0.26, p < 0.001).
Conclusions
The FAME-TC exhibits satisfactory reliability and validity for assessing family engagement in critical care.
Implications for clinical practice
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.
{"title":"Psychometric properties and structural validity of the traditional Chinese version of the FAMily engagement instrument in intensive care units","authors":"Kai-Mei Chang , Kath Peters , Lucie Ramjan , Kevin Shu-Leung Lai , An-Yi Wang , Chen-I Lee , Tzu-Hao Wang , 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> > 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> < 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":"2025-12-20","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}
Pub Date : 2025-12-19DOI: 10.1016/j.iccn.2025.104318
Surui Liang , Xiaojiao Wang , Jing Jing Su , Eliza Mi Ling Wong , Lorna Kwai Ping Suen
Objectives
This systematic review aimed to evaluate the effectiveness of virtual reality (VR) interventions for delirium prevention in adult intensive care units (ICU) patients.
Methods
This review followed the PRISMA guidelines. A comprehensive search was conducted across 11 English and Chinese electronic databases, including PubMed, Web of Science, EMBASE, PsycINFO, AMED, CINAHL Complete, Cochrane Library, CNKI, Wanfang, Weipu, and CBM from 2012 December to September 2025. Eligible studies included randomised controlled trials (RCTs) that assessed VR-based interventions for ICU delirium prevention, compared with standard care or control conditions. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool.
Results
Eight RCTs published between 2021 and 2025 met the inclusion criteria, involving 764 participants (mean age: 63 years; sample sizes ranging from 50 to 150). VR interventions primarily delivered visual and auditory stimuli, including natural scenes (n = 4 studies), interactive games (n = 3 studies), and family-related media (n = 2 studies), typically administered once or twice daily for 15–20 min. Findings indicate that VR may serve as a promising non-pharmacological intervention, with pooled results showing a significant reduction in delirium incidence (n = 5 articles, OR = 0.56, 95 % CI = 0.33 to 0.93, I2 = 16 %; low certainty). VR interventions also demonstrated potential benefits for psychological outcomes, including significant reductions in anxiety (n = 5 studies, SMD = −2.08, 95 % CI = −3.31 to −0.86, low certainty) and depression (n = 4 studies, SMD = −1.16, 95 % CI = −2.12 to −0.21, I2 = 93 %; low certainty), and improvements in sleep quality (n = 3 studies, MD = 2.71, 95 % CI = 0.23 to 5.19, low certainty), and mechanical ventilation duration (n = 3 studies, MD = −3.86, 95 % CI = −6.68 to −1.05, low certainty). Evidence for other outcomes, including ICU length of stay, pain, and cognitive function, was limited or inconclusive.
Conclusions
With low certainty, VR interventions effectively reduce ICU delirium incidence and may improve psychological outcomes (anxiety and depression) and sleep. Further high-quality trials are needed to confirm these benefits and guide clinical use.
Implications for Clinical Practice
VR holds promise as an innovative adjunctive approach for delirium prevention in ICU care and may enhance patient comfort and recovery, pending confirmation from future large-scale trials.
目的本系统综述旨在评价虚拟现实（VR）干预在成人重症监护病房（ICU）患者谵妄预防中的有效性。方法本综述遵循PRISMA指南。从2012年12月至2025年9月，对PubMed、Web of Science、EMBASE、PsycINFO、AMED、CINAHL Complete、Cochrane Library、CNKI、万方、微普、CBM等11个中英文电子数据库进行了全面检索。符合条件的研究包括随机对照试验（RCTs），评估了与标准护理或对照条件相比，基于vr的干预措施对ICU谵妄预防的影响。使用Cochrane Risk of bias 2.0 （RoB 2.0）工具评估偏倚风险。结果2021 - 2025年间发表的8项rct符合纳入标准，共纳入764名受试者（平均年龄63岁，样本量50 - 150人）。VR干预主要提供视觉和听觉刺激，包括自然场景（n = 4项研究）、互动游戏（n = 3项研究）和与家庭有关的媒体（n = 2项研究），通常每天一次或两次，持续15-20分钟。研究结果表明，VR可能作为一种有希望的非药物干预措施，汇总结果显示谵妄发生率显著降低（n = 5篇文章，OR = 0.56, 95% CI = 0.33至0.93,I2 = 16%；低确定性）。VR干预心理结果还演示了潜在的好处,包括显著减少焦虑(n = 5研究,SMD =−2.08,95% CI =−3.31−0.86,低确定性)和抑郁(n = 4研究,SMD =−1.16,95% CI 2.12 =−−0.21,I2 = 93%;低确定性),和改善睡眠质量(n = 3研究,MD = 2.71, 95% CI = 0.23至5.19,低确定性),和机械通气时间(n = 3研究,MD =−3.86,95% CI 6.68 =−−1.05,低确定性)。其他结果的证据，包括ICU住院时间、疼痛和认知功能，是有限的或不确定的。结论在确定性较低的情况下，VR干预可有效降低ICU谵妄发生率，并可改善心理结局（焦虑、抑郁）和睡眠。需要进一步的高质量试验来证实这些益处并指导临床应用。evr有望作为一种创新的辅助方法，在ICU护理中预防谵妄，并可能提高患者的舒适度和康复，有待于未来大规模试验的证实。
{"title":"Effectiveness of virtual reality interventions for delirium prevention in intensive care units: A systematic review and meta-analysis","authors":"Surui Liang , Xiaojiao Wang , Jing Jing Su , Eliza Mi Ling Wong , Lorna Kwai Ping Suen","doi":"10.1016/j.iccn.2025.104318","DOIUrl":"10.1016/j.iccn.2025.104318","url":null,"abstract":"<div><h3>Objectives</h3><div>This systematic review aimed to evaluate the effectiveness of virtual reality (VR) interventions for delirium prevention in adult intensive care units (ICU) patients.</div></div><div><h3>Methods</h3><div>This review followed the PRISMA guidelines. A comprehensive search was conducted across 11 English and Chinese electronic databases, including PubMed, Web of Science, EMBASE, PsycINFO, AMED, CINAHL Complete, Cochrane Library, CNKI, Wanfang, Weipu, and CBM from 2012 December to September 2025. Eligible studies included randomised controlled trials (RCTs) that assessed VR-based interventions for ICU delirium prevention, compared with standard care or control conditions. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool.</div></div><div><h3>Results</h3><div>Eight RCTs published between 2021 and 2025 met the inclusion criteria, involving 764 participants (mean age: 63 years; sample sizes ranging from 50 to 150). VR interventions primarily delivered visual and auditory stimuli, including natural scenes (n = 4 studies), interactive games (n = 3 studies), and family-related media (n = 2 studies), typically administered once or twice daily for 15–20 min. Findings indicate that VR may serve as a promising non-pharmacological intervention, with pooled results showing a significant reduction in delirium incidence (n = 5 articles, OR = 0.56, 95 % CI = 0.33 to 0.93, I<sup>2</sup> = 16 %; low certainty). VR interventions also demonstrated potential benefits for psychological outcomes, including significant reductions in anxiety (n = 5 studies, SMD = −2.08, 95 % CI = −3.31 to −0.86, low certainty) and depression (n = 4 studies, SMD = −1.16, 95 % CI = −2.12 to −0.21, I<sup>2</sup> = 93 %; low certainty), and improvements in sleep quality (n = 3 studies, MD = 2.71, 95 % CI = 0.23 to 5.19, low certainty), and mechanical ventilation duration (n = 3 studies, MD = −3.86, 95 % CI = −6.68 to −1.05, low certainty). Evidence for other outcomes, including ICU length of stay, pain, and cognitive function, was limited or inconclusive.</div></div><div><h3>Conclusions</h3><div>With low certainty, VR interventions effectively reduce ICU delirium incidence and may improve psychological outcomes (anxiety and depression) and sleep. Further high-quality trials are needed to confirm these benefits and guide clinical use.</div></div><div><h3>Implications for Clinical Practice</h3><div>VR holds promise as an innovative adjunctive approach for delirium prevention in ICU care and may enhance patient comfort and recovery, pending confirmation from future large-scale trials.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104318"},"PeriodicalIF":4.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797025","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 : 2025-12-19DOI: 10.1016/j.iccn.2025.104314
Ezekwesiri Nwanosike , Peter Griffiths , Chiara Dall’Ora , Thomas Monks , Natalie Pattison , Tolusha Dahanayake Yapa , Christina Saville , on behalf of the SEISMIC-R study group
Aims
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.
Methods
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.
Results
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.
Conclusions
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.
Implications for Clinical Practice
The findings emphasise the importance of evidence-based staffing policies that optimise skill mix and leadership deployment to improve ICU patient outcomes.
{"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 , Peter Griffiths , Chiara Dall’Ora , Thomas Monks , Natalie Pattison , Tolusha Dahanayake Yapa , Christina Saville , 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":"2025-12-19","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}
Pub Date : 2025-12-19DOI: 10.1016/j.iccn.2025.104307
Mathieu Jozwiak , Michelle S Chew , Ashish K Khanna
{"title":"Vasopressor therapy in septic shock","authors":"Mathieu Jozwiak , Michelle S Chew , Ashish K Khanna","doi":"10.1016/j.iccn.2025.104307","DOIUrl":"10.1016/j.iccn.2025.104307","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104307"},"PeriodicalIF":4.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797023","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 : 2025-12-19DOI: 10.1016/j.iccn.2025.104310
Xia Luo , Jie Peng
{"title":"Reimagining the ICU E-Diary: Integration, Intelligence, and Impact – Letter on Rose et al.","authors":"Xia Luo , 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":"2025-12-19","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号