Intensive and Critical Care Nursing最新文献

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Survival of veno-arterial ECMO patients: Successes, challenges, and future directions 静脉-动脉 ECMO 患者的存活率：成功、挑战和未来方向

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-20 DOI: 10.1016/j.iccn.2024.103775

引用次数: 0

Important cogs in the wheel: Values-based healthcare and what it means for care planning and decision-making in ICU 车轮上的重要齿轮：基于价值观的医疗保健及其对重症监护病房护理规划和决策的意义

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-19 DOI: 10.1016/j.iccn.2024.103774

引用次数: 0

Pain management of adult sedated and ventilated patients in the intensive care units: A survey with free text responses 重症监护室成人镇静和通气患者的疼痛管理：自由文本回复调查

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-19 DOI: 10.1016/j.iccn.2024.103770

Background

Pain management of sedated and ventilated patients in intensive care units lacks consistency.

Objectives

To investigate nurses’ training, governance, practices, knowledge and attitudes relating to pain management in consideration of published guidelines and explore nurses’ perspectives.

Methods

A survey design, using an online questionnaire with free text responses, was employed. Quantitative and qualitative data from nurses working across different hospitals were collated and saved on Qualtrics platform. Quantitative data were analysed non-parametrically and narrative responses thematically. CROSS and SRQR reporting guidelines were adhered to.

Outcome measures

Demographics, training, governance, clinical practice, knowledge, and attitudes.

Results/findings

108 nurses participated with ninety-two completed surveys analysed. Analgesia was used to complete nursing tasks regardless of comfort needs (n = 49, 53.3 %). Changes in vital signs prompted opioid administration (n = 48, 52.1 %). Choice of analgesia depended on doctor’s preference (n = 63, 68.5 %). Non-opioid therapy was administered before opioids (n = 42, 45.7 %). Sedatives were used to alleviate agitation(n = 50,54.3 %). No statistically significant difference in nurses’ knowledge existed between hospitals. Weak positive relationship: r = [0.081], p = [0.441] between “knowledge scores” and “years of ICU experience” and weak negative relationship r = [-0.119], p = [0.260] between “knowledge scores” and “hours of clinical practice” was detected. Lack of training, resources, policies, high patient acuity and casual employment were acknowledged barriers to pain management. Two overarching themes emerged from narrative responses: “Pain assessment, where is it?” And “Priorities of critical illness.”

Conclusion

The study uncovered pain management situation and examined nurses’ demographics, training, governance, practices, knowledge and attitudes. Narrative responses highlighted barriers to pain management.

Implications for clinical practice

Health organisations should provide education, institute governance and develop policies to inform pain management. Nurses’ role encompasses updating knowledge, adhering to interventions and overcoming biases. This subsequently manifests as improvement in patient outcomes.

背景重症监护病房对镇静和通气患者的疼痛管理缺乏一致性。目标根据已发布的指南，调查护士在疼痛管理方面的培训、管理、实践、知识和态度，并探讨护士的观点。方法采用自由文本回答的在线问卷调查设计。对来自不同医院的护士的定量和定性数据进行了整理，并保存在 Qualtrics 平台上。对定量数据进行非参数分析，对叙述性回答进行主题分析。结果测量人口统计学、培训、管理、临床实践、知识和态度。结果/发现108名护士参与了调查，对92份完成的调查问卷进行了分析。在完成护理任务时，无论是否需要舒适，都会使用镇痛剂（n = 49，53.3%）。生命体征的变化促使使用阿片类药物（48 人，占 52.1%）。镇痛的选择取决于医生的偏好（n = 63，68.5%）。在使用阿片类药物之前先使用非阿片类药物（42 人，占 45.7%）。镇静剂用于缓解躁动（50 人，占 54.3%）。不同医院之间护士的知识水平差异无统计学意义。知识得分 "与 "ICU 工作年限 "之间存在微弱的正相关关系：r = [0.081]，p = [0.441]；"知识得分 "与 "临床实践时间 "之间存在微弱的负相关关系：r = [-0.119]，p = [0.260]。缺乏培训、资源、政策、病人急诊率高和临时工是公认的疼痛管理障碍。在叙述性回答中出现了两个最重要的主题："疼痛评估在哪里？和 "危重病人的优先权"。结论这项研究揭示了疼痛管理的现状，并考察了护士的人口统计、培训、管理、实践、知识和态度。对临床实践的启示医疗机构应提供教育、实施管理和制定政策，为疼痛管理提供信息。护士的职责包括更新知识、坚持干预和克服偏见。这随后将表现为患者治疗效果的改善。

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引用次数: 0

Early sepsis recognition: Is hypothermia the most neglected symptom? 早期识别败血症：低体温是最容易被忽视的症状吗？

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-19 DOI: 10.1016/j.iccn.2024.103776

引用次数: 0

Optimizing processes of care and time to diagnosis in acute aortic dissection patients in a chest pain center by implementing a multidisciplinary cooperative first aid mode – A quality improvement report 通过实施多学科合作急救模式，优化胸痛中心急性主动脉夹层患者的护理流程和诊断时间 - 质量改进报告

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-18 DOI: 10.1016/j.iccn.2024.103765

Objective

This study aimed to explore the effectiveness of a multidisciplinary cooperative first aid model in the process of establishing a chest pain center specializing in acute aortic dissection (AD).

Design

A quality improvement report.

Methods

A total of 142 patients with acute aortic dissection treated before and after the optimization of the chest pain center process in our hospital were included. According to their admission time: the group before the optimization process was designated as the control group (66 cases) and the group after the optimization process was the intervention group (76 cases). The control group received conventional emergency treatment, while the intervention group received treatment through a multidisciplinary cooperative first aid model. The treatment times for both groups were compared: the time from first medical contact(FMC) to completion of an electrocardiogram (ECG), the diagnosis time, and the time spent in the emergency department.

Results

The research findings revealed that the intervention group had significantly shorter times for FMC-to-ECG, diagnosis time, and emergency stay compared to the control group (P < 0.001).

Conclusion

Our findings indicate that by optimizing the multidisciplinary cooperative first aid model and procedures, the treatment of patients has indeed been effectively ensured, achieving safety outcomes.

Implications for clinical practice

For chest pain centers, we suggest that to use multidisciplinary cooperative first aid model to get repaid and definite diagnosis of various causes of chest pain. A bedside transthoracic echocardiography is recommended to use in order to identify AD before proceeding with further treatment.

本研究旨在探讨多学科合作急救模式在建立急性主动脉夹层（AD）胸痛中心过程中的有效性。方法纳入我院胸痛中心流程优化前后共收治的 142 例急性主动脉夹层患者。根据入院时间：优化流程前的一组为对照组（66 例），优化流程后的一组为干预组（76 例）。对照组接受常规急救治疗，而干预组则接受多学科合作急救模式治疗。比较了两组的治疗时间：从首次医疗接触（FMC）到完成心电图（ECG）的时间、诊断时间和在急诊室停留的时间。研究结果表明，与对照组相比，干预组从首次医疗接触（FMC）到完成心电图（ECG）的时间、诊断时间和在急诊室停留的时间显著缩短（P <0.001）。结论我们的研究结果表明，通过优化多学科合作急救模式和程序，确实有效地保证了患者的治疗，达到了安全的效果。对临床实践的启示对于胸痛中心，我们建议使用多学科合作急救模式，对各种原因引起的胸痛进行及时、明确的诊断。建议使用床边经胸超声心动图，以便在进行进一步治疗前确定 AD。

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引用次数: 0

Subgroups of ICU patients identified by self-reported symptoms – A prospective multicenter study 通过自述症状识别出的重症监护病房患者亚群--一项前瞻性多中心研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-16 DOI: 10.1016/j.iccn.2024.103761

Background

Intensive care unit (ICU) patients experience several symptoms, yet patterns of symptoms and their relationship with demographic and clinical characteristics have not previously been investigated.

Objectives

To identify and compare subgroups (i.e. latent symptom classes) of intensive ICU patients based on prevalence of co-occurring symptoms over seven days.

Research methodology

Prospective cohort study of adult ICU patients’ self-reports of five symptoms during seven days in ICU. Latent class analysis was applied to identify subgroups of ICU patients.

Setting

Multicenter study with patients from six mixed ICUs in Norway.

Main Outcome Measures

Patient Symptom Survey was used to assess five symptoms (i.e., thirst, pain, anxiousness, tiredness, shortness of breath).

Results

Among 353 included patients, median age was 63 years and 60.3 % were male. Subgroups of patients were identified in a Low class (n = 126, 35.7 %), Middle Class (n = 177, 50.1 %) and High Class (n = 50, 14.2 %) based on reporting of the prevalence of five symptoms. Patients in the Low class had a low prevalence of all symptoms. Middle Class patients had a high prevalence of thirst and tiredness and a low prevalence of pain, anxiousness and shortness of breath. The High class patients had a high prevalence of all symptoms. Symptom prevalence remained stable in the Low and Middle class over time and increased over time in the High class. There were significant differences among symptom classes in use of mechanical ventilation (p = 0.012), analgesics (p < 0.001), alpha-2 agonists (p = 0.004) and fluid restriction (p = 0.006). Patients in the High class received more of these ICU-treatments.

Conclusions

Findings suggest that subgroups of ICU patients with distinct symptom experiences can be identified. The High prevalence class patients had consistently high levels of all symptoms across seven ICU days and received more ICU-related interventions.

Implication for clinical practice

Some ICU patients experience a consistently high prevalence of co-occurring symptoms. Clinicians should be aware of treatment factors that could be linked to a high burden of symptoms.

背景重症监护病房（ICU）患者会出现多种症状，但症状的模式及其与人口统计学和临床特征之间的关系此前尚未得到研究。主要结果测量患者症状调查用于评估五种症状（即口渴、疼痛、焦虑、疲倦、呼吸急促）。结果在353名纳入研究的患者中，中位年龄为63岁，60.3%为男性。根据五种症状的发生率，将患者分为低等组（126 人，占 35.7%）、中等组（177 人，占 50.1%）和高等组（50 人，占 14.2%）。低等病人所有症状的发病率都较低。中等舱患者口渴和疲倦的发病率较高，而疼痛、焦虑和气短的发病率较低。高阶层患者所有症状的发病率都很高。随着时间的推移，低等和中等病人的症状发生率保持稳定，而高等病人的症状发生率则有所上升。在使用机械通气（p = 0.012）、镇痛剂（p < 0.001）、α-2 促效剂（p = 0.004）和液体限制（p = 0.006）方面，不同症状等级的患者之间存在明显差异。结论研究结果表明，可以识别出具有不同症状体验的 ICU 患者亚群。对临床实践的启示一些重症监护室患者的并发症状持续高发。临床医生应注意可能与高症状负担有关的治疗因素。

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引用次数: 0

Physical therapy in the ICU practice makes perfect – Where to go from competency to capability? 重症监护室中的物理治疗实践出真知--从能力到能力，何去何从？

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-16 DOI: 10.1016/j.iccn.2024.103772

引用次数: 0

Refeeding syndrome in the ICU: A serious problem still lacking an evidence-based approach 重症监护室中的再喂养综合征：仍缺乏循证方法的严重问题

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-16 DOI: 10.1016/j.iccn.2024.103771

引用次数: 0

Addressing respect for diversity in reporting race and ethnicity of participants in research studies 在报告调查研究参与者的种族和民族时尊重多样性。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-08 DOI: 10.1016/j.iccn.2024.103758

Melissa J. Bloomer, Elizabeth Manias

引用次数: 0

Innovations for interhospital transfer communication with family members during critical illness events in rural settings – Response to Bhandari et al. 农村地区危重病人院内转运过程中与家属沟通的创新 - 对 Bhandari 等人的回应

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-07-02 DOI: 10.1016/j.iccn.2024.103762

Margie Burns, William Montelpare

引用次数: 0

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