Intensive and Critical Care Nursing最新文献

英文中文

Effectiveness of virtual reality interventions for delirium prevention in intensive care units: A systematic review and meta-analysis 虚拟现实干预在重症监护室预防谵妄的有效性：系统回顾和荟萃分析

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 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}

引用次数: 0

ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates 英国医院信托的ICU人员配备和患者预后：一项关于ICU住院时间、再入院和感染率的纵向观察研究

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 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.

目的：本研究探讨了英国重症监护病房（ICU）注册护士（RN）人员配置与可能对护士敏感的患者结局之间的关系，并评估随着COVID-19大流行的展开而发生的变化。方法本研究是一项纵向回顾性研究，分析了2019年1月- 2022年12月NHS医院信托12家icu常规收集的患者和电子名册数据。感兴趣的变量是注册护士的人员配备水平和人员组合因素。考虑的结果是单位获得性感染、住院时间和再入院。使用协变量调整广义线性混合模型对整个时期以及大流行前、大流行和大流行后时期的关系进行了分析。来自12个icu的数据包括52,267例入院患者，与大流行前的水平（27.0 HPPD, SD = 8.5）相比，护士人员水平（平均）在大流行后期达到峰值（每患者每天34.2小时[HPPD]，标准差(SD) = 12.1）。总体而言，较高的RN HPPD与较低的再入院风险相关，在大流行早期具有最强的保护作用。虽然在大流行后期减少了5% (p = 0.035)，但注册护士人员配备与总体住院时间之间没有统计学上显著的关联。低水平护士管理人员（7 +级）的存在与再入院风险显著降低相关（降低1.3%,p = 0.011），这源于大流行期间的关联，但在所有期间的住院时间都增加了。结论较高的护士配备水平与减少ICU再入院率一致相关，表明充足的护理资源具有保护作用。然而，高级护理人员对其他患者预后的影响是复杂的，并且取决于具体情况，在不同的大流行时期有所不同。研究结果强调了以证据为基础的人员配置政策的重要性，这些政策可以优化技能组合和领导部署，以改善ICU患者的预后。

{"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}

引用次数: 0

Vasopressor therapy in septic shock 感染性休克的血管加压治疗

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104307

Mathieu Jozwiak , Michelle S Chew , Ashish K Khanna

引用次数: 0

Reimagining the ICU E-Diary: Integration, Intelligence, and Impact – Letter on Rose et al. 重新构想ICU电子日记：整合、智慧与影响——致罗斯等人。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104310

Xia Luo , Jie Peng

引用次数: 0

Interventions to enhance family centred care in the neonatal intensive care unit: A scoping review 干预措施，以加强以家庭为中心的护理在新生儿重症监护室：范围审查

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104313

Emma Yeomans , Ashleigh E. Butler , Rod W. Hunt , Beverley Copnell

Objectives

To map the current literature on interventions designed to enhance Family Centred Care (FCC) in Neonatal Intensive Care Units (NICUs) and identify gaps in the existing literature.

Methods

Following Arksey and O’Malley’s scoping review framework, a comprehensive search was conducted on November 10th, 2023, and updated on the 20th May 2025. Four databases were searched: Medline via OVID, CINAHL via EBSCO-Host, OVID Embase and PROQUEST. Studies were included if they described interventions targeting FCC in NICUs. Two reviewers independently conducted the screening at both phases with conflicts resolved by a third reviewer.

Results

The review identified 31 studies outlining 26 interventions, categorised into four categories: Family centred care bundles; Educational interventions; Communication interventions; and Environmental interventions. Study participants included mothers, fathers, families, and healthcare workers, often restricted to specific languages and cultures. Most outcome measures predominantly reflected the perspectives of mothers and nurses. Many interventions were associated with improvement in family engagement and satisfaction. However, evidence was limited on long-term neonatal and parental outcomes and sustainability of the FCC practices. While some interventions, such as Family Integrated Care (FiCare) and The Close Collaboration Program, have been extensively studied, others have been examined only to a limited extent.

Conclusions

This review investigated interventions to enhance FCC in the NICU. The findings highlighted a range of interventions designed to improve family experiences and neonatal outcomes. This review underscores the need for standardised implementation studies on FCC interventions in NICUs. While numerous interventions successfully increased parental involvement and positively influenced staff perspectives, their effectiveness often hinges on the implementation strategies employed, as well as the support from institutions and healthcare providers.

Implications for clinical practice

Understanding FCC interventions implemented worldwide will broaden the application of FCC within the NICU. Further investigation into these interventions across various NICUs is necessary, involving diverse family members and healthcare professionals in assessing outcomes.

目的对旨在加强新生儿重症监护病房（NICUs）家庭中心护理（FCC）干预措施的现有文献进行梳理，并找出现有文献中的空白。方法遵循Arksey和O 'Malley的范围审查框架，于2023年11月10日进行全面检索，并于2025年5月20日更新。检索四个数据库：Medline通过OVID， CINAHL通过EBSCO-Host， OVID Embase和PROQUEST。如果研究描述了针对新生儿重症监护病房FCC的干预措施，则纳入研究。两个审稿人独立地在两个阶段进行筛选，冲突由第三个审稿人解决。结果本综述确定了31项研究，概述了26项干预措施，分为四类：以家庭为中心的一揽子护理；教育干预;传播干预;环境干预。研究参与者包括母亲、父亲、家庭成员和医护人员，通常仅限于特定的语言和文化。大多数结果测量主要反映了母亲和护士的观点。许多干预措施与家庭参与和满意度的改善有关。然而，证据是有限的长期新生儿和父母的结果和FCC实践的可持续性。虽然一些干预措施，如家庭综合护理（FiCare）和密切合作计划，已经得到了广泛的研究，但其他干预措施只在有限的程度上得到了检验。结论本综述探讨了加强新生儿重症监护病房FCC的干预措施。研究结果强调了一系列旨在改善家庭经验和新生儿结局的干预措施。本综述强调了对新生儿重症监护病房FCC干预措施进行标准化实施研究的必要性。虽然许多干预措施成功地增加了家长的参与，并对工作人员的观点产生了积极影响，但其有效性往往取决于所采用的实施战略以及机构和保健提供者的支持。对临床实践的影响了解世界范围内实施的FCC干预措施将扩大FCC在NICU中的应用。有必要在不同的新生儿重症监护室进一步调查这些干预措施，让不同的家庭成员和医疗保健专业人员参与评估结果。

{"title":"Interventions to enhance family centred care in the neonatal intensive care unit: A scoping review","authors":"Emma Yeomans , Ashleigh E. Butler , Rod W. Hunt , Beverley Copnell","doi":"10.1016/j.iccn.2025.104313","DOIUrl":"10.1016/j.iccn.2025.104313","url":null,"abstract":"<div><h3>Objectives</h3><div>To map the current literature on interventions designed to enhance Family Centred Care (FCC) in Neonatal Intensive Care Units (NICUs) and identify gaps in the existing literature.</div></div><div><h3>Methods</h3><div>Following Arksey and O’Malley’s scoping review framework, a comprehensive search was conducted on November 10th, 2023, and updated on the 20th May 2025. Four databases were searched: Medline via OVID, CINAHL via EBSCO-Host, OVID Embase and PROQUEST. Studies were included if they described interventions targeting FCC in NICUs. Two reviewers independently conducted the screening at both phases with conflicts resolved by a third reviewer.</div></div><div><h3>Results</h3><div>The review identified 31 studies outlining 26 interventions, categorised into four categories: Family centred care bundles; Educational interventions; Communication interventions; and Environmental interventions. Study participants included mothers, fathers, families, and healthcare workers, often restricted to specific languages and cultures. Most outcome measures predominantly reflected the perspectives of mothers and nurses. Many interventions were associated with improvement in family engagement and satisfaction. However, evidence was limited on long-term neonatal and parental outcomes and sustainability of the FCC practices. While some interventions, such as Family Integrated Care (FiCare) and The Close Collaboration Program, have been extensively studied, others have been examined only to a limited extent.</div></div><div><h3>Conclusions</h3><div>This review investigated interventions to enhance FCC in the NICU. The findings highlighted a range of interventions designed to improve family experiences and neonatal outcomes. This review underscores the need for standardised implementation studies on FCC interventions in NICUs. While numerous interventions successfully increased parental involvement and positively influenced staff perspectives, their effectiveness often hinges on the implementation strategies employed, as well as the support from institutions and healthcare providers.</div></div><div><h3>Implications for clinical practice</h3><div>Understanding FCC interventions implemented worldwide will broaden the application of FCC within the NICU. Further investigation into these interventions across various NICUs is necessary, involving diverse family members and healthcare professionals in assessing outcomes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104313"},"PeriodicalIF":4.7,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797024","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}

引用次数: 0

The development of ICU diaries – From scratch to AI ICU日记的发展——从无到有到人工智能

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104312

Ella Peschel, Eunkyeong Oh, Peter Nydahl

引用次数: 0

From coping to conservation: Understanding acoustic burden in ICU nursing – Response to Li & Yu 从应对到保护：了解ICU护理中的声负担——对李宇夫妇的回应

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104309

Pyoung Jik Lee , Ziwei Song

引用次数: 0

The importance of eye protection during prone positioning – Letter on Han et al. 俯卧位时眼睛保护的重要性——Letter on Han等。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-19 DOI: 10.1016/j.iccn.2025.104311

Federica Marelli , Alessia Galli , Giada Ruggi , Filippo Binda

引用次数: 0

Effect of diary intervention on sleep quality and risk of stress disorders among critically ill children in pediatric intensive care units and on their parents’ anxiety level: A randomized controlled trial 日记干预对重症儿科重症患儿睡眠质量、应激障碍风险及其父母焦虑水平的影响：一项随机对照试验

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-18 DOI: 10.1016/j.iccn.2025.104315

Yingshuang He , Yuhong Zhang , Huining Xin , Jinling Lin , Shuting Lin , Sijia Li , Xiao Cheng , Guihua Liu , Jinhua Liao

Objectives

To investigate benefits of diary intervention in a pediatric intensive care unit (PICU) on sleep quality and stress-related disorders in critically ill children and anxiety and depression in their parents.

Methods

This single-blind, two-arm, randomized controlled trial enrolled 94 dyads. The control group (n = 47) received standard care; the experimental group (n = 47) additionally received a diary intervention. We compared the sleep quality and stress disorders of children, and anxiety, depression, and stress disorders among parents at various time-points, between groups.

Results

Data of 83 dyads were ultimately analyzed (loss-to-visit rate: 11.7 %). During the PICU stay, the experimental group showed significantly shorter total awakening time of each sleep episode and mean duration of each awakening per sleep session than the control group (P = 0.006; P = 0.032). The Childhood Stress Disorder Checklist scores of children in the experimental group were significantly lower than those in the control group at 1 and 3 months post-discharge (P = 0.003; P = 0.006). Parents in the experimental group reported significantly lower anxiety scores at PICU discharge and 1 month thereafter (P < 0.001; P = 0.015). At discharge, depression scores were significantly lower in the experimental group; this difference remained significant at 1 and 3 months post-discharge (P < 0.001; P < 0.05). At PICU discharge, parental scores were significantly lower in the experimental group than in the control group (P < 0.001).

Conclusions

The PICU diary intervention effectively improved the children’s sleep quality and was associated with stress reduction in parents during their children’s PICU stay and up to 3 months post-discharge. The intervention was also associated with a reduction in negative parental emotions up to 3 months after PICU discharge.

Implications for Clinical Practice

These findings offer valuable insights into supporting the psychological well-being of pediatric patients and their caregivers during and after PICU admission.

目的：探讨儿科重症监护病房（PICU）日记干预对危重儿童睡眠质量和压力相关障碍以及家长焦虑和抑郁的益处。方法：这项单盲、双组、随机对照试验纳入94对。对照组（n = 47）接受标准治疗；实验组（n = 47）在此基础上进行日记干预。我们比较了儿童的睡眠质量和压力障碍，以及父母在不同时间点、不同组之间的焦虑、抑郁和压力障碍。结果：最终分析了83例患者的数据，失访率为11.7%。在PICU停留期间，实验组每次睡眠总觉醒时间和每次睡眠平均觉醒时间明显短于对照组（P = 0.006; P = 0.032）。实验组患儿出院后1、3个月儿童应激障碍量表得分显著低于对照组（P = 0.003; P = 0.006）。结论：PICU日记干预有效改善了儿童的睡眠质量，并与儿童PICU住院期间及出院后3个月家长的压力减轻有关。干预还与PICU出院后3个月父母负面情绪的减少有关。对临床实践的启示：这些发现为支持儿科患者及其护理人员在PICU入院期间和之后的心理健康提供了有价值的见解。

{"title":"Effect of diary intervention on sleep quality and risk of stress disorders among critically ill children in pediatric intensive care units and on their parents’ anxiety level: A randomized controlled trial","authors":"Yingshuang He , Yuhong Zhang , Huining Xin , Jinling Lin , Shuting Lin , Sijia Li , Xiao Cheng , Guihua Liu , Jinhua Liao","doi":"10.1016/j.iccn.2025.104315","DOIUrl":"10.1016/j.iccn.2025.104315","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate benefits of diary intervention in a pediatric intensive care unit (PICU) on sleep quality and stress-related disorders in critically ill children and anxiety and depression in their parents.</div></div><div><h3>Methods</h3><div>This single-blind, two-arm, randomized controlled trial enrolled 94 dyads. The control group (n = 47) received standard care; the experimental group (n = 47) additionally received a diary intervention. We compared the sleep quality and stress disorders of children, and anxiety, depression, and stress disorders among parents at various time-points, between groups.</div></div><div><h3>Results</h3><div>Data of 83 dyads were ultimately analyzed (loss-to-visit rate: 11.7 %). During the PICU stay, the experimental group showed significantly shorter total awakening time of each sleep episode and mean duration of each awakening per sleep session than the control group (P = 0.006; P = 0.032). The Childhood Stress Disorder Checklist scores of children in the experimental group were significantly lower than those in the control group at 1 and 3 months post-discharge (P = 0.003; P = 0.006). Parents in the experimental group reported significantly lower anxiety scores at PICU discharge and 1 month thereafter (P < 0.001; P = 0.015). At discharge, depression scores were significantly lower in the experimental group; this difference remained significant at 1 and 3 months post-discharge (P < 0.001; P < 0.05). At PICU discharge, parental scores were significantly lower in the experimental group than in the control group (P < 0.001).</div></div><div><h3>Conclusions</h3><div>The PICU diary intervention effectively improved the children’s sleep quality and was associated with stress reduction in parents during their children’s PICU stay and up to 3 months post-discharge. The intervention was also associated with a reduction in negative parental emotions up to 3 months after PICU discharge.</div></div><div><h3>Implications for Clinical Practice</h3><div>These findings offer valuable insights into supporting the psychological well-being of pediatric patients and their caregivers during and after PICU admission.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104315"},"PeriodicalIF":4.7,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795853","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}

引用次数: 0

The impact of a noise reduction bundle on ICU staff: A stepped-wedge cluster randomized clinical trial 降噪束对ICU工作人员的影响：一项楔形步聚类随机临床试验。

IF 4.7 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-12-11 DOI: 10.1016/j.iccn.2025.104306

Jeanette Vreman , Cris Lanting , Tim Frenzel , Johannes G. van der Hoeven , Joris Lemson , Mark van den Boogaard

Objectives

To determine the effectiveness of a multicomponent intervention bundle on sound levels in the ICU.

Methods

A stepped-wedge cluster randomized clinical trial was conducted in four intensive care units during a period of 14 months. A multicomponent intervention bundle aimed at reducing sound levels—consisting of education, equipment interventions, designated quiet times, and feedback—was implemented as a standard of care.

The main outcome measures were: A-weighted sound levels (LAeq), alarms/day/bed, annoyance ratings (numeric rating scale 0–10), and the number of observed nurse distractions during medication preparation. Differences in outcomes between the intervention and control periods were tested. For the primary outcome, the minimal clinical importance difference of 3 LAeq was used, as this level is audible to humans.

Results

LAeq control vs intervention, LAeq decreased from 53.7 (±5.8) to 52.9 (±5.9) dBA (p < 0.001) at the central nursing station. The median [IQR] number of alarms/day/bed decreased from 228 [IQR 176–290] during control to 194 [IQR 148–249] during intervention (p < 0.001). Nurses’ annoyance rating control vs. intervention changed from median 3.0 [IQR 2.0–5.0] to median 3.0 [IQR 2.0–4.0] (p < 0.001). Distractions decreased from 73 % during control period to 61 % (p < 0.001) during the intervention.

Conclusions

Use of a multicomponent intervention bundle led to a statistically significant reduction in sound levels— though not to a clinically relevant degree. Importantly, there were statistically significant improvements in the number of alarms, as well as in nurses’ annoyance and distractions, compared with the control period.

目的：确定多组分干预组合对ICU声级的有效性。方法：在4个重症监护病房进行为期14个月的阶梯楔形随机分组临床试验。一套旨在降低声音水平的多组件干预措施——包括教育、设备干预、指定的安静时间和反馈——被作为一种标准护理措施实施。主要结局指标为：a加权声级（LAeq）、闹钟/天/床、烦恼评分（数字评分范围0-10），以及在药物准备过程中观察到的护士分心次数。对干预期和对照期结果的差异进行了测试。对于主要结局，使用最小临床重要性差异3 LAeq，因为这个水平是人类可听到的。结果：LAeq对照组与干预组相比，LAeq从53.7（±5.8）下降到52.9（±5.9）dBA (p)。结论：使用多成分干预束导致声级显著降低，尽管没有达到临床相关程度。重要的是，与控制期相比，在报警次数、护士烦恼和分心方面都有统计学上的显著改善。

{"title":"The impact of a noise reduction bundle on ICU staff: A stepped-wedge cluster randomized clinical trial","authors":"Jeanette Vreman , Cris Lanting , Tim Frenzel , Johannes G. van der Hoeven , Joris Lemson , Mark van den Boogaard","doi":"10.1016/j.iccn.2025.104306","DOIUrl":"10.1016/j.iccn.2025.104306","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine the effectiveness of a multicomponent intervention bundle on sound levels in the ICU.</div></div><div><h3>Methods</h3><div>A stepped-wedge cluster randomized clinical trial was conducted in four intensive care units during a period of 14 months. A multicomponent intervention bundle aimed at reducing sound levels—consisting of education, equipment interventions, designated quiet times, and feedback—was implemented as a standard of care.</div><div>The main outcome measures were: A-weighted sound levels (LAeq), alarms/day/bed, annoyance ratings (numeric rating scale 0–10), and the number of observed nurse distractions during medication preparation. Differences in outcomes between the intervention and control periods were tested. For the primary outcome, the minimal clinical importance difference of 3 LAeq was used, as this level is audible to humans.</div></div><div><h3>Results</h3><div>LAeq control vs intervention, LAeq decreased from 53.7 (±5.8) to 52.9 (±5.9) dBA (p < 0.001) at the central nursing station. The median [IQR] number of alarms/day/bed decreased from 228 [IQR 176–290] during control to 194 [IQR 148–249] during intervention (p < 0.001). Nurses’ annoyance rating control vs. intervention changed from median 3.0 [IQR 2.0–5.0] to median 3.0 [IQR 2.0–4.0] (p < 0.001). Distractions decreased from 73 % during control period to 61 % (p < 0.001) during the intervention.</div></div><div><h3>Conclusions</h3><div>Use of a multicomponent intervention bundle led to a statistically significant reduction in sound levels— though not to a clinically relevant degree. Importantly, there were statistically significant improvements in the number of alarms, as well as in nurses’ annoyance and distractions, compared with the control period.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"93 ","pages":"Article 104306"},"PeriodicalIF":4.7,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746300","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}

引用次数: 0

首页上一页

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Intensive and Critical Care Nursing

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀