Pub Date : 2025-01-24DOI: 10.1016/j.iccn.2025.103949
Silvia Calvino Günther
{"title":"Hand hygiene implementation in ICUs: A critical pillar of patient safety","authors":"Silvia Calvino Günther","doi":"10.1016/j.iccn.2025.103949","DOIUrl":"10.1016/j.iccn.2025.103949","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103949"},"PeriodicalIF":4.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043903","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 : 2025-01-24DOI: 10.1016/j.iccn.2025.103941
Sandra F. Oude Wesselink , Albertus Beishuizen , Martin A. Rinket , Tim Krol , Harry Doornink , Bernard P. Veldkamp
Purpose
A quarter of ICU-patients develop post-traumatic stress disorder (PTSD) after discharge. These patients could benefit from early detection of PTSD. Therefore, we explored the accuracy of text mining with self-narratives to identify intensive care unit (ICU) patients and surviving relatives at risk of PTSD in a pilot study.
Methods
In this prospective cohort study with self-administered questionnaires, discharged ICU-patients and surviving relatives participated. In a single centre study at a 32-bed ICU of a large teaching hospital, we used an online screening tool with self-narratives, to identify ICU-patients and surviving relatives at risk of PTSD using text mining. Study variables were Trauma Screening Questionnaire (TSQ) and self-narratives, administered 3 to 6 months after ICU discharge.
Results
Of the participants 15% had an indication of PTSD based on TSQ. The median length of the self-narratives was 101 words. Using self-narratives, PTSD was predictable with a reasonable performance (AUROC of 0.67), compared to TSQ as gold standard. The most important words of the prediction model were ‘happen’ ‘again’ and ‘done’. These words are difficult to interpret without context.
Conclusions
It is possible to predict risk of PTSD for ICU-patients and surviving relatives using text mining applied on self-narratives, 3 to 6 months after ICU discharge. The model performance is reasonable and helps to identify patients and surviving relatives at risk.
Implications for Clinical Practice
Based on the large proportion of participants with an indication for PTSD, it remains important to persuade patients and surviving relatives to seek help when experiencing mental health problems after discharge.
{"title":"Identifying ICU survivors and relatives with post-traumatic stress disorder using text mining: An explorative study","authors":"Sandra F. Oude Wesselink , Albertus Beishuizen , Martin A. Rinket , Tim Krol , Harry Doornink , Bernard P. Veldkamp","doi":"10.1016/j.iccn.2025.103941","DOIUrl":"10.1016/j.iccn.2025.103941","url":null,"abstract":"<div><h3>Purpose</h3><div>A quarter of ICU-patients develop post-traumatic stress disorder (PTSD) after discharge. These patients could benefit from early detection of PTSD. Therefore, we explored the accuracy of text mining with self-narratives to identify intensive care unit (ICU) patients and surviving relatives at risk of PTSD in a pilot study.</div></div><div><h3>Methods</h3><div>In this prospective cohort study with self-administered questionnaires, discharged ICU-patients and surviving relatives participated. In a single centre study at a 32-bed ICU of a large teaching hospital, we used an online screening tool with self-narratives, to identify ICU-patients and surviving relatives at risk of PTSD using text mining. Study variables were Trauma Screening Questionnaire (TSQ) and self-narratives, administered 3 to 6 months after ICU discharge.</div></div><div><h3>Results</h3><div>Of the participants 15% had an indication of PTSD based on TSQ. The median length of the self-narratives was 101 words. Using self-narratives, PTSD was predictable with a reasonable performance (AUROC of 0.67), compared to TSQ as gold standard. The most important words of the prediction model were ‘happen’ ‘again’ and ‘done’. These words are difficult to interpret without context.</div></div><div><h3>Conclusions</h3><div>It is possible to predict risk of PTSD for ICU-patients and surviving relatives using text mining applied on self-narratives, 3 to 6 months after ICU discharge. The model performance is reasonable and helps to identify patients and surviving relatives at risk.</div></div><div><h3>Implications for Clinical Practice</h3><div>Based on the large proportion of participants with an indication for PTSD, it remains important to persuade patients and surviving relatives to seek help when experiencing mental health problems after discharge.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103941"},"PeriodicalIF":4.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043905","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 : 2025-01-24DOI: 10.1016/j.iccn.2025.103948
Kate Curtis , Belinda Kennedy , Julie Considine , Mary K. Lam , Christina Aggar , Ramon Z. Shaban , James A. Hughes , Margaret Fry , Hatem Alkhouri , Margaret Murphy
Background
Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments.
Objectives
To evaluate HIRAID® on patient experience in the emergency department.
Methods
This modified stepped–wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt’s Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches.
Results
Median (IQR) participant age was 54 (31–67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt’s Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved.
Conclusions
The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care.
Implications
Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding.
{"title":"Use of the structured emergency nursing framework HIRAID® improves patient experience: A stepped-wedge cluster randomised control trial in rural, regional and metropolitan Australia","authors":"Kate Curtis , Belinda Kennedy , Julie Considine , Mary K. Lam , Christina Aggar , Ramon Z. Shaban , James A. Hughes , Margaret Fry , Hatem Alkhouri , Margaret Murphy","doi":"10.1016/j.iccn.2025.103948","DOIUrl":"10.1016/j.iccn.2025.103948","url":null,"abstract":"<div><h3>Background</h3><div>Emergency departments have high levels of uncertainty, long wait times, resource shortages, overcrowding and a constantly changing environment. Patient experience and patient safety are directly linked, yet levels of patient experience are stagnant. To improve emergency nursing care and patient experience, an emergency nursing framework <strong>HIRAID®</strong> (<strong>H</strong>istory including <strong>I</strong>nfection risk, <strong>R</strong>ed flags, <strong>A</strong>ssessment, <strong>I</strong>nterventions, <strong>D</strong>iagnostics, communication, and reassessment) was implemented in 29 Australian emergency departments.</div></div><div><h3>Objectives</h3><div>To evaluate HIRAID® on patient experience in the emergency department.</div></div><div><h3>Methods</h3><div>This modified stepped–wedge cluster randomised control trial was conducted in 29 Australian rural, regional and metropolitan emergency departments and involved over 1300 emergency nurses. A total 2704 (1456 control, 1248 intervention) surveys were completed. We hypothesised implementation of HIRAID® would result in an at least 5% increase in patient experience per Schmidt’s Perceptions of Nursing Care Survey and Australian Hospital Patient Experience Question Set. Patients (of all ages) and/or their carers completed a phone interview. Data were analysed using descriptive statistics and Generalized Estimating Equations approaches.</div></div><div><h3>Results</h3><div>Median (IQR) participant age was 54 (31–67) years. The most common presenting problems were abdominal, chest and respiratory issues. Greater than 5% improvement in all categories of the Schmidt’s Perceptions of Nursing Care Survey, and 10 out of 12 Australian Hospital Patient Experience Question Set was achieved.</div></div><div><h3>Conclusions</h3><div>The implementation of the HIRAID® emergency nursing framework in Australian emergency departments significantly improved patient experience with emergency care.</div></div><div><h3>Implications</h3><div>Demand for emergency care is increasing. Evaluating what methods work to effectively translate evidence to emergency practice, improve patient experience in the complex emergency setting is crucial. We present how a behaviour change informed implementation strategy enabled maximum, sustained uptake of an intervention that improved patient experience in a variety of emergency settings despite the COVID-19 pandemic and catastrophic flooding.</div><div><strong>Trial Registration:</strong> ANZCTR, <span><span>ACTRN12621001456842</span><svg><path></path></svg></span>. 25.10.2021.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103948"},"PeriodicalIF":4.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043907","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 : 2025-01-17DOI: 10.1016/j.iccn.2024.103939
Érica Vieira de Andrade , Vanderlei José Haas , Maíla Fidalgo de Faria , Márcia Marques dos Santos Felix , Maria Beatriz Guimarães Raponi , Elizabeth Barichello , Patricia da Silva Pires , Sagrario Gómez-Cantarino , Maria Helena Barbosa
Purpose
To evaluate the effect of listening to music on preoperative anxiety, postoperative pain (at rest and during coughing), and cardiorespiratory parameters in patients undergoing cardiac surgery.
This study was carried out with 50 adult patients undergoing elective cardiac surgery randomly allocated at a 1:1 ratio to one of the groups, experimental (n = 25) or control (n = 25). The experimental group listened to music during the immediate preoperative period and on the first postoperative day. The control group received standard care. State-Trait Anxiety Inventory and Numeric Pain Rating Scale were used to collect data.
Findings
The classical music significantly reduced preoperative state anxiety scores (p < 0.001; dCohen = 2.1), postoperative pain intensity at rest (p < 0.001; dCohen = 1.4) and during coughing (p < 0.001; dCohen = 1.3). There was also a statistically significant reduction in systolic (p = 0.001; dCohen = 0.9) and diastolic blood pressure (p = 0.01; dCohen = 0.6), heart rate (p < 0.001; dCohen = 2.5), respiratory rate (p < 0.001; dCohen = 1.4), and a significant increase in oxygen saturation (p < 0.001; dCohen = 1.2).
Conclusions
Listening to music had a significant impact on the evaluated outcomes, demonstrating its potential as a complementary intervention to pharmacological treatment for patients undergoing cardiac surgery.
Implications for Clinical Practice
The findings reinforce the evidence that listening to music is a promising nursing intervention to be used in the perioperative period of cardiac surgeries, with the potential to promote well-being to patients and improve the quality of care provided.
{"title":"Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: A randomized clinical trial","authors":"Érica Vieira de Andrade , Vanderlei José Haas , Maíla Fidalgo de Faria , Márcia Marques dos Santos Felix , Maria Beatriz Guimarães Raponi , Elizabeth Barichello , Patricia da Silva Pires , Sagrario Gómez-Cantarino , Maria Helena Barbosa","doi":"10.1016/j.iccn.2024.103939","DOIUrl":"10.1016/j.iccn.2024.103939","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effect of listening to music on preoperative anxiety, postoperative pain (at rest and during coughing), and cardiorespiratory parameters in patients undergoing cardiac surgery.</div></div><div><h3>Design</h3><div>Single-centered, randomized, parallel, superiority clinical trial.</div></div><div><h3>Methods</h3><div>This study was carried out with 50 adult patients undergoing elective cardiac surgery randomly allocated at a 1:1 ratio to one of the groups, experimental (n = 25) or control (n = 25). The experimental group listened to music during the immediate preoperative period and on the first postoperative day. The control group received standard care. State-Trait Anxiety Inventory and Numeric Pain Rating Scale were used to collect data.</div></div><div><h3>Findings</h3><div>The classical music significantly reduced preoperative state anxiety scores (p < 0.001; d<sub>Cohen</sub> = 2.1), postoperative pain intensity at rest (p < 0.001; d<sub>Cohen</sub> = 1.4) and during coughing (p < 0.001; d<sub>Cohen</sub> = 1.3). There was also a statistically significant reduction in systolic (p = 0.001; d<sub>Cohen</sub> = 0.9) and diastolic blood pressure (p = 0.01; d<sub>Cohen</sub> = 0.6), heart rate (p < 0.001; d<sub>Cohen</sub> = 2.5), respiratory rate (p < 0.001; d<sub>Cohen</sub> = 1.4), and a significant increase in oxygen saturation (p < 0.001; d<sub>Cohen</sub> = 1.2).</div></div><div><h3>Conclusions</h3><div>Listening to music had a significant impact on the evaluated outcomes, demonstrating its potential as a complementary intervention to pharmacological treatment for patients undergoing cardiac surgery.</div></div><div><h3>Implications for Clinical Practice</h3><div>The findings reinforce the evidence that listening to music is a promising nursing intervention to be used in the perioperative period of cardiac surgeries, with the potential to promote well-being to patients and improve the quality of care provided.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103939"},"PeriodicalIF":4.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The obesity paradox in sepsis: An ongoing debate","authors":"Kostoula Arvaniti, Dimitrios Lathyris, Despoina Koulenti","doi":"10.1016/j.iccn.2025.103942","DOIUrl":"10.1016/j.iccn.2025.103942","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103942"},"PeriodicalIF":4.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018891","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 : 2025-01-17DOI: 10.1016/j.iccn.2025.103947
Daniel Joseph E. Berdida , Rizal Angelo N. Grande
{"title":"Caring for victims of child abuse in the pediatric intensive care unit","authors":"Daniel Joseph E. Berdida , Rizal Angelo N. Grande","doi":"10.1016/j.iccn.2025.103947","DOIUrl":"10.1016/j.iccn.2025.103947","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103947"},"PeriodicalIF":4.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018830","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 : 2025-01-14DOI: 10.1016/j.iccn.2024.103931
Lois Nunn , Mark Allison , James McEntee , Laura Mooney , Lova Green , Alice Brown , Rhiannon Lewis , Terpsichor Karpasiti , Martine Nurek , Caitlin Meechan , Geraldine Fitzgerald-O’Connor , Emma Long , Peter Spronk , Suveer Singh
Introduction and objectives
Nil by mouth (NBM) is a frequent imposition for patients recovering from critical illness.
Its impact on patients’ wellbeing and rehabilitation is under researched. We sought ICU multidisciplinary opinion to primarily assess the relevance of taste deprivation on patient care and recovery, and to identify future opportunities for innovation and research.
Methodology
A descriptive, multiformat, observational, online survey investigated the experiences of specialist multidisciplinary healthcare professionals (HCP) from two academic hospitals regarding working with NBM patients. An e-survey containing 16 multiformat questions was developed by an experienced multidisciplinary HCP team and distributed over a 3-month period in 2023. The CHERRIES guidelines were followed for reporting of results.
Results
58 HCPs completed the study. 97% of HCPs reported witnessing patient discomfort or distress when NBM. 91% believed felt that it impacted negatively on patients’ engagement in their own recovery. 59% did not discuss food and taste with patients when prolonged NBM was anticipated because there was no solution on offer. 41% of HCPs did discuss flavour and food, to build rapport and help motivate recovery. 57% of HCPs often felt pressure to give oral food/liquid to a NBM patient. 90% of participants reported that a safe taste product could enhance a patient’s ICU experience. Concerns regarding safety and a need for guidelines to enable implementation were common.
Conclusion
HCPs recognise the psychological sequalae on the patient and the impact on their relationship with the patient, that taste deprivation creates in recovering critically ill patients. Safe alternatives to oral intake that can enhance the ICU experience are considered desirable; this needs further research and innovation. Furthermore, with training and support HCPs should feel empowered to discuss NBM associated distress and challenge NBM recommendations.
Implications for clinical practice
There is demand for safe alternatives to oral flavour intake and belief this could enhance the ICU experience with downstream positive impact on ICU morbidity.
{"title":"Nil by mouth in intensive care – A qualitative, multiformat survey exploring the impact of mandatory oral restriction, from the health care providers perspective","authors":"Lois Nunn , Mark Allison , James McEntee , Laura Mooney , Lova Green , Alice Brown , Rhiannon Lewis , Terpsichor Karpasiti , Martine Nurek , Caitlin Meechan , Geraldine Fitzgerald-O’Connor , Emma Long , Peter Spronk , Suveer Singh","doi":"10.1016/j.iccn.2024.103931","DOIUrl":"10.1016/j.iccn.2024.103931","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>Nil by mouth (NBM) is a frequent imposition for patients recovering from critical illness.</div><div>Its impact on patients’ wellbeing and rehabilitation is under researched. We sought ICU multidisciplinary opinion to primarily assess the relevance of taste deprivation on patient care and recovery, and to identify future opportunities for innovation and research.</div></div><div><h3>Methodology</h3><div>A descriptive, multiformat, observational, online survey investigated the experiences of specialist multidisciplinary healthcare professionals (HCP) from two academic hospitals regarding working with NBM patients. An e-survey containing 16 multiformat questions was developed by an experienced multidisciplinary HCP team and distributed over a 3-month period in 2023. The CHERRIES guidelines were followed for reporting of results.</div></div><div><h3>Results</h3><div>58 HCPs completed the study. 97% of HCPs reported witnessing patient discomfort or distress when NBM. 91% believed felt that it impacted negatively on patients’ engagement in their own recovery. 59% did not discuss food and taste with patients when prolonged NBM was anticipated because there was no solution on offer. 41% of HCPs did discuss flavour and food, to build rapport and help motivate recovery. 57% of HCPs often felt pressure to give oral food/liquid to a NBM patient. 90% of participants reported that a safe taste product could enhance a patient’s ICU experience. Concerns regarding safety and a need for guidelines to enable implementation were common.</div></div><div><h3>Conclusion</h3><div>HCPs recognise the psychological sequalae on the patient and the impact on their relationship with the patient, that taste deprivation creates in recovering critically ill patients. Safe alternatives to oral intake that can enhance the ICU experience are considered desirable; this needs further research and innovation. Furthermore, with training and support HCPs should feel empowered to discuss NBM associated distress and challenge NBM recommendations.</div></div><div><h3>Implications for clinical practice</h3><div>There is demand for safe alternatives to oral flavour intake and belief this could enhance the ICU experience with downstream positive impact on ICU morbidity.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103931"},"PeriodicalIF":4.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018890","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 : 2025-01-10DOI: 10.1016/j.iccn.2024.103928
L. Francken , P.J.T. Rood , M.A.A. Peters , S. Teerenstra , M. Zegers , M. van den Boogaard
Background
Physical restraints are frequently used in ICU patients, while their effects are unclear.
Objective
To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status.
Research Methodology/Design
Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses.
Setting
Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands.
Main Outcome Measures
Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores.
Results
2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1–6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, p < 0.001; PCS −2.82, 95 %CI −4.47 to −1,17p < 0.001; MCS −2.67, 95 %CI −4.39 to −0.96, p < 0.01). At 12-months, only the PCS scores remained significantly lower (−1.71, 95 %CI −3.42 to −0.004, p < 0.05).
Conclusion
Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months.
Implications for Clinical Practice
Use of physical restraints is associated with statistical significant worse mental and physical outcomes.
背景：ICU患者经常使用物理约束，但其效果尚不清楚。目的：探讨身体约束与非身体约束ICU患者入院后3个月和12个月的心理健康结局和生活质量与ICU前健康状况的差异。研究方法/设计：前瞻性队列研究。纳入的患者年龄在16岁或以上，入院至少12小时并提供知情同意。采用线性混合模型分析各组间差异。环境：两个ICU，一个35床位的学术ICU和一个12床位的ICU在荷兰的一家教学医院。主要结果测量：焦虑和抑郁症状使用医院焦虑和抑郁量表测量，创伤后应激障碍使用事件影响量表-修订，生活质量使用短表36评分。结果：纳入2764例患者，其中486例（17.6%）患者受到身体限制，中位时间为2 [IQR 1-6]天。身体约束的患者在3个月时报告的结果明显较差（抑郁症状0.89,95% CI 0.37至1.41,p）。结论：使用身体约束与自我报告的抑郁症状加重和ICU后3个月生活质量下降有关，12个月后身体生活质量下降。对临床实践的启示：使用身体约束与统计上显着的更差的精神和身体结果相关。
{"title":"Exploring differences in reported mental health outcomes and quality of life between physically restrained and non-physically restrained ICU patients; a prospective cohort study","authors":"L. Francken , P.J.T. Rood , M.A.A. Peters , S. Teerenstra , M. Zegers , M. van den Boogaard","doi":"10.1016/j.iccn.2024.103928","DOIUrl":"10.1016/j.iccn.2024.103928","url":null,"abstract":"<div><h3>Background</h3><div>Physical restraints are frequently used in ICU patients, while their effects are unclear.</div></div><div><h3>Objective</h3><div>To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status.</div></div><div><h3>Research Methodology/Design</h3><div>Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses.</div></div><div><h3>Setting</h3><div>Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands.</div></div><div><h3>Main Outcome Measures</h3><div>Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores.</div></div><div><h3>Results</h3><div>2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1–6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, <em>p</em> < 0.001; PCS −2.82, 95 %CI −4.47 to −1,17<em>p</em> < 0.001; MCS −2.67, 95 %CI −4.39 to −0.96, <em>p <</em> 0.01). At 12-months, only the PCS scores remained significantly lower (−1.71, 95 %CI −3.42 to −0.004, <em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months.</div></div><div><h3>Implications for Clinical Practice</h3><div>Use of physical restraints is associated with statistical significant worse mental and physical outcomes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103928"},"PeriodicalIF":4.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974079","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 : 2025-01-08DOI: 10.1016/j.iccn.2024.103933
Shan Zhang , Shu Ding , Wei Cui , Xiangyu Li , Jun Wei , Ying Wu
Objectives
To evaluate the impact of Artificial Intelligence Assisted Prevention and Management for Delirium (AI-AntiDelirium) on improving adherence to delirium guidelines among nurses in the intensive care unit (ICU).
Research Methodology/Design
Between November 2022 and June 2023, A cluster randomized controlled trial was undertaken.
Setting
A total of 38 nurses were enrolled in the interventional arm, whereas 42 nurses were recruited for the control arm in six ICUs across two hospitals in Beijing, comparing nurses’ adherence and cognitive load in units that use AI-AntiDelirium or the control group.
Main Outcome Measures
The AI-AntiDelirium tailored delirium preventive or treated interventions to address patients’ specific risk factors. The adherence rate of delirium interventions was the primary endpoint. The other endpoints were adherence to risk factors assessment, ICU delirium assessment, and nurses’ cognitive load. The repeated measures analysis of variance was utilized to explore the influence of time, group, and time × group interaction on the repeated measurement variable (e.g., adherence, cognitive load).
Results
A cumulative total of 1040 nurse days were analyzed for this study. The adherence to delirium intervention of nurses in AI-AntiDelirium groups was higher than control units (75 % vs. 58 %, P < 0.01). When compared to control groups, AI-AntiDelirium was found to be significantly effective in both decreasing extraneous cognitive load (P < 0.01) and improving germane cognitive load (P < 0.01).
Conclusions
This study supports the effectiveness of AI-AntiDelirium in enhancing nurses’ adherence to evidence-based, individualized delirium intervention and also reducing extraneous cognitive load.
Implications for Clinical Practice
A nurse-led system should be applied by nursing administrators to improve compliance with nursing interventions among ICU nurses.
目的：评估人工智能辅助谵妄预防和管理（AI-AntiDelirium）对提高重症监护病房（ICU）护士对谵妄指南的依从性的影响。研究方法/设计：于2022年11月至2023年6月间，进行整群随机对照试验。环境：干预组共招募了38名护士，而对照组招募了42名护士，来自北京两家医院的6个icu，比较了使用AI-AntiDelirium和对照组的护士依从性和认知负荷。主要结局指标：AI-AntiDelirium量身定制谵妄预防或治疗干预措施，以解决患者特定的危险因素。谵妄干预的依从率是主要终点。其他终点是对危险因素评估、ICU谵妄评估和护士认知负荷的依从性。采用重复测量方差分析探讨时间、组、时间×组交互作用对重复测量变量（如依从性、认知负荷）的影响。结果：本研究共分析了1040个护理日。AI-AntiDelirium组护士对谵妄干预的依从性高于对照组（75% vs. 58%）， P结论：本研究支持AI-AntiDelirium在增强护士对循证、个性化谵妄干预的依从性以及减少外来认知负荷方面的有效性。对临床实践的启示：护理管理者应采用护士主导的系统来提高ICU护士对护理干预的依从性。
{"title":"Evaluating the effectiveness of a clinical decision support system (AI-Antidelirium) to improve Nurses’ adherence to delirium guidelines in the intensive care unit","authors":"Shan Zhang , Shu Ding , Wei Cui , Xiangyu Li , Jun Wei , Ying Wu","doi":"10.1016/j.iccn.2024.103933","DOIUrl":"10.1016/j.iccn.2024.103933","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the impact of <strong><u>A</u></strong>rtificial <strong><u>I</u></strong>ntelligence <strong><u>A</u></strong>ssisted Preve<strong><u>nti</u></strong>on and Management for <strong><u>Delirium</u></strong> (<em>AI-AntiDelirium</em>) on improving adherence to delirium guidelines among nurses in the intensive care unit (ICU).</div></div><div><h3>Research Methodology/Design</h3><div>Between November 2022 and June 2023, A cluster randomized controlled trial was undertaken.</div></div><div><h3>Setting</h3><div>A total of 38 nurses were enrolled in the interventional arm, whereas 42 nurses were recruited for the control arm in six ICUs across two hospitals in Beijing, comparing nurses’ adherence and cognitive load in units that use <em>AI-AntiDelirium</em> or the control group.</div></div><div><h3>Main Outcome Measures</h3><div>The <em>AI-AntiDelirium</em> tailored delirium preventive or treated interventions to address patients’ specific risk factors. The adherence rate of delirium interventions was the primary endpoint. The other endpoints were adherence to risk factors assessment, ICU delirium assessment, and nurses’ cognitive load. The repeated measures analysis of variance was utilized to explore the influence of time, group, and time × group interaction on the repeated measurement variable (e.g., adherence, cognitive load).</div></div><div><h3>Results</h3><div>A cumulative total of 1040 nurse days were analyzed for this study. The adherence to delirium intervention of nurses in <em>AI-AntiDelirium</em> groups was higher than control units (75 % <em>vs</em>. 58 %, <em>P</em> < 0.01). When compared to control groups, <em>AI-AntiDelirium</em> was found to be significantly effective in both decreasing extraneous cognitive load (<em>P</em> < 0.01) and improving germane cognitive load (<em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>This study supports the effectiveness of <em>AI-AntiDelirium</em> in enhancing nurses’ adherence to evidence-based, individualized delirium intervention and also reducing extraneous cognitive load.</div></div><div><h3>Implications for Clinical Practice</h3><div>A nurse-led system<!--> <!-->should be applied by nursing administrators to improve compliance with nursing interventions among ICU nurses.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103933"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960567","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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