Intensive and Critical Care Nursing最新文献_第7页

Insights and recommendations for optimising the Wab-WPPEP − Letter on Xiong et al. 优化Wab-WPPEP的见解与建议——关于Xiong等人的信。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103932

Xiaofen Zhao , Sheng Li

引用次数: 0

Muscle strength trajectories and outcomes in critically ill patients: A prospective multicentre cohort study 危重病人肌肉力量轨迹和结局：一项前瞻性多中心队列研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103934

Ting-Ting Wu , Xiu-Xia Lin , Gao-Yan Chen , Jun Yao , Jing Xiong , Chen-Juan Luo , Yao-Ning Zhuang , Mei-Lian Xu , Xue-Xian Chen , Mei-Rong Chen , Hong Li

Objectives

To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.

Design

Prospective multicenter cohort study.

Settings

Ten ICUs across five tertiary hospitals in Fujian Province, China.

Methods

Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.

Results

Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005–0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (P > 0.05).

Conclusions

Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.

Implications for clinical practice

Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.

目的：研究ICU患者肌肉力量的变化轨迹和决定因素及其对1、6和12个月死亡率的影响。设计：前瞻性多中心队列研究。地点：福建省5家三级医院的10个icu。方法：在ICU入院、ICU出院和出院三个时间点，用握力评估肌肉力量。采用基于组的轨迹建模来识别肌肉力量轨迹，而多项逻辑分析则根据基线特征确定预测因子。死亡率结果采用Cox比例风险模型进行评估，该模型经治疗加权逆概率调整。结果：在317例患者中，37例在12个月内死亡，确定了三种肌肉力量轨迹：低水平稳定（38.17%），中等水平改善（47.00%）和高水平改善（14.83%）。年龄较大（≥65岁）、女性、机械通气时间延长和无脂量较低与进入低水平稳定性组的可能性较高相关。调整后，与低水平稳定组相比，中等水平改善组1个月死亡风险降低0.067倍（95% CI: 0.005-0.825）， 6个月或12个月无显著差异（P < 0.05）。结论：确定了三种不同的肌肉力量轨迹：低水平稳定性，中等水平改善和高水平改善。年龄较大、女性、机械通气时间延长、无脂量较低与低水平稳定组密切相关，低水平稳定组1个月死亡率较高。对临床实践的启示：本研究的发现强调了早期识别低水平稳定性患者的重要性，特别是那些年龄较大、需要长时间机械通气或无脂量减少的女性患者。对这些高危人群进行量身定制的早期康复治疗可能会带来实质性的临床益处。

{"title":"Muscle strength trajectories and outcomes in critically ill patients: A prospective multicentre cohort study","authors":"Ting-Ting Wu , Xiu-Xia Lin , Gao-Yan Chen , Jun Yao , Jing Xiong , Chen-Juan Luo , Yao-Ning Zhuang , Mei-Lian Xu , Xue-Xian Chen , Mei-Rong Chen , Hong Li","doi":"10.1016/j.iccn.2024.103934","DOIUrl":"10.1016/j.iccn.2024.103934","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.</div></div><div><h3>Design</h3><div>Prospective multicenter cohort study.</div></div><div><h3>Settings</h3><div>Ten ICUs across five tertiary hospitals in Fujian Province, China.</div></div><div><h3>Methods</h3><div>Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.</div></div><div><h3>Results</h3><div>Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005–0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (<em>P</em> > 0.05).</div></div><div><h3>Conclusions</h3><div>Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.</div></div><div><h3>Implications for clinical practice</h3><div>Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103934"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960638","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

Assessment of spiritual care competencies of critical care health professionals: An integrative review 重症监护卫生专业人员精神护理能力评估：一项综合综述

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103924

Alessandre Carvalho Junior , Adriane Maria Netto de Oliveira , Diéssica Roggia Piexak , Camila Daiane Silva , Giancarlo Lucchetti

Objective

The primary aim of the present study was to assess the competencies related to the spiritual care by nurses and health professionals who work in intensive care units, and how these competencies influence clinical practice. As a secondary objective, we have discussed the strengths, weaknesses and threats of incorporating and teaching these competencies among the included studies.

Method

An integrative review of studies published in English, Spanish and Portuguese was performed in the following databases: Embase, Web of Science, Medline/PubMed, PsycInfo, LILACS and Cochrane.

Results

Eleven out of a total of 2,239 articles were included. Most were cross-sectional studies with nurses and the main competencies included were “spiritual care attitude” and “knowledge-related spirituality”. The studies were separated into three themes: “Strengths”, “Weakness” and “Opportunities”. The results showed there are several challenges for professionals working in ICUs, including lack of time, high workload and the influence of the cultural context. Furthermore, few professionals are actually trained to provide spiritual care in the ICU and this care is often provided only at the end of life. Despite this evidence, only one quasi-experimental study on training on the subject in the ICU was identified and no trials, reinforcing the need for more educational studies.

Conclusion

There is still a large gap regarding spiritual care in the intensive care environment, often related to the lack of training and knowledge of the team. Exploring the competencies involved in spiritual care provided by health professionals is a way to deepen the debate within the healthcare-related scientific scenario.

Implications for Clinical Practice

Our findings allow a better understanding of outcomes related to healthcare, based on the assessment of these competencies and aspects related to critical patients, expanding the possibility of building scientific knowledge in the health area and allowing thoughts about multiple forms of research, including randomized clinical studies.

目的：本研究的主要目的是评估在重症监护病房工作的护士和卫生专业人员的精神护理能力，以及这些能力如何影响临床实践。作为次要目标，我们讨论了在纳入的研究中纳入和教授这些能力的优势、劣势和威胁。方法：在Embase、Web of Science、Medline/PubMed、PsycInfo、LILACS和Cochrane等数据库中对以英语、西班牙语和葡萄牙语发表的研究进行综合综述。结果：共纳入2239篇文献中的11篇。以护士为研究对象，以“精神护理态度”和“与知识相关的灵性”为主要胜任力。这些研究分为三个主题：“优势”、“劣势”和“机遇”。结果表明，在icu工作的专业人员面临着一些挑战，包括缺乏时间、高工作量和文化背景的影响。此外，很少有专业人士真正接受过在重症监护病房提供精神护理的培训，而且这种护理通常只在生命结束时提供。尽管有这些证据，但只有一项关于ICU主题培训的准实验研究被确定，而没有试验，这加强了对更多教育研究的需求。结论：在重症监护环境中，精神关怀仍存在较大差距，这往往与团队缺乏培训和知识有关。探索由卫生专业人员提供的精神护理所涉及的能力是深化卫生保健相关科学场景内辩论的一种方式。对临床实践的影响：基于对这些能力和危重患者相关方面的评估，我们的研究结果可以更好地理解与医疗保健相关的结果，扩大了在卫生领域建立科学知识的可能性，并允许思考多种形式的研究，包括随机临床研究。

{"title":"Assessment of spiritual care competencies of critical care health professionals: An integrative review","authors":"Alessandre Carvalho Junior , Adriane Maria Netto de Oliveira , Diéssica Roggia Piexak , Camila Daiane Silva , Giancarlo Lucchetti","doi":"10.1016/j.iccn.2024.103924","DOIUrl":"10.1016/j.iccn.2024.103924","url":null,"abstract":"<div><h3>Objective</h3><div>The primary aim of the present study was to assess the competencies related to the spiritual care by nurses and health professionals who work in intensive care units, and how these competencies influence clinical practice. As a secondary objective, we have discussed the strengths, weaknesses and threats of incorporating and teaching these competencies among the included studies.</div></div><div><h3>Method</h3><div>An integrative review of studies published in English, Spanish and Portuguese was performed in the following databases: Embase, Web of Science, Medline/PubMed, PsycInfo, LILACS and Cochrane.</div></div><div><h3>Results</h3><div>Eleven out of a total of 2,239 articles were included. Most were cross-sectional studies with nurses and the main competencies included were “spiritual care attitude” and “knowledge-related spirituality”. The studies were separated into three themes: “Strengths”, “Weakness” and “Opportunities”. The results showed there are several challenges for professionals working in ICUs, including lack of time, high workload and the influence of the cultural context. Furthermore, few professionals are actually trained to provide spiritual care in the ICU and this care is often provided only at the end of life. Despite this evidence, only one quasi-experimental study on training on the subject in the ICU was identified and no trials, reinforcing the need for more educational studies.</div></div><div><h3>Conclusion</h3><div>There is still a large gap regarding spiritual care in the intensive care environment, often related to the lack of training and knowledge of the team. Exploring the competencies involved in spiritual care provided by health professionals is a way to deepen the debate within the healthcare-related scientific scenario.</div></div><div><h3>Implications for Clinical Practice</h3><div>Our findings allow a better understanding of outcomes related to healthcare, based on the assessment of these competencies and aspects related to critical patients, expanding the possibility of building scientific knowledge in the health area and allowing thoughts about multiple forms of research, including randomized clinical studies.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103924"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960507","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

Attracting nursing talent to the intensive care unit: A qualitative study on how to create an appealing work environment 吸引护理人才到重症监护室：如何创造有吸引力的工作环境的定性研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103937

Rafael-Jesús Fernández-Castillo , Luis Basco-Prado , Marta Raurell-Torredà

Introduction and objective

The global shortage of nurses who want to work in the intensive care unit (ICU) is alarming, putting at risk quality of care and patient safety. With efforts put into engagement strategies, optimized recruitment programmes are scarce, specifically in the ICU setting. The aim of this study is to describe and explore ICU nurses’ opinions on their work motivational factors that influenced the decision to work in the ICU setting.

Design

A qualitative research was undertaken, with a descriptive exploratory interpretative approach, implementing a QUAL-QUAL design, where two data collection techniques are used simultaneously and complement each other. Experienced ICU nurses were interviewed by focus group, using in-depth interviews for novel nurses. A template content analysis as described by the model of Brooks was performed.

Setting

The selected population was recruited from 6 different public hospitals in Spain.

Findings

A total of 17 nurses participated in the study as we reached data saturation; seven in the focus group and ten by individual interviews. Four main themes emerged from the analysis divided into 13 subthemes: “ICU training and education”, “taking care of the intensive carer”, “optimized human resources management” and “intrinsic and extrinsic motivational factors”.

Conclusion

Nurses consider that an attractive ICU in terms of job satisfaction is the one that is committed to quality continuous training programmes, welcoming professionals with well-designed mentoring, and taking care of its workers by promoting teamwork and work-life balance, burnout syndrome prevention strategies and motivation for intellectual development.

Implications for clinical practice

The description of how to create attractive ICUs will help to build strategies with the aim of recruiting talented highly qualified professionals who will alleviate the need for nurses in the field, optimizing the care provided and generating benefits in management and quality of care.

简介和目的：全球想要在重症监护病房（ICU）工作的护士短缺令人担忧，危及护理质量和患者安全。随着参与策略的努力，优化的招聘计划很少，特别是在ICU环境中。本研究的目的是描述和探讨ICU护士对其工作动机因素的看法，这些因素会影响他们在ICU环境中工作的决定。设计：进行定性研究，采用描述性探索性解释方法，实施quality - quality设计，其中同时使用两种数据收集技术并相互补充。采用焦点小组访谈法对经验丰富的ICU护士进行访谈，对新护士采用深度访谈法。按照Brooks模型的描述进行模板内容分析。环境：所选人群从西班牙6家不同的公立医院招募。结果：共有17名护士参与了研究，我们达到了数据饱和；7个通过焦点小组，10个通过个人访谈。从分析中得出了四个主要主题，分为13个子主题：“ICU培训和教育”，“照顾重症护理人员”，“优化人力资源管理”和“内在和外在激励因素”。结论：护士认为，在工作满意度方面，一个有吸引力的ICU是致力于高质量的持续培训计划，欢迎专业人员和精心设计的指导，并通过促进团队合作和工作与生活的平衡，倦怠综合征预防策略和智力发展的动机来照顾其员工。对临床实践的影响：描述如何创建有吸引力的icu将有助于制定战略，以招募有才能的高素质专业人员，这些专业人员将减轻该领域对护士的需求，优化所提供的护理，并在管理和护理质量方面产生效益。

{"title":"Attracting nursing talent to the intensive care unit: A qualitative study on how to create an appealing work environment","authors":"Rafael-Jesús Fernández-Castillo , Luis Basco-Prado , Marta Raurell-Torredà","doi":"10.1016/j.iccn.2024.103937","DOIUrl":"10.1016/j.iccn.2024.103937","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>The global shortage of nurses who want to work in the intensive care unit (ICU) is alarming, putting at risk quality of care and patient safety. With efforts put into engagement strategies, optimized recruitment programmes are scarce, specifically in the ICU setting. The aim of this study is to describe and explore ICU nurses’ opinions on their work motivational factors that influenced the decision to work in the ICU setting.</div></div><div><h3>Design</h3><div>A qualitative research was undertaken, with a descriptive exploratory interpretative approach, implementing a QUAL-QUAL design, where two data collection techniques are used simultaneously and complement each other. Experienced ICU nurses were interviewed by focus group, using in-depth interviews for novel nurses. A template content analysis as described by the model of Brooks was performed.</div></div><div><h3>Setting</h3><div>The selected population was recruited from 6 different public hospitals in Spain.</div></div><div><h3>Findings</h3><div>A total of 17 nurses participated in the study as we reached data saturation; seven in the focus group and ten by individual interviews. Four main themes emerged from the analysis divided into 13 subthemes: “ICU training and education”, “taking care of the intensive carer”, “optimized human resources management” and “intrinsic and extrinsic motivational factors”.</div></div><div><h3>Conclusion</h3><div>Nurses consider that an attractive ICU in terms of job satisfaction is the one that is committed to quality continuous training programmes, welcoming professionals with well-designed mentoring, and taking care of its workers by promoting teamwork and work-life balance, burnout syndrome prevention strategies and motivation for intellectual development.</div></div><div><h3>Implications for clinical practice</h3><div>The description of how to create attractive ICUs will help to build strategies with the aim of recruiting talented highly qualified professionals who will alleviate the need for nurses in the field, optimizing the care provided and generating benefits in management and quality of care.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103937"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960508","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}

引用次数: 0

Environmental sustainability in intensive care: The crucial role of nursing and healthcare approaches 重症监护中的环境可持续性：护理和保健方法的关键作用。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103879

Andrea Glotta

引用次数: 0

The key role of intensive care nurses in critical illness dysphagia assessment, prevention, and management 重症监护护士在危重疾病吞咽困难评估、预防和管理中的关键作用。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103935

Louise Rose , Peter Spronk , Stacey Skoretz

引用次数: 0

What motivates critical care nurses to stay in their job? – Structural aspects for empowering intrinsic motivation in permissive professional contexts: A scoping review 是什么促使重症监护护士继续工作？-在允许的专业环境中增强内在动机的结构方面：范围审查。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103929

Dagmar Teutsch , Eckhard Frick , Jenny Kubitza

Objective

In the wake of the COVID-19 pandemic, a significant number of critical care nurses have left their positions, citing overload, burnout, and moral distress. This scoping review is not just a theoretical exploration but a timely and crucial investigation into the aspects and structures of critical care nursing that can make the job fulfilling and appealing, thereby promoting intrinsic motivation and staff retention.

Methodology

A scoping review of studies reporting on factors that allow critical care nurses to fall back on their intrinsic job motivation. Qualitative, quantitative, and mixed methods studies from 2019 until 2023 that examined critical care nurses are included. This scoping review, which was conducted in 12 databases, follows the framework proposed by Arksey and O’Malley and the PRISMA framework.

Results

22 studies met the inclusion criteria. The thematic synthesis identified ‘meaning’ as the overarching theme. Meaning can help critical nurses identify their intrinsic motivation and hold tight to it during professional challenges or low morale. Previous studies found meaning-making as an essential element of spirituality. In the present study, it is strongly related to the other subthemes: sense of pride and joy, personal relationships, thriving, and moral responsibility.

Conclusion

It makes sense for care management to create specific structures and work conditions, such as flexible scheduling, opportunities for professional development, and supportive team environments that encourage critical care nurses in their professional autonomy. Measures tailored to the individual needs and resources are also crucial. In this way, existing intrinsic motivation can be nurtured, and critical care nurses are enabled to autonomously discern values set by the employer into their own value system.

Implication for clinical practice

Institutions need to offer critical care nurses decision-making discretion whenever possible, broad information sharing, and a climate of trust and respect, in which the individual may feel autonomous and can develop personally and professionally.

目的：新冠肺炎疫情发生后，大量重症监护护士因工作负担过重、工作倦怠、道德困境等原因离职。这一范围审查不仅是一个理论探索，而且是一个及时和关键的调查方面和结构的重症护理，可以使工作充实和吸引人，从而促进内在动机和员工保留。方法：范围审查的研究报告的因素，使重症监护护士回到他们的内在工作动机。包括从2019年到2023年对重症护理护士进行的定性、定量和混合方法研究。在12个数据库中进行的范围审查遵循了Arksey和O'Malley提出的框架以及PRISMA框架。结果：22项研究符合纳入标准。主题综合将“意义”确定为首要主题。意义可以帮助关键的护士识别他们的内在动机，并在职业挑战或士气低落时紧紧抓住它。先前的研究发现，意义创造是灵性的基本要素。在目前的研究中，它与其他副主题密切相关：自豪感和喜悦感、个人关系、繁荣和道德责任。结论：护理管理应创造特殊的结构和工作条件，如灵活的工作时间安排、专业发展的机会和支持性的团队环境，以鼓励重症监护护士的专业自主权。针对个人需求和资源量身定制的措施也至关重要。这样可以培养现有的内在动机，使重症监护护士能够自主地将雇主设定的价值观识别到自己的价值体系中。对临床实践的启示：机构需要尽可能地为重症护理护士提供决策自由裁量权，广泛的信息共享，以及信任和尊重的氛围，在这种氛围中，个人可能会感到自主，并可以在个人和专业上发展。

{"title":"What motivates critical care nurses to stay in their job? – Structural aspects for empowering intrinsic motivation in permissive professional contexts: A scoping review","authors":"Dagmar Teutsch , Eckhard Frick , Jenny Kubitza","doi":"10.1016/j.iccn.2024.103929","DOIUrl":"10.1016/j.iccn.2024.103929","url":null,"abstract":"<div><h3>Objective</h3><div>In the wake of the COVID-19 pandemic, a significant number of critical care nurses have left their positions, citing overload, burnout, and moral distress. This scoping review is not just a theoretical exploration but a timely and crucial investigation into the aspects and structures of critical care nursing that can make the job fulfilling and appealing, thereby promoting intrinsic motivation and staff retention.</div></div><div><h3>Methodology</h3><div>A scoping review of studies reporting on factors that allow critical care nurses to fall back on their intrinsic job motivation. Qualitative, quantitative, and mixed methods studies from 2019 until 2023 that examined critical care nurses are included. This scoping review, which was conducted in 12 databases, follows the framework proposed by Arksey and O’Malley and the <em>PRISMA</em> framework.</div></div><div><h3>Results</h3><div>22 studies met the inclusion criteria. The thematic synthesis identified ‘meaning’ as the overarching theme. Meaning can help critical nurses identify their intrinsic motivation and hold tight to it during professional challenges or low morale. Previous studies found meaning-making as an essential element of spirituality. In the present study, it is strongly related to the other subthemes: sense of pride and joy, personal relationships, thriving, and moral responsibility.</div></div><div><h3>Conclusion</h3><div>It makes sense for care management to create specific structures and work conditions, such as flexible scheduling, opportunities for professional development, and supportive team environments that encourage critical care nurses in their professional autonomy. Measures tailored to the individual needs and resources are also crucial. In this way, existing intrinsic motivation can be nurtured, and critical care nurses are enabled to autonomously discern values set by the employer into their own value system.</div></div><div><h3>Implication for clinical practice</h3><div>Institutions need to offer critical care nurses decision-making discretion whenever possible, broad information sharing, and a climate of trust and respect, in which the individual may feel autonomous and can develop personally and professionally.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 103929"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960644","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}

引用次数: 0

Effects of DELIMA education programme on nurses’ knowledge, confidence, attitude, and screening accuracy for delirium in paediatric intensive care units DELIMA教育计划对儿科重症监护病房护士谵妄诊断知识、信心、态度及准确性的影响。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2025-01-08 DOI: 10.1016/j.iccn.2024.103938

Iftitakhur Rohmah , Diah Sukmawati Pangarsih , Sri Rahayu , Akhmad Fajri Widodo , Kai-Mei Chang , Mu-Hsing Ho , Yu-Hsin Tseng , Hsiao-Yean Chiu

Objective

To evaluate the effects of a 4-week Delirium Introduction and Maintenance programme based on the knowledge-to-action framework on nurses’ knowledge, self-confidence, attitudes, and screening accuracy for delirium in the paediatric intensive care unit (PICU).

Research Methodology/design

A quasi-experimental study with a pretest–posttest design.

Setting

This study was conducted between January and February 2024 with nurses in two Indonesian PICUs.

Main outcome measures

Nursing knowledge, self-confidence and attitudes were measured at baseline and the third and fourth weeks (maintenance period) after the intervention was implemented. The Cornell Assessment of Pediatric Delirium (CAPD) was used to evaluate the screening accuracy for delirium at the third and fourth weeks postintervention.

Results

A total of 44 nurses with a mean age of 28 years participated in the intervention. At weeks 3 and 4 after the intervention, the intervention group exhibited substantial improvements in knowledge (B = 1.35 and 1.39), self-confidence and attitudes (B = 1.26 and 1.29), and screening accuracy (B = 0.25 and 0.27) compared with the control group (all P < 0.05). The nurses’ screening accuracy for delirium by using the CAPD improved from 50 % (week 1) to 86 % (week 3) and 100 % (week 4) in the intervention group, whereas the nurses’ screening accuracy for delirium in the control group modestly increased from 17 % to 33 % (week 3) and 37 % (week 4).

Conclusions

The theory-driven, multimodal intervention improved the nurses’ knowledge of delirium, self-confidence and attitudes, and screening accuracy for delirium. Implementing comprehensive delirium education programmes can enhance delirium recognition and management in PICUs. Future studies should investigate the long-term effects of delirium education programmes on patient outcomes.

Implications for clinical practice

An integrated instructional approach was employed to improve nurses’ knowledge, self-confidence, attitudes, and screening accuracy for delirium.

目的：评价基于知识-行动框架的4周谵妄介绍和维持方案对儿科重症监护病房（PICU）护士谵妄知识、自信、态度和筛查准确性的影响。研究方法/设计：采用前测后测设计的准实验研究。环境：本研究于2024年1月至2月在两个印度尼西亚picu的护士中进行。主要观察指标：在基线及干预实施后第3、4周（维持期）测量护理知识、自信和态度。采用康奈尔儿童谵妄评估（CAPD）评估干预后第3周和第4周谵妄筛查的准确性。结果：共有44名护士参与干预，平均年龄28岁。干预后第3周和第4周，干预组在知识（B = 1.35和1.39）、自信和态度（B = 1.26和1.29）、筛查准确率（B = 0.25和0.27）方面均较对照组有显著改善（均P < 0.05）。干预组护士使用CAPD对谵妄的筛查准确率从50%（第1周）提高到86%（第3周）和100%（第4周），而对照组护士对谵妄的筛查准确率从17%适度提高到33%（第3周）和37%（第4周）。结论：理论驱动的多模式干预提高了护士对谵妄的认识、自信和态度，提高了谵妄的筛查准确率。实施全面的谵妄教育计划可以提高重症监护病房谵妄的识别和管理。未来的研究应该调查谵妄教育项目对患者预后的长期影响。对临床实践的启示：采用综合教学方法提高护士对谵妄的知识、自信、态度和筛查准确性。

{"title":"Effects of DELIMA education programme on nurses’ knowledge, confidence, attitude, and screening accuracy for delirium in paediatric intensive care units","authors":"Iftitakhur Rohmah , Diah Sukmawati Pangarsih , Sri Rahayu , Akhmad Fajri Widodo , Kai-Mei Chang , Mu-Hsing Ho , Yu-Hsin Tseng , Hsiao-Yean Chiu","doi":"10.1016/j.iccn.2024.103938","DOIUrl":"10.1016/j.iccn.2024.103938","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effects of a 4-week Delirium Introduction and Maintenance programme based on the knowledge-to-action framework on nurses’ knowledge, self-confidence, attitudes, and screening accuracy for delirium in the paediatric intensive care unit (PICU).</div></div><div><h3>Research Methodology/design</h3><div>A quasi-experimental study with a pretest–posttest design.</div></div><div><h3>Setting</h3><div>This study was conducted between January and February 2024 with nurses in two Indonesian PICUs.</div></div><div><h3>Main outcome measures</h3><div>Nursing knowledge, self-confidence and attitudes were measured at baseline and the third and fourth weeks (maintenance period) after the intervention was implemented. The Cornell Assessment of Pediatric Delirium (CAPD) was used to evaluate the screening accuracy for delirium at the third and fourth weeks postintervention.</div></div><div><h3>Results</h3><div>A total of 44 nurses with a mean age of 28 years participated in the intervention. At weeks 3 and 4 after the intervention, the intervention group exhibited substantial improvements in knowledge (B = 1.35 and 1.39), self-confidence and attitudes (B = 1.26 and 1.29), and screening accuracy (B = 0.25 and 0.27) compared with the control group (all <em>P</em> < 0.05). The nurses’ screening accuracy for delirium by using the CAPD improved from 50 % (week 1) to 86 % (week 3) and 100 % (week 4) in the intervention group, whereas the nurses’ screening accuracy for delirium in the control group modestly increased from 17 % to 33 % (week 3) and 37 % (week 4).</div></div><div><h3>Conclusions</h3><div>The theory-driven, multimodal intervention improved the nurses’ knowledge of delirium, self-confidence and attitudes, and screening accuracy for delirium. Implementing comprehensive delirium education programmes can enhance delirium recognition and management in PICUs. Future studies should investigate the long-term effects of delirium education programmes on patient outcomes.</div></div><div><h3>Implications for clinical practice</h3><div>An integrated instructional approach was employed to improve nurses’ knowledge, self-confidence, attitudes, and screening accuracy for delirium.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103938"},"PeriodicalIF":4.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960511","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

Mobility in a cardiac surgery intensive care unit: A behaviour mapping study 心脏外科重症监护病房的移动性：一项行为映射研究。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-12-28 DOI: 10.1016/j.iccn.2024.103918

Emily K. Phillips , Mudra G. Dave , Maureen C. Ashe , Annette S.H. Schultz , Sheila O’Keefe-McCarthy , Rakesh C. Arora , Todd A. Duhamel

Purpose

Mobilization within 24 h post-cardiac surgery (CS) supports improved patient health outcomes. Despite being safe and recommended, it is unknown how much mobility takes place post-CS in the intensive care unit (ICU). Behaviour mapping was used to describe patterns of patients’ mobility in one CS ICU.

Materials and methods

Behaviour mapping gathers information on behaviour regularly over a time period. Two authors observed one CS ICU over a sixteen-hour period (0630–2230 h) on four days. Observers collected data on patients’ mobility mode, location, and support at 15-minute intervals. Data aggregated into four-hour time blocks is described.

Results

A total of 1342 observations were collected over four days: 487 of mode, 485 of location, and 370 of support. Sitting in a chair was observed 430 of 487 observations, 10-fold more than any other mode of mobility. Mobility within the ICU room was observed in 448 of 485 observations. Family support for mobility was observed in 178 of 370 observations. The most common time block for mobilization was from 0630 to 1030, with 488 of 1342 observations.

Conclusions

Research is required to support the integration of early mobility beyond sitting in a chair supported by more team members into local CS ICU clinical care.

Implications for clinical practice

The existence of early mobility protocols does not mean that they are operational in the CS ICU. Integration of these protocols into CS ICU clinical care requires collaboration among researchers and clinicians.

目的：心脏手术后24小时内的活动有助于改善患者的健康状况。尽管安全且被推荐，但目前尚不清楚cs后在重症监护室（ICU）有多少活动。行为映射用于描述一个CS ICU中患者的活动模式。材料和方法：行为映射在一段时间内定期收集行为信息。两位作者对一个CS ICU进行了为期四天的16小时（06:30 -2230小时）观察。观察员每隔15分钟收集患者活动方式、位置和支持的数据。数据汇总成四个小时的时间块描述。结果：在4天内共收集了1342个观测值，其中487个是模式观测值，485个是位置观测值，370个是支持观测值。在487项观察中，有430项是坐在椅子上的，是其他移动方式的10倍。485例观察中有448例观察到ICU病房内的活动能力。在370项观察中，有178项观察到家庭对流动性的支持。最常见的动员时间段是06:30至1030,1342次观测中有488次。结论：需要进行研究，以支持将早期活动整合到当地CS ICU临床护理中，而不是由更多的团队成员支持坐在椅子上。对临床实践的启示：早期活动方案的存在并不意味着它们在CS ICU中是可操作的。将这些方案整合到CS ICU临床护理中需要研究人员和临床医生之间的合作。

{"title":"Mobility in a cardiac surgery intensive care unit: A behaviour mapping study","authors":"Emily K. Phillips , Mudra G. Dave , Maureen C. Ashe , Annette S.H. Schultz , Sheila O’Keefe-McCarthy , Rakesh C. Arora , Todd A. Duhamel","doi":"10.1016/j.iccn.2024.103918","DOIUrl":"10.1016/j.iccn.2024.103918","url":null,"abstract":"<div><h3>Purpose</h3><div>Mobilization within 24 h post-cardiac surgery (CS) supports improved patient health outcomes. Despite being safe and recommended, it is unknown how much mobility takes place post-CS in the intensive care unit (ICU). Behaviour mapping was used to describe patterns of patients’ mobility in one CS ICU.</div></div><div><h3>Materials and methods</h3><div>Behaviour mapping gathers information on behaviour regularly over a time period. Two authors observed one CS ICU over a sixteen-hour period (0630–2230 h) on four days. Observers collected data on patients’ mobility mode, location, and support at 15-minute intervals. Data aggregated into four-hour time blocks is described.</div></div><div><h3>Results</h3><div>A total of 1342 observations were collected over four days: 487 of mode, 485 of location, and 370 of support. Sitting in a chair was observed 430 of 487 observations, 10-fold more than any other mode of mobility. Mobility within the ICU room was observed in 448 of 485 observations. Family support for mobility was observed in 178 of 370 observations. The most common time block for mobilization was from 0630 to 1030, with 488 of 1342 observations.</div></div><div><h3>Conclusions</h3><div>Research is required to support the integration of early mobility beyond sitting in a chair supported by more team members into local CS ICU clinical care.</div></div><div><h3>Implications for clinical practice</h3><div>The existence of early mobility protocols does not mean that they are operational in the CS ICU. Integration of these protocols into CS ICU clinical care requires collaboration among researchers and clinicians.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103918"},"PeriodicalIF":4.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904600","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}

引用次数: 0

Determinants of digital ICU diary implementation and use by ICU professionals: A cross-sectional survey analysis 数字ICU日记实施和ICU专业人员使用的决定因素：横断面调查分析。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-12-28 DOI: 10.1016/j.iccn.2024.103921

Carola M.A. Schol , Erwin Ista , Martin Rinket , Elke Berger , Diederik A.M.P.J. Gommers , Margo M.C. van Mol

Objectives

To identify the key determinants for implementing and utilizing a digital intensive care unit (ICU) diary among ICU professionals.

Background

Despite the advantages of digital diaries over traditional paper ones, their implementation presents challenges that necessitate tailored strategies considering the influencing factors.

Design

A multicentre, cross-sectional survey study.

Methods

A self-developed questionnaire was administered from March to May 2023, targeting ICU professionals across four hospitals in the Netherlands. Participants rated the relevance of 34 determinants on a 5-point Likert scale across four domains: (1) Digital diary introduction and use, (2) Education and information dissemination, (3) Offering the digital diary to patients’ relatives, and (4) Professionals’ engagement in diary writing.

Results

Responses were received from 214 professionals. The most commonly agreed-upon determinants promoting implementation were seamless accessibility (n = 200; 93.5 %), enthusiastic and motivating champions (n = 190; 88.8 %), and comprehensive information and education (n = 184; 86 %). The preferred method for disseminating information was direct instruction from champions in the teams (n = 194; 90.7 %). Promoting factors for providing digital diaries to relatives included understanding its utility (n = 203; 94.9 %) and recognizing its added value (n = 193; 90.2 %). Additionally, 132 professionals (61.7 %) expressed a positive attitude towards co-writing the digital diary.

Conclusion

This study identified key determinants promoting the implementation and utilization of digital diaries in ICUs among professionals. These findings lay a foundation for developing strategies to address challenges and enhance the successful implementation of digital diaries in ICU settings.

Implications for clinical practice

To maximize the impact of digital diaries, it is essential to involve end users early and tailor the design for ease of use. Selecting influential champions is key, and they should receive training to lead and mentor others. Clear communication of the benefits for patients and families will foster professionals’ understanding and motivation, ultimately enhancing patient care.

目的：确定在ICU专业人员中实施和使用数字重症监护病房（ICU）日记的关键因素。背景：尽管数字日记比传统的纸质日记有优势，但它们的实施面临挑战，需要考虑到影响因素的量身定制策略。设计：多中心横断面调查研究。方法：于2023年3月至5月对荷兰四家医院的ICU专业人员进行自行开发的问卷调查。参与者在5点李克特量表上对四个领域的34个决定因素的相关性进行了评级：(1)数字日记的介绍和使用，(2)教育和信息传播，(3)向患者亲属提供数字日记，以及(4)专业人员参与日记写作。结果：收到214名专业人士的回复。促进实施的最普遍商定的决定因素是无缝可及性(n = 200；93.5%)，热情和激励的冠军(n = 190；88.8%)，综合信息教育(n = 184；86%)。传播信息的首选方法是来自球队冠军的直接指导(n = 194；90.7%)。向亲属提供数字日记的促进因素包括了解其效用(n = 203；94.9%)并承认其附加值(n = 193；90.2%)。此外，132名专业人士（61.7%）对共同撰写数字日记持积极态度。结论：本研究确定了促进icu专业人员实施和利用数字日记的关键决定因素。这些发现为制定应对挑战的战略奠定了基础，并提高了ICU环境中数字日记的成功实施。对临床实践的影响：为了最大限度地发挥数字日记的影响，尽早让最终用户参与进来，并为易用性量身定制设计是至关重要的。选择有影响力的拥护者是关键，他们应该接受领导和指导他人的培训。清晰的沟通对病人和家属的好处将促进专业人员的理解和动力，最终提高病人的护理。

{"title":"Determinants of digital ICU diary implementation and use by ICU professionals: A cross-sectional survey analysis","authors":"Carola M.A. Schol , Erwin Ista , Martin Rinket , Elke Berger , Diederik A.M.P.J. Gommers , Margo M.C. van Mol","doi":"10.1016/j.iccn.2024.103921","DOIUrl":"10.1016/j.iccn.2024.103921","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify the key determinants for implementing and utilizing a digital intensive care unit (ICU) diary among ICU professionals.</div></div><div><h3>Background</h3><div>Despite the advantages of digital diaries over traditional paper ones, their implementation presents challenges that necessitate tailored strategies considering the influencing factors.</div></div><div><h3>Design</h3><div>A multicentre, cross-sectional survey study.</div></div><div><h3>Methods</h3><div>A self-developed questionnaire was administered from March to May 2023, targeting ICU professionals across four hospitals in the Netherlands. Participants rated the relevance of 34 determinants on a 5-point Likert scale across four domains: (1) Digital diary introduction and use, (2) Education and information dissemination, (3) Offering the digital diary to patients’ relatives, and (4) Professionals’ engagement in diary writing.</div></div><div><h3>Results</h3><div>Responses were received from 214 professionals. The most commonly agreed-upon determinants promoting implementation were seamless accessibility (n = 200; 93.5 %), enthusiastic and motivating champions (n = 190; 88.8 %), and comprehensive information and education (n = 184; 86 %). The preferred method for disseminating information was direct instruction from champions in the teams (n = 194; 90.7 %). Promoting factors for providing digital diaries to relatives included understanding its utility (n = 203; 94.9 %) and recognizing its added value (n = 193; 90.2 %). Additionally, 132 professionals (61.7 %) expressed a positive attitude towards co-writing the digital diary.</div></div><div><h3>Conclusion</h3><div>This study identified key determinants promoting the implementation and utilization of digital diaries in ICUs among professionals. These findings lay a foundation for developing strategies to address challenges and enhance the successful implementation of digital diaries in ICU settings.</div></div><div><h3>Implications for clinical practice</h3><div>To maximize the impact of digital diaries, it is essential to involve end users early and tailor the design for ease of use. Selecting influential champions is key, and they should receive training to lead and mentor others. Clear communication of the benefits for patients and families will foster professionals’ understanding and motivation, ultimately enhancing patient care.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103921"},"PeriodicalIF":4.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904587","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}

引用次数: 0