Intensive and Critical Care Nursing最新文献_第9页

The relationship between spiritual climate and secondary traumatic stress in ICU nurses: The mediating role of moral resilience ICU护士精神气候与继发性创伤应激的关系：道德弹性的中介作用。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-12-05 DOI: 10.1016/j.iccn.2024.103815

Mengyi Hu , Yan Wang , Hongli Zhang , Chao Wu , Xinhui Liang , Yu Zhang , Hongjuan Lang

Background

Secondary traumatic stress is acknowledged as a substantial psychological risk factor in nursing practice with the potential to negatively impact nurses’ mental health. However, little is known about the mechanisms underlying the spiritual climate and secondary traumatic stress among ICU nurses.

Objectives

This study aimed to assess the spiritual climate, moral resilience, and secondary traumatic stress in Chinese ICU nurses and to investigate whether moral resilience mediates the relationship between spiritual climate and secondary traumatic stress.

Methods

A cross-sectional study design was used to recruit 229 intensive care unit nurses. The nurses completed online questionnaires comprising demographic characteristics, spiritual climate, moral resilience, and secondary traumatic stress. Data analysis and structural equation modeling were conducted using SPSS 26.0 and AMOS 24.0.

Results

STS scores were (38.42 ± 13.27). Secondary traumatic stress was correlated with spiritual climate and moral resilience (r₁ = −0.370, r₂ = −0.575; p < 0.01), and spiritual climate was positively correlated with moral resilience (r = 0.427; p < 0.01). A mediating effect of moral resilience between spiritual climate and secondary traumatic stress held (mediating effect of 0.235, 95 % CI: −2.108 to −0.823, accounting for 57.32 % of the total effect).

Conclusions

The spiritual climate has a significant direct influence on secondary traumatic stress in ICU nurses and serves to reduce their secondary traumatic stress through moral resilience. Creating a positive spiritual climate and enhancing the moral resilience of ICU nurses are effective methods to reduce their secondary traumatic stress.

Implications for clinical practice

This study highlights that the spiritual climate for ICU nurses can reduce their secondary traumatic stress, and that moral resilience diminishes the secondary traumatic stress related to the spiritual climate. Establishing support systems and improving the environment are primary tasks for nursing administrators. These include, but are not limited to, improving the spiritual climate of the department, providing moral resilience training, and taking other measures to prevent and regulate secondary traumatic stress in ICU nurses in order to maintain their mental health.

背景：在护理实践中，继发性创伤应激被认为是一个重要的心理风险因素，有可能对护士的心理健康产生负面影响。然而，对ICU护士的精神气候和继发性创伤应激的机制知之甚少。目的：本研究旨在评估中国ICU护士的精神气候、道德弹性和继发性创伤应激，并探讨道德弹性是否在精神气候和继发性创伤应激之间起中介作用。方法：采用横断面研究设计，招募229名重症监护室护士。护士完成了包括人口特征、精神气候、道德恢复力和继发性创伤压力的在线问卷。采用SPSS 26.0和AMOS 24.0进行数据分析和结构方程建模。结果：STS评分为（38.42±13.27）分。继发性创伤应激与精神气候、道德弹性相关(r1 = -0.370, r2 = -0.575；结论：精神氛围对ICU护士的二次创伤应激有显著的直接影响，并可通过道德弹性降低护士的二次创伤应激。营造积极向上的精神氛围，增强ICU护士的道德韧性，是减轻其继发性创伤应激的有效方法。对临床实践的启示：本研究强调ICU护士的精神气候可以减少其继发性创伤应激，道德弹性可以减少与精神气候相关的继发性创伤应激。建立支持系统和改善环境是护理管理者的首要任务。这些措施包括但不限于改善科室的精神氛围，提供道德韧性培训，以及采取其他措施预防和调节ICU护士的继发性创伤应激，以保持其心理健康。

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引用次数: 0

Family perspectives on physical restraint practices and minimization in an adult intensive care unit: A qualitative descriptive study 成人重症监护病房中身体约束实践和最小化的家庭观点：一项定性描述性研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-12-01 DOI: 10.1016/j.iccn.2024.103901

Ziad Alostaz , Louise Rose , Sangeeta Mehta , Linda Johnston , Craig Dale

Objective

To explore family perspectives on physical restraint practices and their minimization in an adult intensive care unit.

Design & Methods

A qualitative descriptive study with one-on-one semi-structured interviews. A deductive content analysis approach was undertaken using the Theoretical Domains Framework.

Setting

A 20-bed medical, surgical, trauma ICU in Toronto, Canada.

Findings

Fifteen family members were interviewed. Three themes emerged: (i) barriers and facilitators to restraint minimization. Barriers noted by families included patient agitation posing risks of losing endotracheal tubes, nurse reluctance to remove restraints, lack of family involvement, limited knowledge of alternatives, and a noisy environment. Facilitators included family involvement in decision-making, timely extubation, use of less restrictive alternatives such as mittens, mandating shorter periods of restraints application, and environmental modifications; (ii) unilateral decision-making regarding physical restraint use, where clinicians made decisions with inadequate communication with families nor obtaining consent; and (iii) the emotional impact of physical restraint use, with families experiencing sadness and shock and believing the patient would feel similarly.

Conclusion

This qualitative study highlights significant issues surrounding the use of physical restraints, particularly the lack of family involvement in decision-making, the emotional toll on families, and various barriers and facilitators to minimizing restraint use. Effective communication and collaboration between clinicians and families are crucial to addressing these issues.

Implications for Clinical Practice

Our findings underscore the critical need to enhance communication between clinicians and families, alongside consent processes. Identifying barriers and facilitators at various levels can inform individualized strategies to reduce restraint use, including integrating alternatives like mittens and involving families in care. Timely introduction of alternatives and family involvement are vital to prevent further emotional distress for families. Prioritizing the reduction of restraint duration is crucial, particularly in settings emphasizing harm minimization.

目的探讨家庭对成人重症监护病房中肢体约束的影响及其最小化措施。设计,方法采用一对一半结构化访谈法进行定性描述性研究。使用理论领域框架进行演绎内容分析方法。加拿大多伦多拥有20张床位的内科、外科、创伤重症监护室。调查结果15名家庭成员接受了采访。出现了三个主题：(i)尽量减少限制的障碍和促进因素。家属注意到的障碍包括患者躁动造成丢失气管内管的风险，护士不愿拆除束缚物，缺乏家庭参与，对替代方案的了解有限，以及嘈杂的环境。促进因素包括家庭参与决策，及时拔管，使用限制较少的替代品，如连指手套，强制缩短限制的使用时间，以及环境的改变；（ii）关于使用身体约束的单方面决策，临床医生在与家属沟通不足或未获得同意的情况下做出决定；（三）使用身体约束的情感影响，家属经历悲伤和震惊，并相信患者会有类似的感受。本定性研究强调了围绕身体约束使用的重要问题，特别是缺乏家庭参与决策，对家庭的情感伤害，以及减少约束使用的各种障碍和促进因素。临床医生和家庭之间的有效沟通和合作对于解决这些问题至关重要。对临床实践的启示我们的研究结果强调了加强临床医生和家庭之间的沟通以及同意程序的关键必要性。确定各个层面的障碍和促进因素，可以为减少约束使用的个性化战略提供信息，包括将连指手套等替代方案结合起来，并让家庭参与护理。及时引入替代方案和家庭参与对于防止家庭进一步的情绪困扰至关重要。优先考虑减少约束时间至关重要，特别是在强调尽量减少伤害的情况下。

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引用次数: 0

Effectiveness of non-pharmacological interventions for pain reduction following chest tube removal: A systematic review and network meta-analysis 非药物干预对胸管拔除后疼痛减轻的有效性：系统回顾和网络荟萃分析

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-29 DOI: 10.1016/j.iccn.2024.103909

Chun-Sheng Tsai , Heng-Hsin Tung , Ching-Ju Fang , Chia-Te Chen

Objective

This study aimed to determine the most effective non-pharmacological intervention for pain relief following chest tube removal in adult patients.

Methods

We performed a systematic review with network meta-analysis, searching electronic databases for randomized controlled trials up to January 20, 2024. Compared to control or placebo groups, the trials included adult patients receiving non-pharmacological interventions, such as cold therapy, relaxation exercises, music therapy, transcutaneous electrical nerve stimulation, or aromatherapy. Data analysis utilized a random-effects model, reporting standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment ranking was determined through surface under the cumulative ranking analysis and forest plots.

Results

Sixteen studies enrolling 1,342 patients were included, with moderate to high heterogeneity. Cold therapy and relaxation exercises effectively reduced pain after chest tube removal, with SMD of −1.84 (95 % CI: −2.81 to −0.87) and −2.04 (95 % CI: −3.43 to −0.65), respectively, from baseline to immediately post-removal. From baseline to ten to twenty minutes after removal, both therapies continued to show significant pain reduction, with SMD of −1.96 (95 % CI: −3.14 to −0.77) for cold therapy and −2.01 (95 % CI: −3.75 to −0.28) for relaxation exercises. Sensitivity analysis supported these findings, and cold therapy’s efficacy appeared unaffected by obesity. However, publication bias, possibly due to small study samples, was noted.

Conclusions

Cold therapy and relaxation exercises proved most effective for reducing pain immediately and up to ten to twenty minutes after chest tube removal. Given their cost-effectiveness, lack of side effects, and ease of use, we recommend relaxation exercises as a practical alternative to cold therapy. Nonetheless, further studies are needed to comprehensively assess non-pharmacological options for managing chest tube removal pain.

Implications for clinical practice

Incorporate cold therapy and relaxation exercises into post-chest tube removal pain management to improve patient comfort and minimize reliance on pharmacological interventions.

目的探讨成人患者胸管拔除后疼痛的最有效非药物干预方法。方法采用网络荟萃分析方法，检索截至2024年1月20日的随机对照试验电子数据库，进行系统评价。与对照组或安慰剂组相比，试验包括接受非药物干预的成年患者，如冷疗法、放松练习、音乐疗法、经皮神经电刺激或芳香疗法。数据分析采用随机效应模型，报告95%可信区间（CI）的标准化平均差异（SMD），并在累积排序分析和森林样地下通过表面确定处理等级。结果纳入16项研究，共1342例患者，异质性中等至高度。冷疗法和放松练习有效地减轻了胸管取出后的疼痛，从基线到取出后立即，SMD分别为- 1.84 （95% CI: - 2.81至- 0.87）和- 2.04 （95% CI: - 3.43至- 0.65）。从基线到移除后10到20分钟，两种疗法都继续显示出显著的疼痛减轻，冷疗法的SMD为- 1.96 (95% CI: - 3.14至- 0.77)，放松练习的SMD为- 2.01 （95% CI: - 3.75至- 0.28）。敏感性分析支持这些发现，冷疗法的疗效似乎不受肥胖的影响。然而，可能由于研究样本小，发表偏倚也被注意到了。结论：胸腔管拔除后10 ~ 20分钟内，胸腔管拔除后10 ~ 20分钟内，胸腔管拔除后疼痛的缓解效果最好。考虑到它们的成本效益，缺乏副作用，并且易于使用，我们推荐放松练习作为冷疗法的实用替代方案。尽管如此，需要进一步的研究来全面评估治疗胸管拔管疼痛的非药物选择。对临床实践的启示：将冷疗法和放松练习纳入胸管拔管后疼痛管理，以提高患者舒适度，减少对药物干预的依赖。

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引用次数: 0

Multidisciplinary healthcare Professionals’ attitudes towards family engagement in the adult intensive care unit 多学科医疗专业人员对成人重症监护病房家庭参与的态度

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-29 DOI: 10.1016/j.iccn.2024.103896

Brigitte Cypress , Rida Gharzeddine , Mei Rosemary Fu , Thomas Dahan , Samantha Abate

Objectives

Family engagement in the intensive care unit (ICU) is a crucial aspect of healthcare delivery, yet it remains an inconsistent practice and an understudied area of healthcare for adult patients in the ICU. This study aimed to explore the attitudes of healthcare professionals (e.g., registered nurses (RNs), physicians, pharmacists, respiratory therapists, social workers, and dietitians) on family engagement in the adult ICU and to elucidate factors that impact these attitudes.

Methods

We used descriptive cross-sectional analysis to explore the attitudes of a sample of 90 healthcare professionals toward family engagement in the ICU for adult patients. Data were collected using the Families’ Importance in Nursing Care-Nurses’ Attitudes (FINC-NA) questionnaire. The data were analyzed using descriptive statistics and multiple linear regression.

Main Outcome Measures

Healthcare professionals’ attitudes towards family engagement in the ICU varied across different professional roles and were associated with years of experience. Results demonstrated that physicians had the highest positive attitude score towards family engagement on the total attitude scale and the family as a resource.

Implications to Nursing Practice

Understanding the attitudes of healthcare professionals is a crucial step toward developing evidence-based interventions that can facilitate family engagement in care for adult patients in the ICU. Cultivating a partnership culture with patients’ families in the ICU is crucial, but interventions are needed to enhance nurses’ and other healthcare professionals’ attitudes toward family engagement. Specialized training, resources, and institutional policies supporting nurses and other providers in family care are essential to promote positive attitudes toward family engagement. A collective effort is required to change the culture and practice of family engagement by implementing evidence-based policies and guidelines. The study’s findings provided significant insights that may shape and improve healthcare practice, particularly in the ICU.

目的重症监护病房（ICU）的家庭参与是医疗保健服务的一个重要方面，但它仍然是一个不一致的做法，并且是ICU成人患者医疗保健的一个未充分研究的领域。本研究旨在探讨成人ICU医护人员（如注册护士、医师、药师、呼吸治疗师、社工及营养师）对家庭参与的态度，并探讨影响这些态度的因素。方法采用描述性横断面分析，探讨90名医护人员对成人ICU患者家庭参与的态度。采用家庭护理重要性-护士态度问卷（FINC-NA）收集数据。采用描述性统计和多元线性回归对数据进行分析。主要结果测量：ICU医护人员对家庭参与的态度因专业角色的不同而不同，且与工作年限有关。结果显示，医生在总态度量表上对家庭参与的积极态度得分最高，家庭作为一种资源。对护理实践的启示了解医护人员的态度是开发循证干预措施的关键一步，这些干预措施可以促进ICU成年患者的家庭参与。在ICU中培养与患者家属的伙伴关系文化至关重要，但需要采取干预措施来提高护士和其他医疗保健专业人员对家庭参与的态度。支持护士和其他家庭护理提供者的专业培训、资源和制度政策对于促进对家庭参与的积极态度至关重要。需要集体努力，通过实施基于证据的政策和指导方针，改变家庭参与的文化和做法。该研究的发现提供了重要的见解，可能塑造和改善医疗保健实践，特别是在ICU。

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引用次数: 0

Sustainability in ICU: Less plastic, greener future – Response to Lucchini et al. 重症监护室的可持续性：减少塑料，绿色未来--对 Lucchini 等人的回应

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-27 DOI: 10.1016/j.iccn.2024.103914

Mohamed H. Eid, Kevin Hambridge, Patricia Schofield, Jos M. Latour

引用次数: 0

The ongoing challenge: ICU and beyond − managing nursing workload 持续的挑战：重症监护室及其他--管理护理工作量

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-27 DOI: 10.1016/j.iccn.2024.103917

Alberto Lucchini, Lilia de Souza Nogueira, Stefano Bambi

引用次数: 0

Obesity paradox of sepsis in long-term outcome: The differential effect of body composition 脓毒症肥胖悖论的长期结果：身体成分的不同影响

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-27 DOI: 10.1016/j.iccn.2024.103893

Hye Ju Yeo , Ha Lim Kim , Min Wook So , Jong Myung Park , Dohyung Kim , Woo Hyun Cho

Background

The obesity paradox has been widely studied recently; however, its impact on the long-term prognosis of sepsis and the protective mechanism of body mass have not yet been sufficiently revealed.

Methods

We retrospectively evaluated the association between obesity and 1-year survival after sepsis in a single university-affiliated hospital and examined the differential effects of muscle mass and adiposity.

Results

Adult patients with sepsis or septic shock (n = 1492) were classified into obese (n = 300) and nonobese (n = 1192) groups. One-year mortality due to sepsis was lower in the obese than in the nonobese (52.0 % vs. 64.8 %; p < 0.001). In multivariate Cox analysis, one-year mortality due to sepsis was independently associated with body mass index (BMI) (hazard ratio 0.96). In the subgroup analysis, 705 were divided into four groups according to the psoas muscle index (PMI) and body fat percentage (BFP) to assess the differential impact of body fat and muscle mass on the one-year outcome of sepsis. One-year mortality was significantly different among the four groups (high BFP/low PMI, 60.6 %; high BFP/high PMI, 42.1 %; low BFP/high PMI, 34.8 %; low BFP/low PMI, 63.2 %; p = 0.002). The adjusted hazards ratio of one-year mortality of sepsis, which was normalized to the low BFP/high PMI group, were 1.2 (p = 0.585), 2.2 (p = 0.016), and 2.3 (p = 0.009) in groups of high BFP/high PMI, high BFP/low PMI, and low BFP/low PMI, respectively.

Conclusion

An obesity paradox has been observed in the long-term outcomes of patients with sepsis, and muscle mass may be more critical than fat mass as a protective mechanism against obesity.

Implications for clinical practice

A high BMI is linked to a more favorable long-term prognosis in sepsis, with muscle mass playing a more critical role than fat mass. A proactive nutritional and conditioning program may benefit patients anticipating major procedures and potential ICU admission. Such preparation could enhance their resilience and improve outcomes when facing critical illness, including sepsis.

方法我们在一家大学附属医院回顾性评估了肥胖与败血症后 1 年存活率之间的关系，并研究了肌肉质量和脂肪含量的不同影响。结果成人败血症或脓毒性休克患者（n = 1492）被分为肥胖组（n = 300）和非肥胖组（n = 1192）。肥胖组患者因败血症导致的一年死亡率低于非肥胖组（52.0 % vs. 64.8 %; p <0.001）。在多变量 Cox 分析中，败血症导致的一年期死亡率与体重指数（BMI）密切相关（危险比为 0.96）。在亚组分析中，根据腰肌指数（PMI）和体脂百分比（BFP）将 705 人分为四组，以评估体脂和肌肉质量对败血症一年期结果的不同影响。四个组别的一年死亡率有明显差异（高体脂率/低腰肌指数，60.6%；高体脂率/高腰肌指数，42.1%；低体脂率/高腰肌指数，34.8%；低体脂率/低腰肌指数，63.2%；P = 0.002）。与低 BFP/ 高 PMI 组相比，高 BFP/ 高 PMI 组、高 BFP/ 低 PMI 组和低 BFP/ 低 PMI 组一年脓毒症死亡率的调整后危险比分别为 1.2（p = 0.585）、2.2（p = 0.016）和 2.3（p = 0.009）。对临床实践的启示高体重指数与败血症患者更有利的长期预后有关，肌肉质量比脂肪质量发挥着更关键的作用。积极主动的营养和调理计划可能会使预计接受重大手术和可能入住重症监护室的患者受益。这样的准备工作可以增强他们在面对危重疾病（包括败血症）时的应变能力并改善预后。

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引用次数: 0

Corrigendum to “Music as healing in ICU survivors: The road ahead in seeking the right tone” [Intensive Crit Care Nurs. 86 (2025) 103828] 重症监护室幸存者的音乐治疗：寻求正确音调的前行之路" [Intensive Crit Care Nurs.

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-27 DOI: 10.1016/j.iccn.2024.103919

Meropi Mpouzika , Margo van Mol

引用次数: 0

Challenges perceived by pediatric intensive care unit nurses in caring for maltreated children and adolescents: A qualitative phenomenological study 儿科重症监护室护士在护理受到虐待的儿童和青少年时遇到的挑战：定性现象学研究

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-25 DOI: 10.1016/j.iccn.2024.103887

Po-Lin Huang , Ching-Hsuan Lin , Wei-Chieh Tseng , Bih-Shya Gau

Objectives

This study explores the challenges and experiences faced by paediatric intensive care unit (PICU) nurses while caring for maltreated paediatric patients. Research Methodology/Design: A qualitative study was conducted using face-to-face semi-structured interviews from February to May 2022. The data were transcribed verbatim and a simple thematic analysis was used.

Setting

Twenty PICU nurses from National Taiwan University Children’s Hospital were recruited through purposive and snowball sampling.

Findings

Ten sub-themes were identified and synthesised into three primary themes: ‘unstable nurse-patient relationships’, highlighting the tensions and communication challenges between nurses, and the families of maltreated children and adolescents; ‘insufficient pertinent competencies in handling child maltreatment’, pointing to nurses’ lack of sensitivity, experience, and requisite skills for addressing child maltreatment; and ‘challenges in multidisciplinary team collaboration’, which underscores nurses’ feelings of being overwhelmed and apprehensions regarding the continuity of care as various professional teams are involved.

Conclusion

PICU nurses face considerable stress while caring for maltreated children and adolescents. This can be attributed to unstable nurse-patient relationships, insufficient care-related competencies of nurses, and the complexities introduced by multidisciplinary team interventions. Therefore, priority actions include continuous in-service education, sharing pertinent professional experiences, enhancing nurses’ sensitivity toward maltreatment, establishing standard operating procedures, and developing comprehensive case management systems and multidisciplinary expertise tailored to the needs of PICU nurses.

Implications for clinical practice

Understanding the stressors and challenges encountered by PICU nurses in caring for maltreated children and adolescents can guide the design and implementation of interventions by current hospital decision-making bodies or child protection medical centres to enhance the clinical working environment. These interventions can aim to bolster the competencies of nurses and promote joint efforts in delivering superior medical care.

研究目的：本研究探讨儿科重症监护室（PICU）护士在护理受虐待儿科病人时所面临的挑战和经验。研究方法/设计：在 2022 年 2 月至 5 月期间，采用面对面半结构化访谈的方式进行了一项定性研究。研究背景：通过目的性抽样和滚雪球抽样，从台湾大学附属儿童医院招募了 20 名 PICU 护士。结果确定了十个次主题，并将其归纳为三个主要主题：不稳定的护患关系"，强调了护士与受虐待儿童和青少年家属之间的紧张关系和沟通挑战；"处理儿童虐待的相关能力不足"，指出护士缺乏处理儿童虐待问题的敏感性、经验和必要技能；以及 "多学科团队合作的挑战"，强调了护士的不知所措感，以及对不同专业团队参与护理的连续性的担忧。结论PICU 护士在护理受虐待儿童和青少年时面临着巨大的压力。这可归因于不稳定的护患关系、护士护理相关能力不足以及多学科团队干预带来的复杂性。因此，优先采取的行动包括持续的在职教育、分享相关的专业经验、提高护士对虐待问题的敏感性、建立标准操作程序、针对 PICU 护士的需求开发全面的个案管理系统和多学科专业知识。这些干预措施旨在提高护士的能力，促进共同努力，提供优质的医疗护理服务。

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引用次数: 0

Patient-psychologist telemedicine interactions in an intensive care unit recovery clinic: Qualitative secondary analysis 重症监护室康复诊所中患者与心理医生之间的远程医疗互动：定性二次分析。

IF 4.9 2区医学 Q1 NURSING

Intensive and Critical Care Nursing

Pub Date : 2024-11-21 DOI: 10.1016/j.iccn.2024.103886

Ali A. Hussain , Abigail C. Jones , Megan M. Hosey , Amy Kiehl , Valerie Danesh , Joanne McPeake , Kelly Toth , Tammy L. Eaton , Han Su , James C. Jackson , Leanne M. Boehm

Objectives

We aimed to describe the content of patient-psychologist mental health related dialogues during a telemedicine intensive care unit recovery clinic visit.

Research methodology/design

Qualitative descriptive study nested within a randomized controlled pilot trial to assess a telemedicine intensive care unit recovery clinic feasibility and preliminary efficacy. Participants included adults hospitalized with sepsis and/or respiratory failure. Telemedicine visits occurred at 3- and 12-weeks post-discharge involving a critical care pharmacist, physician, and psychologist. The psychologist conducted cognitive and mental health screenings, providing tailored brief psychotherapy and education. Audio-recorded visits were transcribed verbatim and underwent inductive reflexive thematic analysis.

Setting

Intensive care unit recovery clinic at an academic medical center in the southeastern United States.

Main outcome measures

N/A.

Findings

17 participants completed 31 telemedicine intensive care unit recovery clinic visits between December 2019 and March 2022. Caregivers participated in 13 visits. Participant experiences and psychologist responses were identified and separated into two overarching themes: 1) Patient-Identified Challenges and 2) Psychologist-Delivered Strategies. Patient subthemes included 1) mental health challenges (negative thoughts), 2) minimization of mental health impact, and 3) use of coping methods. Psychologist subthemes included 1) rapport building and validation 2) use of psychological assessments, and 3) psychological interventions.

Conclusion

The collaborative effort, including a psychologist, exemplifies the role of a mental health professional within the multidisciplinary intensive care unit recovery clinic team, contributing to a comprehensive approach in identifying and managing post-intensive care syndrome impairments. The focus extends to shaping compassionate care strategies for addressing mental health challenges associated with post-intensive care syndrome, fostering a holistic approach to whole-person recovery.

Implications for clinical practice

A mental health professional (e.g., psychologist, psychiatrist, psychiatric nurse practitioner) can contribute to shaping care strategies for the mental health symptoms associated with post-intensive care syndrome, fostering whole-person recovery after hospital discharge.

Clinical trial registration number

NCT03926533.

研究目的研究方法/设计：定性描述研究嵌套于随机对照试验中，以评估远程医疗重症监护病房康复门诊的可行性和初步疗效。参与者包括因败血症和/或呼吸衰竭住院的成人。重症监护药剂师、医生和心理学家分别在出院后 3 周和 12 周进行了远程医疗访问。心理学家进行认知和心理健康筛查，提供有针对性的简短心理治疗和教育。对访谈录音进行逐字转录，并进行归纳反思式主题分析：地点：美国东南部一家学术医疗中心的重症监护室康复诊所：不详：17 名参与者在 2019 年 12 月至 2022 年 3 月期间完成了 31 次远程医疗重症监护病房恢复门诊访问。护理人员参与了 13 次探访。对参与者的经历和心理学家的回应进行了识别，并将其分为两个总体主题：1）患者确定的挑战和 2）心理学家提供的策略。患者的次主题包括：1）心理健康挑战（消极想法）；2）尽量减少心理健康影响；3）使用应对方法。心理学家的次主题包括：1）建立默契和验证；2）使用心理评估；3）心理干预：包括心理学家在内的合作努力体现了心理健康专业人员在多学科重症监护病房康复门诊团队中的作用，有助于采用综合方法识别和管理重症监护后综合征的损伤。该研究的重点延伸到了为应对与重症监护后综合征相关的心理健康挑战而制定的关怀策略，促进了全人康复的整体方法：对临床实践的启示：心理健康专业人士（如心理学家、精神科医生、精神科护士）可以帮助制定护理策略，以应对与重症监护后综合征相关的心理健康症状，促进出院后的全人康复：临床试验注册号：NCT03926533。

{"title":"Patient-psychologist telemedicine interactions in an intensive care unit recovery clinic: Qualitative secondary analysis","authors":"Ali A. Hussain , Abigail C. Jones , Megan M. Hosey , Amy Kiehl , Valerie Danesh , Joanne McPeake , Kelly Toth , Tammy L. Eaton , Han Su , James C. Jackson , Leanne M. Boehm","doi":"10.1016/j.iccn.2024.103886","DOIUrl":"10.1016/j.iccn.2024.103886","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to describe the content of patient-psychologist mental health related dialogues during a telemedicine intensive care unit recovery clinic visit.</div></div><div><h3>Research methodology/design</h3><div>Qualitative descriptive study nested within a randomized controlled pilot trial to assess a telemedicine intensive care unit recovery clinic feasibility and preliminary efficacy. Participants included adults hospitalized with sepsis and/or respiratory failure. Telemedicine visits occurred at 3- and 12-weeks post-discharge involving a critical care pharmacist, physician, and psychologist. The psychologist conducted cognitive and mental health screenings, providing tailored brief psychotherapy and education. Audio-recorded visits were transcribed verbatim and underwent inductive reflexive thematic analysis.</div></div><div><h3>Setting</h3><div>Intensive care unit recovery clinic at an academic medical center in the southeastern United States.</div></div><div><h3>Main outcome measures</h3><div>N/A.</div></div><div><h3>Findings</h3><div>17 participants completed 31 telemedicine intensive care unit recovery clinic visits between December 2019 and March 2022. Caregivers participated in 13 visits. Participant experiences and psychologist responses were identified and separated into two overarching themes: 1) Patient-Identified Challenges and 2) Psychologist-Delivered Strategies. Patient subthemes included 1) mental health challenges (negative thoughts), 2) minimization of mental health impact, and 3) use of coping methods. Psychologist subthemes included 1) rapport building and validation 2) use of psychological assessments, and 3) psychological interventions.</div></div><div><h3>Conclusion</h3><div>The collaborative effort, including a psychologist, exemplifies the role of a mental health professional within the multidisciplinary intensive care unit recovery clinic team, contributing to a comprehensive approach in identifying and managing post-intensive care syndrome impairments. The focus extends to shaping compassionate care strategies for addressing mental health challenges associated with post-intensive care syndrome, fostering a holistic approach to whole-person recovery.</div></div><div><h3>Implications for clinical practice</h3><div>A mental health professional (e.g., psychologist, psychiatrist, psychiatric nurse practitioner) can contribute to shaping care strategies for the mental health symptoms associated with post-intensive care syndrome, fostering whole-person recovery after hospital discharge.</div></div><div><h3>Clinical trial registration number</h3><div>NCT03926533.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103886"},"PeriodicalIF":4.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693591","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}

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