The Southern African journal of critical care : the official journal of the Critical Care Society最新文献

Background: Nurses working in intensive care units (ICUs) must incorporate new knowledge and evidence-based practice (EBP) into their daily routines to enhance patient outcomes. However, this integration often falls short in ICU settings. Weekly clinical audits reveal incidents where ICU nurses neglect evidence-based interventions, impacting patient outcomes and ICU stays.

Objectives: To explore the factors influencing the translation of knowledge into ICU practice.

Methods: We conducted exploratory, qualitative research to investigate ICU nurses' perspectives on knowledge translation into ICU practices. The study employed purposive sampling to select ICU nurses. We used paired interviews and group discussions to gather insights from ICU nurses regarding the factors influencing the translation of knowledge into ICU practices. Data analysis was performed using Boomer and McCormack's nine steps of creative hermeneutic data analysis.

Results: One main theme, 'We are just surviving' emerged, encompassing two sub-themes: management and workplace culture. Under management, participants described barriers, such as resource scarcity, behaviour, outdated evidence-informed protocols and workload. Under workplace culture, participants mentioned negative attitudes and a lack of teamwork, contributing to poor-quality care.

Conclusion: In ICUs, nurses are expected to integrate new knowledge and scientific evidence into their daily practice, yet they face challenges in doing so. Interventions should be implemented to address management and workplace culture.

Contribution of the study: This study raised awareness for the intensive care nurse practicioner to intergrate new knowledge and scientific evidence into clinical practice. This study highlighted the importance of teamwork and collaboration between nurses and doctors to ensure knowledge translation and quality care of the critical ill/injured patients. This study confirmed that support from management is vital to address challenges such as workload, staff shortage, inadequate equipment and outdated protocols as these aspects impact negatively on intensive care nurses ability to transfer knowledge into clinical practice.

Background: Melioidosis cases are increasing in Southeast Asia, posing a significant challenge owing to the rising number of diabetic and immune compromised patients. Pneumonia is the most common presentation of melioidosis, while cutaneous melioidosis is rare.

Objectives: We report a case of primary cutaneous melioidosis (PCM) that eventually required intensive care unit (ICU) management.

Methods: We describe the case of a 33-year-old male with uncontrolled diabetes mellitus who initially presented with a skin lesion, which was followed by gradual multiorgan involvement diagnosed as melioidosis based on culture-positive results from blood and synovial fluid, and needed ICU admission.

Results: He was successfully treated with intravenous antibiotics and invasive mechanical ventilation after ICU admission.

Conclusion: Cutaneous melioidosis can lead to ICU admission and, if untreated, has a high fatality rate. Faster diagnostic methods like VITEK 2 Compact and MALDI TOF substantially reduce delays in initiating required treatment.

Contribution of the study: Our study emphasize on the need of considering Meliodosis as a possible differential diagnosis, as in lower middle income countries (LMIC) where it can be a frequent cause of multiorgan involvement due to tropical environment and diagnostic resource limitations.

Background: Growing evidence is describing the long-term morbidity experienced by critical illness survivors, a major contributing factor being impaired physical function. Consensus is yet to be reached on which physical function measures should be included in this population. This review aimed to describe physical functioning measurement instruments used in longitudinal studies of critical illness survivors, based on the International Classification of Function (ICF).

Methods: An electronic database search of EbscoHost, Web of Science and Scopus was conducted from inception to November 2023. Two reviewers independently applied the inclusion and exclusion criteria to titles, abstracts and full text-studies. Extracted data included year of publication; country; participant age; follow-up timeframes and physical measurement instruments used. Instruments were classified according to ICF domains.

Results: Eighty studies published between 1995 and November 2023 were included. Forty-four different outcome measures were identified. Most studies (68) included multiple followed-up points and were completed within a year, and few studies (12) follow-up beyond a year. Based on the ICF, 11 (25%) instruments measured impairments and 33 (75%) activity limitations. Muscle power functions were the most frequently measured impairment (65%), utilising manual muscle testing (37.3%). The six-minute walk test (6MWT) was the most frequently used instrument in the activity/participation domain (31.6%). Only one instrument addressed all five the physical activity/participation domains, while the majority focused on mobility domain.

Conclusion: Multiple tools are used to report on physical deficits experienced by ICU survivors, either measuring impairments or activity/ participation limitations. Most studies report on physical function within the first year of survival. The heterogeneity and inconsistency over time of instruments used prevents synthesis of data to determine intervention efficacy. The validity, predictive value and sensitivity of the reported measures within ICU survivors needs to be established, only then can intervention studies be designed to measure effectiveness.

Contribution of the study: This scoping review contributes to the existing literature and development of standardised core outcome measure sets (COMS) for critical illness research by providing a comprehensive and systematic mapping of physical function measurement instruments utilised in longitudinal studies of critical illness survivors. By categorising these instruments according to the International Classification of Functioning, Disability and Health (ICF) framework, the review offers a novel perspective on the current state of outcome measurement in this field.

Background: Caring in a critical care environment may be conceptualised differently compared with other nursing disciplines because of the patient's critical condition and the specialised staffing categories and skills. However, critical care nurses who prioritise caring can meaningfully connect with critically ill patient and their families, resulting in positive healthcare outcomes.

Objectives: To assess critical care nurses' orientations to caring for critically ill patient and their families.

Methods: A quantitative, descriptive, cross-sectional study was conducted with 139 purposively sampled critical care nurses working in a tertiary referral hospital in KwaZulu-Natal, South Africa. Data were collected using the Caring Assessment for Caregivers questionnaire, and analysis included descriptive and comparative statistics.

Results: The overall mean score of critical care nurses' orientations to caring was 116.01 (range of 25 - 125). Of the five subscales (dimensions), the dimension of 'Maintaining belief' had the highest mean score of 24.25 and the dimension of 'Being with' had the lowest mean score of 22.70 (range 5 - 25).

Conclusion: While critical care nurses reported high overall orientations to caring, lower mean scores on the subscale 'Being with' suggest that there are areas for critical care nurses to grow in their role as carers. Further research using qualitative approaches may shed valuable insights into how the critical care environment impacts the caring orientations of critical care nurses.

Contribution of the study: The study aims to highlight the orientations of critical care nurses to different areas of caring. In so doing management can provide specific support to nurses to strengthen their caring abilities.

Background: Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes.

Objectives: To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods.

Methods: This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients.

Results: We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47).

Conclusion: High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI.

Contribution of the study: Hospital-acquired infections are a common problem and cause of morbidity and mortality in intensive care units and general wards globally. However, there is very little literature on the topic from low- and middle-income countries. This study aims to provide insite into the unique factors that contribute to these infections in the South African context.

Background: Necrotising enterocolitis (NEC) is life-threatening with a rising incidence due to improved neonatal care. While researchers' focus has shifted to causes, risk factors and preventative clinical strategies, little is known about the exact aetiology of NEC. Risk factors include the relationship between red blood cell transfusions (RBCTs) and the development of transfusion-associated NEC (TANEC) and peri-transfusion feeding, increasing the risk of TANEC.

Objectives: Evaluate the relationship between RBCT and peri-transfusion feeding practices and the development of TANEC in very low birthweight (VLBW) neonates over 5 years.

Methods: This was a retrospective analytical record review of all VLBW neonates admitted to two tertiary hospitals' neonatal units in Bloemfontein, South Africa (SA), from 1 January 2012 - 31 December 2016.

Results: The study population (n=1 426) had a median birthweight of 1 260 g and a median gestation age of 30 weeks. RBCTs were given to 41.9%, and NEC developed in 7.4%, of whom 47.6% had an RBCT (TANEC). Half (47.2%) were kept nil per os (NPO) around the transfusion. No association was found between NPO status and TANEC development (8.9% NPO patients, 7.9% non-NPO patients, p=0.6826). No significant differences regarding Modified Bell's Staging were found between neonates who developed TANEC v. NEC.

Conclusion: Optimising the administration of RBCTs and evidence-based feeding protocols is crucial in reducing TANEC's impact on premature neonates.

Contribution of the study: The study examines the link between red blood cell transfusion and transfusion-associated necrotising enterocolitis in very low birthweight neonates. It highlights the need for evidence-based feeding protocols to reduce transfusion-associated necrotising enterocolitis risk during transfusions. It calls for standardised clinical guidelines to improve neonatal outcomes and lower necrotising enterocolitis and transfusion-associated necrotising enterocolitis incidence.

The digital expansion in medicine and healthcare has been immense and extremely valuable. The biggest concern in the face of this inevitable growth is how we manage to keep contact with our patients and preserve the human touch so essential in healing. Digital healthcare should not be about technology replacing clinicians. Instead, it should be about augmenting and supplementing healthcare providers to improve the ways in which we deliver personalised healthcare. It is vital that we focus on how we can revitalise the patient-clinician relationship in this digital age.