American Journal of Critical Care最新文献

Background: Parents who report feeling prepared for symptoms and circumstances around their child's end of life report less adverse bereavement outcomes. Yet, the actions that bedside clinicians can initiate to help families feel prepared for a child's death remain unclear.

Objectives: To identify actions that nurses engage in to prepare families for the dying process.

Methods: A deductive approach was used to analyze qualitative data from focus groups and interviews with 20 pediatric intensive care unit nurses.

Results: Most of the 20 nurse participants identified as White women (n = 17; 85%). They reported a broad range of pediatric intensive care unit experience (1-24 years), and most (n = 17; 85%) had cared for at least 10 patients nearing end of life. The study included 3 categories of preparatory actions: leveraging experience and familiarity (processes nurses used to ready themselves to support families navigating end-of-life care), coordinating collaborative team support (optimizing interprofessional teamwork and developing adaptable care plans), and titrating family-responsive support (adjusting interactions or behaviors based on the family's needs).

Conclusions: Combining nurse experience and familiarity, clinical team collaborations, and family-responsive support may offer a comprehensive approach to preparing families of children nearing end of life. Studying end-of-life preparation with larger samples of nurses and families is necessary. Nurses may incorporate these actions into their serious illness care to help support families of children nearing end of life.

Background: Race influences outcomes in patients with cardiovascular diseases. However, the impact of race on cardiogenic shock outcomes is unclear.

Methods: This retrospective cohort study included adult patients admitted to a cardiac intensive care unit for cardiogenic shock from June 2019 through June 2023. For analysis, patients were divided into 3 racial groups: White, Black, and other. Baseline demographics, comorbidities, admission source, and Sequential Organ Failure Assessment scores were collected. Primary outcomes were hospital and cardiac intensive care unit mortality. Secondary outcomes were hospital and cardiac intensive care unit lengths of stay and temporary mechanical circulatory support use. Propensity score weighting was used; pairwise comparisons between each group were performed.

Results: The analysis included 2458 patients (1959 White, 327 Black, 172 other). Black patients were younger, were less likely to be admitted from the emergency department (and more likely to be admitted from inpatient wards), and had higher Sequential Organ Failure Assessment scores than patients in the other 2 groups. Propensity-weighted pairwise comparisons demonstrated no significant differences in hospital and cardiac intensive care unit mortality. However, Black patients had significantly longer hospital (incidence rate ratio, 1.31; P < .001) and cardiac intensive care unit (incidence rate ratio, 1.33; P = .03) stays than did White patients but not patients in the "other" group. Temporary mechanical circulatory support use did not differ among groups.

Conclusions: The results highlight disparities in clinical management of cardiogenic shock and the need for further research to address these inequities.

Background: Meaningful recognition acknowledges the value of individuals' professional contributions to an organization's work. Long recognized as necessary to retain nurses, it includes formal awards programs, informal feedback processes, salary, and scheduling flexibility. With demographic characteristics of the nursing workforce changing, new research is needed to understand how contemporary nurses view meaningful recognition.

Objectives: To evaluate nurses' perceptions of meaningful recognition and the health of their work environment and to explore associations between demographic characteristics and meaningful recognition preferences.

Methods: Participants were registered nurses from a large, urban health care system. Study instruments included the Meaningful Recognition Questionnaire, Healthy Work Environment Assessment Tool, and open-ended questions. Analysis of variance was used to test associations between demographics and meaningful recognition preferences.

Results: Surveys were completed by 565 nurses (mean [SD] age, 43 [11] years; 521 women [92.2%]). Salary was the most valued form of recognition, followed by private verbal feedback and written acknowledgment. Unlike earlier studies, professional development opportunities were the least valued form of recognition, reflecting a shift in nurse preferences. Demographic differences influenced recognition preferences, highlighting the need for personalized and inclusive recognition programs.

Conclusions: Effective meaningful recognition is crucial to foster a healthy work environment and improve nurse retention. Updating recognition practices to align with evolving nurse preferences and demographic changes is essential to maintain a supportive and engaging work environment.

Background: Major critical care organizations advocate for combined spontaneous awakening and breathing trials to expedite ventilator liberation and minimize the complications associated with prolonged intubation. Evaluating staff perceptions of ventilator liberation may enhance protocol changes and implementation.

Objectives: To assess staff perceptions of ventilator weaning practices, barriers to timely extubation, and potential organizational improvements in a Midwest regional health care system.

Methods: In an exploratory, cross-sectional study, a 29-question survey was administered to 91 licensed staff in 6 intensive care units to assess demographics, extubation practices, extubation delays, and opportunities for improvement. Means and SDs were used to describe continuous variables; frequencies and percentages were used to describe categorical variables. Chi-square tests were used to evaluate occupational differences, and 2 investigators independently coded responses to identify themes and resolve discrepancies through discussion and consensus.

Results: More than half of the 91 respondents reported high comfort with ventilator liberation. More than 60% perceived extubation timing as being longer than ideal. Respondents identified staffing ratios, communication failures, distractions, and sedation weaning practices as factors delaying extubation. Identified improvement opportunities were protocol development, enhanced practices related to the roles of critical care physicians and advanced practice providers, and better staff education.

Conclusions: The survey highlighted staff opinions on ventilator liberation and key improvement factors. Addressing staff concerns will aid in refining organizational policies to improve patient and organizational outcomes.

Background: Patients with intellectual developmental disabilities face significant health care disparities, particularly in intensive care units, where the complexity of care and lack of tailored protocols exacerbate challenges. Nurses often encounter a knowledge gap in meeting these patients' unique needs, contributing to poorer outcomes.

Objective: To explore the experiences of nurses caring for patients with intellectual developmental disabilities in an intensive care unit to inform strategies for improving the nursing care of this patient population.

Methods: This study used a descriptive phenomenological design grounded in Edmund Husserl's philosophy and an interpretivist paradigm. Semistructured interviews were conducted via online videoconferencing with licensed nurses in the United States who had cared for patients with intellectual developmental disabilities in intensive care units within the past 5 years. Thematic analysis was used to identify key findings, contextualized using Betty Neuman's systems model to facilitate immediate bedside application for critical care nursing practice.

Results: Five themes emerged: equity and safeguarding, family or caregiver involvement, building ties with people with intellectual developmental disabilities, a need for specialized processes, and need for enhanced nursing support.

Conclusions: The findings show that nurses and health care administrators should invest in specialized training and support for nursing staff. Caring for a vulnerable patient population that needs specialized care requires environmental and systemic adaptability as well as dedicated resources to be successful.