American Journal of Critical Care最新文献

Background: Patients can experience physical, emotional, social, and cognitive challenges following discharge from critical care. Data regarding goals of care for intensive care unit recovery from a patient's perspective are limited.

Objectives: To use data from a multicenter intensive care unit recovery program to explore patients' goals during recovery from critical illness and to understand optimal models of care for future research design and care delivery.

Methods: This multicenter, descriptive cohort study recruited patients who attended critical care recovery services after hospital discharge. During attendance, patients set goals of care with health care professionals. These goals of care were evaluated with framework analysis.

Results: One hundred fifty-one patients were recruited from 3 hospital sites in Scotland. Of these patients, 134 (88.7%) set a total of 314 personal goals. Analysis of the goals revealed 5 categories: physical; health management; emotional and psychosocial; education, employment, and purpose; and social and interpersonal goals. Goals were related to both chronic disease management and acute recovery following critical illness.

Conclusions: Survivors of critical illness have various goals of care for recovery that span physical, social, and emotional needs. Clinicians and researchers should consider these goals of care when planning interventional research in this area to ensure that it meets patients' need and expectations.

During critical illness, tube feedings are used to provide vital nutrition for patients unable to obtain adequate oral intake. Part I of this 2-part review article series examines the history, delivery, and content of enteral formulas in the intensive care unit. Food-based tube feedings date back to ancient times when ill patients received nutrition via enemas composed of ingredients such as barley, eggs, and wine. Since the mid-1900s, the landscape has been dominated by commercially prepared ("commercial" or "conventional") formulas-synthetic blends composed of vitamins and minerals mixed with processed proteins, carbohydrates, fats, thickening agents, and shelf-life extenders such as sodium caseinate, maltodextrin, canola oil, and corn syrup. In response to increasing interest in whole foods and their role in illness recovery, food-based formulas have gained popularity as an alternative, supported by the emergence of plant- and food-based blends, growing scientific attention, and inclusion in hospital formularies. Part I provides an overview of the historical evolution of enteral feeding practices, methods of administration, and the nutritional content of commercial versus food-based formulas. In part II, clinical outcomes and future directions will be evaluated. Together, this 2-part series aims to inform prescribing practices and promote patient-centered nutrition strategies in critical care.

Background: Experiencing a patient's death after a resuscitation effort can be emotionally traumatizing to health care professionals. In a large community teaching hospital, the code blue team implemented "The Pause" as a coping strategy to support the well-being of the interprofessional health care team.

Objectives: To assess the impact of the Pause on compassion fatigue, distress, and mindfulness and to explore clinicians' experiences with patients' death after a code blue event and use of the Pause.

Methods: This multimethod study included preimplementation and postimplementation surveys and interviews of clinical and nonclinical health care staff who respond to house-wide code blue events.

Results: The Pause intervention was implemented in fall 2021; 64 preimplementation surveys were collected in May 2021, and 74 postimplementation surveys were collected in August 2022. Compassion fatigue scores decreased after implementation, and mindfulness scores increased; however, neither change was statistically significant. During the COVID-19 pandemic, participants reported more distress from patient deaths after a code blue event. Qualitative interviews yielded themes such as the impact of the COVID-19 pandemic on death, emotionally coping with death, and the Pause as humanizing.

Conclusions: The Pause was perceived as a helpful coping strategy for code blue-related patient death; however, the COVID-19 pandemic made it difficult to measure intervention effects. The Pause may also offer an opportunity to support and empower health care professionals during an impactful moment, such as witnessing death.

Background: Research on effectiveness of the Get to Know Me board, a patient- and family-centered care intervention, is limited to adult inpatients.

Objectives: This mixed-methods study examined the effect of a neonatal intensive care unit (NICU)-specific Get to Know Me board on perceptions of empathy, trust, and satisfaction among nurses and families.

Methods: Seventy families of NICU patients and 39 bedside nurses across 5 single-patient room clusters were enrolled. Clusters were randomly assigned to continue using standard communication tools (eg, in-room whiteboard) or add the Get to Know Me board. Family members completed validated measures of perceived empathy, trust in nurses, and satisfaction. Nurses completed a validated measure of engagement in caring behaviors. Quantitative data were analyzed with generalized linear mixed models. Qualitative interviews helped contextualize the findings.

Results: Forty-five family members and 39 nurses completed the study. Three months after implementation, nurses' perception of engagement in caring behaviors was unchanged (P = .40). Family members' perception of empathy significantly differed after 2 weeks (P = .05). Thematic analysis of 4 interviews indicated that the Get to Know Me board helps nurses get to know families and families get to know their children but is only 1 of many tools. Patient- and family-centered care elements important to parents of NICU patients were identified.

Conclusions: The Get to Know Me board can promote family-centered care in the NICU, but a family-centered care environment may be most important. Additional studies of the value of the NICU Get to Know Me board are warranted.

Background: Shift work can affect quality of life, especially marital satisfaction.

Objective: To compare marital satisfaction between nurses doing shift work in intensive care units (ICUs) and inpatient departments, focusing on gender differences.

Methods: A descriptive-comparative cross-sectional study was conducted among 126 nurses. Data were collected using self-reported questionnaires, including the ENRICH Marital Satisfaction scale.

Results: The study included 76 ICU nurses (54 women [71%]) and 50 inpatient department nurses (31 women [62%]). The mean ENRICH Marital Satisfaction score was higher (indicating greater marital satisfaction) for ICU nurses (mean [SD], 51.58 [11.03]) than for inpatient department nurses (mean [SD], 49.00 [9.90]), although the difference was not significant (P = .94). Gender-specific differences (mean [SD]) were significant among inpatient department nurses in roles and responsibilities (men, 4.47 [0.53], women, 3.97 [0.62]; P = .004), partner communication (men, 4.32 [0.67], women, 3.80 [0.48]; P = .01), time spent with partner (men, 4.05 [0.91], women, 3.20 [0.96]; P = .003), and religious beliefs (men, 4.21 [0.78], women, 3.70 [0.98]; P = .02) components. Linear regression indicated that the partner's profession in health care (β = -0.21; P = .02) and the partner's satisfaction with the nurse's shift work (β = 0.18; P = .04) were significant predictors of marital satisfaction.

Conclusions: Addressing gender, unit, and other personal factors while promoting the connection between employee well-being and the work environment may enhance marital satisfaction among nurses, foster a more balanced work-family system, and improve professional performance.

Early in my career as a critical care nurse, I noticed discrepancies between arterial blood gas values and noninvasive readings. My unit's clinical nurse specialist encouraged me to conduct a research study; the findings from that study drove a practice change for the unit, and I presented the results at a national conference. This experience inspired a spirit of inquiry and launched my career focused on research and adoption of best evidence to advance nursing practice affecting the patients we serve. Clinical inquiry, both on my part and on the part of the nurses I worked alongside, led me to critically examine evidence to either implement a body of science in practice or generate knowledge to improve practice, health care systems, and patient outcomes. My program of scholarship has focused on understanding ways in which nurses independently influence patient care. As a hospital-based research nurse scientist, I had the opportunity to explore nursing practice by asking questions and seeking answers associated with the impact of technology on practice, hospital-acquired conditions, and evidence translation. Nursing practice questions fostered robust explorations on a wide range of topics from exploring use of technology to inform interventions to understanding new graduate nurses' experiences during the COVID-19 pandemic. As I was recognized as an evidence-based practice expert, my spirit of inquiry led me to promote evidence-based practice as a foundational principle to reduce patient harm and advance nursing practice. Fostering a spirit of inquiry supports the generation of nursing science and translation of best evidence to inform our daily practice.

Background: Invasive intra-arterial blood pressure (IABP) monitoring is common in critical care. However, IABP might be unnecessary if noninvasive blood pressure (NIBP) measurements are similar to IABP measurements.

Objectives: To investigate differences between IABP and NIBP measurements and their clinical relevance.

Methods: In a systematic review and meta-analysis, multiple databases were searched for eligible studies from inception to September 2023. Primary and secondary outcomes were differences between invasive and noninvasive measurements of systolic blood pressure (SBP) and mean arterial pressure (MAP), respectively. Tertiary outcomes were differences of 10 mm Hg or greater in SBP and MAP between IABP and NIBP measurements. Outcomes were expressed as standardized mean differences and 95% CIs. Study quality and heterogeneity were assessed. The study was registered with PROSPERO (CRD42022383924).

Results: The meta-analysis included 23 observational studies (6549 patients). Standardized mean differences between IABP and NIBP measurements were 0.238 (95% CI, 0.121-0.355; P < .001; I2 = 87%) for SBP and 0.062 (95% CI, -0.065 to 0.189; P = .34; I2 = 87%) for MAP. Bland-Altman plots demonstrated that SBP values were often lower with NIBP than with IABP measurements. The prevalence (95% CI) of differences of 10 mm Hg or greater was 0.500 (0.415-0.584) for SBP and 0.330 (0.227-0.452) for MAP.

Conclusions: Measurement via NIBP may underestimate SBP; differences of 10 mm Hg or greater are relatively frequent. The clinical relevance of these differences remains unclear.