Intensive & critical care nursing最新文献

Objectives: To identify priority domains that influence healthcare provider sedation practices and to describe key sedation protocol elements reported by participants that serve as facilitators and barriers to sedation practice change.

Methods: We conducted qualitative individual semi-structured interviews with critical care healthcare providers, including physicians/nurse practitioners, nurses, pharmacists, respiratory therapists, and physiotherapists, to understand sedation practices and define key factors that limit the opportunity for optimization of ICU sedation practices. We analyzed responses with deductive content analysis using the Theoretical Domains Framework (TDF) to identify priority domains related to sedation practices and describe constructs within the priority domains.

Results: We conducted 29 semi-structured interviews virtually from April 29 to December 10, 2024, consisting of 12 physicians/nurse practitioners, 5 respiratory therapists, 8 nurses, 3 pharmacists, and 1 physiotherapist. We identified seven priority TDF domains across healthcare provider groups including: Beliefs about consequences, Beliefs about capabilities, Reinforcement, Memory, attention, and decision processes, Environmental context and resources, Social influence, and Social/professional roles. Participants reported sedation use for multiple purposes including patient and staff safety, unit culture, and to address environmental and organizational challenges (e.g., patient care efficiency). Participants reported several recommendations for optimizing sedation delivery including available nursing-driven sedation protocols for specific patient populations (e.g., alcohol withdrawal) and specific sedation weaning recommendations.

Conclusions: Critical care healthcare providers identified several domains relevant to sedation practices, underpinned by patient and staff safety, key patient-specific factors, and socioenvironmental factors. In understanding priority domains and underlying factors that influence sedation practice, implementation strategies using protocol-driven sedation as a tool to improve guideline adherence should be designed targeting the identified priority domains and underlying driving factors.

Implications for clinical practice: Protocol-driven sedation strategies are more likely to succeed when interventions intentionally address the priority domains and driving factors that influence adherence to clinical practice guidelines during implementation processes.

Background: Globally, family-centred care is the standard of care in paediatric intensive care units (PICUs). However, the types of interventions used, their implementation, and evaluation remain unclear. Mapping family-centred care interventions in PICUs is essential to understanding their components, outcomes, and opportunities for improved family involvement.

Objectives: To identify and map family-centred care interventions implemented in PICU.

Methods: Following PRISMA-ScR guidelines, we searched seven databases from 2013 to 2025. Eligible studies included any family-centred care intervention implemented in PICU. Data were extracted on the interventional components, outcome measures, and family involvement in the development of the intervention. Intervention replicability was assessed using the Template for Intervention Description and Replication (TIDieR) checklist. Methodological quality was appraised using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS) for quality improvement interventions and the Mixed Methods Appraisal Tool (MMAT) for observational studies.

Results: Of 2,921 articles screened, 38 met the inclusion criteria. The most common interventions were family presence during ward rounds (n = 10; 26%), PICU diaries (n = 7; 18%), and nurse participation in goal setting (n = 4; 10%). In total, 102 unique outcome measures were reported, studies used 37 validated tools to measure outcomes. Family satisfaction was the most measured outcome (n = 15; 15%). Only four studies involved parents in the design of the intervention. Replicability scores ranged from 63% to 96%. Methodological quality scores, expressed as the percentage of appraisal criteria met using the QI-MQCS and MMAT, ranged from 19% to 100% across included studies.

Conclusions: This review highlighted wide variation in family-centred care interventions and outcome measures, with limited consistency in evaluation, replicability and quality. Family involvement in design was minimal, underscoring the need for more collaborative, co-designed initiatives.

Implications for practice: Prioritising collaborative family-centred care approaches that incorporate validated outcome measures and parent co-design will support the development of interventions that are relevant, sustainable, and truly reflective of family-centred care in PICU practice.

Background: Family engagement in critical care settings can enhance healthcare outcomes and patient care satisfaction in the intensive care unit. However, there is limited evidence regarding the barriers to and facilitators of engaging families in direct care, notably early mobilisation.

Objectives: To synthesise evidence on barriers and facilitators to including family members in early mobilisation of adult patients in intensive care units.

Methods: Integrative review using Whittemore and Knafl's five-stage framework. A systematic search (January 2015-March 2025) across CINAHL, MEDLINE, ProQuest, ProQuest Dissertations and Theses, and Scopus databases of English-language primary studies examining family participation in early mobilisation of adult patients in intensive care units. Studies were critically appraised using Joanna Briggs Institute tools, and data were extracted and thematically synthesised.

Results: Ten studies ranging from moderate to high quality were included in the final review. Thematic synthesis produced four themes affecting family engagement: patient vulnerability and readiness for shared movement (clinical condition); family confidence and relationships (readiness, knowledge, emotional state); clinician gatekeeping and guidance (workload, confidence, communication); and organisational culture and systems (protocols, visitation policies, resources).

Conclusions: Family engagement in early mobilisation is influenced by barriers and facilitators at multiple levels, including patient, family, clinician, and organisational levels. Multi-level approaches combining structured education, clinician training, and supportive policies are essential to enable safe and sustainable participation.

Implications for clinical practice: A practical first step in promoting family engagement in early mobilisation is to clarify families' roles within the intensive care team. Providing families with clear information, education, and guidance would reduce uncertainty and support safe participation in mobilisation activities. Organisational policies and structured programs that enable clinician-led invitation, supervision, and communication are also important in facilitating consistent and appropriate family engagement. Attention to patient readiness, family confidence, and contextual constraints is essential when including families in early mobilisation practices.

Objectives: The purpose of this study is to establish a model correlating the number of alarms and effective alarms on a monitor, and to use this model to optimise night-time alarm issues in intensive care units in order to reduce alarm fatigue among night shift nurses.

Methods: A retrospective study method was used to track 1,843 samples. Based on partial experimental design analysis, a model for 'alarm frequency' and 'effective alarms' was established for the monitor, which was then optimised using the composite centre factorial (CCF) method. The performance of the model was evaluated using random sampling and night-time model application.

Results: We can model based on three factors: 'APACHE II score,' 'Alarm time period,' and 'Nurse ICU work years.' After using this model, the average number of alarms decreased by 11.86%, and the average proportion of effective alarms increased by 4%.

Conclusions: We can use CCF modeling to manage monitors and help reduce patient and nurse fatigue.

Implications for clinical practice: The number of monitor alarms and effective alarms related to the patient's condition, working time period, and the nurse's experience. We can tailor the management strategy of the monitor based on clinical conditions, reducing the number of night-time alarms while ensuring patient safety, increasing the effectiveness of alarms, and reducing nurse alarm fatigue. The longer the length of service in critical care, the less significant the improvement in monitor alarm performance.

Objective: This study aimed to investigate the effects of acoustic environments in intensive care units (ICUs) on nurses' well-being.

Setting and sample: The research was conducted with 14 ICU registered nurses recruited from four different hospitals in China.

Research methodology: Semi-structured interviews were conducted via video calls to explore ICU nurses' perceptions, reactions, and coping strategies related to noise exposure. A grounded theory approach was used to analyse the data.

Findings: The study identified five categories and 11 themes based on nurses' experiences with noise exposure in ICUs. These themes were interconnected to develop a conceptual model. According to the model, exposure to human and non-human noises led to negative emotions and disturbances in ICU activities, such as medical procedures and conversations. Nurses employed various coping strategies to manage negative perceptions of noise. Several nurses expressed concerns about their physical and mental health, which are related to noise exposures. Additionally, their noise perception and coping strategies were influenced by intervening conditions, such as noise sensitivity, attitudes towards colleagues and patients, and childcare.

Implications for clinical practice: This study highlights the potential risk of physical and mental well-being among ICU nurses. The findings suggest the necessity of interventions to enhance the acoustic environments of ICUs, such as implementing noise reduction strategies, optimising alarm systems, and providing adequate training and support for staff to cope with noise-related stress.