Intensive & critical care nursing最新文献

Introduction and objectives: Nil by mouth (NBM) is a frequent imposition for patients recovering from critical illness. Its impact on patients' wellbeing and rehabilitation is under researched. We sought ICU multidisciplinary opinion to primarily assess the relevance of taste deprivation on patient care and recovery, and to identify future opportunities for innovation and research.

Methodology: A descriptive, multiformat, observational, online survey investigated the experiences of specialist multidisciplinary healthcare professionals (HCP) from two academic hospitals regarding working with NBM patients. An e-survey containing 16 multiformat questions was developed by an experienced multidisciplinary HCP team and distributed over a 3-month period in 2023. The CHERRIES guidelines were followed for reporting of results.

Results: 58 HCPs completed the study. 97% of HCPs reported witnessing patient discomfort or distress when NBM. 91% believed felt that it impacted negatively on patients' engagement in their own recovery. 59% did not discuss food and taste with patients when prolonged NBM was anticipated because there was no solution on offer. 41% of HCPs did discuss flavour and food, to build rapport and help motivate recovery. 57% of HCPs often felt pressure to give oral food/liquid to a NBM patient. 90% of participants reported that a safe taste product could enhance a patient's ICU experience. Concerns regarding safety and a need for guidelines to enable implementation were common.

Conclusion: HCPs recognise the psychological sequalae on the patient and the impact on their relationship with the patient, that taste deprivation creates in recovering critically ill patients. Safe alternatives to oral intake that can enhance the ICU experience are considered desirable; this needs further research and innovation. Furthermore, with training and support HCPs should feel empowered to discuss NBM associated distress and challenge NBM recommendations.

Implications for clinical practice: There is demand for safe alternatives to oral flavour intake and belief this could enhance the ICU experience with downstream positive impact on ICU morbidity.

Background: Physical restraints are frequently used in ICU patients, while their effects are unclear.

Objective: To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status.

Research methodology/design: Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses.

Setting: Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands.

Main outcome measures: Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores.

Results: 2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1-6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, p < 0.001; PCS -2.82, 95 %CI -4.47 to -1,17p < 0.001; MCS -2.67, 95 %CI -4.39 to -0.96, p < 0.01). At 12-months, only the PCS scores remained significantly lower (-1.71, 95 %CI -3.42 to -0.004, p < 0.05).

Conclusion: Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months.

Implications for clinical practice: Use of physical restraints is associated with statistical significant worse mental and physical outcomes.

Objectives: To evaluate the impact of Artificial Intelligence Assisted Prevention and Management for Delirium (AI-AntiDelirium) on improving adherence to delirium guidelines among nurses in the intensive care unit (ICU).

Research methodology/design: Between November 2022 and June 2023, A cluster randomized controlled trial was undertaken.

Setting: A total of 38 nurses were enrolled in the interventional arm, whereas 42 nurses were recruited for the control arm in six ICUs across two hospitals in Beijing, comparing nurses' adherence and cognitive load in units that use AI-AntiDelirium or the control group.

Main outcome measures: The AI-AntiDelirium tailored delirium preventive or treated interventions to address patients' specific risk factors. The adherence rate of delirium interventions was the primary endpoint. The other endpoints were adherence to risk factors assessment, ICU delirium assessment, and nurses' cognitive load. The repeated measures analysis of variance was utilized to explore the influence of time, group, and time × group interaction on the repeated measurement variable (e.g., adherence, cognitive load).

Results: A cumulative total of 1040 nurse days were analyzed for this study. The adherence to delirium intervention of nurses in AI-AntiDelirium groups was higher than control units (75 % vs. 58 %, P < 0.01). When compared to control groups, AI-AntiDelirium was found to be significantly effective in both decreasing extraneous cognitive load (P < 0.01) and improving germane cognitive load (P < 0.01).

Conclusions: This study supports the effectiveness of AI-AntiDelirium in enhancing nurses' adherence to evidence-based, individualized delirium intervention and also reducing extraneous cognitive load.

Implications for clinical practice: A nurse-led systemshould be applied by nursing administrators to improve compliance with nursing interventions among ICU nurses.

Objectives: To investigate the trajectories and determinants of muscle strength in ICU patients and their impact on 1-, 6-, and 12-month mortality outcomes.

Design: Prospective multicenter cohort study.

Settings: Ten ICUs across five tertiary hospitals in Fujian Province, China.

Methods: Muscle strength was assessed using handgrip strength at three time points: ICU admission, ICU discharge, and hospital discharge. Group-based trajectory modeling was employed to identify muscle strength trajectories, while multinomial logistic analysis determined predictors based on baseline characteristics. Mortality outcomes were assessed using a Cox proportional hazards model adjusted by inverse probability of treatment weighting.

Results: Among 317 patients, with 37 deaths within 12 months, three muscle strength trajectories were identified: Low-Level Stability (38.17 %), Medium-Level Improvement (47.00 %), and High-Level Improvement (14.83 %). Older age (≥65 years), female gender, prolonged mechanical ventilation, and lower fat-free mass were associated with a higher likelihood of being in the Low-Level Stability group. After adjustment, the Medium-Level Improvement group had a 0.067 times lower 1-month mortality risk (95 % CI: 0.005-0.825) compared to the Low-Level Stability group, with no significant differences at 6 or 12 months (P > 0.05).

Conclusions: Three distinct muscle strength trajectories were identified: Low-Level Stability, Medium-Level Improvement, and High-Level Improvement. Older age, female sex, prolonged mechanical ventilation, and lower fat-free mass were strongly associated with the Low-Level Stability group, which had higher 1-month mortality.

Implications for clinical practice: Findings from this study underscore the importance of early identification of Low-Level Stability patients, particularly those who are older, female, require prolonged mechanical ventilation, or have reduced fat-free mass. Tailored early rehabilitation in these high-risk individuals may offer substantial clinical benefit.

Objective: The primary aim of the present study was to assess the competencies related to the spiritual care by nurses and health professionals who work in intensive care units, and how these competencies influence clinical practice. As a secondary objective, we have discussed the strengths, weaknesses and threats of incorporating and teaching these competencies among the included studies.

Method: An integrative review of studies published in English, Spanish and Portuguese was performed in the following databases: Embase, Web of Science, Medline/PubMed, PsycInfo, LILACS and Cochrane.

Results: Eleven out of a total of 2,239 articles were included. Most were cross-sectional studies with nurses and the main competencies included were "spiritual care attitude" and "knowledge-related spirituality". The studies were separated into three themes: "Strengths", "Weakness" and "Opportunities". The results showed there are several challenges for professionals working in ICUs, including lack of time, high workload and the influence of the cultural context. Furthermore, few professionals are actually trained to provide spiritual care in the ICU and this care is often provided only at the end of life. Despite this evidence, only one quasi-experimental study on training on the subject in the ICU was identified and no trials, reinforcing the need for more educational studies.

Conclusion: There is still a large gap regarding spiritual care in the intensive care environment, often related to the lack of training and knowledge of the team. Exploring the competencies involved in spiritual care provided by health professionals is a way to deepen the debate within the healthcare-related scientific scenario.

Implications for clinical practice: Our findings allow a better understanding of outcomes related to healthcare, based on the assessment of these competencies and aspects related to critical patients, expanding the possibility of building scientific knowledge in the health area and allowing thoughts about multiple forms of research, including randomized clinical studies.

Introduction and objective: The global shortage of nurses who want to work in the intensive care unit (ICU) is alarming, putting at risk quality of care and patient safety. With efforts put into engagement strategies, optimized recruitment programmes are scarce, specifically in the ICU setting. The aim of this study is to describe and explore ICU nurses' opinions on their work motivational factors that influenced the decision to work in the ICU setting.

Design: A qualitative research was undertaken, with a descriptive exploratory interpretative approach, implementing a QUAL-QUAL design, where two data collection techniques are used simultaneously and complement each other. Experienced ICU nurses were interviewed by focus group, using in-depth interviews for novel nurses. A template content analysis as described by the model of Brooks was performed.

Setting: The selected population was recruited from 6 different public hospitals in Spain.

Findings: A total of 17 nurses participated in the study as we reached data saturation; seven in the focus group and ten by individual interviews. Four main themes emerged from the analysis divided into 13 subthemes: "ICU training and education", "taking care of the intensive carer", "optimized human resources management" and "intrinsic and extrinsic motivational factors".

Conclusion: Nurses consider that an attractive ICU in terms of job satisfaction is the one that is committed to quality continuous training programmes, welcoming professionals with well-designed mentoring, and taking care of its workers by promoting teamwork and work-life balance, burnout syndrome prevention strategies and motivation for intellectual development.

Implications for clinical practice: The description of how to create attractive ICUs will help to build strategies with the aim of recruiting talented highly qualified professionals who will alleviate the need for nurses in the field, optimizing the care provided and generating benefits in management and quality of care.