Intensive & critical care nursing最新文献

Objective: In the wake of the COVID-19 pandemic, a significant number of critical care nurses have left their positions, citing overload, burnout, and moral distress. This scoping review is not just a theoretical exploration but a timely and crucial investigation into the aspects and structures of critical care nursing that can make the job fulfilling and appealing, thereby promoting intrinsic motivation and staff retention.

Methodology: A scoping review of studies reporting on factors that allow critical care nurses to fall back on their intrinsic job motivation. Qualitative, quantitative, and mixed methods studies from 2019 until 2023 that examined critical care nurses are included. This scoping review, which was conducted in 12 databases, follows the framework proposed by Arksey and O'Malley and the PRISMA framework.

Results: 22 studies met the inclusion criteria. The thematic synthesis identified 'meaning' as the overarching theme. Meaning can help critical nurses identify their intrinsic motivation and hold tight to it during professional challenges or low morale. Previous studies found meaning-making as an essential element of spirituality. In the present study, it is strongly related to the other subthemes: sense of pride and joy, personal relationships, thriving, and moral responsibility.

Conclusion: It makes sense for care management to create specific structures and work conditions, such as flexible scheduling, opportunities for professional development, and supportive team environments that encourage critical care nurses in their professional autonomy. Measures tailored to the individual needs and resources are also crucial. In this way, existing intrinsic motivation can be nurtured, and critical care nurses are enabled to autonomously discern values set by the employer into their own value system.

Implication for clinical practice: Institutions need to offer critical care nurses decision-making discretion whenever possible, broad information sharing, and a climate of trust and respect, in which the individual may feel autonomous and can develop personally and professionally.

Objective: To evaluate the effects of a 4-week Delirium Introduction and Maintenance programme based on the knowledge-to-action framework on nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium in the paediatric intensive care unit (PICU).

Research methodology/design: A quasi-experimental study with a pretest-posttest design.

Setting: This study was conducted between January and February 2024 with nurses in two Indonesian PICUs.

Main outcome measures: Nursing knowledge, self-confidence and attitudes were measured at baseline and the third and fourth weeks (maintenance period) after the intervention was implemented. The Cornell Assessment of Pediatric Delirium (CAPD) was used to evaluate the screening accuracy for delirium at the third and fourth weeks postintervention.

Results: A total of 44 nurses with a mean age of 28 years participated in the intervention. At weeks 3 and 4 after the intervention, the intervention group exhibited substantial improvements in knowledge (B = 1.35 and 1.39), self-confidence and attitudes (B = 1.26 and 1.29), and screening accuracy (B = 0.25 and 0.27) compared with the control group (all P < 0.05). The nurses' screening accuracy for delirium by using the CAPD improved from 50 % (week 1) to 86 % (week 3) and 100 % (week 4) in the intervention group, whereas the nurses' screening accuracy for delirium in the control group modestly increased from 17 % to 33 % (week 3) and 37 % (week 4).

Conclusions: The theory-driven, multimodal intervention improved the nurses' knowledge of delirium, self-confidence and attitudes, and screening accuracy for delirium. Implementing comprehensive delirium education programmes can enhance delirium recognition and management in PICUs. Future studies should investigate the long-term effects of delirium education programmes on patient outcomes.

Implications for clinical practice: An integrated instructional approach was employed to improve nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium.

Purpose: Mobilization within 24 h post-cardiac surgery (CS) supports improved patient health outcomes. Despite being safe and recommended, it is unknown how much mobility takes place post-CS in the intensive care unit (ICU). Behaviour mapping was used to describe patterns of patients' mobility in one CS ICU.

Materials and methods: Behaviour mapping gathers information on behaviour regularly over a time period. Two authors observed one CS ICU over a sixteen-hour period (0630-2230 h) on four days. Observers collected data on patients' mobility mode, location, and support at 15-minute intervals. Data aggregated into four-hour time blocks is described.

Results: A total of 1342 observations were collected over four days: 487 of mode, 485 of location, and 370 of support. Sitting in a chair was observed 430 of 487 observations, 10-fold more than any other mode of mobility. Mobility within the ICU room was observed in 448 of 485 observations. Family support for mobility was observed in 178 of 370 observations. The most common time block for mobilization was from 0630 to 1030, with 488 of 1342 observations.

Conclusions: Research is required to support the integration of early mobility beyond sitting in a chair supported by more team members into local CS ICU clinical care.

Implications for clinical practice: The existence of early mobility protocols does not mean that they are operational in the CS ICU. Integration of these protocols into CS ICU clinical care requires collaboration among researchers and clinicians.

Objectives: To identify the key determinants for implementing and utilizing a digital intensive care unit (ICU) diary among ICU professionals.

Background: Despite the advantages of digital diaries over traditional paper ones, their implementation presents challenges that necessitate tailored strategies considering the influencing factors.

Design: A multicentre, cross-sectional survey study.

Methods: A self-developed questionnaire was administered from March to May 2023, targeting ICU professionals across four hospitals in the Netherlands. Participants rated the relevance of 34 determinants on a 5-point Likert scale across four domains: (1) Digital diary introduction and use, (2) Education and information dissemination, (3) Offering the digital diary to patients' relatives, and (4) Professionals' engagement in diary writing.

Results: Responses were received from 214 professionals. The most commonly agreed-upon determinants promoting implementation were seamless accessibility (n = 200; 93.5 %), enthusiastic and motivating champions (n = 190; 88.8 %), and comprehensive information and education (n = 184; 86 %). The preferred method for disseminating information was direct instruction from champions in the teams (n = 194; 90.7 %). Promoting factors for providing digital diaries to relatives included understanding its utility (n = 203; 94.9 %) and recognizing its added value (n = 193; 90.2 %). Additionally, 132 professionals (61.7 %) expressed a positive attitude towards co-writing the digital diary.

Conclusion: This study identified key determinants promoting the implementation and utilization of digital diaries in ICUs among professionals. These findings lay a foundation for developing strategies to address challenges and enhance the successful implementation of digital diaries in ICU settings.

Implications for clinical practice: To maximize the impact of digital diaries, it is essential to involve end users early and tailor the design for ease of use. Selecting influential champions is key, and they should receive training to lead and mentor others. Clear communication of the benefits for patients and families will foster professionals' understanding and motivation, ultimately enhancing patient care.

Objectives: A child's critical illness and admission to intensive care can have significant short- and long-term impacts for the parents and hospitalized child. While experiences of parents have been explored, the impact on siblings remains unclear. The aim was to systematically review and synthesize qualitative research exploring the experiences of siblings when a child is critically ill, from the perspectives of siblings and relevant key stakeholders.

Methods: Comprehensive searches were performed across six databases and three sources of grey literature on October 30, 2023 and September 23, 2024. Original qualitative research focusing on sibling experiences during a child's critical illness were included. Two independent reviewers screened studies, with conflicts resolved by a third reviewer. Data extraction and quality assessment were carried out by one reviewer and verified by a second reviewer using Covidence. Thematic synthesis was used to synthesize extracted data, ensuring the rigor of the findings.

Findings: Of 1,552 studies screened, 24 met inclusion criteria. Seven mixed methods and 17 qualitative studies were included. Experiences of siblings were categorized into eight themes and included elements such as visiting the ICU, being separated, changing roles, looking to the future, and getting support. Sibling experiences could be positively or negatively influenced by parents, healthcare professionals, hospital policies and environment.

Conclusions: This study provides a novel insight into the underrepresented sibling experience in critical care research. Siblings experience significant multi-faceted impacts when a child is critically ill. This review underscores the necessity for further research on siblings' perspectives in critical care, to aid development of appropriate supports and interventions for siblings and families during a child's critical illness.

Implications for clinical practice: Understanding siblings' experiences can enhance holistic family-centered care. Findings from this review demonstrate the need for more supportive practices for siblings in intensive care, through development of inclusive, family-centered care policies and guidelines.

Objective: To assess the predictive effects of end-tidal carbon dioxide partial pressure (PETCO₂) in combination with pH measurement in confirming gastric tube placement in neurologically critical patients.

Methods: This study included 105 patients with gastric tubes placed in the neurological intensive care unit of Henan Provincial People's Hospital between November 2023 and April 2024. By employing X-ray as a gold standard, we compared the predictive value of PETCO₂, pH testing, or PETCO₂ in combination with pH measurement on the position of the tubes.

Results: Receiver operating characteristic curve analysis of the three methods revealed varying diagnostic efficiencies. The PETCO₂ method exhibited low performance, with an area under the curve (AUC) of 0.714, sensitivity of 42.9 %, specificity of 100 %, positive predictive value (PPV) of 100 %, and negative predictive value (NPV) of 96.1 %. In contrast, the pH method demonstrated better diagnostic capability, with an AUC of 0.821, sensitivity of 71.4 %, specificity of 92.9 %, PPV of 41.7 %, and NPV of 97.8 %. PETCO₂ in combination with pH method showed the highest efficiency, achieving an AUC of 0.964, sensitivity of 100 %, specificity of 92.9 %, PPV of 50%, and NPV of 100 %.

Conclusion: Using PETCO₂ combined with pH measurement to confirm gastric tube placement demonstrated high accuracy and reliability, consistent with X-ray results. This combined approach offers a reliable, non-invasive alternative to X-ray for confirming gastric tube placement in neurologically critical patients.

Trial registration: Chinese Clinical Trial Registry (Registration No. ChiCTR2300078001).

Objective: To identify the related factors of neonatal catheter-associated bloodstream infection (CABSI), and provide a basis for constructing a scientific and rational strategy for neonatal CABSI prevention.

Methods: CNKI, Wanfang, PubMed, MEDLINE-Ovid, Web of Science, Embase, CINAHL, and Cochrane Library were searched for publications on neonatal CABSI from the time the database was established until September 30, 2023. The language of publications was not specified. Unpublished reports and gray studies were excluded. All cohort, case-control, and cross-sectional studies were included. A meta-analysis of the incidence and related factors of neonatal CABSI were made using Revman software. Heterogeneity was evaluated using the I² statistic method, and the publication bias was analyzed with funnel plot tests.

Results: A total of 35 studies involving 34,743 patients from 13 different countries were included. There were 15 case-control, 15 cohort, and 5 cross-sectional studies, with 14 related factors discussed. All the studies scored high (score ≥ 6) in their overall quality. According to the meta-analysis, the incidence of neonatal CABSI was 5.93/1000 catheter days (OR = 5.29). The risk factors were identified and ranked as follows according to the degree of influence: 5-minute Apgar score (OR = 4.69), the number of punctures during the stay of the line (OR = 3.49), male (OR = 3.17), mechanical ventilation (OR = 2.73), catheter repair (OR = 2.66), lower gestational age at birth (OR = 2.47), femoral vein catheter (OR = 1.92), dwell time of the catheter (OR = 1.34), and lower birth weight (OR = 1.05). Establishing sterile barrier throughout was a protective factor (OR = 0.41). Subgroup analysis suggested that the study design, catheter type and year of publication might be the primary sources of heterogeneity. The sensitivity analysis demonstrated the robustness of the results. However, the funnel plot indicated a potential publication bias.

Conclusion: Neonatal CABSI carries a significant morbidity rate and is influenced by numerous factors.

Implications for clinical practice: It is crucial to underscore the necessity for additional longitudinal studies to explore evidence-based approaches to lowering the risk and ultimately reducing the incidence of CABSI. Registration The study protocol has been registered with the PROSPERO: CRD42023443697.

Background: Hospital readmission following critical illness is common. There is limited data which examines the patient and family perspective of hospital readmission. Understanding the impact of readmissions from a patient perspective can potentially help design meaningful clinical pathways to support improvements in care.

Objectives: The aim of this qualitative analysis was to explore the experience of patient and family members during readmission to hospital following critical illness. We also sought to understand any perceived drivers of these readmissions from a patient and caregiver perspective.

Methods: Qualitative descriptive study using semi-structured interviews. Data were analysed using a thematic content analysis approach based on Miles and Huberman's framework.

Setting and participants: This study was conducted in a large inner city teaching hospital in the UK. Critical care survivors who had been readmitted to hospital following critical illness and their family members were invited to participate in interviews during the readmission episode.

Results: Interviews were undertaken with 20 participants (15 patients and 5 family members). We derived five themes related to hospital readmission: access to primary care; ongoing physiological disturbance; discharge planning and information provision; treatment burden; and carer strain and social care access.

Conclusions: There are multiple perceived drivers of readmission to hospital following critical illness from a patient and family member perspective. The experience of readmission can be potentially traumatic for those involved. Future research should examine how discharge planning can be improved and how family members can be effectively supported in the post-hospital discharge period.

Implications for practice: Clear discharge planning and information provision is required to ensure effective care for survivors of critical illness. Family members of survivors could also benefit from dedicated support across the continuum of care.

Objectives: Analyze the effectiveness of different non-pharmacological sleep interventions in preventing delirium among postoperative ICU patients.

Research methodology: We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, CINAHL, OpenGrey and reference lists up to May 2024.

Setting: We systematically searched all randomized controlled trials related to non-pharmacological sleep interventions for the prevention of delirium.

Results: The results of the network meta-analysis showed that, compared to Usual Care, multicomponent interventions are the most effective measures for preventing delirium in postoperative ICU patients (RR = 0.32, 95 % CI = 0.20 to 0.51). This is followed by non-pharmacological sleep interventions aimed at stress relief (RR = 0.60, 95 % CI = 0.41 to 0.89) and circadian rhythm (RR = 0.61, 95 % CI = 0.39 to 0.96). Additionally, non-pharmacological sleep interventions focusing on circadian rhythm demonstrated an improvement in sleep quality among postoperative ICU patients (SMD = -0.99, 95 % CI = -1.88 to -0.11).

Conclusions: Our study found that multicomponent non-pharmacological sleep interventions are effective in reducing the incidence of delirium in postoperative ICU patients. Furthermore, non-pharmacological interventions focused on circadian rhythm regulation significantly enhance sleep quality among these patients.

Implications for clinical practice: Based on this study, intensive care units and nursing staff have an opportunity to implement the most effective non-pharmacological sleep interventions to prevent delirium and improve sleep quality in postoperative ICU patients. This could contribute to a reduction in the incidence of delirium in postoperative ICU patients.