Dimensions of Critical Care Nursing最新文献

{"title":"Assessment for Enteral Feeding Intolerance by Critical Care Nurses: A National Survey.","authors":"Jan Powers, Annette M Bourgault, Jennifer S Carroll Simmons","doi":"10.1097/DCC.0000000000000685","DOIUrl":"10.1097/DCC.0000000000000685","url":null,"abstract":"<p><strong>Background: </strong>Enteral feeding intolerance (EFI) occurs in more than one-third of mechanically ventilated patients, yet the cause of this gastrointestinal dysfunction remains unclear. Assessment and diagnostic criteria are often vague and subjective leading to inaccurate recognition or diagnosis of EFI. Nurses are often unsure or unaware of appropriate assessment methods.</p><p><strong>Objectives: </strong>The objective of this descriptive study was to determine current practice for assessment of EFI among critical care nurses.</p><p><strong>Methods: </strong>A national survey to explore EFI assessment practices was conducted with critical care nurses at the American Association of Critical-Care Nurses National Teaching Institute conference in 2022. Nurses completed a 19-item survey to determine assessment practices for EFI among critical care nurses.</p><p><strong>Results: </strong>A total of 344 nurses completed the survey. The majority of nurses practiced direct care at the bedside for adult critical care patients, held a bachelor's degree, had 6 to 15 years of nursing experience, and held specialty certification. There was variability among responses to the practice questions in the survey. Seventy-eight percent of the nurses were aware of and had cared for patients with EFI. EFI was assessed by 84% of participants. The most common assessment criterion for EFI was nausea and vomiting. The majority (81%) of respondents measured gastric residual volume routinely or sometimes.</p><p><strong>Discussion: </strong>This study shows assessment of EFI is not standardized among nurses. This study identifies a need for education about EFI given the lack of understanding of EFI. Findings from this study can be used to inform future research to develop best methods for assessing the presence of EFI.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"44 2","pages":"69-76"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Effect of Nurse-Driven Algorithm in Prevention of Central Catheter-Related Bloodstream Infections in Intensive Care Units.","authors":"Aysun Acun, Nurcan Çalışkan","doi":"10.1097/DCC.0000000000000683","DOIUrl":"10.1097/DCC.0000000000000683","url":null,"abstract":"<p><strong>Background: </strong>Infection control in intensive care units is important for both patients' quality of life and institutions.</p><p><strong>Aim: </strong>This study was conducted to evaluate the effect of a nurse-driven algorithm in preventing central catheter-related bloodstream infections in intensive care units.</p><p><strong>Methods: </strong>This intervention research was implemented in a training and research hospital in Turkey between July 1, 2021, and December 31, 2021. The research was carried out in 3 stages after the creation of the algorithm. The data were collected using the Descriptive Characteristics Form for Nurses, the Descriptive and Medical Characteristics Form for Patients, the algorithm knowledge test, and the Algorithm Parameters Follow-up form. After obtaining the necessary permissions for the study, consent was obtained from the nurses participating in the study. Number, percentage, Wilcoxon, Kruskal-Wallis, and Mann-Whitney U test values were used in the study.</p><p><strong>Results: </strong>With the algorithm, a decrease was found in the rate of infections in the intensive care units.</p><p><strong>Conclusion: </strong>As a result, it was observed that the nurse-driven, central catheter-related bloodstream infection prevention algorithm, prepared using evidence-based clinical guidelines, reduced the rates of infection. Therefore, it is recommended to use algorithm studies as a long-term guide in intensive care units.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"44 2","pages":"91-98"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive Care Unit Memories and Trauma Triggers for Acute Respiratory Distress Syndrome Survivors Hospitalized During the COVID-19 Pandemic.","authors":"Brian C Peach, Laura C Arkin, Lindsey Esparza, Sara Hassan, Leah Shinn","doi":"10.1097/DCC.0000000000000681","DOIUrl":"10.1097/DCC.0000000000000681","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) admissions can be traumatic for critically ill, ventilated acute respiratory distress syndrome (ARDS) patients due to fear of death, an inability to verbally communicate, reliance on health care professionals, and invasive medical interventions. Adult ARDS patients hospitalized during the COVID-19 pandemic were strictly isolated and had limited to no visitation from loved ones, impacting their access to support systems.</p><p><strong>Objective: </strong>To explore the memories and sensory triggers for them (if applicable) of adult ARDS survivors hospitalized during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This study used a phenomenological design with an interpretative descriptive approach. Semistructured interviews with open-ended questions were conducted with survivors. Thematic analysis of 16 ARDS survivors' responses to ICU memories and sensory triggers questions was completed to identify the most prevalent themes.</p><p><strong>Results: </strong>Major themes for vivid memories included (1) altered reality, (2) vivid nonsense dreams, (3) medical treatment/procedures, and (4) feeling lonely/isolated. Themes for triggers included (1) seeing doctors/nurses/hospitals and medical equipment or seeing/hearing media depictions of them, (2) hearing ringtones and beeping/alarms, (3) seeing/hearing helicopters, (4) smelling cleaning products, and (5) seeing/touching scars.</p><p><strong>Discussion/conclusions: </strong>Fifteen of the 16 ARDS survivors reported traumatic vivid memories, often triggered by sensory stimuli they encountered in their everyday lives. It is important for acute care and outpatient nurses to understand the impact of an ICU admission on ARDS survivors' mental health, so they can adopt evidence-based interventions to prevent or limit these effects.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"44 2","pages":"77-84"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Analysis of Preexisting Immunosuppressive Conditions and Infection-Related Readmissions Among Sepsis Survivors.","authors":"Reba A Umberger, Xueyuan Cao, Rebecca B Reynolds, Andrea R Kilgannon, Florian B Mayr, Sachin Yende","doi":"10.1097/DCC.0000000000000672","DOIUrl":"10.1097/DCC.0000000000000672","url":null,"abstract":"<p><strong>Background: </strong>Recurrent episodes of infection and subsequent sepsis are a frequent cause of readmission after sepsis hospitalization. Although persistent immune dysregulation initiated during the sepsis episode may play a role, the impact of preexisting immune suppression (including HIV, organ transplantation, and cancer) and common chronic diseases associated with immune suppression (diabetes and chronic kidney disease) on the risk of recurrent infections after sepsis is unknown.</p><p><strong>Objectives: </strong>To investigate the role of preexisting immune-suppressive conditions (PISCs) and other common chronic diseases on infection-related readmissions after a sepsis admission.</p><p><strong>Methods: </strong>Using the US 2015 Nationwide Readmissions Database, we identified a retrospective cohort of adult patients with an unplanned sepsis index admission from April to September, excluding patients with sepsis during the preceding 90 days. We followed all sepsis survivors for subsequent infection-related admissions for 90 days. We identified clinical conditions using International Classification of Diseases coding.</p><p><strong>Results: </strong>We identified 649 029 unique unplanned sepsis admissions over 6 months; 189 604 (29.2%) had sepsis with PISC, and 459 425 (70.8%) had sepsis without PISC. Overall, sepsis survivors were older (median age, 70 years), and 145 156 (22.4%) experienced at least 1 infection-related readmission within 90 days. The incidence of infection-related readmission among sepsis survivors with PISC was 26.1%, whereas it was 20.8% for those without PISC. The excess risk of infection-related readmissions attributed to PISC was 5.3%, whereas the excess risk attributed to diabetes and chronic kidney disease was 3.7% and 4.7%, respectively. The background risk attributed to new-onset sepsis among participants with none of these conditions was 16.3%. Multivariable regression analysis adjusting for age, gender, and acute illness factors indicated that odds of infection-related readmission were strongly associated with PISC (odds ratio 1.30; 95% confidence interval, 1.29-1.32), closely followed by chronic kidney disease (1.28 [1.27-1.32]) and diabetes (1.17 [1.16-1.19]).</p><p><strong>Conclusion: </strong>The risk of subsequent infection is higher among patients with PISC, although chronic kidney disease and diabetes are also important risk factors for subsequent infection and sepsis readmissions.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"44 1","pages":"48-57"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing Interventions to Prevent Posttraumatic Stress Disorders in People in Intensive Care: A Scoping Review.","authors":"Débora de Fátima Sousa Andrade, Carla Regina Rodrigues da Silva, Derek Braga Moura, Igor Emanuel Soares-Pinto","doi":"10.1097/DCC.0000000000000677","DOIUrl":"10.1097/DCC.0000000000000677","url":null,"abstract":"<p><strong>Objective: </strong>To map nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in the context of intensive care.</p><p><strong>Design: </strong>Scoping review according to the Joanne Briggs Institute methodology.</p><p><strong>Methods: </strong>The search was carried out in the databases PubMed, CINAHL via EBSCO, Joanna Briggs Institute Database of Systematic Reviews, COCHRANE Database of Systematic Reviews, Repositório Científico de Acesso Aberto de Portugal, Dans Easy, and Dart-Europe. Published and unpublished studies (gray literature) were considered. This review integrates articles focused on nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in intensive care in English, Portuguese, and Spanish. Studies with quantitative, qualitative, or mixed designs are covered, as well as systematic reviews and guidelines. The research has 3 eligibility criteria, following the PPC mnemonic: participants (studies involving adults hospitalized in intensive care), concept (studies that address nursing interventions that prevent posttraumatic stress), and context (studies developed in any contextual settings).</p><p><strong>Results: </strong>The present scoping review included 11 articles. Autonomous, nonpharmacologic, pharmacologic, and interdependent nursing interventions were identified, capable of contributing to prevent posttraumatic stress in people hospitalized in intensive care.</p><p><strong>Conclusion: </strong>Identifying nursing interventions that prevent posttraumatic stress in people hospitalized in intensive care allows nurses to develop care plans that include these interventions in the context of intensive care, with a view to improving the quality of nursing care provided.</p><p><strong>Implications for clinical practice: </strong>This scoping review demonstrated that nurses have a crucial role in the prevention of posttraumatic stress in the context of intensive care. It is intended to make nurses aware of this issue, specifically to obtain highly significant and clinically relevant results, sensitive to nursing interventions. It is hoped that this review will be the precursor of research studies, centered on evaluating the degree of effectiveness of the nursing interventions mapped in this review.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"44 1","pages":"36-43"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational Interventions for Rapid Response Team Members: A Narrative Literature Review.","authors":"Alexander Birch, Maureen Varty","doi":"10.1097/DCC.0000000000000655","DOIUrl":"10.1097/DCC.0000000000000655","url":null,"abstract":"<p><strong>Background: </strong>Research continues to be conducted on rapid response systems as patient outcomes associated with rapid response team activations are still not consistently showing benefit. One particular area of focus that is a growing area is the literature regarding training and education for individual team members of the rapid response team.</p><p><strong>Objective: </strong>The purpose of this narrative review was to describe the current literature regarding educational interventions for rapid response team members.</p><p><strong>Methods: </strong>This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. To be included in the narrative review, studies needed to be reporting on educational interventional research for rapid response team members of the efferent limb. No studies were excluded based upon study design or publication years.</p><p><strong>Results: </strong>This narrative review included 6 studies. Four studies assessed outcomes associated with rapid response team members, and 2 of the studies assessed patient outcomes associated with implementing education routinely for rapid response teams. All studies found a positive impact of implementing educational interventions.</p><p><strong>Discussion: </strong>Our narrative review found that limited research has been conducted in the area of educational interventions for rapid response team members, and of the articles identified, most did not assess patient-associated outcomes. The findings demonstrate that this area of research is in its early stages, and further work is needed to identify what content should be provided in the education and what educational methodologies should be employed, and to continue to assess patient health outcomes associated with educational interventions for rapid response team members.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"266-271"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Health Care Decisions Day 2024: As Certain as Death and Taxes.","authors":"Kathleen Ahern Gould","doi":"10.1097/DCC.0000000000000659","DOIUrl":"10.1097/DCC.0000000000000659","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"229-230"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries.","authors":"Jeanne Hlebichuk, Elissa Buck, Angeline L Brooker, Julie K Mackenzie, Meagan Bayless Cleary, Maharaj Singh, Mary Hook","doi":"10.1097/DCC.0000000000000654","DOIUrl":"10.1097/DCC.0000000000000654","url":null,"abstract":"<p><strong>Background: </strong>Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs).</p><p><strong>Objectives: </strong>To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest.</p><p><strong>Method: </strong>This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression.</p><p><strong>Results: </strong>The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03).</p><p><strong>Discussion: </strong>Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 5","pages":"246-252"},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT and Humanization of Care: Return to the Beauty of Little Things.","authors":"Gian Domenico Giusti, Nicola Ramacciati","doi":"10.1097/DCC.0000000000000649","DOIUrl":"10.1097/DCC.0000000000000649","url":null,"abstract":"","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 4","pages":"226-228"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician Prediction of Survival vs Calculated Prediction Scores in Patients Requiring Extracorporeal Membrane Oxygenation.","authors":"Laura Ann Martin, Genesis R Bojorquez, Cassia Yi, Alex Ignatyev, Travis Pollema, Judy E Davidson, Mazen Odish","doi":"10.1097/DCC.0000000000000643","DOIUrl":"10.1097/DCC.0000000000000643","url":null,"abstract":"<p><strong>Background: </strong>Determining appropriate extracorporeal membrane oxygenation (ECMO) candidacy ensures appropriate utilization of this costly resource. The current ECMO survival prediction scores do not consider clinician assessment of patient viability. This study compared clinician prediction of survival to hospital discharge versus prediction scores.</p><p><strong>Objectives: </strong>The aim of this study was to compare clinician prediction of patients' survival to hospital discharge versus prognostic prediction scores (Respiratory ECMO Survival Prediction [RESP] or Survival After Veno-Arterial ECMO [SAVE] score) to actual survival.</p><p><strong>Methods: </strong>This was an observational descriptive study from January 2020 to November 2021 conducted with interviews of nurses, perfusionists, and physicians who were involved during the initiation of ECMO within the first 24 hours of cannulation. Data were retrieved from the medical record to determine prediction scores and survival outcomes at hospital discharge. Accuracy of clinician prediction of survival was compared to the RESP or SAVE prediction scores and actual survival to hospital discharge.</p><p><strong>Results: </strong>Accurate prediction of survival to hospital discharge for veno-venous ECMO by nurses was 47%, 64% by perfusionists, 45% by physicians, and 45% by the RESP score. Accurate predictions of patients on veno-arterial ECMO were correct in 54% of nurses, 77% of physicians, and 14% by the SAVE score. Physicians were more accurate than the SAVE score, P = .021, and perfusionists were significantly more accurate than the RESP score, P = .044. There was no relationship between ECMO specialists' years of experience and accuracy of predications.</p><p><strong>Conclusion: </strong>Extracorporeal membrane oxygenation clinicians may have better predictions of survival to hospital discharge than the prediction scores. Further research is needed to develop accurate prediction tools to help determine ECMO eligibility.</p>","PeriodicalId":46646,"journal":{"name":"Dimensions of Critical Care Nursing","volume":"43 4","pages":"194-201"},"PeriodicalIF":1.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}