{"title":"Ward nurses’ roles and responsibilities during rapid response team activation for patient deterioration: A scoping review","authors":"Hebah Kaljeh RN, MN , Farida Saghafi RN, PhD , Melanie Greenwood RN, PhD","doi":"10.1016/j.aucc.2025.101268","DOIUrl":"10.1016/j.aucc.2025.101268","url":null,"abstract":"<div><h3>Objectives</h3><div>The aim of this scoping review was to explore the existing literature to identify key existing concepts in relation to ward nurses’ engagement and experience during rapid response team (RRT) activation for patient deterioration and highlight gaps in the research.</div></div><div><h3>Review method used</h3><div>The Joanna Briggs Institute methodology was used. The Patterns, Advances, Gaps, Evidence for Practice and Research Recommendations framework was used in a reflective manner alongside the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to guide data synthesis, charting, and reporting of the findings.</div></div><div><h3>Data sources</h3><div>In September 2023, electronic databases—MEDLINE (Ovid), CINAHL Complete (via EBSCO), Embase, Scopus, PubMed, and Google Scholar, for published works, and Web of Science and Networked Digital Library of Theses and Dissertations—were searched. Searches were accompanied by hand-searching grey literature and reference lists.</div></div><div><h3>Review methods</h3><div>Articles were selected according to inclusion and exclusion criteria. A full-text review was completed by two authors independently, with any disagreement resolved by consensus by the third author. A table was developed to extract key information from the eligible studies.</div></div><div><h3>Results</h3><div>Twenty-seven articles were included in the review. Findings highlighted three main patterns: (i) ward nurses' experience; (ii) ward nurses' scope of practice; and (iii) mechanisms affecting ward nurses’ engagement with the RRT.</div></div><div><h3>Conclusions</h3><div>This review identified that the roles and responsibilities of ward nurses during a joint rescue with the RRT are unclear. Multiple mechanisms that impacted the ward nurses' engagement within the RRT were highlighted in this review. Further education and training and specific guidelines on the ward nurses’ role during RRT activation events may help the ward nurses feel more valued as a team member of the RRT and be better prepared and trained to provide nursing care during medical emergencies. Due to the limited data available on the topic, more research regarding the role of ward nurses is necessary.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101268"},"PeriodicalIF":2.6,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elizabeth Manias RN, BPharm, MPharm, MNStud, PhD, DLF-ACN, FAAN, FACCCN, FANZCAP Transitions of Care, Geriatric Medicine , Rebecca Jarden RN, PhD , Kelly Ottosen BN(Hons), MHealthSc(Nurs), RN, PhD , Pauline Wong RN, CCRN, MHthSc, MACN , Philip Peter RN, RM, CCRN, PICNC, BCom Eco, MHthSc, MProfEd&Tmg, MClNse, GCHealthMgt Safe&Qual, GCHealthAdmin, MACN , Sharron Curnow RN, BN , Malcolm Elliott RN, PhD , Frances Lin RN, PhD, FACCCN
{"title":"Engagement with patients and families about managing medications in critical care units: A mixed methods systematic review","authors":"Elizabeth Manias RN, BPharm, MPharm, MNStud, PhD, DLF-ACN, FAAN, FACCCN, FANZCAP Transitions of Care, Geriatric Medicine , Rebecca Jarden RN, PhD , Kelly Ottosen BN(Hons), MHealthSc(Nurs), RN, PhD , Pauline Wong RN, CCRN, MHthSc, MACN , Philip Peter RN, RM, CCRN, PICNC, BCom Eco, MHthSc, MProfEd&Tmg, MClNse, GCHealthMgt Safe&Qual, GCHealthAdmin, MACN , Sharron Curnow RN, BN , Malcolm Elliott RN, PhD , Frances Lin RN, PhD, FACCCN","doi":"10.1016/j.aucc.2025.101267","DOIUrl":"10.1016/j.aucc.2025.101267","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study was to examine how patients and families are engaged in managing medications in critical care units.</div></div><div><h3>Review method used</h3><div>A mixed methods systematic review was conducted.</div></div><div><h3>Data sources</h3><div>A search was conducted of five library databases from inception to January 27, 2024, and updated on September 20, 2024, comprising MEDLINE(R) ALL (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) (Ovid).</div></div><div><h3>Review methods</h3><div>Screening, data abstraction, and quality assessments were completed independently and in duplicate. Included studies were mapped onto a continuum across three levels of engagement, which were consultation, involvement, and partnership and shared leadership.</div></div><div><h3>Results</h3><div>There were 30 studies included. Patients and families were largely engaged through information exchange with health professionals. Patients valued intensive care unit nurses communicating with them as they performed medication activities at the bedside. This communication was considered important regardless of the patients' conscious state. Opportunities for involvement occurred when health professionals asked about patients' and families' needs and preferences for medications. This involvement helped to address symptoms such as pain and anxiety, especially as the patients’ condition improved. There were isolated situations where patients and families were involved in partnerships comprising active decision-making. Interactions between health professionals about medication management during handovers, ward rounds, and informal conversations largely excluded patients and families. Interventional studies had a tenuous focus on patient and family engagement and demonstrated little impact on medication quality and safety.</div></div><div><h3>Conclusions</h3><div>Patients and families faced power differentials, environmental barriers, and unwavering views about their capabilities to be involved about medication management. Many of the situations identified in included studies can be addressed by improving communication opportunities with the healthcare team. Family members can be included in bedside rounds, be allowed to remain present during procedures, and be provided with a routine scheduled opportunity for discussion.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101267"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry Mauricio Parada-Gereda PT MSc , Daniel Molano-Franco MD MSc , Luis Alexander Peña-López PT MSc , Purificación Pérez- Terán MD Spec , Joan Ramon Masclans MD Spec
{"title":"Diaphragmatic Rapid Shallow Breathing Index for predicting successful weaning from mechanical ventilation: A systematic review and meta-analysis","authors":"Henry Mauricio Parada-Gereda PT MSc , Daniel Molano-Franco MD MSc , Luis Alexander Peña-López PT MSc , Purificación Pérez- Terán MD Spec , Joan Ramon Masclans MD Spec","doi":"10.1016/j.aucc.2025.101266","DOIUrl":"10.1016/j.aucc.2025.101266","url":null,"abstract":"<div><h3>Background</h3><div>The Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) has been proposed as a promising tool for predicting successful weaning from mechanical ventilation. By focussing on diaphragmatic activity, the D-RSBI aims to overcome the limitations of the classic rapid shallow breathing index, providing a more specific assessment of the patient's ability to sustain independent breathing following extubation.</div></div><div><h3>Methods</h3><div>Two investigators conducted independent systematic searches in the PubMed, Embase, Cochrane Database, Scopus, Medline, Science Direct, and Epistemonikos databases, covering publications from inception to 30 November 2024. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A meta-analysis was performed using the random-effect model, calculating sensitivity, specificity, diagnostic odds ratio, and the area under the summary receiver operating characteristic curve for the D-RSBI. The systematic review protocol was registered in the Centre for Reviews and Dissemination database 42024582489 of the Prospective International Registry of Systematic Reviews. Subgroup analyses, bivariate meta-regressions, and sensitivity analyses were conducted. Publication bias was evaluated using a funnel plot, along with Begg's and Egger's tests. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology.</div></div><div><h3>Results</h3><div>Fourteen studies were included in the meta-analysis, comprising a total of 1104 patients. The D-RSBI score was significantly lower in the successful weaning group than in the failure group, with a mean difference of −1.09 (95% confidence interval: -1.36 to −0.82; p < 0.05). The pooled sensitivity was 0.88, specificity was 0.82, and the area under the curve was 0.93. The diagnostic odds ratio was 45.2 (95% confidence interval: 23.5 to 87.2; p < 0.05). The studies included were of moderate to high quality, and the certainty of the evidence was rated as moderate.</div></div><div><h3>Conclusions</h3><div>The D-RSBI appears to be a promising predictor for forecasting the success of weaning from mechanical ventilation, offering adequate sensitivity and specificity. However, further clinical trials are needed to confirm and validate these findings and thus to establish the score's potential for enhancing the clinical management of weaning in critically ill patients.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101266"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144272354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luke A. Perry MBBS(Hons) , Greta G. Brooks BA , Noah Greifer PhD , Jackson Hua MD , Belinda Phillips B.Med, FANZCA , Andrew Silvers MBBS, FANZCA , Bobby Ou Yang MD , Zac Tsigaras MD , Bernard Borann BSc(Hons) , Victor Hui MBBS, FANZCA , Rinaldo Bellomo MD, PhD, FCICM
{"title":"The influence of sex on early postoperative opioid administration after cardiac surgery","authors":"Luke A. Perry MBBS(Hons) , Greta G. Brooks BA , Noah Greifer PhD , Jackson Hua MD , Belinda Phillips B.Med, FANZCA , Andrew Silvers MBBS, FANZCA , Bobby Ou Yang MD , Zac Tsigaras MD , Bernard Borann BSc(Hons) , Victor Hui MBBS, FANZCA , Rinaldo Bellomo MD, PhD, FCICM","doi":"10.1016/j.aucc.2025.101260","DOIUrl":"10.1016/j.aucc.2025.101260","url":null,"abstract":"<div><h3>Background</h3><div>Female patients are at an increased risk of experiencing severe postoperative pain and developing chronic pain after cardiac surgery. However, the impact of sex on postoperative opioid administration is underexplored.</div></div><div><h3>Methods</h3><div>This single-centre retrospective cohort study included adults undergoing coronary artery bypass grafting, valve surgery, or a combined procedure at a quaternary referral hospital, between November 2012 and June 2021. Patients were classified as female or male based on biological sex. Opioid doses were converted to oral morphine equivalent daily doses (oMEDDs) to enable comparisons. Energy balancing was used to adjust for baseline differences, including body weight and other confounders. Sex differences in gabapentinoid and antipsychotic drug administration were also evaluated. The aim of this study was to evaluate the association of patient sex and perioperative opioid administration after cardiac surgery.</div></div><div><h3>Results</h3><div>We studied 3188 patients: 825 (25.9%) females and 2363 (74.1%) males. After adjusting for body weight and other confounders, female patients received significantly less opioid analgesia on postoperative day 1 (oMEDD difference: −5.70 mg [95% confidence interval {CI}: −3.15 to −8.25], p < 0.0001), day 2 (oMEDD difference: −9.06 mg [95% CI: −5.05 to −13.08], p < 0.0001), and day 3 (oMEDD difference: −4.50 mg [95% CI: −0.52 to −8.47], p < 0.03). Female patients were also more likely to be prescribed a gabapentinoid (odds ratio: 1.47 [95% CI: 1.02 to 2.13], p = 0.04) but less likely to be prescribed an antipsychotic (odds ratio: 0.63 [95% CI: 0.46–0.86], p = 0.004).</div></div><div><h3>Conclusion</h3><div>In a single-centre cohort study involving over 3000 cardiac surgery patients, female sex was associated with the administration of significantly lower doses of postoperative opioid. Providers involved in the care of cardiac surgery patients should be aware of the potential for implicit bias, and further studies are required to identify mechanisms for the observed disparities.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101260"},"PeriodicalIF":2.6,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond hype: Separating large language model–driven health literacy from clinical decision support system diagnostic rigour","authors":"Zekai Yu BSc Candidate","doi":"10.1016/j.aucc.2025.101265","DOIUrl":"10.1016/j.aucc.2025.101265","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 5","pages":"Article 101265"},"PeriodicalIF":2.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa J. Bloomer RN, PhD, FACCCN, Laura A. Brooks RN, PhD, MACCCN, Krishnaswamy Sundararajan MD, FCICM, Elizabeth Manias RN, PhD, FACCCN
{"title":"Perpetuating collective constructs and othering: We need to do better with identifying and reporting cultural characteristics in critical care research","authors":"Melissa J. Bloomer RN, PhD, FACCCN, Laura A. Brooks RN, PhD, MACCCN, Krishnaswamy Sundararajan MD, FCICM, Elizabeth Manias RN, PhD, FACCCN","doi":"10.1016/j.aucc.2025.101282","DOIUrl":"10.1016/j.aucc.2025.101282","url":null,"abstract":"","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101282"},"PeriodicalIF":2.6,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Post-traumatic stress disorder specific to parents in the neonatal intensive care unit","authors":"Lisa McKeown BN , Sonia Pervin PhD , Kylie Burke PhD , Vanessa E. Cobham PhD , Katie Foxcroft BN, MAppSc , Leonie Callaway MBBS (Hons I), FRACP, PhD","doi":"10.1016/j.aucc.2025.101257","DOIUrl":"10.1016/j.aucc.2025.101257","url":null,"abstract":"<div><h3>Introduction</h3><div>The experience of having an infant admitted to the neonatal intensive care unit (NICU) can be highly traumatic for parents, potentially leading to symptoms of post-traumatic stress disorder (PTSD). Despite the significant emotional impact of the NICU experience, the prevalence rates of probable PTSD among NICU parents, as measured by validated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5) self-report instruments, have not been extensively documented. The aim of this study was to address this gap.</div></div><div><h3>Objective</h3><div>The aim of this pilot study was to assess the prevalence rates of probable PTSD in NICU parents at five time points over 12 months. A secondary aim was to identify differences in probable PTSD between mothers and fathers.</div></div><div><h3>Methods</h3><div>The standardised PTSD Checklist for DSM-5 self-report measure was used to screen parents for symptoms of probable PTSD at the NICU hospital admission, discharge, and 3 months, 6 months, and 12 months of infant corrected age. Probable PTSD was identified with a cut-off score ≥31.</div></div><div><h3>Results</h3><div>A total of 102 parents participated in the study. At hospital admission, 13% of NICU parents met the criteria for a probable PTSD diagnosis, with mothers being twice as likely as fathers to report PTSD symptoms. The majority of parents recovered. A critical subset of parents (6%) reported severe and persistent symptoms of probable PTSD at 12 months.</div></div><div><h3>Conclusions</h3><div>The use of the PTSD Checklist for DSM-5 administered by neonatal nurses can help identify potential signs of parental stress or trauma. Further research must assess whether early screening and referral improve parental outcomes.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101257"},"PeriodicalIF":2.6,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144137756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meilin Liu BS, RN , Ya Guo BS, RN , Jing Bai BS, RN, Zhuoling Wang BM, Jiming Han PhD, MD, Jiayu Zhu BS, RN, Jin Wang MSN, RN
{"title":"Effectiveness of mindfulness-based interventions on psychosocial well-being and occupational-related outcomes among nurses in the intensive care unit: A systematic review and meta-analysis","authors":"Meilin Liu BS, RN , Ya Guo BS, RN , Jing Bai BS, RN, Zhuoling Wang BM, Jiming Han PhD, MD, Jiayu Zhu BS, RN, Jin Wang MSN, RN","doi":"10.1016/j.aucc.2025.101255","DOIUrl":"10.1016/j.aucc.2025.101255","url":null,"abstract":"<div><h3>Background</h3><div>Mindfulness-based interventions may contribute to the mental health status and well-being of nurses. Current results are inconsistent, and there are no systematic review and meta-analyses for intensive care unit (ICU) nurses.</div></div><div><h3>Aim</h3><div>The aim of this study was to assess the effectiveness of mindfulness-based interventions on psychosocial well-being and occupational-related outcomes among nurses in the ICU.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive literature search across 12 electronic databases, including PubMed, Web of Science, Embase, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang, VIP, SinoMed, ClinicalTrials.gov, and preprint repositories (bioRxiv and medRxiv). Additionally, we screened the reference lists of included studies to identify other potentially relevant research. The search covered records from the inception of each database up to July 2024. Two researchers independently screened studies and extracted data. ReviewManager (version 5.3 was used to conduct the meta-analysis.</div></div><div><h3>Results</h3><div>A total of 29 studies were included in the meta-analysis to evaluate the effects of mindfulness-based interventions across different timeframes: immediate-term effects (within 10 days post intervention), short-term effects (10 days–3 months), medium-term effects (3–6 months), and long-term effects (beyond 6 months). The results showed that mindfulness-based interventions significantly alleviated anxiety (mean difference [MD]: −10.80, 95% confidence interval [CI]: [-16.76, −4.83], I<sup>2</sup> = 78%, <em>P</em> < 0.001) and depression (MD: −12.02, 95% CI: [-12.43, −11.61], I<sup>2</sup> = 0%, <em>P</em> < 0.001) in the medium term for ICU nurses. Significant immediate-term effects were observed on well-being (standardised mean difference [SMD]: 0.58, 95% CI: [0.40, 0.76], I<sup>2</sup> = 0%, <em>P</em> < 0.001), resilience (MD: 14.41, 95% CI: [9.71, 19.11], I<sup>2</sup> = 91%, <em>P</em> < 0.001), and death anxiety (MD: −2.35, 95% CI: [-4.39, −0.31], I<sup>2</sup> = 30%, <em>P</em> = 0.02). Mindfulness-based interventions also showed significant short-term effects on well-being (SMD: 0.54, 95% CI: [0.10, 0.99], I<sup>2</sup> = 43%, <em>P</em> = 0.02), sleep quality (MD: −1.19, 95% CI: [-2.32, −0.05], I<sup>2</sup> = 50%, <em>P</em> = 0.04), and stress (SMD: −0.75, 95% CI: [-1.34, −0.17], I<sup>2</sup> = 79%, <em>P</em> = 0.01). Significant effects were observed across immediate-term, short-term, and medium-term timeframes for stress reduction (medium-term effects: MD: −9.69, 95% CI: [-10.18, −9.21], I<sup>2</sup> = 0%, <em>P</em> < 0.001) and mindfulness improvement (medium-term effects: MD: 9.28, 95% CI: [7.20, 11.37], I<sup>2</sup> = 0%, <em>P</em> < 0.001). Additionally, mindfulness-based interventions significantly reduced burnout in the immediate term (SMD: −1.28, 95% CI: [-2.31, −0.25], I<sup>2</sup> = 92%, <em>P</em> = 0.0","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 4","pages":"Article 101255"},"PeriodicalIF":2.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}