Nursing in Critical Care最新文献

{"title":"Health disparities in service delivery in the intensive care unit: A critical ethnographic study.","authors":"Sajad Yarahmadi, Mohsen Soleimani, Mohammad Gholami, Ali Fakhr-Movahedi, Seyed Mohsen Saeidi Madani","doi":"10.1111/nicc.13170","DOIUrl":"10.1111/nicc.13170","url":null,"abstract":"<p><strong>Background: </strong>The intensive care unit has structural complexities, and critically ill patients are exposed to disparities. Thus, the intensive care unit can be a potential health disparity setting.</p><p><strong>Aim: </strong>This study explored cultural knowledge associated with health disparities in the intensive care unit.</p><p><strong>Study design: </strong>This critical ethnographic study was conducted using Carspecken's approach. It was carried out in intensive care units in Western Iran from 2022 to 2023. Data collection and analysis were conducted in three interconnected stages. The initial stage involved over 300 h of field observation. In the subsequent stage, a horizon analysis was performed. Conversations with 17 informants were recorded in the final stage to enrich the dataset further. Then, the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity.</p><p><strong>Results: </strong>This research revealed the following themes: (a) extension of the impact of political, social, and cultural powers, (b) being influenced by individual diversity, (c) balancing services based on the consideration of benefits and consequences, (d) departure from professional behaviour and (e) insufficient organizational discipline.</p><p><strong>Conclusions: </strong>The findings of this study showed that individual diversity, political, social and cultural powers within a context of insufficient organizational discipline, and departure from professional behaviour influence the service delivery culture in the intensive care unit. Moreover, the benefits and consequences of service delivery impact its execution. These stereotypes have the potential to contribute to the emergence of health disparities. Cultural transformation is challenging because of deep-rooted stereotypes, but the reduction of disparities is possible through awareness, critical self-reflection and cultural competence.</p><p><strong>Relevance to clinical practice: </strong>The findings of this research can prompt staff self-reflection in situations prone to disparities. Health leaders can use these findings to shape health policies at both macro and micro levels.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13170"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395069","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":"Knowledge, attitude and practice regarding thirst management in surgical patients among intensive care unit nurses: A cross-sectional study.","authors":"Ying Zhu, Jianhong Lv, Xinqi Wang, Fei Yang, Weiying Zhang","doi":"10.1111/nicc.13176","DOIUrl":"10.1111/nicc.13176","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of thirst in intensive care unit (ICU) surgical patients is high, and its impact is significantly harmful. Nurses play a crucial role in managing thirst. It is essential to develop targeted training programmes for nurses, focusing on their knowledge, attitude and practice (KAP).</p><p><strong>Aim: </strong>To investigate KAP regarding thirst management in surgical patients among ICU nurses and the potential influencing factors related to demographic characteristics.</p><p><strong>Study design: </strong>This is a cross-sectional study. From August to September 2023, a self-developed questionnaire was distributed online in the ICUs of 14 tertiary general hospitals in Shanghai, China. This questionnaire aimed to assess the KAP of ICU nurses concerning thirst management. Influencing factors were analysed using ANOVA and the rank-sum test. Spearman correlation analysis and stratified regression analysis were employed to evaluate the relationship among KAP. The study was reported according to the STROBE checklist.</p><p><strong>Results: </strong>A total of 530 valid questionnaires were obtained online with a response rate of 86.60%. While ICU nurses generally held a positive attitude towards thirst management, there was a noticeable deficiency in knowledge and a lack of standardization in practice. Nurses with higher educational levels, lower academic titles, who had received training and who were familiar with the consensus and guidelines on thirst management had better attitude towards managing thirst. Younger nurses, those with less ICU working experience, lower academic titles, who had received training and who were acquainted with the guidelines showed better practice. It was observed that knowledge and attitude both had a significant positive influence on practice.</p><p><strong>Conclusions: </strong>KAP regarding thirst management of surgical patients among ICU nurses are interconnected and require enhancement. Targeted training, focused on the identified weakness and influencing factors, needs to be carried out.</p><p><strong>Relevance to clinical practice: </strong>An innovative and stratified training system can improve the quality of practice, as well as contributing to the professional development of ICU nurses. Further, the findings of the study provide a foundational understanding of thirst management, promoting the advancement of related scientific research.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13176"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395070","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":"Development and Validation of Decision Needs Scale for Surrogates of Patients When Considering an Invasive Procedure in an Intensive Care Unit.","authors":"Wan-Na Sun, Su-Ying Fang","doi":"10.1111/nicc.70045","DOIUrl":"https://doi.org/10.1111/nicc.70045","url":null,"abstract":"<p><strong>Background: </strong>Patients admitted to intensive care units often rely on surrogates for decision making, especially for invasive procedures. Over 70% of decisions are related to invasive procedures. Surrogates' unmet needs during decision making can lead to conflicts. Existing scales assess the general needs of surrogates, and tools designed explicitly for invasive procedure decision making are lacking, necessitating the development of targeted assessments for use by healthcare professionals.</p><p><strong>Aim: </strong>This study aimed to develop and evaluate the reliability and validity of the Surrogate Decision Needs Scale (SDNS) for surrogates of critically ill patients considering invasive procedures.</p><p><strong>Study design: </strong>This study was conducted at a medical centre. Two clinical and research experts drafted assessment items based on a literature review, which was refined by five experts. A cross-sectional design with convenience sampling was used to measure the needs of the surrogates. Exploratory factor analysis and known group analysis examined the scale's construct validity, while internal consistency reliability was evaluated using Cronbach's alpha.</p><p><strong>Results: </strong>The expert content validity index of the SDNS was 0.93-1. A convenience sample of 100 surrogates of ICU patients completed the 16 items SDNS, and 132 invasive procedures were analysed. Exploratory factor analysis revealed three factors: Information Needs, Support Needs and Recourse Needs, which explained 70.13% of the total variance. Known-group analysis showed that having a high educational level (p = 0.001) and being a child of the patient (p = 0.021) were associated with placing high importance on information, support and resource needs during decision making.</p><p><strong>Conclusions: </strong>The SDNS effectively assesses the needs of ICU surrogates in making decisions about invasive procedures. Findings suggest that surrogate education level and relationship to the patient may influence decision priorities, with college-educated surrogates prioritising information needs while children serving as surrogates emphasised support needs. Future research should explore the SDNS's applicability in diverse cultural settings and surrogate roles to determine whether these patterns are consistent across different populations. Longitudinal studies are needed to examine the trajectory of surrogates' decision needs, particularly in cases involving invasive procedures.</p><p><strong>Relevance to clinical practice: </strong>Healthcare professionals should address decision needs by explaining the risks associated with invasive procedures, discussing specific recommendations with patients' family members and allowing surrogates sufficient time for contemplation before decision-making.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70045"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058065","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":"Reducing the incidence of stage II or higher pressure injuries in patients undergoing prone positioning in the intensive care unit: A pre- post-intervention study.","authors":"Guo Ge, Bing Wu, Dongliang Xu, Qiang Liu, Qian Xie, Meihui Yang, Yiting Feng, Shujuan Mai, Miaohang Shan","doi":"10.1111/nicc.70036","DOIUrl":"https://doi.org/10.1111/nicc.70036","url":null,"abstract":"<p><strong>Background: </strong>Prone positioning (PP) is widely used in intensive care units (ICUs) to improve oxygenation in patients with respiratory distress. However, prolonged maintenance in this non-physiological position, especially in patients with underlying comorbidities, increases the risk of pressure injuries (PIs).</p><p><strong>Aim: </strong>This study aimed to evaluate the effectiveness of a nursing quality improvement (QI) project in reducing the incidence of stage II or higher PIs in ICU patients undergoing prone positioning.</p><p><strong>Study design: </strong>This was a single-centre, pre- and post-intervention QI study conducted in an ICU setting. The intervention included the development of the nursing care protocol for prone-positioned patients and the foam dressing application protocol for prone-positioned patients, along with instructional videos, structured nurse training and enhanced supervision mechanisms. Given that stage II PIs signify damage to both the epidermis and dermis, representing a critical phase in their progression, this study focused primarily on the incidence of stage II or higher pressure injuries.</p><p><strong>Results: </strong>A total of 70 patients were included, with 31 in the pre-intervention group and 39 in the post-intervention group. Before the intervention, 58.06% (18/31) of patients developed stage II or higher PIs across 47 sites, most commonly on the cheeks (n = 9, 19.15%). Post-intervention, 25.64% (10/39) of patients developed PIs, affecting a total of 10 sites, all classified as stage II, with the chin being the most frequently affected area (n = 4, 40.00%). The intervention significantly reduced PI incidence by 55.83% (p = .006, odds ratio = 0.24, 95% CI: 0.08-0.69), with no stage III or higher injuries reported.</p><p><strong>Conclusion: </strong>The implementation of the nursing QI project significantly reduced the incidence of stage II or higher PIs in ICU patients undergoing prone positioning. However, PIs continued to occur predominantly in the head and facial regions, such as the chin and ears, highlighting the need for targeted protective strategies for these high-risk areas.</p><p><strong>Relevance to clinical practice: </strong>This study demonstrates the effectiveness of a structured QI approach in reducing stage II or higher PIs in ICU patients undergoing prone positioning. Standardized protocols, structured training and quality monitoring enhanced adherence to preventive measures, providing practical guidance for ICU nurses in mitigating PI risk.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70036"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059606","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":"Investigating the Impact of the Family Interaction Model on the Anxiety and Mental Well-Being of Patients During Visit Restrictions in Intensive Care Units: A Mixed-Methods Study.","authors":"Esma Atasoy, Adeviye Aydin, Rabia Gurkan, Hilal Özcebe","doi":"10.1111/nicc.70046","DOIUrl":"https://doi.org/10.1111/nicc.70046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients hospitalised in the intensive care unit (ICU) often experience feelings of isolation and a sense of profound loneliness. These individuals frequently report symptoms of anxiety, depression and other psychiatric disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;The aim of this study was to examine the impact of the family interaction model on the anxiety and mental well-being of patients during the visit restrictions in the ICUs. Additionally, the experiences of intensive care patients and their relatives regarding this process were investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This research utilised a parallel design mixed-methods approach, incorporating both quantitative and qualitative designs. A qualitative research design was employed in the quasi-experimental framework to examine post-intervention experiences. The research sample consisted of 47 patients in the intervention group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The intervention group, that received videos and messages from their relatives, exhibited a decrease in anxiety over time. In contrast, the control group demonstrated an increase in anxiety over time. The results indicated that 77% of these changes were due to the group variable (CI: -38.627 to -30.902; p &lt; 0.05). Mental well-being scores demonstrated an increase over time in the intervention group, while a decrease was observed in the control group. The analysis revealed that 83.4% of this change could be attributed to the group variable (CI: 29.178-35.048; p &lt; 0.05). In the interviews, three themes were obtained from both patients and the relatives of the patients in the intervention group. In the control group, four themes were found. In the qualitative interviews conducted with the patients in the intervention group, the subthemes regarding their feelings about the disease process and intensive care experience included fear, uncertainty and anxiety, and hopelessness and longing, while after the patients were shown the video, themes that overlapped with positive feelings were found. These subthemes were determined as happiness, excitement and hope. In the control group, the subthemes regarding their experiences of the disease process were determined as death anxiety, hopelessness and helplessness, uncertainty, agitation and physical discomfort (pain and fatigue).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results of this study demonstrated that using remote communication methods to facilitate interaction between patients and their families was linked to reduced anxiety in patients, improved mental well-being and increased satisfaction among their relatives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Relevance to clinical practice: &lt;/strong&gt;The primary strength of the study is its pioneering role in facilitating communication between intensive care patients and their relatives at the public hospital level during the pandemic period. Additionally, it has shed light on the emotional outcomes associated with this communication. Mor","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70046"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055413","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":"Knowledge, Attitude and Practice Concerning Central Line-Associated Bloodstream Infection Prevention Among ICU Nurses in China: A Multicenter, Cross-Sectional Study.","authors":"Xiaofeng He, Chunlei Li, Zhe Wang, Mayi Yang, Tianjun Zhou, Ying Gu, Yuxia Zhang, Wenchao Wang, Yan Hu","doi":"10.1111/nicc.70047","DOIUrl":"https://doi.org/10.1111/nicc.70047","url":null,"abstract":"<p><strong>Background: </strong>Globally, there has been a general decline in the occurrence of central line-associated bloodstream infection (CLABSI). Still, CLABSI remains a common healthcare-associated infection in the ICUs of hospitals in developing countries.</p><p><strong>Aim: </strong>The aim of the study was to assess knowledge, attitude and practice among ICU nurses in China concerning CLABSI prevention.</p><p><strong>Study design: </strong>A multicentre, cross-sectional study was designed. A self-designed questionnaire, informed by a literature review and expert consultation, was utilised to assess the knowledge, attitude and practice of ICU nurses. The widely used electronic data collection tool in China, known as the Wen Juan Xing platform, facilitated data gathering via the internet. A total of 989 ICU nursing staff from 22 large tertiary public hospitals in China completed the online survey between 1 May 2024 and 30 June 2024.</p><p><strong>Results: </strong>The proportion of ICU nurses with good (≥ 80% accurate response) knowledge, attitude and practice was 31.14%, 45.50% and 89.99%, respectively. ICU nurses' knowledge and attitude were mainly influenced by their age, ICU experience and professional level, meanwhile, their practice differences were found by their gender and educational level. In addition, nursing programs or processes, previous training experience and whether need more information were significantly associated with nurses' knowledge, attitude and practice.</p><p><strong>Conclusions: </strong>In summary, Chinese ICU nurses demonstrated inadequate levels of knowledge and attitude towards CLABSI prevention. Study findings suggest that arranging training in refreshing, taking advantage of experienced nurses' leading roles and changing safety culture might be useful in enhancing ICU nurses' knowledge, attitude and practice.</p><p><strong>Relevance to clinical practice: </strong>The results of this research imply that the government, nursing associations and hospitals themselves should provide tailored training programs, improve safety culture and explore dynamic assessment methods to promote optimal knowledge, attitude and practice relevant to CLABSI prevention among ICU nurses in China.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70047"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055415","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":"Communication difficulties in mechanically ventilated voiceless patients in intensive care units: A qualitative study.","authors":"Sara Brambilla, Davide Ausili, Giulia Locatelli, Stefania Di Mauro, Giacomo Bellani, Michela Luciani","doi":"10.1111/nicc.70037","DOIUrl":"10.1111/nicc.70037","url":null,"abstract":"<p><strong>Background: </strong>Mechanically ventilated patients are unable to verbally communicate due to the endotracheal tube or tracheostomy, rendering them temporarily 'voiceless'. More and more patients are conscious during mechanical ventilation because of a new paradigm based on mild/no sedation. Communicating with conscious voiceless patients can be complex and frustrating, leading to negative outcomes and experiences for patients, family members and health care professionals.</p><p><strong>Aim: </strong>To explore the negative effects of the inability to communicate verbally among voiceless patients in intensive care units (ICUs), considering the perspectives of voiceless patients, health care professionals and family members.</p><p><strong>Study design: </strong>This qualitative study uses Interpretive Description methodology. Semi-structured interviews were conducted with patients, family members and health care professionals. Data were collected at three ICUs in Italy over 3 months. Data were analysed using the Rapid and Rigorous qualitative data analysis.</p><p><strong>Results: </strong>Forty-three people were interviewed (10 patients, 13 caregivers, 13 nurses and 7 physicians). Three major themes were identified: perception of communication difficulties, negative impacts on relationships and emotions, and negative effects on care. These findings indicate that communication difficulties in ICU have negative emotional and psychological consequences for all participants and the health care provided.</p><p><strong>Conclusions: </strong>Effective communication with voiceless patients is essential for their well-being and quality of care. Future research should focus on identifying and evaluating tailored communication methods for voiceless patients.</p><p><strong>Relevance to clinical practice: </strong>This study emphasizes the importance of interventions improving voiceless communication, including training health care professionals and critical care nurses in alternative communication strategies, providing psychological support to voiceless patients, and encouraging extended family presence.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70037"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care providers' perceptions of family participation in essential care in the intensive care unit: A qualitative study.","authors":"Boukje M Dijkstra, Lisette Schoonhoven, Karin M Felten-Barentsz, Margriet J M van der Valk, Johannes G van der Hoeven, Lilian C M Vloet","doi":"10.1111/nicc.13188","DOIUrl":"10.1111/nicc.13188","url":null,"abstract":"<p><strong>Background: </strong>Family participation in essential care may benefit patients and relatives.</p><p><strong>Aim: </strong>To examine the needs, perceptions and preferences of health care providers about family participation in essential care in the adult intensive care unit.</p><p><strong>Study design: </strong>A qualitative descriptive study using inductive thematic analysis. Three focus group interviews with a total of 30 intensive care unit health care providers, consisting of 20 critical care nurses, one nursing assistant, five physicians, three physical therapists and one speech therapist working in three Dutch intensive care units.</p><p><strong>Results: </strong>One overarching theme, balancing interests, and four main themes emerged: looking after the patient's interests, taking the relatives' perspective into account, looking after interests of intensive care unit health care providers and conditions for family participation. The first theme, looking after the patient's interests, included three sub-themes: insecurity about patient's wishes and needs, patient safety concerns and potential benefits for the patient. The second theme, taking the relatives' perspective into account, was also characterized by three sub-themes: concerns about the relatives' possible burden, potential benefits for the relative and the relationship between patient and relative. The third theme, looking after interests of intensive care unit health care providers, included three sub-themes: attitude towards family participation in essential care, differing perceptions of essential care and concerns about intensive care unit health care provider's burden. The last theme, conditions for family participation, included two sub-themes: establishing a relationship and considering family participation in essential care as a process.</p><p><strong>Conclusions: </strong>Health care providers' perceptions and preferences regarding family participation in essential care in the intensive care unit are summarized in the overarching theme balancing interests. This overarching theme also reflects the needs and perceptions of patients and relatives.</p><p><strong>Relevance to clinical practice: </strong>These findings may support critical care nurses and other health care providers when encouraging family participation in essential care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13188"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Nurse-Patient Ratios on Patient Outcomes in Intensive Care Units.","authors":"Ashraf Abdelrhman Elbashir Elmdni","doi":"10.1111/nicc.70054","DOIUrl":"https://doi.org/10.1111/nicc.70054","url":null,"abstract":"<p><strong>Background: </strong>Intensive care units (ICUs) are complex and fast-paced environments where nurse-to-patient ratios significantly influence patient outcomes. Existing research highlights the relationship between staffing levels and outcomes such as mortality, hospital-acquired infections, length of ICU stays, patient safety incidents, and nurse job satisfaction.</p><p><strong>Aim: </strong>This systematic review aims to evaluate the impact of nurse-to-patient ratios on patient outcomes and nurse well-being in ICUs, providing evidence to guide staffing policies.</p><p><strong>Study design: </strong>A systematic review of 20 studies conducted across various locations was undertaken. The review includes retrospective cohort studies, cross-sectional designs, and other methodologies. The studies were analysed to determine the influence of staffing levels on patient and nurse outcomes.</p><p><strong>Results: </strong>Safe nurse staffing levels were associated with a 14% reduction in hospital mortality, shorter ICU stays, a 20% improvement in infection prevention, and an average ICU stay reduction of 1.5 days. Enhanced patient satisfaction by 18% in units with adequate staffing. Conversely, lower staffing ratios were linked to a 25% increase in adverse events, nurse fatigue, and diminished patient safety outcomes. The findings underscore the necessity of adequate staffing strategies and the adoption of workforce technologies to enhance care quality in ICUs.</p><p><strong>Conclusions: </strong>This review highlights the critical role of nurse-to-patient ratios in improving patient outcomes and nurse well-being in ICUs. Future research should focus on standardizing methodologies to evaluate staffing strategies and exploring their long-term impacts on both patient and nurse outcomes.</p><p><strong>Relevance to clinical practice: </strong>These findings emphasize the importance of implementing evidence-based staffing policies and integrating supportive technologies to ensure optimal care delivery and staff satisfaction in ICUs.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70054"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183541","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":"Long-Term Effects of Daily Versus Alternate-Day Chlorhexidine Bathing on Central-Line-Associated Blood Stream Infection in Medical Intensive Care Units: A Four-Year Observational Study.","authors":"Yi-Chen Lin, Hao-Yun Chang, Hui-Ji Lin, Pao-Yu Chen, Shiao-Pei Wang, Pao-Yu Chuang, Yee-Chun Chen, Chia-Chun Tang","doi":"10.1111/nicc.70049","DOIUrl":"https://doi.org/10.1111/nicc.70049","url":null,"abstract":"<p><strong>Background: </strong>Daily chlorhexidine gluconate (CHG) bathing may reduce central line-associated bloodstream infections (CLABSI) in critically ill patients, but evidence remains inconclusive, particularly regarding long-term effects and varying frequencies of use.</p><p><strong>Aim: </strong>This study aimed to examine the association between different CHG bathing frequencies and CLABSI rates in medical intensive care units (MICUs).</p><p><strong>Study design: </strong>A retrospective analysis was conducted in three MICUs in northern Taiwan from March 2018 to June 2022. One MICU implemented daily CHG bathing for 21 months, followed by every-other-day CHG bathing for 30 months, while two MICUs used water and soap as standard care. CLABSI rates per 1000 central line days and other clinical outcomes were compared.</p><p><strong>Results: </strong>Across 46 409 central line days and 5482 admissions, 357 CLABSI events were recorded. No significant difference in CLABSI rates was found between the CHG and standard care groups (IRR = 1.1, p = 0.36) or between the different CHG bathing frequencies (IRR = 0.68, p = 0.06). Other clinical outcomes showed no significant differences.</p><p><strong>Conclusions: </strong>CHG bathing, whether daily or alternate-day, was not significantly associated with lowering CLABSI rates in MICU. The association may vary depending on hospital-specific conditions and infection profiles.</p><p><strong>Relevance to clinical practice: </strong>CHG bathing should not be regarded as a universal infection control strategy in ICUs. It should be evaluated within the context of each ICU's specific conditions and infection prevention strategy.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70049"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038660","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}