Nursing in Critical Care最新文献

{"title":"Knowledge, attitude and practice related to intra-abdominal pressure measurement among intensive care unit nurses and determinant factors: A regional multicentre cross-sectional study.","authors":"Qingqing Sheng, Lihua Chen, Yufeng Tan, Shuqin Zhang, Yao Huang, Tingting He, Xinning Wang, Liting Zeng","doi":"10.1111/nicc.70035","DOIUrl":"https://doi.org/10.1111/nicc.70035","url":null,"abstract":"<p><strong>Background: </strong>Intra-abdominal hypertension is a common serious complication in critically ill patients. Intra-abdominal pressure (IAP) measurement is the only reliable method of detecting and managing IAP. Various factors influence the knowledge, attitude and practice of IAP measurement.</p><p><strong>Aim: </strong>To assess the knowledge, attitude and practice of IAP measurement among ICU nurses and to identify the factors affecting the knowledge, attitude and practice.</p><p><strong>Study design: </strong>A multi-centre cross-sectional survey was conducted in 38 hospitals in Guangdong province, China, from March to June 2024.</p><p><strong>Results: </strong>A total of 1254 valid questionnaires were collected. The median scores of knowledge were 8.0, with an interquartile range of 7.0-8.0. The median scores of attitude were 23.0, with an interquartile range of 21.0-25.0. The median scores of practice were 41.0, with an interquartile range of 36.0-45.0. There was a positive and significant relationship between knowledge, attitude and practice. Multiple linear regression analysis indicated that ICU type (95%CI = -0.469 to -0.163, p = .000), education level (95%CI = 0.024-0.332, p = .024), monthly income (95%CI = 0.054-0.227, p = .002), attitude (95%CI = 0.038-0.090, p = .000) and practice (95%CI = 0.033-0.055, p = .000) independently affected the knowledge; age (95%CI = 0.068-0.815, p = .021), clinical instructor (95%CI = 0.145-0.822, p = .005), head nurse (95%CI = 0.006-1.409, p = .048), knowledge (95%CI = 0.174-0.411, p = .000) and practice (95%CI = 0.077-0.123, p = .000) independently affected the attitude; and age (95%CI = -0.956 to -0.031, p = .036), knowledge (95%CI = 0.871-1.416, p = .000) and attitude (95%CI = 0.446-0.702, p = .000) independently affected the practice.</p><p><strong>Conclusions: </strong>Although the knowledge, attitude and practice of IAP measurement among ICU nurses are acceptable, there is still room for improvement in knowledge and practice. Nursing managers should strengthen management, provide more learning resources and training to meet nurses' needs about IAP measurement, so as to further improve the early recognition and management of increased IAP.</p><p><strong>Relevance to clinical practice: </strong>The data highlight the knowledge, attitude and practice and determinant factors of IAP measurement among ICU nurses and will help to make management protocols in the future. Nursing educators and administrators are recommended to provide guidance, training and support to further improve knowledge and practice of IAP measurement among the ICU nurses.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70035"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991432","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":"Wake Up Call: A Qualitative Study of Nursing and Medical Managers' Perceptions and Support for Nurses' Night Shift Napping in Intensive Care Units.","authors":"Ghada Shalaby Khalaf Mahran, Emran A Abu Aqoulah, Ebtisam Abd Elazeem Saber Seleem, Mervat Abd Elhamed Hawash, Ragaa D M Ahmed","doi":"10.1111/nicc.70056","DOIUrl":"https://doi.org/10.1111/nicc.70056","url":null,"abstract":"<p><strong>Background: </strong>Night shift work in healthcare settings is associated with increased fatigue, decreased alertness and potential risks to patient safety. While nurses napping during night shifts has been proposed as a strategy to mitigate these effects, its implementation remains controversial and understudied from a managerial perspective.</p><p><strong>Aim: </strong>This study aimed to explore nursing and medical managers' perceptions of, and support for nurses' night shift napping policies in intensive care units.</p><p><strong>Study design: </strong>A qualitative descriptive approach was employed from the beginning of March 2024 to the end of October 2024, utilising semi-structured interviews with 40 nursing and medical managers from various intensive care units. Participants were purposively sampled to ensure diversity in experience and department. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.</p><p><strong>Results: </strong>Five main themes emerged: (1) Understanding perceptions of night shift napping, (2) perceptions of the benefits of night shift napping, (3) assessing support for night shift napping, (4) barriers and challenges of applying napping strategies and (5) developing effective implementation strategies to facilitate the successful adoption of napping policies. While most managers acknowledged the potential benefits of night shift napping, they expressed apprehension about its practical implementation, staff coverage concerns and the potential for policy abuse. Supportive managers emphasised the importance of education, structured guidelines and gradual cultural change to successfully integrate napping practices.</p><p><strong>Conclusion: </strong>The findings suggest that while there is growing recognition of the potential benefits of night shift napping, significant barriers to implementation persist. The results can inform the development of evidence-based napping policies and guide strategies to address managerial concerns, ultimately improving night shift working conditions and patient care quality.</p><p><strong>Relevance to clinical practice: </strong>Researching the perceptions and support of nursing and medical managers for night shift napping in ICUs is relevant to clinical practice, as it can provide insights into the potential benefits, challenges and strategies for implementing such policies. These findings may ultimately improve patient safety, staff well-being and quality of care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70056"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081829","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":"Factors related to resilience and attitudes towards care of the dying among critical care nurses.","authors":"Akiko Kondo, Tomomi Oki, Ann L Eckhardt","doi":"10.1111/nicc.13146","DOIUrl":"10.1111/nicc.13146","url":null,"abstract":"<p><strong>Background: </strong>Many critical care nurses provide care to patients who are injured or ill and are at the end-of-life. Therefore, they are at high risk for developing negative emotional responses due to exposure to patient suffering and death.</p><p><strong>Aim: </strong>To determine the association between attitudes towards care of the dying, resilience, and Sense of Coherence.</p><p><strong>Study design: </strong>A cross-sectional descriptive approach was used. Head nurses at 74 hospitals in Japan were sent a letter about the study; 29 head nurses agreed to send information to the critical care nurses in their hospital. Demographic factors, attitudes towards care of the dying, resilience, and Sense of Coherence were collected using Google Forms. Structural equation modelling was used to analyze the associations among the variables.</p><p><strong>Results: </strong>A total of 229 nurses completed the survey. The average years of clinical experience were 10.5 ± 8.4 years. Factors directly related to positive attitudes towards care of the dying were higher resilience, more years of clinical nursing experience, and having a Master's degree. Sense of Coherence was the strongest predictor of resilience. Other predictors for higher resilience included confidence in nursing skills, social support, and religious beliefs towards death. The main predictor for higher Sense of Coherence was workplace satisfaction.</p><p><strong>Conclusion: </strong>Nurses with higher resilience had more positive attitudes about care of the dying. Individual factors, such as a Sense of Coherence, confidence in caring for patients, and religious beliefs were the most important factors related to resilience.</p><p><strong>Relevance to clinical practice: </strong>It is necessary to support newer nurses especially those with lower educational attainment, to increase workplace satisfaction, Sense of Coherence and resilience. It is necessary to develop educational programs focused on care of dying patients and to evaluate their effect so that critical care nurses have a positive response to caring for dying patients.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13146"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019488","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":"Postoperative Care of a Paediatric Patient With Common Arterial Trunk Associated With Ventricular Septal Defect and Pulmonary Arterial Hypertension: A Rare Case Report.","authors":"Huimin Fu, Li Geng, Jingli Chen, Qin Fan, Qiong Hu, Ping Hu","doi":"10.1111/nicc.70048","DOIUrl":"https://doi.org/10.1111/nicc.70048","url":null,"abstract":"<p><p>Common truncus arteriosus is a rare congenital cardiac malformation. This case was associated with a ventricular septal defect (VSD) and also combined with pulmonary hypertension, which, together with the young age of the child and the fragility of the tissues, demanded a high degree of refinement in surgical operation, making the procedure complex and extremely risky. This case reports the postoperative care experience of a child with a common arterial trunk (CAT) combined with a VSD and pulmonary hypertension. Throughout the postoperative nursing process, blood pressure fluctuations should be closely monitored to prevent postoperative bleeding; cardiac changes and in/out volume should be closely monitored to reduce cardiac oedema and to be alert to cardiac arrhythmia; pulmonary physical therapy and early rehabilitation training should be strengthened to promote the recovery of cardiopulmonary function; stepwise nutritional risk screening interventions should be carried out to ensure the supply of nutrients; and maximised humanistic care should be given to prevent neurological complications. In similar cases, doctors and nurses should pay attention to postoperative hemodynamic monitoring, concern for bleeding risk, and anti-heart failure treatment, etc., to promote the recovery of children through careful treatment and care. RELEVANCE TO CLINICAL PRACTICE: Common truncus arteriosus is a rare congenital cardiac malformation, and the relevant literature is mostly studies on genetics, diagnosis, and therapeutic methods, with less practical nursing experience available for clinical caregivers. This case reports the key points and difficulties of postoperative intensive care nursing, which can help critical care nurses to formulate targeted nursing interventions, thus improving the ability of critical care nurses in caring for this type of disease, and promoting the early recovery of postoperative children.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70048"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045516","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":"Predictive model for the risk of paediatric intensive care utilization in children with medical complexity: A longitudinal retrospective cohort study.","authors":"Bibiana Pérez-Ardanaz, Laura Gutiérrez-Rodríguez, Alberto José Gómez-González, José Miguel Morales-Asencio, Antonio Montero-García, Álvaro León-Campos","doi":"10.1111/nicc.13180","DOIUrl":"10.1111/nicc.13180","url":null,"abstract":"<p><strong>Background: </strong>Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long-term health care needs and hospital readmissions. Beyond clinical factors, socio-demographic determinants could impact utilization of acute services.</p><p><strong>Aim: </strong>To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU).</p><p><strong>Study design: </strong>A 6-year longitudinal retrospective cohort study evaluated clinical, socio-demographic and health care utilization.</p><p><strong>Results: </strong>A total of 248 CMC were included, with a median age of 13 years (9.75-17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34-1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54-2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55-0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors.</p><p><strong>Conclusion: </strong>Socio-demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio-economic factors may prevent PICU admissions.</p><p><strong>Relevance to clinical practice: </strong>This study highlights the importance of integrating individualized assessments of socio-demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13180"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395071","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 effect of illness uncertainty and self-efficacy on the perception of shared decision-making among parents of infants in the neonatal intensive care unit.","authors":"Dahae Choi, Hyewon Shin","doi":"10.1111/nicc.13154","DOIUrl":"10.1111/nicc.13154","url":null,"abstract":"<p><strong>Background: </strong>Shared decision-making is essential for improving infant prognoses. Medical staff should consider the effect of illness uncertainty and self-efficacy on parents' perceptions of shared decision-making.</p><p><strong>Aims: </strong>This study examined the impact of illness uncertainty and self-efficacy on the perception of shared decision-making among parents of infants in the neonatal intensive care unit.</p><p><strong>Study design: </strong>A descriptive-analytical cross-sectional study design was used. Data were collected from April to June 2023. A total of 103 parents of infants admitted to the neonatal intensive care unit participated in this study. The participants used a self-report questionnaire that included general characteristics of their infants, uncertainty of illness, self-efficacy and perception of shared decision-making. Data were analysed using descriptive statistics, independent t-test, analysis of variance, Scheffe's test, Pearson's correlation coefficient and multiple linear regression.</p><p><strong>Results: </strong>Illness uncertainty (r = -.659, p < .001, 95% confidence interval = [-1.209, -0.765]) was negatively correlated with self-efficacy, and self-efficacy (r = .255, p = .009, 95% confidence interval = [0.082, 0.569]) was positively correlated with the perception of shared decision-making. Using multiple linear regression, the number of visits to the intensive care unit (β = -1.939, p = .015, 95% confidence interval = [-3.490, -0.389]) and parents' self-efficacy (β = .271, p = .028, 95% confidence interval = [0.030, 0.512]) had a statistically significant effect on the perception of shared decision-making, accounting for 11.9% of the total explanatory power.</p><p><strong>Conclusions: </strong>The results support that higher self-efficacy is associated with a higher degree of perception of shared decision-making among parents of infants in the intensive care unit. Therefore, clinicians might support parents in taking a more active role in shared decision-making by discussing available options with clinicians and reaching treatment plans together.</p><p><strong>Relevance to clinical practice: </strong>The study suggests creating scales to assess nurses' participation in shared decision-making and recommends educational programmes to boost parents' self-efficacy with infants, significantly affecting perceptions of shared decision-making.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13154"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332001","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":"Self-efficacy as a psychological resource in the management of stress suffered by ICU nurses during the COVID-19 pandemic: A prospective study on emotional exhaustion.","authors":"Fernanda Gil-Almagro, F Javier Carmona-Monge, Fernando J García-Hedrera, Cecilia Peñacoba-Puente","doi":"10.1111/nicc.13172","DOIUrl":"10.1111/nicc.13172","url":null,"abstract":"<p><strong>Background: </strong>Intensive care unit (ICU) nurses have experienced a high degree of stress during the COVID-19 pandemic. While the literature on the consequences on emotional symptomatology is abundant, studies on the protective psychosocial variables that have contributed to buffering these consequences are scarcer.</p><p><strong>Aim: </strong>This study analyses the role of self-efficacy as a protective personality trait in ICU nurses during the COVID-19 pandemic, using a moderated mediation model that begins with the stress and anxiety experienced at the onset of the pandemic and concludes with the emotional exhaustion experienced 6 months later.</p><p><strong>Study design: </strong>Prospective longitudinal study with two data collection periods during the COVID-19 pandemic: (1) from 5 May to 21 June 2020 and (2) a follow-up 6 months after the state of alarm finalized (January-April 2021). These were both very stressful periods for ICU staff because of the COVID-19 pandemic. This study was conducted with 129 ICU nurses (a non-probabilistic convenience sample in the Spanish health care system). Socio-demographic, occupational and psychosocial variables (i.e. stress, anxiety, self-efficacy and emotional exhaustion) were assessed. Descriptive analyses, Pearson correlations, covariate analyses (i.e. Student's t-test, one-factor ANOVA) and moderated mediation analyses were carried out (SPSS PROCESS macro, model 7). STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) reporting guidelines were followed.</p><p><strong>Results: </strong>It shows that the higher the self-efficacy score, the lower the effect of stress on anxiety (p < .001); likewise, the moderating role of self-efficacy was equally valid for the whole final model (F = 8.790, p < .001), showing self-efficacy to be a good buffer for emotional exhaustion derived from the stress suffered in the ICU.</p><p><strong>Conclusions: </strong>Self-efficacy (i.e. the belief of being able to do certain tasks successfully) is shown to be a highly relevant trait to enhance among ICU nurses during the COVID-19 pandemic, allowing them to manage work stress effectively and thus buffering the development of anxiety in the short term and emotional exhaustion in the long term.</p><p><strong>Relevance to clinical practice: </strong>Our results point to the need to assess and take action on self-efficacy in ICU nurses in highly stressful situations such as the COVID-19 pandemic. As a psychological variable, self-efficacy refers to beliefs and therefore has to be trained by evidence-based psychological techniques, such as cognitive behavioural therapy. In addition, previous literature has pointed out that previous experience or specific training is an influential (although not a determining) factor in self-efficacy, so specialization for ICU nurses could also be considered.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13172"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395073","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":"Experiences of parents with very premature-born children at risk of neurodevelopmental disorders: A qualitative study.","authors":"Carmen Ropero-Padilla, Miguel Rodriguez-Arrastia, José Enrique Bernabé-Zuñiga, Antonio Javier Alias Castillo, Lola Rueda-Ruzafa, María Del Mar Sánchez-Joya","doi":"10.1111/nicc.13182","DOIUrl":"10.1111/nicc.13182","url":null,"abstract":"<p><strong>Background: </strong>Premature birth is a traumatic and stressful situation for parents who are immediately separated from their infant because of the newborn's need for specialized care. The staff of these units are in charge of following the principles of family-centred care and practices for neonates at risk of neurodevelopmental disorders, including providing training to the family during their hospital stay and after being discharged.</p><p><strong>Aim: </strong>The aim of this study is to explore the perceptions of parents of premature children at risk of neurodevelopmental disorders in regard to care, interventions and assistance provided during the first months of their child's life.</p><p><strong>Study design: </strong>A qualitative descriptive study was carried out through individual interviews. The data analysis was conducted through a thematic analysis. The methodology and results were reported following the standards for preparing qualitative research reports and recommendations.</p><p><strong>Results: </strong>Twenty-one parents of premature children were interviewed. From these interviews, three main themes emerged: (i) parents' perspectives on preterm birth risk communication, (ii) navigating parental support and early interventions in preterm birth and (iii) perceptions of preterm birth protective and challenging factors.</p><p><strong>Conclusions: </strong>The parents of premature children need to receive better communication about the care and interventions for their child, and it is necessary that health personnel are better trained in terms of management and administration of public resources. Strategies must be implemented that continuously guide parents on the follow-up and care of their premature child not only during their first moments of life but also after being discharged from the hospital.</p><p><strong>Relevance to clinical practice: </strong>This study highlights the need to improve care for parents with premature infants at risk, emphasizing the necessity for health care system reforms and support structures, allowing health care professionals to enhance attention and care.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13182"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395060","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 experience of surrogate decision-making and deciphering critically ill patient values: A qualitative study.","authors":"Yuling Lei, Weijing Sui, Ling Chen, Qi Zhou, Yiyu Zhuang","doi":"10.1111/nicc.13171","DOIUrl":"10.1111/nicc.13171","url":null,"abstract":"<p><strong>Background: </strong>Surrogate decision-makers (SDMs) who make decisions for critically ill patients often face great challenges. Although shared decision-making has been advocated, its implementation has been less than satisfactory.</p><p><strong>Aim: </strong>To explore the experience of the surrogate decision-making process and determine how SDMs understand the values and preferences of critically ill patients.</p><p><strong>Study design: </strong>A constructivist qualitative study was used. The data were collected using semistructured interviews with four questions conducted between January and February 2023. The audio recordings were transcribed verbatim and analysed via thematic analysis. Fourteen SDMs (all family members) of 10 critically ill patients were recruited according to the inclusion criteria.</p><p><strong>Results: </strong>We identified eight sub-themes that were classified into three themes: (a) the unbalanced act: no respite for the surrogates, conflict between rationality and emotion, and sacrifice in surrogate decision-making; (b) unclear values and preferences: ignored values, intentional silence and substituted values; and (c) unsatisfying surrogate decisions: decision regret and decreased surrogate decision-making self-efficacy.</p><p><strong>Conclusion: </strong>These findings underscore the urgent need for enhanced communication strategies and support systems to better assist SDMs in navigating their roles. Effective interventions could help clarify patients' values and preferences, thereby improving the decision-making process and outcomes for both SDMs and patients.</p><p><strong>Relevance to clinical practice: </strong>Misalignment between patient values and those of SDMs can potentially degrade the quality of decision-making. Clinicians should be skilled in stimulating SDMs to think about patient values and preferences.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13171"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480254","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":"Iron, selenium, copper and magnesium in critical care: Impact on acquired weakness risk through Mendelian randomization.","authors":"Li Zhang, Hong Zhi Sun, Yuwei Sun, Jinxin Zhang, Xinli Ma","doi":"10.1111/nicc.70032","DOIUrl":"https://doi.org/10.1111/nicc.70032","url":null,"abstract":"<p><strong>Background: </strong>Trace elements play a crucial role in the health of critically ill patients, yet their impact on acquired weakness remains unclear.</p><p><strong>Aim: </strong>This study utilized Mendelian randomization (MR) to explore the relationship between iron, selenium, copper, magnesium, zinc and debilitation risk in this population. The aim of study was to investigate the influence of specific trace elements on acquired weakness in critically ill patients and determine their protective or risk effects.</p><p><strong>Study design: </strong>This project collected a total of 164 627 exposure related datasets and 4 518 732 outcome related datasets. Mendelian randomization was employed to analyse data on trace elements in critically ill patients, assessing how iron, selenium, copper, magnesium and zinc may impact debilitation risk.</p><p><strong>Results: </strong>This study explored the causal relationships between trace elements (iron, copper, zinc, selenium and magnesium) and outcomes (muscle dysfunction, muscle damage and respiratory infections) in critically ill patients. For example, the analysis of iron (ukb-b-20 447) and diaphragmatic hernia (ukb-b-8848) using the Inverse Variance Weighted (IVW) method showed an odds ratio (OR) of 0.996 (95% CI: 0.993-0.999, p = .004). Overall, MR results indicated that iron and selenium are protective factors, while copper and magnesium are risk factors for acquired weakness. Zinc was not causally associated with acquired weakness in critically ill patients.</p><p><strong>Conclusions: </strong>This study highlights the importance of understanding the role of specific trace elements in acquired weakness among critically ill patients, providing valuable insights for personalized care strategies to enhance patient outcomes.</p><p><strong>Relevance to clinical practice: </strong>The findings offer new theoretical foundations and potential molecular targets for the prevention and treatment of debilitation in critical care settings.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 3","pages":"e70032"},"PeriodicalIF":3.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008396","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}