Nursing in Critical Care最新文献

{"title":"A Bundle of Interventions to Prevent Pressure Ulcers During Prone Position in Adult Patients With Acute Respiratory Distress Syndrome: Results of a French Stepped-Wedge Randomized Controlled Trial.","authors":"Lucile Gay, Laure Huot, Hodane Yonis, Sabine Valera, Sami Hraeich, Dominique Matthieu, Arnaud Gacouin, Carole Ouisse, Jean Reignier, Audrey Massard, Jean-Pierre Quenot, Caroline Revol, Adrien Robine, Olivier Guillemault, Gaël Bourdin, Angélina Robert, Jean-Claude Lacherade, Céline Perarder, Michel Badet, Loredana Baboi, Muriel Rabilloud, Evelyne Decullier, Eloïse Montagne, Raphaële Girard, Christine Arcuset, Julie Mevel, Aurélie Méry de Montigny, Claude Guérin","doi":"10.1111/nicc.70084","DOIUrl":"10.1111/nicc.70084","url":null,"abstract":"<p><strong>Background: </strong>In patients with moderate-to-severe acute respiratory distress syndrome, the frequency of pressure ulcers is higher in the prone position than in the supine position.</p><p><strong>Aim: </strong>To assess the effect of a bundle of interventions to prevent pressure ulcers in patients with acute respiratory distress syndrome prone.</p><p><strong>Study design: </strong>ESCARD is a stepped-wedge prospective multicentre trial conducted in France that included patients with moderate-to-severe acute respiratory distress syndrome, intubated and with an indication for pronation. In the control period, patients received the routine means of each centre. In the experimental period, the bundle of specific standardized means included: eye protection with methylcellulose; strapped lower eyelids; 15° body inclination; specific cushions inserted between the mattress and head/thorax and knees/feet; head rotation every 4 h. The primary end-point was the occurrence of a new pressure ulcer at any location and stage in the anterior part of the body 7 days after inclusion. It was assessed from pictures taken in the supine position and independently analysed by two experts blinded to the allocated period.</p><p><strong>Results: </strong>From 16 April 2018 to 3 December 2020 (with an interruption between 12 March and 15 July 2020 because of COVID pandemic), a total of 160 patients were included in 9 centres; 156 were analysed. At the first proning session, all 6 specific preventive means were implemented in 1.2% of the patients in the control period and 91.8% in the experimental period. At Day 7, 53 patients (63.9%) in the control versus 40 (54.8%) in the experimental period had a new pressure ulcer at any location and of any stage (odds ratio = 0.92; 95% confidence interval [0.39; 2.18]). There was a 42.8% discrepancy between the two experts.</p><p><strong>Conclusions: </strong>In this prospective multicentre stepped-wedge trial, the bundle of interventions did not lead to a significant reduction in the frequency of new pressure ulcers in moderate-to-severe acute respiratory distress syndrome patients treated by prone position.</p><p><strong>Relevance to clinical practice: </strong>The critical care nurses were able to manage patients enrolled in a complex trial up to its planned end. Even though negative, the study should encourage intensive care unit (ICU) nurses to better define the bundle of interventions including introducing other methods not used in the present study. ICU nurses should also assess the stage of pressure ulcers consistently over time. ICU nurses should consider further studies because pressure ulcer is a relevant issue of concern during the pronation in acute respiratory distress syndrome patients. If so, the new trial should include a larger number of ICUs.</p><p><strong>Trial registration: </strong>The protocol was approved by an ethics committee (number 2017-A01449-44 on 7 October 2017) and was recorded in clinic","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 4","pages":"e70084"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287067","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":"A Scoping Review of Fatigue Among Nurses in Critical Care Units.","authors":"Reyhaneh Abbaszadeh, Fazlollah Ahmadi, Mitra Khoobi, Anoshirvan Kazemnejad, Mojtaba Vaismoradi","doi":"10.1111/nicc.70088","DOIUrl":"10.1111/nicc.70088","url":null,"abstract":"<p><strong>Background: </strong>Critical care nurses are susceptible to fatigue, which can negatively influence their performance and the safety of patients and organisations.</p><p><strong>Aim: </strong>To identify the available evidence on the dimensions, antecedents and consequences of fatigue in nurses working in critical care units.</p><p><strong>Study design: </strong>This scoping review followed Arksey and O'Malley's 5-step approach for its design and implementation. Electronic databases were searched including PubMed (including Medline), Scopus, Science Direct, Web of Science and Google Scholar. Inclusion criteria were studies published between 2015 and 2024 as a 10-year time frame, nurses working in the cardiac care unit, intensive care unit and haemodialysis departments for adults, paediatric and neonates, published in peer-reviewed journals in English and Farsi.</p><p><strong>Results: </strong>Forty-five studies were included. The review findings revealed that critical care nurses experienced the dimensions of compassion, alarm, physical, mental, emotional, acute and chronic fatigue. The antecedents of fatigue were personal and demographic characteristics, professional and organisational issues and physical and psychological issues. Also, its consequences included individual, patient safety and organisational characteristics.</p><p><strong>Conclusion: </strong>A multidimensional approach is required to mitigate adverse outcomes such as diminished care quality, compromised patient safety, nurse burnout and potential harm to both patients and the healthcare organisation.</p><p><strong>Relevance to clinical practice: </strong>Critical care nurses experience fatigue across multiple dimensions, highlighting the complex and varied nature of fatigue in critical care units. Additionally, the experience of fatigue is influenced by different antecedents leading to multiple consequences for nurses, patients and organisations.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 4","pages":"e70088"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602203","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 of a machine learning predictive model for central venous catheter-associated thrombosis in patients undergoing abdominal surgery.","authors":"Zirong Li, Cheng Zhang, Xiao Gan, Liying Liu, Yanmei Tan, Yanping Ying","doi":"10.1111/nicc.13233","DOIUrl":"10.1111/nicc.13233","url":null,"abstract":"<p><strong>Background: </strong>Central venous catheters (CVCs) are placed where the vena cava meets the right atrium. Their common use raises the risk of catheter-related thrombosis (CRT), a potentially life-threatening complication.</p><p><strong>Aim: </strong>This study leverages machine learning to develop a CRT predictive model for abdominal surgery patients, aiming to refine clinical decisions and elevate treatment quality.</p><p><strong>Study design: </strong>The data were split into training and validation sets using the caret package in R. Decision Trees (DT), Extra Trees (ET), Ada Boost, Gradient Boosting (GB), Light Gradient Boosting Machine (LGBM), K Neighbours Classifier (KNN) and Random Forest (RF) algorithms were used for model construction. Receiver operating characteristic (ROC) curve, area under curve (AUC), accuracy, recall, precision, F1 score, sensitivity and specificity were used to evaluate the performance of the model. Decision curve analysis (DCA) was used to evaluate the clinical utility of each model.</p><p><strong>Results: </strong>Among the 400 subjects, 184 had thrombosis, with an incidence of 46%. Basic characteristics analysis and univariate analysis showed that there were significant differences in the history of radiotherapy or chemotherapy, age, mobility score, retention time, D-dimer, fibrinogen and urea (p < .05). Among the models constructed by the seven algorithms, the performance of DT model was relatively balanced. The AUC of the validation set was 0.782, the sensitivity was 0.618, and the specificity was 0.781.</p><p><strong>Conclusion: </strong>The predictive model for CRT developed using machine learning algorithms demonstrates good discrimination and clinical applicability among abdominal surgery patients, offering valuable guidance for CRT prevention strategies.</p><p><strong>Relevance to clinical practice: </strong>By integrating risk prediction models into the Hospital Information System (HIS), nurses can assess catheter status in a timely and accurate manner, understand the risks of thrombosis for patients, and implement targeted preventive measures. This approach can enhance the efficiency and accuracy of nursing care, holding clinical significance in critical care practice.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13233"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985391","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":"Sleep Quality and Disruptive Factors in Intensive Care Units: A Comparison Between Mechanically Ventilated and Spontaneously Breathing Patients.","authors":"Öznur Erbay Dalli, Nermin Kelebek Girgin","doi":"10.1111/nicc.70097","DOIUrl":"10.1111/nicc.70097","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbances are common in intensive care units (ICUs) and negatively impact patient outcomes. Understanding differences in sleep quality and disrupting factors between patients receiving mechanical ventilation (MV) and spontaneously breathing patients (SBP) is essential for improving ICU care.</p><p><strong>Aim: </strong>To compare sleep quality and sleep-disrupting factors between patients receiving MV and SBP during their ICU stay.</p><p><strong>Study design: </strong>This observational study was conducted in a 16-bed ICU in Türkiye. A total of 186 ICU patients (62 receiving MV and 124 SBP) were included. Sleep quality and disrupting factors were assessed using the Modified Freedman Sleep Quality Questionnaire (mFSQQ) and Richards-Campbell Sleep Questionnaire (RCSQ) at 24-h admission (T0) and pre-discharge (T1).</p><p><strong>Results: </strong>Sleep quality scores were significantly lower in patients receiving MV than in SBP (p < 0.05). At T0, patients receiving MV experienced greater sleep disruptions due to pain and vital sign monitoring, while SBP had more disturbances from nursing interventions, medication administration and alarms (p < 0.05). By T1, sleep disturbances from pain, medical interventions and diagnostic procedures had significantly decreased in both groups (p < 0.05); however, environmental factors such as noise, lighting and staff conversations remained major disruptors. Repeated measures analysis showed a significant time effect for sleep disruptions from pain, nursing interventions, vital sign monitoring and medication administration (p < 0.001), while no time effect was found for noise, light or staff conversations.</p><p><strong>Conclusion: </strong>Although patients receiving MV had lower sleep quality, ICU environmental factors were a major source of sleep fragmentation for all patients. These findings emphasise the need for ICU-wide and targeted interventions to optimise sleep quality.</p><p><strong>Relevance to clinical practice: </strong>Implementing tailored sleep protocols and optimising ICU care can reduce sleep disruptions, enhance patient comfort and improve recovery by addressing both patient-specific and environmental factors.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":"30 4","pages":"e70097"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287072","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":"Development and feasibility of an echocardiography-guided tip location program for central venous catheter implantation.","authors":"Yan Shen, Xin Li, Huiyan Zhang, Jian Chang, Xingmei Zhou","doi":"10.1111/nicc.13207","DOIUrl":"10.1111/nicc.13207","url":null,"abstract":"<p><p>This is a prospective observational study designed to develop an echocardiography-guided tip location program for central venous catheter (CVC) implantation, and to assess the feasibility and the accuracy of the program. First, a multidisciplinary expert committee designed an echocardiography-guided tip location program; then, a pilot prospective observational study was conducted to assess the feasibility of the program in a vascular access clinic in a tertiary hospital. A total of 186 patients participated in the study. Successful echocardiography-guided tip placement was achieved in 172 (92.5%) patients. The accuracy of the program reached 99.4%. The program of echocardiography-guided tip location is feasible and accurate. Ultrasound images revealed notable discrepancies at various locations, allowing specialized nurses to conduct echocardiography-guided tip placement during CVC insertion through targeted training and practice.</p>","PeriodicalId":51264,"journal":{"name":"Nursing in Critical Care","volume":" ","pages":"e13207"},"PeriodicalIF":3.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980627","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":"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}