Intensive and Critical Care Nursing最新文献

{"title":"Understanding adherence and deviations in potassium replacement protocols: A mixed method study","authors":"Kylie O’Neill ,&nbsp;Jason Meyer ,&nbsp;Elizabeth Manias ,&nbsp;Gordon Laurie ,&nbsp;Stewart Mealing ,&nbsp;Kellie Sosnowski ,&nbsp;Belinda Badman ,&nbsp;Melissa J. Bloomer","doi":"10.1016/j.iccn.2025.104013","DOIUrl":"10.1016/j.iccn.2025.104013","url":null,"abstract":"<div><h3>Background</h3><div>Potassium replacement protocols are commonly used in ICUs to standardise replacement and minimise harm. Yet, there is variability in potassium replacement practices.</div></div><div><h3>Aims</h3><div>(i) To examine relationships between potassium levels, potassium administration, and the potassium replacement protocol; and (ii) to explore factors influencing potassium replacement decision-making.</div></div><div><h3>Methods</h3><div>An exploratory mixed methods approach using retrospective audit and interviews was undertaken. Clinical data from two ICUs were extracted about potassium results, potassium administration and other related data from the first 72 h of ICU admission, for all patients admitted between January 2015 and December 2022. Critical care nurses were interviewed between January and March 2024, with interviews professionally transcribed and analysed using inductive content analysis.</div></div><div><h3>Results</h3><div>From the sample of N = 10,613 patients, n = 132,507 potassium results were analysed. Potassium replacement was indicated for 39.7 % (n = 52,592) of potassium results. When replacement was indicated, potassium was administered within 2 h in 59.9 % (n = 31,508) of cases. Interviews with critical care nurses (n = 21) lasted 5–28 min (mean 12 min). Interview participants indicated that potassium replacement decisions were influenced by the patient’s history and current condition, and colleague consultation. There was little concern over potential risks associated with potassium replacement. Greater clarity around the purpose and compulsoriness of potassium replacement protocols was desired.</div></div><div><h3>Conclusion</h3><div>These findings offer valuable insights into the intricacies of protocolised potassium replacement adherence and deviations across two ICU settings. Autonomy and interprofessional collaboration emerged as a key factor, with nurses exercising decision-making ability underpinned by patient specific considerations, assessment, and clinical judgement.</div></div><div><h3>Implications for clinical practice</h3><div>When protocols are used to guide potassium replacement and other electrolytes, clear guidance as to the compulsoriness of the protocol is needed. Alternately, with safety a priority, when and how clinicians may use their clinical judgement and discretion in potassium replacement must also be explicit.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104013"},"PeriodicalIF":4.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing high-flow nasal cannula success in acute hypoxemic respiratory failure – Letter on Zevallos-Villegas et al.","authors":"Yan Fang ,&nbsp;Wen-Li Wu ,&nbsp;Li-Fen Hu ,&nbsp;Xiao-Xiao Luo ,&nbsp;Xian-Rong Shi","doi":"10.1016/j.iccn.2025.104008","DOIUrl":"10.1016/j.iccn.2025.104008","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104008"},"PeriodicalIF":4.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic pain in ICU survivors: Potential risk factors and relationship with post-traumatic stress disorder symptoms and health related quality of life","authors":"Evangelia Giannelou ,&nbsp;Elizabeth Papathanassoglou ,&nbsp;Maria Karanikola ,&nbsp;Margarita Giannakopoulou ,&nbsp;Evangelos Bozas ,&nbsp;Niki Skopeliti ,&nbsp;Meropi Mpouzika","doi":"10.1016/j.iccn.2025.104003","DOIUrl":"10.1016/j.iccn.2025.104003","url":null,"abstract":"<div><h3>Objectives</h3><div>To identify patient characteristics and clinical factors during ICU hospitalization potentially associated with chronic pain occurrence, and to determine its relationship with symptoms of post-traumatic stress disorder (PTSD) and health-related quality of life (HRQoL) at three time points after ICU discharge.</div></div><div><h3>Methods</h3><div>Adult ICU survivors were enrolled in a prospective, repeated measures study. The study was carried out in two phases. Phase I was conducted during the first 5 days of survivors’ ICU hospitalization where patient characteristics and clinical data were collected. Phase II was conducted via telephone interviews after 3 (T1), 6 (T2) and 12 (T3) months post-ICU discharge, where pain, PTSD-related symptoms, and HRQoL were assessed with the Numeric Rating Scale (NRS), Davidson Trauma Scale (DTS), and 36-Item Short Form Survey version 2 (SF-36v2), respectively.</div></div><div><h3>Results</h3><div>Data from 59 survivors were analysed, 69.5% of whom were males. The sample’s mean age was 52.7 (SD 18.9) years and 62.7% of them reported NRS&gt;3 at T1, indicating chronic pain. After adjusting for sex, age, and APACHE II score, chronic pain was significantly associated with: (a) length of stay in the ICU (OR=1.42; 95%CI: 1.03–1.95; p=0.030) and (b) clinically relevant symptoms of PTSD at T1 (OR=10.04; 95%CI: 2.44–41.24; p=0.001) and T2 (OR=11.90; 95%CI: 1.28–110.49; p=0.029). Lower SF-36v2 scores in all domains at T1, several domains at T2, and two domains at T3 were significantly associated with CP occurrence.</div></div><div><h3>Conclusions</h3><div>Of the patient characteristics and clinical factors analysed, only longer length of stay in ICU was significantly associated with higher odds of chronic pain occurrence, which in turn was linked to PTSD-related symptoms and lower HRQoL after ICU discharge.</div></div><div><h3>Implications for Clinical Practice</h3><div>Clinical interventions aimed at optimizing ICU length of stay, such as the implementation of early mobility programs and multidisciplinary rehabilitation, may support prevention of chronic pain occurrence and improve long-term outcomes.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104003"},"PeriodicalIF":4.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing mental health engagement and screening protocols in ICU recovery clinics - Letter on Hussain et al.","authors":"Ya-ting Jiang ,&nbsp;Lucia D'Angelo ,&nbsp;Suwas Bhandari ,&nbsp;Yu-Qiang Gong ,&nbsp;Yu Hao","doi":"10.1016/j.iccn.2025.103992","DOIUrl":"10.1016/j.iccn.2025.103992","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 103992"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensive care nurses’ provision of culturally sensitive care through communication at the end-of-life - Response to Brooks et al.","authors":"Daniel Joseph E. Berdida ,&nbsp;Rizal Angelo N. Grande","doi":"10.1016/j.iccn.2025.104009","DOIUrl":"10.1016/j.iccn.2025.104009","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104009"},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What challenges of family-clinician conversations in the intensive care unit can teach us: A cross-sectional survey study","authors":"Eyleen Reifarth,&nbsp;Jan-Hendrik Naendrup,&nbsp;Boris Böll,&nbsp;Matthias Kochanek,&nbsp;Jorge Garcia Borrega","doi":"10.1016/j.iccn.2025.104011","DOIUrl":"10.1016/j.iccn.2025.104011","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore the perspectives of intensive care unit personnel and patients’ family members on challenges of family-clinician conversations and corresponding learning needs.</div></div><div><h3>Research Methodology/Design</h3><div>Cross-sectional survey study.</div></div><div><h3>Setting</h3><div>Two medical intensive care units of a German academic tertiary care hospital.</div></div><div><h3>Main Outcome Measures</h3><div>Data were collected using an investigator-designed online survey with open- and closed-ended questions. Descriptive statistics were conducted to determine frequencies, free-text responses were analysed using directed qualitative content analysis.</div></div><div><h3>Findings</h3><div>The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45%). Regarding the clinicians’ perspective, three main themes of challenges were deduced: ICU setting, Staff-related challenges, and Family-related challenges. Conversely, the majority of participating family members reported challenges both cognitive and affective in nature, e.g., remembering provided information or discussing the patient’s prognosis. Most clinicians stated their need for a corresponding communication skills training to successfully navigate those challenges in clinical practice, particularly regarding conveying complex information, handling strong emotions, and managing family-clinician conflicts.</div></div><div><h3>Conclusion</h3><div>The identified communication challenges underline the issues of family-clinician conversations that require improvement, making it possible to determine corresponding strategies to attain the desired outcome. Further research is needed to elicit best-practices of communication skills trainings for family-clinician conversations and its implementation in critical care settings.</div></div><div><h3>Implications for clinical practice</h3><div>These findings invite clinicians to engage in self-reflection to identify individually perceived communication challenges and learning needs. Faculty and healthcare institutions may further use these findings to conceptualise tailored communication skills trainings to contribute to the advancement in nursing and medical education.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104011"},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring methods for correct gastric tube placement in neurologically critical patients using PETCO2 and pH – Response to Junjie Yao et al.","authors":"Yunxia Chen,&nbsp;Mengmin Xu","doi":"10.1016/j.iccn.2025.104010","DOIUrl":"10.1016/j.iccn.2025.104010","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104010"},"PeriodicalIF":4.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ICU nurses’ perceptions on family involvement in delirium care for postoperative cardiac surgery patients: A qualitative study","authors":"Dina Azimzadeh ,&nbsp;Alexandra Lapierre ,&nbsp;Zineb Bouaouina ,&nbsp;David Williamson ,&nbsp;Tanya Mailhot ,&nbsp;Caroline Arbour","doi":"10.1016/j.iccn.2025.104001","DOIUrl":"10.1016/j.iccn.2025.104001","url":null,"abstract":"<div><h3>Aims</h3><div>Delirium is common among adults recovering from cardiac surgery in the intensive care unit (ICU), prompting increased family involvement in their care. This study aimed to describe ICU nurses’ perceptions of factors that support or impede family involvement in preventing, assessing, and managing delirium in the postoperative period following cardiac surgery.</div></div><div><h3>Methods</h3><div>A convenience sample of 18 nurses with a mean age 36 years (24–49), 89 % female) was recruited from two university-affiliated ICUs in Canada. After providing written informed consent, participants engaged in a semi-structured individual interview. Descriptive thematic analysis was performed using an established method.</div></div><div><h3>Findings</h3><div>The analysis identified six key themes: 1) Choosing the right time to involve the family, 2) The importance of sharing information, 3) Influence of family characteristics, 4) Influence of organizational characteristics, 5) Family input helps detect delirium, and 6) Families can take concrete actions when delirium occurs. Notably, while information sharing during delirium episodes was highly valued, discussions on delirium prevention were absent among all nurse participants.</div></div><div><h3>Conclusions</h3><div>Overall, ICU nurses perceive family involvement in delirium care as beneficial, depending on factors such as patient condition, nurse attitudes and preferences, family characteristics, and organizational support. This qualitative study provides valuable insights on nurses’ perceptions regarding family involvement in ICU settings.</div></div><div><h3>Implications for clinical practice</h3><div>ICU nurses, healthcare administrators and educators can use these findings to support family involvement in ICU delirium care after cardiac surgery. Overcoming barriers, particularly around delirium prevention, requires further investigation into nurses’ education, resource allocation, and organizational support.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"88 ","pages":"Article 104001"},"PeriodicalIF":4.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential issues related to perceived stress and health literacy on family satisfaction among family members of critically ill patients – Response to Zhao et al.","authors":"Cristobal Padilla-Fortunatti ,&nbsp;Yasna Palmeiro-Silva ,&nbsp;Claudia Bustamante-Troncoso ,&nbsp;Noelia Rojas-Silva","doi":"10.1016/j.iccn.2025.104004","DOIUrl":"10.1016/j.iccn.2025.104004","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104004"},"PeriodicalIF":4.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monitoring methods for correct gastric tube placement in neurologically critical patients using PETCO2 and pH – Letter on Chen et al.","authors":"Junjie Yao,&nbsp;Gang Li","doi":"10.1016/j.iccn.2025.104007","DOIUrl":"10.1016/j.iccn.2025.104007","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"89 ","pages":"Article 104007"},"PeriodicalIF":4.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}