Intensive and Critical Care Nursing最新文献

{"title":"Survival rates with favorable neurological outcomes after in-hospital and out-of-hospital cardiac arrest: A prospective cohort study","authors":"Ali AIT Hssain ,&nbsp;Athanasios Chalkias ,&nbsp;Amir Vahedian-Azimi ,&nbsp;Hussam Elmelliti ,&nbsp;Ans Alamami ,&nbsp;Rabee Tawel ,&nbsp;Marwa Morgom ,&nbsp;Fatima Jamal Ullah ,&nbsp;Rida Arif ,&nbsp;Murad Mehmood ,&nbsp;Hamas El Melliti ,&nbsp;Mohamad Talal Basrak ,&nbsp;Anzila Akbar ,&nbsp;Abdulsalam Saif Ibrahim","doi":"10.1016/j.iccn.2024.103889","DOIUrl":"10.1016/j.iccn.2024.103889","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the survival rates with favorable neurological outcomes among patients who experienced in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA).</div></div><div><h3>Design</h3><div>This prospective cohort study assessed 554 adult patients with IHCA or OHCA referred to Hamad General Hospital, Qatar, between February 2015 and November 2021. Neurologic outcomes were measured using the Cerebral Performance Category (CPC) score. Survival rate and neurologic status were re-evaluated at 28 days, hospital discharge, and one year after cardiac arrest (CA).</div></div><div><h3>Findings</h3><div>For all participants, the hospital discharge and one-year survival rates with a favorable neurological outcome (CPC ≤ 2) were 18.5 % and 19.5 %, respectively. Specifically, among patients with IHCA, the rates were 20.5 % and 19 %, while in patients with OHCA, the rates were 16.4 % and 19.9 %, respectively. Multivariate regression analysis indicated that factors male sex (OR: 2.129, 95 % CI: 1.168–3.881, P = 0.014), initial shockable rhythm (OR: 1.691, 95 % CI: 1.024–2.788, P = 0.041), and the use of ECPR (OR: 1.944, 95 % CI: 1.178–3.209, P = 0.009) were associated with increased likelihood of survival with favorable neurological outcomes at 28 days. Conversely, older age, presence of comorbidities, infection, higher APACHE II score, longer hospital stays, and undergoing tracheostomy were linked to decreased chances of survival with favorable neurological outcomes at different time points.</div></div><div><h3>Conclusion</h3><div>Survival with good neurological outcomes after OHCA was 20.3 %, 16.4 %, and 19.9 % at 28 days, hospital discharge, and one year, respectively. Among patients with IHCA, survival with good neurological outcomes was 20.5 %, 20.5 %, and 19 % at 28 days, hospital discharge, and one year, respectively.</div></div><div><h3>Implications for Clinical Practice</h3><div>Care of CA patients in a cardiac arrest center is associated with improved long-term survival with favorable neurological outcomes. Prioritizing early intervention for shockable rhythms and utilizing ECPR where appropriate could enhance patient prognosis.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103889"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683967","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":"Kotter’s 8-step change model to improve hand hygiene compliance in intensive care unit: A 41-month prospective longitudinal quality improvement study","authors":"Fen Hu ,&nbsp;Ying Wang ,&nbsp;Rui Cao ,&nbsp;Chang Hu ,&nbsp;Bilong Feng ,&nbsp;Jin Li ,&nbsp;Xinbo Ding ,&nbsp;Jing Ma ,&nbsp;Huilin Li ,&nbsp;Pei Wang ,&nbsp;Ying Xu ,&nbsp;Dandan Xu ,&nbsp;Juanjuan Pei ,&nbsp;Xiaoping Zhu ,&nbsp;Jie Chen ,&nbsp;Ke Liang ,&nbsp;Zhiyong Peng ,&nbsp;Kianoush Kashani ,&nbsp;Bo Hu ,&nbsp;Yufeng Yuan","doi":"10.1016/j.iccn.2024.103877","DOIUrl":"10.1016/j.iccn.2024.103877","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous studies assessing bundled interventions to enhance hand hygiene compliance (HHC), compliance rates persist at suboptimal levels. Our objective was to employ Kotter’s Change Model (KCM) to enhance HHC and conduct a comprehensive process evaluation among medical staff within the intensive care unit (ICU).</div></div><div><h3>Methods</h3><div>KCM was implemented at the ICU of Zhongnan Hospital of Wuhan University from March 2018 to August 2021, with a 41-month longitudinal monitoring of HHC. The primary outcome focused on the absolute monthly change in HHC. Secondary outcomes encompassed the HHC characteristics across different phases, varying trends in HHC concerning different hand hygiene opportunities and occupations, quarterly incidences of central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI).</div></div><div><h3>Results</h3><div>This study included 20,222 hand hygiene actions and 24,195 opportunities. The overall HHC was 83.58 % (95 %CI, 83.11 %-84.04 %). Following the KCM implementation, HHC surged from 35.71 % (95 % CI, 22.99 %–50.83 %) to 87.75 % (95 % CI, 85.53 %–89.67 %), reflecting a notable increase of 145.73 %. The most rapid growth in HHC occurred post-patient contact, elevating from 35.29 % to 89.8 %. Despite escalating patient numbers and treatment complexities annually, the quarterly rates of CLABSI (0 ‰–3.53 ‰) and CAUTI (0.96 ‰-4.26 ‰) remained consistently low.</div></div><div><h3>Conclusion</h3><div>Utilizing KCM systematically alters healthcare providers’ perception of hand hygiene, fostering an environment that advocates for and sustains improved HHC among ICU personnel.</div></div><div><h3>Implications for clinical practice</h3><div>The Kotter’s change model can be an effective framework for healthcare organizations to systematically improve and maintain hand hygiene compliance among healthcare providers, which can in turn help reduce healthcare-associated infections.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103877"},"PeriodicalIF":4.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678165","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":"Effect size estimates of risk factors for post-intensive care syndrome: A systematic review and meta-analysis","authors":"Shuang Gao ,&nbsp;Xifeng Liang ,&nbsp;Zhixiu Pan ,&nbsp;Xiuping Zhang ,&nbsp;Liwen Zhang","doi":"10.1016/j.iccn.2024.103888","DOIUrl":"10.1016/j.iccn.2024.103888","url":null,"abstract":"<div><h3>Objective</h3><div>To provide updated evidence on the risk factors and accurately quantify the effect size of the risk factors associated with post-intensive care syndrome (PICS), encompassing cognitive, mental, physical and socio-economic domains.</div></div><div><h3>Research methodology</h3><div>We conducted a systematic review of literature from January 2010 to October 2023. The meta-analysis was conducted to calculate an effect size for every risk factor, and odds ratio and 95% confidence intervals were used as summary statistics.</div></div><div><h3>Results</h3><div>Of 67,468 retrieved studies, 160 were included in qualitative synthesis, 102 were included in quantitative synthesis. A total of 60 factors were identified, categorized into 17 person-related, 23 disease-related and 20 ICU-related categories. The strongest correlations with cognitive health were observed for previous cognitive problems, sedatives and delirium. Factors most strongly correlated with mental health included previous mental problems<strong>,</strong> delirium, lack of social support, illicit drug and bad experience in ICU. The strongest correlations with physical health involved previous mental problem, delirium, organ dysfunction of neurologic and respiratory support. For socio-economic domains, older age and female were identified as significant risk factors.</div></div><div><h3>Conclusions</h3><div>This systematic review and meta-analysis identified and quantified the person, disease, and ICU-related risk factors associated with PICS. These findings may enable clinicians to better recognize the patient at high risk for PICS at an early stage during their stay in ICU.</div></div><div><h3>Implications for clinical practice</h3><div>A thorough investigation of risk factors across the four domains of PICS is necessary to gain a holistic understanding.</div><div>The identification and integration of risk factors associated with PICS empower critical care multidisciplinary teams to optimize management strategies, thereby assisting ICU survivors a better recovery.</div><div>Since multiple risk factors may be simultaneously associated with the four domains of post-intensive care syndrome, it is imperative to develop a comprehensive prediction algorithm.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"87 ","pages":"Article 103888"},"PeriodicalIF":4.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678164","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":"Prevalence and risk factors for burnout, missed nursing care, and intention-to-leave the job among intensive care unit and general ward nurses: A cross-sectional study across six European countries in the COVID-19 era","authors":"Arnaud Bruyneel ,&nbsp;Simon Dello ,&nbsp;Jérôme E. Dauvergne ,&nbsp;Dorothea Kohnen ,&nbsp;Walter Sermeus","doi":"10.1016/j.iccn.2024.103885","DOIUrl":"10.1016/j.iccn.2024.103885","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare the prevalence of burnout, missed nursing care, and intention-to-leave the job among nurses working in general care units and intensive care units (ICUs), and to analyse the risk factors for these outcomes between the two groups.</div></div><div><h3>Design</h3><div>This was a cross-sectional study involving online surveys of nurses at participating hospitals conducted between November 2020 and July 2021 as part of the Magnet4Europe initiative.</div></div><div><h3>Setting and Participants</h3><div>A convenience sample was recruited, consisting of 67 acute care hospitals in 6 countries: Belgium, England, Germany, Ireland, Norway, and Sweden. In total, data for 1,150 ICU nurses and 5,145 general ward nurses (1,901 from surgical wards and 3,250 from medical wards) were analysed.</div></div><div><h3>Results</h3><div>The prevalence of burnout was significantly lower among nurses in ICUs (27.1 % vs. 30.3 %), missed care from care was significantly less frequent (65.5 % vs. 75.4 %), while intention-to-leave was similar (28.1 % vs. 29.2 %) compared with nurses in general wards. Nurses working in a better work environment and with lower workloads had statistically significant lower rates of burnout and intention-to-leave their job compared to those working in a poorer work environment and with higher workloads. Country-specific analysis showed a higher burnout rate and the intention-to-leave the job for nurses working in Germany, Ireland, Scandinavia, and the England compared to Belgium.</div></div><div><h3>Conclusions</h3><div>ICU nurses did not have a higher risk of burnout and had significantly lower risks of missing care and intention-to-leave, compared to nurses in general wards. A better work environment and lower perceived workload were consistently associated with reduced risks for all outcomes studied.</div></div><div><h3>Implications for clinical practice</h3><div>National policies should prioritize creating healthy work environments, reducing workloads, and addressing country-specific challenges to lower burnout rates, minimize missed care, and decrease the intention to leave the job among ICU and general ward nurses.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103885"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634980","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":"Longitudinal trajectories of health-related quality of life among critical care survivors: A latent class growth approach","authors":"Jiyeon Kang,&nbsp;Min Hye Lee","doi":"10.1016/j.iccn.2024.103892","DOIUrl":"10.1016/j.iccn.2024.103892","url":null,"abstract":"<div><h3>Objectives</h3><div>This study explored the trajectories of health-related quality of life (HRQOL) and the factors influencing these trajectories.</div></div><div><h3>Research methodology/design</h3><div>Prospective observational cohort study.</div></div><div><h3>Setting</h3><div>19 intensive care units (ICUs) in South Korea.</div></div><div><h3>Main outcome measures</h3><div>We used the Medical Outcomes Study Short Form version 2 (SF-36v2) to assess HRQOL at 3, 6, 12, and 24 months post-discharge. Additionally, we evaluated intensive care experience, post-intensive care syndrome, and demographic and clinical characteristics to identify factors. HRQOL trajectory groups were identified via latent class growth modeling, with determining factors analyzed using multinomial logistic regression.</div></div><div><h3>Results</h3><div>The analysis identified three distinct groups for the physical component summary (PCS) and mental component summary (MCS) of the SF-36v2. For the PCS, the groups were labeled “Resilient Stable,” “Moderate Recovered,” and “Slow Recovering.” For the MCS, the classifications were “Resilient Stable,” “Low Recovered,” and “Persistent Low.” The determinants of the PCS Moderate Recovered and Slow Recovering Groups included older age, female gender, less educated, increased comorbidities, discharge to extended care facilities, and post-intensive care syndrome. Conversely, the MCS Low Recovered and Persistent Low Groups were determined by the intensive care experience and post-intensive care syndrome.</div></div><div><h3>Conclusion</h3><div>Our study identified specific vulnerable groups for PCS and MCS and their determinants in terms of HRQOL recovery among ICU survivors.</div></div><div><h3>Implications for clinical practice</h3><div>There is a need for a preemptive approach for survivors with determinants that place them in vulnerable groups for poorer HRQOL as well as systematic monitoring of post-intensive care syndrome in various healthcare settings.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103892"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634970","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":"Sociodemographic representation in ICU recovery research","authors":"Joanne McPeake ,&nbsp;Valerie Danesh ,&nbsp;Tammy L. Eaton ,&nbsp;Han Su ,&nbsp;Leanne M. Boehm","doi":"10.1016/j.iccn.2024.103878","DOIUrl":"10.1016/j.iccn.2024.103878","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103878"},"PeriodicalIF":4.9,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634983","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":"Flexible ICU visiting: Improving family outcomes while navigating implementation challenges","authors":"Dongdong Yang ,&nbsp;Meng Zhao ,&nbsp;Yu Shi","doi":"10.1016/j.iccn.2024.103894","DOIUrl":"10.1016/j.iccn.2024.103894","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103894"},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585420","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":"How to prevent ventilator-associated pneumonia (VAP) in trauma patients","authors":"Georgios Papathanakos,&nbsp;Stijn Blot,&nbsp;Despoina Koulenti","doi":"10.1016/j.iccn.2024.103876","DOIUrl":"10.1016/j.iccn.2024.103876","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103876"},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585422","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":"“I will get out of this” - The patients’ experiences of early mobilisation in intensive care. A hermeneutic study","authors":"Annika Söderberg ,&nbsp;Anneli Thelandersson ,&nbsp;Monika Fagevik Olsén ,&nbsp;Veronika Karlsson","doi":"10.1016/j.iccn.2024.103884","DOIUrl":"10.1016/j.iccn.2024.103884","url":null,"abstract":"<div><h3>Background</h3><div>The significance of early mobilisation in intensive care has become increasingly apparent along with a growing understanding of patient experiences within this critical setting. However, there is still a need for more knowledge regarding the complex experiences of the patients. Therefore, this study aimed to gain an in-depth understanding of the significance and deeper meaning of early mobilisation in patients recently treated in intensive care.</div></div><div><h3>Methods</h3><div>A qualitative study with a hermeneutic, interpretive approach. Semi-structured interviews were conducted with 30 participants recently treated in the intensive care units, in two different hospitals.</div></div><div><h3>Findings</h3><div>The analysis yielded three themes: ‘Struggling to regain independence and normal life’, ‘Interaction with healthcare professionals’ and ’Early mobilisation in a chaotic, confused context without control’. The first theme captures the participants’ experiences, motivations, and the deeper significance of early mobilisation, which was hope, the beginning of recovery and a willingness to fight. The other themes describe the context and circumstances surrounding the participants’ mobilisation including the collaboration with healthcare professionals.</div></div><div><h3>Conclusion</h3><div>Early mobilisation’s significance and deeper meaning in intensive care were understood as the starting point of recovery. It had the ability to evoke hope and strengthen the fighting spirit, especially when it included leaving bed. The patients’ pre-existing understanding that resilience and persistence were crucial for regaining strength and mobility contributed, as well as positive interactions with healthcare professionals that restored human dignity and facilitated involvement and participation contributed.</div></div><div><h3>Implications for practice</h3><div>Early mobilisation should be used to inspire hope and a willingness to fight for recovery in patients treated in intensive care. Efforts should be made to engage patients in positive interactions with healthcare professionals that encourage this fighting spirit and active participation in early mobilisation. Mobilisations involving patients getting up and leaving bed should be used as much as possible.</div></div>","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103884"},"PeriodicalIF":4.9,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585419","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":"Early changes in skin surface temperature to predict fever – Response to Xie et al.","authors":"Nai-Ying Ko ,&nbsp;Yi-Ting Chung ,&nbsp;Chun-Yin Yeh ,&nbsp;Yu-Chen Shu ,&nbsp;Chao-Han Lai","doi":"10.1016/j.iccn.2024.103873","DOIUrl":"10.1016/j.iccn.2024.103873","url":null,"abstract":"","PeriodicalId":51322,"journal":{"name":"Intensive and Critical Care Nursing","volume":"86 ","pages":"Article 103873"},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549799","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}