American Journal of Critical Care最新文献_第2页

Availability of Advanced Practice Providers in Adult Intensive Care Units in the United States: A Survey. 美国成人重症监护病房高级实践提供者的可用性：一项调查。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025655

Deena Kelly Costa, Danny Lizano, Allan Garland, Robert Fowler, Vincent X Liu, Damon C Scales, Hannah Wunsch, Hayley B Gershengorn

{"title":"Availability of Advanced Practice Providers in Adult Intensive Care Units in the United States: A Survey.","authors":"Deena Kelly Costa, Danny Lizano, Allan Garland, Robert Fowler, Vincent X Liu, Damon C Scales, Hannah Wunsch, Hayley B Gershengorn","doi":"10.4037/ajcc2025655","DOIUrl":"https://doi.org/10.4037/ajcc2025655","url":null,"abstract":"Background: How advanced practice providers (APPs) are deployed in adult US intensive care units (ICUs) is understudied. Further, whether state-level restrictions on practice affect the availability of these providers is unknown.Objectives: To describe staffing patterns of ICU APPs (nurse practitioners, physician assistants) in the context of physicians-in-training (interns, residents, fellows) and to explore the association between state-level APP practice restrictions and employment.Methods: Data from a national survey of pre-COVID-19 (steady-state) ICU staffing linked to the 2020 American Hospital Association survey were used to examine staffing patterns (via descriptive statistics) and to explore the association of state-level practice restrictions with the presence of APPs in ICUs (via multivariable regression).Results: The cohort included 588 adult ICUs, of which 336 (57.1%) reported both APPs and physicians-in-training, 124 (21.1%) APPs only, 73 (12.4%) physicians-in-training only, and 55 (9.4%) neither. Units with both provider types were more commonly surgical ICUs (17.6% vs ≤9.6%; P < .001), whereas those with neither were 98.2% mixed units. Those units with neither were smaller and more often in smaller, nonteaching, for-profit hospitals in nonmetropolitan areas. Two hundred twenty-five ICUs (38.3%) were in states allowing full APP practice scope. After adjustment, the odds of employing APPs were nonsignificantly higher in ICUs in full-practice states.Conclusions: Both APPs and physicians-in-training are commonly deployed in US adult ICUs, often together. Laws limiting practice scope may impede deployment of these providers in ICUs.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"285-292"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526036","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}

引用次数: 0

COVID-19 Pandemic Sequelae: Mental Health of Cardiothoracic Critical Care Nurses. COVID-19大流行后遗症：心胸重症监护护士的心理健康。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025123

Jonathan Harrington, Catherine Ford, Elizabeth Cortis, Kelly Nicholson

{"title":"COVID-19 Pandemic Sequelae: Mental Health of Cardiothoracic Critical Care Nurses.","authors":"Jonathan Harrington, Catherine Ford, Elizabeth Cortis, Kelly Nicholson","doi":"10.4037/ajcc2025123","DOIUrl":"https://doi.org/10.4037/ajcc2025123","url":null,"abstract":"Background: Critical care nurses are at high risk for anxiety, depression, and posttraumatic stress disorder, leading to poor professional quality of life.Objectives: To explore the current state of cardiothoracic critical care nurses' mental health and professional quality of life as restrictions related to the COVID-19 pandemic were lifted, specifically (1) to explore nurses' levels of posttraumatic stress disorder, anxiety and depression, and professional quality of life; and (2) to determine relationships between demographic characteristics, supportive factors, and intent to leave the profession and dependent variables.Methods: A cross-sectional, descriptive survey was administered to cardiothoracic intensive care nurses in a tertiary care, Magnet-designated academic medical center in the northeastern United States. The survey incorporated established measures of mental health and perceptions of professional quality of life.Results: The sample consisted of 34 mostly female nurses with a bachelor's degree or higher. Participants had a mean (SD) of 10.7 (10.3) years of experience. Severity scores for mental health and professional quality of life ranged from mild to moderate. Significant relationships were found among mental health variables, intent to leave the profession, and evidence-based supportive factors. Supportive factors influenced scores on measures of mental health and burnout. Support from friends and family was related to anxiety and depression scores. Intent to leave the profession was significantly related to all mental health variables. The incidence of burnout was higher among younger nurses.Conclusions: The findings point to the critical need to identify innovative strategies to increase support, particularly from peers and organizational leadership.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"e32-e36"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526037","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}

引用次数: 0

Meaningful Recognition From Bench to Bedside. 从实验室到床边的有意义的认可。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025849

Lakshman Swamy, Cindy L Munro

引用次数: 0

Prone Positioning to Improve Cerebral Oxygenation in Patients With Acute Respiratory Distress Syndrome. 俯卧位改善急性呼吸窘迫综合征患者脑氧合。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025879

Yannick Fedun, Boris Campillo-Gimenez, Agathe Delbove, Angélique Goepp, Eddy Lebas, Fanny De Sevin, François Mateos, Julien Huntzinger, Yoann Launey, Florian Reizine

{"title":"Prone Positioning to Improve Cerebral Oxygenation in Patients With Acute Respiratory Distress Syndrome.","authors":"Yannick Fedun, Boris Campillo-Gimenez, Agathe Delbove, Angélique Goepp, Eddy Lebas, Fanny De Sevin, François Mateos, Julien Huntzinger, Yoann Launey, Florian Reizine","doi":"10.4037/ajcc2025879","DOIUrl":"https://doi.org/10.4037/ajcc2025879","url":null,"abstract":"Background: Acute respiratory distress syndrome (ARDS), a common condition among intensive care patients, is characterized by severe hypoxemia that may lead to acute brain injury. Although prone positioning has emerged as a lifesaving strategy in the management of ARDS, its effects on cerebral oxygenation remain insufficiently explored.Objective: To evaluate the evolution of cerebral oxygenation during prone positioning in patients with ARDS.Methods: This prospective, single-center study was done in the intensive care unit of a community hospital. Consecutive patients with moderate or severe ARDS were prospectively enrolled during a 12-month period. Cerebral oxygenation was assessed by near-infrared spectroscopy before and during an 18-hour period of prone positioning. Continuous variables were compared before and during prone positioning using the Wilcoxon signed rank test. Correlations were assessed using the Spearman rank test.Results: Ten patients were included in the study, with 2 patients exiting at hours 6 and 12 after the start of prone positioning because of hemodynamic instability. Evidence of oxygenation improvement during prone positioning was indicated by an increase in regional cerebral oxygen saturation (rSo2) and the ratio of Pao2 to fraction of inspired oxygen (Fio2). The rSo2/Fio2 ratio was significantly increased from hour 3 to 12 (P = .049 at hour 3, P = .02 at hour 8, and P = .02 at hour 12). Also, rSo2 was significantly correlated with oxygen delivery (ρ = 0.811, P < .001) and cardiac index (ρ = 0.463, P < .001).Conclusion: Prone positioning in patients with ARDS seems to be associated with improved cerebral oxygenation based on rSo2/Fio2 ratio.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"277-284"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526047","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}

引用次数: 0

Nurses' Decision-Making and Confidence With Titration of Vasoactive Medication. 护士对血管活性药物滴定的决策与信心。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-07-01 DOI: 10.4037/ajcc2025332

Eugene Waterval, Tara Hunt, Daleen Penoyer

{"title":"Nurses' Decision-Making and Confidence With Titration of Vasoactive Medication.","authors":"Eugene Waterval, Tara Hunt, Daleen Penoyer","doi":"10.4037/ajcc2025332","DOIUrl":"https://doi.org/10.4037/ajcc2025332","url":null,"abstract":"Background: Critical care nurses are responsible for titration of intravenous vasoactive medications. Before the 2017 publication of The Joint Commission standards requiring nurses to titrate medications within specific protocols, nurses mostly titrated medications autonomously according to clinical judgment. Little is known about how nurses make decisions when titrating vasoactive medications. Additional research on this area of nursing practice is needed to optimize patient outcomes.Objectives: To better understand critical care nurses' practices, perceptions, and decision-making processes when titrating vasoactive medications.Methods: The study used a prospective, single-site, convergent mixed-methods, descriptive design. Nurse surveys using the Clinical Decision-Making in Nursing Scale and the Confidence Scale provided data for quantitative analysis. Semistructured interviews provided results for thematic, qualitative analysis.Results: Nurses' scores for decision-making and confidence when titrating vasoactive medications did not differ significantly between demographic groups. Survey saturation was achieved after 10 interviews, resulting in 4 themes: using the protocol, using knowledge and critical thinking, considering patient history, and collaborating professionally.Conclusions: Titration protocols are valued but have limitations based on patients' responses and medical history. Vasoactive medication titration requires a robust knowledge base, experience, and collaboration with physicians and coworkers. Similar confidence levels despite different years of experience may be attributed to a strong unit support system or accelerated experiences during the COVID-19 pandemic, when nurses were exposed to more patients receiving vasoactive medications.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 4","pages":"e24-e31"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526045","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}

引用次数: 0

Calling Attention to the Practice of Acute and Critical Care Nursing. 呼吁关注急危重症护理实践。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025397

Michele C Balas, Kirsten E Hepburn, Martha A Q Curley

引用次数: 0

Maximizing Data Capture for Race and Ethnicity of Children Admitted to Critical Care Units. 最大限度地获取入住重症监护病房的儿童的种族和民族数据。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025971

Patricia A Hickey, Jean A Connor, Cheryl Toole, Valerie L Ward

{"title":"Maximizing Data Capture for Race and Ethnicity of Children Admitted to Critical Care Units.","authors":"Patricia A Hickey, Jean A Connor, Cheryl Toole, Valerie L Ward","doi":"10.4037/ajcc2025971","DOIUrl":"https://doi.org/10.4037/ajcc2025971","url":null,"abstract":"Background: Access to complete patient sociodemographic data in a hospital's electronic health record is important for identifying and understanding health inequities and designing interventions to close health care gaps. Through participation in a national safety collaborative, this team identified many patients in intensive care units (ICUs) for whom sociodemographic data (race and ethnicity) were incomplete or missing.Objectives: To describe the processes the team used to understand how sociodemographic data were being ascertained for children admitted to hospital ICUs; demonstrate how interprofessional care teams can collaborate to create solutions for vulnerable patients; and provide steps that can be used at other hospitals to decrease missing sociodemographic data and deliver equitable care.Methods: A plan-do-study-act framework guided this initiative to improve collection of data on the race and ethnicity of ICU patients. Via 4 plan-do-study-act cycles, care vulnerabilities and implemented tests of change were evaluated to achieve the goal of capturing sociodemographic data within 72 hours of patient admission.Results: A new process was developed for patient experience representatives to collect, enter, and track sociodemographic data accurately. Through education and use of a script, documentation rates reached 80% to 100%.Conclusions: Overcoming barriers in the electronic health record and creating new processes supported the collection of sociodemographic data for children admitted to ICUs. Engaging and acknowledging the value of interprofessional teams was important in this successful groundwork to help deliver equitable care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"167-173"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957275","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}

引用次数: 0

AACN's Healthy Work Environment Standards: Why They Matter. AACN的健康工作环境标准：为什么它们很重要。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025277

Meredith Padilla

引用次数: 0

Longitudinal Evaluation of Implementation of AACN's Healthy Work Environment Framework in an Intensive Care Unit. 在重症监护室实施AACN健康工作环境框架的纵向评价。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025172

Philip Parker, Heather Pena, Jason Stokes, Jessica Seabrooks, Amanda Ornell, Annie Jaeger, Adam Millard, Robert Stern, Benjamin Edwards, Kelly Kester, Bradi Granger

{"title":"Longitudinal Evaluation of Implementation of AACN's Healthy Work Environment Framework in an Intensive Care Unit.","authors":"Philip Parker, Heather Pena, Jason Stokes, Jessica Seabrooks, Amanda Ornell, Annie Jaeger, Adam Millard, Robert Stern, Benjamin Edwards, Kelly Kester, Bradi Granger","doi":"10.4037/ajcc2025172","DOIUrl":"https://doi.org/10.4037/ajcc2025172","url":null,"abstract":"Background: Bedside nurse turnover in the United States is 22.5%, representing a national challenge that has been attributed to poor work environments. Poor work environments result in decreased nurse satisfaction and retention as well as poor patient outcomes. Healthy work environments have the opposite effects.Objectives: To evaluate the impact of implementation of the American Association of Critical-Care Nurses (AACN) healthy work environment framework in an intensive care unit on work environment scores, turnover, and tenure during a 6-year period.Methods: A prospective, longitudinal design was used to evaluate implementation of the healthy work environment framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 healthy work environment standards were carried out. The AACN Healthy Work Environment Assessment Tool was used to measure each standard in 2017, 2019, 2021, and 2023.Results: No statistically significant differences were found between cohorts. The score for each healthy work environment standard and the overall score increased significantly from 2017 to 2023. Nurse turnover increased during the COVID-19 pandemic but restabilized within 2 years.Conclusions: Findings from this study suggest that targeted interventions addressing the healthy work environment standards are associated with improved staff satisfaction and reduced turnover. Furthermore, the findings highlight the value of the healthy work environment framework in improving nurse retention.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"183-192"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964793","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}

引用次数: 0

Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation. 未接受机械通气的老年人住院期间口腔微生物组的变化。

IF 2.7 3区医学

American Journal of Critical Care Pub Date : 2025-05-01 DOI: 10.4037/ajcc2025470

Kimberly Paige Rathbun, Mary Lou Sole, Shibu Yooseph, Rui Xie, Annette M Bourgault, Steven Talbert

{"title":"Oral Microbiome Changes During Hospitalization in Older Adults Not Receiving Mechanical Ventilation.","authors":"Kimberly Paige Rathbun, Mary Lou Sole, Shibu Yooseph, Rui Xie, Annette M Bourgault, Steven Talbert","doi":"10.4037/ajcc2025470","DOIUrl":"10.4037/ajcc2025470","url":null,"abstract":"Background: Oral bacteria can be pathogenic and may change during hospitalization, potentially increasing risk for complications for older adults, including residents of skilled nursing facilities (SNFs).Objectives: To compare the oral microbiome at hospital admission by prehospital residence (SNF vs home) in older adults not receiving mechanical ventilation and to assess changes in their oral microbiome during hospitalization.Methods: This prospective, observational study included 46 hospitalized adults (≥65 years old) not receiving mechanical ventilation, enrolled within 72 hours of hospitalization (15 admitted from SNF, 31 from home). Oral health was assessed with the Oral Health Assessment Tool at baseline and days 3, 5, and 7. Genomic DNA was extracted from unstimulated oral saliva specimens for microbiome profiling using 16S ribosomal RNA sequencing. Taxonomic composition, relative abundance, α-diversity (Shannon Index), and β-diversity (Bray-Curtis dissimilarity) of bacterial communities were determined.Results: Most patients were female (70%) and White (74%) or Hispanic (11%). Mean age was 78.7 years. More patients admitted from SNFs than from home had cognitive impairment (P < .001), delirium (P = .01), frailty (P < .001), and comorbidities (P = .04). Patients from SNFs had more oral bacteria associated with oral disease, lower α-diversity (P < .001), and higher β-diversity (P = .01). In the 28 study completers, α-diversity altered over time (P < .001). A significant interaction was found between groups after adjusting for covariates (P < .001).Conclusions: Hospitalized older adults admitted from SNFs experience oral microbial and oral health disparities.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"34 3","pages":"208-217"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12183789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964795","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}

引用次数: 0