American Journal of Critical Care最新文献_第5页

Ethical Decision-Making: The Process. 伦理决策：过程。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026133

Catherine Green

引用次数: 0

Overcoming Patient-Centered Outcomes Research Barriers During and After Critical Illness Hospitalization. 克服危重疾病住院期间和之后以患者为中心的结局研究障碍。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-05-01 DOI: 10.4037/ajcc2026665

Ruth Kleinpell, Marianna LaNoue, Susan Lacey, David Y Hwang, Carla M Sevin, Leanne M Boehm, Adair Andrews

{"title":"Overcoming Patient-Centered Outcomes Research Barriers During and After Critical Illness Hospitalization.","authors":"Ruth Kleinpell, Marianna LaNoue, Susan Lacey, David Y Hwang, Carla M Sevin, Leanne M Boehm, Adair Andrews","doi":"10.4037/ajcc2026665","DOIUrl":"https://doi.org/10.4037/ajcc2026665","url":null,"abstract":"Background: Recruiting patients/family for research related to intensive care unit (ICU) care can be challenging.Objectives: To engage diverse stakeholders (patients with recent ICU discharge, their families/caregivers, ICU clinicians, and health services researchers) to identify barriers to research engagement among recently discharged patients and their family members/caregivers and to highlight strategies to address the barriers.Methods: Four sessions of group concept mapping, a participatory research and engagement approach, were used with 16 former patients and their family members/caregivers and 23 professionals (clinicians and researchers) to elicit barriers to ICU research participation. Strategies to address the barriers were outlined and categorized according to themes identified in the literature, with input from a patient and family advisory board.Results: Ninety-eight unique barriers were identified and organized into 7 clusters: negative experiences surrounding ICU stay, difficult research logistics, patient and family characteristics, ICU setting limitations, post-critical illness issues, research fears, and (mis)perceptions about research. Strategies to overcome those barriers were identified and outlined in an open access, web-based toolkit to help ICU clinicians and researchers engage people in research.Conclusions: Ensuring that patients and families have sufficient information about research participation, promoting a research-supportive culture, addressing uncertainty about research participation, and providing clinical staff with access to research training can help engage ICU patients and family members in critical care research.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 3","pages":"199-204"},"PeriodicalIF":2.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809648","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

Healthy Work Environments and Moral Resilience. 健康的工作环境和道德韧性。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026217

Meredith Padilla

引用次数: 0

A Delphi Study to Explore the American Association of Critical-Care Nurses Level of Evidence Resource. 美国重症护理护士协会证据资源水平的德尔菲研究。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026921

Mary Beth Flynn Makic, Ilana I Logvinov, Annette M Bourgault

{"title":"A Delphi Study to Explore the American Association of Critical-Care Nurses Level of Evidence Resource.","authors":"Mary Beth Flynn Makic, Ilana I Logvinov, Annette M Bourgault","doi":"10.4037/ajcc2026921","DOIUrl":"10.4037/ajcc2026921","url":null,"abstract":"Background: Evidence-based practice integrates research evidence, clinical expertise, and patient preferences. The American Association of Critical-Care Nurses (AACN) pioneered evidence-based practice, developing one of the first evidence hierarchy resources for its members to rank the strength of evidence for practice recommendations.Objectives: To evaluate use of the AACN levels of evidence resource and make recommendations for its use, and to explore opportunities to improve the resource.Methods: A 3-round Delphi approach guided by consensus-building theory, where consensus meant ≥80% agreement.Results: Twelve nurse experts in evidence-based practice completed 3 survey rounds. Most participants (83%) worked in clinical settings and were doctorally prepared. In round 1, 83% recommended revisions and 67% advocated changing the hierarchy structure from alphabetical letters to Roman numerals. The resource was used to rank individual pieces of evidence and to rank practice recommendations based on synthesized evidence. Clearer definitions were suggested for qualifying statements. In round 2, 83% of participants supported a synthesis tool for best evidence and development of detailed instructions. Additional sources of evidence were suggested and ranked. In round 3, 75% of participants indicated preferences for the order of research and nonresearch evidence. Experts were divided on continued use of manufacturers' recommendations as an evidence source.Conclusions: This study validated AACN's levels of evidence resource with major revisions to maintain relevancy and usefulness. To facilitate use, additional resources to support the evaluation of quality, strength, and synthesis of evidence are recommended.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 2","pages":"93-99"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321189","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

Intensive Care Unit Nurses as Second Victims of Adverse Events: A Multinational Study in 4 Latin American Countries. 重症监护室护士是不良事件的第二受害者：一项在4个拉丁美洲国家的跨国研究。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026681

Maria Kappes, Silvina Estrada, Gladys Gaviria, Aida Maidana de Zarza, Diego Jara, Ivan Guglielmi, Maria Victoria Brunelli

{"title":"Intensive Care Unit Nurses as Second Victims of Adverse Events: A Multinational Study in 4 Latin American Countries.","authors":"Maria Kappes, Silvina Estrada, Gladys Gaviria, Aida Maidana de Zarza, Diego Jara, Ivan Guglielmi, Maria Victoria Brunelli","doi":"10.4037/ajcc2026681","DOIUrl":"10.4037/ajcc2026681","url":null,"abstract":"Background: Health care professionals, especially intensive care unit (ICU) nurses, are at high risk of experiencing the second victim phenomenon following adverse events, which can lead to significant psychological distress.Objectives: To describe the second victim phenomenon among ICU nurses in Argentina, Chile, Colombia, and Paraguay and to assess the support provided by their organizations.Methods: A multicenter, descriptive, cross-sectional study was conducted with ICU nurses from 4 Latin American countries. Data were collected electronically between January and December 2023 using the Spanish-adapted version of the Second Victim Experience and Support Tool.Results: A total of 762 ICU nurses participated. The psychological dimension was the most significantly affected (mean score on a Likert scale of 1-5, 3.7), with sadness being the most frequently reported emotion (mean score, 3.8). Longer professional experience was associated with increased professional disengagement, absenteeism, and self-doubt. Lower peer support correlated strongly with greater psychological distress and higher absenteeism and turnover intention. Chile reported the highest perception of institutional support.Conclusions: The second victim phenomenon significantly affects ICU nurses in Latin America, predominantly through psychological effects. Implementing structured support programs is essential to mitigate absenteeism and turnover intention.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 2","pages":"108-117"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321237","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

Caring Beyond the Bedside: Family Bereavement Support in Critical Care. 病床外的关怀：重症监护中的家庭丧亲支持。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026581

Margo A Halm

引用次数: 0

Buying Time: Maternity Leave Policies and Critical Care Nurses' Return to Work. 购买时间：产假政策和重症护理护士重返工作岗位。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026269

Adrianna Lorraine Watson, Daluchukwu Megwalu Tapp, Chelsey Young, Saydie Holyoak, Grace Houston, Brooklynn Nelson, Ashlynn Wood, Gabriela Marquez

{"title":"Buying Time: Maternity Leave Policies and Critical Care Nurses' Return to Work.","authors":"Adrianna Lorraine Watson, Daluchukwu Megwalu Tapp, Chelsey Young, Saydie Holyoak, Grace Houston, Brooklynn Nelson, Ashlynn Wood, Gabriela Marquez","doi":"10.4037/ajcc2026269","DOIUrl":"10.4037/ajcc2026269","url":null,"abstract":"Background: The nursing profession faces critical workforce shortages, intensified by high attrition linked to burnout and inadequate family supports. In the United States, maternity leave remains short and often unpaid, forcing premature returns to work that undermine health, family bonding, and career longevity. Although previous studies have quantified these outcomes, few have captured the moral distress and role strain experienced by nurse-mothers.Objective: To explore the lived experiences of nurse-mothers navigating maternity leave transitions within critical care settings.Methods: This study was guided by interpretive phenomenology. Purposive sampling was used to enroll 54 US critical care nurses in the study. Semistructured audiovisual interviews conducted between April and August 2024 were transcribed and analyzed using the hermeneutic circle.Results: The analysis yielded 4 themes: (1) paid time off supplementation for maternity leave; (2) national responsibility in addressing unpaid, underpaid, and brief leave; (3) critical care nurses' need for more time; and (4) the need for additional support and adaptive policies.Conclusions: For critical care nurses, maternity leave often becomes a moral and existential dilemma shaped by time scarcity and financial strain, contributing to burnout and attrition. Evidence-based strategies to address the problem include front-loading paid leave, phased return-to-work options, and guaranteed lactation coverage. Aligning US policy with international standards regarding extended paid leave could promote retention, enhance staffing flexibility, and protect the quality of patient care.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 2","pages":"128-144"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321178","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

Moral Injury Among Intensive Care Unit Nurses: Roles of Moral Resilience and a Healthy Work Environment. 重症监护室护士的道德伤害：道德弹性与健康工作环境的作用。

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026648

Sarah Sumner

{"title":"Moral Injury Among Intensive Care Unit Nurses: Roles of Moral Resilience and a Healthy Work Environment.","authors":"Sarah Sumner","doi":"10.4037/ajcc2026648","DOIUrl":"10.4037/ajcc2026648","url":null,"abstract":"Background: Moral injury, which is caused by actions that violate moral beliefs, gained recognition during the COVID-19 pandemic and still affects intensive care unit (ICU) nurses. Moral resilience and a healthy work environment may be protective by promoting ethical practice and self-stewardship.Objective: To measure the prevalence of moral injury in ICU nurses; examine relationships among moral injury, moral resilience, and healthy work environment; and assess differences in moral injury by demographic characteristics.Methods: A cross-sectional survey was conducted June to July 2023 across 22 hospitals in a large US health system. Instruments were the Moral Injury Symptom Scale-Health Professionals, the Rushton Moral Resilience Scale-16, and the Healthy Work Environment Assessment Tool. Correlation analyses, multiple regression, and analysis of variance were used to test relationships and group differences.Results: Of 304 ICU nurses, 169 (55.6%) met criteria for moderate to severe moral injury symptoms. Moral resilience (r = -0.58) and healthy work environment (r = -0.40) were significantly inversely associated with moral injury (P < .001). The regression model (F2,292 = 91.75; P < .001) explained 38% of variance in moral injury scores. Moral injury scores were lowest in older nurses and those with daily chaplain interactions (P < .001). Ethics consultation participation did not affect moral injury but significantly affected moral resilience; nurses who did not know how to request support had the lowest moral resilience scores.Conclusions: Moral resilience and healthy work environment may reduce moral injury. Future research should explore supportive interventions targeting early-career ICU nurses.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 2","pages":"118-126"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321262","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

Changes in Use of Physical Restraints in Intensive Care Unit Patients During the COVID-19 Pandemic. COVID-19大流行期间重症监护病房患者身体约束使用的变化

IF 2.6 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026317

Nicolas Kumar, Robert B Schonberger, Mayanka Tickoo, Zili He, Hung-Mo Lin, Clark Fisher, John Lutz, George Michel, Amit Bardia

{"title":"Changes in Use of Physical Restraints in Intensive Care Unit Patients During the COVID-19 Pandemic.","authors":"Nicolas Kumar, Robert B Schonberger, Mayanka Tickoo, Zili He, Hung-Mo Lin, Clark Fisher, John Lutz, George Michel, Amit Bardia","doi":"10.4037/ajcc2026317","DOIUrl":"10.4037/ajcc2026317","url":null,"abstract":"Background: Physical restraints are used in the intensive care unit (ICU) to prevent patient self-harm, but they are also associated with adverse outcomes. The COVID-19 pandemic placed unprecedented challenges on health care systems, especially in ICUs.Objective: To investigate pandemic-associated trends in the use of physical restraints.Methods: In this retrospective pre-post analysis, use of physical restraints in adult ICU patients in a tertiary care center from January 1, 2018, through December 31, 2022, was queried. Patients admitted before March 1, 2020, were deemed the pre-COVID-19 group, and those admitted after were deemed the COVID-19 group. Trends between groups and patient-level risk factors associated with higher physical restraint use were compared.Results: A total of 17 285 patients were admitted to the ICU during the pre-COVID-19 period, and 20 421 were admitted during the COVID-19 period. Physical restraint use increased significantly from the pre-COVID-19 period to the COVID-19 period (29.4% vs 32.5%; P < .001). Physical restraint use was disproportionately higher among self-identified Black and Hispanic persons than in all others both before and during the COVID-19 period. Additionally, physical restraint use among non-English speakers increased from 30.6% in the pre-COVID-19 period to 38.4% in the COVID-19 period.Conclusion: Our findings indicate a critical need to understand and address the drivers of increased use of physical restraints during times of stressors on hospital systems. Furthermore, the racial and ethnic disparities in physical restraint use warrant further study and possibly dedicated quality improvement measures.","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":"35 2","pages":"145-149"},"PeriodicalIF":2.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321198","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

Purpose, Significance, and Coherence: Identity in the Intensive Care Unit. 目的、意义和一致性：重症监护病房的身份。

IF 2.2 3区医学

American Journal of Critical Care Pub Date : 2026-03-01 DOI: 10.4037/ajcc2026897

Lakshman Swamy, Cindy L Munro

引用次数: 0