Showing papers in "Dimensions of Critical Care Nursing in 2022"

Parent Perception of Their Role in the Pediatric Cardiac Intensive Care Unit

Abstract: Background/Introduction One way the goal of establishing a partnership with families is accomplished, specific to the pediatric intensive care units, is 24-hour visitation and presence/participation during medical rounds and procedures. Despite the breadth of literature on the positive effect of parent presence, as well as the nearly nationwide adoption of 24-hour pediatric intensive care unit visitation, there is little to no research about how these changes have affected parents' perception of their role in the pediatric cardiac intensive care unit (PCICU). Objectives/Aims The purpose of this study was to explore and better understand the experience of parents in the PCICU within a patient/family-centered care model. Methods Using a qualitative descriptive approach, interviews were conducted with parents of children currently admitted as inpatients in the PCICU. Participants were asked broad, open-ended questions and probes to attain qualitative descriptions of their experiences and perceptions of their parental role in the PCICU. The research design for this study was based on naturalistic inquiry and was used to describe rather than interpret parental experiences in their own words. Results Eleven parents from 7 families were interviewed; parents described their role in terms of 2 main categories, as one who is an advocate and decision maker and one who provides emotional and physical support. Parents valued the expertise of the PCICU team but also shared the significance of the team recognizing their role as parents. Incorporating parents as an integral member of the health care team is a fundamental component to PCICU care. Discussion/Conclusion The role of parents is irreplaceable, particularly in the PCICU. The medical complexity of the intensive care can be a barrier to act as parents resulting in a disruption of family-centered care. Nursing staff avert this disruption through modeling parenting to their child's present circumstances and involvement in normal parenting tasks.

Improving Helmet CPAP Use During COVID-19 Pandemic

Abstract: The aim of this article is to describe the importance of a multidisciplinary team dedicated to noninvasive ventilation training of the emergency department's staff. In our experience, the presence of a medical and nursing "noninvasive ventilation group" made it possible to quickly teach expertise on the management of noninvasive ventilation of COVID-19 patients among emergency department doctors and nurses. This allowed improving a standardized approach regarding the identification and ventilatory assistance of patients with SARS-CoV-2 pneumonia needing ventilatory support, the correct use of the devices, and quick identification and reduction of the complications associated with noninvasive ventilation. In this article, we would like to encourage the formation of similar working groups in all situations where this is not yet present.

The Effect of Intensive Care Unit Diaries on Posttraumatic Stress Disorder, Anxiety, and Depression

Abstract: Patients discharged from the intensive care unit (ICU) suffer from long-term symptoms affecting the physical, psychological, and cognitive well-being and cannot understand memories and dreams. Intensive care unit diaries describe daily events about the patient and may allow them to reconstruct their experience.We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effects of ICU diaries on posttraumatic stress disorder (PTSD), depression, and anxiety.Five electronic databases were searched up to May 6, 2022. We included RCTs comparing patients admitted to the ICU who received a diary to those who did not receive a diary. The primary outcome was the rate of PTSD. Secondary outcomes were rates of depression and anxiety.We included 7 RCTs. Patients who received a diary during the ICU admission had reduced rate of PTSD (78/432 [18%] vs 106/422 [25%]; risk ratio [RR], 0.73; 95% confidence interval [CI], 0.57-0.94; P = .02; I2 = 0%; trial sequential analysis-adjusted CI, 0.55-0.97) when compared with patients who did not receive a diary. We found a non-statistically significant difference toward a reduction in the rate of depression (38/232 [16%] vs 54/224 [24%]; RR, 0.70; 95% CI, 0.49-1.01; P = .06; I2 = 0%) and anxiety (63/232 [27%] vs 70/224 [31%]; RR, 0.64; 95% CI, 0.29-1.40; P = .26; I2 = 67%).Providing an ICU diary to patients admitted to the ICU reduced the rate of PTSD symptoms compared with usual care.

Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults

Abstract: Background Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. Objective The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. Methods This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. Results While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. Conclusions Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.

Risk of Malnutrition and Clinical Outcomes Among Mechanically Ventilated Patients in Intensive Care Units

Abstract: Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes.The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan.A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool.Of the total 129 mechanically ventilated patients, the mean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4% of mechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009).Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU.

Critical Care Resource Nurse Team

Abstract: The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

Shifting Nursing Care Models as a Solution for the Increasing Demand on Intensive Care Unit Beds During a Pandemic

Abstract: An option appraisal of different nursing care delivery models was presented, which were made in between the first and second COVID-19 waves. The authors wanted to inform colleagues on involving nursing care delivery models in the problem-solving process during a pandemic.In the pre-COVID-19 hospital practice, the nursing care delivery model of primary nursing was applied in the intensive care unit (ICU). However, during the COVID-19 pandemic, this situation could not be upheld because of the increased need for ICU beds and the shortages of available ICU nurses.This study used the literature of an ongoing systematic review on nursing care delivery models and expert meetings between the authors and nursing staff.One standard nursing care delivery model and 3 alternative nursing care delivery models were discussed and compared in this case study. Theoretically, a modular system of team nursing seemed the better model to use during a pandemic. This model leads to an equal distribution of expertise and social distancing between experts. Compared with the other models, a strategic reserve can be created.This case study should be primarily considered as an example on how rethinking and reorganizing the nursing care delivery model could contribute to an enlarged, qualitative capacity, which needs to be organized in a short time span.

Risk of Malnutrition and Clinical Outcomes Among Mechanically Ventilated Patients in Intensive Care Units.

Abstract: BACKGROUND Critically ill patients who are mechanically ventilated are at a high risk for malnutrition, which is associated with poor clinical outcomes. AIM The aim of this study was to determine whether the modified version of Nutrition Risk in the Critically Ill (mNUTRIC) score predicts patients' clinical and functional outcomes in intensive care units (ICUs) in Jordan. METHODS A prospective, observational, quantitative research design was used. A convenience sample of 129 mechanically ventilated patients was recruited from ICUs in 7 hospitals across the different Jordanian health care sectors. Each patient was assessed and scored by the mNUTRIC tool. RESULTS Of the total 129 mechanically ventilated patients, the mean (SD) age of critically ill participants was 66.38 (17.46) years, 69.8% of the participants were male (n = 90), and 30.2% were female (n = 39). Approximately 88.4% of mechanical ventilator patients were at a high risk of malnutrition at the time of ICU admission. Overall, high mNUTRIC score (≥5) was significantly associated with MV duration (P = .004), ICU length of stay (P = .002), mortality (odds ratio, 5.43; P = .005), and functional outcomes (odds ratio, 0.184; P = .009). RELEVANCE TO CLINICAL PRACTICE Using nutrition risk screening tools such as the mNUTRIC score will add great benefits to nursing practice through identifying patients who are at a high risk of malnutrition within the first 48 hours of their admission in the ICU.

Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults.

Abstract: Background Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions. Objective The aim of this study was to explore the potential for rapid EEG to detect waveform pattern changes consistent with delirium status. Methods This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between handheld portable EEG data and delirium status. Results While being under powered minimized opportunities to detect statistical differences in EEG-derived ratios using spectral density analysis, sleep-to-wake ratios tended to be higher in patients with delirium. Conclusions Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Although this population is at the highest risk for mortality, delirium is not easily identified by current clinical assessments. Therefore, further investigation of limited lead EEG for delirium detection is warranted.

Factor V Leiden

Abstract: Factor V Leiden (FVL) is a hereditary thrombophilia, which causes the blood to be more hypercoagulable; in essence, the blood tends to clot more easily, especially under certain circumstances. It is the most common genetic mutation, causing thrombophilia in patients of white background. Patients that have FVL are at a higher risk to develop venous thromboembolism (VTE) after surgery and trauma.The purpose of this review is to identify FVL as a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer length of stay (LOS) in the hospital.This article is a systematic review of the literature involving research printed in peer-reviewed journals from 2015 to 2018. The University of Tennessee Health Science Center online library, PubMed, and Google Scholar were used for the literature search.The results of this study determined that although FVL is in fact a risk factor, which may impede optimum acute cardiopulmonary management which may contribute to a longer LOS, management of VTE is no different for a person with FVL compared with those without FVL.Factor V Leiden is a risk factor for the development of VTE, specifically deep vein thrombosis, in surgical, trauma, pregnant, and hormone replacement therapy patients, thus increasing LOS and recurrence of such events. Regardless of FVL status, management of VTE should be initiated promptly and discontinued when appropriate.

Use of Social Media to Exchange Critical Care Practice Evidence During the Pandemic.

Abstract: BACKGROUND The evidence-based practice (EBP) process was challenged during the early phase of the COVID-19 pandemic by factors such as a novel disease, rapidly changing guidelines, shortage of personal protective equipment, and other health care supplies. OBJECTIVES Our aims were to (1) explore sources of evidence sought by critical care nurses during a pandemic and (2) explore nurses' perceptions of EBP. METHODS A qualitative exploratory study was conducted using deidentified data from the American Association of Critical-Care Nurses (ACCN) open-access Facebook page, January 28 to April 30, 2020. RESULTS Two major themes were identified: (1) "sharing and seeking evidence," that is, nurses used both formal and informal sources to explore evidence supporting evolving clinical practices, and (2) "concerns about evidence," that is, nurses expressed concerns about lack of evidence and mistrust of evolving evidence. DISCUSSION Initially, there was a mismatch in nurses' expectations of the American Association of Critical-Care Nurses Facebook page. A major limitation of Facebook is the lack of a repository for quick retrieval of information. Despite these limitations, and fear and mistrust of changing guidelines, social media was used to communicate, collaborate, and share evidence to support clinical practice. Critical care nurses seemed to value evidence to support patient management and their personal safety during this evolving health crisis. CONCLUSIONS Social media played a large role in dissemination of timely evidence-based information during the early pandemic. Our results show that current EBP models should be revised to prepare for future crises and include direction for dealing with limited health care resources, and lack of and/or rapidly changing evidence.

Use of Social Media to Exchange Critical Care Practice Evidence During the Pandemic

Abstract: The evidence-based practice (EBP) process was challenged during the early phase of the COVID-19 pandemic by factors such as a novel disease, rapidly changing guidelines, shortage of personal protective equipment, and other health care supplies.Our aims were to (1) explore sources of evidence sought by critical care nurses during a pandemic and (2) explore nurses' perceptions of EBP.A qualitative exploratory study was conducted using deidentified data from the American Association of Critical-Care Nurses (ACCN) open-access Facebook page, January 28 to April 30, 2020.Two major themes were identified: (1) "sharing and seeking evidence," that is, nurses used both formal and informal sources to explore evidence supporting evolving clinical practices, and (2) "concerns about evidence," that is, nurses expressed concerns about lack of evidence and mistrust of evolving evidence.Initially, there was a mismatch in nurses' expectations of the American Association of Critical-Care Nurses Facebook page. A major limitation of Facebook is the lack of a repository for quick retrieval of information. Despite these limitations, and fear and mistrust of changing guidelines, social media was used to communicate, collaborate, and share evidence to support clinical practice. Critical care nurses seemed to value evidence to support patient management and their personal safety during this evolving health crisis.Social media played a large role in dissemination of timely evidence-based information during the early pandemic. Our results show that current EBP models should be revised to prepare for future crises and include direction for dealing with limited health care resources, and lack of and/or rapidly changing evidence.

Parent Perception of Their Role in the Pediatric Cardiac Intensive Care Unit.

Abstract: Background/introduction One way the goal of establishing a partnership with families is accomplished, specific to the pediatric intensive care units, is 24-hour visitation and presence/participation during medical rounds and procedures. Despite the breadth of literature on the positive effect of parent presence, as well as the nearly nationwide adoption of 24-hour pediatric intensive care unit visitation, there is little to no research about how these changes have affected parents' perception of their role in the pediatric cardiac intensive care unit (PCICU). Objectives/aims The purpose of this study was to explore and better understand the experience of parents in the PCICU within a patient/family-centered care model. Methods Using a qualitative descriptive approach, interviews were conducted with parents of children currently admitted as inpatients in the PCICU. Participants were asked broad, open-ended questions and probes to attain qualitative descriptions of their experiences and perceptions of their parental role in the PCICU. The research design for this study was based on naturalistic inquiry and was used to describe rather than interpret parental experiences in their own words. Results Eleven parents from 7 families were interviewed; parents described their role in terms of 2 main categories, as one who is an advocate and decision maker and one who provides emotional and physical support. Parents valued the expertise of the PCICU team but also shared the significance of the team recognizing their role as parents. Incorporating parents as an integral member of the health care team is a fundamental component to PCICU care. Discussion/conclusion The role of parents is irreplaceable, particularly in the PCICU. The medical complexity of the intensive care can be a barrier to act as parents resulting in a disruption of family-centered care. Nursing staff avert this disruption through modeling parenting to their child's present circumstances and involvement in normal parenting tasks.

Program Evaluation of Implementation Science Outcomes From an Intervention to Improve Compliance With Chlorhexidine Gluconate Bathing

Abstract: Evaluation of implementation science research is warranted to better understand and determine the success of translating evidence-based infection prevention practices at the bedside. The purpose of this program evaluation was to evaluate implementation outcomes from the perspectives of nurses and nursing leaders regarding a previously conducted chlorhexidine gluconate (CHG) bathing implementation science study among 14 critical care units.Focus groups and interviews, using semistructured interview questions, were conducted to examine the perceptions of nurses who participated in a CHG bathing implementation science study. A deductive qualitative analysis using Proctor and colleagues' implementation outcomes framework was used. Transcripts were analyzed and categorized using the framework as a predetermined code list to structure the implementation outcomes of acceptability, appropriateness, adoption, feasibility, and sustainability.A total of 19 nurses and nurse leaders participated in a focus group or interview. Participants noted that both implementation strategies used in the initial study (educational outreach and audit and feedback) were acceptable and appropriate and expressed that the evidence-based CHG bathing practice was feasible to integrate into practice and was being adopted.The program evaluation identified strengths and opportunities for improvement related to the implementation strategies and evidence-based CHG bathing protocol. Findings can inform future studies that seek to implement CHG bathing protocols in the critical care setting using audit and feedback and educational outreach strategies.

Critical Care Resource Nurse Team: A Patient Safety and Quality Outcomes Model.

Abstract: The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol

Abstract: Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied.The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol.One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8).A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year.In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.

An Integrated Review of Obstetric Admissions in the Intensive Care Unit

Abstract: Critically ill expectant mothers are regularly transferred from obstetrics units to an intensive care unit (ICU), placing one specialty population in an environment designed for another.The purpose of this study is to examine the rates of admission, admitting diagnoses, and mortality of obstetric intensive care patients in the United States and peer nations, and discuss implications to the critical care nurse.Relevant studies were identified in PubMed and Cumulative Index of Nursing and Allied Health Literature following strict eligibility criteria, including peer reviewed primary research, from 2010-2021, that examined rates of admissions, diagnoses, morbidity, and mortality of peripartum women requiring intensive care. Specialty ICU and countries with an overall performance score from the World Health Organization that placed them in the lower two-thirds deciles of all member countries were excluded. Fourteen articles, representing 9 countries, were reviewed by a single doctoral student.Few obstetrics patients required intensive care. The majority of admissions and deaths occurred within the postpartum period. The most common admitting diagnoses were hemorrhage, hypertensive disorders of pregnancy, and sepsis. Mean mortality ranged from 0.2% to 9.7%. The most common causes of death were cardiovascular diseases and postpartum hemorrhage.These women represent a truly specialized subset within the critical care population. Limitations include possible selection, confounding, and chronology biases; use of a single data extractor, and a relative dearth of relevant studies, originating in developed nations.This review provided information on characteristics of the obstetric critical care population. Education and instituting early warning systems, formal debriefings, and standardization of protocols may assist in preparing critical care nurses in confidently caring for this population.

Women's Prodromal Myocardial Infarction Symptom Perception, Attribution, and Care Seeking

Abstract: Background Most women experience prodromal myocardial infarction (MI) symptoms, but more information is needed about the perception, attribution, and care-seeking behaviors related to these prodromal symptoms. Objectives We aimed to describe women's perceptions, attributions, and care-seeking behaviors related to prodromal MI symptoms. Method We used a qualitative, multiple case study approach, recruiting participants during summer 2019 from a large hospital in the Midwestern United States. Data were collected from interviews with the women who experienced MI and some of their family members, journals, and electronic health records. An inductive, comparative analysis procedure was applied. Results Ten women, ages 42 to 84, participated in the study. The women experienced a mixture of certainty and uncertainty related to their symptoms and engaged in several cognitive processes to conceptualize and act upon their symptoms. Although all the women retrospectively reported at least 4 prodromal symptoms, they lacked knowledge of prodromal MI symptoms and often responded to prodromal sensations that they experienced using emotion- and avoidance-based strategies. It was difficult for the women to establish a symptom pattern that was attributable to heart disease. Discussion The findings of this study may be used as evidence to support interventions that would facilitate women's care seeking for and health care providers' recognition of prodromal MI symptoms. Additional research is necessary to more fully characterize the cognitive processes at play for women of many different sociocultural backgrounds who experience prodromal MI symptoms.

Quality of Life of Pediatric Nurses During the COVID-19 Pandemic

Abstract: Background In a public health emergency, the psychological stress of nursing staff should be assessed, and nurses who cared for coronavirus disease 2019 (COVID-19) patients were constantly under pressure. Currently, frontline health care workers are experiencing mental health issues. The personal quality of life is directly related to the working environment, especially at this moment, when nursing could be a highly stressful and emotionally draining job. Objectives During the COVID-19 pandemic, the primary objectives of the study were to describe the quality of life, posttraumatic stress disorder, and self-efficacy and to identify any associated factors of pediatric critical care nurses. This study is a multicenter cross-sectional study. Methods Data were collected between February and May 2021 from pediatric critical care nurses. The following instruments were used: the Nursing Quality of Life Scale, the Nursing Profession Self-Efficacy Scale, and the Impact of Event Scale. Results One hundred twelve nurses participated in this study with a 40% of response rate. Data suggest a better global perception of quality of life by male subjects (F = 6.65, P = .011). The nurses who cared for COVID-19 patients reported a lower quality of social life (F = 4.09, P = .045); furthermore, the nurses who had clinically vulnerable people in their families reported a worse quality of physical life (F = 4.37, P = .045). Approximately 50% of nurses reported sleep disturbances, and 37% reported symptoms of posttraumatic stress disorder, especially female nurses (F = 8.55, P = .04). Conclusion According to this study, female nurses were more likely to experience posttraumatic stress disorder symptoms during the COVID-19 pandemic. Furthermore, findings also highlighted a lower quality of social life for those with clinically vulnerable relatives may be due to a self-limitation of interactions with other people. Finally, sleep disturbances were prevalent, potentially affecting nurses' mental health and performance.

Thirst Interventions in Adult Acute Care—What Are the Recommended Management Options and How Effective Are They?

Abstract: The aim of this study was to review the scope and quality of evidence for thirst treatment in adult acute care.A systematic review was completed by 2 independent reviewers using MEDLINE, PubMed, BNI, EMBASE, EMCARE, and CINAHL databases and additional hand searching in June 2020. Interventions to relieve thirst for inpatients receiving acute care were included. Evidence was appraised against the levels of evidence for therapeutic studies, and a risk-of-bias assessment was completed for included studies. Outcomes are presented via narrative synthesis. Meta-analysis was planned.Four studies (out of 844) were eligible reporting thirst outcomes from 611 critical care patients. Meta-analysis could not be completed because a priori criteria were not met. Two randomized controlled trials represented the highest level of evidence. Thirst assessment was completed via a self-reported scale in all reviewed works. Interventions included cold water sprays or swabs, menthol lip moisturizer, and use of humidification. Three works demonstrate reduced thirst scores; all interventions in these studies exploit cooling effects to the oropharynx with the aim of preabsorptive satiation of thirst. A humidified oxygen circuit showed a neutral response when compared with a nonhumidified circuit.There is a limited but growing evidence base related to thirst treatment in the acute setting. Studies using a "bundle" of topical interventions incorporating cooling and menthol treatments showed positive effects in reducing symptom burden. Work to explore the scope of application for thirst treatment for patients unable to self-report, consideration of sustained effects, and a study of individual versus combined effects of bundle elements would be welcomed as the evidence base continues to develop.

Interventions to Reduce Nurses' Moral Distress in the Intensive Care Unit

Abstract: Log in or Register Subscribe to journalSubscribe Get new issue alertsGet alerts Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. Subscribe to eTOC Secondary Logo Journal Logo All Articles Images Videos Podcasts Blogs Advanced Search Toggle navigation Subscribe Register Login Articles & Issues Current IssuePrevious Issues CECollections InfectionsBasic ScienceCardiovascularEditorials: A Closing WordEducationAll Collections For Authors Information for AuthorsLanguage Editing Services Journal Info About the JournalEditorial BoardAdvertisingOpen AccessSubscription ServicesReprintsRights and Permissions All Articles Images Videos Podcasts Blogs Advanced Search

Evidence-Based Critical Care Education for Oncology Nurses

Abstract: Advances in medical care for oncology patients have heightened the complexity of this patient population, leading to an increased need for lifesaving, critical care. Yet, there is a lack of literature on education to prepare nurses to provide care to critically ill oncology patients.The purpose of this quality improvement project was to evaluate oncology nurses' mastery of basic and oncology-specific critical care knowledge after an evidence-based supplemental training intervention.An 8-hour supplemental training intervention was developed to increase oncology nurses' knowledge about basic and oncology critical care by addressing score deficiencies noted on the Basic Knowledge Assessment Tool (9r version). Seventeen oncology nurses completed the supplemental training intervention. The Basic Knowledge Assessment Tool and an Oncology Knowledge Survey were administered pre and post supplemental training, and significant changes were detected with Wilcoxon signed rank tests.Mean total Basic Knowledge Assessment Tool scores significantly improved from 65.7 before initial course to 73.7 post supplemental training (P = .002). Oncology Knowledge Survey total scores increased from 75.3% to 80.9%, which was a statistically significant improvement (P = .039).Critical care training is imperative for oncology nurses preparing to care for high-acuity oncology patients. Adequate knowledge of basic and oncology-specific critical care is important to prevent adverse events and improve outcomes for this complex patient population.

Refinement of the Intensive Care Unit Complexity Assessment and Monitoring to Ensure Optimal Outcomes III Acuity Tool

Abstract: The Intensive Care Unit (ICU) Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool quantifies patient acuity in terms of nursing cognitive workload complexity.The aim of this study was to refine the ICU CAMEO II acuity tool. An expert panel of nursing staff from 4 pediatric ICUs convened to refine the CAMEO II across a large, freestanding children's hospital in the United States.This study used a modified Delphi technique.Through a series of 4 Delphi rounds, the expert panel identified Domains of Care and nursing care items that were suitable to be collapsed or bundled. The number of Domains of Care decreased from 18 to 10. Each of the expert panel members then completed the ICU CAMEO II tool and the newly revised tool, ICU CAMEO III, on 5 to 10 patients. Sixty completed ICU CAMEO II tools, and ICU CAMEO III tools were available for comparison. The average difference of the 2 tools' total scores was 5 points (minimum, 4; maximum, 7). The level of agreement between the 2 tools by CAMEO Complexity Classification level (I-V) was 90%.The ICU CAMEO III acuity tool is a streamlined measure to describe and quantify the acuity of pediatric critical care nursing. Use of this acuity measure will support projection of staffing models, staffing assignments, and benchmarking across pediatric ICUs. Further research is underway to validate the CAMEO III for multisite use.

The Impact of Type of Acute Myocardial Infarction on Cardiac Patient Self-efficacy After Hospitalization

Abstract: Background Self-efficacy is an important psychological construct associated with patient adherence with healthy lifestyle choices. Few studies have focused on the impacts of the type of acute myocardial infarction (AMI), non–ST-elevation myocardial infarction (STEMI) and STEMI, and the different treatment modalities of AMI on changes in cardiac self-efficacy after hospitalization. Objective This study examined the changes in cardiac self-efficacy based on the type of AMI and aimed to investigate the impact of different treatment modalities on changes in cardiac self-efficacy among post-AMI patients during hospitalization and at the 3- and 6-month follow-ups subsequent to hospitalization. Methods A repeated-measures design was used with a convenient sample of 210 patients diagnosed with first AMI. Patients completed the Cardiac Self-efficacy Questionnaire at the 3 time points. The study was implemented in 3 major hospitals in Jordan. Patients did not have access to cardiac rehabilitation. Results There was a statistically significant impact of AMI type on changes in cardiac self-efficacy measured between T1 and T2, between T2 and T3, and subsequently between T1 and T3. Nevertheless, there was no statistically significant impact of treatment modalities of AMI on changes in cardiac self-efficacy measured at the 3 time points. Conclusions Assessment of self-efficacy for post-AMI patients is recommended. Moreover, post–non-STEMI patients need more attention when implementing an intervention to enhance self-efficacy after hospitalization. Health decision makers have to consider establishing cardiac rehabilitation to improve self-efficacy in Jordan. Further research is needed to confirm the study results and to investigate other contributing factors that could influence self-efficacy after hospitalization.

DCCN on the Web

Abstract: Dimensions of Critical Care Nursing 41(6):p 294, 11/12 2022. | DOI: 10.1097/01.DCC.0000889828.40257.0a

DCCN on the Web

Abstract: Dimensions of Critical Care Nursing: 7/8 2022 - Volume 41 - Issue 4 - p 177 doi: 10.1097/01.DCC.0000832484.73497.a9

Respective Impact of Day and Night Bed Baths on Critical Care Patients

Abstract: Despite data supporting the reduction of interactions with patients during nighttime, bed bathing is sometimes performed within this period in sedated patients unable to manage their own hygiene care.To compare patient physiologic variables and adverse effect incidence between night and day bed baths.This was a single-center prospective observational study in a 12-bed intensive care unit during 2 months. Night period was defined to run from 10 pm to 6 am. Night bed baths were provided to sedated ventilated patients whatever their sedation, if their Richmond Agitation Sedation Scale score was -2 or deeper. Bed bath-induced changes in physiological variables, treatments, and related unscheduled events were registered during both night and day bed baths.Twenty-one patients (aged 62.9 [52.5-73.2] years, 14 male patients) were included. We registered 97 night bed baths and 95 day bed baths. Heart rate increased only after day bed baths (85 beats/min [bpm] [69-97 bpm] vs 88 bpm [73-98 bpm], P = .02). Increase in Richmond Agitation Sedation Scale score occurred, respectively, during 13 (13.4%) and 8 (8.4%) night and day bed baths, without significant differences. Body temperature significantly decreased during both night and day bed baths (respectively, 37°C [36.6°C-37.4°C] vs 36.6°C [36.2°C-37.2°C], P < .0001; and 36.9°C [36.5°C-37.2°C] vs 36.7°C [36.2°C-37.2°C], P = .0006). Overall, unscheduled events, whether physiologic changes, pain, or calling a physician in rescue occurred in 97 procedures (50.5%), irrespective of their timing (night vs day, respectively 53% [54.6%] vs 44% [46.3%], P = .31).Although unscheduled events occurred in half of bed baths, differences evidenced between nighttime and daytime bed baths were scarce. The appropriateness of nighttime bed bathing remains questionable.

Listen Deeply

Abstract: Wolters Kluwer Health, Duxbury, Massachusetts. The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.