Experiences and perceptions of critical care nurses on the use of point-of-care ultrasound (POCUS) to establish peripheral venous access in patients with difficult intravenous access: a qualitative study.

OBJECTIVES: This study aims to explore and describe critical care nurses' (CCNs') experiences and perceptions of using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with difficult intravenous access (DIVA). DESIGN: A qualitative design with a hermeneutic approach was chosen for this study. From May to August 2022, data were collected using individual, face-to-face, and digital semistructured interviews and analysed using Braun and Clarke's reflexive thematic analysis. SETTING: The study were conducted in six intensive care units in both Norway and Sweden. PARTICIPANTS: Nine CCNs experienced in using point-of-care ultrasound (POCUS) to establish peripheral intravenous access in patients with DIVA were recruited. RESULTS: Data analysis led to the construction of the overarching theme: 'POCUS simplifies a complicated procedure' based on the following five subthemes: 'Sharing the experience', 'Seeing inside the body', 'Independent in establishing difficult intravenous access', 'Using POCUS to increase action readiness', and 'Appreciating an expanded role as critical care nurses'. CONCLUSION: Ultrasound-guided peripheral intravenous access can become a valuable skill for CCN's caring for patients with DIVA in the intensive care unit. This practice can potentially reduce patient suffering, improve patient outcomes, enable the CCN to provide high-quality care, improve action readiness, time management and job satisfaction for the nurses.

A survey of knowledge, attitudes, and practices among paediatric intensive care unit nurses for preventing pressure injuries: An analysis of influencing factors.

To explore the knowledge, attitudes and practice (KAP) status of preventing pressure injury among clinical nurses working in paediatric ICU, and to examine factors affecting nurses' KAP. A questionnaire survey was conducted among 1906 paediatric ICU nurses in 18 children's hospitals by convenience sampling method. The survey tools were self-designed general data questionnaire, KAP questionnaire for the prevention of pressure injury and the influencing factors were analysed. A total of 1906 valid questionnaires were collected. The scores of overall KPA, knowledge, attitudes, and practice were 101.24 ± 17.22, 20.62 ± 9.63, 54.93 ± 5.81and 25.67 ± 6.76, respectively. The results of multiple linear regression analysis showed that education background, professional title, age and specialist nurse were the main influencing factor of nurses' knowledge of preventing PI; education background and specialist nurse were the main influencing factors of nurses' attitudes of preventing PI; knowledge, attitudes and education background were the main influencing factors of nurses' practice of preventing PI. Paediatric ICU nurses have a positive attitude towards the prevention of PI, but their knowledge and practice need to be improved. According to different characteristics of nurses, nursing managers should carry out training on the knowledge of prevention of PI to establish a positive attitude, so as to drive the change of nursing practice and improve the nursing practice level of ICU nurses to prevent of PI.

An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults.

ABSTRACT: Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.

Palliative Care of Stroke Patients.

Critical care clinicians frequently care for patients with acute brain injury, such as stroke. Regardless of the severity of the neurologic insult, these patients have life-altering deficits that threaten their personal identity and quality of life. The sudden nature of the injury often means that there has been little discussion between patients and their families about life-sustaining treatments, and most patients are unable to speak for themselves because of impaired cognition and communication. Thus, individuals experiencing stroke and their families present clinicians with unique and complex care needs in the acute care setting. Key professional organizations have endorsed the early integration of palliative care into the treatment of patients with stroke and devastating neurologic injury. Implementing interdisciplinary primary or specialty palliative care helps clinicians adopt a patient-centered approach to care and aids in decision-making.

Intersectionality and Inclusive Serious Illness Communication in the Intensive Care Unit.

Serious illness communication can be especially distressing for patients who are critically ill and their loved ones who experience forms of discrimination based on identities such as their race, gender, sexual orientation, and other intersecting identities. In this article, we discuss the concept of intersectionality and its association with serious illness communication, decision-making, and care in the intensive care unit. Additionally, we present relevant concepts from clinical practice and contemporary nursing and health care literature to support critical care nurses in fostering more inclusive serious illness communication in the intensive care unit.

Palliative Care in the Intensive Care Unit: The Standard of Care.

Intensive care unit-based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. Although all critically ill patients inherently have palliative care needs, the path was not linear but rather filled with the challenges of blending the intensive care unit goals of aggressive treatment and cure with the palliative care goals of symptom management and quality of life. Today, palliative care is considered an essential component of high-quality critical care and a core competency of all critical care nurses, advanced practice nurses, and other intensive care unit clinicians. This article provides an overview of the current state of intensive care unit-based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes.

Innovative Strategies for Palliative Care in the Intensive Care Unit.

Palliative care is interdisciplinary care that addresses suffering and improves the quality of care for patients and families when patients are facing a life-threatening illness. Palliative care needs in the intensive care unit include communication regarding diagnosis and prognosis, goals-of-care conversations, multidimensional pain and symptom management, and end-of-life care that may include withdrawal of mechanical ventilation and life support. Registered nurses spend the greatest amount of time with patients and families who are facing death and serious illness, so nurses must be armed with adequate training, knowledge, and necessary tools to address patient and caregiver needs and deliver high-quality, patient-centered palliative care. Innovative approaches to integrating palliative care are important components of care for intensive care nurses. This article reviews 2 evidence-based practice projects, a serious illness support tool and the 3 Wishes Project, to add to the palliative care toolkit for registered nurses and other team members.

Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care.

Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.

Weak Correlation Between Perceived and Measured Intensive Care Unit Nursing Workload: An Observational Study.

BACKGROUND: Efficient management of nursing workload in the intensive care unit (ICU) is essential for patient safety, care quality, and nurse well-being. Current ICU-specific workload assessment scores lack comprehensive coverage of nursing activities and perceived workload. PURPOSE: The purpose of this study was to assess the correlation between ICU nurses' perceived workload and the Nine Equivalents of Nursing Manpower Use Score (NEMS). METHODS: In a 45-bed adult ICU at a tertiary academic hospital, nurses' perceived shift workload (measured with an 11-point Likert scale) was correlated with the NEMS, calculated manually and electronically. RESULTS: The study included 1734 observations. The perceived workload was recorded for 77.6% of observations. A weak positive correlation was found between perceived and objectively measured workload. CONCLUSION: Findings indicate a need to consider the multifaceted nature of nursing activities and individual workload perceptions in the ICU.

Caring touch as communication in intensive care nursing: a qualitative study.

PURPOSE: This article describes intensive care nurses` experiences of using communicative caring touch as stroking the patient`s cheek or holding his hand. Our research question: "What do intensive care nurses communicate through caring touch?" METHODS: In this qualitative hermeneutically based study data from two intensive care units at Norwegian hospitals are analysed. Eight specialist nurses shared experiences through individual, semi-structured interviews. RESULTS: The main theme, Communicating safety and presence has four sub-themes: Amplified presence, Communicating security, trust and care, Creating and confirming relationships and Communicating openness to a deeper conversation. Communicative caring touch is offered from the nurse due to the patient`s needs. Caring touch communicates person-centred care, invites to relationship while respecting the patient's dignity as a fellow human being. Caring touch conveys a human initiative in the highly technology environment. CONCLUSION: Caring touch is the silent way to communicate care, hope, strength and humanity to critical sick patients. This article provides evidence for a common, but poorly described phenomenon in intensive care nursing.

Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study.

BACKGROUND: Changes in healthcare delivery were required during the first year of the COVID-19 pandemic. OBJECTIVE: The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting. METHOD: A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission. RESULTS: Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001). DISCUSSION: The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.

Triggers of intensive care patients with palliative care needs from nurses' perspective: a mixed methods study.

PURPOSE: Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses. METHODS: For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the "content-structuring content analysis" according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey. RESULTS: In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%. CONCLUSION: Intensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

A Review of Chlorhexidine Oral Care in Patients Receiving Mechanical Ventilation.

BACKGROUND: Chlorhexidine gluconate has been considered the criterion standard of oral care for patients receiving mechanical ventilation because of its ability to reduce the incidence of ventilator-associated events. Optimal concentrations and frequencies remain unclear, as do adverse events related to mortality in various intensive care unit populations. OBJECTIVE: To examine the current evidence for the efficacy of chlorhexidine gluconate in reducing the incidence of ventilator-associated events, mortality, intensive care unit length of stay, and duration of mechanical ventilation in patients receiving ventilator support. METHODS: In this integrative review, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, and Health Source: Nursing/Academic Edition were searched using terms related to mechanical ventilation and chlorhexidine gluconate oral care with dates ranging from 2012 to 2023. RESULTS: Seventeen articles were included in this review: 8 systematic reviews, 8 randomized clinical trials (3 of which were not included in any systematic review), and 1 quasi-experimental study. Chlorhexidine gluconate oral care was associated with a reduced incidence of ventilator-associated events, but efficacy depended on concentration and frequency of administration. With stratification by intensive care unit population type, a nonsignificant trend toward increased mortality was found among non-cardiac surgical patients who received this care. CONCLUSION: The evidence regarding the efficacy of chlorhexidine gluconate oral care in reducing ventilator-associated events in specific intensive care unit populations is contradictory. Recently published guidelines recommend de-implementation of chlorhexidine gluconate oral care in all patients receiving mechanical ventilation. Such care may be beneficial only in the cardiac surgical population.