Does Bispectral Index Monitoring Belong in the Intensive Care Unit Setting?: A Narrative Review of Evidence.

Management and leadership of intensive care units for the future.

Postoperative Transplant Immunosuppression in the Critical Care Unit

The purpose of this study was to determine the impact of an educational intervention on the incidence of stage II pressure ulcers (PUs) in adult patients in intensive care units (ICUs) in a Turkish medical center. This was a prospective study of patients admitted to ICUs. Data were collected over a 3-month period. Subjects were assessed using the Braden Scale for Predicting Pressure Sore Risk to determine the risk for developing a PU; assessment was completed within the first 24 hours of admission and each 48 hours thereafter for a maximum of 12 weeks. Educational intervention was employed: Intervention included education of ICU nurses about PU prevention and risk assessment; and following the educational intervention and implementation of the PU prevention protocol in all ICUs, data were collected for study period II. The sample comprised 186 patients admitted to critical care units of a Turkish medical center. Ninety-three subjects participated in a preintervention comparison group, and 93 subjects participated in an intervention group. Data were collected using a demographic and clinical data form, a nursing intervention checklist, and the Braden Scale for Predicting Pressure Sore Risk. Stage II PUs were observed in a total of 50 patients for the overall sample. The most common site was the sacrococcygeal area, which accounted for 46% of ulcers. A statistically significant difference was observed when the rate of stage II PUs in the comparison group, 37% (34 of 93 patients), was compared to the rate in the intervention group, 17% (16 of 93 patients) (chi2 = 8.86, df = 1, P < .01). Education regarding preventive care can be effective in reducing the incidence of PUs in the ICU setting. Therefore, education about risk assessment and PU prevention should be a priority for nurses in critical care settings.

Research needs related to the care of patients on prolonged mechanical ventilation

Advanced practitioners including nurse practitioners and physician assistants are contributing to care for critically ill patients in the intensive care unit through their participation on the multidisciplinary team and in collaborative physician practice roles. However, the impact of nurse practitioners and physician assistants in the intensive care unit setting is not well known. To identify published literature on the role of nurse practitioners and physician assistants in acute and critical care settings; to review the literature using nonquantitative methods and provide a summary of the results to date incorporating studies assessing the impact and outcomes of nurse practitioner and physician assistant providers in the intensive care unit; and to identify implications for critical care practice. We conducted a systematic search of the English-language literature of publications on nurse practitioners and physician assistants utilizing Ovid MEDLINE, PubMed, and the Cumulative Index of Nursing and Allied Health Literature databases from 1996 through August 2007. None. Over 145 articles were reviewed on the role of the nurse practitioner and physician assistant in acute and critical care settings. A total of 31 research studies focused on the role and impact of these practitioners in the care of acute and critically ill patients. Of those, 20 were focused on nurse practitioner care, six focused on both nurse practitioner and physician assistant care, and five were focused on physician assistant care in acute and critical care settings. Fourteen focused on intensive care unit care, and 17 focused on acute care including emergency room, trauma, and management of patients with specific acute care conditions such as stroke, pneumonia, and congestive heart failure. Most studies used retrospective or prospective study designs and nonprobability sampling techniques. Only two randomized control trials were identified. The majority examined the impact of care on patient care management (n = 17), six focused on comparisons of care with physician care, five examined the impact of models of care including multidisciplinary and outcomes management models, and three assessed involvement and impact on reinforcement of practice guidelines, education, research, and quality improvement. Although existing research supports the use of nurse practitioners and physician assistants in acute and critical care settings, a low level of evidence was found with only two randomized control trials assessing the impact of nurse practitioner care. Further research that explores the impact of nurse practitioners and physician assistants in the intensive care unit setting on patient outcomes, including financial aspects of care is needed. In addition, information on successful multidisciplinary models of care is needed to promote optimal use of nurse practitioners and physician assistants in acute and critical care settings.

BackgroundDespite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings.ObjectiveThis scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined.MethodsSearches of MEDLINE, CINAHL, Social Work s and PsycINFO were conducted. English‐language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis.FindingsA total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed‐methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care.ConclusionThree research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio‐cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.

Objectives Nurses working in critical care units may encounter substantial work-related strain, and elevated levels of stress can lead to burnout, ultimately impacting both the quality of nursing care and their overall working experience. This study aimed to assess job burnout and determine the factors that contribute to it among critical care nurses in the Eastern Province of Saudi Arabia. Methods This study employed a descriptive, exploratory, cross-sectional research design. A total of 220 nurses employed in the critical care units of 5 private hospitals in the eastern region were selected for participation in this study using a convenience sample method. An electronic survey was distributed to critical care nurses in the Eastern Province who satisfied the specified inclusion criteria. The job burnout questionnaire utilized in this study was derived from previously conducted research, which has been established as a reliable and valid survey instrument. The process of data analysis was conducted utilizing the SPSS program. The scientific research conducted on human subjects adhered rigorously to all ethical considerations. Results The highest percentage of nurses at the critical care units reported experiencing moderate levels of job burnout. Nurses exhibiting greater levels of professional experience demonstrated a statistically significant reduction in overall burnout scores when compared to their less experienced counterparts. Furthermore, within the realm of sociodemographic factors, it was found that the only significant independent predictor for job burnout was the level of experience among critical care nurses. Conclusions The prevalence of burnout among nurses in critical care settings was found to be significant, with most participants reporting moderate levels of burnout which can yield significant ramifications for nurses and healthcare professionals. Consequently, healthcare organizations must accord primacy to the welfare of their staff and adopt proactive strategies to mitigate job burnout.

Background: Burnout is a syndrome resulting from chronic workplace stress that has not been effectively managed. The level of burnout that is experienced by nurses varies according to geographical region and specialties, such as paediatric and critical care nursing. However, little is known about burnout among nurses in African critical care units. Aim: To explore the available evidence on burnout among nurses in African critical care units. Methods: The review was guided by the Whittemore and Knafl framework for integrative review. Literature was searched in Web of Science, Embase, PubMed, and SCOPUS databases. The search strategy applied Boolean operators AND, OR using the following key terms: critical care nurses, burnout, and Africa. The alternative keywords were: nurs*, OR intensive care nurses OR Critical Care Nursing OR Intensive Care Nursing OR critical care nurs* AND “burnout syndrom*depersonalis/zation” OR “emotional exhaustion, workplace stress, Occupational Stresses, Professional Stress, Job-related Stress” AND specific names of the African countries. Findings: The review included eighteen articles. Two hundred and forty-nine nurses (n = 2,249) who work in critical care settings participated in the studies. The findings showed that nurses in critical care settings experience moderate to high levels of burnout, with emotional exhaustion being a common characteristic. Burnout is associated with factors related to the individual, work, and organization. The consequences of burnout include secondary traumatic stress, intention to leave the job, and increased risk of infection to the patient. Conclusions: The review has significant implications for nursing at various levels. The findings provided could inform future research and interventions to reduce burnout among critical care nurses in Africa.

All types of healthcare professionals can develop burnout syndrome (BOS), while those who serve in critical care and emergency units are more susceptible to it. The emergence of BOS is linked to an imbalance between a team member's personal traits and problems at work or with other organisational elements. BOS is linked to a number of negative effects, including as higher rates of employee turnover, lower patient satisfaction, and lower levels of care quality. BOS also has a direct impact on the mental and physical health of the many physicians and other healthcare workers that work in emergency and critical care settings around the world. Critical care medical professionals and other psychological illnesses went mostly undetected until recently. The current paper examines the burnout prevalence among doctors in critical care (CC) unit and emergency unit physicians, the risk factors (RF) of burnout and their consequences, prevention and treatment measures of BOS and intensive and non-ICU healthcare workers' burnout prevalence comparison were also studied. It finally concludes from the study that the physicians from the Critical Care Unit and emergency department unit are more stressed and prone to high burnout levels than others.

First, Do No Harm: Less Training ≠ Quality Care

PREFACE

‘How would you feel …?’: a reflective case study

Factors influencing the implementation and adherence to volume-based enteral feeding protocols in the critical care setting: A scoping review.

Medical errors are common in intensive care units. Nurses are uniquely positioned to identify, interrupt, and correct medical errors and to minimize preventable adverse outcomes. Nurses are increasingly recognized as playing a role in reducing medical errors, but only recently have their error-recovery strategies been described. To describe error-recovery strategies used by critical care nurses. Data were collected by audio taping focus groups with 20 nurses from 5 critical care units at 2 urban university medical centers and 2 community hospitals on the East and West coasts of the United States. Transcript content was analyzed as recommended by Krueger and Casey. Analysis of focus group data revealed that nurses in critical care settings use 17 strategies to identify, interrupt, and correct errors. Nurses used 8 strategies to identify errors: knowing the patient, knowing the "players," knowing the plan of care, surveillance, knowing policy/procedure, double-checking, using systematic processes, and questioning. Nurses used 3 strategies to interrupt errors: offering assistance, clarifying, and verbally interrupting. Nurses used 6 strategies to correct errors: persevering, being physically present, reviewing or confirming the plan of care, offering options, referencing standards or experts, and involving another nurse or physician. These results reflect the pivotal role that critical care nurses play in the recovery of medical errors and ensuring patient safety. Several error-recovery strategies identified in this study were also reported by emergency nurses, providing further empirical support for nurses' role in the recovery of medical errors as proposed in the Eindhoven model.

Development and Clinical Application of Electroencephalographic Bispectrum Monitoring Jay Johansen;Peter Sebel; Anesthesiology