The Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO) acuity tool was developed to inform nurse staffing decisions and projections. We propose a novel use of the CAMEO data, ie, CAMEO Acuity Curves, to identify high-acuity periods after congenital heart surgery. The aims of this study were to describe CAMEO acuity scores for selected congenital heart surgeries and examine acuity trends during the cardiac intensive care unit (CICU) admissions. We performed a retrospective review of 3 common congenital heart procedures between January 2017 and January 2020: stage I palliation for single ventricle (stage I), Arterial Switch Operation (ASO) for dextro transposition of great arteries with or without ventricular septal defect repair (ASO), and tetralogy of Fallot repair. Postoperative acuity was assessed using CAMEO Acuity Curves stratified by severity of residual lesions in anatomic area of repair as assessed by the Residual Lesion Score (RLS). Among 205 cases (stage I, n = 45; ASO, n = 60; tetralogy of Fallot repair, n = 100), the overall mean CAMEO scores varied in acuity by procedure, with the highest acuity during cardiac intensive care unit stay noted for stage I (76%), followed by ASO (69%) and tetralogy of Fallot repair (62%). When stratified by RLS, acuity increased for each procedure, with RLS 3 having a higher acuity than RLS 1 and 2. The CAMEO Acuity Curves enabled construction of postoperative acuity timeline in cardiac intensive care unit, allowing description and comparison of acuity across various case complexities, which may guide clinical decision-making and optimize staffing to meet patient care resource needs.

End-of-life care is administered to individuals in the terminal stages of their life, typically when their health is steadily declining. This form of care is integral to palliative care, encompassing the alleviation of physical symptoms; the delivery of emotional, social, and spiritual assistance; and the honoring of the preferences of both patients and their families. This research aimed to explore the attitudes and behaviors of intensive care nurses regarding end-of-life care and the experience of death. This study employed a descriptive and correlational research design. The participant pool comprised 306 nurses actively engaged in the intensive care units of a hospital during the period from June to December 2022. Data were gathered through the utilization of 3 instruments: "Individual Characteristics Form," "The Scale of the Attitudes and Behaviors of Intensive Care Unit Nurses Intended for End-of-Life Care," and the "Death Attitude Profile-Revised." The results indicated that the attitudes and behaviors of nurses concerning end-of-life care and death were, on average, at a moderate level. Married nurses, those with postgraduate education, individuals working in the intensive care unit, those with 11 or more years of experience, and those who perceived their knowledge about end-of-life issues as adequate demonstrated more favorable attitudes and behaviors towards end-of-life care compared to other groups. The study revealed that nurses with postgraduate education and those employed in the intensive care unit exhibited more favorable attitudes towards death. To enhance these attitudes and provide necessary support, it is advisable to implement supportive interventions and organize in-service training programs.

Family presence during resuscitation (FPDR) represents a vital yet complex aspect of critical care, blending ethical, emotional, and clinical dimensions to enhance family engagement. Although FPDR offers significant benefits, such as fostering closure and transparency, addressing health care providers' concerns about potential disruptions and workflow challenges is essential to its effective and equitable implementation. This article investigated critical care and emergency nurses' perceived risks and challenges of FPDR and barriers to implementing FPDR, as well as suggested measures to enhance the implementation of this care approach. A qualitative descriptive approach was utilized using purposeful sampling to recruit critical care and emergency nurses from Midwestern US hospitals. Participants were interviewed using Zoom. Twenty-one nurses participated, predominantly female, White/non-Hispanic, with 1 to 25 years of experience and mostly bachelor-level education. The study identified 3 themes: risks and challenges of FPDR, barriers to its implementation, and recommendations for its facilitation. Participants highlighted barriers, challenges, and risks to FPDR, alongside facilitators such as institutional support, education, communication training, clear policies, family-related factors, assessment of family readiness, and designating a support person. Addressing these barriers and utilizing facilitators through education and strategic management can improve FPDR awareness and implementation in critical and emergency care.

Conjugated hyperbilirubinemia, characterized by elevated levels of direct bilirubin (DB) may indicate underlying hepatobiliary disorders, such as biliary atresia, and warrants further investigation. The aim of this study was to accurately measure jaundice, related to DB levels, in newborn infants using an artificial intelligence (AI)-based computer vision tool. The computer vision tool used data processing, color transformations, and contrast enhancement techniques. Additionally, a convolutional neural network was created to predict DB levels. The study included 80 infants for training and validation and 17 infants for retesting. Five photographs were taken from the face, neck-chest, abdomen, extremities, and back after blood was drawn to measure DB levels. The photographs were captured using a professional camera under white light in the neonatal intensive care unit. Data analysis involved calculating the margin of error, percentage margin of error, and correlation statistics. The retest findings were analyzed to determine the margins of error. The study revealed a 5.24% discrepancy between the AI-based computer vision tool and the DB values obtained from laboratory blood tests. Furthermore, a positive correlation was observed between patient blood values and the mean calculated by the AI system. This study concluded that DB measurements, conducted under appropriate conditions, were accurately determined using AI with a good level of precision. Subsequent research on total bilirubin is recommended.

Many barriers exist in the literature related to the implementation of the Clinical Practice Guidelines for the Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in the intensive care unit (ICU). The objective of this integrative review was to identify barriers to and facilitators of nurses' PADIS delirium guideline implementation in adult ICU settings. We followed the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines as a framework for this review and the Joanna Briggs Institute quality appraisal guidelines. The inclusion criteria led to the identification of quantitative and qualitative studies, quality improvement projects, and review studies published in English between 2013 and 2023 that addressed adult ICU patients and explored facilitators and barriers regarding nurses' delirium guideline implementation in a variety of countries. The 15 selected studies were 5 cross-sectional studies, 2 mixed-methods studies, 1 cohort report, 3 qualitative studies, 3 quality improvement projects, and 1 systematic review. The most commonly reported barriers concerned a lack of interdisciplinary collaboration and support, a workload burden, and knowledge deficits among nurses. The most commonly reported facilitators were related to interdisciplinary collaboration and education on delirium, PADIS guideline, and ABCDE bundle. Delirium is crucial to address in critically ill patients, and nurses' implementation of PADIS guidelines is vital for better outcomes. This review identified barriers and facilitators at individual, educational, and institutional levels. The review findings emphasize the need for routine and structured education for nurses on delirium risk factors, prevalence, outcomes, complications, management, and assessment to combat the educational deficits that inhibit guideline implementation. The review findings also highlight the need for interdisciplinary collaboration and education to effectively support nurses. Hospitals and other institutions can leverage these insights to develop strategic interdisciplinary education planning, including delirium-focused rounds and routine interdisciplinary discussions about incorporating delirium guidelines into the care of ICU patients.

Family engagement in interdisciplinary rounds is a patient- and family-centered approach to critical care that allows family members to be present and participate in information sharing and clinical decision-making with the health care team. However, this approach has not been adopted as standard practice in adult critical care units. Thus, family engagement in care for critically ill patients remains an inconsistent practice. Moreover, it remains an underresearched family-centered care intervention. Research is needed to understand health care professionals' perspectives on feasible ways of integrating family inclusion and engagement into clinical practice flow to potentially shape the future of family engagement in care for critically ill patients. This qualitative exploratory research study aimed to (1) explore and understand the registered nurses' and physicians' perspectives on current practices and feasible approaches to family inclusion and engagement during patient- and family-centered interdisciplinary rounds and (2) identify the facilitators and barriers to implementing this vital practice. A qualitative exploratory research study was conducted to inform the main study, a randomized controlled trial that tested the impact of the Nurse-TECH-Family program during patient- and family-centered interdisciplinary rounds in the intensive care unit. For this focus group study, 7 health care providers working in an adult critical care unit were recruited via email, referrals, and personal contact. The focus group included 4 registered nurses and 3 physicians working in the intensive care unit. It was conducted using structured questions via videoconferencing. The discussions were recorded and transcribed verbatim. A rigorous data analysis method was conducted using Braun and Clarke's constructionist and contextualist approach for thematic analysis. Two essential themes that reflected health care providers' perspectives on current critical care practice and feasible ways of integrating family inclusion and engagement into clinical practice were illuminated. The first theme conveys that rounds are "information-giving" that addresses family members' questions, transparency, shared decision-making, and less uncertainty among family members. The second theme denotes that rounds are a "safe space" for caring and compassion, which helps build trust. The health care providers also identified that the barriers to family engagement in patient- and family-centered interdisciplinary rounds include diverse perceptions and practices of family inclusion and engagement during rounds, difficulty establishing logistics in integrating family engagement in interdisciplinary rounds to clinical practice, and anxiety related to disclosure of information and uncertainty about family response. The identified facilitators are clear, consistent, realistic, and feasible interdisciplinary rounds logistics and information. This qualitative exploratory research study provided a deeper understanding of the registered nurses' and physicians' perspectives on current practices and feasible ways regarding family engagement during patient- and family-centered interdisciplinary and identified barriers to and facilitators for implementing this vital practice. The study's findings informed the researchers in the sampling, design, and plan for the intervention and setting for the randomized controlled trial. The findings can pave the way for a more focused, multifaceted approach and interventions to address family inclusion and engagement during interdisciplinary rounds in the critical care unit. This offers hope for improved patient outcomes and family experiences.

Sepsis is a leading cause of hospital readmission. Preexisting economic hardships may lead to increased hospital readmissions. To examine the causal impact of economic disparity on unplanned 90-day readmissions after sepsis and to identify factors associated with readmission. We identified a prospective, records-based cohort of US adult sepsis survivors within the 2018 Nationwide Readmissions Database using International Classification of Diseases, Tenth Revision, Clinical Modification codes for sepsis between January and September. Sepsis survivors were followed for unplanned all-cause 90-day readmissions. We examined the impact of preadmission factors (demographic factors, access to care, and income), index hospitalization factors (severity of illness, length of stay, and discharge destination) on all-cause 90-day readmissions using a directed acetyl graph to guide the analysis using baseline income as the independent variable. We used descriptive statistics and regression models to examine the associations with hospital readmissions and 1:1 propensity matching to control for potential confounding and for sensitivity analysis. We identified a large national cohort of sepsis survivors (N = 2 850 357). The 90-day all-cause readmission rate was 17.3% for the cohort and 30.8% for survivors in the lowest-income quartile. As income increased, the risk of readmission decreased (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.86-0.89]). All directed acetyl graph preadmission factors and index hospitalization factors were associated with an increased risk of readmission except younger age, mechanical ventilation during index hospital stay, and self-pay status. After adjustment, having 2 or more comorbidities (OR, 2.39; 95% CI, 2.36-2.41) had the strongest risk for all-cause readmissions, followed by discharge against medical advice (OR, 2.09; 95% CI, 2.02-2.16). Sepsis and infections were common causes of readmission after sepsis. Higher level of income at the time of the index hospital stay protects against hospital readmission in sepsis survivors. More research is needed to understand the impact of economic disparities on the trajectory of recovery after sepsis, including hospital readmission and the impact of modifiable and nonmodifiable risk factors.