Ventilator-associated pneumonia (VAP) is a significant healthcare-associated infection. Compliance with VAP guidelines reduces infection and leads to better patient outcomes. The study investigated the VAP rate, nurses' compliance with the VAP bundle and the correlation between nurses' compliance with the VAP bundle and key patient-related outcomes. This descriptive correlational prospective study was conducted at two tertiary hospitals. All intensive care unit patients on mechanical ventilators who met the inclusion criteria for 48 h or more were recruited. Data were analysed using descriptive statistics, Chi-square, independent t-test and Spearman's rank correlation. Out of the 103 patients recruited, 22.3% of patients developed VAP, with a VAP rate of 5.6 per thousand ventilator days. Nurses' compliance with VAP guidelines in both hospitals was 69% and decreased over the admission period. Compliance with the VAP bundle was linked to less length of stay (rho = -0.260, p < .008), fewer mechanical ventilation days (rho = -0.300, p < .002) and less hospital cost (rho = -0.266, p < .007). The mean compliance with the VAP care bundle was higher in the non-VAP group (M = 72.9, SD = 23.79) than in patients who developed VAP (M = 56.6, SD = 18.96). The findings underscore the critical need for healthcare organizations to prioritize strategies to enhance compliance with VAP guidelines for improved patient outcomes. Ongoing quality improvement efforts through regular audits of the VAP bundle implementation are crucial for reducing infections and complications and improving patient outcomes. Future research is recommended to investigate factors that impact nurses' adherence to VAP guidelines to develop interventions to enhance compliance.

Unfinished Nursing Care (UNC) refers to essential patient care that is postponed or neglected, significantly impacting outcomes such as increased morbidity, mortality and hospital-acquired infections. In Intensive Care Units (ICUs), the complexity of patient conditions results in higher UNC rates, particularly for basic care interventions. The Missed Intensive Nursing Care Scale (MINCS) assesses the frequency and types of missed care in these settings. This study aimed to translate, culturally adapt and validate MINCS for use in the Italian ICU context, ensuring its psychometric robustness. A methodological research for translation, cross-cultural adaptation and validation was conducted in two hospitals in north-eastern Italy, involving general, neurosurgical and cardiothoracic ICUs. The process included translation, back-translation, expert evaluation, pilot testing and psychometric analysis of MINCS-Italy (MINCS-IT) using Cronbach's alpha, Exploratory Factor Analysis (EFA) and Rasch analysis. A total of 135 ICU nurses participated in the study, 76.3% were female, and an average ICU experience of 11.1 years. The final version of MINCS-IT contained 48 items, divided into three sections: demographics, elements of missed nursing care (34 items, α = 0.92), and reasons for missed care (14 items, α = 0.94). EFA revealed a five-factor structure for elements of missed care (53.2% variance explained) and a two-factor structure for reasons (64.9% variance explained). Rasch analysis supported item validity, except for one item ("Assessing patient nutritional status"), which showed suboptimal values. The MINCS-IT is a reliable tool for assessing missed nursing care in Italian ICUs, addressing both fundamental and complex patient needs. Its comprehensive approach supports targeted interventions to improve care quality. The MINCS-IT enables nurse managers to identify missed care patterns, fostering improvements in nursing practises and patient-family care outcomes, ultimately elevating ICU standards.

Intra-abdominal hypertension is a common serious complication in critically ill patients. Intra-abdominal pressure (IAP) measurement is the only reliable method of detecting and managing IAP. Various factors influence the knowledge, attitude and practice of IAP measurement. To assess the knowledge, attitude and practice of IAP measurement among ICU nurses and to identify the factors affecting the knowledge, attitude and practice. A multi-centre cross-sectional survey was conducted in 38 hospitals in Guangdong province, China, from March to June 2024. A total of 1254 valid questionnaires were collected. The median scores of knowledge were 8.0, with an interquartile range of 7.0-8.0. The median scores of attitude were 23.0, with an interquartile range of 21.0-25.0. The median scores of practice were 41.0, with an interquartile range of 36.0-45.0. There was a positive and significant relationship between knowledge, attitude and practice. Multiple linear regression analysis indicated that ICU type (95%CI = -0.469 to -0.163, p = .000), education level (95%CI = 0.024-0.332, p = .024), monthly income (95%CI = 0.054-0.227, p = .002), attitude (95%CI = 0.038-0.090, p = .000) and practice (95%CI = 0.033-0.055, p = .000) independently affected the knowledge; age (95%CI = 0.068-0.815, p = .021), clinical instructor (95%CI = 0.145-0.822, p = .005), head nurse (95%CI = 0.006-1.409, p = .048), knowledge (95%CI = 0.174-0.411, p = .000) and practice (95%CI = 0.077-0.123, p = .000) independently affected the attitude; and age (95%CI = -0.956 to -0.031, p = .036), knowledge (95%CI = 0.871-1.416, p = .000) and attitude (95%CI = 0.446-0.702, p = .000) independently affected the practice. Although the knowledge, attitude and practice of IAP measurement among ICU nurses are acceptable, there is still room for improvement in knowledge and practice. Nursing managers should strengthen management, provide more learning resources and training to meet nurses' needs about IAP measurement, so as to further improve the early recognition and management of increased IAP. The data highlight the knowledge, attitude and practice and determinant factors of IAP measurement among ICU nurses and will help to make management protocols in the future. Nursing educators and administrators are recommended to provide guidance, training and support to further improve knowledge and practice of IAP measurement among the ICU nurses.

Prone positioning (PP) is widely used in intensive care units (ICUs) to improve oxygenation in patients with respiratory distress. However, prolonged maintenance in this non-physiological position, especially in patients with underlying comorbidities, increases the risk of pressure injuries (PIs). This study aimed to evaluate the effectiveness of a nursing quality improvement (QI) project in reducing the incidence of stage II or higher PIs in ICU patients undergoing prone positioning. This was a single-centre, pre- and post-intervention QI study conducted in an ICU setting. The intervention included the development of the nursing care protocol for prone-positioned patients and the foam dressing application protocol for prone-positioned patients, along with instructional videos, structured nurse training and enhanced supervision mechanisms. Given that stage II PIs signify damage to both the epidermis and dermis, representing a critical phase in their progression, this study focused primarily on the incidence of stage II or higher pressure injuries. A total of 70 patients were included, with 31 in the pre-intervention group and 39 in the post-intervention group. Before the intervention, 58.06% (18/31) of patients developed stage II or higher PIs across 47 sites, most commonly on the cheeks (n = 9, 19.15%). Post-intervention, 25.64% (10/39) of patients developed PIs, affecting a total of 10 sites, all classified as stage II, with the chin being the most frequently affected area (n = 4, 40.00%). The intervention significantly reduced PI incidence by 55.83% (p = .006, odds ratio = 0.24, 95% CI: 0.08-0.69), with no stage III or higher injuries reported. The implementation of the nursing QI project significantly reduced the incidence of stage II or higher PIs in ICU patients undergoing prone positioning. However, PIs continued to occur predominantly in the head and facial regions, such as the chin and ears, highlighting the need for targeted protective strategies for these high-risk areas. This study demonstrates the effectiveness of a structured QI approach in reducing stage II or higher PIs in ICU patients undergoing prone positioning. Standardized protocols, structured training and quality monitoring enhanced adherence to preventive measures, providing practical guidance for ICU nurses in mitigating PI risk.

Critical care nursing often involves providing care in environments where mortality is prevalent. Nurses' attitudes towards death significantly influence their approach to spiritual caregiving, which addresses patients' emotional, psychological and spiritual needs. Understanding this relationship is crucial for improving holistic care and patient outcomes. Investigates how spiritual caregiving affects critical care nurses' attitudes towards death. A descriptive correlational research design was used. The study included a convenient sample of 931 critical care nurses from four hospitals. Data were collected using the death attitude profile and the Arabic version of the Spiritual Caregiving Scale. Nurses showed a positive attitude towards spiritual caregiving, with mean scores ranging from 3.89 to 4.24 across spiritual subscales. However, high levels of fear (mean = 4.48, SD = 1.32) and death avoidance (mean = 4.66, SD = 1.29) were prevalent, particularly among younger, male and urban nurses. A significant positive correlation was found between spiritual caregiving and acceptance of death (r = 0.266, p < 0.001, 95% CI [0.198, 0.334]), while a negative correlation was observed with fear of death (r = -0.109, p < 0.001, 95% CI [-0.182, -0.036]) and death avoidance (r = -0.010, p = 0.755, 95% CI [-0.083, 0.063]). Multivariate regression indicated that deeper engagement in spiritual caregiving predicted more positive or neutral attitudes towards death (B = -0.390, p < 0.001, 95% CI [-0.467, -0.313], R2 = 0.117). Spiritual caregiving was associated with more positive death attitudes among critical care nurses, indicating its potential to enhance holistic care in critical settings. Integrating spiritual caregiving into clinical practice enhances holistic care by addressing patients' emotional, psychological and spiritual needs while helping nurses manage their fear and avoidance of death. This approach promotes emotional resilience, job satisfaction and compassionate care, ultimately improving patient outcomes and supporting critical care nurses in delivering high-quality care in demanding, mortality-prevalent environments.

Globally, there has been a general decline in the occurrence of central line-associated bloodstream infection (CLABSI). Still, CLABSI remains a common healthcare-associated infection in the ICUs of hospitals in developing countries. The aim of the study was to assess knowledge, attitude and practice among ICU nurses in China concerning CLABSI prevention. A multicentre, cross-sectional study was designed. A self-designed questionnaire, informed by a literature review and expert consultation, was utilised to assess the knowledge, attitude and practice of ICU nurses. The widely used electronic data collection tool in China, known as the Wen Juan Xing platform, facilitated data gathering via the internet. A total of 989 ICU nursing staff from 22 large tertiary public hospitals in China completed the online survey between 1 May 2024 and 30 June 2024. The proportion of ICU nurses with good (≥ 80% accurate response) knowledge, attitude and practice was 31.14%, 45.50% and 89.99%, respectively. ICU nurses' knowledge and attitude were mainly influenced by their age, ICU experience and professional level, meanwhile, their practice differences were found by their gender and educational level. In addition, nursing programs or processes, previous training experience and whether need more information were significantly associated with nurses' knowledge, attitude and practice. In summary, Chinese ICU nurses demonstrated inadequate levels of knowledge and attitude towards CLABSI prevention. Study findings suggest that arranging training in refreshing, taking advantage of experienced nurses' leading roles and changing safety culture might be useful in enhancing ICU nurses' knowledge, attitude and practice. The results of this research imply that the government, nursing associations and hospitals themselves should provide tailored training programs, improve safety culture and explore dynamic assessment methods to promote optimal knowledge, attitude and practice relevant to CLABSI prevention among ICU nurses in China.

Patients admitted to intensive care units often rely on surrogates for decision making, especially for invasive procedures. Over 70% of decisions are related to invasive procedures. Surrogates' unmet needs during decision making can lead to conflicts. Existing scales assess the general needs of surrogates, and tools designed explicitly for invasive procedure decision making are lacking, necessitating the development of targeted assessments for use by healthcare professionals. This study aimed to develop and evaluate the reliability and validity of the Surrogate Decision Needs Scale (SDNS) for surrogates of critically ill patients considering invasive procedures. This study was conducted at a medical centre. Two clinical and research experts drafted assessment items based on a literature review, which was refined by five experts. A cross-sectional design with convenience sampling was used to measure the needs of the surrogates. Exploratory factor analysis and known group analysis examined the scale's construct validity, while internal consistency reliability was evaluated using Cronbach's alpha. The expert content validity index of the SDNS was 0.93-1. A convenience sample of 100 surrogates of ICU patients completed the 16 items SDNS, and 132 invasive procedures were analysed. Exploratory factor analysis revealed three factors: Information Needs, Support Needs and Recourse Needs, which explained 70.13% of the total variance. Known-group analysis showed that having a high educational level (p = 0.001) and being a child of the patient (p = 0.021) were associated with placing high importance on information, support and resource needs during decision making. The SDNS effectively assesses the needs of ICU surrogates in making decisions about invasive procedures. Findings suggest that surrogate education level and relationship to the patient may influence decision priorities, with college-educated surrogates prioritising information needs while children serving as surrogates emphasised support needs. Future research should explore the SDNS's applicability in diverse cultural settings and surrogate roles to determine whether these patterns are consistent across different populations. Longitudinal studies are needed to examine the trajectory of surrogates' decision needs, particularly in cases involving invasive procedures. Healthcare professionals should address decision needs by explaining the risks associated with invasive procedures, discussing specific recommendations with patients' family members and allowing surrogates sufficient time for contemplation before decision-making.

Patients hospitalised in the intensive care unit (ICU) often experience feelings of isolation and a sense of profound loneliness. These individuals frequently report symptoms of anxiety, depression and other psychiatric disorders. The aim of this study was to examine the impact of the family interaction model on the anxiety and mental well-being of patients during the visit restrictions in the ICUs. Additionally, the experiences of intensive care patients and their relatives regarding this process were investigated. This research utilised a parallel design mixed-methods approach, incorporating both quantitative and qualitative designs. A qualitative research design was employed in the quasi-experimental framework to examine post-intervention experiences. The research sample consisted of 47 patients in the intervention group. The intervention group, that received videos and messages from their relatives, exhibited a decrease in anxiety over time. In contrast, the control group demonstrated an increase in anxiety over time. The results indicated that 77% of these changes were due to the group variable (CI: -38.627 to -30.902; p < 0.05). Mental well-being scores demonstrated an increase over time in the intervention group, while a decrease was observed in the control group. The analysis revealed that 83.4% of this change could be attributed to the group variable (CI: 29.178-35.048; p < 0.05). In the interviews, three themes were obtained from both patients and the relatives of the patients in the intervention group. In the control group, four themes were found. In the qualitative interviews conducted with the patients in the intervention group, the subthemes regarding their feelings about the disease process and intensive care experience included fear, uncertainty and anxiety, and hopelessness and longing, while after the patients were shown the video, themes that overlapped with positive feelings were found. These subthemes were determined as happiness, excitement and hope. In the control group, the subthemes regarding their experiences of the disease process were determined as death anxiety, hopelessness and helplessness, uncertainty, agitation and physical discomfort (pain and fatigue). The results of this study demonstrated that using remote communication methods to facilitate interaction between patients and their families was linked to reduced anxiety in patients, improved mental well-being and increased satisfaction among their relatives. The primary strength of the study is its pioneering role in facilitating communication between intensive care patients and their relatives at the public hospital level during the pandemic period. Additionally, it has shed light on the emotional outcomes associated with this communication. Moreover, the project facilitated the transmission of the patient's final statements to their relatives, effectively serving as a verbal testament to the bond between the patient and their family. Primarily, communicating the final statements of deceased patients is of paramount humanitarian importance. The results of this study prove that intensive care nurses have an important role in enabling patients to connect with their loved ones in their final stages. Thus, nurses can support recovery, increase communication and ensure farewells.

The recruitment of participants in adult critical care studies is often challenging. We surveyed chief investigators of UK multicentre adult critical care studies in this cross-sectional survey to evaluate what strategies they used to provide study information to potential participants. Of 61 eligible responses, we received completed surveys from 35 investigators (response rate 57%). Most chief investigators reported using a written participant information sheet (n = 34, 97%), but the uptake of alternative strategies was limited to 9 studies (26%). Only 6 studies (17%) utilized digital methods. Most chief investigators (63%) reported that they planned to adopt alternative strategies in their next study. RELEVANCE TO CLINICAL PRACTICE: This cross-sectional online survey study explores the strategies currently used by chief investigators for providing research information in critical care and explores how likely chief investigators are to adopt alternative strategies.