Intensive Care Unit Environment Research Articles

A retrospective study of the predictors of mortality among patients in intensive care units at North West-Bank hospitals in Palestine

ABSTRACT Objectives The intensive care unit (ICU) mortality rate remains high especially in developing countries regardless of the advances in critical management. There is a lack of studies about mortality causes in hospitals and particularly ICUs in Palestine. This study evaluated the demographic and clinical characteristics of critically ill patients and determined the predictors of mortality among patients in the ICU. Methods A retrospective study assessed all patients who stayed in ICU for more than 24 hours from January 2017 to January 2019. Data were collected from the patient’s files. Patient characteristics (background, clinical variables, and comorbidities) were recorded. Results The study included 227 eligible ICU patients. The cases’ mean age was 55.5 (SD ± 18.2) years. The overall ICU mortality rate was 31.7%. The following factors were associated with high adjusted mortality odds: admission from inside the hospital (adjusted odds ratio (aOR), 2.1, 95%CI: 1.1-3.9, p < 0.05), creatinine level ≥2 mg/dl on admission (aOR, 2.7, 95%CI: 1.3-5.8, p < 0.01), hematology malignancy patients (aOR, 3.4, 95%CI: 1.6-6.7, p = 0.001), immune-compromised (aOR, 2.5, 95%CI: 1.3-4.7, p < 0.01), septic shock (aOR, 27.1, 95%CI: 7.9-88.3, p < 0.001), hospital-acquired infections (aOR: 13.4, 95%CI: 4.1-57.1, p < 0.001), and patients with multiple-source infection (aOR: 16.3, 95%CI: 6.4-57.1, p < 0.001). Also, high SOFA and APACHE scores predicted morality (p < 0.001). Conclusion The mortality rate among ICU patients was high. It was higher among those admitted from the hospital wards, septic shock, hospital-acquired infection, multiple infection sources, and multi-drug resistance infections. Thus, strategies should be developed to enhance ICU environment and provide sufficient resources to minimize the effects of these predictors.

Stress level and associated factors among nurses working in the critical care unit and emergency rooms at comprehensive specialized hospitals in Southern Ethiopia, 2023: explanatory sequential mixed-method study

BackgroundStress is a pervasive occurrence within certain professions, including nurses working in emergency and intensive care unit environments. Nurses in these settings often confront various stress-inducing factors, such as unsupportive management and distressing events like patient mortality, and experience notably higher levels of stress. Nevertheless, information is scarce regarding the precise level of stress in Ethiopia, particularly within southern hospitals.ObjectiveTo assess stress levels and associated factors among nurses working in the critical care unit and emergency rooms at comprehensive specialized hospitals in southern Ethiopia, 2023.MethodsA facility-based cross-sectional explanatory sequential mixed-method study was undertaken, involving a total of 239 nurses. For the quantitative component, all nurses working in intensive care units and emergency rooms were included as participants, while a purposive sampling technique was employed to select participants for the qualitative aspect. Data for the quantitative study were gathered through the utilization of self-administered questionnaires, while interviews were conducted using a structured interview guide for the qualitative portion. Quantitative data entry and analysis were performed using EpiDataV4.6 and the Statistical Package for the Social Sciences software, respectively. Thematic analysis of the qualitative data was conducted using the OpenCode software.ResultsThe level of stress among nurses in the emergency and intensive care units was low (19.3%), moderate (55.9%), and high (24.8%). Workload (Adjusted odds ratio (AOR) = 3.51, 95% confidence interval (CI) (1.17–10.56) and time constraints (AOR = 2.5, 95% CI (1.03–6.07) were significantly associated with moderate stress level, while duty demands (AOR = 3.03, 95% CI (1.17–7.14), availability of medical equipment and supplies (AOR = 1.42, 95% CI (1.18–4.97), and witnessing death and dying (AOR = 2.34, 95% CI (1.13–5.88) were significantly associated with high-stress level. The qualitative data analysis revealed that the participants underscored the significant impact of organizational factors, individual factors, and profession-related factors on the stress levels experienced by nurses in emergency and critical care settings.Conclusion and recommendationBased on the findings, the participants in this study experienced some level of stress, to varying degrees. Therefore, it is crucial to implement effective strategies such as optimizing staffing and workflow, improving communication and collaboration, providing adequate support and resources, leveraging technology and innovation, emphasizing patient-centered care, and implementing data-driven quality improvement to alleviate the burden.

Emerging trends of invasive yeast infections and azole resistance in Beijing intensive care units

Invasive fungal infections pose a substantial threat to patients in healthcare settings globally. Recent changes in the prevalence of fungal species and challenges in conducting reference antifungal susceptibility testing emphasize the importance of monitoring fungi and their antifungal resistance. A two-phase surveillance project was conducted in Beijing, China, involving 37 centers across 12 districts, from January 2012 to December 2013 and from January 2016 to December 2017. We found that the proportion of Candida albicans in intensive care units (ICUs) during 2016–2017 exhibited a significant decline compared to the 2012–2013 period, although it remained the most predominant pathogen. In contrast, the prevalence of Nakaseomyces glabratus (formerly Candida glabrata) and Candida tropicalis notably increased during the two-phase surveillance. The high prevalence of C. tropicalis and its resistance to azole drugs posed a serious threat to patients in ICUs. The pathogens causing invasive fungal infections in Beijing were relatively sensitive to echinocandins. While C. albicans continued to exhibit susceptibility to azoles, the resistance and growth rates of C. tropicalis towards azoles were particularly prominent. Concerns were raised due to the emergence of multiple, short-term isolates of Clavispora lusitaniae and Candida parapsilosis complex in neonatal ICUs, given their similarity in antifungal susceptibilities. Such occurrences point towards the potential for transmission and persisting presence of these pathogens within the ICU environment. Our study complements existing data on the epidemiology of invasive fungal infections. It is imperative to exercise cautious medication management for ICU patients in Beijing, paying particular attention to azole resistance in C. tropicalis.

Psychometric Evaluation of the Family Willingness for Caregiving Scale.

Family members and close friends of patients undergoing mechanical ventilation in the intensive care unit (ICU) often experience stress and a sense of helplessness. Participating in the care of their loved one may improve their adaptation to the ICU environment and better prepare them for caregiving after discharge. The primary aim of this study was to develop the Family Willingness for Caregiving Scale (FWCS) and test its psychometric properties. The secondary aim was to examine relationships between family members' demographic characteristics and caregiving willingness. The process of scale development followed DeVellis's 8-step method, and the scale was tested in 3 phases. The first 2 phases examined content validity and face validity, respectively. In phase 3, the FWCS was administered to a sample of family members currently visiting an ICU patient. Content validity and face validity were confirmed. The internal consistency reliability of the scale was acceptable, and exploratory factor analysis revealed a 1-factor structure comprising both physical and emotional/supportive care tasks. Caregiving willingness differed significantly by sex, with women reporting greater willingness than men reported. Further testing of the FWCS is needed. After refinement, the FWCS could be used to evaluate factors contributing to caregiving willingness of family members of ICU patients and advance the science related to family engagement in the ICU. Additionally, it could be used as a practical tool to suggest family caregiving activities in the ICU.

The effect of developmental care on the length of hospital stay and family centered care practice for very low birth weight infants in neonatal intensive care units: A cluster randomized controlled trial

BackgroundDespite previous studies suggesting that developmental care can provide benign stimulation to promote neural development of newborns, more evidence is needed regarding the other clinical benefits of developmental care. ObjectiveTo evaluate the effect of implementing developmental care on the length of hospital stay, the improvement of care practice in neonatal intensive care units, as well as the short-term outcome of very low birth weight infants. DesignCluster-randomized controlled trial. Setting(s) and participantsFrom March 1, 2021 to March 1, 2022, 1400 very low birth weight infants were recruited from 14 tertiary neonatal intensive care units in China. MethodsWe assigned 14 neonatal intensive care units to either developmental care or standard care. The length of hospital stay of the infants was the primary outcome analyzed at the individual level. Secondary outcomes were family centered care practice including parental involvement, the skin to skin care, exclusive breast milk, oral immune therapy and breastfeeding. The environmental management (noise and light) and the short-term outcomes were also evaluated. ResultsThe length of hospital stay for the developmental care group was 65 % as long as that for the control group (HR: 0.65, 95 % CI, 0.451–0936, p = 0.021). After controlling the covariables, the adjusted HR = 0.755 (95 % CI, 0.515 to 1.107, p = 0.150). When compared to the control group, the developmental care group had greater access to SSC, with 22 infants (3.8 %) in the developmental care group compared to 13 infants (1.7 %) in the standard care group (p = 0.013). A greater proportion of infants in the developmental care group were fed at the breast, than those in the standard care group (136 [23.6 %] vs 9 [1.1 %]; p = 0.029). Compared to the control group, exclusively breast milk was significantly more favorable in the developmental care group (435 [75.6 %] vs 114 [15.0 %]; p = 0.001). The difference remained significant even after adjusting for covariates. However, the rate of oral immune therapy and parental involvement was similar in the two groups. The average noise and light levels in the developmental care group were significantly lower than those in the standard care group. After adjusting for confounders, the difference remained significant. There were no significant differences among groups in the mortality and major morbidity. ConclusionsDevelopmental care might have developed an accumulated effect over time on the length of hospital stay among very low birth weight infants. The implementation of developmental care can greatly improve family centered care practices and the neonatal intensive care unit environment. RegistrationClinicalTrials.govNCT05166720. Registration date: 1 March, 2021.

Breastfeeding Barriers for Preterm Infants in Neonatal Intensive Care Unit Environments: A Systematic Assessment and Meta-Analysis.

Background: Breast milk is vital for the growth and development of preterm infants. However, in Neonatal Intensive Care Units (NICUs), mothers often encounter significant challenges in breastfeeding. Objective: This study aims to systematically evaluate the barriers to breastfeeding in NICUs, thereby providing evidence-based support for clinical practices. Methods: A comprehensive search was conducted in the Cochrane Library, PubMed, Web of Science, Embase, and Scopus databases, up to September 2023. Meta-analysis was performed using Stata 15.0, applying fixed or random effects models to calculate odds ratios (OR) and their 95% confidence intervals (CI). Study quality was assessed using the Newcastle-Ottawa Scale for cases and cohorts and the Agency for Healthcare Research and Quality standards for cross-sectional studies. Heterogeneity was evaluated using Cochran's chi-squared test (Cochran's Q) and I2 statistics, and publication bias was assessed through funnel plots and symmetry tests. Results: A total of 32 studies were included, encompassing 96,053 preterm infants. The main barriers to breastfeeding in preterm infants included: low gestational age (OR = 1.36, 95% CI: 1.06-1.75), lower maternal education (OR = 1.64, 95% CI: 1.39-1.93), insufficient breast milk (OR = 2.09, 95% CI: 1.39-1.93), multiple births (OR = 1.615, 95% CI: 1.18-2.210), smoking (OR = 2.906, 95% CI: 2.239-3.771), and single motherhood (OR = 1.439, 95% CI: 1.251-1.654). Conclusion: This study underscores the need for individualized breastfeeding support strategies in NICUs, taking into account the diverse backgrounds of mothers. Future research should focus on unraveling the underlying mechanisms affecting breastfeeding in preterm infants, with the goal of enhancing breastfeeding rates and improving developmental outcomes.

Joint observation in NICU (JOIN): A randomized controlled trial testing an early, one-session intervention during preterm care to improve perceived maternal self-efficacy and other mental health outcomes.

Parents of preterm infants in the Neonatal Intensive Care Unit (NICU) environment may experience psychological distress, decreased perceived self-efficacy, and/or difficulties in establishing an adaptive parent-infant relationship. Early developmental care interventions to support the parental role and infant development are essential and their impact can be assessed by an improvement of parental self-efficacy perception. The aims were to assess the effects of an early intervention provided in the NICU (the Joint Observation) on maternal perceived self-efficacy compared to controls (primary outcome) and to compare maternal mental health measures (perceived stress, anxiety, and depression), perception of the parent-infant relationship, and maternal responsiveness (secondary outcomes). This study was a monocentric randomized controlled trial registered in clinicatrials.gov (NCT02736136), which aimed at testing a behavioural intervention compared with treatment-as-usual. Mothers of preterm neonates born 28 to 32 6/7 weeks gestation were randomly allocated to either the intervention or the control groups. Outcome measures consisted of self-report questionnaires completed by the mothers at 1 and 6 months after enrollment and assessing perceived self-efficacy, mental health, perception of the parent-infant relationship and responsiveness, as well as satisfaction with the intervention. No statistically significant group effects were observed for perceived maternal self-efficacy or the secondary outcomes. Over time, perceived maternal self-efficacy increased for mothers in both groups, while anxiety and depression symptoms decreased. High satisfaction with the intervention was reported. The joint observation was not associated with improved perceived maternal self-efficacy or other mental health outcomes, but may constitute an additional supportive measure offered to parents in a vulnerable situation during the NICU stay.

Explore Parent’s Perception Regarding Role of Nurse as an Educator in an Intensive Care Unit Punjab Pakistan: A Qualitative Study

Background: The neonatal intensive care unit (NICU) environment is highly stressful for both neonates and their family caregivers. The quality of interaction between caregivers and medical staff can significantly influence caregiver trust and satisfaction, which are crucial for the effective care and recovery of the neonate. Objective: This study aims to assess the perceptions of family caregivers regarding the role of nurses as educators in a NICU in Punjab, Pakistan, focusing on the communication strategies employed by nurses and the support infrastructure available to caregivers. Methods: This qualitative study involved semi-structured interviews with 14 family caregivers of neonates hospitalized in the Allama Iqbal Teaching Hospital's NICU. Participants were selected based on their intensive involvement in the care of their hospitalized newborns. Data were analyzed using content analysis to explore the themes related to nursing care quality as perceived by the caregivers. Results: Caregivers generally perceived the nursing care as excellent, noting particularly the professionalism and empathy of the nursing staff. However, issues such as inadequate hospital infrastructure, particularly sleeping facilities for caregivers, and occasional lapses in communication and caregiving flexibility were identified as areas needing improvement. The study also highlighted the critical role of timely and accurate information provided to caregivers in reducing anxiety and enhancing their involvement in the care process. Conclusion: Effective communication and adequate support infrastructure are essential in enhancing caregiver trust and satisfaction in the NICU setting. Improving these areas can significantly impact the recovery and well-being of both neonates and their families.

Role of Emotional Intelligence, in Relationship between Compassion Satisfaction, Compassion Fatigue and Quality of Life Among Nurses Working in ICU

Background: Intensive Care Unit (ICU) nurses encounter emotionally taxing situations that can affect their well-being, making the examination of factors such as emotional intelligence (EI), compassion satisfaction, and fatigue crucial in understanding their quality of life. Objective: This study aimed to explore the interplay between EI, compassion satisfaction, compassion fatigue, and quality of life among ICU nurses, and to examine the mediating role of EI in these relationships. Methods: A convenience sampling method was employed to collect data from 167 ICU nurses using a structured online questionnaire. Demographic data and measures for compassion satisfaction, fatigue, EI, and quality of life were analyzed using SPSS version 25. Path coefficients and mediation analysis were conducted using Partial Least Squares (PLS). Results: The majority of participants were below 30 years (76.2%) and female (67.9%). EI positively correlated with quality of life (path coefficient = 0.139, p = 0.007) and was a partial mediator between compassion satisfaction and quality of life. Higher compassion satisfaction was significantly associated with increased EI and quality of life (path coefficients = 0.264 and 0.628, respectively, p &lt; 0.001). Gender-based analysis revealed differences in quality of life (Males: M = 100.65, SD = 7.98; Females: M = 96.58, SD = 12.59; p = 0.035) and compassion fatigue (Males: M = 65.24, SD = 7.77; Females: M = 61.42, SD = 8.59; p = 0.007). Conclusion: Emotional intelligence is instrumental in enhancing quality of life by mediating the effects of compassion satisfaction and fatigue among ICU nurses. These insights suggest that interventions aimed at increasing EI may be beneficial for nurses facing the demanding conditions of ICU environments.

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

ObjectivesMedication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to...

Caring for hearts and minds: a quality improvement approach to individualized developmental care in the cardiac intensive care unit.

Infants with congenital heart disease (CHD) are at high risk for developmental differences which can be explained by the cumulative effect of medical complications along with sequelae related to the hospital and environmental challenges. The intervention of individualized developmental care (IDC) minimizes the mismatch between the fragile newborn brain's expectations and the experiences of stress and pain inherent in the intensive care unit (ICU) environment. A multidisciplinary group of experts was assembled to implement quality improvement (QI) to increase the amount of IDC provided, using the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), to newborn infants in the cardiac ICU. A Key Driver Diagram was created, PDSA cycles were implemented, baseline and ongoing measurements of IDC were collected, and interventions were provided. We collected 357 NIDCAP audits of bedside IDC. Improvement over time was noted in the amount of IDC including use of appropriate lighting, sound management, and developmentally supportive infant bedding and clothing, as well as in promoting self-regulation, therapeutic positioning, and caregiving facilitation. The area of family participation and holding of infants in the CICU was the hardest to support change over time, especially with the most ill infants. Infants with increased medical complexity were less likely to receive IDC. This multidisciplinary, evidence-based QI intervention demonstrated that the implementation of IDC in the NIDCAP model improved over time using bedside auditing of IDC.

Contextual design requirements for decision-support tools involved in weaning patients from mechanical ventilation in intensive care units

Weaning patients from ventilation in intensive care units (ICU) is a complex task. There is a growing desire to build decision-support tools to help clinicians during this process, especially those employing Artificial Intelligence (AI). However, tools built for this purpose should fit within and ideally improve the current work environment, to ensure they can successfully integrate into clinical practice. To do so, it is important to identify areas where decision-support tools may aid clinicians, and associated design requirements for such tools. This study analysed the work context surrounding the weaning process from mechanical ventilation in ICU environments, via cognitive task and work domain analyses. In doing so, both what cognitive processes clinicians perform during weaning, and the constraints and affordances of the work environment itself, were described. This study found a number of weaning process tasks where decision-support tools may prove beneficial, and from these a set of contextual design requirements were created. This work benefits researchers interested in creating human-centred decision-support tools for mechanical ventilation that are sensitive to the wider work system.

The ICU environment contributes to the endemicity of the "Serratia marcescens complex" in the hospital setting.

Serratia marcescens is an opportunistic pathogen historically associated with sudden outbreaks in intensive care units (ICUs) and the spread of carbapenem-resistant genes. However, the ecology of S. marcescens populations in the hospital ecosystem remains largely unknown. We combined epidemiological information of 1,432 Serratia spp. isolates collected from sinks of a large ICU that underwent demographic and operational changes (2019-2021) and 99 non-redundant outbreak/non-outbreak isolates from the same hospital (2003-2019) with 165 genomic data. These genomes were grouped into clades (1-4) and subclades (A and B) associated with distinct species: Serratia nematodiphila (1A), S. marcescens (1B), Serratia bockelmannii (2A), Serratia ureilytica (2B), S. marcescens/Serratia nevei (3), and S. nevei (4A and 4B). They may be classified into an S. marcescens complex (SMC) due to the similarity between/within subclades (average nucleotide identity >95%-98%), with clades 3 and 4 predominating in our study and publicly available databases. Chromosomal AmpC β-lactamase with unusual basal-like expression and prodigiosin-lacking species contrasted classical features of Serratia. We found persistent and coexisting clones in sinks of subclades 4A (ST92 and ST490) and 4B (ST424), clonally related to outbreak isolates carrying blaVIM-1 or blaOXA-48 on prevalent IncL/pB77-CPsm plasmids from our hospital since 2017. The distribution of SMC populations in ICU sinks and patients reflects how Serratia species acquire, maintain, and enable plasmid evolution in both "source" (permanent, sinks) and "sink" (transient, patients) hospital patches. The results contribute to understanding how water sinks serve as reservoirs of Enterobacterales clones and plasmids that enable the persistence of carbapenemase genes in healthcare settings, potentially leading to outbreaks and/or hospital-acquired infections.IMPORTANCEThe "hospital environment," including sinks and surfaces, is increasingly recognized as a reservoir for bacterial species, clones, and plasmids of high epidemiological concern. Available studies on Serratia epidemiology have focused mainly on outbreaks of multidrug-resistant species, overlooking local longitudinal analyses necessary for understanding the dynamics of opportunistic pathogens and antibiotic-resistant genes within the hospital setting. This long-term genomic comparative analysis of Serratia isolated from the ICU environment with isolates causing nosocomial infections and/or outbreaks within the same hospital revealed the coexistence and persistence of Serratia populations in water reservoirs. Moreover, predominant sink strains may acquire highly conserved and widely distributed plasmids carrying carbapenemase genes, such as the prevalent IncL-pB77-CPsm (pOXA48), persisting in ICU sinks for years. The work highlights the relevance of ICU environmental reservoirs in the endemicity of certain opportunistic pathogens and resistance mechanisms mainly confined to hospitals.

Rationing of nursing care and assessment of work safety and a healthy work environment in intensive care units: A cross-sectional, correlational study

IntroductionRationing of nursing care, whichrefers to the aspects of care not delivered by nurses in an intensive care unit (ICU), has implicationsfor patient outcomes and experiences. ObjectivesThis study aimed to identify the extent to which nursing care is rationed in intensive care units, as well as asses quality of nursing care, and the level of job satisfaction and its correlation with an assessment of the climate of work safety, teamwork, and a healthy work environment. MethodologyA cross-sectional, correlational study was conducted. The study included 226 ICU nurses. It was conducted with the use of three instruments: the Perceived Implicit Rationing of Nursing Care (PRINCA) questionnaire on the rationing of nursing care, assessment of patient care quality and job satisfaction, American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool (HWEAT) and the Safe Attitudes and Behaviours Questionnaire questionnaire in the version: Teamwork and Safety Climate (BePoZa). SettingsIntensive Care Units in Warmia and Mazury Region in Poland. Main Outcome MeasuresLevel of Nursing Care Rationing in Intensive Care Units. ResultsThe majority of participants were women (89.82 %) with a mean age of 42.47 years. The average score for nursing care rationing across all groups was 0.58. The mean score for the HWEAT was 2.7 and BePoZa was 3.72. The scores from the questionnaires were negatively correlated with the nursing care rationing scores, being −0.36 for the HWEAT and −0.45 for BePoZa. All correlation coefficients were statistically significant at a p-value of less than 0.05. ConclusionsIt is important to monitor work safety, teamwork climate, and standards of a healthy work environment in ICUs to minimise the risk of rationing nursing care. Implications for Clinical PracticeInterventions that enhance work organisation and teamwork can elevate nursing quality and job satisfaction in ICUs, while underestimating patient care tasks; thus, highlighting the need for further research on the factors influencing nursing performance.

Development of a Patient Safety Simulation Program for New Nurses in the Intensive Care Unit

Purpose: Intensive care units (ICUs) are departments that use high-risk drugs and medical devices. Therefore, patient safety is especially important in ICUs. However, new nurses in ICUs often lack patient safety competencies. Thus, it is necessary to improve patient safety competencies for new nurses working in ICUs.Methods: This methodological study was designed to develop a simulation program to improve patient-safety competencies among new nurses working in ICUs. To develop a patient-safety simulation program, we conducted a survey on educational needs and reviewed the core competencies of patient safety applicable to healthcare providers. Additionally, we conducted an expert validation process and a pilot test.Results: A simulation-based patient safety program was developed that spanned 4 weeks (240 minutes).Conclusion: The patient safety simulation program, which considered the characteristics and competence levels of new nurses working in ICUs, was found to be appropriate. This program is expected to improve the patient safety competencies of new intensive care nurses, thereby contributing to the creation of a safer ICU environment.

Associations between prematurity, postpartum anxiety, neonatal intensive care unit admission, and stress.

It is well established that a premature birth increases the likelihood of developing anxiety during the postpartum period, and that the environment of the neonatal intensive care unit (NICU) might be a contributing factor. Mothers of earlier premature infants may experience these anxieties to a higher degree compared to mothers of later premature infants. The aim of this study was to explore the association between prematurity and postpartum-specific anxiety, and the relationship between postpartum-specific anxiety and stress in the NICU. Mothers (N = 237) of infants aged between birth and 12 months completed an online survey containing the Postpartum Specific Anxiety Scale - Research Short Form (PSAS-RSF) and the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). Structural equation modeling was used to analyze the relationship between gestational age and postpartum-specific anxiety, with one-way ANOVAs used to analyze this relationship with respect to categories of gestational age. Hierarchical regression models analyzed the relationship between postpartum-specific anxiety and stress in the NICU. For the PSAS-RSF, Practical Infant Care Anxieties (p = 0.001), Maternal Competence and Attachment Anxieties (p = 0.033), and Infant Safety and Welfare Anxieties (p = 0.020) were significantly associated with week of gestation. Practical Infant Care and Infant Safety and Welfare Anxieties were significantly higher for mothers of late premature infants, compared to mothers of term infants (p < 0.001; p = 0.019). There were no significant between-group differences with respect to Maternal Competence and Attachment Anxieties. After controlling for potential confounders, Infant Safety and Welfare Anxieties were significantly associated with increased stress in the NICU (p < 0.001) as measured by the PSS:NICU. Our findings highlight the need for interventions for mothers with premature infants, which specifically target anxieties reflected in the PSAS-RSF, such as routine care and increasing maternal self-efficacy.

Perceptions, barriers, and challenges of oral care among nursing assistants in the intensive care unit: a qualitative study

BackgroundAlthough oral hygiene is closely related to various diseases, it is sub-optimal in the Intensive Care Unit (ICU). Oral care in the ICU is challenged by nursing workloads, low staffing, and higher acuity patients, there are few policies and written guidelines for oral care. Nurses often delegate oral care to nursing assistants (NAs) whose role is overlooked. This study is to explore the perspectives, obstacles, and challenges of NAs in the oral care of the ICU.MethodsA qualitative study and semi-structured interviews were conducted with NAs in three ICU units, and Colaizzi’s phenomenological method was used to analyze the records.ResultsInitially, 13 NAs met the inclusion criteria, and two did not participate in this study as they refused to be recorded. Finally, 11 ICU NAs were interviewed, with three receiving face-to-face interviews and eight receiving telephone interviews. Using Colaizzi’s phenomenological method, two themes and eight subthemes emerged from the data, we examined the self-perception, barriers and challenges of NAs regarding oral care and identified the subthemes: (1) The target audience, frequency, and importance; (2) Role; (3) Evaluation; (4) Patient-related factors; (5) Oral care tools; (6) Psychology of NAs; (7) Lack of education and training; (8) Lack of team support.ConclusionNursing assistants whose roles are overlooked by the nursing team are important members of the ICU team. Though oral care is closely related to disease prevention, it is rarely considered an essential task. Major barriers to implementing oral care in the ICU environment and patients include the psychological quality of participants, non-standard education and training, and inadequate team support. The expectation is that medical personnel will prioritize oral hygiene and recognize the significance of NAs in nursing work. Furthermore, future ICU oral care should investigate suitable tools and mouthwashes, simplified and standardized processes, standardized training, and multidisciplinary team collaboration.

Environmental Metagenomic Analysis of "ESKAPE" Pathogens in the Pediatric Intensive Care Unit of General Hospital Yogyakarta Indonesia

Healthcare-associated infections (HAIs) are infections that occur while receiving health care, develop in a hospital or other healthcare facility, and first appear 48 hours or more after hospital admission, or within 30 days after having received health care. HAIs are linked to high mortality rates, prolonged stays, increased hospital overhead costs, and financial burdens on patients. Bacterial transmission from medical personnel or the environment, or patient-to-patient contact are all potential causes of these infections. A molecular epidemiology approach is needed to examine the contribution of risk factors and the distribution of "ESKAPE" pathogens within the hospital environment. In this study, we conducted a comprehensive analysis of the distribution of ESKAPE bacterial pathogens in the environment of pediatric intensive care units over a 30-day time interval using shotgun metagenomics. We collected samples from handwashing sinks, the floor around patients, and ventilator screens and tubes in the pediatric intensive care unit (PICU) of General Hospital, Yogyakarta, Indonesia in March 2022. We determine taxonomic profiles and also detect resistome, and virulome distribution of ESKAPE pathogens on various environmental surfaces through shotgun metagenomic sequencing. The microbiomes of the floor, sink, and mechanical ventilator exhibit a diverse composition of microbial communities, featuring significant species richness based on Shannon and Simpson’s index. These microbiomes encompass a wide array of microbial species, including ESKAPE bacterial pathogens, as well as profiles related to resistome and virulome. ESKAPE pathogens, especially Acinetobacter baumannii, predominated in the PICU environment. Most virulome have been associated with metabolism/nutrition and adhesion. Noteworthy findings include resistome genes characterized by mechanisms like efflux pumps (MDR) and alterations in antibiotic targets.

The effect of the intensive care unit nurse manpower on care behaviours and stress level on the nurses.

Nurses working in the intensive care units (ICU) regarding the work-index-nursing work environment, the effect level ICU environment has on the nurses' care behaviors and stress levels of the nurses should be determined. The study aimed to investigate the effect of the nurse manpower on care behaviours and stress level of the nurses working in the ICU. This was a cross-sectional and correlational study. The sample of the study consisted of 123 nurses working in the ICUs. The data were collected using the survey form, Distress Thermometer (DT), The Practice Work Environment Scale of the Nursing Work Index (PES-NWI), and Caring Behaviors Scale-24 (CBS-24). The mean age of nurses in the ICU was 30.2±5.6 and the mean of working time in the intensive care unit of nurses in the ICU was 3.7±3.1 years. The mean of the DT was 4.8±3.4, and the mean score of PES-NWI was 2.6±1.0 and the mean score of CBS-24 was 4.7±1.1 in nurses in the ICU. The regression model which was studied to investigate the relationship between caring behaviors and stress and nurse manpower of nurses working in intensive care unit was significant. Care behaviors and stress levels of nurses working in intensive care units are negatively affected by insufficient nurse manpower.

Reimagine the ICU: Healthcare Professionals' Perspectives on How Environments (Can) Promote Patient Well-Being.

This study aims (1) to understand the needs and challenges of the current intensive care unit (ICU) environments in supporting patient well-being from the perspective of healthcare professionals (HCPs) and (2) to explore the new potential of ICU environments enabled by technology. Evidence-based design has yielded how the design of environments can advocate for patient well-being, and digital technology offers new possibilities for indoor environments. However, the role of technology in facilitating ICU patient well-being has been unexplored. This study was conducted in two phases. First, a mixed-method study was conducted with ICU HCPs from four Dutch hospitals. The study investigated the current environmental support for care activities, as well as the factors that positively and negatively contribute to patient experience. Next, a co-creation session was held involving HCPs and health technology experts to explore opportunities for technology to support ICU patient well-being. The mixed-method study revealed nine negative and eight positive patient experience factors. HCPs perceived patient emotional care as most challenging due to the ICU workload and a lack of environmental support in fulfilling patient emotional needs. The co-creation session yielded nine technology-enabled solutions to address identified challenges. Finally, drawing from insights from both studies, four strategies were introduced that guide toward creating technology to provide holistic and personalized care for patients. Patient experience factors are intertwined, necessitating a multifactorial approach to support patient well-being. Viewing the ICU environment as a holistic unit, our findings provide guidance on creating healing environments using technology.