Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms

Despins, Laurel A.  | Factors influencing when intensive care unit nurses go to the bedside to investigate patient related alarms: A descriptive qualitative study | Intensive and Critical Care Nursing

Objective

This study examines what prompts the intensive care unit (ICU) nurse to go to the patient’s bedside to investigate an alarm and the influences on the nurse’s determination regarding how quickly this needs to occur.

Method

A qualitative descriptive design guided data collection and analysis. Individual semi-structured interviews were conducted. Thematic analysis guided by the Patient Risk Detection Theoretical Framework was applied to the data.

Results

ICU nurses go the patient’s bedside in response to an alarm to catch patient deterioration and avert harm. Their determination of the immediacy of patient risk and their desire to prioritize their bedside investigations to true alarms influences how quickly they proceed to the bedside.

Conclusion
Ready visual access to physiological data and waveform configurations, experience, teamwork, and false alarms are important determinants in the timing of ICU nurses’ bedside alarm investigations.

Link to the full abstract here

Burnout and health among critical care professionals

To analyse the mediational role of resilience in relationships between burnout and health in critical care professionals; to determine relationships among resilience level, three burnout dimensions, and physical/mental health | Intensive & Critical Care Nursing

Participants/setting: A total of 52 critical care professionals, mainly nurses, were recruited from an intensive care unit of Madrid (Spain).

Conclusions: Resilience minimises and buffers the impact of negative outcomes of workplace stress on mental health of critical care professionals. As a result, resilience prevents the occurrence of burnout syndrome. Resilience improves not only their mental health, but also their ability to practice effectively. It is therefore imperative to develop resilience programs for critical care nurses in nursing schools, universities and health centres.

Full reference: Arrogante, O & Aparicio-Zaldivar, E. (2017) Burnout and health among critical care professionals: The mediational role of resilience. Intensive & Critical Care Nursing. DOI: http://dx.doi.org/10.1016/j.iccn.2017.04.010

Patient participation in the intensive care unit

Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care | Intensive and Critical Care Nursing

Image source: Yau Hoong Tang – Flickr // CC BY-NC-ND 2.0

The purpose of the study was to explore critical care nurses’ perceptions of patient participation for critically ill patients.

In the ICU, the possibilities for patient participation in nursing care are not only dependent on the patient’s health condition but also on the nurse’s ability to include patients in various care actions despite physical and/or mental limitations. When the patient is not able to participate, nurses strive to achieve participation through relatives’ knowledge and/or other external sources of information.

Full reference: Schandl, A. et al. (2017) Patient participation in the intensive care unit. Intensive and Critical Care Nursing. Published online:May 20, 2017

Survey among critical care nurses and physicians about delirium management

Delirium is a serious complication in patients in intensive care units. Previous surveys on delirium management in daily practice showed low adherence to published guidelines | Nursing in Critical Care

Aim: To evaluate delirium management in nurses and physicians working in intensive care units in German-speaking countries and to identify related differences between nurses and physicians.

Conclusion: In German-speaking countries, assessment of delirium needs further improvement, leading to accurate assessment. Delirium-related structures and processes appear to be implemented widely, with only a few differences between nurses and physicians.

Full reference: Nydal, P. et al. (2017) Survey among critical care nurses and physicians about delirium management. DOI: 10.1111/nicc.12299

Transfusion in critical care – a UK regional audit of current practice

Plumb, J et. al. Transfusion in critical care – a UK regional audit of current practice Anaesthesia. 2017 May; 72(5) :633-640

Introduction 

Critical care publications have advised that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. However, translation into clinical practice has been slow. These authors describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units in Wessex.

Methods and results

All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 hours of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148). The median (interquartile range [range]) haemoglobin concentration before transfusion was 73 (68–77 [53–106]) g/L, with only 34% of transfusion episodes using a transfusion threshold of <70 g/L. In a subgroup analysis that did not study patients with a history of cardiac disease (n = 42), haemoglobin concentration before transfusion was 72 (68–77 [50–98]) g/L, with only 36% of transfusion episodes using a threshold of < 70 g/L. Most blood transfusions given to critically ill patients who were not bleeding in this audit used a haemoglobin threshold >70 g/L.

 Conclusions

The authors conclude that it is unclear why recommendations on transfusion triggers have not translated into clinical practice. With a clear national drive to decrease usage of blood products and clear evidence that a threshold of 70 g/L is non-inferior, the authors find it surprising that a scarce and potentially dangerous resource is still being overused within critical care. They suggest that simple solutions such as electronic patient records that force pause for thought before blood transfusion, or prescriptions that only allow administration of a single unit in non-emergency circumstances, may help to reduce the incidence of unnecessary blood transfusions.

Interventions affecting mortality in critically ill and perioperative patients

Martina, B.R. et al. Journal of Critical Care | Published online: 4 May 2017

Highlights: 

• No systematic exploration of confounders in randomized controlled trials reporting a significant effect on mortality in critically ill patients has been performed.
• Almost half of these trials were single centre and one third were not analysed according to the intention to treat principle, inflating effect size.
• Blinded and/or multicentre design was associated with an increased number needed to treat/harm.
• Major systematic biases exist and affect trial findings irrespective of the intervention being studied.

Read the full abstract here

Acute kidney injury in the ICU: from injury to recovery

Reports from the 5th Paris International Conference | Annals of Intensive Care

The French Intensive Care Society organized its yearly Paris International Conference in intensive care on June 18–19, 2015. The main purpose of this meeting is to gather the best experts in the field in order to provide the highest quality update on a chosen topic. In 2015, the selected theme was: “Acute Renal Failure in the ICU: from injury to recovery.” The conference program covered multiple aspects of renal failure, including epidemiology, diagnosis, treatment and kidney support system, prognosis and recovery together with acute renal failure in specific settings. The present report provides a summary of every presentation including the key message and references and is structured in eight sections:

(a) diagnosis and evaluation,

(b) old and new diagnosis tools,

(c) old and new treatments,

(d) renal replacement therapy and management,

(e) acute renal failure witness of other conditions,

(f) prognosis and recovery,

(g) extracorporeal epuration beyond the kidney,

(h) the use of biomarkers in clinical practice

Find out more about the conference here