Ward nurses’ experiences of the discharge process between intensive care unit and general ward

This piece of qualitative research by Kauppi, Proos and Olausson was published in the January 2018 issue of Nursing in Critical Care.

Background:  Intensive care unit (ICU) discharges are challenging practices that carry risks for patients. Despite the existing body of knowledge, there are still difficulties in clinical practice concerning unplanned ICU discharges, specifically where there is no step-down unit.

Aims and Objectives:  The aim of this study was to explore general ward nurses’ experiences of caring for patients being discharged from an ICU.

Design and Methods:  Data were collected from focus groups and in-depth interviews with a total of 16 nurses from three different hospitals in Sweden. An inductive qualitative design was chosen.

Findings:  The analysis revealed three themes that reflect the challenges in nursing former ICU patients: a vulnerable patient, nurses’ powerlessness and organizational structure. The nurses described the challenge of nursing a fragile patient based on several aspects. They expressed feeling unrealistic demands when caring for a fragile former ICU patient. The demands were related to their own profession and knowledge regarding how to care for this group of patients. The organizational structure had an impact on how the nurses’ caring practice could be realized. This evoked ethical concerns that the nurses had to cope with as the organization’s care guidelines did not always favour the patients.

Conclusions:  The structure of the organization and its leadership appear to have a significant impact on the nurses’ ability to offer patients the care they need.

Relevance to Clinical Practice:  This study sheds light on the need for extended outreach services and intermediate care in order to meet the needs of patients after the intensive care period.

Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Critical Care Reviews Newsletter 320 28th January 2018

The Critical Care Reviews Newsletter, bringing you the best critical care research and open access articles from across the medical literature over the past seven days.  This week’s issue is packed full of great articles, including randomised controlled trials investigating antibiotic cycling and mixing on antibiotic resistance, ventilation in abdominal surgery and thrombectomy for stroke at 6 to 16 hours; observational studies on acute myocardial infarction after influenza infection, PEEP

 

and paediatric ARDS mortality and ECMO in paediatric acute respiratory failure; an AHA/ASA guideline on acute ischemic stroke and narrative reviews on hepatorenal syndrome, long-term outcome after ARDS and reperfusion therapy in acute ischemic stroke.

The full copy of newsletter 320 28^th January 2018 can be accessed via this link.

Stool cultures at the ICU: get rid of it!

This research by Manthey and colleagues was published in Annals of Intensive Care January 2018 issue.

Background:  Stool cultures for Campylobacter, Salmonella and Shigella and/or Yersinia spp. are frequently ordered in critically ill patients with diarrhea. The aim of this study is to analyze the diagnostic yield in a large cohort of critically ill patients. Therefore, we performed a cohort study at the Department of Intensive Care Medicine of a University Hospital (11 ICUs).

Results:  From all patients who were admitted to the ICU between 2010 and 2015, stool cultures were taken from 2.189/36.477 (6%) patients due to diarrhea. Results of all stool cultures tested for Campylobacter, Salmonella and Shigella and/or Yersinia spp. were analyzed. Overall, 5.747 tests were performed; only six were positive (0.1%). In four of these, Campylobacter spp. were detected; diarrhea started within 48 h after ICU admission. Two patients with Salmonella spp. detection were chronic shedders. On the contrary, testing for Clostridium difficile via GDH- and toxin A/B-EIA yielded positive results in 179/2209 (8.1%) tests and revealed 144/2.189 (6.6%) patients with clinically relevant C. difficile infection.

Conclusions:  Stool testing for enteric pathogens other than C. difficile should be avoided in ICU patients and is only reasonable when diarrhea commenced less than 48 h after hospital admission.

The full text of the article is available via this link.

Critical Care Reviews Newsletter 319 21st January 2018

This issue contains reaction to the Critical Care Reviews meeting held in Belfast particularly regarding the Adrenal trail.

Also included are links to a range of published research articles such as randomised controlled trials “Individualised perioperative open lung approach versus standard protective ventilation in abdominal surgery (iPROVE)” and secondary research such as “Oxygen Therapy in patients with acute myocardial infarction: a systematic review and meta-analysis”

The full copy of newsletter 319 21^st January 2018 can be accessed via this link.

Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

This article by Han et al was published in the Japan Journal of Nursing Science in December 2017.
Aim:  To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units.Methods:  A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared.

Results:  After education, there was a significant improvement in the nurses’ self-efficacy and clinical performance in emergency airway management situations.
Conclusion:  Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education.
Rotherham Foundation Trust Library members can order the full text of journal articles via our website using the article requests online via this link.

Critical Care Reviews Newsletter 318 14th January 2018

This issue contains information about the Critical Care Reviews meeting being held in Belfast including how to access videos of the presentations if you are not attending.

Also included are links to a range of published research articles including randomised controlled trials such as “Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery” and  observational research such as “Mechanical Ventilation–induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes”.  There are also links to new guidelines including the “European Resuscitation Council Guidelines for Resuscitation”.

The full copy of newsletter 318 14^th January 2018 can be accessed via this link.

Intensive Care Medicine Volume 44 Number 1 January 2018

To view Intensive Care Medicine’s January issue’s contents page follow this link.

This issue includes a range of articles including secondary research such as “Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomised trials” and original research such as “Prevention of hospital infections by intervention and training (PROHIBIT): results of a pan-European cluster-randomized multicentre study to reduce central venous catheter-related bloodstream infections”.

 

To read the full text of any of these articles via the journal’s homepage requires a personal subscription to “Intensive Care Medicine”.  Individual articles can be ordered from the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

The full text of articles from issues older than one year ago is available via this link to an archive of issues of Intensive Care Medicine.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

This article by Han et al was published in the Japan Journal of Nursing Science in December 2017.
Aim:  To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units.
Methods:  A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared.
Results:  After education, there was a significant improvement in the nurses’ self-efficacy and clinical performance in emergency airway management situations.
Conclusion:  Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education.
Library members can order the full text of journal articles via our website using the article requests online via this link.

Effect of Standardized Handoff Curriculum on Improved Clinician Preparedness in the Intensive Care Unit: A Stepped-Wedge Cluster Randomized Clinical Trial

This RCT was by Parent et al was published in the January 2018 issue of JAMA surgery.
Importance:  Clinician miscommunication contributes to an estimated 250 000 deaths in US hospitals per year. Efforts to standardize handoff communication may reduce errors and improve patient safety.
Objective:  To determine the effect of a standardized handoff curriculum, UW-IPASS, on inter clinician communication and patient outcomes.
Design, Setting, and Participants:  This cluster randomized stepped-wedge randomized clinical trial was conducted from October 2015 to May 2016 at 8 medical and surgical intensive care units at 2 hospital systems within an academic tertiary referral centre. Participants included residents, fellows, advance-practice clinicians, and attending physicians (n = 106 clinicians, with 1488 handoff events over 8 months) and data were collected from daily text message-based surveys and patient medical records.
Exposures:  The UW-IPASS standardized handoff curriculum.
Main Outcomes and Measures:  The primary aim was to assess the effect of the UW-IPASS handoff curriculum on perceived adequacy of inter clinician communication. Patient days of mechanical ventilation, intensive care unit length of stay, reintubations within 24 hours, and order workflow patterns were also analysed. Mixed-effects logistic regression was used to compute odds ratios and confidence intervals with adjustment for location, time period, and clinician.
Results:  A total of 63 residents and advance practice clinicians, 13 fellows, and 30 attending physicians participated in the study. During the control period, clinicians reported being unprepared for their shift because of a poor-quality handoff in 35 of 343 handoffs (10.2%), while UW-IPASS-period residents reported being unprepared in 53 of 740 handoffs (7.2%) (odds ratio, 0.19; 95% CI, 0.03-0.74; P = .03). Compared with the control phase, the perceived duration of handoffs among clinicians using UW-IPASS was unchanged (+5.5 minutes; 95% CI, 0.34-9.39; P = .30). Early morning order entry decreased from 106 per 100 patient-days in the control phase to 78 per 100 patient-days in the intervention period (-28 orders; 95% CI, -55 to -4; P = .04). Overall, UW-IPASS was not associated with any changes in intensive care unit length of stay, duration of mechanical ventilation, or the number of reintubations.
Conclusions and Relevance:  The UW-IPASS standardized handoff curriculum was perceived to improve intensive care provider preparedness and workflow. IPASS-based curricula represent an important step forward in communication standardization efforts and may help reduce communication errors and omissions.
Library members can order the full text of journal articles via our website using the article requests online via this link.

Critical Care Reviews Newsletter 317 January 2018

This issue contains the final details of the Critical Care Reviews meeting to be held in Belfast next week including information on a number of the trials to be presented.  It also includes links to a research published in journals such as “Effect of pre-oxygenation using non-invasive ventilation before intubation on subsequent organ failures in hypoxaemic patients: a randomized clinical trial” and “The efficacy and adverse effects of buprenorphine in acute pain management: a systematic review and meta-analysis of randomised controlled trials.”
The full copy of newsletter 317 January 2018 can be accessed via this link.