Intensive care nurses fail to translate knowledge and skills into practice – A mixed-methods study on perceptions of oral care

This research by Andersson et al was published in “Intensive and Critical Care Nursing” October 2018 issue.
Objectives:  To identify intensive care nurses’ perceptions of oral care according to Coker et al.’s (2013) conceptual framework and to contribute to the knowledge base of oral care in intensive care.
Design/Methods:  This was a concurrent embedded mixed-methods design, with more weight given to the quantitative part. Participants responded to the Nursing Care related to Oral Health questionnaire, including perceptions of oral care antecedents (18 items), defining attributes (17 items), and consequences (6 items) and two open-ended questions. The data were analysed with descriptive and correlation statistics and qualitative content analysis.
Setting:  Intensive care nurses (n = 88) in six general intensive care units.
Results:  Intensive care nurses perceived that an important part of nursing care was oral care, especially to intubated patients. They perceived that the nursing staff was competent in oral care skills and had access to different kinds of equipment and supplies to provide oral care. The oral cavity was inspected on a daily basis, mostly without the use of any assessment instruments. Oral care seemed to be task-oriented, and documentation of the patients’ experiences of the oral care process was rare.
Conclusions:  The antecedents, knowledge and skills are available to provide quality oral care, but intensive care nurses seem to have difficulties translating these components into practice. Thus they might have to shift their task-oriented approach towards oral care to a more person-centred approach in order to be able to meet patients’ needs.
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Dexmedetomidine in prevention and treatment of postoperative and intensive care unit delirium: a systematic review and meta-analysis

This article by Flukiger et al was published in Annals of intensive care September 2018.
Background:  To determine the preventive and therapeutic effect of dexmedetomidine on intensive care unit (ICU) delirium.
Methods:  The literature search using PubMed and the Cochrane Central Register of Controlled Trials was performed (August 1, 2018) to detect all randomized controlled trials (RCTs) of adult ICU patients receiving dexmedetomidine. Articles were included if they assessed the influence of dexmedetomidine compared to a sedative agent on incidence of ICU delirium or treatment of this syndrome. Accordingly, relevant articles were allocated to the following two groups: (1) articles that assessed the delirium incidence (incidence comparison) or articles that assessed the treatment of delirium (treatment comparison). Incidence of delirium and delirium resolution were the primary outcomes. We combined treatment effects comparing dexmedetomidine versus (1) placebo, (2) standard sedatives, and (3) opioids in random-effects meta-analyses. Risk of bias for each included RCT was assessed following Cochrane standards.
Results:  The literature search resulted in 28 articles (25 articles/4975 patients for the incidence comparison and three articles/166 patients for the treatment comparison). In the incidence comparison, heterogeneity was present in different subgroups. Administration of dexmedetomidine was associated with significantly lower overall incidence of delirium when compared to placebo (RR 0.52; 95% CI 0.39-0.70; I2 = 37%), standard sedatives (RR 0.63; 95% CI 0.46-0.86; I2 = 69%), as well as to opioids (RR 0.61; 95% CI 0.44-0.83; I2 = 0%). Use of dexmedetomidine significantly increased the risks of bradycardia and hypotension. Limited data were available on circulatory insufficiency and mortality. In the treatment comparison, the comparison drugs in the three RCTs were placebo, midazolam, and haloperidol. The resolution of delirium was measured differently in each study. Two out of the three studies indicated clear favorable effects for dexmedetomidine (i.e., compared to placebo and midazolam). The study comparing dexmedetomidine with haloperidol was a pilot study (n = 20) with high variability in the results.
Conclusions:  Findings suggest that dexmedetomidine reduces incidence and duration of ICU delirium. Furthermore, our systematic searches show that there is limited evidence if a delirium shall be treated with dexmedetomidine.
The full text of the article is available via this link.

Strengthening workplace well-being: perceptions of intensive care nurses

This article by Jarden et al was published in the September 2018 issue of Nursing in Critical Care.
Background:  Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses’ ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses’ workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective.
Aims and Objectives:  Identify intensive care nurses’ perspectives of strategies that strengthen their workplace well-being.
Design:  An inductive descriptive qualitative approach was used to explore intensive care nurses’ perspectives of strengthening work well-being.
Method:  New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being.
Findings:  Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems’ strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other.
Conclusions:  Strengtheners of intensive care nurses’ workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses’ identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change.
Relevance to clinical practice:  Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.
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Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses’ and ward nurses’.

This article was published in “Intensive and Critical Care Nursing” September 2018 issue by Haggstrom and colleagues.
Objective:  The aim of this study was to describe critical care nurses’ and ward nurses’ perceptions of the benefits and challenges with a nurse-led follow-up service for intensive care-survivors at general wards.
Background:  Patients recently transferred from intensive care to the general ward are still vulnerable and require complex care. There are different models of intensive care follow-up services and some include ward visits after transfer from intensive care. Research methodology/design: This study had a qualitative design. Data from 13 semi-structured interviews with Swedish critical care nurses and ward nurses were analysed using qualitative content analysis.
Findings:  The findings consisted of one theme, namely, “Being a part of an intra-organisational collaboration for improved quality of care”, and four subthemes: “Provides additional care for the vulnerable patients, “Strengthens ward-based critical care”, “Requires coordination and information”, and “Creates an exchange of knowledge”. The nurse-led follow-up service detected signs of deterioration and led to better quality of care. However, shortage of time, lack of interaction, feedback and information about the function of the follow-up service led to problems.
Conclusion:  The findings indicate that ward visits should be included in the intensive care follow-up service. Furthermore, intra-organisational collaboration seems to be essential for intensive care survivors’ quality of care.
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Critical Care Reviews Newsletter 354 23rd September 2018

Critical Care Reviews Newsletter brings you the best critical care research and open access articles from across the medical literature during the last week.
The 354th issue includes “randomised controlled trials on over sedation prevention in ventilated critically ill patients & endotracheal tube-mounted camera-assisted intubation; systematic reviews and meta analyses on selective digestive and oropharyngeal decontamination & adjunctive corticosteroids in septic shock; and an observational study on upper airway virus detection in critically ill haematology patients. There is also another protocol from Critical Care Horizons, this time for the Role of Active De-resuscitation After Resuscitation-2 (RADAR-2) study, plus guidelines on targeted temperature management & control of confounding and reporting of results in causal inference studies; narrative reviews on VA ECMO for cardiogenic shock and cardiac arrest, should we prescribe more protein to critically ill patients, & searching for dysregulation in sepsis.”
The full text of the newsletter is available via this link.

“Intensive Care Medicine” Volume 44 Number 9 September 2018

“Intensive Care Medicine” is a publication for the communication and exchange of current work and ideas in intensive care medicine.  To access the latest issue’s contents page follow this link.
intensive-care-medicineArticles in this edition include “Factors associated with health-related quality of life 6 years after ICU discharge in a Finnish paediatric population: a cohort study” and “Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study”.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal.  Some articles may be available freely without a password.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the 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.

High-flow nasal cannula oxygen therapy alone or with non-invasive ventilation during the weaning period after extubation in ICU: the prospective randomised controlled HIGH-WEAN protocol

This article by Thille and colleagues as part of the REVA research network was published in BMJ Open in September 2018.
Introduction:  Recent practice guidelines suggest applying non-invasive ventilation (NIV) to prevent postextubation respiratory failure in patients at high risk of extubation failure in intensive care unit (ICU). However, such prophylactic NIV has been only a conditional recommendation given the low certainty of evidence. Likewise, high-flow nasal cannula (HFNC) oxygen therapy has been shown to reduce reintubation rates as compared with standard oxygen and to be as efficient as NIV in patients at high risk. Whereas HFNC may be considered as an optimal therapy during the postextubation period, HFNC associated with NIV could be an additional means of preventing postextubation respiratory failure. We are hypothesising that treatment associating NIV with HFNC between NIV sessions may be more effective than HFNC alone and may reduce the reintubation rate in patients at high risk.
Methods and Analysis:  This study is an investigator-initiated, multicentre randomised controlled trial comparing HFNC alone or with NIV sessions during the postextubation period in patients at high risk of extubation failure in the ICU. Six hundred patients will be randomised with a 1:1 ratio in two groups according to the strategy of oxygenation after extubation. The primary outcome is the reintubation rate within the 7 days following planned extubation. Secondary outcomes include the number of patients who meet the criteria for moderate/severe respiratory failure, ICU length of stay and mortality up to day 90.
Ethics and Dissemination: The study has been approved by the ethics committee and patients will be included after informed consent. The results will be submitted for publication in peer-reviewed journals.
The full text of this article is freely available via this link.