Information or education interventions for adult intensive care unit (ICU) patients and their carers

This research by Lewis and colleagues was published in the Cochrane database of systematic reviews in October 2018.
Backgcochrane-57-1round:  During intensive care unit (ICU) admission, patients and their carers experience physical and psychological stressors that may result in psychological conditions including anxiety, depression, and post-traumatic stress disorder (PTSD). Improving communication between healthcare professionals, patients, and their carers may alleviate these disorders. Communication may include information or educational interventions, in different formats, aiming to improve knowledge of the prognosis, treatment, or anticipated challenges after ICU discharge.
Objectives:  To assess the effects of information or education interventions for improving outcomes in adult ICU patients and their carers.
Search Methods:  We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO from database inception to 10 April 2017. We searched clinical trials registries and grey literature, and hand searched reference lists of included studies and related reviews.
Selection Criteria:  We included randomised controlled trials (RCTs), and planned to include quasi-RCTs, comparing information or education interventions presented to participants versus no information or education interventions, or comparing information or education interventions as part of a complex intervention versus a complex intervention without information or education. We included participants who were adult ICU patients, or their carers; these included relatives and non-relatives, including significant representatives of patients.
Data Collection and Analysis:  Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and applied GRADE criteria to assess certainty of the evidence.
Main Results:  We included eight RCTs with 1157 patient participants and 943 carer participants. We found no quasi-RCTs. We identified seven studies that await classification, and three ongoing studies.  Three studies designed an intervention targeted at patients, four at carers, and one at both patients and carers. Studies included varied information: standardised or tailored, presented once or several times, and that included verbal or written information, audio recordings, multimedia information, and interactive information packs. Five studies reported robust methods of randomisation and allocation concealment. We noted high attrition rates in five studies. It was not feasible to blind participants, and we rated all studies as at high risk of performance bias, and at unclear risk of detection bias because most outcomes required self reporting.  We attempted to pool data statistically, however this was not always possible due to high levels of heterogeneity. We calculated mean differences (MDs) using data reported from individual study authors where possible, and narratively synthesised the results. We reported the following two comparisons.  Information or education intervention versus no information or education intervention (4 studies)For patient anxiety, we did not pool data from three studies (332 participants) owing to unexplained substantial statistical heterogeneity and possible clinical or methodological differences between studies. One study reported less anxiety when an intervention was used (MD -3.20, 95% confidence interval (CI) -3.38 to -3.02), and two studies reported little or no difference between groups (MD -0.40, 95% CI -4.75 to 3.95; MD -1.00, 95% CI -2.94 to 0.94). Similarly, for patient depression, we did not pool data from two studies (160 patient participants). These studies reported less depression when an information or education intervention was used (MD -2.90, 95% CI -4.00 to -1.80; MD -1.27, 95% CI -1.47 to -1.07). However, it is uncertain whether information or education interventions reduce patient anxiety or depression due to very low-certainty evidence.  It is uncertain whether information or education interventions improve health-related quality of life due to very low-certainty evidence from one study reporting little or no difference between intervention groups (MD -1.30, 95% CI -4.99 to 2.39; 143 patient participants). No study reported adverse effects, knowledge acquisition, PTSD severity, or patient or carer satisfaction.  We used the GRADE approach and downgraded certainty of the evidence owing to study limitations, inconsistencies between results, and limited data from few small studies.  Information or education intervention as part of a complex intervention versus a complex intervention without information or education (4 studies)One study (three comparison groups; 38 participants) reported little or no difference between groups in patient anxiety (tailored information pack versus control: MD 0.09, 95% CI -3.29 to 3.47; standardised general ICU information versus control: MD -0.25, 95% CI -4.34 to 3.84), and little or no difference in patient depression (tailored information pack versus control: MD -1.26, 95% CI -4.48 to 1.96; standardised general ICU information versus control: MD -1.47, 95% CI -6.37 to 3.43). It is uncertain whether information or education interventions as part of a complex intervention reduce patient anxiety and depression due to very low-certainty evidence.  One study (175 carer participants) reported fewer carer participants with poor comprehension among those given information (risk ratio 0.28, 95% CI 0.15 to 0.53), but again this finding is uncertain due to very low-certainty evidence.  Two studies (487 carer participants) reported little or no difference in carer satisfaction; it is uncertain whether information or education interventions as part of a complex intervention increase carer satisfaction due to very low-certainty evidence. Adverse effects were reported in only one study: one participant withdrew because of deterioration in mental health on completion of anxiety and depression questionnaires, but the study authors did not report whether this participant was from the intervention or comparison group.  We downgraded certainty of the evidence owing to study limitations, and limited data from few small studies.  No studies reported severity of PTSD, or health-related quality of life.
Authors’ Conclusions:  We are uncertain of the effects of information or education interventions given to adult ICU patients and their carers, as the evidence in all cases was of very low certainty, and our confidence in the evidence was limited.  Ongoing studies may contribute more data and introduce more certainty when incorporated into future updates of the review.
The full text of this Cochrane Review is freely available via this link to the Cochrane Database of Systematic Reviews.

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Implementing an educational program to improve critical care nurses’ enteral nutritional support

This research by Kim and Chang was published in “Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses” in May 2018.
Background:  Although international nutrition societies recommend enteral nutrition guidelines for patients in intensive care units (ICUs), large gaps exist between these recommendations and actual clinical practice. Education programs designed to improve nurses’ knowledge about enteral nutrition are therefore required. In Korea, there are no educational intervention studies about evidence-based guidelines of enteral nutrition for critically ill patients.
Objectives:  We aimed to evaluate the effects of an education program to improve critical care nurses’ perceptions, knowledge, and practices towards providing enteral nutritional support for ICU patients.
Methods:  A quasi-experimental, one-group study with a pre- and post-test design was conducted from March to April 2015. Nurses (N = 205) were recruited from nine ICUs from four tertiary hospitals in South Korea. The education program comprised two sessions of didactic lectures. Data were collected before (pre-test) and 1 month after (post-test) the education program using questionnaires that addressed nurses’ perceptions, knowledge, and practices relating to providing enteral nutritional support for ICU patients.
Results:  After the program, nurses showed a significant improvement in their perceptions and knowledge of enteral nutrition for ICU patients. There was a significant improvement in inspecting nostrils daily, flushing the feeding tube before administration, providing medication that needs to be crushed correctly, changing feeding sets, and adjusting feeding schedules.
Conclusions:  The findings indicate that an enteral nutrition education program could be an effective strategy to increase critical care nurses’ support for the critically ill. This education program can be incorporated into hospital education or in-service training for critical care nurses to strengthen their perceptions and knowledge of nutritional support in the ICU. This may improve the clinical outcomes of ICU patients.
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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 theoxygen-502887_960_720 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.
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Controlling catheter-related bloodstream infections through a multicentre educational programme for intensive care units

This paper was published in the Journal of Hospital Infection August issue by Musu and colleagues.

Background:  Bloodstream infections (BSIs) associated with insertion and maintenance of central venous catheters (CR-BSIs) are the most common causes of health care-associated infections in intensive care units (ICUs). They are responsible for increased length of hospital stay and additional health care costs.

Aim:  To investigate whether an educational program addressed at healthcare workers resulted in a significant change in the level and trend of infections.

Methods:  The research was conducted in five Italian ICUs from July 2012 to August 2014. Surveillance and educational interventions to control infections were applied. Compliance with hand hygiene (HH) procedures was assessed via risk relative analysis and 95% interval confidence. Interrupted time series analysis was used to investigate the change in level and trend of infection during the intervention.

Results:  Compliance with HH procedures improved during the intervention for all staff groups, but physicians showed the lowest compliance rates (nurses from 52.4% to 92.1%; nurse aides from 71.0% to 92%; physicians from 71.0% to 92%, p< 0.001). Significant reductions of 21% to 55% in the CR-BSI were observed during the intervention. Small improvements in the monthly infection trend were also observed, but these were not statistically significant.

Conclusions:  An educational programme focussing on general good infection control practice, rather than CVC care bundles resulted in a decreased CR-BSI rate, even if the improvement was not sustained over time. Continuous performance feedback should be provided to promote long-term adherence to guidelines among all health workers.

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Developing a trauma care syllabus for intensive care nurses in the United Kingdom: A Delphi study

Whiting, D. & Cole, E. Intensive and Critical Care Nursing. Published online: 2 May 2016

educational-773651_960_720Background: Increased rates of mortality in the intensive care unit (ICU) following injury have been associated with a lack of trauma specific training. Despite this, training relevant to nurses is limited. Currently, little consideration has been given to understanding the potential training needs of ICU nurses in caring for critically injured patients.

Objectives: The aim of this study was to construct a consensus syllabus of trauma care for registered nurses working in an intensive care setting.

Design: A two round modified Delphi was conducted.

Methods: Twenty-eight intensive care professionals participated in the study in 2014 in the United Kingdom. Data were analysed using content and descriptive statistics.

Results: Round-1 generated 343 subjects. Following analysis these were categorised into 75 subjects and returned to the panel for rating. An 82% (23/28) response rate to round-2 identified high consensus (equal to or greater than 80%) in 55 subjects, which reflected the most severely injured patients needs.

Conclusions: There is a requirement for specific training to prepare the ICU nurse for caring for the critically injured patient. This survey presents a potential core syllabus in trauma care and should be considered by educators to develop a meaningful programme of trauma education for ICU nurses.

Read the abstract here