Nursing Care in the ICU

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Critical Care".

Deadline for manuscript submissions: 30 June 2024 | Viewed by 11126

Special Issue Editor

Heraklion University Hospital, 71110 Heraklion, Greece
Interests: critical care; intensive care; sleep medicine; nursing/sleep in ICU

Special Issue Information

Dear Colleagues,

The ICU environment is challenging for both patients and staff. The management of critically ill patients is extremely demanding, and the workload and knowledge level required of staff are high. ICU nurses are responsible for the care and treatment of patients in an unstable and/or critical clinical situation, assessing therapies and high-intensity interventions. ICU nursing practice includes crucial clinical decisions based on the best available scientific evidence, clinical experience and patient preferences. ICU nurses carry out specific, autonomous or complementary interventions of a technical–scientific, managerial, relational and educational nature; plan healthcare assistance through scientifically validated tools; and identify, analyze, calculate and treat risks related to care provision by systematically evaluating healthcare outcomes.

This Special Issue of Healthcare is dedicated to offering an overview of these activities. Topics that will be included are:

  • Nursing care protocols (sedation, pain, nutrition etc.);
  • Delirium;
  • Sleep;
  • Infections;
  • Pressure ulcers;
  • Mobilization;
  • Recording;
  • Relatives;
  • Oncology ICU patients;
  • Elderly patients.

Groups from all specialties are encouraged to submit original research, project reports, short reports, reviews, and opinion papers.

Dr. Christina Alexopoulou
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ICU nursing
  • critical care
  • intensive care
  • delirium
  • sleep
  • infections
  • pressure ulcers mobilization
  • recording
  • relatives
  • oncology ICU patient
  • elderly patient

Published Papers (10 papers)

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Research

Jump to: Review, Other

13 pages, 471 KiB  
Article
Blood Transfusion Procedure: Assessment of Serbian Intensive Care Nurses’ Knowledge
by Dragana Simin, Vladimir Dolinaj, Branislava Brestovački Svitlica, Jasmina Grujić, Dragana Živković and Dragana Milutinović
Healthcare 2024, 12(7), 720; https://doi.org/10.3390/healthcare12070720 - 25 Mar 2024
Viewed by 339
Abstract
Many patients require administering one or more blood components during hospitalisation in the Intensive Care Unit (ICU). Therefore, nurses’ knowledge of who is responsible for immediately administering blood transfusions, monitoring patients, and identifying and managing transfusion reactions is crucial. This cross-sectional descriptive-analytical study [...] Read more.
Many patients require administering one or more blood components during hospitalisation in the Intensive Care Unit (ICU). Therefore, nurses’ knowledge of who is responsible for immediately administering blood transfusions, monitoring patients, and identifying and managing transfusion reactions is crucial. This cross-sectional descriptive-analytical study aimed to assess the knowledge of ICU nurses in tertiary healthcare institutions about blood transfusion procedures. The questionnaire about the transfusion procedure was designed and reviewed by experts. The questionnaire consisted of 29 items divided into three domains. The scores on the knowledge test ranged from 10 to 27. Generally, 57.7% of nurses had moderate, 23.4% low, and 18.9% high levels of knowledge about the transfusion procedure. Most nurses answered correctly about refreezing fresh frozen plasma, verifying the transfusion product, and identifying the patient. Of the nurses, 91.0% would recognise mild allergic reactions, and 98.2% knew about the supervision of sedated patients. Nurses showed poor knowledge of the length of usage of the same transfusion system for red blood cells, labelling, and transfusion administration in febrile patients. Nurses with higher education and longer working experience had significantly better outcomes (p = 0.000) on the knowledge test. Continuous education of ICU nurses on safe transfusion usage is recommended. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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18 pages, 1127 KiB  
Article
Personality Traits, Burnout, and Psychopathology in Healthcare Professionals in Intensive Care Units—A Moderated Analysis
by Varvara Pakou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva and Vasilios Koulouras
Healthcare 2024, 12(5), 587; https://doi.org/10.3390/healthcare12050587 - 04 Mar 2024
Viewed by 909
Abstract
This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5–10 [...] Read more.
This study explored the associations between personality dimensions, burnout, and psychopathology in healthcare professionals in intensive care units (ICUs). This study further aimed to discern the differences in these relationships when considering the variables of critical care experience (less than 5 years, 5–10 years, and more than 10 years), profession (nurses versus intensivists), and the urban size of the city where the ICU is located (metropolitan cities versus smaller urban cities). This cross-sectional investigation’s outcomes are based on data from 503 ICU personnel, including 155 intensivists and 348 nurses, in 31 ICU departments in Greece. Participants underwent a comprehensive assessment involving a sociodemographic questionnaire, the Eysenck Personality Questionnaire (EPQ), the Maslach Burnout Inventory (MBI), and the Symptom Checklist-90 (SCL-90). To analyze the interplay among critical care experience, burnout status, and psychopathology, a moderation analysis was conducted with personality dimensions (i.e., psychoticism, extraversion, and neuroticism) serving as the mediator variable. Profession and the urban size of the ICU location were considered as moderators influencing these relationships. Male healthcare professionals showed higher psychoticism levels than females, aligning with prior research. Experienced nurses reported lower personal achievement, hinting at potential motivation challenges for professional growth. Psychoticism predicted high depersonalization and low personal achievement. Neuroticism and psychoticism negatively impacted ICU personnel’s mental well-being, reflected in elevated psychopathology scores and burnout status. Psychoticism appears to be the primary factor influencing burnout among the three personality dimensions, particularly affecting intensivists. In contrast, nurses are more influenced by their critical care experience on their mental health status. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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11 pages, 1376 KiB  
Article
Reduction in the Incidence Density of Pressure Injuries in Intensive Care Units after Advance Preventive Protocols
by Ru-Yu Lien, Chien-Ying Wang, Shih-Hsin Hung, Shu-Fen Lu, Wen-Ju Yang, Shu-I Chin, Dung-Hung Chiang, Hui-Chen Lin, Chun-Gu Cheng and Chun-An Cheng
Healthcare 2023, 11(15), 2116; https://doi.org/10.3390/healthcare11152116 - 25 Jul 2023
Cited by 1 | Viewed by 1210
Abstract
(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce [...] Read more.
(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014–2016) and post-bundle (2017–2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149–0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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11 pages, 443 KiB  
Article
Impact of Care Interventions on the Survival of Patients with Cardiac Chest Pain
by Silmara Meneguin, Camila Fernandes Pollo, Murillo Fernando Jolo, Maria Marcia Pereira Sartori, José Fausto de Morais and Cesar de Oliveira
Healthcare 2023, 11(12), 1734; https://doi.org/10.3390/healthcare11121734 - 13 Jun 2023
Viewed by 785
Abstract
Background: Chest pain is considered the second most frequent complaint among patients seeking emergency services. However, there is limited information in the literature about how the care provided to patients with chest pain, when being attended to in the emergency room, influences their [...] Read more.
Background: Chest pain is considered the second most frequent complaint among patients seeking emergency services. However, there is limited information in the literature about how the care provided to patients with chest pain, when being attended to in the emergency room, influences their clinical outcomes. Aims: To assess the relationship between care interventions performed on patients with cardiac chest pain and their immediate and late clinical outcomes and to identify which care interventions were essential to survival. Methods: In this retrospective study. We analyzed 153 medical records of patients presenting with chest pain at an emergency service center, São Paulo, Brazil. Participants were divided into two groups: (G1) remained hospitalized for a maximum of 24 h and (G2) remained hospitalized for between 25 h and 30 days. Results: Most of the participants were male 99 (64.7%), with a mean age of 63.2 years. The interventions central venous catheter, non-invasive blood pressure monitoring, pulse oximetry, and monitoring peripheral perfusion were commonly associated with survival at 24 h and 30 days. Advanced cardiovascular life support and basic support life (p = 0.0145; OR = 8053; 95% CI = 1385–46,833), blood transfusion (p < 0.0077; OR = 34,367; 95% CI = 6489–182,106), central venous catheter (p < 0.0001; OR = 7.69: 95% CI 1853–31,905), and monitoring peripheral perfusion (p < 0.0001; OR = 6835; 95% CI 1349–34,634) were independently associated with survival at 30 days by Cox Regression. Conclusions: Even though there have been many technological advances over the past decades, this study demonstrated that immediate and long-term survival depended on interventions received in an emergency room for many patients. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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10 pages, 477 KiB  
Article
Development and Validation of the CVP Score: A Cross-Sectional Study in Greece
by Konstantinos Giakoumidakis, Athina Patelarou, Anastasia A. Chatziefstratiou, Michail Zografakis-Sfakianakis, Nikolaos V. Fotos and Evridiki Patelarou
Healthcare 2023, 11(11), 1543; https://doi.org/10.3390/healthcare11111543 - 25 May 2023
Viewed by 890
Abstract
Although central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to [...] Read more.
Although central venous pressure (CVP) is among the most frequent estimated hemodynamic parameters in the critically ill setting, extremely little is known on how intensive care unit (ICU) nurses use this index in their decision-making process. The purpose of the study was to develop a new questionnaire for accessing how ICU nurses use CVP measurements to address patients’ hemodynamics investigating its validity and reliability. A cross-sectional study was conducted among 120 ICU nurses from four ICUs of Greece. Based on a comprehensive literature review and the evaluation by a panel of five experts, a new questionnaire, named “CVP Score”, was created, having eight items. The construct validity and the reliability of the questionnaire were examined. Half of the study participants (51.7%) worked at a specialized ICU, and they had a mean [±Standard Deviation (SD)] ICU experience of 13(±7.1) years. The estimated construct validity of the newly developed tool was acceptable, while the internal consistency reliability as measured by Cronbach alpha was excellent (0.901). CVP Score had acceptable test–retest reliability (r = 0.996, p < 0.001) and split-half reliability (0.855). The CVP score is a valid and reliable instrument for measuring how critical care nurses use CVP measurements in their decision-making process. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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11 pages, 1336 KiB  
Article
Quality of Life and Family Support in Critically Ill Patients following ICU Discharge
by Konstantina Avgeri, Epaminondas Zakynthinos, Vasiliki Tsolaki, Markos Sgantzos, George Fotakopoulos and Demosthenes Makris
Healthcare 2023, 11(8), 1106; https://doi.org/10.3390/healthcare11081106 - 12 Apr 2023
Cited by 2 | Viewed by 1226
Abstract
Background: Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. Objectives: To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role [...] Read more.
Background: Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. Objectives: To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role of support by family members and friends. Methods: This prospective study was conducted in the University Hospital of Larissa Greece between 2020 and 2021. Patients hospitalized at the ICU for at least 48 h were included and assessed at hospital discharge, at 3 and at 12 months later. The research implements of the study were a dedicated questionnaire and the SF-36 health questionnaire for the appraisal of the QoL. Lung function changes were assessed by spirometry and physical performance by the 6-min walking test (6MWT). Results: One hundred and forty-three participants were included in the study. The mean (SD) of the physical and mental health SF-36 scores at hospital discharge, 3 and 12 months were 27.32 (19.59), 40.97 (26.34) and 50.78 (28.26) (p < 0.0001) and 42.93 (17.00), 55.19 (23.04) and 62.24 (23.66), (p < 0.0001), respectively. The forced expiratory volume in one second and 6MWT significantly improved over 12 months. Patients who were supported by two or more family members or patients who were visited by their friends >3 times/week presented better scores in the physical and mental SF36 domains at 12 months. Conclusion: This study shows that the quality of life of Greek patients who were discharged from the ICU can be positively affected both by the support they receive from their family environment and friends. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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12 pages, 902 KiB  
Article
Agreement between Family Members and the Physician’s View in the ICU Environment: Personal Experience as a Factor Influencing Attitudes towards Corresponding Hypothetical Situations
by Paraskevi Stamou, Dimitrios Tsartsalis, Georgios Papathanakos, Elena Dragioti, Mary Gouva and Vasilios Koulouras
Healthcare 2023, 11(3), 345; https://doi.org/10.3390/healthcare11030345 - 25 Jan 2023
Cited by 1 | Viewed by 1074
Abstract
Background: It is not known whether intensive care unit (ICU) patients’ family members realistically assess patients’ health status. Objectives: The aim was to investigate the agreement between family and intensivists’ assessment concerning changes in patient health, focusing on family members’ resilience and their [...] Read more.
Background: It is not known whether intensive care unit (ICU) patients’ family members realistically assess patients’ health status. Objectives: The aim was to investigate the agreement between family and intensivists’ assessment concerning changes in patient health, focusing on family members’ resilience and their perceptions of decision making. Methods: For each ICU patient, withdrawal criteria were assessed by intensivists while family members assessed the patient’s health development and completed the Connor–Davidson Resilience Scale and the Self-Compassion Scale. Six months after ICU discharge, follow-up contact was established, and family members gave their responses to two hypothetical scenarios. Results: 162 ICU patients and 189 family members were recruited. Intensivists’ decisions about whether a patient met the withdrawal criteria had 75,9% accuracy for prediction of survival. Families’ assessments were statistically independent of intensivists’ opinions, and resilience had a significant positive effect on the probability of agreement with intensivists. Six months after discharge, family members whose relatives were still alive were significantly more likely to consider that the family or patient themselves should be involved in decision-making. Conclusions: Resilience is related to an enhanced probability of agreement of the family with intensivists’ perceptions of patients’ health progression. Family attitudes in hypothetical scenarios were found to be significantly affected by the patient’s actual health progression. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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13 pages, 807 KiB  
Article
Competency in ECG Interpretation and Arrhythmias Management among Critical Care Nurses in Saudi Arabia: A Cross Sectional Study
by Mohammed Saeed Aljohani
Healthcare 2022, 10(12), 2576; https://doi.org/10.3390/healthcare10122576 - 19 Dec 2022
Cited by 3 | Viewed by 2705
Abstract
Background: Electrographic interpretation skills are important for healthcare practitioners caring for patients in need of cardiac assessment. Competency in ECG interpretation skills is critical to determine any abnormalities and initiate the appropriate care required. The purpose of the study was to determine the [...] Read more.
Background: Electrographic interpretation skills are important for healthcare practitioners caring for patients in need of cardiac assessment. Competency in ECG interpretation skills is critical to determine any abnormalities and initiate the appropriate care required. The purpose of the study was to determine the level of competence in electrocardiographic interpretation and knowledge in arrhythmia management of nurses in critical care settings. Methods: A descriptive cross-sectional design was used. A convenience sample of 255 critical care nurses from 4 hospitals in the Al-Madinah Region in Saudi Arabia was used. A questionnaire was designed containing a participant’s characteristics and 10 questions with electrocardiographic strips. A pilot test was carried out to evaluate the validity and reliability of the questionnaire. Descriptive and bivariate analyses were conducted using an independent t-test, one-way ANOVA, or bi-variate correlation tests, as appropriate. A statistical significance of p < 0.05 was assumed. Results: Females comprised 87.5% of the sample, and the mean age of the sample was 32.1 (SD = 5.37) years. The majority of the participants (94.9%) had taken electrocardiographic interpretation training courses. The mean total score of correct answers of all 10 ECG strips was 6.45 (±2.54) for ECG interpretation and 4.76 (±2.52) for arrhythmia management. No significant differences were observed between ECG competency level and nursing experience or previous training. Nurses working in the ICU and CCU scored significantly higher than those working in ED. Conclusions: The electrocardiographic knowledge in ECG interpretation and arrhythmia management of critical care nurses is low. Therefore, improving critical care nurses’ knowledge of ECGs, identification, and management of cardiac arrhythmias is essential. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)

Review

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13 pages, 616 KiB  
Review
Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review
by Jéssica Moura Gabirro Fernando, Margarida Maria Gaio Marçal, Óscar Ramos Ferreira, Cleoneide Oliveira, Larissa Pedreira and Cristina Lavareda Baixinho
Healthcare 2024, 12(5), 545; https://doi.org/10.3390/healthcare12050545 - 25 Feb 2024
Viewed by 497
Abstract
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there [...] Read more.
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there are difficulties in adhering to and maintaining this therapy. The aim of this study is to identify nursing interventions for client and family training in the proper use of noninvasive ventilation in the transition from hospital to community. A scoping review was carried out by searching MEDLINE, CINAHL, Scopus, and Web of Science. The articles were selected by two independent reviewers by applying the predefined eligibility criteria. Regarding transitional care, the authors opted to include studies about interventions to train clients and families during hospital stay, hospital discharge, transition from hospital to home, and the first 30 days after returning home. The eight included publications allowed for identification of interventions related to masks or interfaces, prevention of complications associated with noninvasive ventilation, leakage control, maintenance and cleaning of ventilators and accessories, respiratory training, ventilator monitoring, communication, and behavioral strategies as transitional care priority interventions to guarantee proper training in the transition from hospital to community. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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Other

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11 pages, 1454 KiB  
Case Report
A Fatal Case of Presumptive Diagnosis of Leptospirosis Involving the Central Nervous System
by Christina Alexopoulou, Athanasia Proklou, Sofia Kokkini, Maria Raissaki, Ioannis Konstantinou and Eumorfia Kondili
Healthcare 2024, 12(5), 568; https://doi.org/10.3390/healthcare12050568 - 29 Feb 2024
Viewed by 493
Abstract
Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild [...] Read more.
Leptospirosis is a reemerging zooanthroponosis with a worldwide distribution, though it has a higher incidence in areas with tropical climate. A characteristic finding of the disease is its wide spectrum of symptoms and organ involvement, as it can appear either with very mild flu-like manifestations or with multiorgan failure, affecting the central nervous system (CNS) with a concomitant hepatorenal dysfunction (Weil’s syndrome) and significant high mortality rate. We report herein a fatal case of a 25 years old female, previously healthy, with impaired neurological status. She had high fever and severe multiorgan failure. The clinical data and the epidemiological factors were not conclusive for the diagnosis, and the first serology test from the cerebrospinal fluid (CSF) and sera samples were negative. When the repetition of the blood test showed elevated IgM antibodies, Leptospirosis was the presumptive diagnosis. Although CNS involvement is rare, the diagnosis should be considered when there is an elevated risk of exposure. The diagnostic protocol should encompass direct evidence of the bacterium and indirect measurement of antibodies. Timely detection and management are imperative to forestall complications and fatality associated with the disease. Full article
(This article belongs to the Special Issue Nursing Care in the ICU)
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