Intensive and Critical Care Nursing

Editorial Board

2010-04-01

Challenges and rewards in multi-national research

Ruth Endacott, Julie Benbenishty, Myriam Seha — 2010-04-01

The recent Declaration of Vienna launched by the European Society of Intensive Care Medicine () emphasises the global nature of disease yet the increasingly uneven distribution of resources. Over the past decade, studies have identified variation across European countries in physician values and practices (), resuscitation directives () end of life practices () and nurse involvement in end-of-life decision-making (). Increase in the use of internet and e-mail for data collection has made international studies much easier to conduct, for example the EPIC study examining the prevalence of nosocomial infection was supported by 1417 ICUs across Europe () and the ETHICUS study examining end of life practices across Europe included data from 37 units in 17 countries ().

Preparing research instruments for use with different cultures

Ruth Endacott, Julie Benbenishty, Myriam Seha — 2010-04-01

Summary: There is a growing requirement to use standardised instruments for collecting research data and monitoring patient progress. Two sets of properties should be addressed when selecting and adapting research instruments: psychometric properties (validity, appropriateness, reliability, and responsiveness) and clinical properties (feasibility and acceptability of the instrument). This paper outlines steps necessary to fulfil these requirements when using a research instrument in different cultures.

Implementation of a research awareness program in the critical care unit: effects on families and clinicians

Craig Dale, Robert A. Fowler, Neill K.J. Adhikari, Ruxandra Pinto, Louise Rose — 2010-04-01

Summary: Background: Successful conduct of research studies in the critically ill requires communication with families, substitute decision-makers and clinicians.Objective: To assess the effect of a communication package on attitude, knowledge and research awareness among family members and clinicians.Methods: We conducted a prospective, single centre, before and after study. We distributed a validated questionnaire to family members and clinicians assessing the three domains of research attitude, knowledge and awareness before and after implementation of a research communication package consisting of an informational pamphlet and display poster.Results: Response rates for the family member survey were 22% (baseline) and 15% (post-intervention). No differences were found in the attitude, knowledge and awareness of family members following implementation of the research communication package. The global awareness score (calculated by summing the domain responses) rose 4.0 points (P=0.056). Response rates for clinicians were 36% (baseline) and 33% (post-intervention). No differences were found in attitude, knowledge and awareness and global awareness score.Conclusion: Passive dissemination of research materials was not sufficient to generate an increased awareness, knowledge, or perceived utility of research.

Serial evaluation of SOFA score in a Brazilian teaching hospital

2010-04-01

Summary: Objectives: To evaluate the application of the Sequential Organ Failure Assessment (SOFA) in describing the severity of organ dysfunctions and the associated mortality rates in critically ill patients at a teaching hospital.Research methodology: Prospective longitudinal study performed in 1164 adult, critically ill patients who were admitted consecutively into intensive care units between January 2004 and December 2005. We analysed static evaluation of SOFA and dynamic changes in the SOFA scores. The discriminative power of SOFA was evaluated using ROC curves.Results: There was an increase in the mortality rate when the SOFA scores increased (, p<0.001, increase rate=0.13). The SOFA score on the third day in the ICU had the highest area under the curve for hospital mortality (AUC: 0.817±0.0133, CI 95%: 0.792–0.840). We analysed SOFA score changes with time and observed that patients with low scores (0–5) upon admission and who increased to the medium or high SOFA groups had a significantly higher mortality rate (51.7 and 100%, respectively, p<0.001).Conclusions: Applying SOFA to critically ill patients effectively described the severity of organ dysfunctions, and higher SOFA scores had a positive association with mortality.

Are vital signs valid indicators for the assessment of pain in postoperative cardiac surgery ICU adults?

Caroline Arbour, Céline Gélinas — 2010-04-01

Summary: The aim of this study was to examine the discriminant and criterion validity of vital signs (mean arterial pressure [MAP], heart rate [HR], respiratory rate [HR], transcutaneous oxygen saturation [SpO2], and end-tidal CO2) for pain assessment in postoperative cardiac surgery ICU adults. A repeated-measure within-subject design was used. A convenience sample of 105 patients from a cardiology health center in Canada participated. Patients were observed during three testing periods: (1) unconscious and mechanically ventilated, (2) conscious and mechanically ventilated and (3) after extubation. For each of these testing periods, vital signs were assessed using the ICU monitoring at rest, during a nociceptice procedure and 20min postprocedure. Conscious patients’ self-reports of pain were obtained. Discriminant validity was supported with significant changes in most vital signs during the nociceptive procedure. Some of the vital signs (HR, RR, and SpO2) were associated with the patients’ self-reports of pain but were dependent on the patients’ status (mechanically ventilated or not). Findings regarding the use of vital signs for pain assessment are not consistent and should be considered with caution. As recommended by experts, vital signs should only be used as a cue when behavioural indicators are no longer available in mechanically ventilated or unconscious patients.

Relatives’ experiences of visiting a conscious, mechanically ventilated patient—A hermeneutic study

V. Karlsson, A. Forsberg, I. Bergbom — 2010-04-01

Summary: Background: In recent years, light or no sedation has become a common approach to invasive mechanical ventilation in patients with respiratory distress. The experience of visiting a conscious patient receiving mechanical ventilation in the ICU has to our knowledge not yet been investigated.Aim: The aim of the study was to describe the meaning attributed by relatives to their experiences of meeting, seeing and communicating with a patient cared for on a mechanical ventilator while conscious.Method: This study used a prospective, exploratory design comprising interviews with ten relatives conducted on two occasions; in connection with their visits to a patient cared for on a ventilator while conscious and approximately a week after the end of intensive care. The data were analysed by means of hermeneutic interpretation to obtain a deeper understanding of relatives’ experiences.Results: Striving to achieve contact with the patient was the most important aspect of being a close relative of a patient receiving ventilator treatment while conscious and was described by four main themes: feeling ambivalent towards consciousness; feeling ambivalent towards sedation; feeling dependent on the carer and being disappointed; and suppressing own suffering and sadness.Conclusion: The patients’ consciousness enabled the relatives to judge their condition for themselves and enter into contact. This resulted in a sense of being in control but also efforts to suppress own suffering.

Improving safety and documentation in intrahospital transport: Development of an intrahospital transport tool for critically ill patients

Rebecca J. Jarden, Sara Quirke — 2010-04-01

Summary: Transporting the critically ill patient is described within the literature as a high-risk procedure. Both guidelines and minimum standards are available to inform practice. However, a practical, clinically useful, and evidence-based document (tool) for the ICU nurse to use when transporting a critically ill patient was not identified in the literature. Consequently, the development of an intrahospital transport tool is described. This transport tool was designed to mitigate the risks associated with patient transport by providing the Intensive Care Unit (ICU) nurse with an integrated documentation record, incorporating patient assessment with a procedural guideline. The result is a framework for the ICU nurse to use throughout intrahospital transfers, informing and supporting them to provide and document continuity of nursing care. The potential benefit of using this tool is enhanced patient outcomes through safer ICU intrahospital transport processes.

Nursing workload and staff allocation in an intensive care unit: A pilot study according to Nursing Activities Score (NAS)

2010-04-01

Summary: Objectives: The objectives of the study were to identify the daily nursing workload in an intensive care unit (ICU) and to analyse the adequacy of nursing staff in a six hour shift according to the Nursing Activities Score (NAS).Method: The sample consisted of 68 patients from a general 25-bed adult ICU in a private hospital with 250 beds in São Paulo, Brazil. The nursing workload of all patients admitted in the ICU over a one month period in 2004 were measured daily according to the NAS. For the analysis of nursing staff it was considered the number of nurses available in a six hour shift. Data were submitted to descriptive analyses.Results: Most patients were elderly and remained on average 12 (±16.4) days in the ICU. The mean NAS was 63.7 (±2.4%) and remained above 58.5% throughout the month. Apart from the 16th day of data collection there was an excess of nursing professionals in a six hour shift during the study period (range from 0.8 to 4.8 professionals).Conclusions: The study results show the importance of nursing staff adequacy to workload fluctuations for reducing ICU costs.

Supporting families in the ICU: A descriptive correlational study of informational support, anxiety, and satisfaction with care

2010-04-01

Summary: Background: Informational support to family members of ICU patients has significant potential for reducing their psychological distress, enabling them to better cope and support the patient.Objectives: To describe family member perception of informational support, anxiety, satisfaction with care, and their interrelationships, to guide further refinement of a local informational support initiative and its eventual evaluation.Methodology/design: This cross-sectional descriptive correlational pilot study collected data from a convenience sample of 29 family members using self-report questionnaires.Setting: 22-bed medical-surgical intensive care unit of a 659-bed university affiliated teaching hospital in Montreal, Quebec, Canada.Results: Mean informational support, assessed with a modified version of the CCFNI (), was 55.41(SD=13.28; theoretical range of 20–80). Mean anxiety, assessed with the State Anxiety Scale () was 45.41 (SD=15.27; theoretical range of 20–80). Mean satisfaction with care, assessed using Androfact™ (Version 4.0, 2001), was 83.09 (SD=15.49; theoretical range of 24–96). A significant positive correlation was found between informational support and satisfaction with care (r=0.741, p<.001). No significant relationships were noted between informational support and anxiety nor between satisfaction with care and anxiety.Conclusion: Findings are related to the ultimate objectives of refining a local informational support initiative and its eventual evaluation, and in so doing, are of more widespread interest to others striving to make evidence based improvements to the care of similar populations.

Chest X-ray quiz

2010-04-01