Intensive and Critical Care Nursing RSS feed: Current Issue. The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects. http://www.intensivecriticalcarenursing.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Intensive and Critical Care Nursing0964-3397283June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.intensivecriticalcarenursing.com/article/PIIS0964339712000407/abstract?rss=yesEditorial Board10.1016/S0964-3397(12)00040-7Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-Xiihttp://www.intensivecriticalcarenursing.com/article/PIIS0964339711001315/abstract?rss=yesSummary: Paediatric intensive care has a significant impact on the children and families who experience it. This effect continues post-discharge as the family attempt to recover from their ordeal. This article begins with an exploration of what makes a Paediatric Intensive Care Unit (PICU) admission potentially so traumatising and then examines current models for recovery which exist in the literature. These remain sparse and do not provide a coherent model for recovery after PICU. This paper therefore presents research which aimed to develop a model to understand the recovery journey for families. Children who had been PICU patients and their parents were interviewed and the transcripts analysed using grounded theory. Participants highlighted the importance of physical, psychological and social recovery and these have been integrated into a biopsychosocial model of recovery. Finding and accepting a ‘new normal’ were the culmination of this biopsychosocial journey. This paper concludes that an integrated approach to recovery is necessary and makes some recommendations for further research and clinical practice.A ‘biopsychosocial’ model for recovery: A grounded theory study of families’ journeys after a Paediatric Intensive Care AdmissionEllie Atkins, Gillian Colville, Mary John10.1016/j.iccn.2011.12.002Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles133140http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001054/abstract?rss=yesSummary: Background: Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with possible serious consequences.Objective: The aim of this study was to get insight into sleeping and sedation practices in the adult ICUs in the Netherlands and survey which factors are important with respect to sleep in critically ill patients in the ICU.Method: A multi-centre, exploratory survey sent via mail to nurse managers of all adult ICUs in the Netherlands.Results: Interventions without medication to improve the sleep of the critically ill patients were mostly defined as keeping patients awake during the day (94.2%), reducing noise of the ICU staff (89.7%) and reducing nursing interventions at night (86.8%). None of the ICUs used a sleep questionnaire. Nursing autonomy regarding sleep and sedation practices for patients (rated on a 10-point numerical scale) was judged as moderate (median 5, interquartile range (IQR) 3–7). How often nursing observations influence sleeping practices in the ICU was judged as good (median 8, IQR 7–8). How the average ICU patient was sleeping was judged as moderately well (median 6, IQR 5–7). Most intensive care units (83.8%) did not have a sleeping protocol, but 67.6% of these intensive care units suggested they should implement a sleeping protocol.Conclusions: The average critically ill patient has sleep disturbances, that is, is sleeping moderately well according to nurses’ views and opinions, mostly due to a disturbed sleep–awake cycle, delirium and nursing interventions. Intensive care nurses perceive only a moderate feeling of autonomy and influence regarding the management of sleeping practices.Sleep disturbances and sedation practices in the intensive care unit—A postal survey in the NetherlandsJosé G.M. Hofhuis, Gerdien Langevoort, Johannes H. Rommes, Peter E. Spronk10.1016/j.iccn.2011.10.006Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles141149http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000978/abstract?rss=yesSummary: Becoming critically ill and in need of ventilator treatment is a considerable burden. Fear and anxiety are natural reactions and it is not uncommon for patients to experience hopelessness, withdrawal and depression. In situations like these the possession of inner strength can be of vital importance.Objectives: To gain knowledge on what factors contribute to inner strength in critically ill patients cared for in an intensive care unit. The depth interviews were conducted with six former ventilator-treated patients aged 60–72years.Setting: The informants were recruited through the ICU at an urban hospital in Norway.Research methodology/design: The study has an exploratory and descriptive design. A hermeneutic approach was used to interpret the data, in which Kvale's self-perception, critical common sense and theoretical levels were applied.Results: The study clearly demonstrates that there are certain factors that promote the inner strength of patients undergoing ventilator treatment. These are: “To have the support of next of kin”, “The wish to go on living”, “To be seen” and “Signs of progress”. Amongst these patients it appears that the presence of one's next of kin has prime significance in promoting inner strength.Experiences of inner strength in critically ill patients – A hermeneutical approachLise-Merete Alpers, Sølvi Helseth, Ingegerd Bergbom10.1016/j.iccn.2011.10.004Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles150158http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001297/abstract?rss=yesSummary: Introduction: In connection with the care received in the intensive care unit (ICU), the patient can experience discomfort and frustration. Earlier studies have shown mechanical ventilation (MV) to be a factor that increases patients’ delusional memories in the ICU. The patients who need MV after a physical trauma constitute a vulnerable group who so far has attracted little attention from a long-term perspective.Aim: The aim for this study is to describe mechanically ventilated trauma patients over time regarding their memories, psychological recovery and health related quality of life (HRQoL).Methods: In a multicentre study, 41 patients who had received MV, answered a questionnaire with the SF-36, HAD and ICUM tool on two occasions about one and five years after the injury and care in the ICU.Results: The patients’ memories were stable over time and significantly more patients remembered panic and anxiety. 37% remembered pain one year after the trauma and 46% five years thereafter. The majority of the patients remembered the family's presence from their ICU stay. Half of the patients had thoughts regarding why they had so few recollections. One fourth of the patients experienced clear symptoms of anxiety and the same amount had symptoms of depression one year after the injury. In seven of the patients the symptoms of probable anxiety persisted after five years. In six of the patients the symptoms of probable depression persisted after five years. Two of eight dimensions in HRQoL, the physical and emotional role functions, had improved significantly five years after the injury.Conclusions: Five years after the trauma, the memories from the ICU were still the same and the HRQoL improved in only two out of eight dimensions. A smaller group of patients had remaining symptoms of psychological ill-health. MV in connection with trauma may result in continued reduced health in the long term.Memories from intensive care unit persist for several years—A longitudinal prospective multi-centre studyPer Zetterlund, Kaety Plos, Ingegerd Bergbom, Mona Ringdal10.1016/j.iccn.2011.11.010Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles159167http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001339/abstract?rss=yesSummary: Aim: This study aimed to examine anaesthetists’ perceptions of facilitative weaning from the mechanical ventilator in the intensive care unit (ICU).Methods: Explorative qualitative interviews in a phenomenographic reference frame with a purposive sample of 14 eligible anaesthetists from four different ICUs with at least one year of clinical experience of ICU and of ventilator weaning.Findings: Four categories of anaesthetists’ perceptions of facilitative decision-making strategies for ventilator weaning were identified. These were the instrumental, the interacting, the process-oriented and the structural strategies” for ventilator weaning. The findings refer to a supportive multidisciplinary holistic ICU quality of care. Choice of strategy for ventilator weaning was flexible and individually tailored to the patients’.Conclusions: Choice of strategy was flexible and individually adjustable. Introduction of evidence-based guidelines from ventilator weaning is necessary in the ICU. The guidelines should also cover the responsibilities of various professional groups. Regular evaluations of methods and strategies used in practice need to be implemented. This may facilitate decision-making strategies for ventilator weaning in practice at the ICU. Greater attention needs to focus on family members’ experiences. The strategies should be an integral part of continuous staff training.Anaesthetists’ perceptions of facilitative weaning strategies from mechanical ventilator in the intensive care unit (ICU): A qualitative interview studySara Pettersson, Mariola Melaniuk-Bose, U. Edell-Gustafsson10.1016/j.iccn.2011.12.004Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles168175http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001327/abstract?rss=yesSummary: The rooms in Intensive Care Units are considered as high-tech environments and believed to affect recovery process and wellbeing of patients. Moreover, the design and interiors affect the interplay between the patient and the next of kin.Objective: The aim of this study was to describe and interpret the meanings of the intensive care patient room as experienced by next of kin.Design: Next of kin (n=14) from two different intensive care units participated. Data were collected through photo-voice and analysed using a phenomenological hermeneutical method.Results: Three major themes emerged; dwelling in the room and time, becoming at home and extension of the room. The results show that the room is perceived as a lived and extended place and space. The design, interiors and furnishing in the patient room are fundamental in shaping the next of kin's experiences in the room and affect wellbeing.Conclusions: How intensive care patient rooms are designed, the place given to next of kin and the way they are received in the room are decisive for the support given to the loved one. Simple interventions can make the patient room a more healing environment.The ICU patient room: Views and meanings as experienced by the next of kin: A phenomenological hermeneutical studySepideh Olausson, Margaretha Ekebergh, Berit Lindahl10.1016/j.iccn.2011.12.003Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XOriginal Articles176184http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001236/abstract?rss=yesSummary: Aim: This article aims to review current literature into the use of assessment tools for the diagnosis of delirium and the implications of care for the patient with delirium.Background: Delirium is a common often misdiagnosed, unrecognised and misunderstood condition in the critical care setting that has been associated with increased mortality and cognitive dysfunction.Relevance to clinical practice: Delirium has implications for increasing cost to the National Health Service as it is linked to prolonged ventilation and the associated risks and increased hospital stay.Conclusion: Nurses play a key role in identification of delirium using CAM-ICU, a valid and reliable tool and identifying modifiable risks to improve the delirious ICU patient's outcome.Delirium: A review of the nurses role in the intensive care unitRebecca Boot10.1016/j.iccn.2011.11.004Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XReview185189http://www.intensivecriticalcarenursing.com/article/PIIS0964339712000122/abstract?rss=yesChest X-ray quiz10.1016/j.iccn.2012.02.001Intensive and Critical Care Nursing 28, 3 (2012)2012-06-01Intensive and Critical Care Nursing2012-06-01283S0964-3397(12)X0003-XReview191192