Artificial intelligence (AI) is increasingly embedded in critical care environments to support clinical decision-making, risk prediction and workflow optimisation. However, many AI systems operate as opaque 'black boxes', raising ethical, professional and safety concerns in high-acuity settings where nurses remain accountable for patient outcomes. Explainable artificial intelligence (XAI) has emerged in response to these concerns by emphasising transparency, interpretability and human oversight. To critically discuss XAI and examine its relevance and implications for critical care nursing practice. Discussion paper informed by literature on nursing ethics, professional accountability, critical care practice and healthcare AI. This paper examines XAI as an approach to clinical AI that foregrounds transparency, interpretability, traceability and contestability. It argues that these features are especially important in critical care nursing, where nurses must assess, communicate, justify and, when necessary, challenge AI-informed recommendations in rapidly changing and high-stakes clinical situations. The paper discusses the relevance of XAI to clinical decision support, communication, handover and the exercise of clinical judgement and considers challenges related to cognitive workload, interpretive competence, workflow integration, governance and implementation. It further argues that the value of XAI in critical care depends not only on technical explainability but also on whether explanations are clinically meaningful and usable in bedside practice. XAI should be understood not simply as a technical enhancement, but as a professional and ethical requirement for the responsible use of AI in critical care nursing. When implemented thoughtfully, XAI can strengthen clinical reasoning, transparency and accountable care. Critical care nurses should be recognised essential stakeholders in the design, implementation, governance, education and policy development of clinical AI systems. Embedding explainability into AI is central to preserving nursing autonomy, professional accountability, patient safety and patient-centred care in technologically advanced critical care environments.
Professional values and moral resilience are recognized as essential attributes of nursing practice. In critical care settings, where nurses routinely face ethical complexity and high-stakes decisions, it is important to understand how these attributes shape professional competence. To examine the relationship between professional values and professional competence among critical care nurses, and to determine whether moral resilience mediates this relationship. This descriptive and correlational study was conducted among nurses working in the critical care units of six hospitals between August and October 2025. The reporting was conducted in accordance with the STROBE guidelines. Three validated instruments were used: a professional values scale (range 1-5, with higher scores indicating stronger professional values), a moral resilience scale (range 1-4, with higher scores indicating greater moral resilience) and a professional competence scale (range 1-5, with higher scores indicating greater professional competence). In total, 201 nurses participated in the study. Mean scores were high for professional values (4.45 ± 0.61 out of 5), moral resilience (3.27 ± 0.43 out of 4) and professional competence (4.26 ± 0.36 out of 5). Professional values were significantly and positively correlated with professional competence (r = 0.329, p < 0.001), whereas moral resilience showed no significant association with either variable. The direct effect of professional values on professional competence was significant (β = 0.193, p < 0.001), whereas the indirect effect through moral resilience was non-significant (β = 0.003, 95% CI [-0.005, 0.014]). Professional values appear to play an important role in promoting professional competence among critical care nurses, whereas moral resilience did not mediate this relationship. Strengthening ethics-based education and professional value development may enhance competence in critical care practice. Nurse educators and managers should prioritize the integration of professional values into nursing curricula, continuing professional development and clinical practice to strengthen professional competence among critical care nurses. Because moral resilience was not associated with competence, resilience-supporting initiatives may be directed primarily at nurses' well-being and retention rather than competence.
Professional values are fundamental determinants of nursing care quality and ethical practice. Self-compassion has emerged as an important psychological resource that may support nurses' well-being and caregiving performance, particularly in demanding environments such as intensive care units. However, limited evidence exists regarding the relationships among professional values, self-compassion and caring behaviours in intensive care nurses. To examine the relationships between intensive care nurses' professional values, self-compassion and caring behaviours and to determine the mediating role of self-compassion in the relationship between professional values and caring behaviours. A descriptive and correlational study was conducted in the intensive care units of a university hospital in eastern Türkiye between November 2025 and February 2026. Data were collected using the Personal Information Form, Nurses' Professional Values Scale, Short Form Self-Compassion Scale, and Caring Behaviors Inventory. Descriptive statistics, Pearson correlation analysis, hierarchical regression analysis, and PROCESS Macro (Model 4) mediation analysis were used. A total of 134 intensive care nurses participated in the study. Professional values and caring behaviours were high (149.91 ± 12.02 and 167.32 ± 16.73, respectively), whereas self-compassion was moderate (36.66 ± 8.41). Significant positive correlations were found among professional values, self-compassion, and caring behaviours (p < 0.01). Professional values significantly predicted self-compassion (β = 0.418) and caring behaviours (β = 0.580), while self-compassion significantly predicted caring behaviours (β = 0.222). After controlling for gender, income status, unit of work, and number of patients cared for, self-compassion partially mediated the relationship between professional values and caring behaviours (indirect effect = 0.129; 95% CI: 0.036-0.223). The model explained 53% of the variance in caring behaviours. Professional values influence intensive care nurses' caring behaviours both directly and indirectly through self-compassion. Self-compassion appears to be an important psychological mechanism that strengthens the positive effect of professional values on caring behaviours. Enhancing self-compassion may contribute to improving nursing care quality in intensive care settings. Interventions aimed at strengthening self-compassion and educational programmes that promote professional values may enhance caring behaviours among intensive care nurses and improve the quality of patient care.
Advanced life support (ALS) competence may deteriorate within months after certification, but what supports ongoing competence in critical care remains unclear. To map factors influencing maintenance of ALS competence among critical care professionals working in critical care settings. Scoping review conducted in accordance with Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE, CINAHL and the Cochrane Library were searched (from February to March 2025). We included peer-reviewed and grey sources from hospital-based critical care settings that assessed ALS competencies over time. Data were synthesised using inductive thematic analysis. Twenty-five sources were included (19 peer-reviewed, 6 grey). Factors were mapped to three domains. Educational factors were most frequently reported and centred on simulation-based rehearsal, structured feedback and debriefing and spaced refreshers delivered in brief, frequent sessions. Institutional determinants related to protected training time, access to resources, standardised roles and content and monitoring through audit and feedback. Individual determinants included clinical exposure and experience, perceived preparedness and self-confidence, stress and cognitive load, engagement in ongoing learning and non-technical behaviours. Outcomes were largely simulation-based or self-reported, and longer-term durability was inconsistently assessed. Maintenance of ALS competence appears to require coordinated educational and organisational supports; longitudinal evaluations with explicit definitions and validated outcomes are needed. Critical care services may strengthen ALS competence maintenance by embedding recurrent, context-aligned rehearsal with feedback, supported by protected training time, accessible training infrastructure and ongoing performance monitoring. The review protocol was prospectively registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/PEQJH.
Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care. To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research. This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included. The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care. Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families. The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.
Central venous catheters are essential in paediatric intensive care but are associated with catheter-related bloodstream infections (CRBSIs) and skin complications. Chlorhexidine gluconate (CHG)-impregnated dressings may reduce infection risk; however, concerns remain regarding their dermatological safety in vulnerable paediatric populations. To evaluate the dermatological safety of CHG-impregnated dressings in critically ill paediatric patients requiring central venous catheters and to explore their impact on catheter-related outcomes. A single-blind, prospective randomised clinical trial was conducted in a tertiary paediatric intensive care unit. Within routine clinical practice, patients were randomly assigned to receive either a conventional transparent dressing or a dressing incorporating a 2% CHG gel pad. The primary outcome was the occurrence of tegumentary alterations at the catheter insertion site. Secondary outcomes included CRBSI incidence and catheter maintenance variables. Skin alterations were identified in 14.0% of patients, with no significant differences between groups (16.8% vs. 11.2%; p = 0.202). However, dermatological alterations occurred at a significantly younger age in the CHG group (6.5 ± 4.8 vs. 46.0 ± 43.2 months; p = 0.003), with a similar pattern for pruritus. Multivariable analysis showed a significant interaction between dressing type and age, indicating age-dependent dermatological responses. CHG dressings were associated with fewer dressing changes and longer intervals between replacements. CRBSI incidence was lower in the CHG group (2.4% vs. 18.4%; p < 0.001), although this was a secondary outcome. CHG-impregnated dressings showed an acceptable dermatological safety profile. Their use was associated with improved catheter-related outcomes, although skin reactions occurred at younger ages. CHG dressings may support safer catheter management but require careful dermatological monitoring in infants. These findings may help inform dressing selection and catheter care strategies in paediatric intensive care settings where infection prevention and skin integrity must be balanced.
Nursing students need to be equipped with effective clinical skills to prevent ventilator-associated pneumonia (VAP) in high-risk patients in intensive care units. The study aimed to determine the effectiveness of scenario-based simulation training in developing knowledge and skills for the prevention of VAP in undergraduate nursing students. A single-group, pretest-posttest quasi-experimental study was conducted with undergraduate nursing students enrolled in an intensive care course. Scenario-based simulations and a VAP Prevention Performance Checklist were prepared for the study. The students' skill performance was assessed simultaneously by two independent observers before and after the simulation training. Pretest and posttest scores were compared with Wilcoxon, McNemar and McNemar-Bowker tests, and interrater agreement was assessed using intraclass correlation coefficients (ICC). In total, 36 students participated in the study. The content validity of the VAP Prevention Performance Checklist was assessed using the Delphi method, which resulted in expert consensus for all items in the second round (the scale-level content validity index was 1.00). There was excellent interrater agreement in the skill performance assessment (ICC = 0.982; p < 0.001). The students' VAP prevention performance scores were significantly higher in the posttest than in the pretest (38.38 ± 7.81 vs. 18.38 ± 5.06, p = 0.002, Cohen's d = 1.25). Scenario-based simulation training was shown to be effective in increasing nursing students' awareness and implementation of skills that contribute to the prevention of VAP. Scenario-based simulations can be used as an effective method to improve VAP prevention knowledge and skills during undergraduate nursing education and in-service training. Scenario-based simulations can be used as an effective method to improve VAP prevention knowledge and skills during undergraduate nursing education and in-service training.
Critical care nurses are essential in delivering end of life care (EOLC) within Intensive Care Units (ICUs). Nevertheless, a research gap has been identified regarding the perceptions of EOLC and the necessary training among critical care nurses in South and Southeast Asia. The aim of this scoping review was to understand critical care nurses' perceptions regarding the delivery of EOLC in ICUs across South and Southeast Asia. We utilized Joanna Briggs Institute's scoping review methodology and used PRISMA framework to support our search process. The review included 23 studies, mostly from Southeast Asia. Key themes identified were navigating the needs of family members during EOLC, training and support needs of the nurses, therapeutic communication in EOLC, interdisciplinary collaborations, holistic care in EOLC, previous experiences of the nurses with EOLC, religious perspectives of the nurses' and nurse's views on peaceful death. The findings of the review identified the unmet needs of critical care nurses in delivering culturally tailored EOLC in South and Southeast Asia with a significant gap in training and support for critical care nurses. Due to the inadequate attention to EOLC in many critical care settings worldwide, particularly in resource-limited environments, these findings are relevant to clinical practice because it will help hospital administrators develop standard guidelines and policies to empower critical care nurses.
Physical restraint use in intensive care units (ICUs) raises important ethical, clinical and decisional challenges, particularly among critically ill older patients who are especially vulnerable to its adverse physical and psychological effects. Although nurses play a central role in restraint-related decisions, little qualitative evidence has examined their experiences of using physical restraint with older adults in critical care settings, particularly in Saudi Arabia. To explore ICU nurses' attitudes toward physical restraint use in critically ill older patients, examine their decision-making processes and understand the ethical dilemmas they encounter in practice. An exploratory qualitative study was conducted across multiple healthcare settings in the Al-Ahsa region, Saudi Arabia. Semi-structured, in-depth interviews were conducted with ICU nurses who had direct experience with physical restraint use in critically ill older patients. Data were analysed using reflexive thematic analysis following Braun and Clarke's six-phase approach. Reporting was guided by the Consolidated Criteria for Reporting Qualitative Research. Interviews with 15 ICU nurses identified three interrelated themes: navigating the safety-autonomy tension, the weight of restraint decisions and working within systemic and cultural boundaries. Nurses described restraint as a measure used to protect patients from device removal, falls and self-harm, yet also as a practice that compromised dignity and autonomy. Decision-making was shaped by moral distress, clinical uncertainty, family expectations, staffing constraints, policy gaps and cultural values related to elder respect and family involvement. Physical restraint decision-making in critically ill older patients is shaped by a complex interplay of clinical urgency, ethical tension, organisational constraints and cultural influences. ICU nurses occupy a central yet under-supported role in these decisions and often experience considerable moral distress. ICU policy and practice should support restraint minimisation through clear evidence-based guidance, structured ethical decision-making, culturally sensitive family communication and education on alternatives to restraint to protect the safety and dignity of critically ill older patients.
Delirium is a critical yet often under-recognized complication in paediatric intensive care units (PICUs), associated with adverse clinical outcomes and increased healthcare burden. A clearer understanding of the existing literature may help strengthen paediatric delirium care and guide future nursing-focused research. To map research trends and identify knowledge gaps in delirium research within paediatric intensive care settings to inform clinical practice and future research priorities. A bibliometric analysis was conducted using the Web of Science Core Collection, PubMed and Scopus. Records were retrieved using search terms related to delirium, paediatric populations and intensive or critical care settings. Only articles published between 2015 and 2025 were included. Analyses were performed using R, RStudio and the Bibliometrix package. A total of 532 articles were included. Publication output showed a steady increase, particularly after 2020. The United States was the most productive country, followed by China, Germany and Canada. Thematic trend mapping identified two dominant research domains: assessment-related research (e.g., screening tools, validity and risk factors) and clinical management (e.g., analgesia, prevention and pain). Emerging and underdeveloped areas included guideline implementation, nurse education and standardized delirium care protocols. This study provides the first comprehensive bibliometric mapping of delirium research in paediatric intensive care settings, highlighting established research domains and critical gaps requiring further investigation. Strengthening delirium screening, integrating evidence-based protocols, enhancing nurse education and promoting interdisciplinary collaboration may improve early detection and management of delirium in PICU settings.
Alarm fatigue occurs when nursing staff are exposed to clinically excessive false alarms, leading to sensory overload and desensitization. It is a global occupational health concern in intensive care settings, with numerous studies investigating this complex phenomenon. To investigate the levels of alarm fatigue, its determinants and its association with professional quality of life among nurses in intensive care settings in Amman, Jordan. A cross-sectional descriptive quantitative study was conducted. All nurses were recruited from eight hospitals in Amman, Jordan, representing public, educational and private sectors. Data were collected using alarm fatigue and professional quality of life questionnaires. The data were analysed using chi-squared, one-way ANOVA, Kruskal-Wallis and multiple linear regression. In total, 250 nurses were recruited. Overall, 59.2% of nurses reported moderate alarm fatigue, and 28.8% reported severe alarm fatigue. Burnout and secondary traumatic stress were significantly associated with alarm fatigue (p < 0.001). Five factors (shift type, hospital sector, burnout, secondary traumatic stress and compassion satisfaction) explained 16.5% of the variance in alarm fatigue scores. Compassion satisfaction was not significantly associated with alarm fatigue, suggesting that nurses may retain professional fulfillment despite high alarm exposure. Shift type (p = 0.031) and hospital sector (p = 0.042) were significantly associated with alarm fatigue. Intensive care nurses working on ABC shift patterns and in the public sector experienced high levels of alarm fatigue. The findings highlight the necessity of nursing administrators to develop alarm management policies and training courses for intensive care nurses. Nursing education policymakers should incorporate alarm fatigue and burnout concepts into nursing curricula. This study reveals how alarm fatigue adversely affects nurses' professional quality of life in intensive care settings. It provides evidence for targeted interventions to reduce alarm fatigue and improve nurse well-being.
Psychological safety is a key component of effective healthcare teams and may impact job satisfaction, commitment and change readiness among critical care nurses. The design of nurse-physician collaboration may influence psychological safety but has not been systematically studied in intensive care settings. To investigate how nurse autonomy, participation in ward rounds, quality of nurse-physician relations and team size relate to psychological safety in critical care nurses, and how psychological safety mediates statistical effects on job satisfaction, affective commitment and commitment to change. We performed a multicentre, cross-sectional, multi-informant survey study conducted between December 2013 and March 2015 using a convenience sample of 22 intensive care units (ICUs) in 19 German hospitals, including university, public and private hospitals. Organisational data were provided by ICU leaders. Validated scales were used to assess psychological safety, job satisfaction, affective commitment to unit and commitment to change (nurse survey), and nurse-physician collaboration (physician survey). An organisational questionnaire was developed to assess nurses' autonomy and structural factors. Linear regression and mediation analyses tested hypothesised associations at the unit level. Of 1216 invited nurses and 379 invited physicians, 600 and 217 participated, respectively. Higher nurse autonomy (0.51 [95% CI: 0.1, 0.91], p = 0.016), consistent participation in ward rounds (0.51 [0.11, 0.91], p = 0.014), better nurse-physician collaboration (0.59 [0.21, 0.97], p = 0.004) and lower number of nurses working in a unit (-0.55 [-0.94, -0.16], p = 0.008) were statistically significantly associated with higher psychological safety in linear regression analysis. Psychological safety mediated effects of all predictors on job satisfaction, affective commitment and commitment to change. Psychological safety among critical care nurses can be enhanced through interprofessional collaboration, nurse autonomy and smaller team structures. These findings inform organisational strategies to improve nurse wellbeing and retention, as well as organisational readiness to change. Fostering interprofessional collaboration and enhancing nurses' autonomy in critical care are key to enhancing psychological safety and thereby enhancing job satisfaction and retention. Increasing team size can have unintended negative consequences that need to be weighted against potential gains. German Clinical Trial Register: DRKS00005357.
Thirst is a common and distressing symptom among critically ill patients, yet it is often under-assessed and inadequately managed in intensive care units (ICUs). Evidence on changes in thirst during ICU stay and factors associated with its persistence remains limited. To examine changes in thirst intensity during ICU stay and identify clinical factors associated with persistent thirst in critically ill adults. In this prospective observational study in South Korea, thirst intensity was assessed using an 11-point numeric rating scale within 72 h of ICU admission (T1) and within 24 h prior to ICU discharge (T2). Persistent thirst was defined as a T2 score of ≥ 4. Univariable and multivariable logistic regression analyses identified factors associated with persistent thirst, and linear regression examined factors associated with thirst intensity at T1. Mean thirst intensity significantly decreased from T1 to T2 (4.69 ± 2.93 vs. 1.93 ± 2.46, p < 0.001). However, persistent thirst was observed in 22.5% (16/71) of patients. In multivariable analysis, invasive mechanical ventilation (adjusted OR 5.16, 95% CI 1.18-22.53, p = 0.029) was independently associated with persistent thirst, whereas early net fluid balance showed an inverse association (adjusted OR 0.85, 95% CI 0.76-0.94, p = 0.002). No clinical factor was independently associated with thirst intensity at T1. Although thirst intensity decreased during ICU stay, persistent thirst remained relevant in a subset of critically ill patients. Invasive mechanical ventilation and negative fluid balance were independently associated with persistent thirst, highlighting the need for systematic assessment and targeted management. Thirst assessment should be incorporated into nursing practice, particularly for patients receiving invasive mechanical ventilation and those experiencing negative fluid balance. Early identification of high-risk patients may facilitate timely implementation of individualized, non-fluid-based comfort interventions while maintaining appropriate fluid management.
In Brazil, intensive care nurses are primarily trained through lato sensu postgraduate programmes, which are mostly theoretical and vary widely in duration, workload, modality and area of subspecialization. These factors raise concerns about the quality of education and development of crucial professional competencies. Although competencies required for intensive care nurses have been defined, they are often broad, extensive and difficult to integrate into training programmes. Entrustable professional activities (EPAs) were introduced to implement competency-based education in clinical practice and facilitate trainees' assessment. Identify, develop and validate the content of a set of EPAs for adult intensive care in Brazil. This methodological study was conducted in five interdependent steps, involving intensive care nurses, educators and researchers. The nominal group and modified Delphi consensus techniques were used to identify, review and validate eligible EPAs as well as analyse the quality of pre-designed EPAs. The nominal group initially proposed 14 EPAs, which were reduced to 13 after quality control. The modified Delphi process included two rounds, with 26 and 11 responses, respectively. After the second round of the Delphi technique, consensus was reached regarding the 13 EPAs; the content validation index for indispensability and clarity was > 0.8. In this study, 13 EPAs for adult intensive care nurses in Brazil were identified, developed and validated using consensus methods. The EPAs cover management, soft skills, teaching and direct patient care and offer a comprehensive overview of essential nursing activities in intensive care. The development of these EPAs can help clarify the role of intensive care nurses, support the design of competency-based curricula for intensive care nursing residency programmes and guide evaluations based on key professional activities. This study serves as a reference for research about the development of EPAs for nursing, other intensive care specialties and may encourage further clinical validation studies.
Extracorporeal membrane oxygenation (ECMO) is a complex, high-risk therapy requiring interdisciplinary expertise and structured education to optimise patient outcomes. International experts recommend standardised, structured ECMO education, incorporating simulation, to support competency across clinician groups. To evaluate changes in intensive care unit (ICU) clinicians' self-reported ECMO knowledge, confidence and skills after participation in a 1-day ECMO interdisciplinary simulation workshop. A retrospective study of pre- and post-survey evaluation data from ECMO simulation workshops delivered at a metropolitan quaternary adult hospital (2014-2019). Participants (registered nurses, medical officers, perfusionists and physiotherapists) self-rated their knowledge of veno-venous (VV) and veno-arterial (VA) ECMO, confidence in providing regular care and emergency management of ECMO in the ICU, and ECMO circuit problem-solving skills on Likert-type scales [1 = lowest (worst possible/most negative), 9 = highest (best possible/most positive)]. Paired t-tests compared pre- and post-scores and were stratified by clinician group. Free-text response data were thematically analysed. Matched pre- and post-workshop evaluations were analysed (n = 275) across 20 ECMO simulation workshops (99% response rate). Most participants (65%) were self-rated novices at baseline. Significant improvements across all individual domains (p < 0.001) were measured: Clinicians' self-rated knowledge of VV-ECMO (3.63-6.59; mean change 2.95, 95% CI, 2.78-3.12) and VA-ECMO (3.44-6.41; mean change 2.97, 95% CI, 2.80-3.14) as well as confidence in routine ECMO management (3.24-6.31; mean change 3.07, 95% CI, 2.88-3.25) and emergency management (2.42-6.09; mean change 3.68, 95% CI, 3.49-3.87) plus ECMO circuit skills (2.41-6.10; mean change 3.69, 95% CI, 3.50-3.89). Registered nurses demonstrated the greatest improvements in most domains. Themes corroborated workshop effectiveness. These findings support incorporating interdisciplinary, simulation-based ECMO education into credentialing and continuing education frameworks, particularly for nurses. Future research should examine how workshop participation translates into sustained learning retention, meaningful changes in clinical practice and improved patient-centred outcomes. The findings indicate that the single-day, simulation-based ECMO workshop improved ICU clinicians' self-reported ECMO knowledge, confidence and skill, particularly in managing emergencies and circuit-related complications. All workshop domains were considered appropriate for nurses' ECMO learning. The workshop's interdisciplinary format supports its inclusion in local ECMO credentialing pathways, alongside supervised clinical practice and ongoing education.
Family-centred care (FCC) has come into the focus of treatment in intensive care units (ICUs). Primary nursing (PN) as a patient-centred care nursing organisation model seems to be a good prerequisite for the integration of patients' families into nursing care. Current research on families' perspectives of PN on ICUs is rare. To evaluate satisfaction of families with PN, compared with individual nursing as standard care (SC). Secondary aims were to evaluate nursing framework conditions, support by physicians, interprofessional collaboration and environmental factors of the hospital. Cross sectional study with patients' family members in a surgical and medical ICU. A validated questionnaire with 27 items and 3 or 5-point Likert scales was used. The Wilcoxon rank test was used to calculate group differences. Data collection took place between November 2023 and May 2025. Overall, 213 questionnaires were incorporated into the analysis. Family members of patients in PN (n = 63) reported better information about care measures, with a median of 1 (IQR 1 to 2) on a 5-point Likert scale (1 = very good; 5 = very bad) compared to 2 (IQR: 1 to 3) in SC (n = 150; p = 0.047). They also reported better information to help support patients' recovery (PN: 1 [IQR: 1 to 2]; SC: 2 [IQR: 1 to 3]; p = 0.01). Nursing framework conditions were similar in both groups, as well as most of physicians' support of families, the collaboration of interprofessional staff on ICU and environmental factors of the hospital. Families within our study had contact to PN or SC. Positive results in both groups are in line with how PN and also individual nursing are described in the literature. Follow-up studies using a mixed-methods design are necessary to further investigate the effects of PN. Family members ranked PN and SC positively, with trends for PN. This could indicate that FCC is being carried out on both ICUs.
Intensive care units contribute significantly to healthcare's environmental footprint. While nurses are pivotal in implementing sustainable practices, limited evidence exists regarding their environmental sustainability profile in intensive care settings. To assess the environmental sustainability profile of intensive care nurses in Türkiye and identify factors associated with sustainable practices. This descriptive cross sectional study was conducted with intensive care nurses across Türkiye between November 2025 and January 2026. Data were collected via an online survey comprising a sociodemographic questionnaire and a 31-item author-developed Environmental Sustainability Profile Survey (five content areas; Cronbach's α = 0.926). Data were analysed using Spearman's rank correlation for bivariate associations, the Mann-Whitney U test for two-group comparisons and the Kruskal-Wallis H test (with Bonferroni-adjusted post hoc comparisons) for comparisons across three or more groups. The mean environmental sustainability score was 125.32 ± 16.59 (mean item score = 4.04 on a 5-point Likert-type scale), indicating a high sustainability profile based on the interpretive framework adopted for this study. While 80.2% acknowledged responsibility for environmental impact, 63.5% were uncertain about their knowledge to guide sustainable practice, and 84% lacked formal training. Only 6.2% had heard of 'green ICU' concepts. Significantly higher scores were observed among female nurses, postgraduate-trained nurses, hospital employees, neonatal ICU nurses, day shift workers, disaster-region workers and those with prior sustainability training. Turkish ICU nurses demonstrate a high environmental sustainability profile but substantial knowledge gaps. Structured education programmes, institutional support and context-specific interventions are urgently needed. Developing structured sustainability education programmes, integrating environmental competencies into ICU training curricula and strengthening institutional support mechanisms may enhance environmentally responsible practice without compromising patient care.
Intensive Care Unit (ICU) admission is a highly stressful and often unexpected experience for family members, frequently resulting in significant psychological distress and ongoing caregiving burden. Despite widespread awareness and recognition of these needs, structured psychosocial interventions for family members remain limited. In response, a family well-being intervention was developed within a UK ICU psychology service, incorporating a clinician-delivered psychoeducational and support programme alongside an information and well-being booklet. This study evaluated the booklet prior to implementation. To explore family members' perceptions of the newly developed ICU information and well-being booklet, focusing on its usefulness, accessibility and acceptability and to inform refinement prior to clinical implementation. A qualitative design was adopted. Semi-structured interviews were conducted with five family members of patients previously admitted to ICU in a London hospital. Participants were purposively sampled and reviewed the booklet during interviews conducted via Microsoft Teams. Data were analysed using reflexive thematic analysis. Four overarching themes were identified: (1) Information as Emotional Containment and Orientation; (2) Communication as Containment and Validation; (3) Preparation for Transitions and Recovery Beyond ICU; and (4) The Overlooked Burden: Acknowledging Carers' Well-being. Participants described the booklet as accessible, clear and emotionally containing. It was perceived to reduce uncertainty, validate emotional responses, support communication with staff and provide anticipatory guidance regarding recovery and transitions. Family members particularly valued explicit recognition of caregiver distress and permission to prioritise self-care. The ICU psychoeducation and well-being booklet was perceived as a useful and acceptable resource that addresses both informational and psychological needs of family members. Beyond information provision, findings suggest the booklet may function as a psychologically containing and orienting tool during periods of acute uncertainty.
Critical care nurses are frequently exposed to high levels of occupational stress and fatigue because of demanding workloads, emotional burden and the need for sustained vigilance in complex clinical environments. To evaluate the effects of an online meditation programme on perceived stress and fatigue among intensive care nurses. This single-centre, two-arm, pre-test/post-test randomised controlled trial was conducted in a hospital in Türkiye between December 2021 and January 2022 using a convenience sample of eligible intensive care nurses. Nurses were randomly assigned to the intervention and control groups. The intervention group participated in a six-week online meditation programme delivered via WhatsApp, consisting of 20-min sessions three times per week. Forty nurses completed the study and were included in the final analysis (20 in the intervention group and 20 in the control group). Baseline perceived stress and fatigue scores were similar between groups. At post-test, the intervention group had significantly lower perceived stress scores than the control group (25.50 ± 4.22 vs. 30.90 ± 7.50, p = 0.008) and significantly lower fatigue severity scores (3.06 ± 0.65 vs. 3.99 ± 0.77, p < 0.001). A brief online meditation programme may be a feasible supportive intervention for reducing stress and fatigue among intensive care nurses; however, larger multi-centre trials are needed to confirm these findings. Remotely delivered meditation may offer an accessible and low-cost adjunct to staff well-being initiatives in intensive care settings, particularly for nurses working rotating shifts, but it should complement rather than replace organisational approaches to workforce well-being.
Hyperglycaemia is common among intensive care unit (ICU) patients and is associated with increased mortality. However, whether intensive or liberal glucose control is more beneficial remains controversial. To compare the benefits and risks of intensive versus liberal glucose control in ICU patients. A Meta analysis of randomized controlled trials. Systematic review and meta-analysis of randomized controlled trials (RCTs). We systematically searched PubMed, Cochrane Library, Embase and Web of Science from inception to October 30, 2024. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were independently screened and extracted by four reviewers. Relative risks (RRs) were pooled using a random effects model, and trial sequential analysis was performed for the primary outcome. Seventy RCTs were included, comprising 36 502 patients, of which 64 RCTs (32 491 patients, 89%) were conducted in adults and 6 RCTs (4011 patients, 11%) in children. The RR of all-cause mortality after intensive and liberal glucose control was 0.99 (95% CI, 0.93-1.05) in adults. Comparable findings were observed for all-cause mortality in children. Intensive glucose control had a statistically significantly higher risk of severe hypoglycaemia in both children (RR 5.70; 95% CI 2.60-12.51) and adults (RR 3.55; 95% CI 2.49-5.07). However, intensive glucose control had a statistically lower risk of infection in both children (RR 0.83; 95% CI 0.70-0.98) and adults (RR 0.78; 95% CI 0.63-0.97). In the subgroup analysis of adults, a lower risk of infection was observed in all surgical groups, but not in the medical group. There was no statistically significant difference in other complications, including sepsis, acute renal injury, new need for dialysis and need for blood transfusion. Intensive and liberal glucose control had similar effects on all-cause mortality in adults and children, though paediatric data are limited and should be interpreted cautiously. Intensive glucose control reduced infection risk, especially in surgical ICUs, but increased the risk of severe hypoglycaemia. These findings suggest that routine intensive glucose control does not improve survival and should be applied cautiously due to increased hypoglycaemia risk, although it may reduce infection risk, particularly in surgical ICU patients.