Intensive Care Unit-Acquired Weakness and Post-Intensive Care Syndrome are common among critically ill patients, substantially impairing quality of life after discharge. Intensive Care Unit rehabilitation has been shown to mitigate these outcomes, and physiotherapists contribute by systematically assessing patient progress using standardized measurement tools such as the Norwegian version of Chelsea Critical Care Physical Assessment Tool (the CPAx-NOR). However, implementing such tools in intensive care settings is often challenging. This study explored the perceived applicability of the CPAx-NOR and examined facilitators and barriers to its use in Norwegian ICUs. A qualitative exploratory design was applied. Three focus group interviews were conducted with ten physiotherapists, one physician, one nurse, and one former ICU patient recruited from five Norwegian hospitals. Data collection was guided by a semi-structured interview guide. The Consolidated Framework for Implementation Research informed the thematic analysis. Participants perceived the CPAx-NOR as being well aligned with physiotherapy practice, adaptable to ICU rehabilitation, and important when developing a shared professional language within multiprofessional teams. Barriers included tension for change, difficulties in grip strength assessment, organizational constraints, and concerns about professional autonomy. The identified facilitators and barriers highlight the need for tailored implementation strategies to promote successful implementation of the CPAx-NOR in Norwegian ICUs. Measurement tools in the intensive care unit are vital for guiding rehabilitation and identifying patients at risk of physical morbidity.Integrating the Norwegian version of the Chelsea Critical Care Physical Assessment Tool into clinical workflows enables the multidisciplinary team to plan and communicate individualized rehabilitation strategies from admission to discharge.By systematically identifying the barriers to implementing the Norwegian version of Chelsea Critical Care Physical Assessment Tool in the intensive care unit, targeted implementation strategies can be developed to facilitate the successful implementation of the tool.The primary barriers to implementing the Norwegian version of Chelsea Critical Care Physical Assessment Tool were tension for change, difficulties with grip-strength assessment, organizational constraints, and concerns about professional autonomy.
Growing cultural diversity in critical care underscores the need for curricula translating transcultural nursing theory into advanced critical care nursing practice. This article presents a conceptual framework to address this gap. A theory-based design synthesizes Leininger's Culture Care Theory and Campinha-Bacote's model of cultural competence with participatory pedagogies. The Co-Creation for Cultural Competence (C4) Framework integrates storytelling, citizen science, and critical reflection as strategies for embedding lived experience. The framework maps theoretical constructs to pedagogical methods and outcomes in advanced nursing in intensive care. Implementation considerations include faculty preparation, ethical engagement of migrant communities, evaluation using validated transcultural measures and educational models. The C4 Framework operationalizes culturally congruent care in critical care education, extending Leininger theory and Campinha-Bacote model. It offers guidance for educators while advancing transcultural nursing theory and supporting global goals of equity and inclusion.
The United States declared endemic measles eliminated in 2000. However, outbreaks continued, with resurgences in 2019 and 2025. In 2025, more than 2200 cases across 48 outbreaks, the most since 1992, were reported. In the first half of 2026, 2073 cases were reported. Declining measles, mumps, and rubella vaccination rates have increased susceptibility among children. Acute and critical care nurses are central to early recognition and management of measles for optimal outcomes. To summarize current evidence on measles epidemiology, pathophysiology, clinical presentation, complications, treatment strategies, and acute and critical care nursing implications, emphasizing preparedness amid rising case numbers. A literature review was conducted using PubMed and CINAHL databases and websites of Centers for Disease Control and Prevention, World Health Organization, professional organizations, and pediatric hospitals. English-language sources published from 2015 to August 2025 were prioritized; relevant earlier studies were included. Reference lists were searched for additional articles. Measles is among the most contagious human diseases. Typical features include fever, cough, coryza, conjunctivitis, and morbilliform rash. Severe respiratory and neurological complications may require critical care hospitalization. Complications like encephalitis may present weeks to years after acute infection. Management remains supportive, with vitamin A supplementation recommended. Acute and critical care nursing priorities include early recognition, isolation precautions, specimen collection, respiratory and hemodynamic support, neurological monitoring, serial assessments, hydration, nutrition, and caregiver education. Measles is resurging in the United States despite being vaccine preventable. Nurse preparedness, including knowledge of clinical features, complications, and infection control, is essential to mitigate morbidity and mortality and to support outbreak prevention. (Critical Care Nurse. Published online ahead of print July 17, 2026).
Central line-associated bloodstream infection (CLABSI) remains a clinically important healthcare-associated infection in intensive care units. Routinely collected electronic health record (EHR) data may capture patient-level care-process complexity not reflected by conventional catheter-related variables alone. To examine whether an EHR-derived care-exposure burden score was associated with adjudicated CLABSI or CLABSI-like bloodstream infection among critically ill adults with central venous catheter exposure. This multi-source retrospective cohort study used harmonised data from MIMIC-IV, the eICU Collaborative Research Database, and a Chinese real-world critical care cohort. Adult patients with documented central venous catheter exposure and an ascertainable post-catheterisation observation window were included. The primary care-exposure burden score summarised cumulative care-process complexity using charting frequency, unique caregivers, concurrent vascular lines, catheter duration, pre-insertion mechanical ventilation duration, antibiotic-type count, and 24-h fluid input and output after catheterisation. Components were log-transformed, robustly standardised within each data source, averaged into a composite score, and categorised into database-specific quartiles. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). A 48-h landmark-compatible sensitivity analysis recalculated the score after excluding total catheter duration. The final cohort included 12,693 patients: 10,868 from MIMIC-IV, 1,489 from eICU, and 336 from the Chinese cohort. Overall, 910 patients developed adjudicated CLABSI or CLABSI-like bloodstream infection (7.2%). Event rates were 4.7, 19.1, and 33.6%, respectively. Patients with events had higher care-exposure burden scores than those without events [median 0.27 (IQR, 0.00-0.46) vs. -0.02 (IQR, -0.21 to 0.20); p < 0.001]. In the primary clinically adjusted model, higher burden quartiles showed progressively greater odds compared with Q1: Q2 aOR 1.46, Q3 aOR 2.51, and Q4 aOR 4.99. The association was attenuated but persisted in the landmark-compatible analysis excluding total catheter duration. Higher EHR-derived care-exposure burden was associated with higher odds of adjudicated CLABSI or CLABSI-like bloodstream infection. The score should be interpreted as a pragmatic patient-level marker of cumulative care complexity and infection-prevention prioritisation, rather than as a causal measure of care quality or nursing performance. Prospective validation is required before clinical implementation.
Intensive care units constitute one of the most stressful working environments for healthcare workers, and workplace violence represents a significant occupational risk in these units. Violence is not limited to physical harm alone; it negatively impacts nurses' psychosocial well-being, performance and the quality of care. This study aims to examine experiences of workplace violence conceptualised as 'invisible wounds' in intensive care units using a mixed methods approach with a sample of intensive care nurses. This study used a mixed methods design, combining a cross-sectional survey with qualitative content analysis. The research was designed as a mixed methods study and was conducted between 15 February and 5 April 2026. In the qualitative phase, semi-structured interviews were conducted with 13 nurses; in the quantitative phase, the Demographic Characteristics Form and The Multidimensional Presenteeism in Nurses Scale were administered to 130 nurses. Data were analysed using IBM SPSS 27 and MAXQDA 2022. Of the total sample (N = 130), 64.6% of nurses reported exposure to workplace violence at least once in their professional practice (n = 84/130); the most common type of violence was verbal violence (91.7%). The rate of physical violence was 32.1%, and the most significant source of violence was patients' relatives (67.9%). Only 46.4% of nurses who had been exposed to violence reported the incident. The mean scores on the 'Experience of Presenteeism at Work' scale were 19.13 ± 8.57 for the experience dimension, 43.64 ± 11.44 for the reasons dimension, and 69.52 ± 18.86 for the consequences dimension. Qualitative findings revealed that the experience of violence was described using the metaphor of an 'invisible wound', that violence became normalised over time, and that nurses predominantly turned to individual coping strategies. Workplace violence among intensive care nurses is a widespread, multidimensional and largely normalised problem. Low reporting rates and the normalisation of violence create a vicious cycle in which opportunities for learning and improvement are lost. To break this cycle, it is necessary to strengthen a culture of reporting, develop institutional support mechanisms and implement holistic strategies that prioritise staff safety. Identifying the prevalence, under-reporting and normalisation of workplace violence in intensive care units enables targeted interventions that reduce exposure to violence, improve nurses' well-being and performance and promote a safety culture through effective reporting systems.
To retrieve, evaluate, and summarize the evidence related to nutritional risk screening and assessment in adult critically ill patients, providing an evidence-based decision-making reference for clinical healthcare professionals. This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. According to the '6S' model of evidence resources, evidence on nutritional risk screening and assessment in adult critically ill patients was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus, and systematic evaluations. Up to date, BMJ Best Practice, Cochrane Library, Joanna Briggs Institute (JBI), Embase, PubMed, WanFang Medical, China Biomedical Literature Database, CNKI, and relevant professional society websites including the National Institute for Health and Care Excellence (NICE), GIlN, the National Guideline Clearinghouse, and Yi Maitong were searched from the establishment of these databases to Dec. 2024. Eleven literature sources were included, comprising 8 guidelines, 2 expert consensuses, and 1 evidence summary. Through rigorous synthesis, 18 best practice recommendations were distilled across eight critical domains: multidisciplinary team formation, screening targets, screening timing, screening instruments, screening frequency, assessment targets, assessment core parameters, and assessment frequency. This study summarizes the current best evidence regarding nutritional risk screening and assessment in adult critically ill patients, providing optimal evidence support for standardizing nutritional risk screening and assessment in this population. In clinical practice, it is essential to select the best evidence for localized and individualized application while continuously updating the evidence to standardize nursing practice. Clinical medical staff are encouraged to use evidence-based recommendations for the screening and assessment of nutritional risks in adult critically ill patients. By implementing these best evidence practices, healthcare professionals can enhance patient care and improve clinical outcomes, ensuring that nutritional needs are effectively addressed. The effective screening and assessment of nutritional risk in critically ill patients are crucial for optimizing patient outcomes. This study summarizes 18 pieces of best evidence concerning nutritional risk screening and assessment, highlighting their importance in clinical practice. Implementing these recommendations can enhance the quality of nutritional care, reduce complications, and ensure that patients receive appropriate nutritional interventions tailored to their needs. By focusing on these best practices, healthcare providers can significantly improve the management of nutrition in critically ill patients. This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing. The registration number is 'ES20221368'.
Frailty is increasingly recognized as an important predictor of adverse outcomes in critically ill patients, but its association with hospital and Intensive Care Unit (ICU) readmissions remains uncertain. We conducted a systematic review and meta-analysis of observational studies in accordance with PRISMA and MOOSE guidelines (PROSPERO: CRD420251046386). PubMed, EMBASE, and Scopus were searched from inception to May 6, 2025. Eleven studies involving 1,051,568 patients were included. Frailty was associated with a significantly increased risk of hospital readmission (pooled RR 1.66, 95% CI 1.16-2.37; I² = 99.2%; 7 studies). In contrast, no significant association was observed between frailty and ICU readmission (pooled RR 1.55, 95% CI 0.93-2.58; I² = 89.3%; 5 studies). Subgroup analyses suggested that heterogeneity was partly explained by differences in frailty assessment methods, study design, and patient populations. Frailty appears to be an important predictor of hospital readmission in critically ill patients, whereas its association with ICU readmission remains uncertain and warrants further investigation.
To explore how first-time fathers articulated their caregiving roles for preterm infants following admission to neonatal intensive care units (NICUs) and to identify the dominant discourses shaping their caregiving identities. A qualitative study informed by Fairclough's three-dimensional framework for critical discourse analysis, grounded in social constructivist and poststructuralist perspectives. Four focus group interviews were conducted with 17 Danish first-time fathers of preterm infants between October 2022 and January 2023. Transcripts were coded and thematized using an emic, data-driven approach. Fairclough's framework guided analysis at the textual, discursive, and social levels. Butler's theory of performativity informed interpretation of how fathers reproduced, reinforced, and challenged gender norms through caregiving practices and language use. Three themes were identified in the textual analysis: (1) first-time fathers' practical and emotional involvement in caregiving; (2) first-time fathers' expressions of protection and responsibility; and (3) shared parenting practices and negotiations of caregiving roles. These themes intersected with broader discourses: paternity leave, caregiving, the father's role, and gender roles. Fathers expressed strong emotional and practical engagement but were sometimes positioned as secondary caregivers by organizational routines. First-time fathers actively constructed identities as competent and involved caregivers while negotiating institutional and societal expectations. Findings highlight opportunities for neonatal nurses to foster father-inclusive, family-centered care by actively involving fathers in caregiving tasks and addressing implicit gender assumptions. Promoting inclusive caregiving cultures that recognize both parents as competent caregivers may advance gender equity and improve outcomes for preterm infants.
Critical care nursing includes physically, emotionally, and ethically challenging jobs which can induce role conflict and organizational cynicism amongst other organizational attitudes. This research aimed to evaluate the association between role conflict and organizational cynicism among critical care nurses. This cross-sectional study recruited 322 nurses working in intensive care units of hospitals under Tehran University of Medical Sciences who completed Role Conflict Questionnaire by Rizzo et al., and Organizational Cynicism Questionnaire by Dean et al. The data were analyzed through Spearman correlation test and multiple linear regression analysis. The mean age of participants was 36.26 ± 8.61, and 73.6% were women. Role conflict had a mean score of 2.58 ± 0.83 and organizational cynicism of 2.73 ± 0.96, showing moderate level of both variables. A significant positive correlation was found between role conflict and organizational cynicism (r = 0.765, p < 0.01) as well as with its emotional, cognitive, and behavioral components. Multiple job holding and number of workplaces at one time were identified as the main factors for both variables. There exists a high association between role conflict and organizational cynicism among critical care nurses. Not applicable.
This case series discusses the nursing care and clinical outcomes of 3 pediatric patients with febrile infection-related epilepsy syndrome (FIRES) and acute-phase complications, focusing on critical care interventions such as seizure management, respiratory support, and nutritional therapy. Three male patients, aged 10, 5, and 7, presented with altered consciousness, seizures, and recurrent fever. Diagnostic tests, including magnetic resonance imaging, electroencephalogram (EEG), and cerebrospinal fluid analysis, revealed abnormal EEG findings, suspected meningeal inflammation, and cerebrospinal fluid abnormalities. All patients were diagnosed with FIRES, accompanied by acute neurological deterioration, supported by EEG and magnetic resonance imaging. All patients required intensive care unit mechanical ventilation. Two underwent tracheostomy during prolonged ventilator dependence, whereas 1 was extubated to low-flow nasal oxygen after approximately 14 days without tracheostomy. Seizure management included anticonvulsants and a ketogenic diet, with individualized adjustments according to clinical response. Multidisciplinary care involved specialists in neurology, respiratory medicine, and rehabilitation. Short-term outcomes differed. One tracheostomized patient was later decannulated and discharged clinically improved, with recovery of communication, oral intake, and independent ambulation. The non-tracheostomized patient remained off invasive ventilation but continued inpatient neurologic and nutritional management, while the other tracheostomized patient still required ventilatory and neurologic management in the latest available record. Coordinated multidisciplinary nursing, early nutritional planning, and structured monitoring may help organize acute-phase FIRES care while supporting individualized respiratory, seizure, and complication management.
Integrating telenursing into health care offers opportunities and challenges, but gaps remain in understanding nurses' perceptions, implementation barriers, and practical use across clinical settings. This study aimed to assess nurses' perceptions of telenursing implementation and identify key barriers in various health care settings in Egypt, providing insights from a resource-limited, middle-income country undergoing digital transformation. A convergent mixed-methods design was employed, involving 240 nurses from 42 private hospitals across Egypt, selected via multistage random and convenience sampling. The study was conducted between January and May 2025. Quantitative data were collected using a 12-item structured questionnaire measuring perceptions across 4 dimensions (methods, patterns, advantages, and disadvantages of telenursing). Qualitative data were gathered through open-ended questions exploring implementation barriers, which were analyzed using inductive thematic analysis following Braun and Clarke's 6-phase framework. The findings indicated a generally positive perception of telenursing among participating nurses, with a mean perception score of 36.4±11.3; 62.9% of nurses held favorable views. A statistically significant association was found between nurses' perceptions and age, educational level, years of experience, and prior training in telenursing. Regression analysis revealed that these factors explained 18.5% of the variance in perception scores (R2=0.185, adjusted R2=0.164). Thematic analysis of qualitative responses identified 5 major barrier themes: (1) lack of institutional support and unclear policies, (2) technological infrastructure deficits, (3) training and competency gaps, (4) patient-related challenges, including digital literacy limitations, and (5) privacy and ethical concerns regarding data security. While nurses in this resource-limited Egyptian context demonstrate positive perceptions of telenursing (mean 36.4±11.3), successful implementation hinges on addressing multilevel barriers that are more acute than those reported in high-income systems. Implications include developing clear institutional policies, providing comprehensive training programs, establishing standardized protocols, and creating supportive technological infrastructure to optimize telenursing adoption and patient outcomes.
The neonatal period is a critical time for both the newborn and the parents, as they transition into parenthood. Mothers with babies admitted to neonatal intensive care units (NICUs) often experience emotional distress, uncertainty, separation from their babies, and disruption of expected maternal roles. In low-resource settings such as Northern Uganda, where neonatal care and psychosocial support services remain limited, little is known about the experiences of mothers with babies admitted to the NICU. This study explored the lived experiences of mothers with babies admitted to the NICU of Lira Regional Referral Hospital in Northern Uganda. A descriptive phenomenological study was conducted at a public regional hospital in Northern Uganda (PRRH). We purposively selected 10 mothers whose babies had been admitted to the NICU for at least three days. Data were collected through phenomenological in-depth interviews. Interviews were audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke's thematic analysis framework. Four major themes emerged from the analysis: emotional grief regarding baby's hospitalization/admission needs, burden of a baby's hospitalization, mother's satisfaction with care given by healthcare workers and altered motherhood role and support systems. Mothers described intense emotional distress characterized by fear, uncertainty, hopelessness, and disruption of maternal expectations. Financial hardship, prolonged hospitalization, and separation from family further intensified their experiences. Despite these challenges, many mothers expressed appreciation for the compassionate care provided by healthcare workers and relied on spirituality and hope as coping mechanisms. Mothers' experiences were shaped by communication from health workers, the baby's clinical condition, hospital requirements, and the availability of interpersonal support. Improving communication, ensuring availability of essential supplies, and strengthening interpersonal support may improve mothers' experiences during NICU admission.
Intensive Care Units (ICUs) care for critically ill patients across all age groups, with many deaths occurring during or shortly after admission. For families, this can be associated with significant psychological distress, including prolonged grief, depression, and post-traumatic stress. Family experiences are influenced by the quality of end-of-life communication, involvement in decision-making, and the availability of bereavement support. Despite this, bereavement care across neonatal, paediatric, and adult ICUs remains inconsistent, highlighting the need for evidence-based strategies. To identify, summarise, and report the effectiveness and impact of end-of-life and bereavement interventions delivered by ICU staff on family psychological, social, and physiological outcomes. Overview of reviews. Neonatal, paediatric, and adult ICUs internationally. A comprehensive search (PROSPERO CRD42024581827) was conducted across Medline, Embase, Scopus, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, and PsycINFO, with an updated search in 2025. Screening was completed by two research team members. Risk of bias was assessed using ROBIS. Data were extracted as reported in each systematic review and analysed narratively. Fifteen systematic reviews (145 primary studies) were included across neonatal (n = 4), paediatric (n = 1), adult (n = 9), and mixed settings. Interventions were diverse and often multi-component. Communication-focused strategies that were timely, honest, and individualised were associated with improved family satisfaction and perceptions of care. Opportunities for family presence, shared decision-making, and relational nursing support were reported as central to understanding, acceptance, and adjustment. Memory making and bereavement follow-up were valued, though impacts on psychological outcomes varied. Evidence was limited by inconsistent outcome measures and minimal paediatric-specific reviews. ICU family-focused end-of-life and bereavement interventions can provide meaningful support, but effectiveness is difficult to determine due to inconsistent implementation and methodological variation. Findings highlight the importance of individualised and relational approaches, and suggest culturally responsive care may influence how interventions are experienced.
Firearm-related injury is the leading cause of death in children in the United States. Safe storage counseling with gun lock distribution is an evidence-based practice to reduce firearm injury; however, it is infrequently employed in the pediatric intensive care unit (PICU), creating a missed opportunity for injury prevention. We assessed caregiver perceptions after implementing safe storage counseling in our PICU, hypothesizing that caregivers would find this practice acceptable and increase intent to safely secure firearms. With multidisciplinary PICU clinicians and family advisory board input, we created a workflow for universal safe storage counseling and lock distribution. We identified patients with planned discharge or transfer daily and approached those with a caregiver at bedside to provide safe storage counseling, a free cable gun lock, and a postcounseling survey. 350 (86%) of 407 caregivers, predominantly mothers, completed the postcounseling survey. This was the first time receiving counseling from a health care clinician for 87% of caregivers; 97% found the PICU an acceptable location. The majority (78%) reported an increased likelihood of asking about safe storage of firearms in other homes where their children spend time, 87% reported they intended to share information received. 30% planned to use the lock provided, and 56% would give the lock to someone else. Others planned to remove a firearm (3%) and/or change their firearm storage practices (17%). We demonstrated high acceptability and potential impact of a universal approach to safe storage counseling and gun lock distribution in the PICU.
The COVID-19 pandemic accelerated digital communication adoption in intensive care units when traditional bedside visits became restricted. Understanding multi-stakeholder satisfaction with digital communication is essential for optimizing family-centred care in the post-pandemic era. To examine satisfaction with digital communication among physicians, nurses and families in intensive care units, identify influencing factors and analyse implications for practice. A cross-sectional study using purposive sampling was conducted from August 2023 to May 2024 in intensive care units at a medical center in Taiwan. In total, 300 participants (100 physicians, 100 nurses, and 100 family members) participated in this study. Family members reported significantly higher satisfaction (mean 84.6, 95% CI: 82.4-86.8) than physicians (mean 80.6, 95% CI: 78.5-82.7) and nurses (mean 77.8, 95% CI: 75.2-80.5). Communication perception was the strongest predictor of satisfaction (β = 0.34, p < 0.001), explaining 34.0% of variance. Nurses scored significantly higher on communication regulations than physicians (F = 3.39, p = 0.035) and uniquely identified privacy concerns (10 mentions), workload issues and team coordination challenges. Communication perception is the primary determinant of digital communication satisfaction across all stakeholder groups. Nurses demonstrated significantly lower satisfaction and unique concerns regarding workload, privacy and team coordination, requiring targeted institutional support. Optimizing ICU digital communication requires integrated strategies addressing communication quality, workforce support and organizational infrastructure. Healthcare institutions should implement empathetic communication training focussed on positive attitudes (the most valued factor across all groups), establish dedicated communication staff to reduce nurse workload burden, address technical infrastructure barriers (the most frequently cited concern), develop clear protocols for privacy protection and workflow integration and provide simplified medical explanations to enhance family comprehension in ICU digital communication.
This study aimed to evaluate the association between Plan-Do-Study-Act (PDSA) cycle-based quality improvement measures and the correct implementation rate of head-of-bed elevation, artificial airway cuff pressure compliance, and ventilator-associated pneumonia (VAP) incidence in mechanically ventilated patients, and to identify independent influencing factors of the two core care indicators. A total of 4305 patients receiving mechanical ventilation for ≥48 hours in the Emergency Intensive Care Unit (EICU) and Respiratory Intensive Care Unit (RICU) were enrolled, divided into the pre-implementation group (n=2163, Jan-Dec 2024) and the post-implementation group (n=2142, Jan-Dec 2025). The post-implementation group received comprehensive improvement measures based on the PDSA cycle, including standardized monitoring, normalized measuring tools and continuous quality control. The two indicators' compliance rates and VAP incidence were compared between groups. Univariate and multivariate Logistic regression analyses were used to identify influencing factors, and Spearman correlation analysis was performed to explore the relationship between indicator compliance and VAP incidence. The post-implementation group had significantly higher compliance rates of both indicators and lower VAP incidence (all P<0.05). Both indicators were significantly negatively correlated with VAP incidence (all P<0.001). APACHE II score ≥25, mechanical ventilation ≥10 days, patient agitation and delirium, and insufficient nursing staffing were independent risk factors for lower compliance rates, while standardized processes and quality monitoring were independent protective factors (all P<0.05). PDSA cycle-based comprehensive quality improvement measures were associated with improved compliance rates of head-of-bed elevation and artificial airway cuff pressure in mechanically ventilated patients, and lower VAP incidence. Standardized procedures and continuous quality monitoring are key to maintaining high compliance of these two core VAP prevention indicators.
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Post-Intensive Care Syndrome-Family (PICS-F) is a condition that often develops in family caregivers of ICU patients and severely impacts their quality of life. Currently, there is a lack of comprehensive assessment tools suitable for the Chinese cultural context. To develop and validate a culturally appropriate scale for assessing PICS-F in family members of ICU patients within the Chinese context. This study adopted an exploratory sequential mixed-methods design. The scale was developed based on a preliminary qualitative study and guided by the Theory of being devastated by the critical illness journey in the family. An initial pool of 42 items was generated. Content validity was evaluated through expert consultation. A pilot survey was conducted. A cross-sectional survey was then performed with 447 family members. Reliability and validity were assessed using item analysis, exploratory factor analysis, confirmatory factor analysis, and Cronbach's α coefficient. Content validity indices were adequate (item-level content validity index (I-CVI): 0.80-1.00; scale-level content validity index/average (S-CVI/Ave) = 0.98). The final PICS-F Assessment Scale contains 19 items across three dimensions: Psychological Trauma and Distress (8 items), Social and Family Functioning Impairment (8 items), and Deteriorating Physical Health (3 items). Exploratory Factor Analysis (EFA) supported the three-factor structure, accounting for 56.98% of the total variance. Confirmatory Factor Analysis (CFA) indicated adequate model fit [χ 2/d f = 2.268, root-mean-square error of approximation (RMSEA) = 0.075, comparative fit index (CFI) = 0.934, Tucker-Lewis index (TLI) = 0.924, Standardized Root Mean Square Residual (SRMR) = 0.064]. The scale demonstrated high internal consistency (Cronbach's α = 0.918 for the total scale; subscales: 0.919, 0.903, 0.851). The scale provides a practical tool for early screening and assessment of PICS-F in clinical settings, facilitating timely and targeted support for at-risk family caregivers. The PICS-F Assessment Scale demonstrated promising preliminary psychometric properties for holistically assessing the impact of critical illness on family members, demonstrating good internal consistency reliability, content validity, and construct validity. Further validation with larger samples and criterion-related measures is needed.
Delays in end-of-life (EOL) decisions and prolonged life-sustaining treatments (LST) are common in pediatric intensive care units (PICUs), but the influence of underlying disease on EOL decision-making remains unclear. We compared EOL decision patterns and LST practices between oncology and non-oncology patients in PICUs. This retrospective study was conducted at two tertiary PICUs in Seoul, Korea (March 2023-February 2025 at one center; March 2024-February 2025 at the other). Inclusion criteria were patients (0-25 years) admitted to the PICU with a documented EOL decision. Among 55 patients, 23 were oncology and 32 were non-oncology. Non-oncology patients were younger (median 4.8 vs. 10.8 years, p = 0.040), had more pre-PICU CPR (p = 0.004), and higher Pediatric Logistic Organ Dysfunction-2 (PELOD-2) scores (p = 0.001). Time from PICU admission to EOL decision (15.5 vs. 5.0 days, p = 0.034) was longer in non-oncology patients. Palliative care consultation at EOL decision was more frequent among non-oncology patients (78.1% vs. 47.8%, p = 0.025). In exploratory multivariable negative binomial regression adjusting for age and PELOD-2, non-oncology status was associated with a longer time from PICU admission to documented EOL decision (IRR 2.13, 95% CI 1.05-4.35). Withdrawal of LST was more common in non-oncology patients (65.6% vs. 26.1%), while no escalation of support was more common in oncology patients (60.9% vs. 31.3%, p = 0.011). EOL decision timing and care patterns differed between oncology and non-oncology patients, suggesting disease trajectory may influence EOL decision-making in PICUs.
Pediatric intensive care unit (PICU) nurses spend the most time with patients and families during a critical illness. However, nurses, families, and other clinicians conceptualize suffering differently, leaving some types of suffering when a child is nearing the end-of-life (EOL) unaddressed. PICU nurses are thus well-positioned but underequipped to address suffering during EOL. We aimed to 1) characterize distinctive features that indicate the presence and/or absence of suffering; and 2) identify nursing care responses that help attend to EOL suffering. Using qualitative interpretive description, we collaborated with a purposive sample of bereaved parents and interdisciplinary health professionals, including nurses, to develop a conceptual model to better equip nurses to notice and respond to EOL suffering. The sample participated in 3 focus group discussions. Two coders generated descriptive codes from each focus group, which were revised with participants at subsequent sessions and then arranged into overarching categories. Categories and sub-categories were then co-designed into a conceptual model that was iteratively refined by participants and the research team. Participants (N = 25) included 8 parents, 6 PICU nurses, 3 PICU physicians/advanced practice providers (APPs), 3 palliative care physicians/APPs, and 5 allied health professionals. Together with the research team, participants co-designed A Conceptual Framework to Guide Bedside Nursing Care to Address EOL Suffering, which relates four overlapping categories: 1) Noticeable Indicators for Acknowledgement and Validation, 2) Responsive Indicators for In-the-Moment Interventions, 3) Collaborative Responses, and 4) Dynamic Contextual Factors. Participants described that some indicators of suffering may be acknowledged and/or validated (such as shattered assumptive world) but not always eased. Whereas other indicators (such as physical and emotional expressions) may be responsive to in-the-moment interventions (such as facilitating opportunities for connection). Collaborative Responses included nurse strategies to address suffering such as partnering with parents, promoting connection and comfort, and connecting with resources. Dynamic Contextual Factors included external influences beyond the patient, family, and nurse, that shaped how nurses notice and respond to suffering, such as uncertainty. This study helped operationalize indicators of and nurse-led responses to EOL suffering using a parent and clinician collaborative approach. The conceptual model can inform nurse-led, parent-partnered interventions to acknowledge and ease suffering among children nearing EOL and their families. Some manifestations of suffering during EOL in the PICU may be readily addressable through nursing care while others may be witnessed and validated by nurses. Partnership between parents and nurses is a cornerstone of holistically addressing suffering.