This study aims to assess critical care nurses’ knowledge of blood transfusion safety in a university hospital in Jordan. A descriptive cross-sectional study was conducted among 200 critical care nurses who completed a questionnaire assessing knowledge of transfusion procedures, safety protocols, and management of transfusion reactions. Of the participants, 58% were female, with a mean clinical experience of 9.37 years (SD = 5.4); 68% had more than 10 years of experience. The mean blood transfusion safety score was 18.9 (54%) out of 35 (SD = 5.92), indicating poor overall knowledge. Major gaps were noted in recognizing acute transfusion reactions (86.5%) and identifying drug restrictions during transfusion (74.5%). In contrast, most nurses were knowledgeable about informed consent (90.5%) and blood cross-matching (87%). Knowledge levels differed significantly by gender, education, experience, and workplace ( P < .05), with intensive care unit nurses scoring lower than those in emergency, burn, or dialysis units. Multiple linear regression showed that the workplace was the only significant predictor, explaining 10.3% of the variance. Significant knowledge gaps in transfusion safety were identified, underscoring the need for targeted education and training to improve nurses’ competency, enhance patient safety, and reduce transfusion-related adverse outcomes.
Intensive care unit (ICU) patients often have compromised oral health due to their overall condition and intensive treatment. Oral hygiene is a crucial nursing intervention, particularly for preventing ventilator-associated pneumonia. In the Czech Republic, intensive care is provided in standard ICUs for critically ill but relatively stable patients requiring continuous monitoring, and in anesthesiology and resuscitation units, which provide the most advanced and intensive supportive interventions for patients at immediate risk of life-threatening deterioration (such as cardiac arrest). The aim is to investigate professional and situational factors affecting the quality of oral care in ICU patients with invasive airway management. A prospective observational study was conducted over 5 months (August 2023 to January 2024) in 6 ICU units. Data were collected via participant observation of health care professionals. Statistical analysis used the chi-square test ( P < .05) in SPSS 28.0. Preparation for oral care was insufficient in all areas. Personal protective equipment was used by 70% of health care professionals, 62.1% placed patients in Fowler’s position, 9.2% assessed the oral cavity, and 73.3% suctioned oral secretions before cleaning the mouth. Only 36 of 87 health care professionals (41.38%) performed dental care correctly. The most used tools were disposable foam swabs (41.38%), toothbrushes (31.03%), and suction toothbrushes (8.05%). Proper rinsing and suction were completed by 14.94%, and tongue, palate, and mucosa care were properly done by 64.37%. Oral care for ICU/critical care unit patients, particularly those with invasive airway management, remains insufficient due to limited attention to and assessment of the oral cavity. These findings are clinically relevant for nursing research and practice, as they highlight gaps in routine nursing care and emphasize the need for standardized, evidence-based oral care protocols and improved adherence to support better patient outcomes.
Aim:The aim of this study is to determine the predictive power of the National Early Warning Score in identifying the outcomes of intensive care unit (ICU) patients. Methods:In this study, 300 patients hospitalized in the ICUs (medical and general) of two teaching hospitals affiliated with Tehran University of Medical Sciences were evaluated and followed up for 30 days between June 2023 and April 2024. The samples were selected by convenience sampling based on inclusion criteria. A checklist containing the components of early warning criteria introduced by Braden, SOFA and APACHE II, as well as outcomes of hospitalization in the ward, was used. The early warning criteria were assessed by the researcher at the time of admission, as well as 6 and 24 h after the admission of patients to ICU. The collected data were analysed by SPSS-27 and STATA-14 software using Kruskal-Wallis, Pearson and chi-square tests, as well as the area under the receiver operating characteristic (ROC) curve of early warning system. Results:The mean age of patients was 41 years (31-56), and 63.70% of them were male. Comparison of the area under the ROC curve of early warning tool showed that the early warning score in predicting death at the time of admission, 6 h after admission and 24 h after admission was 0.697, 0.712 and 0.87, respectively. Also, this score in predicting adverse outcomes at the time of admission, 6 h after admission and 24 h after admission was 0.700, 0.784 and 0.936, respectively. In other words, the early warning system had a good predictive power in indicating the occurrence of outcomes at all three times (at admission, 6 hours after admission and 24 h after admission), but the best time to predict death and adverse outcomes was estimated to be 24 h after admission. Conclusion:By evaluating the predictive power of early warning score in identifying the outcomes of patients hospitalized in ICUs, we found that the early warning score at 24 h after admission had a higher predictive power than other times.
Background: Pressure injuries represent a significant healthcare challenge in ICUs, particularly among older adults with diabetes. This study examined the relationship between hemoglobin levels and hospital-acquired pressure injury (HAPrI) development. Methods: This retrospective cohort study analyzed MIMIC-IV database data from 10,468 ICU patients aged ≥65 years with stays of 2-14 days. Primary outcome was HAPrI development during ICU stay. Clinical and laboratory factors were compared between diabetic and non-diabetic patients. Results: Among 10,468 patients (mean age 77.56±8.05 years), 366 (3.5%) developed HAPrIs. Diabetes patients (n=1,513, 14.5%) had significantly higher HAPrI rates than non-diabetic patients (6.3% vs 3.0%; P<0.001). Diabetic patients who developed HAPrIs had markedly lower minimum hemoglobin levels than those without HAPrIs (7.94±2.07 vs 10.00±1.73 g/dL; P<0.001). Among diabetic patients with HAPrIs, those developing multiple injuries had lower hemoglobin levels than those with single injuries (7.22±2.06 vs 8.30±2.00 g/dL; P=0.02). Conclusions: Low hemoglobin levels are strongly associated with HAPrI development in older ICU patients with diabetes, with anemia severity correlating with multiple injury occurrence. Hemoglobin optimization may represent an important targeted prevention strategy for high-risk ICU patients.
Background:Physicians and nurses working in intensive care units (ICUs) are frequently exposed to emotionally demanding and high-stress situations, placing them at increased risk for anxiety. Eye movement desensitization and reprocessing (EMDR) has shown promise in reducing anxiety in various high-stress populations; however, its effectiveness among ICU staff remains underexplored. Objective:To evaluate the efficacy of EMDR in reducing anxiety severity among ICU physicians and nurses. Methods:This quasi-experimental study was conducted among 60 ICU staff members who were allocated to either an EMDR intervention group (n = 30) or a control group (n = 30). Anxiety severity was assessed using the Beck Anxiety Inventory (BAI) at baseline and post-intervention. The EMDR protocol consisted of eight sessions delivered twice weekly. Data were analyzed using paired t-tests and ANCOVA controlling for baseline anxiety. Internal consistency of the BAI was assessed using Cronbach's alpha. Results:All participants completed the study with no dropouts. Baseline characteristics were comparable between groups. The EMDR group showed a significant reduction in anxiety from baseline to post-intervention (p < 0.01), whereas the control group showed no significant change. ANCOVA revealed a significant effect of EMDR on post-intervention anxiety scores (F(1,57) = 4.21, p = 0.045). Cronbach's alpha for the BAI in this sample was 0.89. Conclusion:EMDR significantly reduced anxiety among ICU physicians and nurses. Given the high emotional burden in critical care settings, EMDR may be a valuable component of mental health support programs for healthcare professionals. Further randomized controlled trials with long-term follow-up are recommended.
This review highlights current approaches in managing hypertensive acute heart failure (H-AHF) relevant to nurse practitioners. It emphasizes the shift from volume overload to vascular redistribution as the primary cause of congestion, prioritizing vasodilators over diuretics unless overt fluid overload exists. Sequential nephron blockade and high-dose IV nitroglycerin demonstrate promise in overcoming diuretic resistance and rapidly reducing cardiac pressures. Noninvasive ventilation supports respiratory recovery in acute pulmonary edema. While these strategies improve outcomes, further research is needed to optimize safety and efficacy in diverse clinical settings.
Heart failure is a growing public health burden with high morbidity and mortality, often requiring mechanical circulatory support such as femoral intra-aortic balloon pump (f-IABP) for patients in cardiogenic shock awaiting heart transplantation. Traditionally, bedrest is a standard practice for f-IABP patients due to concerns over catheter displacement, leading to muscle deconditioning and functional decline. This quality improvement project implemented and evaluated a nurse-led, modified Ramsey protocol to assess the safety and feasibility of early mobility in f-IABP patients. The protocol included verticalization using a tilt bed, followed by structured ambulation for eligible patients. Sixty-two patients were enrolled, with 42 undergoing verticalization only and 20 advancing to ambulation. Data on ICU and hospital length of stay, adverse events, and discharge disposition were collected. Results showed minimal complications across groups, with improved post-transplant recovery and higher rates of home discharge in the ambulation group. This initiative demonstrates that nurse-led mobility programs can be safely executed in critically ill cardiac patients with f-IABP, offering promising implications for functional preservation and postoperative recovery. The study supports the integration of early mobility into standard care for this complex patient population.
Aim:Postoperative delirium is a clinically important complication among patients admitted to a surgical intensive care unit (ICU). Remimazolam is increasingly used for perioperative and ICU sedation, but its association with postoperative delirium after elective surgery remains uncertain. This study evaluated the association between remimazolam-based postoperative sedation and postoperative delirium in surgical ICU patients. Design:A single-center prospective cohort study. Methods:Adult patients admitted to a surgical ICU after elective surgery between June 2024 and May 2025 were categorized according to their early postoperative sedation strategy. The remimazolam group was compared with a nonremimazolam sedation strategy group, which included patients receiving dexmedetomidine, midazolam, propofol/ciprofol, or no continuous sedative infusion. The primary outcome was postoperative delirium within the first 5 postoperative days or during the ICU stay, whichever was shorter. Delirium was assessed using the Confusion Assessment Method for the ICU and/or the Intensive Care Delirium Screening Checklist when patients were sufficiently arousable. Stabilized inverse probability of treatment weighting was used to reduce measured baseline imbalance. Weighted logistic regression was used for delirium, and weighted median regression was used for skewed continuous outcomes. Results:Of 307 patients assessed for eligibility, 208 were enrolled, and 204 were included in the final analysis, of whom 125 received remimazolam and 79 received nonremimazolam sedation strategies. Postoperative delirium occurred in 15 patients (12.0%) in the remimazolam group and 7 patients (8.9%) in the comparator group. After inverse probability weighting, remimazolam was not statistically significantly associated with postoperative delirium (adjusted odds ratio 1.69, 95% confidence interval 0.61-4.69; p = 0.312). Mechanical ventilation duration was longer in the remimazolam group (median difference 6.00 h, 95% confidence interval 2.00-8.00; p < 0.001). Conclusion:Remimazolam was not statistically significantly associated with postoperative delirium compared with nonremimazolam sedation strategies. However, the low event rate, wide confidence interval, and heterogeneous comparator group mean that clinically important differences cannot be excluded. The longer ventilation duration observed in the remimazolam group should be interpreted cautiously because residual confounding may remain. Trial Registration: Chinese Clinical Trial Registry: ChiCTR2400085877.
ObjectivesTo adapt evidence-based clinical practice guidelines (CPGs) for sedation, analgesia, withdrawal, and delirium assessment and management with a focus on early mobility in critically ill children admitted to a pediatric intensive care unit (PICU).DesignThe panel included two groups: the guideline adaptation group (GAG), which consisted of two consultant pediatric intensivists, a clinical pharmacist, a senior nurse specialist, and a general pediatrician and a CPG methodologist, and an external review and consultation group, which included five consultant pediatric intensivists, a clinical pharmacist, and two CPG expert physicians. A formal methodology for CPG adaptation was followed and included three phases: set-up, adaptation, and finalization.ResultsThe provided assessment tools and management algorithms focused on adequacy of sedation and analgesia, medication selection, dosing, initiation, and adjustment for both noninvasive and invasive mechanical ventilation; withdrawal assessment; weaning of sedation and analgesia; withdrawal management; delirium screening; delirium management; as well as early mobility facilitation. Implementation tools included behavioral scoring tool for sedation and pain, Withdrawal Assessment Tool with a management guide, screening score for delirium with a management guide, 3 clinical management algorithms for sedation management, analgesia management, and weaning process.ConclusionsBased on a systematic adaptation framework and the interdisciplinary and multidisciplinary approach, the present study formulated an adapted CPG with practically applicable implementation tools and management algorithms that might help standardize sedation, analgesia, and withdrawal assessment and management in critically ill children at the PICU. We recommend further studies to clarify the generalizability, impact of its implementation, and practices to overcome potential barriers.
Activation of the NF-κB signaling pathway in sepsis plays a crucial role in the expression of TNF-α, IL-8, and MMP-8, which can further exacerbate the condition. The management of sepsis requires complex strategies. Glutamine and arginine are amino acids that can modulate inflammatory processes and enhance immune function, and their levels are often deficient in sepsis. This study aimed to analyze the effects of glutamine and arginine combination (GAC) on TNF-α, NF-κB, IL-8, and MMP-8 expressions in sepsis. Seventy-two Rattus norvegicus were divided into three main intervention groups, each of which was further divided into three subgroups that received therapy initiated at different time points (6 h, 24 h, and 48 h) after the intervention. Therapy was administered once daily for three consecutive days. Termination was performed 2 h after the final therapy, after which jejunal tissues were collected. The administration of GAC resulted in different cells expressing IL-8 (p = 0.026) in the 24-h treatment group and MMP-8 (p < 0.001) in the 6-h treatment group. No differences were found in cells expressing TNF-α, NF-κB, and IL-8 in the 6-h treatment group (p > 0.05); TNF-α, NF-κB, and MMP-8 in the 24-h treatment group (p > 0.05); and TNF-α, NF-κB, IL-8, and MMP-8 in the 48-h treatment group (p > 0.05). The supplementation of GAC demonstrated different cells expressing IL-8 (in therapy started at 24 h) and MMP-8 (in therapy started at 6 h). Future studies should be conducted on dose evaluation over a longer research duration to validate more specific results.
Background:Sepsis has a heterogenous clinical presentation with distinct regional epidemiological profiles. The study aims to identify clinical phenotypes from an Indian sepsis cohort. Methods:The cohort included all adult patients admitted through the emergency department with a presumed diagnosis of sepsis following Surviving Sepsis Guidelines criteria. The unsupervised k-means clustering method was used, and the identified Indian clusters were compared using distance matching to phenotypic clusters in Seymour et al., which had previously identified four reproducible sepsis phenotypes in large Western ICU cohorts. The association of focus of infection and outcomes among the clusters were assessed. Results:Of the 1009 patients, four clusters were identified. Age (p = 0.024) and gender (p = 0.04) significantly differed among the clusters. The Indian clusters that exhibited close association to the alpha, beta, gamma, and delta phenotypes reported in Seymour et al. were termed i-Alpha (254, 25%), i-Beta (141, 14%), i-Gamma (389, 39%), and i-Delta (225, 22.3%) respectively. The clusters demonstrated significant variations in clinical profiles and outcomes. Septic shock and in-hospital mortality were highest among i-Alpha at 19% (48/254) and i-Beta at 34% (48/141) (p < 0.001), respectively. Prevalence of pneumonia (p = 0.018), SSI (p = 0.011), and bacteremia (p = 0.004) significantly differed among the clusters. Pseudomonas (p = 0.008) and Staphylococcus aureus (p = 0.02) were also observed to be significantly different. i-Gamma was characterized by a lower mortality rate and a high prevalence of soft tissue infections. Conclusion:Understanding these unique phenotypes can guide personalized treatment and improve sepsis outcomes in resource-limited settings, highlighting the importance of localized research in sepsis management.
Background:Endovascular thrombectomy (EVT) is a well-established treatment for acute ischemic stroke (AIS). However, the optimal choice of general anesthesia (GA) during this procedure remains uncertain. This study aims to compare the effects of volatile anesthesia (VA) and total intravenous anesthesia (TIVA) on outcomes in AIS patients undergoing EVT. Methods:We conducted a systematic search of PubMed, Embase, and Cochrane databases for studies comparing VA and TIVA in this context. Key outcomes assessed were favorable functional outcome (defined as a Modified Rankin Scale [mRS] 0-2), mortality, successful recanalization (mTICI 2b/3), and intraoperative mean arterial pressure (MAP). A subgroup analysis was also performed for patients with anterior circulation stroke. Results:A total of 568 patients from four observational studies were included, of whom 187 (33%) received TIVA. In the unadjusted analysis, no statistically significant differences were observed between TIVA and VA in terms of favorable functional outcome (OR 1.28; p = 0.403), mortality (OR 0.54; p = 0.082), successful recanalization (OR 1.38; p = 0.344), or MAP (MD -0.56; p = 0.755). Adjusted ORs (aORs) were extracted from multivariable models, with covariates varying across studies. The aORs suggested TIVA may be associated with improved outcomes, being linked to a higher likelihood of favorable functional outcome (aOR 1.96, 95% CI [1.15-3.34], p = 0.013) and reduced mortality (aOR 0.40, 95% CI [0.20-0.79], p = 0.008). In the subgroup of patients with anterior circulation stroke, TIVA was similarly associated with better recovery (aOR 2.66; p = 0.033) and lower mortality (aOR 0.38; p = 0.002) at 3 months, but no significant differences were found when the timing after stroke was not specified. Conclusion:Among AIS patients undergoing EVT, TIVA may lead to improved functional outcome and reduced mortality compared to VA. These findings support the use of TIVA as a potentially more favorable strategy in this context, warranting further prospective trials.
BACKGROUND:Frequent activation of monitor alarms, many of which are clinically insignificant, may contribute to alarm fatigue and reduced attentiveness among nurses. OBJECTIVE:To determine the effect of monitor alarm management training on the level of alarm fatigue of nurses in intensive care units. METHODS:A single-group, quasi-experimental study with a pre- and post-test design was conducted in 2024 among 48 ICU nurses from 2 tertiary hospitals in southern Iran. Participants were selected systematically based on predefined criteria. The intervention included 6 weeks of educational sessions, comprising lectures, workshops, and multimedia classes, focused on alarm management for bedside monitoring equipment, ventilators, and infusion pumps. Data were gathered using a demographic questionnaire and a standardized alarm fatigue scale. Statistical analysis was performed using SPSS v26 and paired t-tests at the 0.05 significance level. RESULTS:The mean age of participants was 30.89 ± 4.41 years; most were women (58.3%) and held bachelor's degrees (95.8%). Alarm fatigue scores significantly declined from 34.52 ± 10.47 to 26.64 ± 4.80 post-intervention (mean difference = 7.88, 95% CI 5.33-10.38, P < .001). CONCLUSIONS:Incorporating targeted training on alarm settings can be an effective step toward reducing alarm fatigue and supporting safer, more attentive nursing practice in critical care settings. Given that a large proportion of monitor alarms-85-99%-are false or clinically insignificant, integrating this knowledge into training programs helps nurses prioritize clinically relevant alerts and enhance patient safety.
Nursing clinical handover is a complex process used at the patient's bedside to enhance communication and safety during shift changes. It is negatively influenced by environmental and other factors. This study aimed to explore nurses' perceived barriers to the implementation and sustainability of safe patient handover in the clinical setting. From December 1, 2022, to January 31, 2023, 148 nurses from 2 medical wards, 3 intensive care units, and the emergency department of a university hospital participated in a cross-sectional survey study using a self-administered questionnaire. The most significant performance barriers reported by nurses were difficulty in recognizing which information is essential and the provision of irrelevant medical information during handover. The main environmental barriers were staff shortages and busy periods, followed by poor workforce planning and long working hours. The primary systemic barriers reported were a lack of training and overwhelmed staff. Handover is a complex process negatively influenced by the work environment. Organizational adjustments, such as workload reduction and dedicated handover training for staff, are necessary to improve handover procedures and enhance patient safety.
This review highlights current approaches in managing hypertensive acute heart failure (H-AHF) relevant to nurse practitioners. It emphasizes the shift from volume overload to vascular redistribution as the primary cause of congestion, prioritizing vasodilators over diuretics unless overt fluid overload exists. Sequential nephron blockade and high-dose IV nitroglycerin demonstrate promise in overcoming diuretic resistance and rapidly reducing cardiac pressures. Noninvasive ventilation supports respiratory recovery in acute pulmonary edema. While these strategies improve outcomes, further research is needed to optimize safety and efficacy in diverse clinical settings.
Heart failure is a growing public health burden with high morbidity and mortality, often requiring mechanical circulatory support such as femoral intra-aortic balloon pump (f-IABP) for patients in cardiogenic shock awaiting heart transplantation. Traditionally, bedrest is a standard practice for f-IABP patients due to concerns over catheter displacement, leading to muscle deconditioning and functional decline. This quality improvement project implemented and evaluated a nurse-led, modified Ramsey protocol to assess the safety and feasibility of early mobility in f-IABP patients. The protocol included verticalization using a tilt bed, followed by structured ambulation for eligible patients. Sixty-two patients were enrolled, with 42 undergoing verticalization only and 20 advancing to ambulation. Data on ICU and hospital length of stay, adverse events, and discharge disposition were collected. Results showed minimal complications across groups, with improved post-transplant recovery and higher rates of home discharge in the ambulation group. This initiative demonstrates that nurse-led mobility programs can be safely executed in critically ill cardiac patients with f-IABP, offering promising implications for functional preservation and postoperative recovery. The study supports the integration of early mobility into standard care for this complex patient population.
Moral resilience plays a key role in providing quality care to patients. The way nurses view ethical issues directly affects their decision-making. This study aimed to investigate the relationship between the ethical ideology and moral resilience of nurses working in critical care units. The present study is a cross-sectional, correlational study. The study sample included 196 nurses working in critical care units. In addition to the demographic questionnaire, Forsyth's Ethics Position Questionnaire was used to examine ethical ideology, and Rushton Moral Resilience Scale (RMRS-16) questionnaire was employed to assess moral resilience. The relationship between ethical ideology and the moral resilience of nurses was examined via Spearman's correlation coefficient. The total RMRS-16 score was 2.67 (median: 2.69). Per quartile analysis, 75% of nurses achieved scores beyond 2.44, with 50% reaching beyond 2.69 and 25% above 2.88. The results revealed that most nurses tended toward idealism. The overall level of moral resilience of nurses was also assessed as moderate to high. There was a significant positive correlation between the mean score of relativism and the total score of the RMRS-16. The results of this study indicate that ethical ideology can affect nurses' ability to maintain moral values and cope with job pressures. Additionally, relativistic nurses showed significantly higher moral resilience, suggesting their context-dependent approach may better navigate complex ethical decisions. Our findings show that critical care nurses' ethical beliefs directly influence their moral resilience and clinical decisions. To support idealist nurses facing systemic barriers, units should implement ethics consultations and structured debriefings. Simultaneously, units can leverage relativist nurses' resilience by adopting flexible decision frameworks that balance contextual needs with core principles. These targeted improvements will help nurses navigate ethical challenges more effectively.
This study aims to assess critical care nurses' knowledge of blood transfusion safety in a university hospital in Jordan. A descriptive cross-sectional study was conducted among 200 critical care nurses who completed a questionnaire assessing knowledge of transfusion procedures, safety protocols, and management of transfusion reactions. Of the participants, 58% were female, with a mean clinical experience of 9.37 years (SD = 5.4); 68% had more than 10 years of experience. The mean blood transfusion safety score was 18.9 (54%) out of 35 (SD = 5.92), indicating poor overall knowledge. Major gaps were noted in recognizing acute transfusion reactions (86.5%) and identifying drug restrictions during transfusion (74.5%). In contrast, most nurses were knowledgeable about informed consent (90.5%) and blood cross-matching (87%). Knowledge levels differed significantly by gender, education, experience, and workplace (P < .05), with intensive care unit nurses scoring lower than those in emergency, burn, or dialysis units. Multiple linear regression showed that the workplace was the only significant predictor, explaining 10.3% of the variance. Significant knowledge gaps in transfusion safety were identified, underscoring the need for targeted education and training to improve nurses' competency, enhance patient safety, and reduce transfusion-related adverse outcomes.
