BACKGROUND:As a patient-centred model of nursing care, primary nursing (PN) ensures continuity of care while promoting systematic involvement of patients and family members in the therapeutic process. To date, comprehensive published research projects that address the implementation of PN on intensive care units (ICUs) are rare. AIMS:Primary aim was to evaluate the overall process of development and implementation of PN in two German ICUs of a university hospital. Secondary aims were to identify changes on ICU, as well as nursing performance indicators. STUDY DESIGN:Quantitative design on a surgical (ICU 1) and medical (ICU 2) ICU. We used the validated German Instrument zur Erfassung von Pflegesystemen (IzEP(c)) with separate questionnaires for patients, relatives and medical staff at three data collection points as an as-is analysis before (t0), after six (t1) and 12 months (t2) of implementation of PN in practice. IzEP(c) enables a percentage calculation of the practiced nursing organisation model (overall ICU profile; PN at > 75%), information of the ICU profile (e.g., communication) and nursing performance indicators (e.g., patient participation). For descriptive statistics, a programmed Microsoft Excel spreadsheet with built-in percentage calculations, developed by the IzEP(c) development team, was used. RESULTS:Data collection took place between September 2023 and March 2025, and 264 questionnaires were analysed. The overall profile on ICU 1 started with individual nursing (44.5%, t0) up to PN in t2 (83.0%). ICU 2 reached individual nursing between t0-t2 with characteristics toward PN (t0: 51.0%; t2: 69.0%). Between t0-t2, ICU profile showed good development in communication in ICU 1 (36.0%; 77.0%) and necessary change in ICU 2 (38.5%; 46.5%). Nursing performance indicators reached good development in both ICUs with development potential in, for example, patient participation in ICU 2 (54.0%; 49.5%). CONCLUSIONS:PN was practiced in all included patients in both ICUs, but implementation was not fully achieved in ICU 2. Nevertheless, PN was practiced in included patients on ICU 2. Another evaluation on ICU 2 should be planned. RELEVANCE TO CLINICAL PRACTICE:PN on ICU is feasible and needs continuous support from nursing managers for successful implementation. An accompanying evaluation is mandatory for this purpose. TRIAL REGISTRATION:This study is registered at the German Clinical Trials Register as DRKS00030966.

Im Rahmen der fachschulischen und hochschulischen Pflegeausbildung lernen Pflegefachpersonen die Sonografie als ärztliches Diagnose- und Therapieinstrument in der Theorie und Praxisversorgung kennen. Gleiches gilt für zusätzliche Qualifikationsmaßnahmen wie etwa die Weiterbildung Intensivpflege Anästhesie oder das Hochschulstudium in Critical Care. Für den Praxisalltag auf der Intensivstation stellt sich jedoch die Frage, ob die Sonografie hier im Kontext des Pflegeprozesses eingesetzt werden kann und sollte. Die Autoren geben hierzu einen zusammenfassenden Überblick.

BACKGROUND:Relatives of patients with delirium are often confronted with challenging behaviours such as hyperactivity, aggression or hallucinations. As a consequence, anxiety and depressive episodes are observed among relatives. There is currently a lack of studies on stress aspects and the need for support of relatives of patients with delirium in German intensive care units. AIM:Exploration of perceived stress and support needs of relatives of patients with delirium in intensive care units of two university hospitals in Germany. STUDY DESIGN:Qualitative interview study with 13 relatives of patients with delirium. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis according to Ritchie and Spencer. FINDINGS:Relatives observe symptoms such as disturbances in perception, attention, impaired orientation, hallucinations and anxiety in their family members with delirium. As a consequence, they experience feelings of fear, shock, irritation and helplessness. Relatives wish to receive information on delirium communicated in written form or in combination with verbal communication, provided when the delirium occurs and even before. The results indicate that relatives request education on delirium on an individual basis rather than in groups. CONCLUSIONS:Our findings show the need for tailored information to address relatives' needs. RELEVANCE TO CLINICAL PRACTICE:The findings provide the basis for future intervention planning. Also, they can be used to adapt support services for relatives and sensitise intensive care unit teams to the various aspects of stress experienced by relatives.

BACKGROUND:The long-standing shortage of qualified nursing staff in intensive care and anesthesia nursing poses substantial structural and organizational challenges for hospitals in Germany. Working conditions, qualification structures, nursing leadership resources and organizational frameworks have become increasingly more important for maintaining high-quality specialist nursing care and supporting professional nursing development. Despite ongoing discussions regarding workforce development, advanced nursing roles and qualitative skill and grade mix, systematic nationwide data describing leadership, team composition, qualification structures and organizational conditions within intensive care and anesthesia nursing in Germany have so far been lacking. AIM:The primary aim of this nationwide cross-sectional survey was to assess the current state of nursing development in intensive care and anesthesia nursing in Germany. Secondary objectives were to describe leadership structures, team composition, organizational characteristics and structures for specialist education, continuing professional development and qualification pathways. METHODS:A quantitative nationwide cross-sectional online survey was conducted among individuals holding leadership positions in intensive care and anesthesia nursing in German hospitals. A 44-item questionnaire was distributed through professional nursing networks. Data were analyzed using descriptive and bivariate statistical methods. RESULTS:Of the 749 participants 550 datasets (73.4%) were included in the analysis. State-certified specialist nurses (German postregistration specialist nursing qualification; Fachkrankenpflege) assumed extended professional responsibilities in some departments (17.1%, n = 94), whereas academically qualified nurses had so far only been integrated into clinical practice on a selective basis. Many nursing managers reported limited or no protected time for leadership responsibilities (35.9%, n = 118), despite simultaneously leading large teams and facing persistent staff shortages (49.6%, n = 273 reporting vacant positions). The team composition was heterogeneous and included registered nurses as well as other professional groups, including anesthesia technical assistants. Organizational structures supporting nursing development, specialist education, continuing professional development and nursing leadership varied considerably across institutions and frequently depended on the personal commitment of individual nursing managers. CONCLUSION:This nationwide cross-sectional survey demonstrates considerable variation in the organizational structures supporting intensive care and anesthesia nursing in Germany and identifies structural barriers to effective nursing leadership, qualification development and the systematic implementation of advanced nursing roles. The findings provide a comprehensive baseline for describing current organizational conditions within the German healthcare system and couldsupport future workforce planning, leadership development and qualification strategies. Strengthening organizational support for nursing leadership, establishing clear responsibilities and consistently utilizing existing professional qualifications appear essential for the sustainable development of intensive care and anesthesia nursing and for implementing an appropriate qualitative skill and grade mix.

BACKGROUND:As a neuropsychiatric syndrome, delirium worsens the prognosis of critically ill patients in the intensive care unit (ICU). Risk factors such as sleep deprivation increase the incidence of delirium. Targeted light exposure influences the circadian rhythm, and daylight interventions can help to restore the natural daily rhythm. To date, a review of daylight therapy for German-speaking countries is lacking. OBJECTIVE:This work aims to provide an overview of the currently available evidence on the use of daylight therapy in critically ill patients on the ICU, with a medical focus on cardiology or thoracic and cardiovascular surgery. The potential effects of daylight therapy on delirium and sleep are discussed. MATERIALS AND METHODS:A systematic literature search was conducted in the databases CareLit (hpsmedia, Hungen, Germany), Cochrane Library (The Cochrane Collaboration, London, U.K.), Livivo (German National Library of Medicine - Information Centre for Life Science, Cologne, Germany), and Medline via PubMed (U.S. National Library of Medicine, Bethesda, MD, USA). German- and English-language literature involving ICU patients at least 18 years of age in the context of light therapy was included. A critical appraisal was performed using the assessment tools developed by Behrens and Langer. RESULTS:Fourteen full texts were included, most of which involved multiple nonpharmacological interventions. The studies varied in terms of light application mode, timing, and duration. No significant effects on the delirium incidence were found, but positive effects on sleep promotion and psychological outcomes were observed. CONCLUSION:There are few conclusive studies on daylight therapy in the ICU. Most involved multicomponent intervention strategies. The prevailing evidence suggests beneficial effects on sleep promotion and psychological outcomes, which could contribute to delirium prevention strategies. Further research is needed.

BACKGROUND:Verification of correct gastric tube placement is a major patient safety issue. Guidelines recommend different procedures. AIM:To evaluate international guidelines for verifying correct gastric tube placement in adult hospitalised patients, identifying recommended practices and methodological quality. STUDY DESIGN:Systematic review with searches conducted in Medline, CINAHL and guideline repositories until January 2024. Reference lists of identified articles were also screened. Guidelines on adult gastric tube placement based on a systematic literature search and/or a formal consensus process were included. Data extraction and quality assessments, using the AGREE-II tool, were conducted by two and four reviewers respectively. RESULTS:Six guidelines from three countries were included. Radiographic confirmation is widely regarded as the gold standard for verifying gastric tube placement, especially when the position is uncertain, although bedside methods such as pH measurement, capnography and visual inspection are increasingly recommended. There is great variability regarding recommended bedside techniques, pH thresholds and routine monitoring practices. Marking the tube's exit site and routinely monitoring external length are universally recommended. Five guidelines recommend against the auscultation method either in general or at least with regard to its sole use. Methodological quality and evidence strength vary significantly across guidelines. CONCLUSIONS:While consensus exists on some aspects, variability in recommendations reflects inconsistent evidence bases. Most guidelines showed insufficient methodological quality. International standardisation and high-quality primary research are necessary. RELEVANCE TO CLINICAL PRACTICE:This review synthesizes current guidelines on gastric tube placement, exposing methodological weaknesses, recommendation inconsistencies and unreliability of auscultation, identifying a critical information gap in clinical practice.

BACKGROUND: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. AIMS: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. METHODS: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. RESULTS: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. CONCLUSIONS: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. RELEVANCE TO CLINICAL PRACTICE:Family members ranked PN and SC positively, with trends for PN. This could indicate that FCC is being carried out on both ICUs.

BACKGROUND:Thirst and xerostomia are common symptoms in patients with chronic heart failure (CHF) and can be very distressing. Studies on the prevalence and associating factors of these symptoms are lacking in patients with CHF in Germany. The aim of the study was to assess the prevalence of thirst and xerostomia, to determine factors associated with thirst and xerostomia intensity, and to identify interventions that patients use to reduce these symptoms. METHODS:A cross-sectional study was conducted in seven hospitals. Participants completed a questionnaire on thirst and xerostomia and on interventions they performed themselves. Additionally, they were asked about possible associated factors (e.g., fluid restriction, other symptoms, alcohol intake). Prevalence of thirst and xerostomia was estimated with percentages and a 95% confidence interval. A multiple linear regression analysis was conducted to assess factors associated with the intensity of thirst and xerostomia. Interventions used by patients to alleviate thirst or xerostomia were content-analyzed. RESULTS:Of 371 patients with CHF (71.7% male, mean age 62.4 ± 14.9 years), 78.7% reported thirst and 64.8% xerostomia in the last three days. Statistically significant factors associated with thirst intensity were thirst distress and body height. Fluid restriction, thirst in the last three days, leg oedema, and drug-treated diabetes mellitus were associated with xerostomia intensity. The most frequently reported intervention to reduce thirst or xerostomia was fluid intake (thirst: 95.1%; xerostomia: 86.2%). CONCLUSION:A high proportion of patients with CHF reported thirst and/or xerostomia. Factors were identified that could have an influence on the occurrence of these symptoms.

Als neuropsychiatrisches Syndrom verschlechtert das Delir die Prognose kritisch kranker Personen auf der Intensivstation (ITS). Risikofaktoren wie Schlafmangel begünstigen die Delirinzidenz. Eine gezielte Anwendung von Licht nimmt Einfluss auf den zirkadianen Rhythmus und Tageslichtinterventionen können zur Regenerierung des natürlichen Tagesrhythmus beitragen. Bisher fehlt es an einer Übersichtsarbeit zur Tageslichttherapie (TLT) für den deutschsprachigen Raum. Erstellung einer Übersichtsarbeit über die aktuell verfügbare Evidenz zum Einsatz der TLT bei kritisch kranken Personen auf der ITS mit den medizinischen Schwerpunkten Kardiologie oder Thorax- und Kardiovaskularchirurgie und mögliche Auswirkungen auf das Delir und den Schlaf. Systematische Literaturrecherche in den Datenbanken CareLit (hpsmedia, Hungen, Deutschland), Cochrane Library (The Cochrane Collaboration, London, U.K.), Livivo (Deutsche Zentralbibliothek für Medizin – Informationszentrum Lebenswissenschaften, Köln, Deutschland) und Medline via PubMed (U.S. National Library of Medicine, Bethesda, MD, USA). Es wurde deutsch- und englischsprachige Literatur eingeschlossen, die kritisch kranke Personen ≥ 18 Jahre im Kontext von Lichttherapie einbezog. Eine kritische Beurteilung erfolgte mit den Beurteilungsbögen von Behrens und Langer. Insgesamt konnten 14 Volltexte eingeschlossen werden, die größtenteils mehrere nichtpharmakologische Interventionen adressierten. Es zeigte sich eine heterogene Studienlage zur Art der Lichtapplikation, Anwendungszeiten und -dauer. Es konnten keine statistisch signifikanten Auswirkungen auf die Delirinzidenz, jedoch positive Effekte im Bereich der Schlafförderung und Psyche aufgezeigt werden. Zur TLT auf der ITS fanden sich wenig aussagekräftige Studien. Ein Großteil bezog multikomponente Interventionsstrategien ein. Die vorherrschende Evidenz lässt Rückschlüsse auf positive Wirkungen im Bereich der Schlafförderung und Psyche zu, die im Rahmen einer Präventionsstrategie zur Senkung der Delirinzidenz beitragen könnten. Weitere Forschung ist nötig.

Der seit Jahren bestehende Fachkräftemangel in der Intensiv- und Anästhesiepflege stellt Einrichtungen vor erhebliche strukturelle und organisationale Herausforderungen. Arbeitsbedingungen, Qualifikationsstrukturen und organisationale Rahmenbedingungen haben dabei zentrale Bedeutung. Trotz zahlreicher Einzelberichte fehlen bislang systematische bundesweite Daten zu Leitungs‑, Team- und Qualifikationsstrukturen in diesen Fachbereichen. Primäres Ziel der bundesweiten Querschnitterhebung war die Erfassung der aktuellen Situation der Pflegeentwicklung in der Intensiv- und Anästhesiepflege in Deutschland. Sekundäres Ziel war u. a., Leitungs‑, Team- und Organisationsstrukturen sowie Strukturen der Aus‑, Fort- und Weiterbildung zu erfassen. Quantitative Online-Querschnittbefragung leitender Personen in der Intensiv- und Anästhesiepflege in Krankenhäusern der Bundesrepublik Deutschland mit 44 Items, die in professionelle Netzwerke versendet wurde. Die Datenanalyse erfolgte deskriptiv und bivariat. Von 749 Teilnehmenden konnten 550 Datensätze (73,4