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1.
ObjectiveAssessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs.MethodsA search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms ‘safety culture’, ‘safety climate’, ‘safety attitude’, ‘intensive care’, ‘ICU’ and ‘critical care’. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the sample population included participants working in an adult intensive care, and the findings were reported in the context of intensive care.ResultsOf the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups.ConclusionThough the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered. 相似文献
2.
Background
Compassion satisfaction and compassion fatigue influence nurses’ intention to stay or leave nursing. Identification of compassion satisfaction or fatigue in critical care nurses is important in this high turnover workforce.Objectives
The aim of this study was to examine factors predicting and contributing to compassion satisfaction and compassion fatigue experienced by critical care nurses in Australian intensive care units.Methods
A self-reported cross-sectional survey using an established tool collected data from critical care nurses of two adult Australian intensive care units.Results
Overall, these critical care nurses reported what Professional Quality of Life Scale guidelines designated as ‘average’ levels of compassion satisfaction and burnout, and ‘low’ levels of Secondary Traumatic Stress (STS). Compared to Site B, nurses at Site A had significantly higher compassion satisfaction (p = 0.008) and lower STS scores (p = 0.025), with site significantly predictive for compassion satisfaction (p < 0.024) and STS (p < 0.002). Nurses with postgraduate qualifications had significantly higher compassion satisfaction scores (p = 0.027), and compassion satisfaction significantly increased with increasing duration of practice (p = 0.042) as a nurse and in their current ICU (p = 0.038). Burnout scores significantly reduced with increasing age, years of tenure and practice; burnout was predicted by lower years of tenure (p < 0.016).Conclusion
These critical care nurses revealed profiles that, whilst not in crisis, fell short of the ideal high compassion satisfaction and moderate/low fatigue. More recent tenure flags those potentially at higher risk of compassion fatigue, whilst the better scores associated with postgraduate education and from one site need further exploration. Further research should develop understanding and interventions to enhance compassion satisfaction and support retention of this crucial nursing workforce. 相似文献3.
《Australian critical care》2023,36(5):863-871
BackgroundEvidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post–intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life.ObjectivesWe aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies.MethodA scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines.FindingsWe identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools.ConclusionThese results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge. 相似文献
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《Australian critical care》2020,33(3):287-294
ObjectiveThe objective of this study was to identify the risk factors for each area of post–intensive care syndrome (PICS) and to determine their effect size.Review method usedThis study used systematic review and meta-analysis.Data sourcesPubMed, CINAHL, EMBASE, PsycINFO, and Cochrane Library were searched.Review methodsEighty-nine studies were selected for the review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PICS areas and risk factors reported in the individual studies were reviewed and categorised. We used the Newcastle–Ottawa Scale to evaluate the quality of studies. The effect size of each risk factor was calculated as odds ratio (OR).ResultsThere were 33 mental health studies, 15 cognitive impairment studies, 32 physical impairment studies, eight studies on two areas, and one study on all three areas. Sixty risk factors were identified, including 33 personal and 27 intensive care unit (ICU)–related factors. Significant risk factors for mental health included female sex (odds ratio [OR] = 3.37, 95% confidence interval [CI]: 1.12–10.17), previous mental health problems (OR = 9.45, 95% CI: 2.08–42.90), and negative ICU experience (OR = 2.59, 95% CI: 2.04–3.28). The only significant risk factor for cognitive impairment was delirium (OR = 2.85, 95% CI: 1.10–7.38). Significant risk factors for physical impairment included older age (OR = 2.19, 95% CI: 1.11–4.33), female sex (OR = 1.96, 95% CI: 1.32–2.91), and high disease severity (OR = 2.54, 95% CI: 1.76–3.66).ConclusionsAlthough PICS is a multidimensional concept, each area has been studied separately. Significant risk factors for PICS included older age, female sex, previous mental health problems, disease severity, negative ICU experience, and delirium. To prevent PICS, the multidisciplinary team should pay attention to modifiable risk factors such as delirium and patients’ ICU experience. 相似文献
6.
Tiziano Innocenti Diego Ristori Simone Miele Marco Testa 《Journal of bodywork and movement therapies》2019,23(3):604-618
BackgroundDiagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated.ObjectivesTo investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions.MethodsA systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken.Results6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups.ConclusionsMusculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment. 相似文献
7.
Objectives
Family satisfaction in intensive care units (ICU) is of increasing relevance for family-centred cared. The objective of this review was to explore the characteristics of studies that have used questionnaires to measure the satisfaction of family members of ICU patients.Review methods
A literature review was performed for studies evaluating family satisfaction in the ICU, independent of design. The following data were obtained for each selected article: publication year, country of origin, design, number of family members, instrument for family satisfaction, instrument score range, response rate, moment at which satisfaction was evaluated, and average level of reported satisfaction.Data sources
The following databases were systematically searched: PubMed, CINAHL, ProQuest Nursing, ProQuest Social Science, ProQuest Psychology, Science Direct, PsycINFO, LILACS, and Scielo.Results
Thirty-seven articles met inclusion criteria, showing high levels of family satisfaction. Among these, nine different questionnaires were identified. In 31.6% of the studies, family satisfaction was evaluated during the ICU stay, whereas 36.9% did not report the evaluation moment. The mean response rate was 65.5%, and response rates greater than 70% were found only in 28.2% of the studies.Conclusions
High satisfaction levels among family members of ICU patients must be contextualised in light of questionnaire heterogeneity, low response rates, and variability in the moment at which family satisfaction is evaluated. The creation of methodological standards for evaluating and reporting family satisfaction could facilitate comparing results between investigations in this field. 相似文献8.
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ObjectiveTo explore the impact of family centred care interventions on parents’ satisfaction and length of stay for patients admitted to a paediatric intensive care unit or a neonatal intensive care unit.MethodsA systematic review was conducted. Searches have been done in Cinahl, Cochrane, Embase and PubMed from February 2016 till October 2017. All included studies were quality appraised. Due to the heterogeneity of interventions findings were narratively reviewed.ResultsSeventeen studies were included in this review of which 12/17 studies investigated parents’ satisfaction and 7/17 length of stay. For this review two types of interventions were found. Interventions improving parents-professional collaboration which increased parents’ satisfaction, and interventions improving parents’ involvement which decreased length of stay. Overall quality of the included studies was weak to good.ConclusionsStrong evidence was found for a significant decrease in length of stay when parents where participating in caring for their infant in a neonatal intensive care unit. Moderate evidence was found in parents’ satisfaction, which increased when collaboration between parents and professionals at a neonatal intensive care unit improved. Studies performed in a paediatric intensive care setting were of weak to moderate quality and too few to show evidence regarding parents satisfaction and length of stay. 相似文献
11.
Zunirah Ahmed Akshay Shetty David W Victor Sudha Kodali 《World Journal of Meta-Analysis》2022,10(3):99-121
Viral hepatitis continues to be a major health concern leading to hepatic decompensation ranging from acute hepatitis to cirrhosis and hepatocellular carcinoma. The hepatic and extrahepatic manifestations are not only debilitating but also associated with a significant economic burden. Over the last two decades, the field of virology has made significant breakthroughs leading to a better understanding of the pathophysiology of viral hepatitis, which in turn has led to new therapeutic options. The advent of direct-acting antiviral agents changed the landscape of hepatitis C virus (HCV) therapy, and new drugs are in the pipeline for chronic hepatitis B virus (HBV) treatment. There has also been a significant emphasis on screening and surveillance programs, widespread availability of vaccines, and linkage of care. Despite these efforts, significant gaps persist in care, and there is a pressing need for increased collaboration and teamwork across the globe to achieve a reduction of disease burden and elimination of HBV and HCV. 相似文献
12.
T Clarke E Mackinnon K England G Burr S Fowler L Fairservice 《Australian critical care》1999,12(3):109-118
In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe. It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings. Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a 'progressive patient care' model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes. 相似文献
13.
《Intensive & critical care nursing》2000,16(4):228-242
In view of market-driven health-care policies and the move to greater efficiencies within the health-care system, the cost of nursing care is being increasingly scrutinised. Different overseas practices are commonly cited as justification for changing practices within Australia. This study is based on a review of the literature on intensive care nurse staffing requirements in Australasia; specifically, New South Wales, the United States (US) and, to a lesser extent, Europe.It was found that looking to the US for cost-cutting strategies in intensive care units (ICUs) is based on a false premise: that we are comparing like with like. ICUs in the US have a different historical trajectory and culture, service wider constituencies, have technicians and unregistered personnel providing nursing care and do not provide demonstrably better outcomes or significant cost savings.Research indicates that continuous nursing care by trained professionals provides the best outcomes. If costs must be cut, technology, pharmaceuticals and laboratory tests should be targeted. Further, a greater commitment to the development of a ‘progressive patient care’ model in hospital planning is required, in order to establish or consolidate an intermediate level of nursing care between the ward and the ICU. Programs aiming to improve and continuously monitor patient care, such as adverse event monitoring, the prevention of unplanned extubation and facilitation of early extubation, should be instituted, as these have been shown to not only reduce ICU costs but also improve patient outcomes. 相似文献
14.
《Australian critical care》2021,34(5):435-445
BackgroundIntensive care unit–acquired muscle weakness (ICUAW) has an incidence of 40–46%. Early mobilisation is known to be a protective factor.ObjectiveThe aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW.MethodsA 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse–patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3–5 of the ICU stay.ResultsThe data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53–62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00–1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00–1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38–0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95–0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97–0.99]), presence of delirium (OR = 0.98; 95% CI [0.97–0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97–0.99]).ConclusionsThe risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU. 相似文献
15.
Ruth M. Lebet Lisa A. Asaro Athena F. Zuppa Martha A.Q. Curley 《Australian critical care》2018,31(3):167-173
Background
Clinicians recognise that some critically ill children are difficult-to-sedate. It may be possible to identify this clinical phenotype for sedation response using statistical modelling techniques adopted from machine learning. This requires identification of a finite number of variables to include in the statistical model.Objective
To establish face and content validity for 17 candidate variables identified in the international literature as characteristic of the difficult-to-sedate child phenotype.Methods
Paediatric critical care clinicians rated the relevance of 17 variables characterising the difficult-to-sedate child using a four-point scale ranging from not (1) to highly relevant (4). Face and content validity of these variables were assessed by calculating a mean score for each item and computing an item-level content validity index. Items with a mean score >1 were rated as having adequate face validity. An item-level content validity index ≥0.70 indicated good to excellent content validity.Setting and participants
Web-based survey emailed to members of the Pediatric Acute Lung Injury and Sepsis Investigators Network or the Society of Critical Care Medicine Pediatric Sedation Study Group.Results
Of 411 possible respondents, 121 useable surveys were returned for a response rate of 29%. All items had a mean score >1, indicating adequate face validity. Ten of 17 items scored an item-level content validity index ≥0.70. The highest scoring items were requiring three or more sedation classes simultaneously, daily modal sedation score indicating agitation, sedation score indicating agitation for 2 consecutive hours, receiving sedatives at a dose >90th percentile of the usual starting dose, and receiving intermittent paralytic doses for sedation.Conclusions
Computation of an item-level content validity index validated variables to include in statistical modelling of the difficult-to-sedate phenotype. The results indicate consensus among paediatric critical care clinicians that the majority of candidate variables identified through literature review are characteristic of the difficult-to-sedate child. 相似文献16.
Rello J Koulenti D Blot S Sierra R Diaz E De Waele JJ Macor A Agbaht K Rodriguez A 《Intensive care medicine》2007,33(6):1066-1070
Objective To explore the type and frequency of oral care practices in European ICUs and the attitudes, beliefs, and knowledge of health
care workers.
Design An anonymous questionnaire was distributed to representatives of European ICUs. Results were obtained from 59 ICUs (one questionnaire
per ICU) in seven countries 91% of respondents were registered nurses.
Measurements and results Of the respondents 77% reported that they had received adequate training on providing oral care; most (93%) also expressed
the desire to learn more about oral care. Oral care was perceived to be high priority in mechanically ventilated patients
(88%). Cleaning the oral cavity was considered difficult by 68%, and unpleasant as well as difficult by 32%. In 37% of cases
respondents felt that despite their efforts oral health worsens over time in intubated patients. Oral care practices are carried
out once daily (20%), twice (31%) or three times (37%). Oral care consists principally of mouth washes (88%), mostly performed
with chlorhexidine (61%). Foam swabs (22%) and moisture agents (42%) are used less frequently as well as manual toothbrushes
(41%) although the literature indicates that these are more effective for thorough cleaning of the oral cavity. Electric toothbrushes
were never used.
Conclusions In European ICUs oral care is considered very important. It is experienced as a task that is difficult to perform, and that
does not necessarily succeed in ensuring oral health in patients with prolonged intubation. Oral care consists primarily of
mouth washes. The use of toothbrushes should be given more attention.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.
This research was supported in part by PIO5/2410 FIS of the Spanish government and the Catalonian Research Fund (2005/SGR920),
and by CibeRes (CB06/06/0036). 相似文献
17.
The delivery of critical care is no longer limited to the intensive care unit. The information gained by utilization of new
technologies has proven beneficial in some populations. Research into earlier and more widespread use of these modalities
may prove to be of even greater benefit to critically ill patients. 相似文献
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AimThis systematic review reports on healthcare professionals’ knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals’ knowledge and attitudes.BackgroundSurgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies.DesignThis review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines.MethodsA search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals’ knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals’ knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections.ResultsA total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals’ role in prevention. Only three studies examined the effects of interventions on healthcare professionals’ knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge.ConclusionsOverall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals’ knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient.Tweetable abstractKnowledge and attitudes of surgical site infection prevention amongst healthcare professionals. 相似文献