Medical Device-Related Pressure Injury Care and Prevention Training Program (DevICeU): Effects on intensive care nurses' knowledge, prevention performance and point prevalence.

OBJECTIVE: To determine the effect of the training given to intensive care unit (ICU) nurses to prevent medical device-related pressure injuries (MDRPIs) on nurses' knowledge levels, their prevention performance, and the point prevalence (PP) of MDRPIs. RESEARCH METHODOLOGY/DESIGN: A pre-post test intervention study without a control group. SETTING: The study was conducted between May and July 2023 with ICU nurses in three phases: pre-training phase (E0) (104 nurses, 116 patients), training implementation phase (E) and post-training phase (E1) (89 nurses, 120 patients). MAIN OUTCOME MEASURES: The data were collected by using the Patient (E0, E1) and Nurse (E0) Characteristic Forms, MDRPI Follow-up and Prevalence Form (E0, E1), D.E.V.I.C.E Performance Observation Checklist (E0, E1), MDRPI Knowledge Assessment Questionnaire (E0, E1), Braden Pressure Ulcer Risk Assessment Scale (E0, E1), Pressure Injury Grading Form (E0, E1), and Feedback Form about the Training Process (E). RESULTS: The mean MDRPI knowledge score of the nurses increased significantly from E0 to E1 (13.23 ± 1.43 vs. 20.02 ± 1.30, p = 0.001), with the highest improvement in the staging and prevention themes. Nurses' MDRPI prevention performance increased significantly from E0 to E1 (2.15 ± 1.01 vs. 11.17 ± 1.65, p = 0.001). There was a significant difference between the PP rate at E0 (61.2 %) and E1 (27.5 %) (p = 0.001). CONCLUSION: The study indicated that the training on MDRPIs given to ICU nurses increased their knowledge and prevention performance and decreased the prevalence of MDRPIs. However, further studies with a larger sample size are needed to confirm these findings. IMPLICATIONS FOR CLINICAL PRACTICE: Since MDRPIs have more complex staging and prevention practices than conventional PIs, they require the adoption of a training approach that includes visual materials and practical methods in addition to theoretical knowledge. Accurate definitions of medical device dimensions and fixation, skin assessment, and prevention practices will lead to the desired outcome of reducing MDRPIs in ICUs.

Level of caregiving burden and affecting factors in family caregivers of patients with lung cancer: A cross-sectional study.

PURPOSE: To determine the caregiving burden level and affecting factors of family members caring for patients with lung cancer (LC). METHODS: This study used a cross-sectional design and a convenience sampling method. The study was conducted between April 2023 and August 2023 with the LC patients (n = 448) and their caregivers (n = 448) who met the inclusion criteria and were followed up in seven clinics of a specialized hospital for pulmonary diseases in Turkey. Data were collected by using (1) a demographic questionnaire (for patient and caregiver), (2) the Zarit Burden Interview (ZBI), (3) the Beck Depression Inventory (BDI), and (4) the Caregiver Quality of Life Index-Cancer (CQoLC). RESULTS: The study included 448 caregivers, with a mean age of 45.09 ± 13.48 years, and 71.4% were female. The mean ZBI score of 31.45 ± 16.71 indicated mild to moderate burden. Pearson correlation analysis showed that caregivers' depression levels increased and quality of life decreased significantly as the care burden increased. Multiple regression analysis indicated a significant relationship between the caregiver burden and the patient's age (p < 0.05), caregiver's chronic disease (p < 0.05), type of treatment given to the patient (p < 0.05), patient's metastasis status (p < 0.05) and caregiver's quality of life (p < 0.01). CONCLUSION: The fact that most of the risk factors identified in this study are non-modifiable highlights the necessity of identifying caregiver burden early by nurses and initiating the appropriate support processes.

Adaptation and validation of the Turkish version of the alarm fatigue assessment questionnaire.

OBJECTIVE: Alarm fatigue may endanger the safety of patients by negatively affecting nurses' concentration and ability to provide effective care. Identifying alarm fatigue and taking appropriate measures are critical in preventing medical errors and for nurses to work with high motivation. This study aimed to test the psychometric properties of the Turkish version of the 23-item Alarm Fatigue Assessment Questionnaire (AFAQ). METHOD: The study was conducted between February 2022 and April 2022 and included nurses with at least one year of clinical or intensive care experience. The data were collected via a web-based questionnaire. During the adaptation of AFAQ, language, content, and construct validity were evaluated; reliability was examined by internal consistency analysis. RESULTS: The item and scale content validity index of AFAQ were found to be high (>0.80). The Kaiser-Meyer-Olkin measure of sampling adequacy indicated an adequate sampling (0.85); Bartlett's test of sphericity χ2 was 1935.074, p<0.001. Exploratory factor analysis (EFA) showed that the 21-item scale had a five-factor structure, explaining 51.606% of the total variance, and the factor loadings of the items were >0.30 (0.422-0.803). Confirmatory factor analysis (CFA) showed that the five-factor model had a good fit index (χ2/df=1.855, SRMR=0.039, RMSEA=0.048, CFI=0.915, and TLI=0.908) and appropriate factor loadings (>0.30). The internal consistency of AFAQ (Cronbach's alpha coefficient) was 0.85, and the corrected item-total correlations were between 0.32-0.55. CONCLUSION: The results indicated that the Turkish version of the Alarm Fatigue Assessment Questionnaire was sufficiently valid and reliable to measure alarm fatigue in nurses.

Practices of the ABCDEF care bundle in intensive care units as reported by nurses: A cross-sectional study from Turkey.

BACKGROUND: Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs. AIM: To assess the current practices of the ABCDEF care bundle as reported by ICU nurses. STUDY DESIGN: A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members. RESULTS: A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits. CONCLUSIONS: While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation. RELEVANCE TO CLINICAL PRACTICE: Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs.

Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study.

AIMS AND OBJECTIVE: To investigate the incidence, characteristics and risk factors of delirium in the ICU. BACKGROUND: Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. DESIGN: An observational cohort study conducted according to STROBE Guidelines. METHOD: The study was conducted with patients who stayed in ICU ≥24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. RESULTS: The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 ± 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score ≥3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay ≥7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. CONCLUSIONS: In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. RELEVANCE TO THE CLINICAL PRACTICE: Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.

The effectiveness of music interventions on stress response in intensive care patients: A systematic review and meta-analysis.

AIM AND OBJECTIVE: To investigate the effectiveness of music interventions on physiological and psychological stress response in intensive care unit (ICU) patients. BACKGROUND: ICU patients are exposed to several physiological and psychological stressors during their treatments. Music interventions can be implemented to control these negative effects. DESIGN: Systematic review and meta-analysis conducted according to PRISMA Guidelines. METHOD: Seven electronic literature databases, reference lists of similar reviews, grey literature and the Clinical Trials Registry were searched for potential studies up to 30 January 2022. Studies were expected to meet PICOS inclusion criteria. Two reviewers independently assessed the risk of bias of the included studies by using the Cochrane Collaboration tool. Overall, meta-analysis and subgroup analyses (comparator group and music session frequency) were performed using RevMan 5.4. Meta-analysis was conducted when data were available; otherwise, a narrative description was provided. RESULTS: Twenty-five articles were included in this meta-analysis. Across all studies, regardless of the comparator, music was found to significantly reduce anxiety scores with an SMD of 1.81 ([95% CI: -3.09,-0.53]; p = .006). Music was found to significantly reduce anxiety scores with an SMD of 1.97 (95% CI: -3.66, -0.28) compared to standard care (p = .02), but there was no significant change in anxiety scores in comparison with the noise cancellation group (p > 0.05). It was found that multiple music sessions reduced the anxiety level better than a single music session. Music had no effect the systolic/diastolic blood pressure, respiratory or heart rate level in both subgroup and general analyzes concerning the physiological stress (p > 0.05). CONCLUSIONS: Music interventions involving multiple sessions can be used as a nursing intervention to control the anxiety levels of ICU patients. RELEVANCE TO THE CLINICAL PRACTICE: Using music to reduce anxiety and stress levels may reduce the pharmacological need (for sedative or antipsychotic medications) and the risk of associated side effects in ICU patients.

Knowledge, perception and prevention performance of intensive care unit nurses about medical device-related pressure injuries.

AIM AND OBJECTIVE: To examine intensive care unit (ICU) nurses' knowledge, perceptions and prevention performance about medical device-related pressure injuries (MDRPIs). BACKGROUND: Prevention of MDRPIs has been an important part of nursing care, and there is a limited number of studies on nurses' level of knowledge or perception about MDRPIs. DESIGN: This study was designed as a cross-sectional survey and conducted according to STROBE Guidelines. METHOD: The data of the study were collected with the Nurse Information Form and the MDRPI Knowledge Assessment Questionnaire. In the first phase, the psychometric properties of the questionnaire were evaluated (content validity, internal consistency and test-retest). A pilot study was conducted with 20 nurses for the test-retest phase. These nurses were excluded from the general sample. RESULTS: The study was conducted with 142 ICU nurses. The average percent knowledge score of ICU nurses on MDRPIs was 68.4%. In the survey, the highest rate of correct response was found in the expressions about MDRPIs skin assessment (83.6%), and the lowest was in those about follow-up (50.8%). There was no significant relationship between the total score and age, work experience and specialties (p > .05 for each). However, scores were significantly higher in females than males (65.5 vs. 47.8, p = .020) and in those with a postgraduate degree than those with a bachelor's degree (81.8 vs. 57.9, p = .008). CONCLUSIONS: Our study demonstrated that nurses do not have sufficient perception of MDRPIs. The findings of the study can be used to improve nursing policies and practices in acute care settings. Additional studies will be needed with nurses and healthcare professionals working in different clinical settings. RELEVANCE TO THE CLINICAL PRACTICE: This study demonstrates the nurses' need for more knowledge about MDRPIs and will help inform healthcare institutions and their management teams in developing programs and improving protocols to reduce the incidence of MDRPIs.

Incidence, characteristics and risk factors of medical device-related pressure injuries: An observational cohort study.

OBJECTIVES: This study aimed to investigate the cumulative incidence, characteristics, and risk factors of medical device-related pressure injuries (MDRPIs), including patient outcomes, in the intensive care unit (ICU) of a university hospital. RESEARCH METHODOLOGY/DESIGN: A prospective observational cohort study. SETTING: The study was conducted in an university hospital between November 2019 and October 2020. METHODS: The study included patients over the age of 18 years who had a device in situ and stayed in the ICU for more than 24 h. Each device was monitored twice a day for 15 days; the clinical assessment was performed daily until ICU discharge or death. The Case Report Form, MDRPI Monitoring Form, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE-II), Braden Scale, National Pressure Injury Advisory Panel (NPIAP) staging and categories, and Glasgow Coma Scale (GCS) were used for data collection. Patients with and without MDRPIs were compared for demographic and clinical characteristics, length of ICU stay, and mortality by using t-test and Chi-square test. Cumulative incidence was calculated. Logistic regression model was used to investigate risk factors. RESULTS: The incidence rate of MDRPIs was 48.8% (84/172 patients). Most of the MDRPIs developed in the mucosa; hence, they could not be staged (63.7%). Of the remaining MDRPIs on the skin, 18.7%, 13%, and 4.6% were categorized as Stage I, II, and III, respectively. In terms of anatomical locations, most commonly occurred in the head and neck region (62.3%). Among the twelve medical devices that caused MDRPIs, endotracheal tubes (61 cases), urinary catheters (46 cases), nasogastric tubes (30 cases) and non-invasive masks (17 cases) were most commonly reported. In multivariate analysis, age (46-64 years) (p = 0.008, OR = 12.457), history of cardiovascular diseases (p = 0.021, OR = 0.044), administration of vasopressors (p = 0.013, OR = 0.089), length of ICU stay (≥22 days, p = 0.048, OR = 0.055) and requirement for mechanical ventilation (p = 0.028, OR = 10.252) were identified as independent risk factors of the occurrence of MDRPI. CONCLUSIONS: This study provides a comprehensive understanding of the risk of MDRPI in critically ill adults. The incidence of MDRPIs was high and was associated with several factors. It is critical that MDRPIs are taken seriously by all members of the healthcare team, especially nurses, and that protocols should be established for improvements.