End-of-life Care in the Intesive Care Unit and Nursing Roles in Communicating with Families.

Introduction: Professionals in Intensive Care Units face death, shifting their role from therapists to caregivers in end-of-life management. The nursing attitude and response to death has been shown to affect the quality of palliative care and end-of-life services that are interrelated services. Aim of the study: The aim of this research was to evaluate the professional attitude of nurses towards the care of the families of critically ill patients in the ICU, leading to the emergence of specific attitudes, relating them to their demographic and professional characteristics, with the aim of drawing conclusions for the improvement of quality in end-of-life care. Material and Methods: The sample of the study was 81 nurses from a large tertiary hospital. Participants completed the "Nurse Activities for Communicating with Families" (NACF) questionnaire. The questions are about ways in which nurses can help the patient's family during the patient's stay in the ICU. Results: The results revealed that the nurses took actions related to the information and psychological support of the patient's family. On the contrary, they did not focus on the spiritual / religious needs of the patient and the needs of the family based on their cultural background. Conclusions: The professional treatment of staff is characterized by compassion and empathy, but it is necessary to train them on important issues related to diversity, including the religious, spiritual values and beliefs of patients and their relatives.

Associations Between Core Temperature Disorders and Outcomes of Pediatric Intensive Care Unit Patients.

BACKGROUND: The few studies of associations between fever and outcomes in pediatric intensive care unit (PICU) patients have conflicting findings. Associations between hypothermia and patient outcomes have not been studied. OBJECTIVE: To investigate the incidence and characteristics of fever and hypothermia and their associations with adverse outcomes among PICU patients. METHODS: Patients consecutively admitted to 2 PICUs in a 2-year period were prospectively studied. Core temperature was mainly measured by rectal or axillary thermometry. Fever and hypothermia were defined as core temperatures of greater than 38.0 °C and less than 36.0 °C, respectively. Prolonged mechanical ventilation, prolonged PICU stay, and PICU mortality were the adverse patient outcomes studied. Associations between patient outcomes and core temperature disorders were evaluated with univariate comparisons and multivariate analyses. RESULTS: Of 545 patients enrolled, fever occurred in 299 (54.9%) and hypothermia occurred in 161 (29.5%). Both temperature disorders were independently associated with prolonged mechanical ventilation and prolonged PICU stay (P < .001) but not with PICU mortality. Late onset of fever (P < .001) and hypothermia (P = .009) were independently associated with prolonged mechanical ventilation, fever magnitude and duration (both P < .001) were independently associated with prolonged PICU stay, and fever magnitude (P < .001) and infectious cause of hypothermia (P= .01) were independently associated with higher PICU mortality. CONCLUSIONS: These findings provide evidence that the manifestation and characteristics of fever and hypothermia are independent predictors of adverse outcomes in PICU patients.

IS THERE AN ASSOCIATION BETWEEN HEALTH LITERACY AND ADHERENCE TO THE MEDITERRANEAN DIET? A CROSS-SECTIONAL STUDY IN GREECE.

OBJECTIVE: The aim: To evaluate the relationship between adherence to the Mediterranean diet and health literacy and to find possible differences based on the demographic characteristics of the participants. PATIENTS AND METHODS: Materials and methods: A cross-sectional study was carried out with a convenience sample from the Greek general population (n=203). The questionnaires were distributed through the Google Forms platform, while some of them were given on hand. The questionnaire used included demographic information, questions about the participants' health status and nutrition habits and the Health Literacy Scale (HLS - EU-Q16) and the MedDietScore. The survey was conducted June - July 2022. The program SPSS v. 26.0 was used for the analysis of data. RESULTS: Results: The mean score in HLS-EU-Q16 was 12.08 (SD=4.17) (15.8%=inadequate level, 30% =problematic level, 54.2%=sufficient level). The mean score in Med DietScore was 31.54 (SD=4.84) and the majority (72.4%) had medium adherence to the Mediterranean diet. Concerning the HLS-EU-Q16, women and those who had not children, were not patients and used the Internet for finding health information had higher score. In contrast, widows/ers and those with elementary education had lower score. With regard to the Med DietScore, those who were patients and had normal weight had higher score than the rest categories. A negative correlation was found between age-HLS-EU-Q16 (r=-.605, p<.01) and between BMI-Med DietScore (r=-.142, p<.05). CONCLUSION: Conclusions: Most of the participants had sufficient level of health literacy and medium adherence to the Mediterranean diet. Furthermore, there was not a significant correlation between adherence to the Mediterranean diet and health literacy. Several demographic and medical characteristics impact the health literature level and the adherence to the Mediterranean diet. Future research is suggested to further evaluate the results of this study.

When the first vaccine arrived: An investigation of factors that influenced the intention of health care workers in the national health system of Greece to be vaccinated against the SARS COV-2 virus during the first trimester of vaccine arrival.

BACKGROUND: COVID-19 vaccination started in Greece in the last days of December 2020. Health care workers (HCWs) of the public national health system (NHS) were on the frontline and they would be role models for all the citizens. AIM: Investigation of the intention and hesitation of HCWs (doctors, nurses, and nursing assistants) of the NHS of Greece, regarding the vaccine against SARS COV-2 virus and the factors that affect them, during the first trimester of the availability of vaccines, in the country. METHODS: A multicenter cross-sectional study was conducted in Greece among health professionals (n = 2484) of the NHS. Data were collected with the use of an online questionnaire through snowballing sampling. RESULTS: Acceptance of a safe and effective COVID- 19 vaccines was higher among doctors (85.6%), followed by nurses (66.3%), and nursing assistants (64.1%). This study confirms pre-existing research on the interaction of gender, age, quality of personal information, educational level, training by the employer, and cognitive background regarding viruses and vaccines. CONCLUSION: In conclusion, our study showed that once a vaccine was available, most HCWs were willing to be vaccinated. These findings could be used in the future to tailor communication and promotion campaigns, using anthropocentric strategies.

Delayed Admission to the Intensive Care Unit and Mortality of Critically Ill Adults: Systematic Review and Meta-analysis.

Delayed admission of patients to the intensive care unit (ICU) is increasing worldwide and can be followed by adverse outcomes when critical care treatment is not provided timely. This systematic review and meta-analysis appraised and synthesized the published literature about the association between delayed ICU admission and mortality of adult patients. Articles published from inception up to August 2021 in English-language, peer-reviewed journals indexed in CINAHL, PubMed, Scopus, Cochrane Library, and Web of Science were searched by using key terms. Delayed ICU admission constituted the intervention, while mortality for any predefined time period was the outcome. Risk for bias was evaluated with the Newcastle-Ottawa Scale and additional criteria. Study findings were synthesized qualitatively, while the odds ratios (ORs) for mortality with 95% confidence intervals (CIs) were combined quantitatively. Thirty-four observational studies met inclusion criteria. Risk for bias was low in most studies. Unadjusted mortality was reported in 33 studies and was significantly higher in the delayed ICU admission group in 23 studies. Adjusted mortality was reported in 18 studies, and delayed ICU admission was independently associated with significantly higher mortality in 13 studies. Overall, pooled OR for mortality in case of delayed ICU admission was 1.61 (95% CI 1.44-1.81). Interstudy heterogeneity was high (I 2 = 66.96%). According to subgroup analysis, OR for mortality was remarkably higher in postoperative patients (OR, 2.44, 95% CI 1.49-4.01). These findings indicate that delayed ICU admission is significantly associated with mortality of critically ill adults and highlight the importance of providing timely critical care in non-ICU settings.

Diagnostic accuracy of oral thermometry for fever detection in adult patients: literature review and meta-analysis.

AIMS AND OBJECTIVES: To synthesise the evidence on the accuracy and precision of oral thermometry in adult patients, as well as on its sensitivity and specificity for fever detection. BACKGROUND: Oral thermometry has long been used in various clinical settings thanks to its rapid, safe and convenient measurements, which are easy to obtain and minimally prone to operator errors. DESIGN: Literature review and meta-analysis that adhered to the PRISMA statement. METHODS: By using key terms, literature searches were conducted in CINAHL, PubMed, Web of Science, Scopus and Cochrane Library. Method-comparison studies, which were published from January 1990 to December 2020 in English-language, peer-reviewed journals, compared oral temperature measurements with invasive thermometry ones, and were conducted on patients ≥18 years, were included. Methodological quality of selected studies was evaluated with QUADAS-2. RESULTS: Sixteen articles were selected for inclusion. Risk of bias was assessed as low in most of them. Quantitative synthesis indicated that pooled mean oral temperature was lower than core temperature by .07℃, with 95% limits of agreement ranging between -.22℃ and .08℃. Pooled sensitivity and specificity for fever detection (defined as core temperature ≥38℃ in most studies) were .53 (95% confidence interval, .39-.66) and .98 (95% confidence interval, .97-.99), respectively. Sensitivity analysis indicated larger temperature underestimation in case rectal temperature was used as reference standard. CONCLUSION: Despite its satisfactory accuracy, precision and specificity, oral thermometry has low sensitivity for fever detection, which entails a high number of false-negative readings and uncertainty for excluding fever in patients found to be non-febrile. RELEVANCE TO CLINICAL PRACTICE: Oral thermometry cannot be recommended for replacing invasive thermometry methods in hospitalised adult patients, considering the high incidence of fever in them and possible negative effects of missing fever for patient diagnosis and outcomes.

Missed Nursing Care in the Postanesthesia Care Unit: A Cross-Sectional Study.

PURPOSE: This study aimed to investigate the prevalence, activities, and reasons for missed nursing care in the postanesthesia care unit (PACU) and the effect of intensive care unit (ICU) overflow patients. DESIGN: This is a single-center, cross-sectional survey. METHODS: Nineteen PACU-registered nurses of a tertiary care hospital participated. Over a 7-month period, participants were asked to complete a validated questionnaire, which included 19 items related to missed nursing care activities and 10 items related to reasons for missed nursing care. χ2 test and 1-way analysis of variance were used for data analysis. FINDINGS: Questionnaires (N = 397) were completed. Prevalence of missed nursing care activities was 78.1% and was significantly higher in cases of ICU overflow patients (P < .001). The three most reported missed nursing care activities were "drug preparation, administration, and assessment of effectiveness," "patient surveillance and assessment," and "care associated with pain"; prevalence was significantly higher in cases of ICU overflow patients (P = .036, P = .003, and P = .004, respectively). The three most reported reasons for missed nursing care were "inadequate number of nursing personnel," "unexpected rise in patient volume or acuity," and "heavy admission or discharge activity". CONCLUSIONS: The findings indicated missed nursing care was common in the PACU and increased in case of ICU overflow patients. Therefore, missed nursing care needs to be identified and minimized, while the number and length of stay of critically ill patients admitted to the PACU should be limited.

Exploring home care nurses' perceptions regarding their services in economic crisis: A qualitative approach.

This article explores the home care nurses' perceptions on the services they provide in Cyprus, which has been hit by a financial crisis. Semistructured interviews were conducted in Greek at the home care nurses' offices. Data were analyzed using qualitative content analysis. The participants' perceptions are described in terms of provision of home care nursing, administration of homecare nursing, job satisfaction, financial issues, and suggesting improvements. The financial crisis influences the home care services with regard to workload increase, staff shortage, and lack of resources. Home care nurses are well engaged in the provision of proper services in order to address the patients' needs. However, the financial crisis has set obstacles in the provision of care.