Experience of relatives in the first three months after a non-COVID-19 Intensive Care Unit discharge: a qualitative study.

BACKGROUND: The novel coronavirus brought Intensive Care Units (ICUs) back to their past when they were closed to family members. The difficulties of family caregivers encountered after the ICU discharge might have been increased during the coronavirus disease 2019 (COVID-19) pandemic. However, no traces of their experience have been documented to date. The objective of this study is to explore the everyday life experience of relatives in the first three months after a non-COVID-19 ICU discharge. METHODS: A descriptive qualitative study was conducted in 2020-2021. Two Italian general non-COVID-19 ICUs were approached. Follow-up telephone interviews were conducted three months after the ICU discharge. The study has been conducted according to the COnsolidated criteria for REporting Qualitative research principles. RESULTS: A total of 14 family members were interviewed. Participants were mostly females (n = 11; 78.6%), with an average age of 53.9 years. After three months of care of their beloved at home, relatives' experience is summarised in three themes: "Being shaken following the ICU discharge", as experiencing negative and positive feelings; "Returning to our life that is no longer the same", as realising that nothing can be as before; and "Feeling powerless due to the COVID-19 pandemic", given the missed care from community services and the restrictions imposed. CONCLUSIONS: Relatives seem to have experienced a bilateral restriction of opportunities - at the hospital without any engagement in care activities and their limited possibility to visit the ICU, and at home in terms of formal and informal care.

Nursing care factors influencing patients' outcomes in the intensive care unit: Findings from a rapid review.

AIMS: To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. BACKGROUND: A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. DESIGN: Rapid review, following the seven-stage process outlined by Tricco and colleagues. DATA SOURCES: Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. REVIEW METHODS: Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. RESULTS: A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse-led programmes, independent nursing interventions and nurse behaviours have been investigated to date. CONCLUSION: The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels.

Are intensive care units good places for nursing students' learning compared to other settings? Findings from an Italian national study.

OBJECTIVE: To explore students' perceived quality of the intensive care unit learning environment during their rotations; to compare these perceptions with that reported by students attending other settings and to assess correlations between the perceptions regarding the quality of the environment and the competences learned. RESEARCH METHODOLOGY: A secondary analysis of data collected by a national cross-sectional study carried out in Italy. A total of 9607 nursing students participated; they ranked the intensive care units' quality, as assessed by the Clinical Learning Quality Evaluation Index; the perceived competences learned were also ranked with a Likert scale; from 0 = None to 3 = Very much. RESULTS: A total of 323 (3.5%) participants attended their rotation in an intensive care unit. They perceived the quality of the environment to be significantly higher (n = 2.11 out of 3) than those rotating in non-intensive care unit wards (n = 1.91; p < 0.001). The competences learned by intensive care unit students were significantly higher than that reported by students attending non-intensive care unit wards (n = 2.31 out of 3 vs 2.06 out of 3; p < 0.001). CONCLUSION: Intensive care units are highly appreciated by students, both in terms of their quality learning environment and their capacity to promote learning compared to other settings. Therefore, intensive care units should be considered as a place for clinical rotation to promote positive attitudes regarding critical care patients.

[How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the Covid-19 outbreak? Results from an exploratory research in some European countries]. / Come sono cambiati gli ospedali, le Terapie Intensive, l'assistenza al malato critico in tempi di Covid-19? Risultati di una indagine esplorativa in alcuni contesti europei.

. How hospitals, Intensive Care Units and nursing care of critically ill patients have changed during the COVID-19 outbreak? Results from an exploratory research in some European countries. INTRODUCTION: During the Covid-19 outbreak, the health care institutions and the Intensive Care Units (ICUs) have been reorganized with significant consequences at both organizational and clinical levels. AIMS: To investigate (1) the organizational changes of hospitals and ICUs in dealing with the Covid-19 outbreak; (2) the characteristics of the nursing care; (3) the most important challenges perceived by nurses in caring for Covid-19 patients. METHODS: Cross-sectional online survey, available from May 11th and July 10th, 2020. Participants were nurses caring for Covid-19 patients in European ICUs. RESULTS: A total of 62 nurses responded to the survey; average age 37.5 years, 31 (60.8%) were female, mostly from Italy, France and United Kingdom. All hospitals underwent many changes, such as the opening of new dedicated wards and the restriction of family visits. The number of ICU beds doubled during the pandemic (p<0.01), as well as the number of nurses per shift from 10.2 (SD 7.3) before to 17.9 (SD 13.6) during the pandemic (p<0.01). However, changes in the nurse-to-patient ratio were not significant: from 1:1.5 to 1:2 (p=0.05). Among nursing care activities, clinical risk management (n=14, 22.6%), psychological support for patients (n=22, 35.5%) and family's involvement (n=31, 50%) resulted as more challenging; 64.5% of nurses suffered from protective equipment shortages, and 66.1% experienced psychological burden. CONCLUSION: These findings can help to reflect on how to better prepare both nurses and health care institutions for other events that may threaten clinical practice and require major and innovative efforts.

What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review.

BACKGROUND: Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly. OBJECTIVES: To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care. DESIGN: A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019. DATA SOURCES: The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened. REVIEW METHODS: Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation. RESULTS: Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%). CONCLUSIONS: From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.

Actigraphic monitoring in critically ill patients: preliminary results toward an "observation-guided sedation".

PURPOSE: The aim of this study is to evaluate continuous wrist actigraphy (measurement of limb movements) in intensive care unit patients as a neurologic status monitoring. MATERIALS AND METHODS: This is a prospective, observational study on motor activity of adult patients using wrist actigraphs. Nurses recorded the number of sleep and agitation hours as well as assessed pain and anxiety level (verbal numeric rating) and the agitation/sedation level (Richmond Agitation-Sedation Scale). RESULTS: Thirteen mechanically ventilated patients were studied during their whole intensive care unit stay (total, 165 patients/d). The number of surveyed movements was gathered for each hour, obtaining an estimation of patient motor status. This measure was different between days and nights (33.3 [20.3-49.0] vs 8.5 [4.4-13.8]; P < .001), with a correlation with sleeping hours estimated by nurses (P = .017 during the days [D], P < .001 during the nights [N]), agitation hours (P = .002 D, P = .017 N), Richmond Agitation-Sedation Scale value (P < .001 D and N), pain (P = .012 D), and anxiety (P < .001 D) verbal numeric rating. No differences were found using epochs of 15 or 120 seconds. Compliance with patients and nurses was acceptable. CONCLUSIONS: Patients' limb movements were significantly related to all studied neurologic status indexes. Continuous actigraphy measuring may become important as a clinical tool both to guide utilization of sedative drugs and to enhance early recognition and management of agitation.