Effectiveness of specialised support surface modes in preventing pressure injuries in intensive care: A systematic review and meta-analysis.

BACKGROUND: Patients in intensive care units (ICU) are at an increased risk of pressure injuries. In ICUs, specialised support surfaces are an intervention often used to prevent pressure injuries. This systematic review and meta-analysis aimed to ascertain the effectiveness of different specialised support surface modes for preventing pressure injuries to adult ICU patients. METHODS: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, PEDro, Cochrane Library, Clinicaltrials.gov and eligible paper references were searched for appropriate studies. Studies were included if they investigated both dynamic support surface modes low-air-loss (LAL) and alternating pressure (AP), involved adult ICU patients (≥18 years old), and investigated pressure injury incidence. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Mixed Methods Appraisal Tool (MMAT) checklists were used for reporting and quality assessment. Risk ratios (RRs) with 95 % Confidence Intervals (CIs) were used to summarise pressure injury incidence. The pooled RR was calculated with the random-effects model using the Mantel-Haenszel method. Further secondary analysis examined length of stay (LoS) and severity of illness. RESULTS: The four included studies involved 3,308 patients. These studies were heterogeneous in design. When AP surface mode was compared with LAL surface mode, there was no significant difference in the occurrence of pressure injury (8.9 % versus 10.9 %, RR 0.64). Mattress mode also had no direct association with length of stay and severity of illness. CONCLUSION: This systematic review and meta-analysis found no significant difference in the effectiveness of LAL and AP support surface modes in preventing pressure injuries in adult ICU patients. IMPLICATIONS FOR CLINICAL PRACTICE: Clinicians should remember that mattresses are just one element within strategies to prevent pressure injuries in ICUs. The equivocal findings of this systematic review highlight the complexity of preventing pressure injuries and underscore the importance of holistic nursing care.

Investigating ward nurses' responses to deteriorating patients.

Deteriorating patients often present with suboptimal vital signs. If these are not recognised by healthcare staff, the patient's condition can deteriorate further, potentially leading to serious complications and even death. Despite efforts to improve ward nurses' recognition of, and responses to, deteriorating patients, this aspect of care has been found to be suboptimal. AIM: To identify factors that influence ward nurses' responses to deteriorating patients. METHOD: A literature review was undertaken, based on the research question 'What factors influence the trigger component of ward-based registered nurses' afferent response to deteriorating patients?' Several electronic databases were searched electronically to identify relevant articles, alongside hand-searching. Inclusion and exclusion criteria were set to determine which articles should be included in the literature review. FINDINGS: Nine studies were identified for inclusion in the literature review. Four main themes that influenced ward nurses' responses to deteriorating patients emerged: communication, diurnal and weekend variation, knowledge and attitudes, and nurse staffing levels. CONCLUSION: Effective communication was identified as an important factor in improving ward nurses' responses to deteriorating patients, as was improved knowledge of 'do not attempt cardiopulmonary resuscitation' (DNACPR) orders. It was also identified that increased ward nurse numbers improved responses to deteriorating patients, as did increased availability of senior healthcare staff, which enabled junior staff to escalate care.

Investigating ward nurses' responses to deteriorating patients.

Deteriorating patients often present with suboptimal vital signs. If these are not recognised by healthcare staff, the patient's condition can deteriorate further, potentially leading to serious complications and even death. Despite efforts to improve ward nurses' recognition of, and responses to, deteriorating patients, this aspect of care has been found to be suboptimal. AIM: To identify factors that influence ward nurses' responses to deteriorating patients. METHOD: A literature review was undertaken, based on the research question 'What factors influence the trigger component of ward-based registered nurses' afferent response to deteriorating patients?' Several electronic databases were searched electronically to identify relevant articles, alongside hand-searching. Inclusion and exclusion criteria were set to determine which articles should be included in the literature review. FINDINGS: Nine studies were identified for inclusion in the literature review. Four main themes that influenced ward nurses' responses to deteriorating patients emerged: communication, diurnal and weekend variation, knowledge and attitudes, and nurse staffing levels. CONCLUSION: Effective communication was identified as an important factor in improving ward nurses' responses to deteriorating patients, as was improved knowledge of 'do not attempt cardiopulmonary resuscitation' (DNACPR) orders. It was also identified that increased ward nurse numbers improved responses to deteriorating patients, as did increased availability of senior healthcare staff, which enabled junior staff to escalate care.

Tension pneumothorax recurrence in COPD: a care study.

This care study concerns a patient with chronic obstructive pulmonary disease, who endures the recurrence of a tension pneumothorax. A holistic and evidence-based approach is employed to critically discuss his assessment, pathophysiology, and nursing care. These discussions facilitate extrapolation of implications pertinent to nursing practice.