Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi-centre prospective point prevalence study.

Despite increasing preventive efforts, pressure injury still occurs in intensive care patients. This study was aimed to describe pressure injury prevalence, risk factors, and prevention practices in adult intensive care patients. This was a multi-centre, one-day, prospective point prevalence study in which a total of 198 intensive care units from 21 provinces in China participated. Overall and ICU-acquired prevalence in intensive care patients were 12.26% and 4.31%, respectively. Consistent with earlier reports, almost half of the ICU-acquired pressure injuries were at stage I, one-fourth were at stage 2, and the most common body sites for pressure injuries were sacral and heel region. Risk factors identified were consistent with prior studies. Repositioning was the most commonly used pressure injury prevention strategy, followed by alternating pressure mattresses/overlays, floating heels, and air-filled mattresses/overlays. These reflect a good level of adherence to recommended international pressure injury prevention clinical practice guidelines. The results provide a baseline reference for overall and ICU-acquired prevalence among adult intensive care patients in China. Future research on what contributed to the lower pressure injury incidence in China needs to be conducted to inform healthcare organisations on their future preventive strategies for pressure injury prevention.

Patient involvement in surgical wound care research: A scoping review.

Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this occurs in surgical wound care is not evident. This scoping review aimed to identify how patients have been involved in surgical wound care research and the quality of its reporting. Full-text studies focused on preoperative and postoperative surgical wound care in the acute care setting, published in English between 2004 and 2019, were included in the review. Screening, data charting, and quality assessment were conducted by two reviewers independently, adjudicated by a third, and then reviewed by five others. Thematic analysis synthesised the findings. Of the eight included studies, seven explained the methods for patient involvement and five described aims related to patient involvement and commented on patient involvement in the discussion. None met all of the quality assessment criteria. Three themes emerged: involvement in modifying and refining research processes, connecting and balancing expert and patient views, and sharing personal insights. Recommendations to improve patient involvement in surgical wounds research include the following: using framework and tools to inform future research; training researcher and patients in their respective research roles; and ongoing monitoring of patient involvement.

Facilitating the relocation of an intensive care unit from shared room to single room setting: Staff perceptions on the effectiveness of a multicomponent intervention.

BACKGROUND: Current strategies for new and redesigned intensive care units (ICUs) involve incorporation of single occupancy rooms. These changes have largely been made for infection control and patient privacy reasons. However, there is limited literature available on how to manage the transition of an ICU from shared room to a single room environment. AIMS: The aim of this study was to evaluate staff members' perceived effectiveness of a multicomponent intervention to facilitate transition from a shared to a single room setting. METHODS: This qualitative study was conducted in a 20-bed ICU of an Australian tertiary teaching hospital. In total, 24 staff members were interviewed in five groups and five individual interviews 6 months after the ICU relocation. FINDINGS: Three themes emerged from data analysis: (1) facilitating staff members' transition and engagement during relocation planning; (2) simulating new work processes for the single room setting; and (3) supporting nurses working in the single rooms. The components of the intervention, including the change agent, the relocation working party, Assistance, Coordination, Contingency, Education, Supervision, and Support nurse rounding model, and the safe single room model, were perceived as important strategies to support the relocation transition. The regular newsletter and the information dissemination strategy informed by the social networking survey were viewed to improve communication. Staffing levels and education models that are suitable for the single room setting were identified as areas for improvement. DISCUSSION AND CONCLUSION: A systematic change management approach, clear communication, staff engagement, and continuously monitoring new work processes are important strategies to ensure the success of the relocation. Delivery of education in the clinical area needs to be further explored to ascertain the impact of a single room environment on its delivery. Intervention co-creation involving research team members and the clinical staff was important in building change management capacity, which may contribute to intervention sustainability and continued clinical practice improvement.

Relocating an intensive care unit: An exploratory qualitative study.

BACKGROUND: As new hospitals are built to replace old and ageing facilities, intensive care units are being constructed with single patient rooms rather than open plan environments. While single rooms may limit hospital infections and promote patient privacy, their effect on patient safety and work processes in the intensive care unit requires greater understanding. Strategies to manage changes to a different physical environment are also unknown. OBJECTIVES: This study aimed to identify challenges and issues as perceived by staff related to relocating to a geographically and structurally new intensive care unit. METHODS: This exploratory ethnographic study, underpinned by Donabedian's structure, process and outcome framework, was conducted in an Australian tertiary hospital intensive care unit. A total of 55 participants including nurses, doctors, allied health professionals, and support staff participated in the study. We conducted 12 semi-structured focus group and eight individual interviews, and reviewed the hospital's documents specific to the relocation. After sorting the data deductively into structure, process and outcome domains, the data were then analysed inductively to identify themes. FINDINGS: Three themes emerged: understanding of the relocation plan, preparing for the uncertainties and vulnerabilities of a new work environment, and acknowledging the need for change and engaging in the relocation process. DISCUSSION AND CONCLUSIONS: A systematic change management strategy, dedicated change leadership and expertise, and an effective communication strategy are important factors to be considered in managing ICU relocation. Uncertainty and staff anxiety related to the relocation must be considered and supports put in place for a smooth transition. Work processes and model of care that are suited to the new single room environment should be developed, and patient safety issues in the single room setting should be considered and monitored. Future studies on managing multidisciplinary work processes during intensive care unit relocation will add to the learnings we report here.

Perceptions and attitudes toward COVID-19 vaccination among health professional students in Australia: a qualitative study.

Using two qualitative data sources: free-text responses to an open-ended question of an online survey and subsequent interviews and focus groups, we explored perceptions and attitudes toward COVID-19 vaccination among health professional students enrolled in Australian universities during the pandemic with data collected from October 2021 to April 2022. Students provided free-text responses to the open-ended question (n = 313) in the online survey and participated in interviews or focus groups (n = 17). Data analysis revealed three themes, including perceptions of COVID-19 seriousness and the risk of contracting the virus, information dissemination, and attitudes toward the vaccine mandate. The study identified evolving perceptions of COVID-19 seriousness among Australian health professional students and their sentiments toward the vaccine mandate. There is a need to ensure the quality of information dissemination related to the vaccine mandate. This may not only support students' uptake of mandatory vaccination but also provide a means for them to address vaccination with healthcare consumers and patients.

Interventions to improve patient admission and discharge practices in adult intensive care units: A systematic review.

OBJECTIVES: To identify and synthesise interventions and implementation strategies to optimise patient flow, addressing admission delays, discharge delays, and after-hours discharges in adult intensive care units. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Five electronic databases, including CINAHL, PubMed, Emcare, Scopus, and the Cochrane Library, were searched from 2007 to 2023 to identify articles describing interventions to enhance patient flow practices in adult intensive care units. The Critical Appraisal Skills Program (CASP) tool assessed the methodological quality of the included studies. All data was synthesised using a narrative approach. SETTING: Adult intensive care units. RESULTS: Eight studies met the inclusion criteria, mainly comprising quality improvement projects (n = 3) or before-and-after studies (n = 4). Intervention types included changing workflow processes, introducing decision support tools, publishing quality indicator data, utilising outreach nursing services, and promoting multidisciplinary communication. Various implementation strategies were used, including one-on-one training, in-person knowledge transfer, digital communication, and digital data synthesis and display. Most studies (n = 6) reported a significant improvement in at least one intensive care process-related outcome, although fewer studies specifically reported improvements in admission delays (0/0), discharge delays (1/2), and after-hours discharge (2/4). Two out of six studies reported significant improvements in patient-related outcomes after implementing the intervention. CONCLUSION: Organisational-level strategies, such as protocols and alert systems, were frequently employed to improve patient flow within ICUs, while healthcare professional-level strategies to enhance communication were less commonly used. While most studies improved ICU processes, only half succeeded in significantly reducing discharge delays and/or after-hours discharges, and only a third reported improved patient outcomes, highlighting the need for more effective interventions. IMPLICATIONS FOR CLINICAL PRACTICE: The findings of this review can guide the development of evidence-based, targeted, and tailored interventions aimed at improving patient and organisational outcomes.

Barriers and facilitators to COVID-19 vaccine uptake among Australian health professional students during the pandemic: a nationwide study.

Using a cross-sectional online survey we investigated knowledge, attitudes, and risk perception about COVID-19 vaccination and identified factors influencing vaccine uptake among Australian health professional students from October 2021 to January 2022. We analysed data from 1114 health professional students from 17 Australian universities. Most participants were enrolled in nursing programs (n = 958, 86.8%), and 91.6% (n = 858) of the participants received COVID-19 vaccination. Approximately 27% believed COVID-19 was no more serious than seasonal influenza and that they had a low risk of acquiring COVID-19. Nearly 20% disagreed that COVID-19 vaccines in Australia were safe and perceived they were at higher-risk of acquiring COVID infection than the general population. Higher-risk perception viewing vaccination as their professional responsibility, and vaccine mandate strongly predicted vaccination behaviour. Participants consider COVID-19 information from health professionals, government websites, and World Health Organization as the most trusted information sources. The findings highlight that healthcare decision-makers and university administrators need to monitor students' hesitancy with vaccination to improve students' promotion of the vaccination to the general population.

An audit of central venous catheter insertion and management practices in an Australian tertiary intensive care unit: A quality improvement project.

INTRODUCTION: Central venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear. AIM: This study was aimed to describe clinicians' adherence to recommended practices in central venous catheter insertion and management. METHOD: A cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools. RESULTS: Our audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants' practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation. CONCLUSION: Our audit showed a detailed picture of clinician's adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit.

Patient and family perceptions and experiences of same-day discharge following percutaneous coronary intervention and those kept overnight.

OBJECTIVE: To explore perceptions and experiences of patients discharged the same day (or not) and their family members towards same-day discharge following percutaneous coronary intervention. DESIGN AND METHODS: A qualitative interpretative design. Semi-structured phone interviews were conducted with consented patients who underwent percutaneous coronary intervention, and their family members (n = 23). Data were analysed using a content analysis approach. SETTING: This study was undertaken in the cardiac services department of an Australian tertiary hospital. MAIN OUTCOME MEASURES: Perceptions and experiences of same-day discharge. FINDINGS: A total of 31 patients and 23 family members were interviewed. Two categories emerged from the analysis: communication challenges with hospital staff and perceptions of same-day discharge. Family members were often not provided discharge instructions, and some same-day discharged patients felt vulnerable following discharge. When asked, most participants perceived same-day discharge as a preferred option because of its comfort and convenience. Some expressed uncertainty towards same-day discharge due to feeling anxious and apprehensive. Others misperceived same-day discharge as a signal that their heart problem was fixed without realising their underlying chronic health conditions. CONCLUSION: Most patients and family members perceived same-day discharge as a preferred option. However, strategies are needed to support their transition from hospital to home, therefore, recognising and improving their long-term disease management.