To investigate the effect of a simplified prevention bundle with alcohol-based, dual hand hygiene (HH) audit on the incidence of early-onset ventilation-associated pneumonia (VAP).
This 3-year, ...quasi-experimental study with interrupted time-series analysis was conducted in two cardiovascular surgery intensive care units in a medical center. Unaware external HH audit (eHH) performed by non-unit-based observers was a routine task before and after bundle implementation. Based on the realistic ICU settings, we implemented a 3-component bundle, which included: a compulsory education program, a knowing internal HH audit (iHH) performed by unit-based observers, and a standardized oral care (OC) protocol with 0.1% chlorhexidine gluconate. The study periods comprised 4 phases: 12-month pre-implementation phase 1 (eHH+/education-/iHH-/OC-), 3-month run-in phase 2 (eHH+/education+/iHH+/OC+), 15-month implementation phase 3 (eHH+/education+/iHH+/OC+), and 6-month post-implementation phase 4 (eHH+/education-/iHH+/OC-).
A total of 2553 ventilator-days were observed. VAP incidences (events/1000 ventilator days) in phase 1-4 were 39.1, 40.5, 15.9, and 20.4, respectively. VAP was significantly reduced by 59% in phase 3 (vs. phase 1, incidence rate ratio IRR 0.41, P = 0.002), but rebounded in phase 4. Moreover, VAP incidence was inversely correlated to compliance of OC (r2 = 0.531, P = 0.001) and eHH (r2 = 0.878, P < 0.001), but not applied for iHH, despite iHH compliance was higher than eHH compliance during phase 2 to 4. Compared to eHH, iHH provided more efficient and faster improvements for standard HH practice. The minimal compliances required for significant VAP reduction were 85% and 75% for OC and eHH (both P < 0.05, IRR 0.28 and 0.42, respectively).
This simplified prevention bundle effectively reduces early-onset VAP incidence. An unaware HH compliance correlates with VAP incidence. A knowing HH audit provides better improvement in HH practice. Accordingly, we suggest dual HH audit and consistent bundle performance does matter in quality-of-care VAP prevention.
The intensive care unit (ICU) is designed to care for patients with high disease severity who require critical care and close monitoring. Patients in the ICU may be transferred to the general ward ...for further treatment following recovery from the acute phase. Transferring from the ICU to the general ward after acute phase recovery is a stressful event that may stress both the patient and their family, potentially resulting in relocation stress syndrome (RSS). RSS has been found to be closely related to unplanned ICU readmissions, prolonged hospitalization, and adverse events, affecting recovery to health and family peace of mind. Furthermore, RSS may result in ineffective disease coping, feelings of uncertainty, and poor treatment response, leading to prolonged hospitalization, reduced trust in medical staff, and decreased happiness and quality of life. In recent years, the nursing profession has attached increasing importance to holistic health care. This has encouraged critical care teams to map out customi
Severely ill patients often experience problems with sleep. Either acupressure or valerian aromatherapy are reported as helpful in promoting sleep.
The purpose of this study was to explore the ...effectiveness of valerian acupressure on the sleep of patients in the intensive care unit (ICU).
A randomized clinical trial.
A 42-bed adult intensive care unit.
Forty-one subjects in the experimental group and 44 subjects in the control group.
The measurement included observation, and actigraphy measures during 10pm–6am, and the Stanford Sleepiness Scale (SSS) measures on the next morning. Experimental groups received valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints between 7pm and 10pm of the second day while control groups received regular treatment. Heart rate was measured for 5min before and after valerian acupressure present for HR variability analysis to measure relaxation response.
The results indicated that after receiving valerian acupressure, patients’ sleeping hours increased, wake frequency reduced and SSS grades declined. The HR variability data indicated relaxation response immediately after valerian acupressure.
This study supports the hypothesis that valerian acupressure on the Shenmen, Neiguan, and Yongquan acupoints could improve the sleeping time and quality of ICU patients.
Background: Critical care nurses must often care for patients who are dying and their families. Thus, understanding the self-efficacy and life attitudes of nursing staff in the ICU in response to ...death is important to the development and provision of relevant education and training. Purpose: This study was designed to explore the self-efficacy of ICU nurses in response to death and related predictive factors. Methods: This was a cross-sectional research study. The subjects were 216 nurses in the adult ICU of a medical center in northern Taiwan. The research tools used included the death coping self-efficacy scale and the life attitude scale. Data were analyzed using Pearson's correlation, t-test, one-way ANOVA, and multiple regression. Result: The results showed: 1. In terms of death coping self-efficacy, the mean score was 112.0 ± 14.3, with the highest scoring subscale, hospice care, earning a mean score of 51.1 ± 6.3. In terms of life attitude, the mean score was 128.9 ± 13.8, with the highest scoring subs
碩士
國立陽明大學
護理學系暨研究所
96
The purpose of this study was to explore the sleep quality of the critical ill patient in the intensive care unit. A convenient sample of 70 patients was included and their ...sleeps during their ICU stay were observed. Data collected were the care activities, environmental noise and light levels. Sleep quality was assessed by observation and actigraphy during 10pm to 6am. Daytime sleepiness was assessed by the Stanford Sleepiness Scale (SSS) at 7:30 to 8:30 am. The total observation nights were 269. Data were processed by SPSS 13.0 and the major statistical procedures applied were t-test, chi-square, Pearson correlation, and stepwise multiple linear correlation. A p value of less than .05 was taken as significant.
The results of this study demonstrated that the mean frequency of care activity per night was 20.2(SD 4.5) with the most frequent at 1 AM and least frequent at 4 AM. The mean duration of sleep was 3.0(SD 1.8) hours by observation and 7.5(SD 1.0) hours by actigraphy. The average o
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