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Prolonged bed rest is a known contributor to muscle atrophy, weakness, and deconditioning. Early active mobilization protocols aim to combat acquired weakness and loss of function in patients in the intensive care unit. Despite these benefits, mobilization of patients in the intensive care unit remains a challenge, most notably for patients with limited ability to get out of bed because of invasive devices and prolonged hospitalization. Virtual reality has gained favor for use in critical care to mitigate patients' stress, pain, and anxiety and to provide distraction and socialization. This case report demonstrates a novel application of virtual reality and the ease with which virtual reality can be used to facilitate early mobility and activity progression in the critically ill., (©2024 American Association of Critical-Care Nurses.)

Background: Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood., Aim: The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting., Study Design: A cross-sectional, multi-centre, survey-based study., Results: The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings., Conclusions: Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings., Relevance to Clinical Practice: This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes., (© 2024 British Association of Critical Care Nurses.)

Background: Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice., Aim: This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses., Study Design: This study adopted a mixed-methods approach., Methods: Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics., Results: Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training)., Conclusion: IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care., Relevance for Clinical Practice: The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring., Methods: A systematic academic database and grey literature search strategy was conducted using CINAHL, Medline Psych Info, and Google Scholar. Keywords used included truth, children, nurse, disclosure, serious illness, and communication. A total of 17 publications of varying types were included in the final data set., Ethical Considerations: As this was a review of the literature, there were no direct human participants. Empirical studies included in the review had received ethics approval., Results: Of the 17 articles included in the review, only one directly reported on the experiences of nurses asked to withhold the truth from patients. Empirical studies were limited to HIV-positive children and children diagnosed with cancer and the dying child., Conclusion: A paucity of literature exploring the experiences, attitudes, and beliefs of nurses with regard to truth-telling to seriously ill children is evident. Little consideration has been given to the role nurses play in communicating medical information to children in a hospital setting. The 17 articles included in the review focused on cancer, and HIV, diagnosis, and end-of-life care. Further research should be undertaken to explore the experiences and attitudes of nurses to clinical information sharing to children hospitalised with a wide range of serious illnesses and in diverse clinical scenarios., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients., Method: We designed the intervention named "DyDel" (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction)., Results: Overall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06)., Conclusion: Non-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs., Implications for Clinical Practice: DyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In society, people live in a social reality where multiculturalism is an increasingly relevant and prevalent topic in their contexts. Facing this, caring for multicultural patients in an emergency service or intensive care unit setting requires a high level of cultural competence due to the complexity, vulnerability of the patient, rapid changes in hemodynamic status, involvement of the family, their informational needs., Objective: To map the strategies for nursing care of critically ill multicultural patients., Method: A Scoping Review was conducted following the Joanna Briggs Institute's recommendations, with the research question: What are the strategies for nursing care of critically ill multicultural patients? The study was guided by PRISMA. The research was conducted through the EBSCOHost platform, SciELO, Portugal's Open Access Scientific Repository, the Virtual Health Library and a search in grey literature. This was achieved by combining the descriptors DECS/MESH: cultural competence; critical care; emergency room; intensive care; and natural words: cultural care; nurs* interventions; nurs* strategies; within the time frame from 2012 to 2024. The study screening was performed by three independent reviewers through the reading of titles, abstracts and full texts, applying exclusion criteria. The study results were then subjected to content analysis, from which categories emerged., Results: The selected articles highlight various strategies that contribute to the improvement of nursing care for critically ill multicultural patients, focusing on care practice and cultural diversity training for both nurses and nursing students., Conclusion: Nurses with cultural competence possess more knowledge and strategies to provide tailored care for multicultural critically ill patients, thereby enhancing the quality of care delivered and contributing to the humanization of healthcare., Relevance to Clinical Practice: Nurses need to have knowledge of existing strategies for caring for multicultural critically ill patients., Patient or Public Contribution: No direct patient or public contribution to the review., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Competing Interests: The author declares no conflicts of interest.

Abstract: Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU., (Copyright © 2024 InterVarsity Christian Fellowship.)

Serious illness communication can be especially distressing for patients who are critically ill and their loved ones who experience forms of discrimination based on identities such as their race, gender, sexual orientation, and other intersecting identities. In this article, we discuss the concept of intersectionality and its association with serious illness communication, decision-making, and care in the intensive care unit. Additionally, we present relevant concepts from clinical practice and contemporary nursing and health care literature to support critical care nurses in fostering more inclusive serious illness communication in the intensive care unit., (©2024 American Association of Critical-Care Nurses.)

Implementation science is the process of integrating an intervention into practice within an organization or health system and is a useful strategy to improve practice, affect patient outcomes, and promote practice sustainability. In this series, AJN and the journal JBI Evidence Implementation have partnered to deliver examples of how health care facilities from around the world have worked to solve common patient care problems. Through this partnership, we strive to create awareness and share knowledge and experiences by publishing summaries of studies that have appeared in JBI Evidence Implementation. These summaries are designed to provide nursing teams with an overview of the barriers faced and the strategies and resources needed to improve practice and drive change at the unit level. Our goal is to ensure that AJN readers have access to important evidence-based information designed to influence patient outcomes and nursing practice.-Carl A. Kirton, DNP, MBA, RN, ANP, FAAN., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings., Local Problem: This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed., Methods: This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project., Results: During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients., Conclusions: Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding., (©2024 American Association of Critical-Care Nurses.)

Objectives: Analyse the effect of varying start times for early exercise interventions on the prevention of intensive care unit-acquired weakness., Research Methodology: We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, China Biology Medicine Disc, China National Knowledge Infrastructure, Wan Fang Database, and reference lists up to May 2023., Setting: We systematically searched the literature for all randomized controlled trials on the effect of early mobilization in patients with critical illness., Main Outcome Measures: The primary outcome assessed was the incidence of intensive care unit-acquired weakness. The secondary outcomes included: the Medical Research Council Score, the Barthel Index, duration of mechanical ventilation, length of intensive care unit stay, total length of hospital stay, mortality and incidence of intensive care unit-related complications., Results: The results of meta-analysis showed that compared with routine care, less than 24 hours after admission (RR = 0.44, 95 %CI: 0.28-0.68), more than 24 hours (RR = 0.33, 95 %CI: 0.16-0.67), less than 72 hours after admission (RR = 0.33, 95 %CI: 0.20-0.52) may lead to a lower incidence of intensive care unit-acquired weakness. The results of under surface cumulative ranking showed that early mobilization within 72 hours may have the lowest incidence of intensive care unit-acquired weakness (SUCRA = 81.9 %)., Conclusions: The current empirical evidence from intensive care unit patients suggests that initiating mobilization protocols within 24-72 hours timeframe following admission to the intensive care unit could potentially be the most beneficial strategy to reduce the incidence of intensive care unit-acquired weakness and the related medical complications. Moreover, this strategy seems to significantly improve rehabilitation and treatment outcomes for these patients., Implications for Clinical Practice: According to this study, medical and nursing staff in the intensive care unit have the chance to identify the most suitable timing for the implementation of early rehabilitative measures for patients. This can potentially prevent intensive care unit-acquired weakness and enhance various clinical outcomes for patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: to develop and assess a nursing care protocol for critically ill users with tracheostomy under mechanical ventilation., Methods: a methodological study, developed through two phases, guided by the 5W2H management tool: I) target audience characterization and II) technology development., Results: thirty-four nursing professionals participated in this study, who presented educational demands in relation to care for critical users with tracheostomy, with an emphasis on standardizing care through a protocol and carrying out continuing education., Final Considerations: the creation and validity of new technologies aimed at this purpose enhanced the participation of nursing professionals and their empowerment in the health institution's microsectoral actions and in macrosectoral actions, highlighting the need for public policies that guarantee the conduct of a line of care for users with tracheostomy.

This scholarly project implemented the 3 Wishes Project (3WP), which aims to fulfill the final wishes of dying critically ill patients, in a 16-bed tertiary intensive care unit (ICU). The project assessed outcomes through sur.

Background: Intensive care unit (ICU) patients experience hypoglycemia at nearly 4 times the rate seen in non-ICU counterparts. Although inpatient hypoglycemia management relies on nurse-driven protocols, protocol adherence varies between institutions and units., Objective: To compare hypoglycemia management between ICU and non-ICU patients in an institution with high adherence to a hypoglycemia protocol., Methods: This secondary analysis used retrospective medical record data. Cases were ICU patients aged 18 years or older with at least 1 hypoglycemic event (blood glucose level < 70 mg/dL); non-ICU controls were matched by age within 10 years, sex, and comorbidities. Time from initial hypoglycemic blood glucose level to subsequent blood glucose recheck, number of interventions, time to normoglycemia, and number of spontaneous hypoglycemic events were compared between groups., Results: The sample included 140 ICU patients and 280 non-ICU controls. Median time to blood glucose recheck did not differ significantly between groups (19 minutes for both groups). Difference in mean number of interventions before normoglycemia was statistically but not clinically significant (ICU, 1.12; non-ICU, 1.35; P < .001). Eighty-four percent of ICU patients and 86% of non-ICU patients returned to normoglycemia within 1 hour. Median time to normoglycemia was lower in ICU patients than non-ICU patients (21.5 vs 26 minutes; P = .01). About 25% of patients in both groups experienced a spontaneous hypoglycemic event., Conclusion: Adherence to nurse-driven hypoglycemia protocols can be equally effective in ICU and non-ICU patients. Further research is needed to determine protocol adherence barriers and patient characteristics that influence response to hypoglycemia interventions., (©2024 American Association of Critical-Care Nurses.)

Background: Critically ill patients in intensive care often struggle with disrupted sleep, a prevalent issue in this population. However, the question of which non-pharmacological intervention is most effective in enhancing sleep quality remains unanswered. This study was conducted to comprehensively evaluate and compare the efficacy of various non-pharmacological interventions aimed at improving sleep quality among critically ill individuals., Methods: We conducted a search of PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) without language restrictions to identify articles published until July 15, 2023. Randomized controlled trials (RCTs) that investigated various nursing interventions designed to improve sleep quality in critically ill patients were included in this network meta-analysis. All analyses were performed using R software (version 3.4.3) with the "gemtc" package., Results: A total of 2036 patients from 31 RCTs were included in the network meta-analysis, involving 11 different nursing interventions (routine care, relaxation combined with imagery (RI), nursel, music + earplugs + eye masks, music, eye masks, earplugs + eye masks, earplugs, aromatherapy, Warm footbath combined with acupoint exercise (WFA), Virtual reality meditation (VR)). Eye masks and earplugs + eye masks were associated with improved sleep quality compared to routine care intervention (P < .05)., Conclusions: In summary, eye masks and earplugs + eye masks stand out as the most effective interventions for enhancing sleep quality in critically ill patients. Therefore, critical care nurses should consider incorporating the use of eye masks alone or combining music with eye masks into the sleep care regimen for critically ill patients., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

In order to improve the nursing effect of respiratory critical illness, this paper combines the refined nursing method to explore the nursing plan of respiratory critical illness. Moreover, this paper uses the variable control method to explore the effects of nursing management, combines the hospital patient samples to conduct a controlled trial analysis, and conducts sample grouping according to the random grouping method. The patients in the control group are managed by traditional nursing management methods, the patients in the test group are managed by refined nursing management methods, and other conditions are basically the same. In addition, the experiment process variable control is carried out according to the mathematical statistics method, and the reasonable statistics and data processing are carried out. Through the comparison method, we can see that the refined management method proposed in this paper has a good effect in the nursing of respiratory critical illness., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Wenjuan Shi et al.)

Background: The extent to which the degree of baseline frailty, as measured using standardized multidimensional health assessments before hospital admission, predicts survival among older adults after admission to an ICU remains unclear., Research Question: Is baseline frailty an independent predictor of survival among older adults receiving care in an ICU?, Study Design and Methods: Retrospective cohort study of community-dwelling older adults (age, ≥ 65 years) receiving public home services who were admitted to any ICU in Ontario, Canada, between April 1, 2009, and March 31, 2015. All individuals underwent an interRAI Resident Assessment Instrument-Home Care (RAI-HC) assessment completed within 180 days of ICU admission. These assessments were linked to hospital discharge abstract records. Patients were categorized using frailty measures each calculated from the RAI-HC: a classification tree version of the Clinical Frailty Scale; the Frailty Index-Acute Care; and the Changes in Health, End-Stage Disease, Signs, and Symptoms Scale. One-year survival models were used to compare their performance. Patients were stratified based on the receipt of mechanical ventilation in the ICU., Results: Of 24,499 individuals admitted to an ICU within 180 days of a RAI-HC assessment, 26.4% (n = 6,467) received mechanical ventilation. Overall, 43.0% (95% CI, 42.4%-43.6%) survived 365 days after ICU admission. In general, among the overall cohort and both mechanical ventilation subgroups, mortality hazards increased with the severity of baseline frailty. Models predicting survival 30, 90, and 365 days after admission to an ICU that adjusted for one of the frailty measures were more discriminant than reference models that adjusted only for age, sex, major clinical category, and area income quintile., Interpretation: Severity of baseline frailty is independently associated with survival after ICU admission and should be considered when determining goals of care and treatment plans for people with critical illness., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: This study explored the experience of pediatric ICU (PICU) nurses who volunteered at a camp for families of children and adolescents with cancer., Background: PICU nurses are at risk of developing symptoms of posttraumatic stress disorder, compassion fatigue, depression, and burnout due to exposure(s) to traumatic events. Spending time with patients, families, and nurse colleagues at camp may reduce the effects of this exposure., Methods: A qualitative descriptive study was conducted using content analysis. Fifteen nurse participants completed a precamp questionnaire and semistructured focus groups immediately following camp. Individual interviews were conducted 6 months after camp., Results: Three categories emerged: 1) personal factors, changes in the nurses themselves; 2) patient and family factors, changes in how nurses perceived patients and families; and 3) work-related factors, relationships with colleagues., Conclusions: Supporting PICU nurses to participate with patients, families, and colleagues outside of the hospital may reduce burnout and support nurses' well-being., Competing Interests: Jacob's Heart Children's Cancer Support Services is the sponsor of the camp for families with cancer. L.B. is the founder of Jacob’s Heart. The other authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission., Design: Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015., Setting: Two tertiary hospital ICU's in Victoria, Australia., Patients: Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial., Interventions: The dosage of mobilization in ICU was measured by: 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome., Measurements and Main Results: Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [β] 0.022 [95% CI, 0.002-0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain β = 0.127 [CI, 0.049-0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status., Conclusions: In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission., Competing Interests: Dr. Hodgon’s institution received funding from Monash Partners Academic Health Service Centre, Heart Foundation Australia, and a National Health and Medical Research Council Investor Grant; she received funding from the Heart Foundation Future Leader Fellowship. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Abstract: Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To adapt and validate a chart-based delirium detection tool for use in critically ill adults., Design: Validation study., Setting: Medical-surgical intensive care unit (ICU) in an academic hospital., Measurements: A chart-based delirium detection tool (CHART-DEL) was adapted for use in critically ill adults (CHART-DEL-ICU) and compared with prospective delirium assessments (i.e., clinical assessments (reference standard) by a research nurse trained by a neuropsychiatrist and routine delirium screening tools Confusion Assessment Method (CAM-ICU)) and (Intensive Care Delirium Screening Checklist (ICDSC)). The original CHART-DEL tool was adapted to include physician-reported ICDSC score (for probable delirium) and Richmond-Agitation Sedation Scale score (for altered level of consciousness and agitation). Two trained chart abstractors blinded to all delirium assessments manually abstracted delirium-related information from medical charts and electronic medical records and rated if delirium was present (four levels: uncertain, possible, probable, definite) or absent (no evidence)., Results: Charts were manually abstracted for delirium-related information for 213 patients who were included in a prospective cohort study that included prospective delirium assessments. The CHART-DEL-ICU tool had excellent interrater reliability (kappa = 0.90). Compared to the reference standard, the sensitivity was 66.0% (95% CI = 59.3-72.3%) and specificity was 82.1% (95% CI = 78.0-85.7%), with a cut-point that included definite, probable, possible, and uncertain delirium. The AUC of the CHART-DEL-ICU alone is 74.1% (95% CI = 70.4-77.8%) compared with the addition of the CAM-ICU and ICDSC (CAM-ICU/CHART-DEL-ICU: 80.9% (95% CI = 77.8-83.9%), P = .01; ICDSC/CHART-DEL-ICU: 79.2% (95% CI = 75.9-82.6%), P = .03)., Conclusion: A chart-based delirium detection tool has improved diagnostic accuracy when combined with routine delirium screening tools (CAM-ICU and ICDSC), compared to a chart-based method on its own. This presents a potential for retrospective detection of delirium from medical charts for research or to augment routine delirium screening methods to find missed cases of delirium., (© 2020 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.)

This article explores the experiences and learnings of 2 ambulatory care nurse leaders on the front lines of the Covid-19 pandemic using the theory "navigating through chaos" as a framework., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: In Europe, the novel coronavirus outbreak started in the northern regions of Italy at the end of February 2020. Initially, resources were insufficient to deal with the abrupt influx of critically ill patients requiring respiratory support. This article recounts the authors' experiences caring for patients with COVID-19 in an Italian ICU during this period in order to help colleagues in the international critical care nursing community successfully manage similar circumstances in the ongoing pandemic., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Critical care medicine continues to evolve. However, critical care cases require increasing amount of medical resources. Intensive care unit (ICU) mortality significantly impacts the overall efficiency of healthcare resources within a system of limited medical resources. This study investigated the factors related to ICU mortality using long-term nationwide cohort data in South Korea., Materials and Methods: This retrospective cohort study used data of 14905721 patients who submitted reimbursement claims to the Korean Health Insurance Service between January 1, 2011 and December 31, 2015. A total of 1498102 patients who were admitted to all ICU types, except neonatal and long-term acute care hospitals, were enrolled., Results: Of the total 1498102 participants, 861397 (57.5%) were male and 636705 (42.5%) were female. The mean age at admission was 63.4±18.2 years; most of the subjects were aged over 60 years. During the 5-year period, in-hospital mortality rate was 12.9%. In Cox analysis, both in-hospital and 28-day mortality rates were significantly higher in male patients and those of lower socioeconomic status. As age increased and the number of nursing staff decreased, the mortality risk increased significantly by two or three times. The mortality risk was lower in patients admitted to an ICU of a tertiary university hospital and an ICU where intensivists worked., Conclusion: The number of nursing staff and the presence of an intensivist in ICU were associated with the ICU mortality rate. Also, increasing the number of nursing staff and the presence of intensivist might reduce the mortality rate among ICU patients., Competing Interests: The authors have no potential conflicts of interest to disclose., (© Copyright: Yonsei University College of Medicine 2021.)

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is erupting and spreading globally. Cardiovascular complications secondary to the infection have caught notice. This study aims to delineate the relationship of cardiac biomarkers and outcomes in severe cases of corona virus disease 2019 (COVID-19). One hundred forty-eight critically ill adult patients with COVID-19 were enrolled. From these patients, the demographic data, symptoms, cardiac biomarkers, treatments, and clinical outcomes were collected. Data were compared between survivors and non-survivors. Four patients in the non-survivor group were selected, and their cardiac biomarkers were collected and analyzed. Among the 148 patients, the incidence of cardiovascular complications was 19 (12.8%). Five of them were survivors (5.2%), and 14 of them were non-survivors (26.9%). Compared with the survivors, the non-survivors had higher levels of high-sensitivity cardiac troponin I, creatine kinase isoenzyme-MB, myoglobin, and N-terminal pro-brain natriuretic peptide (P < 0.05). The occurrence of cardiovascular events began at 11-15 days after the onset of the disease and reached a peak at 14-20 days. COVID-19 not only is a respiratory disease but also causes damage to the cardiovascular system. Cardiac biomarkers have the potential for early warning and prognostic evaluation in patients with COVID-19. It is recommended that cardiac biomarker monitoring in patients with COVID-19 should be initiated at least from the 11th day of the disease course.

Introduction: Invasive mechanical ventilation (IMV) is associated with several complications. Placement of a long-term airway (tracheostomy) is also associated with short and long-term risks for patients. Nevertheless, tracheostomies are placed to help reduce the duration of IMV, facilitate weaning and eventually undergo successful decannulation., Methods: We performed a narrative review by searching PubMed, Embase and Medline databases to identify relevant citations using the search terms (with synonyms and closely related words) "non-invasive ventilation", "tracheostomy" and "weaning". We identified 13 publications comprising retrospective or prospective studies in which non-invasive ventilation (NIV) was one of the strategies used during weaning from IMV and/or tracheostomy decannulation., Results: In some studies, patients with tracheostomies represented a subgroup of patients on IMV. Most of the studies involved patients with underlying cardiopulmonary comorbidities and conditions, and primarily involved specialized weaning centres. Not all studies provided data on decannulation, although those which did, report high success rates for weaning and decannulation when using NIV as an adjunct to weaning patient off ventilatory support. However, a significant percentage of patients still needed home NIV after discharge., Conclusions: The review supports a potential role for NIV in weaning patients with a tracheostomy either off the ventilator and/or with its decannulation. Additional research is needed to develop weaning protocols and better characterize the role of NIV during weaning., (Copyright © 2020 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a "tsunami" warning requiring instantaneous implementation and escalation of disaster plans., Evidence Review: An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis., Implementation: The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S's became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted., Evaluation: Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications., Sustainability: The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19., (©2020 American Association of Critical-Care Nurses.)

In this case report, an elderly patient with COVID-19 pneumonia and a protracted intensive care course, who was unable to wean from mechanical ventilation, was transferred to the hospice unit for ventilator withdrawal and end of life care. Although symptom management was anticipated to focus on treating acute dyspnea, conditions mandated a shift to addressing the psychological challenges associated with prolonged critical illness. The interventions typical to hospice care-patient centered, family focused, and culturally sensitive-served to alleviate psychological symptoms of demoralization and despair, contributing to an outcome that pointed beyond pulmonary pathophysiology. Thought to be facing imminent death once the ventilator was removed, this patient defied the science behind weaning protocols, which can only be explained by a "will to live," through loving engagement with his family, his favorite music, and a dedicated multidisciplinary hospice team.

Background: The coronavirus disease 2019 (COVID-19) pandemic is responsible for millions of infections worldwide, and a substantial number of these patients will be admitted to the intensive care unit (ICU). Our objective was to describe the characteristics, outcomes and management of critically ill patients with COVID-19 pneumonia at a single designated pandemic centre in Montréal, Canada., Methods: A descriptive analysis was performed on consecutive critically ill patients with COVID-19 pneumonia admitted to the ICU at the Jewish General Hospital, a designated pandemic centre in Montréal, between Mar. 5 and May 21, 2020. Complete follow-up data corresponding to death or discharge from hospital health records were included to Aug. 4, 2020. We summarized baseline characteristics, management and outcomes, including mortality., Results: A total of 106 patients were included in this study. Twenty-one patients (19.8%) died during their hospital stay, and the ICU mortality was 17.0% (18/106); all patients were discharged home or died, except for 4 patients (2 awaiting a rehabilitation bed and 2 awaiting long-term care). Twelve of 65 patients (18.5%) requiring mechanical ventilation died. Prone positioning was used in 29 patients (27.4%), including in 10 patients who were spontaneously breathing; no patient was placed on extracorporeal membrane oxygenation. High-flow nasal cannula was used in 51 patients (48.1%). Acute kidney injury was the most common complication, seen in 20 patients (18.9%), and 12 patients (11.3%) required renal replacement therapy. A total of 53 patients (50.0%) received corticosteroids., Interpretation: Our cohort of critically ill patients with COVID-19 had lower mortality than that previously described in other jurisdictions. These findings may help guide critical care decision-making in similar health care systems in further COVID-19 surges., Competing Interests: Competing interests: Paul Warshawsky reports personal fees from Gilead Sciences Canada, outside the submitted work. No other competing interests were declared., (Copyright 2020, Joule Inc. or its licensors.)

Background: It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China., Aim: The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients., Design: A descriptive and cross-sectional design was used., Methods: A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones., Results: As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%)., Conclusions: Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain., Relevance to Clinical Practice: Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization., (© 2020 British Association of Critical Care Nurses.)

Background: Despite the known benefits of mobilising critically ill patients, bed rest is still a common practice in intensive care units. The reasons for this are not fully understood. Early mobilisation can reduce the length of stay in the intensive care unit and in hospitals as well. However, the decision to mobilise a patient can be delayed while health professionals decide whose role it is to implement it., Aim and Objectives: The aim of this study was to explore the ways in which nurses make decisions to mobilise critically ill patients and what factors influence the decision-making process., Study Design and Method: This was a qualitative study involving semi-structured interviews with 12 critical care nurses at a large urban district hospital. Interpretative phenomenological analysis was used to analyse verbatim transcripts of the interviews., Results: The findings demonstrated inconsistencies in the nurses' knowledge of the benefits to mobilising patients and that mobilisation was deemed to be a low priority. Decision-making was influenced by time constraints, staffing levels, and unit demands. A lack of communication and collaborative working was identified, along with uncertainty and role ambiguity, with regard to who decides to mobilise a patient. Mobilisation was found to be complicated by existing cultural influences and by previous experiences of complex mobilisation., Conclusion: Re-education strategies are needed to re-enforce the benefits of mobilisation, along with multidisciplinary training sessions to clarify roles and overcome collaborative working issues., Relevance to Clinical Practice: This study has provided a greater understanding of the influencing factors on nurses' decision-making with regard to mobilising critical ill patients., (© 2019 British Association of Critical Care Nurses.)

Background: The aim of this meta-analysis was to assess if early mobilization and rehabilitation in the intensive care unit (ICU) could reduce ICU-acquired weakness (ICU-AW), improve functional recovery, improve muscle strength, shorten the length of ICU and hospital stays, and reduce the mortality rate., Methods: A comprehensive literature search in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and National Knowledge Infrastructure, China (CNKI) was performed. Results were expressed as a risk ratio (RR) with 95% confidence intervals (95% CIs) or weight mean difference (WMD) with 95% CIs. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies., Results: Fifteen randomized controlled trials involving a total of 1941 patients were included in this meta-analysis. Pooled estimates suggested that early mobilization significantly reduced the incidence of ICU-AW (RR = 0.49, 95% CI: 0.26, 0.91; P = .025), shortened the length of ICU (WMD = -1.82 days, 95% CI: -2.88, -0.76; P = .001) and hospital (WMD = -3.90 days, 95% CI: -5.94, -1.85; P < .001) stays, and improved the Medical Research Council score (WMD = 4.47, 95% CI: 1.43, 7.52; P = .004) and Barthel Index score at hospital discharge (WMD = 21.44, 95% CI: 10.97, 31.91; P < .001). Moreover, early mobilization also decreased complications such as deep vein thrombosis (RR = 0.16, 95% CI: 0.04, 0.59; P = .006), ventilator-associated pneumonia (RR = 0.26, 95% CI: 0.11, 0.63; P = .003), and pressure sores (RR = 0.14, 95% CI: 0.04, 0.44; P = .001). However, early mobilization did not reduce the ICU mortality rate (RR = 1.31, 95% CI: 0.97, 1.76; P = .074), improve the handgrip strength (WMD = 4.03 kg, 95% CI: -0.68, 8.74; P = .094), and shorten the duration of mechanical ventilation (WMD = 0.20 days, 95% CI: -0.10, 0.50; P = .194)., Conclusion: This study indicated that early mobilization was effective in preventing the occurrence of ICU-AW, shortening the length of ICU and hospital stay, and improving the functional mobility. However, it had no effect on the ICU mortality rate and ventilator-free days., Relevance to Clinical Practice: ICU-AW is a common neuromuscular complication of critical illness, and it is predictive of adverse outcomes. Early mobilization of critically ill patients is a candidate intervention to reduce the incidence and severity of ICU-AW. Some clinical studies have demonstrated this, whereas others found opposite results. The aim of our study is to assess if early mobilization and rehabilitation in the ICU could reduce the ICU-AW, improve functional recovery, improve muscle strength, shorten length of ICU and hospital stay, and reduce the mortality rate., (© 2019 British Association of Critical Care Nurses.)

Objective: to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios., Methods: an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil., Results: five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers' health support, also subsidizing registration and documentation during the COVID-19 pandemic., Final Considerations: valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.

Background: Early enteral nutrition (EN) and prone position may both improve the outcome of patients affected by moderate to severe Acute Respiratory Distress Syndrome. Recent guidelines suggest to administer early EN also during prone position. However, EN intolerance, such as high residual gastric volumes, regurgitation or vomiting, may occur during pronation., Aim: This systematic review aims to assess the occurrence of high residual gastric volume, regurgitation or vomiting episodes, that can be encountered in patients receiving EN during prone position., Methods: We have conducted a systematic review. We queried three scientific databases (MEDLINE, EMBASE and CINAHL) from inception until November 19, 2019 without language restrictions, using keywords and related MeSH terms. All relevant articles enrolling adult patients receiving invasive mechanical ventilation and evaluating the use of early EN during prone position were included., Results: From 111 records obtained, we included six studies. All studies but one reported no differences with respect to gastric residual volumes between supine and prone positions. A 24-hours EN administration protocol seems to be better, as compared to an 18-hours feeding protocol. The need to stop EN and vomiting episodes were higher during prone position, although the rate of high gastric volume was similar between supine and prone positions. Ventilator associated pneumonia, lengths of stay and mortalities were similar between supine and prone positions. Only one study reported lower mortality in patients receiving EN throughout the entire day, as compared to an 18-hours administration protocol., Conclusion: Protocols should be followed by healthcare providers in order to increase the enteral feeding volume, while avoiding EN intolerance (such as EN stops, high residual volume, regurgitation and vomiting)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Although diaries are an evidence-based practice that improves the quality of life of patients in an intensive care unit and their loved ones, centers in the United States are struggling to successfully implement diary programs in intensive care units. Currently, few published recommendations address how to facilitate implementation of a diary program, and how to effectively sustain it, in an intensive care unit., Objectives: To discuss challenges with implementing diary programs in intensive care units at 2 institutions in the United States, and to identify solutions that were operationalized to overcome these perceived difficulties., Methods: The teams from the 2 institutions identified local barriers to implementing diaries in their intensive care units. Both groups developed standard operating procedures that outlined the execution and evaluation phases of their implementation projects., Results: Barriers to implementation include liability and patient privacy, diary program development, and implementation and sustainability concerns. Various strategies can help maintain clinical and family member engagement., Conclusion: Through a team's sustained dedication and a diligent assessment of perceived obstacles, a diary program can indeed be implemented within an intensive care unit., (©2020 American Association of Critical-Care Nurses.)

Background: Many patients in the intensive care unit (ICU) suffer from pain and are non-communicative. Therefore, alternative pain measures are necessary. Although behavioral pain measures are available, physiological measures are lacking. The Nociception Level index (NOL™) provides a value from combination of multiple physiological parameters to measure pain and its use in the ICU is new., Aim: To explore the use of a multiple physiological parameter measure for pain assessment, the NOL™ index, in mechanically ventilated patients able to self-report pain in the ICU., Methods: A prospective cohort study was performed. Data were collected before, during, and 15 minutes after a non-nociceptive procedure (noninvasive blood pressure using cuff inflation) and a nociceptive procedure (endotracheal suctioning). NOL index, 0 to 10 pain intensity, and Critical-Care Pain Observation Tool (CPOT) scores were also obtained. Data were analyzed using Friedman and Mann-Whitney tests. Feasibility of study procedures was described., Results: Out of 28 patients who consented, 17 remained eligible and data were analyzed for 15. Technical issues prevented obtaining a NOL signal in 2 patients. NOL values were higher during endotracheal suctioning (median = 41.6) compared with before (median = 11.2) and after the procedure (median = 11.8) and compared with cuff inflation (median = 15.1; Friedman test, p < .001). NOL values were associated with pain intensity and CPOT scores (Mann-Whitney tests, p < .05)., Conclusions: The study procedures with the NOL were found feasible; NOL values could discriminate between nociceptive and non-nociceptive procedures, and values were associated with reference pain measures. Further NOL testing is required in other ICU patient groups and procedures., (Copyright © 2020. Published by Elsevier Inc.)

Energy expenditure (EE) is the sum of metabolic activity within the body at a given time and comprises basal EE, diet-induced thermogenesis, and physical activity. In the intensive care unit, EE is most often assessed to determine a patient's caloric requirements. Energy expenditure also may be useful to understand disease states and the metabolic impact of interventions. Several methods for estimating EE are relevant for clinical use, including indirect calorimetry, predictive equations, exhaled carbon dioxide volume, and the Fick method. Indirect calorimetry is the preferred method for evaluating EE and is considered the gold standard for estimating EE in hospitalized patients. However, use of indirect calorimetry is not always practical or possible. Therefore, other methods of estimating EE must be considered. In this review, methods of evaluating EE in critically ill adults are examined and the benefits and limitations of each method are discussed, with practical considerations for use., (©2020 American Association of Critical-Care Nurses.)

Systemic lupus erythematosus is a chronic autoimmune disorder that causes a wide range of mild to life-threatening conditions that require hospitalization and critical care. The morbidity and mortality of systemic lupus erythematosus are associated with the organ system damage caused by intermittent or chronic disease activity and with the complications of long-term and toxic immunosuppressant medication regimens. This article reviews the epidemiologic, clinical, diagnostic, and therapeutic information essential for critical care clinicians who provide care to patients with systemic lupus erythematosus., (©2020 American Association of Critical-Care Nurses.)

Aims: To explore the meaning of comfort and know the factors that contribute to it from the point of view of the young adults who received care in a paediatric intensive care unit, the family of the patient and the interdisciplinary team attending the patient., Findings: A total of 30 people were invited to participate in the focus groups; 24 did so. Thematic analysis yielded the following common categories: meaning of comfort, environmental factors in paediatric intensive care unit, family accompaniment during paediatric intensive care unit stay, management of information in the paediatric intensive care unit and, finally, the intimacy and privacy of the critically ill paediatric patient and their family., Conclusions: Paediatric intensive care unit professionals need to consider not only the environmental input that may lead to discomfort but also aspects such as continuous family accompaniment, the sharing of complete information with the family and the promoting of privacy., (© 2019 Nordic College of Caring Science.)

Background: Intensive care unit-acquired weakness (ICU-AW) is an acquired neuromuscular lesion and a common occurrence in patients who are critically ill. There are already systematic reviews on ICU-AW. Therefore, we provide a protocol for an overview of systematic reviews to improve the effectiveness of the construction of an evidence-based practice for prevention of ICU-AW., Methods: We will search the PubMed, CINAHL, EMBASE, and the Cochrane Library for the relevant systematic review or meta-analyses about ICU-AW. Study selection, data extraction, and the quality assessment of the included studies will be performed independently by 2 reviewers. And the methodological quality, report quality and evidence quality will be evaluated by Assessment of Multiple Systematic Reviews-2 tool, Preferred Reporting Items for Systematic Reviews and Meta Analyses Statement checklist and Grading of Recommendations Assessment, Development and Evaluation system, respectively., Results: This overview of systematic reviews and meta-analysis will collect the evidence published about the ICU-AW., Conclusion: We hope that our research will contribute to clinicians and public decision making about the ICU-AW., Registration Number: INPLASY202070067.

Background: Delirium is a complex syndrome prevalent in the intensive care unit. It has been associated with significant morbidity including distress, longer hospital stays, prolonged cognitive impairment, and increased mortality., Objective: To describe a nurse-led interdisciplinary quality improvement initiative to increase nurses' knowledge of delirium, documentation of delirium assessment, and patient mobility., Methods: Sixty-seven nurses in medical and surgical intensive care units were required to attend an interactive education program on delirium assessment and management. Scores on tests taken before and after the education program were used to evaluate knowledge. Medical records and bedside rounds were used to validate Confusion Assessment Method for the Intensive Care Unit documentation and interventions. Descriptive statistics were used to describe changes over time. A delirium resource team composed of nurses, physicians, and therapists provided didactic education paired with simulation training and bedside coaching. Mobility screening tests and computer templates guided assessments and interventions., Results: Documentation of the Confusion Assessment Method improved from less than 50% to consistently 99%. Mobilization in the surgical intensive care unit increased from 90% to 98% after intervention. Days of delirium significantly decreased from 51% before intervention to 31% after intervention (χ12=7.01, P = .008)., Conclusions: The success of this quality improvement project to enhance recognition of delirium and increase mobility (critical components of the pain assessment, breathing, sedation choice, delirium, early mobility, and family education bundle) was contingent on nursing leaders hip, interdisciplinary team collaboration, and interactive education., (©2020 American Association of Critical-Care Nurses.)