American Journal of Men's Health

This study aims to assess the crisis management and problem-solving skills of nurses caring for patients with COVID-19. The participants of this descriptive cross-sectional were 132 nurses who cared for patients with COVID-19 in a public hospital. The crisis management scale (CMS), problem-solving inventory (PSI), and Nurse Introduction Form were used to collect data. In this study, the nurses’ CMS total score average was 3.75 ± 0.442, the average PSI total score was 86.32 ± 24.420, and it was determined that their crisis management ability was at a good level and their problem-solving skills were at a medium level. A significant difference was found between the nurses’ descriptive characteristics of having children (P = .029), being informed about crisis management (P = .035), and their total average score on the CMS (P < .05). A statistically significant negative relationship was found between the nurses’ total CMS and PSI scores (P < .05).This study showed that the problem-solving skill levels of nurses caring for patients with COVID-19 affected their crisis management skills.

The transition period from undergraduate nursing education to professional practice is a time of uncertainty and great difficulty for new graduate nurses (NGNs). Nurse residency programs (NRPs) provide structured education, simulation-based learning, and preceptorship to ease the transition. Although its effect on improving retention of NGNs is well established in the literature, the effect on clinical competency has not been documented as well. The purpose of this integrative review is to appraise the available literature and synthesize the evidence that demonstrates the effect of NRPs on clinical competency of NGNs entering the critical care setting. Inclusion criteria were quantitative and qualitative studies, peer-reviewed studies published after 2004 and in English, identified through a systematic literature search using the CINAHL database. Critical appraisal of the articles was completed using Law et al’s Critical Review Form. Eight articles (4 quantitative, 3 mixed method, and 1 qualitative study) met the inclusion criteria. The themes identified were common tools used to assess the efficacy of NRPs, improved clinical competency of NGNs, improved self-confidence, improved retention rates, and peer support among NGNs. Implications for nursing education and practice include applying evidence-based NRPs, incorporating simulation, enhancing sustainability, and reducing NRP variability through accreditation.

Sepsis is a condition of life-threatening organ dysfunction caused by a dysregulated host response to infection. It is the result of a series of exaggerated physiologic responses that lead to simultaneous hyper- and hypoinflammatory states. In the hyperinflammatory phase, there is an exuberant release of cytokines, commonly referred to as a cytokine storm. The immune-suppressive phase is characterized by counterregulatory attempts to achieve homeostasis that sometimes “overshoot”, leaving the host in a state of immunosuppression, thus predisposing to recurrent nosocomial and secondary infections. The aging population with comorbidities faces higher risks of immune dysfunction and inflammation. Thus, the number of sepsis survivors that develop subsequent infections is predicted to rise substantially in the next few decades. Understanding sepsis-induced immune dysregulation may enhance surveillance and outcomes. This review is intended to describe the pathophysiology of sepsis and its effects on the immune system.

Acute kidney injury (AKI) is a common complication of sepsis due to a myriad of contributing factors and leads to significant morbidity and mortality in critically ill patients. Prompt identification and management are vital to reverse and/or prevent the worsening of AKI. When renal function is severely compromised, there may be a need for dialytic therapy to meet the metabolic needs of patients. This article will review the definition of AKI, epidemiology, risk factors, and pathophysiology of AKI in sepsis, along with both non-dialytic and dialytic treatment strategies. We will also review landmark trials in fluid resuscitation in sepsis.

It has been suggested that the use of statin pills beforehand could potentially influence the outcomes when individuals are hospitalized with COVID-19. In this study, we investigated how the prior use of statin medication could influence the COVID-19 severity parameters. In this retrospective cohort study, we categorized COVID-19 patients into 2 groups: statin users and non-users. Then, various data including age, gender, the patient’s need for ventilation support, the lowest oxygen blood saturation level, the length of hospitalization, receiving remdesivir treatment, and their COVID-19 vaccination status were collected. Out of 168 patients, 62 had taken statin medication before being admitted. Using statins decreased the patient’s need for ventilation support, length of hospitalization, ventilation duration, and oxygen saturation level (P < .001). Interaction effect analysis showed that receiving remdesivir statically affected the length of hospitalization, ventilation duration, and oxygen saturation level but did not significantly affect the association between statins and needing to ventilator. The use of statin pills before COVID-19 admission reduced the requirement for ventilator support.

Despite limited evidence to support it, resuscitation in sepsis has primarily targeted aggressive fluid administration and liberal administration of oxygen. In 2024, new thought paradigms emerged to suggest that dysregulation of aerobic metabolism are essential underpinnings of sepsis, and that in fact, aggressive resuscitation with fluids liberal oxygen could potentially aggravate oxidative stress and organ failure in sepsis. As sepsis continues to be shaped and molded by the latest research; therapies targeting sepsis and septic shock management warrant similar scrutiny. Methods: We searched literature pertaining to what is known about metabolic dysregulation in sepsis, to consider approaches to identifying new targets for resuscitation and management in sepsis. Results: Therapeutic hypoxemic targets of 88-92% have been shown to have some benefit in sepsis resuscitation in a limited number of studies. The benefit is believed to result from protection from excessive accumulation of harmful reactive oxygen species. Conclusion: Limited supporting evidence exists in the literature to recommend targeted hypoxemia or hypercapnia in patients with sepsis. Mixed results have been observed in the literature, including minimal benefit to mortality. New research designs with consideration to the dysregulated metabolic sequelae in sepsis could improve the meaningfulness of these therapies in sepsis.

The onset of cardiac arrest is unpredictable, and it is crucial to administer cardiopulmonary resuscitation (CPR). The flipped classroom has generated considerable interest in medical education in the last decade. To optimize the effectiveness of a flipped classroom intervention, there is a need to understand which component, if any, of the intervention may be successful in improving CPR competency. This study aimed to use mixed-method intervention development techniques to develop and validate a flipped classroom intervention to improve CPR competency. The theoretical framework underpinning the intervention is Competency Outcomes and Performance Assessment (COPA). The content validity index (CVI) and the content validity ratio (CVR) were calculated and found to be satisfactory. The results provided a clear specification of the intervention protocol for researchers in the next phase of the study – a pilot RCT to preliminarily explore the effect of the developed intervention.

Atrial fibrillation (AF) is a highly prevalent, progressive cardiac arrhythmia that significantly impacts the patient’s health-related quality of life. AF is linked to a 5-fold and 2-fold higher risk of stroke and cognitive dysfunction, respectively. With advancements in cardiac electrophysiology, many risk factors have been identified, which increase the risk for the development of AF. These risk factors encompassing age, hypertension, smoking, diabetes mellitus, male gender, obesity, alcohol intake, obstructive sleep apnea and so on, can be categorized into 3 major groups: modifiable, non-modifiable, and cardiac. Multiple AF prediction models have been successfully validated to identify people at high risk of AF development using these risk factors. These prediction models, such as CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology) and HARMS2-AF score can be used in clinical practice because of their easy applicability. It is crucial to address modifiable risk factors in individuals with a high risk of developing AF. Furthermore, the implementation of primary AF prevention in individuals at high risk can contribute to improved long-term outcomes. This review aims to provide the most recent, concise explanation of the risk factors linked to AF, the prediction of AF, and strategies for the primary prevention of AF.

Both adults and pediatric patients who are on mechanical ventilation face high rates of mortality and morbidity due to ventilator-associated pneumonia (VAP), which is the most prevalent deadly hospital-acquired infection. Healthcare organizations provide evidence-based guidelines to help nurses decrease VAP in ICUs; however, there are obstacles to putting these guidelines into practice. An extensive investigation was conducted for pertinent English studies published from January 2014 to February 2024 in the databases of Science Direct, Scopus, PubMed, and CINAHL. The study centered on nurses’ understanding, adherence, and obstacles regarding introducing VAP prevention guidelines. The majority of ICU nurses have a basic to intermediate understanding of evidence-based methods to reduce VAP. The nurses in the ICUs typically followed the guidelines for preventing VAP about 60% of the time. A basic analysis of descriptive content identified the obstacles preventing critical care nurses (CCNs) from following VAP PGs. The obstacles were separated into 2 groups: barriers related to nurses (such as education, experience, and training) and barriers related to the work environment (such as lack of supplies, staffing shortage, lack of policies, and ineffective supervision). To improve their skills, CCNs should get frequent updates on courses and seminars related to the VAP PG implementation. Healthcare administrators must be aware of these obstacles and implement work procedures that help CCNs overcome them if they want to increase compliance.

Sepsis is a severe and often life-threatening condition which can lead to widespread organ dysfunction, septic shock, and even death. Antimicrobials are critical in improving outcomes for patients with sepsis. This chapter details the general principles of antimicrobial therapy, appropriate selection and de-escalation of antimicrobials, and challenges in antimicrobial stewardship.

The foremost challenge encountered by patients in intensive care units is nosocomial infections impacting their prognosis. Nurses play a vital role in infection control, necessitating adequate knowledge and adherence to protocols. Therefore, the study aims to assess nurses’ knowledge, attitude, practice, and perceived barriers of infection control measures in the Intensive care units at the Northwest Bank Hospitals. The study employed a quantitative cross-sectional and observational design, utilizing a self-administration questionnaire and checklist distributed among 115 ICU nurse working in governmental hospitals in the Northwest Bank. The study revealed that the majority of nurses demonstrated a moderate to low knowledge level. However, 63.5% exhibited a positive attitude toward infection control measures, and 72.9% demonstrated good practice levels. Among the sociodemographic determinants, gender was the only significant factor in relation to practice, where male nurses demonstrated better practices than female nurses (P < .05). Nursing staff identified several barriers to achieving infection standards, including lack of equipment, inadequate training courses on infection control, challenges posed by visitors, absence of infection control policies and standards, insufficient isolation rooms, and heavy workload. The majority of nurses displayed good practice levels and positive attitudes toward infection prevention. Additionally, male nurses practiced infection control measures significantly more effectively than female nurses. The major barriers were lack of equipment, lack of training courses, and challenges related to visitors. Addressing these barriers is essential to improving infection control measures in critical care units.

Critical care nursing is considered one of the most challenging and demanding fields in nursing. Critical care nurses work in high-stress environments, tending to patients who are experiencing acute illness and necessitate intensive care. Nurses play a crucial role in providing nursing care for critically ill patients, encompassing duties such as assessment, administration of medications, ventilator management, diligent monitoring, and responding to life-saving situations. Despite the significance of their contributions, there are limited assessment tools used to assess critical care nurses’ perceptions about their roles and responsibilities in intensive care units (ICU). The main aim of this study was to develop a tool to assess the critical care nurses’ knowledge, awareness, and perception of their roles and responsibilities in the critical care units. The researcher developed the Critical Care Nurses’ Roles and Responsibilities Assessment Tool. Subsequently, the tool underwent content validity assessment by five nursing experts, resulting in a final tool with 17 Likert-scale items. The scores ranged from 17 to 85, with intervals indicating varying levels of awareness. To assess the nurses’ perception of the roles and responsibilities identified in the tool, a study was conducted on 120 registered nurses working in the ICU units across 9 governmental hospitals in Jordan. Data were collected through an online questionnaire covering demographical data and the roles and responsibilities of critical care nurses in the ICU. The collected data were subjected to quantitative analysis using appropriate statistical methods. Regarding the results among the experts, the content validity index (CVI) of the tool was 0.93. Among the participants, Cronbach alpha was measured to assess the reliability and internal consistency of the tool and the result was 0.912. Regarding the nurses’ perception, a small percentage of participants, specifically (9%), demonstrated a moderate level of agreement with the roles and responsibilities mentioned in the tool (mean of scores = 40 – 63). Conversely, a substantial majority of participants (91%), exhibited a high level of agreement (mean of scores = 64 – 85). In conclusion, the results of this study revealed a powerful and reliable tool that has earned widespread acclaim among experts and participants alike.

Background: Approximately 48% of patients with chronic respiratory disorders experience post-extubation respiratory failure necessitating noninvasive respiratory support or reintubation, which is linked to higher morbidity and mortality. So, it is necessary to determine patients’ preparedness for weaning and extubation. Objectives: To examine the effect of implementing respiratory care unit (RCC) ventilator weaning assessment checklist on weaning and extubation outcomes. Methods: Randomized controlled trial, carried out in 70 patients receiving mechanical ventilation from January 2023 to September 2023 at the respiratory intensive care units at Assiut University Hospital, Egypt. Patients were randomly assigned to a study and a usual care group, with 35 patients for each group. The usual care group weaned using the routine method, while the study group weaned using (RCC) ventilator weaning assessment checklist; the 2 groups were compared concerning weaning and extubation outcomes. Results: Compared to the usual care group, the study group’s weaning success rate was significantly higher than that of the usual care group (88.6% vs 51.4%; P = .008), and extubation failure rate was significantly lower (17.1% vs 45.7%; P = .010). Conclusions: Using RCC ventilator weaning assessment checklist improving weaning and extubation outcomes.

Several studies attempt to identify predictors for weaning and extubation from mechanical ventilation (MV) and none have been shown to be particularly accurate. Therefore, the objective of the study was to evaluate whether markers of renal function may be associated with extubation failure. This retrospective study collected data through electronic medical records for 2 consecutive years. The inclusion criteria were: ≥18 years old and requiring invasive MV for a period of ≥48 hours. Extubation failure was determined when subjects needed to return to invasive MV within 48 hours of the tracheal tube withdrawal. Acute kidney injury (AKI) was assessed according to the KDIGO classification. From a total of 167 subjects, 15% evolved with extubation failure. Lower creatinine clearance and higher fluid balance was observed in the extubation failure group compared to the successful extubation group (42 mL/min vs 100 mL/min, P = 0.01 and 739 mL vs − 189 mL, P = 0.01, respectively). Subjects with AKI are 51% more likely to evolve with extubation failures than those with normal renal function (OR = 2.7; 95% CI: 1.6-4.7; P < 0.01). Renal dysfunction was related to the rate of extubation failure. Fluid balance and serum creatinine may be aspects to be considered when making the extubation decision.