Unplanned extubations in an intensive care unit: Findings from a critical incident technique

Danielis, Matteo; Chiaruttini, Simona; Palese, Alvisa

doi:10.1016/j.iccn.2018.04.012

Cited by 13 publications

(14 citation statements)

References 37 publications

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“…Interventions aimed at weaning, presented in the final version of the proposed instrument, refer to using standardized protocols. On this subject, a study maintains that the implementation of standardized weaning protocols should be promoted, with a view to improving the quality of care and ensuring the comfort of intubated patients (7) . Standardized weaning protocols were associated with a lower incidence of UPE, and its use is viable for promoting compliance among professionals in patient care, when the protocols are clinically prescribed (44) .…”

Section: Discussionmentioning

confidence: 99%

“…Although the intervention "Determining nursing sizing according to the technical standards in force in each institution" is not in the final version of the Brazilian instrument, which is in compliance with expertts' assessment in the country, an inadequate proportion of nurses/patients is a factor that increases the risk of UPE (7) . Nursing staff sizing in services, including for intensive care, is supported by Resolution 543/2017 of the Federal Nursing Council (Conselho Federal de Enfermagem) (48) .…”

Section: Discussionmentioning

confidence: 99%

“…The literature supports some strategies to cope with this AE such as increased interprofessional communication (7) , workload optimization, adequate nurse/patient relationship and adoption of UPE protocols (4) . Despite this, it is known instruments use such as guidelines, bundles and checklists, associated with training and permanent education of professionals are pillars of patient safety (8)(9) ; these specific instruments allow nurses and other professionals to make better care choices and possibilities for quality of life (10) .…”

Section: Introductionmentioning

confidence: 99%

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Care for unplanned extubation prevention: analysis of the validity of an instrument’s content

et al. 2021

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Objectives: to analyze the validity of a nursing care instrument content for unplanned extubation prevention in Intensive Care Units. Methods: a methodological study carried out with 40 nurses, containing 26 interventions distributed in the components: agitation/delirium/pain management; respiratory device stability; weaning from sedation and spontaneous breathing assessment; human resource management. Content Validity Index, average and universal proportion, and Fleiss’ Kappa coefficient were applied. Results: Brazilian female experts stood out, with an average age of 44.9 years and a standard deviation of 7.75 years. Two interventions did not reach a valid Content Validation Index (≥0.78), when considering the set of evaluated criteria. A universal agreement of 4.0% was identified among Brazilians and 26.6% among foreigners. Conclusions: the instrument is relevant and represents “unplanned extubation prevention in Intensive Care Units”, which can be implemented in Brazil and in Latin countries, in Brazilian and foreign versions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Care for unplanned extubation prevention: analysis of the validity of an instrument’s content

et al. 2021

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“…The critical incidents (CIs) (11) in this study refer to situations perceived as relevant by GPs dealing with the COVID-19 pandemic. The concept of "technique" in the CIT entails critical reflection focused on analyzing the human behaviors and contextual factors underlying the phenomena in question (12,13).…”

Section: Methodsmentioning

confidence: 99%

General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study

Kurotschka

Serafini

Demontis³

et al. 2021

Front. Public Health

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Since February 2020, when coronavirus disease began to spread in Italy, general practitioners (GPs) were called to manage a growing number of health situations. The challenges experienced by Italian GPs remained unrevealed. This study aimed at exploring Italian GPs' care experiences and practices associated with critical incidents during the first wave of the pandemic. A qualitative study design involving the critical incident technique through an online survey was applied. Sociodemographic data and open-ended responses were collected. While participants' characteristics were analyzed through descriptive statistics, qualitative data were thematically analyzed employing the framework method. 149 GPs responded to the survey and 99 participants completed the survey (dropout rate = 33%). Eight themes emerged indicating factors related to the organization of the healthcare system and factors related to the clinical management of patients, that were perceived as impacting on the GPs' care provision. The analysis revealed difficulties in communicating with other local services. This, together with the lack of coordination among services, was reported as a major challenge. Primary care was perceived as having been undervalued and criticalities in the organization of GP courses, led in a bureaucratic fashion, posed at risk some trainees to be infected. The digital technologies adopted for remote patient consultations were seen as useful tools for daily practice helping the GPs to stay emotionally connected with their patients. Besides, the improvement in the GP–patient relationship in terms of solidarity between patients and doctors and compliance to rules, had a positive impact. Moreover, many respondents addressed the importance of professional collaboration and teamwork, in terms of both support in practical issues (to find PPE, diagnostics and guidelines) and emotional support. At the same time, the lack of resources (e.g., PPE, swabs) and of specific guidelines and protocols impacted on the care provision. Our findings suggest that GPs in Italy are at risk of being left behind within the epidemic management. Communication and coordination among services are essential and should be substantially improved, and primary care research should be initiated to collect the context-specific evidence necessary to enhance the system's preparedness to public health emergencies and the quality of primary care services.

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“…In researching lived experience, the method is rooted in phenomenology (Fridlund et al, 2017 ) and of multidisciplinary use. In relation to health care, CIT is often used in emergency settings (Benneck & Bremer, 2019 ; Bohström et al, 2017 ; Danielis et al, 2018 ).…”

Section: Methodsmentioning

confidence: 99%

A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

Hjalmarsson

Östlund

Asp

et al. 2022

International Journal of Qualitative Studies on Health and Well

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Purpose This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. Methods An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. Results Experiences related to the main areas of Lifesaving competence and Collaborative care . Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority , which involved safeguarding the person while being directed by the EMS. Conclusions Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.

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Unplanned extubations in an intensive care unit: Findings from a critical incident technique

Cited by 13 publications

References 37 publications

Care for unplanned extubation prevention: analysis of the validity of an instrument’s content

Care for unplanned extubation prevention: analysis of the validity of an instrument’s content

General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study

A matter of participation? A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services

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