2025 National Teaching Institute Research Abstracts Free

Chie Hatozaki, Nobutake Shimojo, Yoshiaki Inoue, Gen Inoue, Takahiro Hiki, Hisao Nakajima, Yuki Enomoto; University of Tsukuba Hospital, Tsukuba City, Japan

Frailty in critically ill patients is associated with outcomes such as intensive care unit (ICU) length of stay and death. Consequently, routine frailty screening of ICU patients has been suggested. However, few facilities conduct frailty screening as part of routine care, and the relationship between frailty and outcomes in critically ill patients remains unclear.

We conducted a retrospective observational study of patients admitted to the ICU between April 2023 and March 2024. Frailty was classified using the Clinical Frailty Scale (CFS), with patients categorized as nonfrail (CFS score 1-4) or frail (CFS score 5-8). The primary outcome was the difference in the in-hospital mortality rate between groups. The association between frailty and death was assessed by logistic regression analysis, adjusting for age, sex, Sequential Organ Failure Assessment (SOFA) score, and type of hospitalization.

Data on 483 patients were included in the analysis. The median age was 69 (IQR, 53-76) years, the median SOFA score was 7 (IQR, 4-10), and 317 participants (66%) were male. A total of 141 patients (29.2%) were evaluated as frail at ICU admission. The in-hospital mortality rate was significantly higher in the frail group than in the nonfrail group (23.4% vs 8.2%; P < .001). After adjustment for covariates, frailty was associated with increased in-hospital mortality rate (adjusted odds ratio, 2.01 [95% CI, 1.02-4.00]; P = .04).

In this study, 29.2% of patients were classified as frail at ICU admission, and frailty was significantly associated with an increased rate of in-hospital mortality. These findings are consistent with those of previous studies. Identifying frailty before ICU admission may support better decision-making, including treatment plan and goal of care.

Frailty was present in 29.2% of patients at ICU admission and was associated with increased in-hospital mortality rate.

Joao Silva, Kelly Brown, Anna Mall, Bradi Granger; Duke University Health System, Durham, NC

Femoral vascular catheters (FVCs) used for dialysis pose a barrier to patient mobility in the intensive care unit (ICU). In a pilot study, the Evaluating Early Mobility in Patients With Temporary Femoral Venous Dialysis Catheters (EARLY-WALCS) protocol (ie, site assessment, liberation from dialysis, and mobility with restricted hip flexion [≤45°]) provided a safe approach to mobilize patients with FVCs. This project explored sustainability of the protocol.

A prospective, single-cohort design was used to evaluate the 12-month sustainability of the EARLY-WALCS mobility protocol for patients with FVCs in a 24-bed adult cardiac ICU. A Wilcoxon signed-rank test was used to analyze differences in frequency and type of adverse events. Differences in ICU and hospital length of stay and discharge disposition between those who were mobilized versus those who were not were analyzed using an independent samples t test.

Among patients with FVCs (n = 77), 36 were eligible for mobility. The majority were men (n = 43; 55.8%) and White (n = 35; 46%); their mean age was 63.3 (SD 14.8) years. Adverse events did not differ between those who were mobilized versus those who were not (for bleeding, P > .99; for central catheter–associated bloodstream infection, P = .32; for dislodgment, P = .32). Mobilized and nonmobilized patients did not differ in ICU (P = .18) or hospital (P = .86) length of stay. Patients who mobilized were more likely to be discharged to home versus skilled nursing or rehabilitation (P = .001).

Mobilization of patients with FVCs receiving dialysis in the ICU was safe and sustainable at 1 year after implementation of a mobility protocol. No increase in adverse events was observed and length of stay was not affected by incorporation of the protocol as standard practice.

These results provide further evidence for the safety and efficacy of early mobilization of patients with FVCs. In addition, our findings suggest that patients who are mobilized are more likely to be discharged to home, potentially saving costs for both patients and health care systems.

Mallory A. Perry-Eaddy, Timothy Moore, Heidi Flori, Nadine Halligan, Martha A. Q. Curley, Scott Weiss, Mary K. Dahmer; University of Connecticut, Storrs, CT

Up to 23% of critically ill children with acute respiratory failure (ARF) requiring mechanical ventilation (MV) will be discharged with new or worsening functional morbidity. Elevated inflammation during acute illness may contribute. We explore the potential role of inflammation in functional morbidity after pediatric intensive care unit (PICU) discharge.

Phase I of the Pediatric Recovery After Sepsis Treatment in the Pediatric Intensive Care Unit (Persist-PICU; National Institute of General Medical Sciences grant R00GM145411) study is a secondary analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial and the ancillary biomarker study, Genetic Variation and Biomarkers in Children with Acute Lung Injury (BALI). Persist-PICU includes children aged 2 weeks to 17 years who have ARF requiring MV and who have survived at least 6 months after PICU discharge (N = 207). Analyses included data on 12 inflammatory biomarkers obtained during each child’s critical illness and 6-month functional follow-up data. Our primary outcome is new functional morbidity, defined as any change in the Pediatric Overall Performance Category (ΔPOPC).

Six months after being in the PICU, 15% of patients had a ΔPOPC. Increased (median [IQR]) Pediatric Risk of Mortality illness severity scores (10 [5-18] vs 8 [3-12]; P = .04), MV days (8 [6-15] vs 6 [4-10]; P = .004), opioid days (15 [18-28] vs 9 [5-19]; P = .01), and sedative polypharmacy (3 [3-4] vs 3 [2-4]; P = .02) were associated with ΔPOPC. Interleukin-6 (IL-6), receptor for advanced glycation end products (RAGE), and IL-8 were associated with ΔPOPC. Models with IL-6, RAGE, IL-8, and thrombomodulin improved fit, but no single biomarker was associated with ΔPOPC.

Functional morbidity is common in children with ARF requiring MV. Modifiable PICU factors, such as number of MV days, extended opioid use, and sedative polypharmacy, may increase a child’s risk for poor outcomes. Inflammatory biomarkers may also be associated with new morbidity and may present new prognostic and/or therapeutic targets.

Critically ill children are at increased risk of new functional morbidity after time in the PICU. Attention to risk factors, including inflammatory biomarkers, during the acute phase of illness may provide clinicians and families needed anticipatory guidance to optimize recovery after being in the PICU.

Adrianna Watson, Jeanette Drake; Brigham Young University, Provo, UT

This study explores student experiences of a critical care bootcamp, repeated skill demonstrations, and peer-reviewed practice and the effects of those interventions on the confidence levels of senior undergraduate nursing students (N = 113) in their critical care semester.

A pretest-posttest study of mixed-methods design was used in this study of senior nursing students participating in their critical care semester. Students participated in several active learning techniques in a nursing laboratory for critical care skill mastery. Data were analyzed using proportional odds logistic regression and thematic analysis.

Quantitative analysis demonstrated a statistically significant increase in student confidence levels in performing skills. Qualitative analysis identified key themes of (1) who critical care nurses are, (2) how critical care skills are performed, and (3) why critical care skill mastery is imperative in practice.

These techniques can be valuable tools for improving current and future nurses’ confidence and mastery of critical care skills. Academic and clinical nurse educators may use these strategies to enhance skill performance.

Active learning strategies can enhance nursing confidence in performing key critical care skills. These methods may contribute to better patient outcomes and increased mastery of critical care skills.

Kayla Witthoeft; Prisma Health Upstate, Prisma Health Oconee Memorial Hospital, Seneca, SC

Perioperative hypothermia (PH) occurs in 50% to 90% of surgical patients and triples the risk of surgical site infections and morbid myocardial events. The purpose of this institutional review board–approved study was to examine the effects that prewarming has on postoperative temperatures and shivering for patients undergoing elective robotic abdominal surgery.

A total of 50 patients undergoing elective robotic abdominal surgery were randomly assigned to either a study group, in which patients were prewarmed with a forced-air warmer (FAW) for 30 minutes, or a control group that was not prewarmed. All received FAW for the duration of their surgery. Oral temperatures were obtained upon arrival at the postanesthesia care unit (PACU) and shivering was assessed during the patients’ PACU stay, using the bedside shivering assessment score. The PACU nurses were not made aware of patients’ prewarming status.

Both groups had a decrease in temperature; however, the mean temperature loss was 1.13 °F (0.63 °C) in the control group and 0.57°F (0.32 °C) in the study group (P = .03). Shivering was noted in 7 patients in the control group and only 2 patients in the study group. A mean shivering score of 0.52 was assessed in the control group and 0.08 in the study group (P = .02). Additionally, 8 patients in the control group and 4 in the study group had a body temperature less than 96.8°F (36.0°C).

This study adds to the body of knowledge on the importance of prewarming surgical patients. The literature supports that normothermic patients will have less blood loss and are less likely to develop surgical site infections, morbid myocardial events, pressure injuries, electrolyte imbalances, emergence delirium, and impaired drug metabolism.

Patients should be prewarmed before they undergo robotic abdominal surgery to mitigate the risk of perioperative hypothermia and shivering; prewarming will lead to an overall reduction in surgical complications and improved outcomes.

Cynthia Bautista, Mary Guanci, Lorin Daniels, Lori Rhudy, Marianne Vyas; Fairfield University, Fairfield, CT

Critical care (CC) neuroscience nursing is a specialized field requiring a complex knowledge base and unique clinical orientation. CC neuroscience orientations are often hospital-based and regionally specific. We aimed to obtain expert consensus on the essential components of a CC neuroscience nursing orientation.

A Delphi method was used to collect expert consensus on CC neuroscience nursing orientation components. After university ethics approval was obtained, electronic surveys were distributed to 161 neuroscience CC orientation experts in 2 Delphi rounds. Participant demographic data and a Likert rating scale (score range, 1-5) of literature-based components of a CC neuroscience orientation were collected. Consensus results were analyzed.

The survey response rates were 23.6% for round 1 and 14.2% for round 2. The round 1 survey included 47 elements, 36 of which met the a priori threshold of at least a 75% consensus of being important or very important. Two additional elements resulted from write-in recommendations. In round 2, 38 elements were included in the survey, and 37 of these elements met consensus. Expert consensus on the essential components of a CC neuroscience orientation included 37 elements divided among 5 major components.

The practical implication of a CC neuroscience nursing orientation is to provide a guide to help standardize neuroscience specialty orientation. Nurse educators can develop orientation resources that support nurses new to neuroscience CC. Improved orientation could lead to enhanced nurse retention and solidify evidence-based practice.

CC neuroscience nursing orientation experts achieved consensus on the essential components of an adult CC neuroscience orientation. Five components and 37 elements achieved expert consensus as important in an initial 12- to 18-week adult CC neuroscience nursing orientation program.

Connie Clauson, Kathleen Tolland, DeWayne Pursley, Yarden Fraiman; Beth Israel Deaconess Medical Center, Boston, MA

There are notable racial and ethnic inequities in neonatal outcomes and family experience within and among institutions. These inequities are not accounted for only by quality of care. Potential mechanisms include racism and bias. Education leads to cultural change. A review of available curricula demonstrated a lack of focus on neonatal intensive care unit (NICU) populations.

We developed an educational class that included the history of race, the social construct of race, levels of racism, types of bias, review of published neonatal inequity data, and upstander training. Instructional approaches included lecture, group participation, videos, and personal vignettes. The class was mandatory for all patient-facing staff in a 62-bed, level III, urban NICU. Effectiveness was evaluated by conducting in-person before- and after-class surveys and an online follow-up survey at 3 months

Since July 2023, 169 individuals from 7 disciplines have participated. After the class, there was improvement in knowledge of types of bias (from 46% to 99%) and inequities (from 50% to 98%). Learners agreed or strongly agreed the class was educational, engaging, and will change patient care (99%, 99%, and 88%, respectively). At 3 months, most respondents (n = 59) agreed or strongly agreed that their patient care had changed (69%), they had tools to address bias (91%), and they felt comfortable using those tools (90%).

A new education module was created to address lack of knowledge of the impact of bias and racism on neonatal health inequities and skills to combat it. The module provided foundational knowledge of race, racism, bias, and health inequities, plus upstander training to respond. The module had a significant short- and long-term impact on knowledge and behaviors.

A 1-hour interactive class led to significant improvement in knowledge and behaviors in terms of racism, bias, and upstander behaviors.

Rose LaPlante, Kathy Ahern Gould; Brigham & Women’s Faulkner Hospital, Boston, MA

Working in health care is stressful. Negative impacts on nurse wellness threaten a sustainable workforce. The National Academy of Medicine and authors of multiple recent studies challenge organizations to measure nurse wellness. In response, in this study, we measured key concepts of wellness in critical care nurses.

This observational study was open to all registered nurses attending the 2024 American Association of Critical-Care Nurses National Teaching Institute Conference. This institutional review board–approved study used brief versions of instruments to measure 4 wellness concepts: professional fulfillment, burnout, psychological safety, and resilience. Both univariate and multivariate statistical procedures were used to analyze data.

Findings from the sample of 218 nurses revealed high levels of resilience, moderate levels of professional fulfilment and psychological safety, and low burnout. Significant correlations were observed between all variables, with an expected negative correlation to burnout. A multivariate logistic regression model indicated that nurses with higher levels of professional fulfillment and psychological safety were less likely to experience burnout.

This national sample, collected as an expansion of a single-site pilot study at a community hospital, provides additional data to explore the feasibility of using brief versions of valid and reliable instruments to measure wellness. Nurses with higher scores of professional fulfillment and psychological safety had lower levels of burnout.

This national sample provides a more comprehensive view of nurse wellness and may inform nurse leaders when developing innovative and targeted strategies to promote professional fulfillment and psychological safety to improve nurse wellness and to address the current nursing workforce crisis.

Carmen Petersen, Martha Morales, Natalie Bermudez; Baptist Health South Florida, Miami, FL

Family-witnessed resuscitation (FWR) and the presence of a family support person (FSP) are well-studied evidence-based practices with positive outcomes for family members. There is little evidence on nurses’ perceptions of the FSP. The aim of this qualitative study was to explore intensive care nurses’ perceptions of FSP presence during FWR.

Data were collected via 1-to-1 interviews between April 2023 and January 2024. Data saturation was achieved after 7 interviews. Recorded interviews were transcribed. Data were analyzed using Braun and Clarke’s thematic analysis approach. Between February 2024 and May 2024, 3 researchers reviewed and coded transcripts separately and met several times to discuss and agree on emerging codes and themes. After mutual agreement, the researchers finalized the names of the themes and subthemes.

Two themes, each with 3 subthemes, emerged from the data. The first theme was disparate perspectives of FWR; its subthemes were approval (beneficial), conditional approval or disapproval, and rationalized or unrationalized disapproval. The second subtheme was perceptions of the FSP; its subthemes were clinical relief, communicator-translator-comforter, and misconstrued disapproval.

The results of this study showed that positive perspectives and experiences with FWR influence nurses’ views and attitudes about FWR. The most illuminating result was nurses’ misperceptions of the FSP role, highlighting the need for clarification. As such, nurses’ negative FWR perceptions related to FSP misperceptions may contribute to FWR rejection.

Based on the results, we recommend nurse leaders develop and implement strategies to increase nurses’ awareness and knowledge related to the FSP role during FWR. Future studies exploring the impact of the influence of clear and positive perspectives of the FSP on FWR acceptance are also recommended.

Karen Giuliano, Nancy Richards; University of Massachusetts, Amherst, MA

Left ventricular assist devices (LVADs) are used as a bridge to transplant or to support patients who are not candidates for transplantation. LVADs require external power using a percutaneous lead (the driveline), creating a chronic wound site. With no gold standard for driveline exit-site care, there is a need for data to support clinical practice.

The standard of care for driveline infection prevention in our program is for the patient to shower and have the driveline dressing changed every 3 days. We conducted a retrospective review of the routinely collected LVAD driveline infection rate data for late driveline infection (L-DLI). From January 1, 2016, to October 31, 2018, chlorhexidine gluconate (CHG) dressings were used. From November 1, 2018, to December 31, 2023, antimicrobial silver–plated dressings were used. There were no other changes in the standard for driveline care.

Quarterly L-DLI rates (no. of infections per 100 patient-months) with each of these different dressing types were compared. With CHG dressings, the mean quarterly L-DLI rate was 2.02 versus 0.88 for the antimicrobial silver–plated dressings. This represents a 40.1% reduction in the quarterly L-DLI rate. Although data on duration of therapy would be helpful for additional interpretation of the findings, such data were not available for these analyses.

In this study, antimicrobial silver–plated dressings resulted in a lower L-DLI rate. Given that the data collection time was much longer for the antimicrobial silver–plated dressings, this sample most likely represents a longer mean duration of therapy, which would further accentuate the difference.

Although more data are needed to improve interpretation, this study’s findings provide support for the current International Consortium of Circulatory Assist Clinicians recommendations for antimicrobial silver–plated dressings as best practice. These findings also provide a foundation to inform future research.

Disclosure: Karen Giuliano—Recovery Force, health consultant; Bravida Medical, consultant; Stryker Medical, research support; GE Medical, research support.

Stephen Breazeale, Deborah Stein, Katherine Frey, Nathan O’Hara, Elliott Haut, Renan Castillo; Baptist Health South Florida, Miami, FL

A recent trial suggests aspirin is a practical alternative to enoxaparin for venous thromboembolism (VTE) prophylaxis in orthopedic trauma survivors. The impact of these findings on VTE prophylaxis prescribing is unknown. We evaluated VTE prophylaxis–prescribing patterns among clinicians who treat patients after orthopedic trauma.

We recruited clinicians who prescribe VTE prophylaxis to orthopedic trauma survivors in 40 states. Clinicians were shown 7 clinical vignettes describing hypothetical orthopedic trauma survivors, including information on fracture type, treatment, VTE risk factors, additional injuries, and health insurance status. We assessed VTE prophylaxis medications prescribed in-hospital and at discharge, patient factors associated with prescribing preferences, and practice variation by specialty and provider training.

The median age of the 287 respondents was 43 (interquartile range, 38-50) years, and 154 were male (weighted average, 63%). Enoxaparin was prescribed in 83% of the presented in-hospital scenarios; aspirin was prescribed in 13% (P < .001). Aspirin was prescribed more frequently at discharge than was enoxaparin (50% vs 41%; P < .001). Clinicians with an aspirin discharge preference were 12% more likely to switch to enoxaparin if additional VTE risk factors were present (95% CI, 4-19; P = .005).

We found that despite new evidence, clinicians’ in-hospital VTE prophylaxis prescribing patterns remain unchanged, highlighting the delay between knowledge generation and clinical practice changes. Such reluctance may negatively affect outcomes, because aspirin is easier to administer and less costly; however, more work is needed to evaluate this potential.

Despite new evidence, in-hospital VTE prophylaxis prescribing practices for orthopedic trauma survivors remain unchanged from a decade ago. Clinicians have significantly increased their preference for aspirin for thromboprophylaxis at discharge, unless the patient has additional risk factors.

Disclosures: Deborah Stein—Commonwealth Serum Laboratories-Behringwerke, paid consultant, Data Safety Monitoring Board chair; Nathan O’Hara— stock options with Arbutus Medical Inc.