Leanne M Aitken

• BHSc(Nurs)Hons, PhD
• Professor at City, University of London

Background Internationally, one in three children develop delirium during their intensive care stay. International guidelines strongly recommend twice‐daily screening for paediatric delirium using validated instruments. In the United Kingdom and Ireland, delirium was assessed only when suspected and few intensive care units (ICUs) used validated in...

Background Every year, sepsis affects almost 50 million people worldwide, and 1/5 affected die. Survivors suffer long-term negative consequences. This presentation provides an overview of a review study on sepsis survivorship examining 4-outcomes. Aim The aim of this study was to explore long term outcomes after recovering from sepsis and septic sh...

Introduction An association between deep sedation and adverse short-term outcomes has been demonstrated although this evidence has been inconsistent. The A2B (alpha-2 agonists for sedation in critical care) sedation trial is designed to determine whether the alpha-2 agonists clonidine and dexmedetomidine, compared with usual care, are clinically an...

Aim The early warning scores (EWS), quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria have been proposed as sepsis screening tools. This review aims to summarise and compare the performance of EWS with the qSOFA and SIRS criteria for predicting sepsis diagnosis and in‐hospital mortality in...

Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence. To establish whether a deficiency in whol...

Introduction Almost all patients receiving mechanical ventilation (MV) in intensive care units (ICUs) require analgesia and sedation. The most widely used sedative drug is propofol, but there is uncertainty whether alpha2-agonists are superior. The alpha 2 agonists for sedation to produce better outcomes from critical illness (A2B) trial aims to de...

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Barts Charity Nurse / Allied Healthcare Professional Clinical Research Fellowship (MRC0229, Improving cognitive health after cardiac surgery) Background Postoperative cognitive dysfunction (POCD) occurs in up to 50% of patients after card...

Introduction: We hypothesized that routine intravenous (IV) thiamine supplementation in intensive care unit (ICU) will reduce delirium occurrence. Thiamine di-phosphate (TDP), the active form of thiamine, is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity; all reported in delirium occurrence [...

Purpose: The purpose of this study was to assist clinicians to identify critically ill patients at greatest risk of acute muscle loss and to analyse the associations between protein intake and exercise on acute muscle loss. Materials and methods: Secondary analysis of a single-centre randomised clinical trial of in-bed cycling using a mixed effe...

Background Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart r...

Aims and objectives: To examine the effectiveness of cognitive interventions after general anaesthesia to improve cognitive functioning. Background: The number of surgical procedures performed worldwide is large and growing. Postoperative cognitive dysfunction is a common complication associated with poor postoperative outcomes. A variety of cog...

Background Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients’ perspective. Aims To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. Methods Electronic d...

Background: Postoperative morbidity places considerable burden on health and resources. Thus, strategies to identify, predict, and reduce postoperative morbidity are needed. Aims: To identify and explore existing preoperative risk assessment tools for morbidity after cardiac surgery. Methods: Electronic databases (including MEDLINE, CINAHL, an...

Clinical pharmacist’s views on the role of alpha-2-agonists in practice and research for the management of agitation, sedation and delirium (ASD).

Objective Improving dementia diagnosis rates are a key feature of dementia strategy and policy worldwide. This study aimed to explore the experience of carers of people diagnosed with dementia during or following a hospital admission in order to identify factors that had prevented them from seeking help beforehand. Semi-structured interviews were c...

Aims: Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others. POCD is a decline in cognitive function from baseline performance measured with neuropsychological tests before and after surgery1. Manifestat...

Evidence on sepsis screening and care in developing nations is insufficient to inform implementation practices in hospital wards. The aim of this multi‐method study was to describe and evaluate the implementation of a three‐step intervention (sepsis screening, alert activation, care) in five wards in Argentina in 2017. The implementation involved t...

Aims Postoperative cognitive dysfunction (POCD) is often experienced by cardiac surgery patients; however, it is not known if some groups of patients experience this more frequently or severely than others. The aim of this systematic review was to identify preoperative and postoperative predictors of cognitive dysfunction in adults following cardia...

Aim There is limited evidence on the diagnostic accuracy of a quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) sepsis screening (SS) tool in developing nation health settings. The aim of this study was to test the diagnostic accuracy of a qSOFA-based SS tool, and the predictive validity of the qSOFA score in hospital ward patients...

Background: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this...

Background Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs. Objectives This systematic review aimed to provide...

Aim We aimed to understand practice nurses’ perceptions about how they engage with parents during consultations concerning the measles, mumps and rubella (MMR) vaccine. Background The incidence of measles is increasing globally. Immunisation is recognised as the most significant intervention to influence global health in modern times, although man...

Objectives: Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment,...

Purpose To determine the effect of depth of sedation on intensive care mortality, duration of mechanical ventilation, and other clinically important outcomes. Methods We searched MEDLINE, Embase, Cochrane Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO from 2000 to 2020. Randomised controlled trial...

Aim: To explore barriers and enablers of recognition and response to signs of patient deterioration by nursing staff in an acute hospital. Design: A theory-driven interview study underpinned by the Theoretical Domains Framework of behaviour change. Methods: Between 07/01/2019 and 18/12/2019 a purposive sample of registered nurses and healthcar...

Background: Patients who have had prolonged stays in intensive care have ongoing rehabilitation needs. This is especially true of COVID-19 ICU patients, who can suffer diverse long-term ill effects. Currently there is no systematic data collection to guide the needs for therapy input for either of these groups nor to inform planning and developmen...

Background: Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation n...

Aims To understand the experiences of nursing students and academic staff of an intervention to decrease burnout and increase retention of early career nurses, in order to identify acceptability and feasibility in a single centre. Background Internationally, retention of nurses is a persistent challenge but there is a dearth of knowledge about the...

Background Failure of clinicians to recognise and respond to patient clinical deterioration is associated with increased hospital mortality. Emergency response teams are implemented throughout hospitals to support direct‐care clinicians in managing patient deterioration, but patient clinical deterioration is often not identified or acted upon by cl...

Aim The aim of this study was to explore which aspects of their role practice nurses perceive to be most influential and the strategies they employ to promote the MMR vaccine. Design Qualitative study employing in depth interviews. Method Fifteen London based practice nurses, nine in 2014 and six in 2018, took part in semi‐structured interviews t...

Purpose The purpose of this study was to examine the current utilisation of altered rapid response calling criteria (ARRCCs) at a tertiary hospital. Methods A retrospective review of all acute care admissions across 17 months was undertaken using the hospital administration system and electronic medical record to identify patients with ARRCCs. In...

Objectives The objectives of this study was to explore the accuracy of the Cornell Assessment for Pediatric Delirium (CAP-D), Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Preschool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU) when implemented in routine care as delirium screening tools, an...

Aim: To improve understanding of afferent limb behaviour in acute hospital ward settings, to define and specify who needs to do what differently and to report what afferent limb behaviours should be targeted in a subsequent multi-phase, theory-based, intervention development process. Design: Focused ethnography was used including direct observat...

Co-production is a process employed to solve complex issues, recognising the expertise of all stakeholders. This paper reports on co-production undertaken by nursing students, early career nurses and researchers as part of a larger study to design an intervention to increase retention of early career nurses. Mixed methods were used to evaluate the...

Objective: The aim of this study was to evaluate the outcomes of implementing a sepsis screening (SS) tool based on the quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and the presence of confirmed/suspected infection. The implementation of the 6-hour (6-h) bundle was also evaluated. Design: Interrupted times series with prosp...

Purpose To examine whether in-bed cycling assists critically ill adults to reduce acute muscle wasting, improve function and improve quality of life following a period of critical illness. Materials and methods A single-centre, two-group, randomised controlled trial with blinded assessment of the primary outcome was conducted in a tertiary ICU. Cr...

Background In-bed cycling is a promising intervention that may assist critically ill patients to maintain muscle mass and improve their trajectory of recovery. The acceptability of in-bed cycling from the different perspectives of patients, clinicians, and families are unknown. In addition, the safety and feasibility of in-bed cycling in an Austral...

Objective To identify barriers and facilitators to help seeking for a dementia diagnosis from the perspective of carers and people with dementia. Design A systematic review of the literature was conducted according to the PRISMA guidelines (PROSPERO protocol registration CRD42018092524). Nine electronic databases were searched for qualitative, qua...

Background Interventions to support psychological recovery after critical illness, including information provision via an intensive care unit (ICU) diary or discharge summary, have been widely adopted in some regions, albeit without strong empirical evidence. Objective The objective of this study was to examine the feasibility and acceptability, f...

Purpose A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilis...

Background Evidence about the effectiveness of electronic health records in improving nursing workload efficiency is uncertain. Aim To measure, compare and describe nurse time spent on patient care prior to, and following implementation of an integrated electronic health record roll-out using a standardised approach. Design Structured, continuous...

Objectives: To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment. Research design: A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observa...

Background: To optimise care of deteriorating patients, healthcare organisations have implemented Rapid Response Systems including an 'afferent' and 'efferent' limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour, and reduce adverse patient outcomes, the National Early Warning Sco...

Objectives This study aims to (i) describe the time to exercise commencement (sitting and upright activities) relative to ICU admission and relative to achievement of initial neurological, respiratory and cardiovascular stability; (ii) examine factors associated with whether sitting and upright activities occurred in ICU; and (iii) examine factors...

Aim To develop a theory‐based complex intervention (targeting nursing staff), to enhance enablers and overcome barriers to enacting expected behaviour when monitoring patients and responding to abnormal vital signs that signal deterioration. Design A mixed method design including structured observations on hospital wards, field notes, brief, un‐re...

Background: Nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective: T...

Introduction Young People (YP) aged 13–18 years admitted to Paediatric Intensive Care (PICU), experience physical and psychological challenges during their recovery. YP likely have different experiences than children or adults (Manning et al, 2017). Anxiety as a characteristic of illness recovery is largely under-reported, as are the experiences of...

Background: The sedation needs of critically ill patients have been recognized as a core component of critical care that is vital to assist recovery and ensure humane treatment. Evidence suggests that sedation requirements are not always optimally managed. Suboptimal sedation, both under- and over-sedation, have been linked to short-term (e.g. len...

Implementation results of in-bed cycling including: Time to commence in-bed cycling from ICU admission (2.3 days), Successful implementation of planned sessions (90.8%), Barriers (patient fatigue primary barrier) and Facilitators (early in the day session commencement), Safety (0.7% minor adverse events), Session duration and distance cycled a...

ABSTRACT Aim: To ascertain the beliefs and perceptions of practice nurses’ influence about the uptake of the Measles, Mumps and Rubella vaccine. Background: Immunisation decision making for parents is a complex process. Principle health professionals involved in immunisation programmes are health visitors, general practitioners and practice nurses...

Objectives: Interruptions occur frequently in the intensive care unit (ICU) and are associated with errors. To date, no causal connection has been established between interruptions and errors in healthcare. It is important to know whether interruptions directly cause errors before implementing interventions designed to reduce interruptions in ICUs...

The aim of this multiphase mixed-method study was to improve access, flow, and consistency of information transfer for multitrauma patients leaving the Emergency Department. Methods included literature review, focus group interviews, chart audits, staff surveys, and a review of international trauma forms to inform an intervention developed with a r...

Background: Interruptions during handover may compromise continuity of care and patient safety. Local problem: Interruptions occur frequently during handovers in the intensive care unit. Methods: A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurre...

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief and authors as there was a major error in reporting the results of the "Nurses' attitudes towards obesity and obese patients scale" (NATOOPS). In s...

Introduction: There is widespread use of clinical information systems in intensive care units however, the evidence to support electronic handover is limited. Objectives: The study aim was to assess the barriers and facilitators to use of an electronic minimum dataset for nursing team leader shift-to-shift handover in the intensive care unit pri...

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of int...

Introduction In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. Methods and analysis A single-...

Examinations of interruptions in healthcare often focus on a single clinical discipline, and solutions are targeted accordingly. This approach does not take into account the inter-disciplinary dependencies and other sociotechnical aspects that make up the healthcare work system, and suggested solutions may not meet the needs of all stakeholders. In...

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to ex...

Background: Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported. Objectives: To assess the association between the inciden...

Background: High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adult patients experiencing acute respiratory failure in the intensive care unit (ICU). Objectives: We evaluated studies that included participants 16 years of age...

Introduction: Sepsis is a common condition observed outside critical care areas. The purpose of this review was to examine the application of sepsis screening tools for early recognition of sepsis in general hospitalised patients to: (i) identify the accuracy of these tools; (ii) determine the outcomes associated with their implementation and; (ii...

Duration of bed rest among critically ill patients in ICU has been associated with development of persistent weakness that can last for more than five years. Commencing early exercise interventions in ICU is likely to reduce critically ill patients’ physical dysfunction. However, critically ill patients often experience prolonged periods of bed res...

Background: Despite increasing demand for structured processes to guide clinical handover, nursing handover tools are limited in the intensive care unit. Objectives: The study aim was to identify key items to include in a minimum dataset for intensive care nursing team leader shift-to-shift handover. Methods: This focus group study was conduct...

Background: Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. Method:...

Interruptions are widely considered a problem in healthcare. Results from observation and experimental studies have guided extensive mitigation efforts, but the effectiveness of interventions remains mixed. We have built on current theories and methods for studying interruptions to develop a novel observational approach – the Dual Perspectives Meth...

Purpose: Diaries summarizing intensive care are routine practice in some countries, although evidence to support diary use is limited. The purpose of this study was to identify whether distress post-intensive care influences patients' and relatives' choice as to whether they would like to receive a diary and what information delivery method is pre...

Background: Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. Objective: To identify research traditions that ha...

Introduction: A focus on what is important to patients has been recognized as an essential pillar in care to ensure safe patient care that focuses on outcomes identified as important by patients. Despite this, asking trauma patients and their families what they consider should be the priorities of care and recovery has been neglected. Methods: A...

Aims and objectives: To understand: (1) staff perceptions of best practice for information transfer for multitrauma patients on discharge from the emergency department; (2) what information should be conveyed at transfer and (3) how information is transferred. Background: Information transfer for multitrauma patients is an integral factor for co...

Background: Despite a proliferation of evidence and the development of standardised tools to improve communication at handover, evidence to guide the handover of critical patient information between nursing team leaders in the intensive care unit is limited. Objective: The study aim was to determine the content of information handed over during...

Background: Anxiety is an unpleasant emotion that most intensive care patients experience. This emotion is an important issue in intensive care settings because of its prevalence, adverse effects and severity. Little is known about the factors associated with state and trait anxiety during critical illness. Objectives: To describe the patterns o...

Background: Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. Aim: To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported s...

Background: Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. Objective: To identify which rationales for rehabilitative exercise interventions...

Background: Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. Aim: To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reporte...