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Healthcare
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Enhancing Patient Safety in Critical Care Settings
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Enhancing Patient Safety in Critical Care Settings

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Critical Care".

Deadline for manuscript submissions: 20 March 2026 | Viewed by 3256

Special Issue Editor

Dr. Meropi Mpouzika

E-Mail Website
Guest Editor
Department of Nursing, Cyprus University of Technology, 3041 Limassol, Cyprus
Interests: biomarkers; pain; critically ill patient care and outcomes; psychological distress; stress

Special Issue Information

Dear Colleagues,

Critical care settings, including all types of adult intensive care units (ICUs) and the emergency department (ED), are essential for providing comprehensive care to patients with severe, life-threatening conditions. Despite advancements in medical technology and treatment protocols, patient safety in these settings remains a paramount concern due to the complexity of care and the vulnerability of critically ill patients. Ensuring patient safety in critical care hinges on evidence-based practices, advanced monitoring technologies, and effective multidisciplinary teamwork. Nursing care is pivotal, as nurses are often the first to detect changes in patient conditions and intervene. Implementing rigorous protocols and continuous training for staff further enhances the precision and effectiveness of care. Additionally, addressing the psychological distress of both patients and healthcare providers is crucial for maintaining a safe and supportive environment. Subsequently, interventions enhancing the resilience of patients and clinicians are also important. Enhancing patient safety in critical care settings can improve patient outcomes, reduce healthcare costs, and elevate overall healthcare quality. 

We are pleased to invite you to this Special Issue, which aims to gather cutting-edge research and expert insights dedicated to advancing patient safety in critical care. Original research articles, reviews, case reports, and short communications exploring innovative strategies, successful implementations, and future directions for ensuring the highest standards of patient safety in critical care settings are welcome. Research areas may include, but are not limited to, evidence-based management protocols, clinical decision-making, interprofessional collaboration, prevention strategies, psychological well-being and resilience, simulation, and training.

I look forward to receiving your contributions. 

Dr. Meropi Mpouzika
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • clinical guidelines
  • critical care
  • delirium
  • emergency department
  • error prevention
  • ICU
  • pain
  • patient safety
  • psychological support
  • stress management/resilience

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Research

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11 pages, 1138 KiB  
Article
Early Mobilization of Critically Ill Patients: A Survey of Knowledge, Practices and Perceptions of Greek Physiotherapists
by Elpida Papadimitriou, Stavros Petras, Georgios Mitsiou, Ioannis Vasileiadis, Eirini Grammatopoulou and Irini Patsaki
Healthcare 2025, 13(11), 1248; https://doi.org/10.3390/healthcare13111248 - 26 May 2025
Abstract
Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted [...] Read more.
Background/Objective: Early mobilization (EM) of critically ill patients is a feasible and safe intervention that limits the implications of bed rest and improves lung function. However, its limited implementation suggests a gap between the research evidence and clinical practice. It is widely accepted that early mobilization faces a variety of barriers. This study aimed to investigate the perceptions of Greek physiotherapists on EM barriers and record their knowledge and practices. Methods: We conducted an electronic survey using the online platform “Microsoft Forms”, among critical care physiotherapists in 66 hospitals that had an Intensive Care Unit (ICU) department in Greece in 2024. We administered a questionnaire, developed based on valid and reliable international questionnaires, with the following domains: education and knowledge on early mobilization, practices, perception regarding EM, and perceived barriers to early mobilization. Results: A total of 126 Greek physical therapists participated. The majority of them worked in urban area hospitals and in a rotation schedule around all departments. Most physical therapists stated that early mobilization is a priority for the patient’s rehabilitation and an important factor in preventing the complications of bed rest. Yet, they do not use specific protocols. Most had knowledge of what EM involved and the international guidelines. The most common barriers reported were the hemodynamic instability and the incoherence with the ventilator. Dedicated physiotherapists singled out certain barriers like the presence of delirium and the lack of communication among ICU staff. Additionally, physiotherapists with more years of experience did not acknowledge tubes, connections, femoral lines and Body Mass Index (BMI) as barriers. Conclusions: Most Greek physiotherapists believe that early mobilization is crucial for the rehabilitation of critically ill patients. A significant percentage know the guidelines, yet they do not follow a specific protocol. Various barriers prevent its implementation, which depends on the patients, healthcare providers, and the overall process. Yet, It is recognized that practices and perceived barriers are influenced by experience and work schedule. Establishing clinical protocols is essential to facilitate the implementation of early mobilization and support patient rehabilitation. Future efforts should focus on designing strategies and EM protocols for physiotherapy in Greek ICUs. Also, we need to monitor changes in perceived barriers across other countries as focus on the matter via published studies and clinical seminars could lead to significant changes. Full article
(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)
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22 pages, 284 KiB  
Article
“Divergent Needs and the Empathy Gap”: Exploring the Experience of Workplace Violence Against Nurses Employed in the Emergency Department
by Christina Koutsofta, Maria Dimitriadou and Maria Karanikola
Healthcare 2025, 13(10), 1118; https://doi.org/10.3390/healthcare13101118 - 11 May 2025
Viewed by 852
Abstract
Background/Objectives: Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses’ professional attitudes, their work life and related implications to patient safety issues may be valuable. [...] Read more.
Background/Objectives: Violence in healthcare settings, especially in emergency departments (ED), remains an important public health issue worldwide. Thus, additional insight into the effect of these incidents into nurses’ professional attitudes, their work life and related implications to patient safety issues may be valuable. We investigated ED nurses’ living experience of exposure to workplace violence by healthcare service users, with focus on the impact on them. Methods: Following a qualitative study design, data were collected (January–June 2024) through semi-structured interviews with open-ended questions and were analyzed according to an inductive, content analysis approach. Participants provided informed consent, and data collection continued until theoretical saturation was reached. Results: The sample included six nurses. Various forms of workplace violence and its psychological, social, and professional consequences were identified. Violence was more frequently perpetrated by patients’ relatives, with verbal aggression being the most common form. A fundamental divergence in needs and expectation between patients and their family members/caregivers, on one side, and participants, on the other, revealed a pronounced empathy gap. Each group remained focused on its own priorities while struggling to recognize or accommodate others’ perspectives. This lack of mutual understanding contributed to tension that, in some cases, escalated even into physically violent incidents against the participants. A similar gap was identified between the participants’ needs and administrators’ attitudes and related policies. The failure of administrative measures to bridge this gap was described as a crucial factor in further escalating conflicts and tension in the ED. Conclusions: Further research on quality improvement projects, including all stakeholders, aiming to enhance empathy in all parties involved is proposed. Full article
(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)

Review

Jump to: Research, Other

14 pages, 1344 KiB  
Review
The Long-Term Impact of Resilience-Building Interventions on Nurses: A Narrative Review of the Quantitative Evidence and Its Implications for Critical Care Nurses
by Maria Kyranou and Maria Karanikola
Healthcare 2025, 13(3), 274; https://doi.org/10.3390/healthcare13030274 - 30 Jan 2025
Viewed by 1264
Abstract
Background: To minimize systematic bias, long-term follow-up is essential to assess the effect of resilience-building interventions. However, research focuses on the short-term period immediately following these interventions. Objectives: We investigated the long-term impact of resilience-building interventions on nurses, as measured via RCTs. Methods: [...] Read more.
Background: To minimize systematic bias, long-term follow-up is essential to assess the effect of resilience-building interventions. However, research focuses on the short-term period immediately following these interventions. Objectives: We investigated the long-term impact of resilience-building interventions on nurses, as measured via RCTs. Methods: A narrative review based on a systematic literature search (September–15 November 2024) using the keywords “Resilience/Psychological, Adaptation/Psychological, nurses, randomized controlled trial, follow-up” in the EBSCOhost, MEDLINE, ProQuest, Google Scholar, PubMed, and Scopus databases was applied. Results: A total of 38 studies were identified. Of these, only six encompassed long-term follow-up assessment after resilience-building interventions, also meeting the inclusion criteria for this review. Two of them focused on critical care nurses. Intervention durations ranged from 8 to 12 weeks, with shorter interventions also included (90 min lecture on stress, 3 h sensory awareness class). These data suggest that resilience improvements may become apparent 3 months post intervention, even when no immediate improvement is observed upon program completion, highlighting the importance of timing in the assessment process. Conclusions: These findings provide valuable insights for researchers designing resilience programs in critical care environments. Selecting appropriate assessment tools and conducting measurements at multiple time points may be as crucial as the interventions themselves in determining their effectiveness. This is clinically meaningful since it may inform providers of resilience programs for the time frame during which they need to be applied. Potentially, future research can explore what characteristics these interventions need to have in order to be effective longitudinally. Full article
(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)
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Other

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40 pages, 3203 KiB  
Systematic Review
Disempowered Warriors: Insights on Psychological Responses of ICU Patients Through a Meta-Ethnography
by Elizabeth Kusi-Appiah, Maria Karanikola, Usha Pant, Shaista Meghani, Megan Kennedy and Elizabeth Papathanassoglou
Healthcare 2025, 13(8), 894; https://doi.org/10.3390/healthcare13080894 - 13 Apr 2025
Viewed by 417
Abstract
Objectives: to systematically examine and synthesize qualitative evidence on adult patients’ psychological distress during an intensive care unit stay to inform development of interventions tailored to their needs. Method: We conducted systematic literature searches in CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Dissertations and Theses [...] Read more.
Objectives: to systematically examine and synthesize qualitative evidence on adult patients’ psychological distress during an intensive care unit stay to inform development of interventions tailored to their needs. Method: We conducted systematic literature searches in CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Dissertations and Theses Global, and Google Scholar databases using predefined eligibility criteria. We synthesized primary qualitative research evidence using Noblit and Hare’s meta-ethnographic approach. Reporting was based on the eMERGe framework. The quality of included articles was assessed by the Critical Appraisal Skills Program tool. Findings: We identified 31 primary studies from 19 countries. The studies were of moderate to high quality. Data analysis revealed five themes: “disempowerment”, “altered self-identity” “fighting”, “torment”, and “hostile environment”. One overarching theme, “the disempowered warrior”, captured the perpetual tension between the need to fight for their lives and the need to succumb to the care process. Our synthesis discloses that critically ill patients perceive themselves to be in a battle for their lives; while at the same time they may feel helpless and disempowered. Conclusions: Our review revealed the tension between the need to fight for one’s life and the sense of powerlessness in the intensive care unit environment. Although participants recognize the important role of healthcare workers, they desired more involvement, collaboration, control, empathy, and empowerment in the care process. These findings can inform approaches to empowering critically ill patients and managing their psychological responses. Care standards must include distress assessment and management that maximize patients’ empowerment and emotional safety with the care process. Full article
(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)
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