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Enhancing Patient Safety in Critical Care Settings

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A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: 20 March 2026 | Viewed by 9099

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Special Issue Editor

Dr. Meropi Mpouzika

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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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Published Papers (7 papers)

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Research

Jump to: Review, Other

12 pages, 525 KB

Open AccessArticle

Frequency, Grades of Toxicity, and Predictors of Hepatotoxicity and Acute Kidney Injury with Remdesivir in COVID-19 Patients: A Multicenter Retrospective Cohort Study

by Yazed Saleh Alsowaida, Shuroug A. Alowais, Dalal Alsowaida, Alia Alshammari, Bader Alshoumr, Kareemah Alshurtan, Mohammed Almunef, Thamer A. Almangour, Omar A. Alshaya and Khalid Bin Saleh

Healthcare 2025, 13(17), 2143; https://doi.org/10.3390/healthcare13172143 - 28 Aug 2025

Viewed by 409

Abstract

Background: Remdesivir is associated with hepatotoxicity and acute kidney injury (AKI). The objective of this study was to assess the hepatotoxicity and AKI with remdesivir. Method: This is a multicenter, retrospective cohort study for adult patients who used remdesivir for COVID-19 from 3/2020 to 10/2021. The study was conducted at Rhode Island Hospital, Rhode Island, United States. Data were analyzed with descriptive statistics as well as logistic regression analysis using STATA 18. Results: A total of 1635 patients were evaluated for hepatotoxicity: 337 developed hepatotoxicity, and 1298 had normal hepatic function. The overall median frequency of hepatotoxicity occurred in 319 patients (19.5%). Patient age (OR 1.02, 95% CI: 1–1.04, p = 0.02) and selective serotonin reuptake inhibitors (SSRIs) use (OR 1.7, 95% CI: 1.1–2.6, p = 0.01) were potential risk factors for remdesivir-associated hepatotoxicity. In contrast, being male gender was protective against remdesivir-associated hepatotoxicity (OR 0.63, 95% CI: 0.47–0.87, p = 0.02). The frequency of AKI with remdesivir occurred in 280 patients (17.3%). Conclusions: The frequency of hepatotoxicity was 19.5%, and the frequency of AKI was 17.3%. Increasing age and using SSRIs were risk factors for remdesivir-associated hepatotoxicity, while male gender was a protective factor. Clinicians should vigilantly monitor hepatic and renal functions for patients using remdesivir, especially in elderly patients. Full article

(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)

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13 pages, 251 KB

Open AccessArticle

Enhancing Patient Safety Through Predictors of Job Performance in Greek Critical Care Nurses

by Thalia Bellali, George Panayiotou, Polyxeni Liamopoulou, Theodora Mantziou, Evgenia Minasidou and Georgios Manomenidis

Healthcare 2025, 13(14), 1636; https://doi.org/10.3390/healthcare13141636 - 8 Jul 2025

Viewed by 505

Abstract

Background/Objectives: Job performance among critical care nurses is a pivotal determinant of patient safety. While individual psychosocial factors such as self-care and self-compassion have been separately linked to professional efficacy, limited research has examined their integrated contribution to job performance in high-stakes healthcare environments. Methods: A cross-sectional study was conducted in five public hospitals in Northern Greece. A convenience sample of 311 critical care nurses and nurse assistants completed validated self-report measures assessing self-care, self-compassion, mindfulness, physical activity, secondary traumatic stress, and job performance. The data were analyzed using non-parametric statistics and multivariate linear regression. Results: Higher levels of self-care (p = 0.003) and self-compassion (p = 0.042), and lower levels of secondary traumatic stress (p = 0.04), were significantly associated with better job performance. The final regression model explained 31% of the variance in performance scores (R² = 0.31). Mindfulness and physical activity were not significantly associated with job performance. Secondary traumatic stress emerged as the strongest negative predictor. Conclusions: Internal psychosocial resources, particularly self-care and self-compassion, significantly contribute to job performance among critical care nursing personnel. These findings underscore the relevance of embedding staff well-being strategies into organizational patient safety agendas. This multidimensional model provides a novel framework for developing targeted interventions in high-acuity healthcare settings. Full article

(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)

11 pages, 1138 KB

Open AccessArticle

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

Viewed by 1585

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 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 KB

Open AccessArticle

“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 2131

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. 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

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31 pages, 513 KB

Open AccessReview

Psychosocial Support Interventions for Adult Critically Ill Patients During the Acute Phase of Their ICU Stay: A Scoping Review

by Usha Pant, Krooti Vyas and Elizabeth Papathanassoglou

Healthcare 2025, 13(17), 2182; https://doi.org/10.3390/healthcare13172182 - 1 Sep 2025

Viewed by 562

Abstract

Background: Addressing Intensive Care Unit (ICU) patients’ psychological well-being is crucial, yet psychosocial support interventions that can facilitate effective coping, ultimately decreasing stress-related physiological, mental health, and cognitive sequelae, are not currently included in clinical practice guidelines and standards. Objective: To identify and synthesize research evidence on psychosocial support interventions in the ICU, including types of outcomes and measures of effectiveness, and to explore research gaps and barriers to implementation. Method: The review was directed by a protocol based on current guidance for scoping reviews. The quality of studies was assessed using the National Institute for Health and Clinical Excellence. The review focused on articles containing evaluations of psychosocial interventions through an experimental or quasi-experimental design or pretest-posttest comparisons. Databases searched included Medline, CINAHL, PubMed, PsychInfo, and the Cochrane Library. Results: Ten highly heterogeneous studies were identified, encompassing diverse interventions (e.g., relaxation, psychotherapy, spirituality, and positive suggestions) and patient populations. Across the 10 studies, no intervention type was replicated, and most samples were small and quasi-experimental, limiting internal validity and preventing quantitative synthesis. Despite these limitations, the evidence reviewed supports that various psychosocial interventions, including positive suggestions (constructive, reassuring thoughts), relaxation techniques, psychotherapy (emotional, behavioral guidance), and spiritual and/or religious support can alleviate psychological sequelae, such as depression, anxiety, and Post Traumatic Stress in ICU patients. Conclusions: This review highlights the positive impact of psychosocial interventions on alleviating psychological distress in ICU patients. However, a critical gap exists in understanding their effects on other clinical and physiological outcomes, necessitating comprehensive research. Full article

(This article belongs to the Special Issue Enhancing Patient Safety in Critical Care Settings)

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14 pages, 1344 KB

Open AccessReview

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

Cited by 2 | Viewed by 2068

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: 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 KB

Open AccessSystematic 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

Cited by 1 | Viewed by 730

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 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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