Nurses' clinical leadership in the intensive care unit: A scoping review

[Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles]

BACKGROUND

In the Federal Republic of Germany, it has been possible for some years to study (intensive) nursing care alongside further training in intensive care and anaesthesia. This results in a nursing skill-grade mix in the intensive care unit (ICU), which nursing management must consider.

OBJECTIVES

The aim is to show the development and implementation of a new nursing management structure in the ICU and also provide an overview of the parallel role development with preliminary results at a university hospital.

MATERIALS AND METHODS

Within a working group of nursing management, a narrative analysis of the current situation was carried out with close involvement of the ICU ward managers and the staff units for nursing development, further education and nursing education. The content was organized into subject areas and a new management model was subsequently developed. The evaluation took place narratively within the context of employee interviews.

RESULTS

The management model in the ICU was divided into the areas of nursing management, nursing education, and nursing science as a management triangle. Nursing management is staffed by at least two people as ward managers and deputies, while the nursing education and science team leaders have equal decision-making powers in terms of shared governance. The respective specialist departments work together within the hospital in networks with other ICUs. Other specialist roles such as primary nurses, advanced practice nurses, heart failure nurses or practical instructors are given specific contact persons in the management team to match their tasks, which was viewed positively.

CONCLUSIONS

The development of nursing practice can be promoted through close co-operation within the management team.

Clinician-perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness

AIM

To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness.

DESIGN

Qualitative descriptive interview study.

METHODS

Secondary analysis of semi-structured telephone interviews (December 2018 - February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model.

RESULTS

We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community-level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator.

CONCLUSION

Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness.

IMPACT

Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness.

REPORTING METHOD

Consolidated criteria for reporting qualitative studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The relationship between role ambiguity and anxiety in intensive care unit nurses: The mediating role of emotional intelligence

BACKGROUND

Role ambiguity is recognized as a significant psychological risk stressor in nursing practice, which undermines the psychological well-being of nurses. Since the well-being of nurses plays a crucial role in ensuring positive patient outcomes, it becomes imperative to identify strategies for improving nurses' psychological well-being.

OBJECTIVES

This study aimed to explore the effects of role ambiguity on anxiety in intensive care unit nurses and the mechanisms mediating emotional intelligence.

METHODS

In April-June 2023, a convenience sampling method was used to collect data from 360 intensive care unit nurses in a total of 7 hospitals in Shaanxi Province, Hunan Province, Beijing, and Jiangsu Province, China. A linear regression model was used to verify the mediating effect.

RESULTS

Role ambiguity was significantly and positively associated with anxiety in ICU nurses (p < 0.01). A mediating mechanism between role ambiguity and anxiety was established for emotional intelligence (p < 0.01).

CONCLUSIONS

Role ambiguity has a significant impact on the mental health of intensive care nurses, and emotional intelligence plays a mediating role in reducing role ambiguity and anxiety in nurses.

IMPLICATIONS FOR CLINICAL PRACTICE

This study highlights that role ambiguity in the intensive care unit setting increases nurses' anxiety, while emotional intelligence alleviates the anxiety associated with role ambiguity. Creating support systems and improving the environment is a top priority for nursing administrators. This includes, but is not limited to, clarifying the roles of nurses, conducting social-emotional training, and developing emotional intelligence to prevent and regulate nurses' anxiety and maintain mental health.

Effectiveness of a self-assessment application in evaluating the care coordination competency of intensive care unit nurses in managing patients on life support: An intervention study

AIM

To examine the effectiveness of the feedback from the Nurses' Care Coordination Competency Scale (NCCCS) application (app) used for self-assessing the care coordination competency of intensive care unit (ICU) nurses in managing patients on life support.

METHODS

A non-randomized open-label study was conducted in Japan from November 2021 to March 2022. Participants were 318 ICU nurses from acute hospitals in Japan. They were divided manually into two groups based on their certification status. The intervention was immediate feedback on the results of the care coordination competency self-assessment through the NCCCS app; the control group performed the NCCCS survey with no feedback. The primary outcome was an increase in the NCCCS score 1 month after the intervention. Mann-Whitney U test was used to compare the scores of the intervention and control groups. Wilcoxon's signed rank sum test was used to compare the scores in the first and second NCCCS surveys.

RESULTS

Forty-one participants were lost to follow-up, leaving 277 participants (intervention = 141, control = 136) for analysis. One month later, NCCCS scores similarly increased in both groups. For nurses with at least 5 years of ICU experience (n = 152), the NCCCS score increased in the intervention group (n = 75) (rising point mean: 4.8, standard deviation [SD]: 9.8) compared with that in the control group (n = 77) (rising point mean: 1.3, SD: 8.3) (p = .048).

CONCLUSIONS

Feedback from the NCCCS app can improve care coordination behavior. However, a certain level of ICU experience may be required to translate feedback into improved behavior.