Critical care nurses' knowledge of arterial pressure monitoring

The knowledge and practice of maintaining the patency of arterial catheters

BACKGROUND

Maintaining the patency of arterial catheters-routinely inserted in critically ill patients in intensive care units (ICUs)-is essential for obtaining physiological measurements and enabling blood sampling.

AIM

This study aims to evaluate current ICU nurse knowledge and practice of maintaining the patency of arterial catheters and explore the factors that influence nurses' knowledge level.

DESIGN

This was a cross-sectional survey conducted in China.

METHODS

This research was conducted in 20 tertiary hospitals in Beijing, China between March and June 2020. The data were collected by electronic questionnaire, which was designed in accordance with the literature and consisted of 28 questions. Descriptive and inferential statistics were used to analyse the data.

RESULTS

A total of 576 completed questionnaires were returned. The mean score of nurses' knowledges was 3.66 ± 1.35, which is a moderate level. There was a statistically significant difference between the mean scores of nurses with different professional titles and work experiences (mean 3.58 vs 4.04/7; mean 3.50 vs 3.58 vs 3.94/7). Considering ICU nurses' practice of maintaining the patency of arterial catheters, 376(65.3%)nurses replaced the pressure transducer as per the manual, and 347 (60.2%) nurses zeroed the pressure transducer once per shift. More than 90% ICU nurses aligned the transducer with the heart surface marker during zeroing procedures. Furthermore, 79.9% of nurses performed fast-flush tests routinely, 459 (85.9%) nurses flushed the arterial catheter routinely, and 80% of nurses evaluated the patency of the arterial catheter every shift.

CONCLUSIONS

This study found that the practices of ICU nurses varied, and their knowledge of how to maintain the patency of arterial catheters was moderate and could be improved. ICU nurses should be trained effectively to develop a unified standard of arterial catheter management.

RELEVANCE TO CLINICAL PRACTICE

Training programmes on arterial catheter management for ICU nurses are essential for improving knowledge and practice.

[Nurses of adult intensive care unit: evaluation about direct and indirect blood pressure measurement]

This is a descriptive and cross-sectional study with the aim to evaluate and self-evaluate the knowledge of nurses from adult Intensive Care Units about direct and indirect blood pressure measurement. Fifty-four nurses from three Intensive Care Units were approached. They answered a self-administered questionnaire with 65 questions (40 related to blood pressure). Nurses had insufficient performance on the test that assessed knowledge (average score 4.6). Half of the sample felt dissatisfied with their knowledge about blood pressure. After answering the questionnaire the subjects self-rated their knowledge as regular (48.2%), bad (27.8%) and poor (9.3%) indicating they are aware of the importance for the subject to practice. The results show the need of urgent implementation of continuing education for this sample, since they are professionals who work directly with a priority vital sign on care to critical patients.

Competence in intensive and critical care nursing: a literature review

This literature review defines and describes the concept of competence in adult intensive care nursing, with special reference to clinical and professional competence. The aim was to see whether and how the studies reviewed defined or described the concept of competence, and which domains of competence have been investigated in intensive and critical care nursing research. The review focuses on empirical studies retrieved from the COCHRANE and MEDLINE (1994-2005) databases. The final analysis comprised 45 studies. The studies were analysed by inductive content analysis. Very few (n=7) of the studies offered any definitions or descriptions of the concept of competence. Clinical and professional competence in intensive and critical care nursing can be defined as a specific knowledge base, skill base, attitude and value base and experience base of intensive and critical care nursing. Clinical competence can be divided into three and professional competence into four constituent domains. In clinical competence, these are the principles of nursing care; clinical guidelines; and nursing interventions. In professional competence, the domains are ethical activity; decision-making; development work; and collaboration. More empirical research is needed to examine competence in intensive and critical care nursing.

The need for nurses to have in service education to provide the best care for clients with chest drains

Chest drains are a widespread intervention for patients admitted to acute respiratory or cardiothoracic surgery care areas. These are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management and identify and to ascertain how nurses keep informed about the developments related to the care of patients with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a selected group of nurses and a paucity of resources. Nurse managers are encouraged to identify educational needs in this area, improve resources and the delivery of in service and web-based education and to encourage nurses to reflect upon their own knowledge deficits through portfolio use and ongoing professional development.

Nurses’ knowledge of chest drain care: an exploratory descriptive survey

Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Chest drains are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses. Several service-led options exist with regard to improving knowledge in this area, such as service study days as well as ward-based tutorials. However, in an era of increasing accountability together with the impetus for each nurse to provide evidence-based care, it is crucial for individual nurse responsibility in the pursuit of knowledge in this area. Nurses must be supported by local practice development and through personal portfolio use to identify gaps in knowledge and seek appropriate training and resources.

Biological and physiological knowledge and skills of graduating Finnish nursing students to practice in intensive care

This study describes the basic biological and physiological knowledge and skills of graduating nurse students in Finland against the requirement of their being able to practice safely and effectively in intensive care. The study describes also their interest and willingness to work in intensive care. Measurements were based on the Basic Knowledge Assessment Tool (BKAT-5) developed by Toth in the United States. The sample consisted of 130 nursing students graduating in December 2001 and January 2002. The data were analysed statistically. The students were most knowledgeable in the areas of appropriate precautions, living will and medical calculation, followed by neurology and endocrinology. Scores were poorest for pulmonary, gastrointestinal and cardiovascular knowledge. Intensive care studies and the desire to work in intensive care correlated significantly with the respondents' basic intensive care knowledge. It is important for nursing education to concentrate on developing those areas of intensive care studies where the performance of students is weakest.

Evaluación de la competencia práctica y de los conocimientos científicos de enfermeras de UCI en la aspiración endotraqueal de secreciones

Tracheal suctioning is essential to maintain permeability of the artificial airway. This procedure may be associated to risks for the patients. Thus, it is very important to know if the nurses perform it correctly and if the practice is based on scientific evidence. This investigations objectives are: evaluate practical competence of the nurses, as well as the scientific knowledge that they have on this procedures in a Polyvalent Intensive Care Unit and analyze if there are discrepancies between the practice competence and scientific knowledge. This descriptive study, performed in 34 nurses, analyzed the performance of tracheal suctioning by direct observation, using the data collection of a structured grid that included 19 aspects to evaluate, grouped into 6 categories. In the same way, knowledge on the procedure was analyzed, using a 19-item self-administered questionnaire, also grouped into 6 categories, which evaluated the same aspects observed. The total mean score obtained in the practice observation grid (P) was 12.09 for a maximum score of 19, while it was 14.24 in the knowledge questionnaire (Q). When analyzed by categories, discrepancies were obtained in the following aspects: in the need for hand washing prior to suctioning (P = 55.9%; Q = 97.1%), in cleaning of the suction catheter after each suctioning during the procedure (P = 0%; Q = 38.2%), in the correct performance of hyperoxygenation and hyperinsuflation, before, during and after the procedure (P = 11.8%; Q = 941%), in the correct selection of the size suction catheter in relationship with endotracheal tubes internal lumen (P = 0%; Q = 52.9%), in the maximum time the catheter remains in the trachea (P = 100%; Q = 23.5%), in the maximum number of times that the catheter should be introduced in each suctioning (P = 100%; Q = 73.5%) and in the non-instillation of saline solution (P = 29.4%; Q = 58.8%). When the total scores obtained were compared, both in practice and knowledge, with the years of experience in ICU, no statistically significant differences were found. It is concluded that the study nurses have scientific knowledge of the suctioning procedure that are better than their practice competence. Discrepancies between practice and knowledge were also found in several of the aspects evaluated, which orients towards the specific needs of training in this procedure.

Naturalistic Decision Making: A Model to Overcome Methodological Challenges in the Study of Critical Care Nurses’ Decision Making About Patients’ Hemodynamic Status

The quality of critical care nurses’ decision making about patients’ hemodynamic status in the immediate period after cardiac surgery is important for the patients’ well-being and, at times, survival. The way nurses respond to hemodynamic cues varies according to the nurses’ skills, experiences, and knowledge. Variability in decisions is also associated with the inherent complexity of hemodynamic monitoring. Previous methodological approaches to the study of hemodynamic assessment and treatment decisions have ignored the important interplay between nurses, the task, and the environment in which these decisions are made. The advantages of naturalistic decision making as a framework for studying the manner in which nurses make decisions are presented.