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Oxenbøll Collet M, Albertsen H, Egerod I. Patient and family engagement in Danish intensive care units: A national survey. Nurs Crit Care 2024; 29:614-621. [PMID: 37402590 DOI: 10.1111/nicc.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Patient and family engagement in the intensive care unit increases the quality of care and patient safety. AIM The aim of our study was to describe current practice and experiences of contemporary patient and family engagement in the intensive care unit at the individual level, the organizational level, and in the research process according to critical care nurses. DESIGN/METHOD We conducted a national qualitative survey of intensive care units in Denmark from 5th May-5th June 2021. Questionnaires were piloted and sent to intensive care nurse specialists and research nurses at 41 intensive care units, allowing one respondent per unit. All respondents were provided with written information about the study by email, and by activating the survey link, they accepted participation. RESULTS Thirty-two nurses responded to the invitation, 24 completed and 8 partially completed the survey, yielding a response rate of 78%. At the individual level, 27 respondents stated that they involved patients and 25 said they involved family in daily treatment and care. At the organizational level, 28 intensive care units had an overall strategy or guideline for patient and family engagement, and 4 units had established a PFE panel. And, finally, 11 units engaged patients and families in the research process. CONCLUSIONS Our survey suggested that patient and family engagement was implemented to some degree at the individual level, organizational level, and in the research process, but only 4 units had established a PFE panel at the organizational level, which is key to engagement. RELEVANCE TO CLINICAL PRACTICE Patient engagement increases when patients are more awake, and family engagement increases when patients are unable to participate. Engagement increases when patient and family engagement panels are implemented.
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Affiliation(s)
- Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Helle Albertsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Rehmani AI, Au A, Montgomery C, Papathanassoglou E. Use of nursing care bundles for the prevention of ventilator-associated pneumonia in low-middle income countries: A scoping review. Nurs Crit Care 2024. [PMID: 38613215 DOI: 10.1111/nicc.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a significant concern in low-middle-income countries (LMICs), where the burden of hospital-acquired infections is high, and resources are low. Evidence-based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs. AIM This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines. STUDY DESIGN The review was conducted using Arksey and O'Malley's (2005) five-stage framework and the PRISMA-ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies. RESULTS After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities. CONCLUSIONS This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC. RELEVANCE TO CLINICAL PRACTICE IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP.
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Affiliation(s)
| | - Alesia Au
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carmel Montgomery
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Segev R, Suliman M, Gorodetzer R, Zukin L, Spitz A. Nursing roles in disaster zones: Experiences and lessons from Turkey's 2023 earthquakes. Int Nurs Rev 2024. [PMID: 38602067 DOI: 10.1111/inr.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 03/23/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Disasters affect human health and well-being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment. AIM This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission. METHODS Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research. FINDINGS The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission. CONCLUSION Nurses in disaster zones offer valuable insights to enhance preparation, cross-cultural communication, and postmission implementation. NURSING AND HEALTH POLICY IMPLICATIONS Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster-related skills. Additionally, it can help foster collaboration among international healthcare teams.
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Affiliation(s)
- Ronen Segev
- Department of Nursing, The Stanley Steyer School of Health Professions, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Moriya Suliman
- Intensive Care Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Roee Gorodetzer
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ludmila Zukin
- Head Nurse, Israel Defense Forces Medical Corps, Tel HaShomer, Israel
| | - Ahuva Spitz
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
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Takiguchi C, Inoue T. 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. Jpn J Nurs Sci 2024; 21:e12584. [PMID: 38273738 DOI: 10.1111/jjns.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/09/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024]
Abstract
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.
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Affiliation(s)
| | - Tomoko Inoue
- International University of Health and Welfare, Tokyo, Japan
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Twamley J, Hamer O, Hill J, Kenyon R, Twamley H, Casey R, Zhang J, Williams A, Clegg A. Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study. Nurs Crit Care 2024; 29:313-324. [PMID: 36458458 DOI: 10.1111/nicc.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/18/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. AIM This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. STUDY DESIGN A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. RESULTS In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. CONCLUSIONS This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. RELEVANCE TO CLINICAL PRACTICE This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.
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Affiliation(s)
- Jacqueline Twamley
- Centre for Health Research and Innovation, NIHR Lancashire Clinical Research Facility, Chorley, UK
| | - Oliver Hamer
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - Roger Kenyon
- Critical care survivor, University of Central Lancashire, Preston, UK
| | - Huw Twamley
- Intensive Care Department, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, UK
| | - Rob Casey
- Digital Therapy Solutions to empower Stroke, Dementia, Parkinson's Rehabilitation, DancingMind Pte Ltd, London, England, United Kingdom
| | | | - Alexandra Williams
- Intensive Care Department, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, Lancashire, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
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Gil-Almagro F, García-Hedrera FJ, Carmona-Monge FJ, Peñacoba-Puente C. From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic. Medicina (Kaunas) 2024; 60:215. [PMID: 38399503 PMCID: PMC10890432 DOI: 10.3390/medicina60020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.
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Affiliation(s)
- Fernanda Gil-Almagro
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain;
| | | | | | - Cecilia Peñacoba-Puente
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
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Wade CL, Robinson LJ, Baker K, Saxton JM, Wright SE, Adams N, Scott J. A group concept mapping and ethnographic study of intensive care rehabilitation culture. Nurs Crit Care 2024; 29:226-233. [PMID: 38288621 DOI: 10.1111/nicc.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/09/2023] [Accepted: 04/13/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Early physical activity and physical rehabilitation are advocated in the critical care unit for patients recovering from critical illness. Despite this, there are still many factors associated with implementation of early physical rehabilitation into routine critical care and practice. One such factor that has been consistently identified is unit culture, yet there is little understanding of how or why the culture of a critical care unit impacts on implementation of early rehabilitation. AIM To develop a detailed understanding of the cultural barriers and enablers to the promotion and implementation of physical activity and early mobilization in National Health Service (NHS) critical care units in the United Kingdom (UK). STUDY DESIGN A mixed-methods, two-phase study incorporating online group concept mapping (GCM) and ethnography. GCM will be conducted to provide a multistakeholder co-authored conceptual framework of rehabilitation culture. Ethnographic observations and interviews will be conducted of culture and behaviours in relation to the implementation and promotion of early physical activity and rehabilitation in two NHS critical care units in the North East of England. RESULTS The results of the Group Concept Mapping and ethnographic observations and interviews will be triangulated to develop a contextual framework of rehabilitation culture in critical care. RELEVANCE TO CLINICAL PRACTICE This study will provide a detailed understanding of barriers and facilitators in relation to providing a positive rehabilitation culture in the critical care unit.
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Affiliation(s)
- Clare L Wade
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Therapy Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lisa J Robinson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- Therapy Services, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Baker
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - John M Saxton
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
- School of Sport, Exercise and Rehabilitation, University of Hull, Hull, UK
| | - Stephen E Wright
- Peri-Operative and Critical Care Directorate, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Adams
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Jason Scott
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
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Zhang Y, Zhao L, Zhang M, Guo X, Xin C, Gai Y. Framework of humanistic care for patients in the ICU: A preliminary study. Nurs Crit Care 2024; 29:125-133. [PMID: 36567483 DOI: 10.1111/nicc.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Humanistic care involves caring, concern, paying attention to people's individuality, meeting their needs and respecting their rights, which is the core concept and central task of nursing. Effective care can enhance patients' ability to deal with stress and promote patient recovery. Implementing humanistic care in the intensive care unit (ICU) is particularly important for health care providers. AIM This study aims to develop a framework of the humanistic care in the ICU. STUDY DESIGN The qualitative research followed Strauss' procedural grounded theory approach. Purposive sampling and theoretical sampling were used to select 12 nurses in the Department of Critical Medicine, 16 patients, and eight family members for semi-structured interviews from October 2020 to April 2021. Results were summarized and analysed through three-level coding based on grounded principles. RESULTS Sixteen subcategories and six main categories were extracted after three-level coding, and the final ICU humanistic care framework was formed with home, activity, visit, environment, nursing and safety ("HAVENS") as the core. CONCLUSIONS This study provides an explanatory theory of humanistic care in the ICU that can guide nurses' practice in ICU clinical work. RELEVANCE TO CLINICAL PRACTICE This theory provides guidance for nurses to implement humanistic care in critical care practice to improve the ICU stay experience of critically ill patients.
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Affiliation(s)
- Yuchen Zhang
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Li Zhao
- Nuclear Medicine Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojing Guo
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chen Xin
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yubiao Gai
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Occhiali E, Rodrigues B, Prieur W, Tiarci S, Carmon N, Veber B, Achamrah N. Reducing diarrhoea in an adult surgical intensive care unit: A quality improvement study. Nurs Crit Care 2024; 29:208-218. [PMID: 37323065 DOI: 10.1111/nicc.12940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. AIMS We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. STUDY DESIGN The first part of this before/after study consisted in assessing the proportion of patients receiving an anti-diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. RESULTS Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti-diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p = .40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p = .35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1-7] vs. 0 day [0-2]; p < .001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p < .001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. CONCLUSIONS The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. RELEVANCE TO CLINICAL PRACTICE The use of specific anti-diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU.
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Affiliation(s)
- Emilie Occhiali
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Bastien Rodrigues
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Wendy Prieur
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Safia Tiarci
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Nicolas Carmon
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Benoit Veber
- Department of Anaesthesiology, Critical Care and Perioperative Medicine, Surgical Intensive Care Unit, Rouen University Hospital, Rouen Cedex, France
| | - Najate Achamrah
- Department of Nutrition, Rouen University Hospital, Rouen Cedex, France
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10
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Şanlı D, Sarıkaya A, Pronovost PJ. Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections. Int J Qual Health Care 2023; 35:mzad104. [PMID: 38157270 DOI: 10.1093/intqhc/mzad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.
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11
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Holm A, Dreyer P. Nurses' experiences of the phenomenon 'isolation communication'. Nurs Crit Care 2023; 28:885-892. [PMID: 36156341 DOI: 10.1111/nicc.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/12/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. AIM To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. STUDY DESIGN A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. FINDINGS Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. CONCLUSION The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. RELEVANCE TO CLINICAL PRACTICE As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.
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Affiliation(s)
- Anna Holm
- Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Aarhus University Hospital, Aarhus, Denmark
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Price AM, McAndrew NS, Thaqi Q, Kirk M, Brysiewicz P, Eggenberger S, Naef R. Factors influencing critical care nurses' family engagement practices: An international perspective. Nurs Crit Care 2023; 28:1031-1044. [PMID: 35831205 DOI: 10.1111/nicc.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. AIM To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. STUDY DESIGN Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. RESULTS Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. CONCLUSIONS Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. RELEVANCE TO CLINICAL PRACTICE Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world.
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Affiliation(s)
- Ann M Price
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Qendresa Thaqi
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
| | - Mary Kirk
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sandra Eggenberger
- College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, Mankato, Minnesota, USA
| | - Rahel Naef
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
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Didvar F, Ghaffari F, Shamsalinia A. Evaluating and Ranking the Factors Affecting the Acute Pain Management in Older Adults with Dementia after Hip Fracture Surgery: Second-Order Confirmatory Factor Analysis. Iran J Nurs Midwifery Res 2023; 28:751-757. [PMID: 38205413 PMCID: PMC10775869 DOI: 10.4103/ijnmr.ijnmr_386_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 01/12/2024]
Abstract
Background Even though nurses take various measures to decrease acute pain after surgery in older adults with dementia, it is unclear why most of them suffer from severe pain. This study aimed to evaluate the factors affecting acute pain management in older adults with dementia after hip fracture surgery. Materials and Methods This cross-sectional study used single-stage cluster and convenience sampling to select 330 nurses working in hospitals located in Western Mazandaran, Iran, in 2020. The demographic characteristic questionnaire and the Obstacles to Postoperative Pain Management in Dementia Scale (OPOPMDS) were used to collect data. Results The study results confirmed the modified model. The second-order Confirmatory Factor Analysis (CFA) indicated that the Critical Ratio (CR) for all three factors was more than 1.96, and the significance level was considered 0.05. Based on the values of standard coefficients, older people-related (β = 0.86, p < 0.001), system-related (β = 0.70, p < 0.001), and healthcare provider-related (β = 0.61, p < 0.001) factors had the highest impacts on the OPOPMD. Conclusions The study results suggested that older adult-related factors had the most significant impact on the OPOPMD.
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Uğurlu YK, Enç N. The effect of local cold compresses for nitroglycerin-induced headache: An observational pretest-posttest study. Nurs Crit Care 2023; 28:1097-1105. [PMID: 35840175 DOI: 10.1111/nicc.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nitroglycerin (NTG)-induced headache is the most common side effect of nitrate therapy and negatively affects the quality of life. AIMS To assess the preventive and severity-reducing effect of cold compresses applied to the bilateral frontotemporal and occipital regions, where pain is most frequently experienced, for headache among individuals receiving intravenous NTG treatment. STUDY DESIGN This research used an observational, two-group, pretest-posttest design and was completed from October 2020 to May 2021 in the coronary intensive care unit of a state hospital located in the north of Turkey. The first group in the research had cold compresses applied for 20 min with the aid of an applicator at the start of NTG infusion, while the second group had the same implementation when headache developed during infusion. RESULTS Both groups were similar in terms of the demographic and clinical features of participants. In our study, more headache was observed in the group without local cold compresses at the start of infusion (53.3%) compared with the group with local cold compresses at the start of infusion (25.8%) (χ2 = 4.841, p = .028). In both groups, the heart rate, systolic and diastolic blood pressure values of patients significantly approached normal values after cold compresses. Patients with local cold compresses applied when headache developed had significantly different visual analog scale scores before (5.75) and after (2.00) the cold compresses application (z = 3.558, p = .000). CONCLUSION At the beginning of the infusion, local cold compresses application may prevent NTG-induced headache in patients without headache, and local cold compresses applied when headache develops may reduce the severity of NTG-induced headache. RELEVANCE TO CLINICAL PRACTICE Application of cold compresses immediately when treatment begins is recommended as a simple and effective practice with no side effects for patients receiving NTG treatment.
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Affiliation(s)
- Yasemin Kalkan Uğurlu
- Faculty of Health Sciences, Medical Nursing Department, Ordu University, Ordu, Turkey
| | - Nuray Enç
- Florence Nightingale Faculty of Nursing, Medical Nursing Department, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Fuseini AKJ, Teixeira da Costa EIM, de Matos FAS, Merino-Godoy MDLA, Nave F. Patient-Safety Culture among Emergency and Critical Care Nurses in a Maternal and Child Department. Healthcare (Basel) 2023; 11:2770. [PMID: 37893844 PMCID: PMC10606642 DOI: 10.3390/healthcare11202770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION The quality of healthcare has multiple dimensions, but the issue of patient safety stands out due to the impact it has on health outcomes, particularly on the achievement of the Sustainable Development Goals (SDGs), expressly SDG3. In the services that we propose to study, the patient-safety culture had never been evaluated. AIM To evaluate nurses' perceptions of the patient-safety culture in the Emergency and Critical Care Services of the Maternal and Child Department of a University Hospital and to identify strengths, vulnerabilities, and opportunities for improvement. METHODS This an exploratory, cross-sectional study with a quantitative approach, using the Hospital Survey on Patient Safety Culture as an instrument for data collection. The population were all nurses working in the emergency and critical care services of the maternal and child-health department, constituted, at the time of writing, by 184 nurses, with a response rate of 45.7%. RESULTS Applying the guidelines from the Agency for Healthcare Research and Quality (AHRQ), only teamwork within units had a score greater than 75%. For this reason, it is considered the strength (fortress) in the study. The lowest-rated were non-punitive responses to errors and open communication. CONCLUSION The overall average percentage score is below the benchmark of the AHRQ, indicating that issue of patient safety is not considered a high priority, or that the best strategies to make it visible have not yet been found. One of the important implications of this study is the opportunity to carry out a deep reflection, within the organization, that allows the development of a non-punitive work environment that is open to dialogue, and that allows the provision of safe nursing care.
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Affiliation(s)
- Abdul-Karim Jebuni Fuseini
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal (E.I.M.T.d.C.); (F.A.S.d.M.); (F.N.)
| | - Emília Isabel Martins Teixeira da Costa
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal (E.I.M.T.d.C.); (F.A.S.d.M.); (F.N.)
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
| | - Filomena Adelaide Sabino de Matos
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal (E.I.M.T.d.C.); (F.A.S.d.M.); (F.N.)
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
| | | | - Filipe Nave
- Nursing Department, Health School, University of Algarve, 8000 Faro, Portugal (E.I.M.T.d.C.); (F.A.S.d.M.); (F.N.)
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3000 Coimbra, Portugal
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Lopes KR, Jorge BM, Barbosa MH, Barichello E, Nicolussi AC. Use of ultrasonography in the evaluation of urinary retention in critically ill patients. Rev Lat Am Enfermagem 2023; 31:e4025. [PMID: 37820221 PMCID: PMC10561797 DOI: 10.1590/1518-8345.6618.4025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/25/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. METHOD quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. RESULTS the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. CONCLUSION bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention. (1) Ultrasonography of the bladder showed an advantage for a better nursing diagnosis. (2) Critical patients had urinary retention after removal of urinary catheter. (3) Overflow incontinence was detected after removal of the urinary catheter. (4) Patients with urinary tract infection were 7.4 times more likely to have retention.
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Affiliation(s)
| | | | - Maria Helena Barbosa
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
| | - Elizabeth Barichello
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
| | - Adriana Cristina Nicolussi
- Universidade Federal do Triângulo Mineiro, Departamento de Enfermagem na Assistência Hospitalar, Uberaba, MG, Brasil
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Kelly N, Blackwood B, Credland N, Stayt L, Causey C, Winning L, McAuley DF, Lundy FT, El Karim I. Oral health care in adult intensive care units: A national point prevalence study. Nurs Crit Care 2023; 28:773-780. [PMID: 37125669 DOI: 10.1111/nicc.12919] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. AIM This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. STUDY DESIGN A national one-day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. RESULTS Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24-h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24-h period and variable assessment methods were used. CONCLUSION There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient-relevant practice. RELEVANCE TO CLINICAL PRACTICE Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.
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Affiliation(s)
- Niamh Kelly
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Nicki Credland
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Louise Stayt
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Christine Causey
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Lewis Winning
- Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ikhlas El Karim
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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Villarante DM, O'Donoghue SC, Medeiros M, Milton E, Walsh K, O'Donoghue AL, Celi LA, Hayes MM, Dilibero J. A National Survey of Stress and Burnout in Critical Care Nurses: A Prepandemic Study. Dimens Crit Care Nurs 2023; 42:248-254. [PMID: 37523722 PMCID: PMC10403271 DOI: 10.1097/dcc.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Critical care nurses (CCNs) experience a higher level of stress and burnout than nurses in other specialties. Approximately 50% of CCNs are mildly stressed, and almost 20% are moderately stressed. Prolonged periods of stress can lead to burnout, which has been shown to have deleterious effects on quality and patient safety. OBJECTIVES The purpose of this study is to determine the prevalence of burnout among a national sample of CCNs and the association with environmental factors. METHODS A national survey of CCNs working in the United States was implemented using an exploratory descriptive design. The anonymous survey was developed iteratively according to best practices of survey design. The survey included the Perceived Stress Scale and the Copenhagen Burnout Inventory tool. Pretesting and pilot testing were conducted with CCN specialists, and the survey was revised based on their feedback. An anonymous link was distributed to respondents using convenience sampling through social media and further disseminated via snowball sampling. RESULTS Two hundred seventy nurses responded to the survey. The mean (SD) Perceived Stress Scale score in the study population was 18.5 (6.4), indicating moderate stress. The mean (SD) Copenhagen Burnout Inventory score was 61.9 (16.5), indicating moderate burnout. Our study found that the overall health of the work environment was one of the most important factors associated with both stress and burnout. CONCLUSIONS This study has demonstrated the relationship between the health of the work environment and burnout among CCNs. It is imperative that health care organizations evaluate and implement strategies to optimize the health of the work environment to mitigate burnout and its negative sequelae on the nurse, patient, and system.
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Sharifnia AM, Green H, Fernandez R, Alananzeh I. Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis. Nurs Ethics 2023:9697330231167543. [PMID: 37535974 DOI: 10.1177/09697330231167543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. AIM To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. RESEARCH DESIGN Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. PARTICIPANTS AND RESEARCH CONTEXT Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. ETHICAL CONSIDERATIONS The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. FINDINGS Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. CONCLUSIONS Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses.
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Affiliation(s)
- Amir Masoud Sharifnia
- Student Research Committee, Khomein University of Medical Sciences, Khomein, Iran; Isfahan University of Medical Sciences, Isfahan, Iran
| | - Heidi Green
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia; Centre for Evidence-Based Initiatives in Health Care: a Joanna Briggs Centre of Excellence, Wollongong, NSW, Australia
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Ibrahim Alananzeh
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; School of Humanities, Social Sciences and Health, UOWD, Dubai, UAE
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Landreth S, Pridgeon S, Ge B, Craig K, Scott SD. Navigating the Storm: Documenting the Experience of Inpatient Registered Nurses Amid the COVID Pandemic-Palliative Care Team Insights. J Hosp Palliat Nurs 2023; 25:129-136. [PMID: 36971763 PMCID: PMC10171095 DOI: 10.1097/njh.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Nominal research illustrates the lived experience of intensive care unit registered nurses during the COVID pandemic. Palliative care team leaders and nurse researchers designed this cross-sectional study to discover opportunities for palliative care team members to enhance the experience of nurses who cared for critically ill patients during this challenging time. The study aimed to compare the effect of caring for patients in COVID versus non-COVID units. Surveys were distributed after the area's initial COVID patient influx. Questions included general demographics, the Professional Quality of Life survey instrument (measuring compassion satisfaction, burnout, and secondary traumatic stress), and open-ended questions to identify protective factors and unique challenges. Across 5 care settings with 311 nurses eligible for the study in total, 90 completed the survey. The population consisted of COVID-designated unit nurses (n = 48, 53.33%) and non-COVID unit nurses (n = 42, 46.67%). Analysis between COVID-designated and non-COVID units revealed significantly lower mean compassion scores and significantly higher burnout and stress scores among those working within COVID-designated units. Despite higher levels of burnout and stress and lower levels of compassion, nurses identified protective factors that improved coping and described challenges they encountered. Palliative care clinicians used insights to design interventions to mitigate identified challenges and stressors.
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Pourvakhshoori N, Karami K, Sigaroudi AE, Adib M, Salari A, Bazyar J, Hosseini SA. Experiences and challenges of nursing education in response to the COVID-19 pandemic: A qualitative study in Iran. J Educ Health Promot 2023; 12:163. [PMID: 37404921 PMCID: PMC10317258 DOI: 10.4103/jehp.jehp_970_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/09/2022] [Indexed: 07/06/2023]
Abstract
BACKGROUND The preparedness of nurses in the COVID-19 pandemic, will be of great importance when it comes to the unknown future of the pandemic and other similar ones. Identifying their problems can lead to better planning, preparation, and management. This study aims to explore Iranian nurses' experience of their preparedness challenges to give an effective response to the pandemic. MATERIALS AND METHODS A qualitative content analysis approach using semi-structured interviews was employed to explore nurses' preparedness experiences. 28 nurses were interviewed, after transcription of the interviews, a content analysis using constant comparison was performed for data analysis based on Graneheim and Lundman approach. RESULTS The results of the study can be summarized in 6 main categories and 14 subcategories, such as the necessity of continuing educational workshops, the necessity of holding exercises in the same environment, the importance of familiarity with the pandemic, the importance of educating all those involved in providing services in the pandemic, the need for providing immersive education for the pandemic and the need for planning and practice concerning the pandemic. CONCLUSION When nurses receive more support, they can have their best performance. up-to-date training can prepare nurses more effectively, which will, in turn, make prepared nurses available, maximize their efficiency, and minimize their adverse mental consequences. Nurse managers may support nurses and increase hospital resilience in such emergencies. Nurses indicated some issues including managers' support, workplace culture, education, physical space, access to PPE, and willingness to provide the best care. These findings can be helpful in the management of the pandemic and preparing nurses as a large group of healthcare workers. Necessary training, along with the provision of adequate resources, should be programmed to support this effective group of health providers.
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Affiliation(s)
- Negar Pourvakhshoori
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Kimia Karami
- Social Determinants of Health Research Center, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Abdolhossein Emami Sigaroudi
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoomeh Adib
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran, Medical Education Research Center, Education Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arsalan Salari
- Department of Cardiology, Cardiovascular Diseases Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Jafar Bazyar
- School of Public Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Lewandowska K, Mędrzycka-Dąbrowska W, Tomaszek L, Wujtewicz M. Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study. J Clin Med 2023; 12:jcm12093120. [PMID: 37176561 PMCID: PMC10179395 DOI: 10.3390/jcm12093120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION With the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue. METHODS A cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021. RESULTS The overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10). CONCLUSION Monitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.
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Affiliation(s)
- Katarzyna Lewandowska
- Department of Anaesthesiology and Intensive Care Nursing, Medical University of Gdansk, 7 Debinki Street, 80-211 Gdansk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology and Intensive Care Nursing, Medical University of Gdansk, 7 Debinki Street, 80-211 Gdansk, Poland
| | - Lucyna Tomaszek
- Department of Specialist Nursing, Faculty of Medicine and Health Sciences, Kraków Academy of Andrzej Frycz Modrzewski, St. Gustawa Herlinga-Grudzińskiego 1, 30-705 Kraków, Poland
- Institute of Tuberculosis and Lung Diseases, Rabka-Zdrój Branch, 34-700 Rabka-Zdrój, Poland
| | - Magdalena Wujtewicz
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, 17 Smoluchowskiego Street, 80-214 Gdansk, Poland
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Hong L, Hou C, Chen L, Huang X, Huang J, Liu W, Shen X. Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study. Nurs Open 2023; 10:2449-2463. [PMID: 36463394 PMCID: PMC10006586 DOI: 10.1002/nop2.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
AIM To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. DESIGN A qualitative study was performed following the consolidated criteria for reporting qualitative research. METHODS Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. RESULTS A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. RELEVANCE TO CLINICAL PRACTICE This framework can be a reference for the assessment and training of ECMO nurses.
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Affiliation(s)
- Liwei Hong
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Chunyi Hou
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Lihua Chen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiaoqun Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Jingye Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Weijuan Liu
- Department of PediatricsFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiangxiang Shen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
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Kissel KA, Filipek C, Folz E, Jenkins J. The Impact of a 3-Tiered Model of Nursing Redeployment During the COVID-19 Pandemic: A Cross-Sectional Study. Intensive Crit Care Nurs 2023; 77:103431. [PMID: 37060812 PMCID: PMC10027952 DOI: 10.1016/j.iccn.2023.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
Objective The COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units (ICUs). We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in ICUs during the COVID-19 pandemic. Methodology In this cross-sectional study, 931 nurses (464 ICU and 467 redeployed nurses) who worked within 4 adult ICUs in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid ICU orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire. Results A total of 191 survey responses were retained (59 ICU nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, ICU, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent ICU nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models. Conclusion Nurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and ICU nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward.
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Affiliation(s)
- Katherine A Kissel
- Department of Critical Care Medicine, Alberta Health Services, Alberta, Canada. https://twitter.com/@kissel_katie
| | - Christine Filipek
- Department of Critical Care Medicine, Alberta Health Services, Alberta, Canada.
| | - Emma Folz
- Department of Critical Care Medicine, Alberta Health Services, Alberta, Canada. https://twitter.com/@emma_folz
| | - Jessica Jenkins
- Department of Critical Care Medicine, Alberta Health Services, Alberta, Canada; Clinical Associate, Faculty of Nursing, University of Calgary, Alberta, Canada. https://twitter.com/@jessjenkinsNP
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Alenazy FS, Dettrick Z, Keogh S. The relationship between practice environment, job satisfaction and intention to leave in critical care nurses. Nurs Crit Care 2023; 28:167-176. [PMID: 34882918 DOI: 10.1111/nicc.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue. AIMS To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. DESIGN Cross-sectional correlational (observational) design. METHODS Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. RESULTS A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930). CONCLUSIONS Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. RELEVANCE TO CLINICAL PRACTICE Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.
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Affiliation(s)
- Faisal S Alenazy
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Nursing, ICU/Critical Care, University of Ha'il, Ha'il, Kingdom of Saudi Arabia
| | - Zoe Dettrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Segev R. Learning from critical care nurses' wartime experiences and their long-term impacts. Nurs Crit Care 2023; 28:253-260. [PMID: 35833305 DOI: 10.1111/nicc.12819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/12/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The history of critical care nursing is intertwined with that of battlefield nursing, where for almost 200 years, nurses worked to save injured soldiers' lives, risking their own physical and emotional injuries. Today, with nurses increasingly deployed to provide critical care during natural, man-made and public health crises that can resemble battlefield situations, there is much to learn from battlefield nurses. AIM This qualitative study aims to explore the lessons of the experiences of civilian nurses deployed to Israeli battlefields in three wars between 1967 and 1982. METHODS Qualitative, semi-structured, in-depth interviews were conducted with twenty-two former military nurses who were deployed in three wars between 1967 and 1982. We analysed interview transcripts using a content analysis approach. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation. FINDINGS Data analysis revealed three main themes, with ten related subthemes: Field Service Challenges, Coping with Challenges, and Nurses' Need for Recognition. CONCLUSION The findings identify mental, emotional, and organizational issues resulting from nurses' wartime experiences, revealing numerous opportunities for better preparing and supporting critical care nurses before, during, and after crises. RELEVANCE TO CLINICAL PRACTICE Critical care nursing during crises, such as wartime, is unique but increasingly common. The memories and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders planning for future deployments during wartime or other disasters such as the COVID-19 pandemic and the Russo-Ukrainian war.
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Affiliation(s)
- Ronen Segev
- Department of Nursing Sciences, Ruppin Academic Center, Emek-Hefer, Israel
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27
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Friedrich S, Teja B, Latronico N, Berger J, Muse S, Waak K, Fassbender P, Azimaraghi O, Eikermann M, Wongtangman K. Subjective Assessment of Motor Function by the Bedside Nurses in Mechanically Ventilated Surgical Intensive Care Unit Patients Predicts Tracheostomy. J Intensive Care Med 2023; 38:151-159. [PMID: 35695208 DOI: 10.1177/08850666221107839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In many institutions, intensive care unit (ICU) nurses assess their patients' muscle function as part of their routine bedside examination. We tested the research hypothesis that this subjective examination of muscle function prior to extubation predicts tracheostomy requirement. METHODS Adult, mechanically ventilated patients admitted to 7 ICUs at Beth Israel Deaconess Medical Center (BIDMC) between 2008 and 2019 were included in this observational study. Assessment of motor function was performed every four hours by ICU nurses. Multivariable logistic regression analysis controlled for acute disease severity, delirium risk assessment through the confusion assessment method for the ICU (CAM-ICU), and pre-defined predictors of extubation failure was applied to examine the association of motor function and tracheostomy within 30 days after extubation. RESULTS Within 30 days after extubation, 891 of 9609 (9.3%) included patients required a tracheostomy. The inability to spontaneously move and hold extremities against gravity within 24 h prior to extubation was associated with significantly higher odds of 30-day tracheostomy (adjusted OR 1.56, 95% CI 1.27-1.91, p < 0.001, adjusted absolute risk difference (aARD) 2.8% (p < 0.001)). The effect was magnified among patients who were mechanically ventilated for >7 days (aARD 21.8%, 95% CI 12.4-31.2%, p-for-interaction = 0.015). CONCLUSIONS ICU nurses' subjective assessment of motor function is associated with 30-day tracheostomy risk, independent of known risk factors. Muscle function measurements by nursing staff in the ICU should be discussed during interprofessional rounds.
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Affiliation(s)
- Sabine Friedrich
- Department of Anesthesiology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Anesthesia, Critical Care and Pain Medicine, 1859Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Germany
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, 1859Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Jay Berger
- Department of Anesthesiology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sandra Muse
- Department of Nursing & Patient Care, 1811Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen Waak
- Department of Physical Therapy, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Philipp Fassbender
- Department of Anesthesia, Critical Care and Pain Medicine, 1859Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Klinik für Anästhesiologie, operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | - Omid Azimaraghi
- Department of Anesthesiology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthias Eikermann
- Department of Anesthesiology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,Klinik für Anästhesiologie und Intensivmedizin, 39081Universität Duisburg-Essen, Essen, Germany
| | - Karuna Wongtangman
- Department of Anesthesiology, 2013Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, 65106Mahidol University, Bangkok, Thailand
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Powers K, Duncan JM, Renee Twibell K. Family support person role during resuscitation: A qualitative exploration. J Clin Nurs 2023; 32:409-421. [PMID: 35170118 PMCID: PMC10078650 DOI: 10.1111/jocn.16248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To provide guidance to nurses by examining how critical care nurses perceive and perform the family support person role during resuscitation. BACKGROUND Nurses can serve as family support person when families witness a loved one's resuscitation. However, few studies have examined the role of family support person to provide nurses with sufficient knowledge to enact the role. DESIGN An exploratory-descriptive qualitative design with individual, semi-structured interviews. METHODS Sixteen critical care nurses who had served as family support person completed interviews. The data were analysed by thematic analysis. COREQ guidelines were followed. RESULTS Six themes were identified: Hard but Rewarding Role, Be With, Assess, First Moments, Explain and Support. Findings explicated nurses' perceptions of the role and key role activities. CONCLUSIONS Nurses perceived the role as hard but rewarding. Role challenges included the need for quick, accurate assessments and interventions to keep family members safe, informed and supported, while allowing them to witness resuscitation. Key role activities included: being fully present and compassionately attentive to family, continuously assessing family members, coordinating the first moments when family presence during resuscitation commences, explaining in simple, tailored terms the resuscitation activities, and supporting the family emotionally and psychologically through a variety of strategies. Nurses noted the high variability in how families respond and the complexity of simultaneously performing the multi-faceted role activities. RELEVANCE TO CLINICAL PRACTICE To effectively support the growing global trend of family presence during resuscitation, nurses need the knowledge this study provides about how to fulfil the family support person role. Identifying the role activities may facilitate development of clinical guidelines and educational preparation for the role. Nurses can refine the many skills this role requires, building their competence and confidence, to increase opportunities for family members to experience family presence during resuscitation in a safe, and high-quality manner.
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Affiliation(s)
- Kelly Powers
- University of North Carolina at Charlotte, School of Nursing, Charlotte, North Carolina, United States
| | - Jaclyn M Duncan
- Atrium Health Kings Mountain, Kings Mountain, North Carolina, United States
| | - K Renee Twibell
- Ball State University, School of Nursing, Indiana University Health Ball Memorial Hospital, Muncie, Indiana, United States
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Fredholm A, Engströlm Å, Andersson M, Nordin A, Persenius M. Learning in intensive care during the COVID-19 pandemic postgraduate critical care nursing students' experiences. Int J Med Educ 2022; 13:335-344. [PMID: 36580689 PMCID: PMC9911281 DOI: 10.5116/ijme.6399.ea3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. METHODS An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. RESULTS The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor. 2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.
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Affiliation(s)
- Angelica Fredholm
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
| | - Åsa Engströlm
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Lulea, Sweden
| | - Maria Andersson
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Lulea, Sweden
| | - Anna Nordin
- Faculty of Health, Science, and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden
| | - Mona Persenius
- Faculty of Health, Science, and Technology, Department of Health Science, Karlstad University, Karlstad, Sweden
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Aljohani MS. Competency in ECG Interpretation and Arrhythmias Management among Critical Care Nurses in Saudi Arabia: A Cross Sectional Study. Healthcare (Basel) 2022; 10. [PMID: 36554100 DOI: 10.3390/healthcare10122576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Electrographic interpretation skills are important for healthcare practitioners caring for patients in need of cardiac assessment. Competency in ECG interpretation skills is critical to determine any abnormalities and initiate the appropriate care required. The purpose of the study was to determine the level of competence in electrocardiographic interpretation and knowledge in arrhythmia management of nurses in critical care settings. Methods: A descriptive cross-sectional design was used. A convenience sample of 255 critical care nurses from 4 hospitals in the Al-Madinah Region in Saudi Arabia was used. A questionnaire was designed containing a participant’s characteristics and 10 questions with electrocardiographic strips. A pilot test was carried out to evaluate the validity and reliability of the questionnaire. Descriptive and bivariate analyses were conducted using an independent t-test, one-way ANOVA, or bi-variate correlation tests, as appropriate. A statistical significance of p < 0.05 was assumed. Results: Females comprised 87.5% of the sample, and the mean age of the sample was 32.1 (SD = 5.37) years. The majority of the participants (94.9%) had taken electrocardiographic interpretation training courses. The mean total score of correct answers of all 10 ECG strips was 6.45 (±2.54) for ECG interpretation and 4.76 (±2.52) for arrhythmia management. No significant differences were observed between ECG competency level and nursing experience or previous training. Nurses working in the ICU and CCU scored significantly higher than those working in ED. Conclusions: The electrocardiographic knowledge in ECG interpretation and arrhythmia management of critical care nurses is low. Therefore, improving critical care nurses’ knowledge of ECGs, identification, and management of cardiac arrhythmias is essential.
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Winnie KA, Sanchez K, Winfrey E, Furlow A, Thong L, Mitchell C, Cannon J. Practice Integration as an Effective Educational Strategy. AACN Adv Crit Care 2022; 33:319-328. [PMID: 36477847 DOI: 10.4037/aacnacc2022171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bundles are composed of individually established practices supported by research that, when combined, structure patient care. Implementing bundles improves patient outcomes. The ABCDEF initiative is an example of a bundled approach that improves outcomes of critically ill patients that are related to the likelihood of hospital death within 7 days, delirium and coma days, physical restraint use, intensive care unit readmission, and discharge disposition, with outcomes being proportional to the number of appropriate components performed. The purpose of this quality improvement project was to implement practice integration as an educational strategy to increase nursing knowledge of complex topics and, specifically, components of the ABCDEF bundle. Nurses' knowledge of all the BDE components of the ABCDEF bundle increased after implementing practice integration. Findings from this project support the use of resources to implement practice integration as an educational strategy for comprehensive concepts, specifically the BDE components of the ABCDEF bundle.
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Affiliation(s)
- Kathrine Anne Winnie
- Kathrine Anne Winnie is Clinical Nurse Specialist, Keck Hospital of USC, 1721 Wayne Avenue, South Pasadena, CA 91030
| | - Kimberly Sanchez
- Kimberly Sanchez is Clinical Nurse Specialist, Keck Hospital of USC, Los Angeles, California
| | - Elizabeth Winfrey
- Elizabeth Winfrey is Clinical Educator, Keck Hospital of USC, Los Angeles, California
| | - Amber Furlow
- Amber Furlow is Clinical Nurse Educator, Los Alamitos Medical Center, Los Alamitos, California
| | - Lani Thong
- Lani Thong is Clinical Educator, Keck Hospital of USC, Los Angeles, California
| | - Christopher Mitchell
- Christopher Mitchell is Clinical Educator, Keck Hospital of USC, Los Angeles, California
| | - Jennifer Cannon
- Jennifer Cannon is Clinical Educator, USC Norris Comprehensive Cancer Center, Los Angeles, California
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Stenkjaer RL, Egerod I, Moszkowicz M, Greisen G, Ista E, Herling SF, Weis J. Clinical application of 'Sophia Observation withdrawal Symptoms-Paediatric Delirium' screening tool in Danish version: A feasibility study. Scand J Caring Sci 2022; 36:1027-1036. [PMID: 35253260 PMCID: PMC9790259 DOI: 10.1111/scs.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/29/2022] [Accepted: 02/22/2022] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES The aims of the present study were investigating the feasibility of: (1) using the Danish version of Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) screening tool in clinical practice and (2) comparing SOS-PD performance to a child psychiatrist's assessment using the diagnostic criteria as a reference standard. BACKGROUND Critically ill children risk developing delirium potentially causing discomfort and suffering. Intensive care delirium has a fluctuating course complicating detection. Systematic screening during and after intensive care is central to manage paediatric delirium. DESIGN AND METHODS We used a descriptive and comparative design. First aim: Bedside nurses were asked to evaluate their experience of using the SOS-PD. Second aim: We compared the SOS-PD performance with the child psychiatrist assessment in 50 children aged 4 weeks to 18 years. RESULTS Nurses found the Danish version of the SOS-PD applicable and easy to use. Of the 50 children included, 13 were diagnosed with delirium by the child psychiatrist. Consistency was found between the SOS-PD score and the child psychiatrist's assessment (88%). We found three false-negative and three false-positive SOS-PD cases. The false-negative cases could be explained by the differences in time periods for the assessments. SOS-PD assessments covered the past 4 h, whereas the psychiatric assessments covered the past 24 h. We assume the false-positive cases represent an acceptable inconsistency between the two assessment methods. CONCLUSIONS The Danish version of the SOS-PD appeared suitable for identifying paediatric delirium. Our results emphasised the importance of assessment at least once during each nursing shift to ensure delirium detection around the clock due to the fluctuating course of delirium. RELEVANCE TO CLINICAL PRACTICE Implementing the Danish SOS-PD may increase awareness of this critical disorder by improving systematic identification of paediatric delirium in clinical practice paving the way for improved delirium prevention and management.
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Affiliation(s)
| | - Ingrid Egerod
- Department of Intensive CareCopenhagen University Hospital RigshospitaletCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Mala Moszkowicz
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Research Unit at Child and Adolescent Mental Health CenterCapital Region of DenmarkCopenhagenDenmark
| | - Gorm Greisen
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark,Department of Neonatology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Erwin Ista
- Department of Pediatric SurgeryPediatric Intensive CareErasmus MC – Sophia Children’s HospitalRotterdamthe Netherlands
| | | | - Janne Weis
- Department of NeonatologyCopenhagen University Hospital RigshospitaletCopenhagenDenmark
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Vieira JV, Deodato S, Mendes F. Therapeutic Futility in Nursing: A Focus Group. SAGE Open Nurs 2022; 8:23779608221134768. [PMID: 36330534 PMCID: PMC9623345 DOI: 10.1177/23779608221134768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The implementation of futile nursing interventions
seems to be a persistent problem in adult intensive care units. Understanding
this phenomenon can contribute to its prevention and all deleterious effects
associated with it. Objective: To identify the perceptions of
expert nurses from adult intensive care units about therapeutic futility in
nursing. Methods: This study consists of a conventional content
analysis. Data was collected through a focus group interview that included five
expert nurses in adult intensive care, with a minimum of fifteen years of
professional experience in intensive care. To analyze the information, the
technique of thematic categorical analysis was used, according to Bardin.
Results: Four central categories were identified for the topic
under study, for which several subcategories were identified that allow a better
understanding of this phenomenon. Conclusion: Adult intensive care
expert nurses advocate that therapeutic futility in nursing is a reality
perceived by teams and families, which should be avoided due to the risk of
potentiating the implementation of ethically reprehensible care.
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Affiliation(s)
- João V. Vieira
- Centre for Interdisciplinary Health Research, Universidade Católica
Portuguesa, Lisboa, Portugal,Department of Health, Instituto Politécnico de Beja, Beja,
Portugal,João V. Vieira, Rua Tenente Valadim, 77-C,
7800-073 Beja, Portugal
| | - Sérgio Deodato
- Centre for Interdisciplinary Health Research, Universidade Católica
Portuguesa, Lisboa, Portugal
| | - Felismina Mendes
- Comprehensive Health Research Centre, Universidade de Évora, Évora, Portugal
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Dias TO, Assad LG, de Paula VG, de Almeida LF, de Moraes EB, Nassar PRB. Good practices in central venous catheter maintenance in time of covid-19: an observational study. Rev Bras Enferm 2022; 75:e20210397. [PMID: 36197429 PMCID: PMC9728808 DOI: 10.1590/0034-7167-2021-0397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/15/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to assess adherence to good practices for central venous catheter maintenance by the nursing team during the COVID-19 pandemic. METHODS observational, cross-sectional, quantitative research with non-participant observation. Data collection was guided by an instrument developed for this study, consisting of five dimensions. It took place in the intensive care unit of a university hospital in the city of Rio de Janeiro. RESULTS a total of 700 observations were carried out, which resulted, in general, in 402 (57.4%) procedures for adherence to good practices. Hand hygiene (8%) and Performing the dressings (10%) were the dimensions with the lowest adherence. CONCLUSIONS good practices for central venous catheter maintenance were partially present in the routine of the nursing team during the COVID-19 pandemic. In critical moments, intensifying the qualification of the teams for a better adaptation to the new work processes is a strategy to sustain the patient safety culture.
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Affiliation(s)
- Taís Oliveira Dias
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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35
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López Cárdenas WI, Gil Vidal E, Altamirano Ceron RM, Henao Murillo NA, Santa Mejía YA, Jurado Jiménez AC. Care Perceptions in two ICU Nursing Care Delivery Models: A qualitative-comparative approach. Invest Educ Enferm 2022; 40:e15. [PMID: 36867788 PMCID: PMC10017135 DOI: 10.17533/udea.iee.v40n3e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 10/03/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Analyzed in compared perspective perceptions about nursing care, nurse-patient interaction, and nursing care outcomes in two ICU nursing staff in a high-complexity hospital institution, whose Nursing are Delivery Models (NCDM) are differentiated by the proportion of nurses and nurse assistants (NA) per team and by the assigned tasks and responsibilities. METHODS Particularist ethnography with adaptation to virtual methodologies. It included the sociodemographic characteristics of 19 nurses and 23 NA, 14 semi-structured interviews, review of patients' clinical records, and a focus group. Coding, categorization, inductive analysis, validation of results with participants were conducted and thematic saturation was achieved. RESULTS Four themes were identified: i) Professionalized care: a nursing of superior value; ii) senses and feelings of care; iii) nursing workload, generating factors and impacts; and iv) nursing missed care as concrete expression of the nursing workload. CONCLUSIONS Compared nursing teams perceived nursing care in different ways, since it was experienced based on the assigned responsibilities and the possibilities of interaction with patients. Nursing care in the NCDM of the ICU with prevalence of direct bedside care by nurses with support from NA, it was perceived as holistic, comprehensive, and empathetic; whereas in the ICU with prevalence of delegated care to NA, it was related with administrative leadership and management of the ICU. Regarding the results, the NCDM of the ICU of direct bedside care by nurses showed better performance in patient safety and was closer to the skill level and legal responsibility of the nursing staff.
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Affiliation(s)
| | - Esteban Gil Vidal
- Facultad de Enfermería, Universidad de Antioquia, Medellín (Colombia)
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36
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Boggs S, de Caen G, Lobos AT, Plint AC, Krmpotic K. Resource Utilization in Children who Receive a Pediatric Intensive Care Unit Consult in the Emergency Department: A Retrospective Cohort Study. J Intensive Care Med 2022; 38:106-113. [PMID: 35795966 DOI: 10.1177/08850666221109176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the characteristics, critical care resource requirements, and outcomes of children who were hospitalized after a Pediatric Intensive Care Unit (PICU) consult in the Emergency Department (ED). METHODS In this single-centre retrospective cohort study, we conducted chart reviews for children (<18 years) hospitalized following a PICU consult in the ED to examine patient characteristics, timing of consult, ED length of stay, Medical Emergency Team (MET) utilization, PICU nursing workload, and critical care interventions for children who were and were not admitted to the PICU. RESULTS During the one-year study period, 247 PICU consults were performed in the ED resulting in 161 (65.2%) direct admissions to PICU and 1 indirect PICU admission via the ward. Of 105 children with complex chronic conditions, 73 (69.5%) were admitted to PICU, including 32 (91.4%) of 35 children with chronic home ventilatory needs, only 2 (6.2%) of whom received a critical care intervention beyond respiratory support. Within 24 h of hospitalization, 112 (69.1%) of 162 PICU admissions received a critical care-specific intervention. Of 86 (34.8%) ward admissions, 16 (18.6%) were reviewed by the MET. Children admitted to the ward had a significantly longer post-consult ED length of stay than children admitted to PICU (median 428 min vs. 130 min; p <0.0001). CONCLUSIONS Over two-thirds of children admitted to PICU from the ED required early critical care interventions, with the remainder potentially benefitting from closer monitoring or a higher frequency of non-critical care interventions than can be reasonably provided on general inpatient wards. More research is needed to evaluate critical care and hospital resource utilization when children are triaged to the ward following a PICU consult in the ED.
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Affiliation(s)
- Samantha Boggs
- Division of Pediatric Critical Care, 27338CHEO, Ottawa, Canada.,274065CHEO Research Institute, Ottawa, Canada
| | | | - Anna-Theresa Lobos
- Division of Pediatric Critical Care, 27338CHEO, Ottawa, Canada.,274065CHEO Research Institute, Ottawa, Canada.,Department of Pediatrics, 6363University of Ottawa, Ottawa, Canada
| | - Amy C Plint
- 274065CHEO Research Institute, Ottawa, Canada.,Department of Pediatrics, 6363University of Ottawa, Ottawa, Canada.,Division of Emergency Medicine, 27338CHEO, Ottawa, Canada.,Department of Emergency Medicine, 6363University of Ottawa, Ottawa, Canada
| | - Kristina Krmpotic
- Department of Pediatric Critical Care, 3682IWK Health, Halifax, Canada.,Department of Critical Care, 3688Dalhousie University, Halifax Canada
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37
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Johansen E, Bredesen IM, Jónasdóttir RJ, Lind R. ABCD before E-verything else-Intensive care nurses' knowledge and experience of pressure injury and moisture-associated skin damage. Int Wound J 2022; 20:285-295. [PMID: 35746849 PMCID: PMC9885462 DOI: 10.1111/iwj.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 02/03/2023] Open
Abstract
Patients in intensive care units are at high risk of developing pressure injuries and moisture-associated skin damages. Prevention and care rely much on intensive care nurses' competency and attitudes. This study explored intensive care nurses' experience, knowledge and bedside practice in prevention and care of pressure injuries and moisture-associated skin damages with a descriptive qualitative design. Six focus groups (n = 25) were carried out in three University hospitals, two in Norway and one inIceland. Interviews were guided by a questioning route, recorded and transcribed verbatim before an inductive content analysis. Three interconnected main categories related to nurses' experience, knowledge and bedside care were identified: (a) nursing; (b) context; and (c) patients. Intensive care nurses recognise patients' risk of developing pressure injuries, as well as their continuous need of personal hygiene because of leakage of body fluids. Nurses were therefore attentive to skin inspection and preventive care but felt insecure and in need of expert help in pressure injury wound care. It varied whether nurses had access to suitable beds and mattresses and experts in wound care. ABCD had to be before E-verything else, but the skin had higher priority in long-stay compared with short-stay patients.
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Affiliation(s)
- Edda Johansen
- Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayBorreNorway
| | - Ida Marie Bredesen
- Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayBorreNorway,Division of Orthopaedic SurgeryOslo University HospitalOsloNorway
| | | | - Ranveig Lind
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway,Intensive Care UnitUniversity Hospital of North NorwayTromsøNorway
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38
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Marques R, Araújo F, Fernandes M, Freitas J, Dixe MA, Gélinas C. Validation Testing of the European Portuguese Critical-Care Pain Observation Tool. Healthcare (Basel) 2022; 10. [PMID: 35742126 DOI: 10.3390/healthcare10061075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 12/03/2022] Open
Abstract
Aim. The study aim was to validate the Portuguese version of the Critical-Care Pain Observation Tool (CPOT) in the critically ill adult population of Portugal. Methods. A prospective, observational cohort study was conducted to evaluate the CPOT in mechanically ventilated patients who were admitted to an intensive care unit. A consecutive sample of 110 patients was observed at rest pre-procedure, during a nociceptive procedure (NP) which includes turning/positioning and endotracheal or tracheal suctioning and 20 min post-procedure. Two raters participated in the data collection. The discriminative validity, criterion validity, convergent validity and inter-rater reliability of the CPOT were examined. Results. The inter-rater reliability was excellent (0.93 ≤ α ≤ 1.00) at rest and fair to moderate (0.39 ≤ α ≤ 0.60) during the NP. The CPOT could discriminate between conditions with higher scores during the NP when compared to CPOT scores at rest (p < 0.001). The optimal CPOT cut-off score was >2, with a sensitivity of 71% and a specificity of 80%, and self-reported pain was the gold standard criterion. Significant correlations (<0.40) were found between CPOT scores, the heart rate and the respiratory rate during the nociceptive procedure. Conclusions. The CPOT appears to be a valid alternative for both ventilated and non-ventilated patients who are unable to communicate.
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Monsees J, Moore Z, Patton D, Watson C, Nugent L, Avsar P, O'Connor T. A systematic review of the effect of early mobilization on length of stay for adults in the intensive care unit. Nurs Crit Care 2022. [PMID: 35649531 DOI: 10.1111/nicc.12785] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND EM has been hypothesized to help prevent the development of ICU acquired weakness and may therefore result in positive outcomes for ICU patients. AIM To establish the impact of Early mobilization (EM) on adult Intensive Care Unit (ICU) patients in terms of ICU length of stay (LOS), as well as hospital LOS, duration of mechanical ventilation, mortality, and functional independence. STUDY DESIGN Systematic Review. METHODS EMBASE, MEDLINE, CINAHL, and the Cochrane Library were searched on 24th November 2020. Included studies and other systematic reviews were hand-searched for further includable studies. The primary outcome was ICU LOS whilst secondary outcomes were duration of MV, mortality, hospital LOS and functional independence. The PRISMA guidelines were utilized to perform the review. Ten randomized controlled trials with a combined total of 1291 patients met inclusion criteria and were scrutinized using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews. Revman 5.4.1 was used to conduct meta-analysis were possible. RESULTS Results were limited by the evidence available for inclusion, in particular small sample sizes. However, a trend towards a shorter duration of ICU LOS and duration of mechanical ventilation emerged. There was also a trend towards higher rates of functional independence for intervention groups. Mortality rates appeared unaffected and results of meta-analysis were statistically non-significant (p = 0.90). CONCLUSIONS By applying a stricter time limit than previous systematic reviews a trend emerged that the commencement of EM has a positive effect on patient outcomes, in particular ICU LOS. RELEVANCE TO CLINICAL PRACTICE The evidence base surrounding EM remains poor; however on the balance of the available evidence the application of EM should not be delayed.
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Affiliation(s)
- Jonas Monsees
- Post Anaesthetic Critical Care Unit, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,School of Nursing & Health, Lida Institute, Shanghai, China.,School of Medicine, University of Wales, Cardiff, UK.,School Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Declan Patton
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School Nursing and Midwifery, Griffith University, Queensland, Australia.,Wounds and Trauma Research Centre, School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland.,Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chanel Watson
- School of Nursing and Midwifery, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia.,School of Nursing & Health, Lida Institute, Shanghai, China.,School Nursing and Midwifery, Griffith University, Queensland, Australia.,School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
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40
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Blake JWC, Fiske SM, Giuliano KK. A qualitative analysis of intravenous smart pump usability. Nurs Open 2022; 9:2171-2178. [PMID: 35591755 PMCID: PMC9190672 DOI: 10.1002/nop2.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/05/2022] Open
Abstract
AIM To understand the experience of critical care nurses when performing common, yet error-prone, programming tasks on two unfamiliar intravenous smart pumps. DESIGN A qualitative descriptive study using data collected during a previous quantitative pilot study. METHODS Following completion of common intravenous programming tasks each participant was interviewed using a semi-structured interview guide. All interview data were coded line-by-line and thematic analysis revealed themes across all participants' interviews. RESULTS The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety.
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Affiliation(s)
- Jeannine W C Blake
- Elaine Marieb Center for Nursing and Engineering Innovation, Elaine Marieb College of Nursing & Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Sarah M Fiske
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Karen K Giuliano
- Elaine Marieb Center for Nursing and Engineering Innovation, Elaine Marieb College of Nursing & Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Cui N, Yan X, Zhang Y, Chen D, Zhang H, Zheng Q, Jin J. Non-Pharmacological Interventions for Minimizing Physical Restraints Use in Intensive Care Units: An Umbrella Review. Front Med (Lausanne) 2022; 9:806945. [PMID: 35573001 PMCID: PMC9091438 DOI: 10.3389/fmed.2022.806945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background There is a relationship between the application of physical restraints and negative physiological and psychological effects on critically ill patients. Many organizations have supported and advocated minimizing the use of physical restraints. However, it is still common practice in many countries to apply physical restraints to patients in intensive care. Objective This study aimed to assess the effectiveness of various non-pharmacological interventions used to minimize physical restraints in intensive care units and provide a supplement to the evidence summary for physical restraints guideline adaptation. Methods Based on the methodology of umbrella review, electronic databases, including Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, MEDLINE, EMBASE, CINAHL, Web of Science, PsycInfo/Psyc Articles/Psychology and Behavioral Science Collection, China National Knowledge Infrastructure, SinoMed, and Wanfang Data, were searched to identify systematic reviews published from January 2016 to December 2020. Two independent reviewers undertook screening, data extraction, and quality appraisal. The methodological quality of systematic reviews was evaluated by AMSTAR 2. Evidence quality of each intervention was assessed according to GRADE. The corrected covered area was calculated as a measure of overlap. Results A total of 47 systematic reviews were included in the umbrella review, of which six were evaluated as high quality, five were of moderate quality, and the rest were of low or critically low quality. The corrected covered area range was from 0.0 to 0.269, which indicated that there was mild overlap between systematic reviews. The included systematic reviews evaluated various types of non-pharmacological interventions for minimizing physical restraints in intensive care units, which included multicomponent interventions involving healthcare professionals' education, family engagement/support, specific consultations and communication, rehabilitation and mobilization (rehabilitation techniques, early mobilization, inspiratory muscle training), interventions related to reducing the duration of mechanical ventilation (weaning modes or protocols, ventilator bundle or cough augmentation techniques, early tracheostomy, high-flow nasal cannula), and management of specific symptoms (delirium, agitation, pain, and sleep disturbances). Conclusion The number of systematic reviews related to physical restraints was limited. Multicomponent interventions involving healthcare professionals' education may be the most direct non-pharmacological intervention for minimizing physical restraints use in intensive care units. However, the quality of evidence was very low, and conclusions should be taken with caution. Policymakers should consider incorporating non-pharmacological interventions related to family engagement/support, specific consultations and communication, rehabilitation and mobilization, interventions related to reducing the duration of mechanical ventilation, and management of specific symptoms as part of the physical restraints minimization bundle. All the evidence contained in the umbrella review provides a supplement to the evidence summary for physical restraints guideline adaptation. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242586, identifier: CRD42021242586.
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Affiliation(s)
- Nianqi Cui
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Xiaoli Yan
- Health Management Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiong Zheng
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
- Changxing Branch Hospital of SAHZU, Huzhou, China
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Razban F, Arab M, Radfar A, Karzari Z, Hosseini SMA. Recall of Intensive Care Unit Stay in Critical Illness Survivors in Southeast Iran. AACN Adv Crit Care 2022; 33:23-30. [PMID: 35259222 DOI: 10.4037/aacnacc2022823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In survivors of critical illness, recall of an intensive care unit stay plays an important role in the development of post-intensive care unit syndrome, which includes psychological impairment after intensive care unit discharge. OBJECTIVE To investigate memories of the intensive care unit among survivors in southeast Iran. METHODS In this descriptive study, the intensive care unit memory tool was used to assess patients' memories of intensive care units. RESULTS All participants (N = 100) had 1 or more factual memories (89%), memories of feelings (66%), or delusional memories (34%) from the intensive care unit. Patients who received mechanical ventilation were 4 times as likely to have delusional memories as those who did not receive mechanical ventilation. Unmarried patients were 4.8 times as likely as married patients to have memories of feelings from the intensive care unit. CONCLUSIONS Steps should be taken to minimize distressing memories of an intensive care unit admission. Follow-up programs should take into account the psychological problems faced by intensive care unit survivors.
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Affiliation(s)
- Farideh Razban
- Farideh Razban is Assistant Professor, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mansoor Arab
- Mansoor Arab is Lecturer, Bam University of Medical Sciences, Bam, Iran
| | - Ali Radfar
- Ali Radfar is Assistant Professor, Faculty of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Zahra Karzari
- Zahra Karzari is Lecturer, Department of Nursing and Midwifery, Islamic Azad University, Kerman Branch, Kerman, Iran
| | - Seyed Mohsen Askari Hosseini
- Seyed Mohsen Askari Hosseini is Nurse, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran, 7616913555
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Kapoor S, Singh S. Providing individualised nursing care can improve the experiences and health outcomes of sepsis patients with learning disability. Evid Based Nurs 2022; 25:ebnurs-2021-103492. [PMID: 35236740 DOI: 10.1136/ebnurs-2021-103492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Sumeeta Kapoor
- Anesthesia, Alberta Health Services, Calgary, Alberta, Canada
| | - Shaminder Singh
- School of Nursing & Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, Alberta, Canada
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Nygaard AM, Haugdahl HS, Laholt H, Brinchmann BS, Lind R. Professionals' narratives of interactions with patients' families in intensive care. Nurs Ethics 2022; 29:885-898. [PMID: 35196935 PMCID: PMC9289990 DOI: 10.1177/09697330211050995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: ICU patients’ family members are in a new, uncertain,
and vulnerable situation due to the patient’s critical illness and complete
dependence on the ICU nurses and physicians. Family members’ feeling of being
cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with
critically ill ICU patients´ families and discuss this in light of the ethics of
care. Research design: A qualitative study using participant observation,
focus groups, and thematic narrative analysis. Participants and research context: Data were gathered from July 2017
to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven
focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and
Health Research Ethics and the Norwegian Centre for Research Data approved the
study. Findings: Quality of ICU family care depends on nurses’ and
physicians’ attitudes, behavior, and personality traits. Three main themes were
identified: being attentive, an active
approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of
care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant
clinicians represent a culture of ethical care that gives families greater
freedom of action and active participation in patient care. Clinicians must not
bear sole responsibility for this culture; it must have a firm basis in the
hospital and ICU and be established through training, interprofessional
reflection, and support of clinicians.
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Affiliation(s)
- Anne M Nygaard
- Department of Health and Care Sciences, 60482UiT, The Arctic University of Norway, Tromso, Norway
| | - Hege S Haugdahl
- Department of Public Health and Nursing, Levanger Hospital, 60500Nord-Trøndelag Hospital Trust and NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Hilde Laholt
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Troms, Norway
| | | | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Harstad, Norway
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Adel TZVD, van Dijk M, de Heer M, Hoekstra S, Steenhorst J, van Rosmalen J, Verbruggen S, Toussaint-Duyster L, Ista E. Quality improvement intervention to stimulate early mobilization of critically ill children. Nurs Crit Care 2022. [PMID: 35191161 DOI: 10.1111/nicc.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immobility during hospital stay is associated with muscle weakness, delirium, and delayed neurocognitive recovery. Early mobilization of critically ill adults improves their physical functioning and shortens the duration of mechanical ventilation. However, comparable research in children is lacking. AIMS To determine the effects of the implementation of an early mobilization (EM) program on mobility activities for critically ill children and to explore barriers and facilitators and clinical outcomes before and after implementation. STUDY DESIGN A prospective single-centre before-and-after study. METHODS This study was conducted in a PICU of a large tertiary hospital. Children aged from 3 months to 18 years, with an expected stay of ≥3 days were eligible to participate. In the "before" phase, participants received usual care; in the "after" phase we implemented a multicomponent, multidisciplinary EM protocol. The primary outcome was a change in the process outcome "mobilization activities". Secondary outcomes were PICU staff opinions on mobilization (survey), safety, process measures, involvement of parents and physical therapist, and clinical outcomes (sedative use and prevalence of delirium). RESULTS A total of 113 children were included; 55 before and 58 after, with a median age of 31 months (IQR: 10-103) and 35 months (IQR: 7-152), respectively. The number of mobilization activities (per patient per day) had significantly increased from 5 (IQR: 2-7) to 6 (IQR: 4-8) (U = 272185.0; p < .001). PT consultations for mobilization had significantly increased from 23.6% (13/55) to 46.5% (27/58) (X2 = 6.48; p = .011). In both phases, no mobilization-related adverse events were documented. The survey showed that PICU staff found EM of critically ill children useful and feasible. In the after phase, PICU staff rated the perceived benefit of the support of the physical therapist during mobilization activities significantly higher than in the before phase (X2 = 34.80; p < .001). CONCLUSIONS Implementation of a structured EM program for critically ill children is feasible and safe. RELEVANCE TO CLINICAL PRACTICE It is suggested to start the implementation of a structed EM program with the idendentification of local barriers and facilitators by an interdisciplinary PICU team. Further, an increased presence of physiotherapists on the PICU would improve mobilisation levels, and facilitate mobilisation in critically ill children. Also, they can support and advice PICU nurses and parents in mobilising children.
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Affiliation(s)
- Tabitha Zanen-van den Adel
- Department of Orthopedics, Section Physical Therapy, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mariska de Heer
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sjoukje Hoekstra
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Judith Steenhorst
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sascha Verbruggen
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Leontien Toussaint-Duyster
- Department of Orthopedics, Section Physical Therapy, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation(s)
- Sarah Vollam
- Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Nikolaos Efstathiou
- School of Nursing, University of Birmingham, United Kingdom of Great Britain and Northern Ireland
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Bersaneti MDR, Whitaker IY. Association between nonpharmacological strategies and delirium in intensive care unit. Nurs Crit Care 2022; 27:859-866. [PMID: 35052018 DOI: 10.1111/nicc.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several nonpharmacological strategies for the prevention and treatment of delirium have been increasingly used because the aetiology of delirium is multifactorial. AIMS To verify the association between nonpharmacological strategies (presence of companion, mobilization, absence of physical restraint and natural light) and the occurrence of delirium, and to identify risk factors for delirium in intensive care unit (ICU) patients. STUDY DESIGN The study was conducted in a Brazilian medical and surgical ICU. The sample included patients older than 18 years with length of ICU stay greater than 24 h and without delirium on admission. Delirium was identified by applying the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). The association between the variables and delirium was analysed using Mann-Whitney and chi-square tests, and multivariate logistic regression to identify the predictive factors. RESULTS Of the 356 patients, 64 (18%) had delirium. The presence of a companion, mobilization, and physical restraint were associated with delirium, and the first two were identified as protective factors. That is, the odds of delirium decreased by 88% when a companion was present and by 95% when the patient was mobilized. The risk factors of delirium were length of ICU stay and age. CONCLUSIONS The presence of a companion and patient mobilization were identified as protective factors against delirium, highlighting their importance as preventive actions, especially in patients with a higher risk of developing this disorder. The findings regarding physical restraint can also be considered evidence indicating the need for careful use of this measure in clinical practice until evidence of its relationship with delirium is confirmed. RELEVANCE TO CLINICAL PRACTICE The implementation of strategies such as early mobilization, presence of a companion and careful assessment for the use of physical restraint by the multidisciplinary team can help control the occurrence of delirium in the ICU.
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Monesi A, Imbriaco G, Mazzoli CA, Giugni A, Ferrari P. In-Situ Simulation for Intensive Care Nurses During the COVID-19 Pandemic in Italy: Advantages and Challenges. Clin Simul Nurs 2022; 62:52-56. [PMID: 34721739 PMCID: PMC8542439 DOI: 10.1016/j.ecns.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic required a global increase in intensive care unit (ICU) resources and the recruitment of a great number of nurses without any tprior critical care experience. The opportunities for traditional education and supervised clinical training were limited to prevent infections. The massive increase of nursing staff resources required a rethinking of the usual educational strategies for newly acquired nurses. This short communication describes our experience of an "in-situ" simulation training course in an Italian tertiary level hospital. A series of two-part classes were structured with short lectures on fundamental principles of intensive care nursing and brief hands-on sessions, and a set of simulated scenarios, based upon the most common situations to be faced in the ICU. In-situ simulation offers greater realism and transferability and represents a cost-effective strategy, avoiding the costs and the maintenance of a dedicated simulation center. The simulated multidisciplinary teamwork in the real ICU setting contributes to an effective experiential learning, improving staff familiarity with devices, equipment, and environment, and allows trainees to improve both technical and nontechnical skills.
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Affiliation(s)
- Alessandro Monesi
- Intensive Care Unit, Maggiore Hospital, Bologna, 40133, Italy
- Critical Care Nursing Master course, University of Bologna, Bologna, Italy
| | - Guglielmo Imbriaco
- Critical Care Nursing Master course, University of Bologna, Bologna, Italy
- Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital, Bologna, 40133, Italy
| | - Aimone Giugni
- Division of Anesthesia, Intensive Care, and Prehospital Emergency, Maggiore Hospital, Bologna, 40133, Italy
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Marinaki C, Kapadochos T, Katsoulas T, Rubbi I, Liveri A, Stavropoulou A, Bonacaro A, Papageorgiou D. Early versus Late Tracheostomy Promotes Weaning in Intensive Care Unit Patients: a retrospective observational study. Acta Biomed 2022; 93:e2022152. [PMID: 35545976 PMCID: PMC9534218 DOI: 10.23750/abm.v93is2.12998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/01/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND AIM The time interval between the patients' intubation and the performance of a tracheostomy has been considered as critical for the disease prognosis and outcome. The aim of the present study was to compare and contrast the outcomes of early vs late tracheostomy with regard to ICU patients' weaning from respiratory support. METHODS This retrospective observational study, involved patients who were hospitalized in two general and one Covid-19 ICUs of two tertiary hospitals in Athens and were subjected to tracheostomy. Data were collected from the patients' medical records in order to estimate the duration of patient weaning and the number of days from the patients' intubation until the time of tracheostomy. In the present study the term earlytracheostomy denotes tracheostomy performed within 14 days from patient intubation and late tracheostomydefines the tracheostomy carried out after 14 days. For Covid-19 patients, guidelines suggested that tracheostomies should be performed 21 days following intubation, due to the high risk of virus transmission. RESULTS One hundred and thirty-one patients who underwent tracheostomy participated in the study. Most tracheostomies were performed using the percutaneous technique. The group of patients tracheostomized within 14 days after their admission in ICU weaned faster from respiratory support compared to ones who were tracheostomized after 14 days. CONCLUSIONS The most common distinction between early and late tracheostomy is 14 days, with early tracheostomy being more beneficial in terms of patients' outcomes, and specifically ICU patients' weaning.
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Affiliation(s)
| | | | - Theodoros Katsoulas
- Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | - Ivan Rubbi
- Contracted Lecturer, School of Nursing, University of Bologna, Italy
| | - Athanasia Liveri
- Department of Statistics and Insurance Science, University of Piraeus, Greece
| | | | - Antonio Bonacaro
- School of Health and Sports Sciences, University of Suffolk, Ipswich, United Kingdom
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Abstract
BACKGROUND/OBJECTIVE Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain. METHODS A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24. RESULTS A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett's Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis. CONCLUSION The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate.
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Affiliation(s)
- Yeray Gabriel Santana-Padilla
- Surgery Unit of the Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
| | | | - Luciano Santana-Cabrera
- Intensive Care Unit of the Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Canary Islands, Spain
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