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Background: In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. Aim: To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. Research design: The study used a qualitative approach with an interpretive descriptive design. Research context and participants: Twenty critical care nurses from eight intensive care units in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. Ethical considerations: This study was approved by The Swedish Ethics Review Authority. Findings: Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients' deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. Conclusion: Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context. [ABSTRACT FROM AUTHOR]

Backgrounds: Moral distress significantly affects pediatric ICU nurses, leading to nurse burnout, increased turnover and reducing patient care quality. Despite its importance, there's a notable gap in knowledge on how to manage it effectively. Aims: This review aimed to systematically identify and analyze coping strategies and interventions targeting moral distress among pediatric nurses in ICU, uncovering research gap and future studies directions. Methods: A scoping review was conducted followed framework by Levac, Colquhoun, and O'Brien and Arksey and O'Malley. Searches were performed in 11 electrical databases, like PubMed and China Biology Medicine disc, within a timeframe of the database construction to November 2023, and performed literature screening and data extraction. Results: Sixteen articles were ultimately included. Coping strategies adopted by pediatric ICUs nurses can be categorized into adaptive and maladaptive strategies, with the latter including passive acceptance, taking leave, and drinking, while the former involve pursuing interests outside of work, reflection and philosophizing, and communication. Nine articles described and evaluated the effectiveness of interventions for moral distress, categorizing them into individual and institutional levels. Individual-level interventions include Interprofessional Perspective-Taking, the PICU Resiliency Bundle, Ethics Education/Skills, and the Center for Caring. Institutional-level interventions encompasses Comprehensive Care Round, Goals of Care Conversations, Pediatric Ethics and Communication Excellence Rounds, Nursing Ethics Council, and Medical Ethical Decision-Making, though not all were effective in alleviating moral distress. Conclusions: Nurses often use self-adjustment strategies for moral distress, institutional ethical support focusing on enhancing nurses' moral resilience, promoting reflective thinking and improving communication remains crucial. Various interventions for moral distress are currently available, but nurse engagement is low and their effectiveness remained to be verified. Future studies should explore what aids or hinders these interventions. There's also a need for large, multicenter trials and ongoing evaluations to create effective support systems for pediatric ICU nurses. [ABSTRACT FROM AUTHOR]

Background: Enteral feeding intolerance (EFI) occurs in more than one-third of mechanically ventilated patients, yet the cause of this gastrointestinal dysfunction remains unclear. Assessment and diagnostic criteria are often vague and subjective leading to inaccurate recognition or diagnosis of EFI. Nurses are often unsure or unaware of appropriate assessment methods. Objectives: The objective of this descriptive study was to determine current practice for assessment of EFI among critical care nurses. Methods: A national survey to explore EFI assessment practices was conducted with critical care nurses at the American Association of Critical-Care Nurses National Teaching Institute conference in 2022. Nurses completed a 19-item survey to determine assessment practices for EFI among critical care nurses. Results: A total of 344 nurses completed the survey. The majority of nurses practiced direct care at the bedside for adult critical care patients, held a bachelor's degree, had 6 to 15 years of nursing experience, and held specialty certification. There was variability among responses to the practice questions in the survey. Seventy-eight percent of the nurses were aware of and had cared for patients with EFI. EFI was assessed by 84% of participants. The most common assessment criterion for EFI was nausea and vomiting. The majority (81%) of respondents measured gastric residual volume routinely or sometimes. Discussion: This study shows assessment of EFI is not standardized among nurses. This study identifies a need for education about EFI given the lack of understanding of EFI. Findings from this study can be used to inform future research to develop best methods for assessing the presence of EFI. [ABSTRACT FROM AUTHOR]

In the study, it was aimed to determine the experiences of elderly COVID-19 patients hospitalized in intensive care units. The study was conducted based on the phenomenological design, one of the qualitative research methods. In-depth interviews were conducted using a semi-structured interview form with 15 participants, who were determined by the homogeneous and criterion sampling methods, two of the purposive sampling methods. Data were analyzed using Colaizzi's seven-step method. After the interviews, four themes were determined: intensive care experiences, importance of nursing care, intensive care environment and coping mechanisms related to COVID-19 disease, and post-intensive care realizations. In addition, 13 sub-themes were determined. This study provided a better understanding of the psychological experiences of elderly individuals during the disease, who have been hospitalized in intensive care unit and survived COVID-19. [ABSTRACT FROM AUTHOR]

Background: The development of nursing competencies in antimicrobial stewardship (AMS) is influenced by a two-dimensional model, encompassing both internal and environmental factors. In the context of Italian clinical nursing, this study aims to assess and measure these aspects. Methods: Employing a cross-sectional online survey design, nurses from various clinical specialties in Italy were involved. The questionnaire assessed individual variables, knowledge, attitudes, practices, as well as structural and process-related variables influencing AMS. Statistical analyses were performed, encompassing descriptive statistics, Pearson correlation, and multiple linear regression. Results: A total of 1,651 nurses aswered the survey, with a participation rate of 50.8%. The participant demographic revealed that 77% were female, and they had an average of 15 years of experience. Workplace and regional factors were found to significantly impact both AMS practices and attitudes. Surgical nurses reported higher practices scores (β = 0.467, P <.01), while critical care nurses scored lower (β= -0.398, P <.01). Regarding perceptions of structure, workplace characteristics significantly influenced nurses' scores, indicating lower perceptions among surgical nurses compared to their medical counterparts (β= -0.315, P <.01). Conclusions: The study reveals the intricate interplay between internal and external factors that impact nurses' AMS competence. This underscores the urgent need for targeted interventions and education initiatives to enhance nurses' AMS competencies. Specifically, addressing variations in settings and nurses' behaviours becomes imperative for achieving improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Work-related musculoskeletal disorders (WRMSDs) are significant concern in intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU nurses, providing valuable insights for targeted interventions. Methods: In this six-month convergent mixed methods study, 200 consenting nurses with over one year of experience from seven ICUs across three public tertiary hospitals of Ahmedabad participated. Structured questionnaires were used to collect data on socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain (through modified Nordic Musculoskeletal Questionnaire) and ergonomic issues using REBA (Rapid Entire Body Assessment) scale. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analysis involved chi-square, t-test and logistic regression, with a significance level set at p < 0.05. Thematic analysis was used to interpret the findings of qualitative study. Results: The study included predominantly female ICU nurses (78%) with a mean age of 34 years. A high prevalence of WRMSDs (84%) was observed, with the lower back and neck being the most affected regions. Nurses with WRMSDs reported significantly higher mean scores for physical factors (15.1 vs. 11.1, p = 0.00), physical workload (12.8 vs. 10.7, p = 0.001), work environment (13.1 vs. 10.1, p = 0.00), and risk perception (11.8 vs. 8.9, p = 0.00) compared to those without WRMSDs. Logistic regression identified key risk factors for WRMSDs, including longer ICU tenure [OR = 1.4 (1.13–1.66)], high shift frequency [OR = 2.7 (1.27–5.95)], higher physical factor score [OR = 1.2 (1.05–1.42)], higher physical workload score [OR = 1.2 (1.09–1.49)], higher risk perception [OR = 1.3 (1.10–1.78)], and lack of exercise [OR = 0.5 (0.27–0.93)]. The qualitative findings highlighted key ergonomic challenges, including inadequate equipment, heavy patient loads, poor posture during tasks, and insufficient breaks, contributing to WRMSDs among ICU nurses. Conclusion: The findings underscore urgent need for targeted interventions to address risk factors associated with WRMSDs, including ergonomic training, workplace modifications, and education programs to enhance risk awareness and preventive behaviours. Future research should focus on developing and evaluating comprehensive interventions that integrate both physical and work environment factors to effectively mitigate WRMSDs among ICU nurses. [ABSTRACT FROM AUTHOR]

Background: Intensive care nurses frequently encounter ethical issues with potentially severe consequences for nurses, patients, and next of kin. Therefore, ethical issues in intensive care units (ICU) should be recognized and managed. Research objectives: To analyze ethical issues reported by intensive care nurses and how reported issues were managed within the organization using register data from the HaiPro critical incident reporting system (CIRS), and to explore the suitability of this system for reporting and managing ethical issues. Research design: This was a retrospective descriptive register study. CIRS reports on ethical issues in adult ICUs (n = 12) in one hospital district in Finland over 25 months (2019–2021) were analyzed through inductive content analysis and descriptive quantification. The CIRS's suitability for reporting and managing ethical issues was evaluated through a strengths, weaknesses, opportunities, and threats (SWOT) analysis. Ethical considerations: The study was approved by the University Ethics Committee, and permission to conduct the research was granted before data collection within the organization. Results: CIRS reports on ethical issues (n = 35) made by nurses were found in seven of the 12 ICUs. The CIRS managers of these units managed these reports. The ethical issues described by the nurses were divided into four main categories: nature, situational information, consequences, and contributing factors. Management of reported ethical issues was divided into three main categories: preventive actions proposed by nurses, proposals for actions by CIRS managers, and actions taken by CIRS managers. Conclusions: Systematic register data broadly describe ethical issues and their management, indicating that the CIRS could be suitable for reporting and managing ethical issues, thereby enabling the monitoring and development of ethical quality at the unit and organizational levels. [ABSTRACT FROM AUTHOR]

Background: Central venous catheters (CVCs) are used in pediatric patients to deliver IV fluids, blood products, medications, and nutrients. Potential complications include central line infection, which carries a high risk of morbidity and mortality in this population. Pediatric critical care nurses play a crucial role in helping to reduce the risk of infection. Purpose: The aim of this study was to develop, implement, and evaluate the effectiveness of a serious, simulated, gaming-based intervention to improve the skills and knowledge of RNs in the early stages of their career regarding central line insertion, care, and infection prevention. Methods: A single-arm, pre- and postinterventional pilot study was conducted at the Riley Hospital for Children at Indiana University Health, from July 2021 to July 2022. The study participants were bedside pediatric critical care nurses who were provided with education and skills training regarding CVC placement and maintenance through a so-called serious game—essentially, a video game with a purpose. A simulation session and multiple-choice knowledge test were used to assess skills and knowledge retention both before and after the intervention. Results: A total of 32 pediatric critical care nurses participated in the study; however, 1 nurse did not complete the follow-up assessment. The study revealed a statistically significant increase in the overall mean (SD) global performance score from 4.06 (2.11) before the intervention to 5.97 (1.80) afterward. Specific areas of performance also showed significant improvement: handwashing prior to the procedure (P = 0.04), covering the procedure site (P = 0.01), cleaning the site properly (P < 0.01), and ensuring central line placement before use (P < 0.01). However, there was no statistically significant difference in the nurses' performance on the multiple-choice knowledge test before and after the intervention. Conclusion: This study suggests that serious games have the potential to improve nursing education, particularly in complex procedures like central line insertion and maintenance. Our findings indicate that serious gaming is effective in engaging learners and enhancing their skills. More research is needed to evaluate the long-term impact of serious games on learning outcomes and patient care. This study evaluated the effectiveness of a serious, simulated, gaming-based intervention to improve nurses' skills and knowledge regarding central line insertion, care, and infection prevention. [ABSTRACT FROM AUTHOR]

Background: Endotracheal tube (ETT) placement is crucial for neonates with respiratory failure. Ultrasonography (US) has emerged as a valuable tool to detect ETT positioning, competing with traditional methods. Nurses, being front-line caregivers, can perform basic ultrasound examinations. This study aimed to assess whether a nurse inexperienced in US could identify the correct ETT position in neonates after a brief ultrasound training. Methods: This study included intubated neonates hospitalized in a NICU with a postmenstrual age of under 45 weeks. A NICU nurse, following a short ultrasound training, measured the distance of the ETT tip to the right pulmonary artery and aortic arch. Chest X-rays (CXRs) confirmed the ETT position. The neonates' ages, genders, weights, and examination times were recorded. Results: This study involved 67 neonates, including 40 (59.7%) males, with 39 (58.2%) weighing below 1500 g. The median time for correct ETT placement confirmation by CXR was 12.6 min, while US-assisted ETT recognition took 6 min initially and 5.1 min at the end of the training, which was a significant difference. No major differences were found in US distance based on the neonate's weight and age. Gender marginally influenced US distance (β = −0.089, p = 0.056). Conclusions: The NICU nurse responded well to ultrasound training, showing results comparable with CXR. Further studies with more patients and additional studied factors are needed to fully assess US's reliability in determining ETT positioning. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To appreciate that transferring critical care patients to the imaging department can compromise their safety • To recognise that using transfer checklists can enhance preparation and reduce patient safety incidents • To read about the development and evaluation of a transfer checklist at an intensive care unit in England. Critically ill patients often need to be transferred from the intensive care unit (ICU) to the imaging department. This can compromise their safety, not only because of the inherent risk of deterioration but also because of the potential for incidents due to the inadequate preparation of medicines, equipment and monitoring. Using a patient transfer checklist can reduce the risk of human factor errors. This article reports on a quality improvement project conducted at the ICU of an acute hospital trust in the Midlands to develop and evaluate a patient transfer checklist. The checklist was developed based on guidance from the Intensive Care Society and evaluated using retrospective incident reports, an audit of staff compliance and a user survey. Using a transfer checklist in the ICU is likely to reduce patient safety incidents during transfers, but a shift in workplace culture may be needed to enhance incident reporting. [ABSTRACT FROM AUTHOR]

Background: Patient and family satisfaction with care in intensive care units is not reflected in Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Gaps may be unknown. Local Problem: In a cardiothoracic intensive care unit, patient satisfaction scores were not assessed and gaps could not be addressed. The primary aim was to obtain baseline data on patient and family satisfaction. The secondary aim was to improve identified gaps in satisfaction. Methods: A preintervention-postintervention, 2-cycle quality improvement project and a 12-month sustainability assessment were conducted to evaluate patient and family satisfaction in a cardiothoracic intensive care unit in a large academic health system from August 2022 to August 2023. The Nursing Intensive Care Satisfaction Scale was used to measure patients' satisfaction and the European Quality Questionnaire was used to measure family members' satisfaction with intensive care unit nursing care. Standardized scripting, processes for patient and family engagement during rounds, and structured communication were used to enhance patient and family engagement. Results: At baseline (47 patients, 35 family members), overall patient and family satisfaction was high (mean [SD] satisfaction scores: patients, 87.6 [19.3]; family members, 94.6 [9.7]; P =.06). After intervention cycle 2, family members (n = 50) had high mean satisfaction scores on the Information Needs sub-scale of the European Quality Questionnaire. Family participation in rounds improved from 18.5% of rounds at baseline to 76.5% after intervention cycle 2 and was 61.5% at 12 months. Conclusion: Strategies that engage family members in rounds improve communication and satisfaction. [ABSTRACT FROM AUTHOR]

Background: Prolonged intubation has been associated with unfavorable outcomes after cardiac surgery. A standardized approach is needed to ensure prompt extubation and shorten intensive care unit stays. Local Problem: This quality improvement project was designed to evaluate the impact of a fast-track extubation protocol on time to extubation and intensive care unit length of stay. Methods: The intervention group consisted of 26 adult cardiac surgery patients who underwent the fast-track extubation protocol. A Mann-Whitney test was used to compare time to extubation and intensive care unit length of stay in this group with those of a pair-matched control group of patients from the previous year who did not undergo the fast-track extubation protocol. Interventions: An evidence-based literature review was used to develop a fast-track extubation protocol involving extubation in less than 6 hours. An educational activity was created to improve intensive care unit staff members' knowledge of the fast-track extubation protocol, and its effectiveness was measured by a posttest score of 80%. Results: The percentage of patients with extubation times of less than 6 hours was significantly higher in the fast-track extubation protocol group than in the pair-matched control group (U = 179, P =.003). The mean intensive care unit stay decreased from 2.92 days in the control group to 1.85 days in the fast-track extubation protocol group. Conclusion: Implementing a fast-track extubation protocol for adult cardiac surgery patients shortened time to extubation and intensive care unit stay, expediting and improving recovery processes in the intensive care unit. [ABSTRACT FROM AUTHOR]

Background: In critical care settings during night shift, the number of staff members is reduced and a designated time for structured patient care discussions is often absent. The absence of organized collaboration and shared decision-making strains professional relationships. Local Problem: In a 21-bed cardiovascular intensive care unit, advanced practice providers were frequently interrupted by night shift nurses to discuss nonurgent clinical matters while engaged in patient care activities. Methods: This quality improvement project used a preintervention-postintervention design. Surveys were distributed to advanced practice providers and nurses to determine perceptions of communication. All advanced practice providers and nurses working night shift in the cardiovascular intensive care unit were included. Nightly bedside rounds for advanced practice providers and nurses using a goal sheet to improve communication were implemented in the cardiovascular intensive care unit. Preintervention and postintervention scores on survey subscales (perceptions of collaboration, workflow, and communication) were examined with analysis of variance for both groups. Results: Mean scores increased after the intervention for both advanced practice providers and nurses. Scores for perception of collaboration significantly increased for both advanced practice providers and nurses (both P =.01). The score for perception of workflow significantly increased for nurses (P <.001) but not for advanced practice providers. Scores for perception of communication did not significantly change for either group. Conclusion: Implementation of bedside rounds using a goal sheet for advanced practice providers and nurses working night shift in the cardiovascular intensive care unit improved perceptions of collaboration and workflow. [ABSTRACT FROM AUTHOR]

Introduction: Prone ventilation is a standard treatment for acute respiratory distress syndrome, and its clinical benefits are well established. However, implementing prone positioning safely and effectively is challenging in patients who are pregnant, have intra-abdominal hypertension, or are in other high-risk groups. Clinical Findings and Diagnosis: A patient in the third trimester of pregnancy (28 weeks and 6 days of gestation) developed a body temperature of 39 °C and severe respiratory distress. She was transferred to the intensive care unit, received noninvasive ventilation, and ultimately underwent endotracheal intubation. Because her oxygenation index remained below 100, she received a diagnosis of severe acute respiratory distress syndrome. Interventions: The patient was safely placed in the prone position with a swim ring while receiving venovenous extracorporeal membrane oxygenation. During this period, her intra-abdominal pressure did not increase significantly. Outcomes: The fetus was delivered by cesarean birth, and the patient was transferred to the general ward after extubation. Conclusion: This case report describes the use of prone positioning in a pregnant patient. The report offers critical care nurses insights into the clinical management of patients who are pregnant or have intra-abdominal hypertension. [ABSTRACT FROM AUTHOR]

A specialty certification test which measures the expertise of nurses in caring for critically ill patients and patients who underwent cardiac surgery is presented.

Background: Hospital-acquired pressure injuries are a significant patient safety concern. The Centers for Medicare & Medicaid Services tracks hospital-acquired pressure injuries as a patient safety indicator. Health care organizations with higher-than-expected rates may incur penalties. Local Problem: The pressure injury prevalence rate in a cardiothoracic intensive care unit was above the National Database of Nursing Quality Indicators benchmark. The current standard of care—use of the Braden scale for pressure injury risk assessment and the SKIN (surface, keep turning, incontinence care, and nutrition) care bundle—may not adequately address the needs of the intensive care unit population. In addition, cardiac patients present a special challenge because of their disease process and the mechanical support devices used to treat patients in cardiogenic shock, which place them at risk for the development of hospital-acquired pressure injuries. Methods: A performance improvement project was carried out in the cardiothoracic intensive care unit to reduce the prevalence and incidence of hospital-acquired pressure injuries. A preintervention convenience cohort was compared with a postintervention cohort. The intervention consisted of use of the Cubbin-Jackson scale, an intensive care unit–specific risk-assessment tool, with linked interventions to prevent pressure injuries. Results: The preintervention and postintervention cohorts consisted of 102 patients each. The pressure injury prevalence and incidence rates decreased by 67.84% and 36.43%, respectively, from before to after the intervention. Conclusion: The use of an intensive care unit–specific risk-assessment tool with linked interventions to prevent pressure injury can help reduce hospital-acquired pressure injuries in an intensive care unit. [ABSTRACT FROM AUTHOR]

Copyright of ProCare is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patients hospitalized outside of monitored environments may experience sudden clinical worsening requiring transfer to the Intensive Care Unit. Early detection based on the clinical nurse's identification of the risk of clinical deterioration represents an opportunity to prevent serious adverse events. Nurse worry is defined as the use of clinical reasoning combined with intuition that precedes the patient's clinical deterioration. Objective: The objective of this study was to evaluate nurse worry as a trigger for rapid response team activation in patients hospitalized in non-critical units and its association with the need in ICU admission. Methods: This retrospective cohort study utilized data retrieved from an anonymized institutional database used to monitor the actions of the rapid response team. Data collected from January 2021 to December 2022 were analyzed, encompassing patients over 18 years old admitted to non-critical units and evaluated by the rapid response team. Analyzed variables included demographic characteristics, MEWS score, and causes for activating the rapid response team, such as changes in vital signs and nurse worry. Main outcomes assessed were transfer to the ICU, medical procedures, and drug administration. Patients were divided into three groups for analysis: those triggered for RRT assessment exclusively by changes in vital signs, those triggered exclusively by nurse worry and those triggered by the nurse worry combined with changes in vital signs. Results: A total of 4634 rapid response team consultations were included, with 1574 triggered by changes in vital signs, 1263 triggered by nurse worry and 1797 triggered by the nurse worry associated with changes in vital signs. The group with nurse concern showed a lower need for transfers to the ICU (40%) compared to the group with changes in vital signs (50%) p < 0.001 although there was no difference in relation to the need for medical procedures,17% in both groups. Conclusion: The NW emerges as a relevant factor in triggering RRT and may be associated with improved outcomes, such as reduced need for ICU transfers. However, the observational design of the study does not allow for establishing causal relationships. [ABSTRACT FROM AUTHOR]

Background: Intensive care unit (ICU) nurses work under heavy workloads, which can lead to serious consequences for nurses' outcomes and patient safety. This study aimed to examine the relationship between professional quality of life (Pro QOL), and sleep quality among ICU nurses during the COVID-19 outbreak. Methods: A cross-sectional and multicentre study was conducted on 253 nurses in 20 COVID-19 ICUs in four major teaching hospitals from July 2021 to June 2022. Data were collected via a demographic information form, the Professional Quality of Life Scale, and the Pittsburgh Sleep Quality Index (PSQI). Results: Nurses in COVID-19 ICUs experienced moderate levels of compassion satisfaction, compassion fatigue, and poor sleep quality. The mean scores of the Pro QOL dimensions were 33.49 ± 6.77, 32.28 ± 8.83, and 29.58 ± 11.67 for compassion satisfaction, burnout, and secondary traumatic stress, respectively. The results revealed that 220 (87%) of the nurses experienced poor sleep quality. A significant relationship was shown between the Pro QOL dimensions and the mean total score of sleep quality, which can predict 0.45% of the variance (F = 7.11, p < 0.001, adjusted R2 = 0.45). Conclusion: Our results confirmed the link between the Pro QOL and sleep quality among ICU nurses. It is suggested that nurse managers implement practical interventions to improve the QWL of nurses in the ICUS. This will subsequently lead to improved outcomes for nurses and ensure patient safety. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Paediatric emergency and critical care require skilled nurses, but they often face a lack of motivation during continuing professional development. Motivation‐based, engaging activities in training programmes are essential to sustain interest and improve learning outcomes in these high‐stress environments.This study aims to develop, implement and evaluate the effectiveness of a Paediatric Emergency Course (PEC) using the ARCS (Attention, Relevance, Confidence, Satisfaction) Motivational Design Model to equip nurses with the knowledge and skills needed to manage paediatric patients in emergency and critical care settings.The study employed a quasi‐experimental pretest/post‐test design. The PEC was conducted from 1 June to 31 December 2023, with the participation of 57 nurses working in emergency and critical care units. To evaluate the programme's effectiveness, a paired t‐test was used for pre‐test and post‐test comparisons, and logistic regression analysis was conducted to determine the factors affecting course success (lecture test activities and motivational tactics).Pre‐lecture assessments averaged 9.55, significantly increasing to 16.88 post‐lecture (out of 22), indicating a substantial improvement in knowledge after the lecture series (t = −20.26, df = 55, p < .001; 95% CI [−8.05, −6.60]). Similarly, pre‐course scores rose from 7.21 to 17.14 post‐course (out of 25), reflecting significant gains in overall understanding and competency (t = −20.83, df = 56, p < .001; 95% CI [−10.89, −8.97]). Logistic regression analysis demonstrated that a one‐unit increase in post‐lecture test scores increased the likelihood of course success by 22.5%, with an odds ratio of 1.225 (B = .203, SE = 0.092, p = .028; 95% CI [1.023, 1.468]). Additionally, motivational design significantly influenced course success, increasing the likelihood by 433.3%, with an odds ratio of 5.333 (B = 1.674, SE = 0.363, p < .001; 95% CI [3.134, 9.074]).The PEC continuing education programme, developed using the ARCS Motivational Design Model to support the professional development of nurses in emergency and critical care, was successfully implemented. These results suggest that both knowledge acquisition and motivational factors play a substantial role in enhancing course success among participants. Significant improvements in pre‐ and post‐test results, along with high scores on the motivational design scale, demonstrated the effectiveness of the programme.The use of motivation‐enhancing tactics and strategies in training has led to successful outcomes, demonstrating that structured programmes designed with these methods can significantly improve the clinical competencies, expertise, decision‐making and patient safety of nurses working in paediatric emergency and critical care services in high‐pressure environments. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusions Relevance to Clinical Practice Early mobility is one strategy to reduce the harm from immobility that children experience in the paediatric intensive care unit (PICU). Early‐mobility programmes rely on nurses, who currently perceive insufficient training as a barrier to mobilizing critically ill children. Nurses have identified simulation as a strategy to improve implementation of early‐mobility protocols.To use adult learning theory to develop an early‐mobility simulation curriculum for nurses and to evaluate if the curriculum improves nursing self‐efficacy, knowledge and skills in mobilizing critically ill children.Using a curriculum development framework, an interprofessional team created a simulation curriculum. The educational strategies included group simulations, debriefing sessions and didactic sessions. The curriculum evaluation was conducted as quality improvement initiative using a pre‐post quasi‐experimental design to evaluate nurses' mobility self‐efficacy, knowledge and clinical skills.Eleven PICU nurses participated in the simulation‐based early mobility curriculum. Before participation in the curriculum, 73% of nurses felt fairly confident and no nurses felt confident mobilizing a PICU patient. After participation, 100% of nurses felt at least fairly confident mobilizing a PICU patient (p = .031). Knowledge scores improved from a median of 14 (IQR, 12–16) questions correct to 17 (IQR, 16–18) questions correct (p = .001). Nurses completed more required clinical tasks during the Observed Structured Clinical Examination, with improvement from a median of 15 items correct (IQR, 14–16) to 19 items correct (IQR, 15–20; p = .0037).Developing a simulation‐based early‐mobility curriculum for PICU nurses is feasible. Nurses who completed the curriculum had improved self‐efficacy, knowledge and clinical skills in mobilizing critically ill children.The findings of this study demonstrate that simulation is a potentially useful educational tool to teach nurses to safely and effectively mobilize critically ill children. The strategy should be evaluated further to determine if it impacts physical rehabilitation at the bedside. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim(s) Design Methods Results Conclusion Impact Patient or Public Contribution To investigate the correlation between compassion Fatigue, emotional labour and missed nursing care among intensive care unit nurses.A cross‐sectional design.Data were collected from two hospitals in Shandong Province, China, from July to August 2024. A total of 226 intensive care unit nurses completed the questionnaires. The completion rate for the surveys was 98%. The Demographic Characteristic Questionnaire, Chinese version of Compassion Fatigue‐Short Scale, Chinese version of Emotional Labor Scale and Chinese version of Missed Nursing Care Questionnaire were used for investigation. Descriptive statistics, Multiple‐linear regression and Spearman correlation analyses were used for data analysis.The mean (SD) scores of compassion fatigue, emotional labour and missed nursing care were 51.17 (24.64), 2.98 (0.51) and 37.71(14.11), respectively. Spearman correlation showed that compassion fatigue was positively associated with emotional labour (p < 0.05), and missed nursing care (p < 0.01). Furthermore, deep acting, a form of emotional labour, had a significant negative relationship with missed nursing care (p < 0.01).The nursing care was rarely missed among intensive care unit nurses, while compassion fatigue and emotional labour were positively associated with missed nursing care. Therefore, focusing on developing interventions for alleviating compassion fatigue and emotional labour may contribute to decrease the incidence of missed nursing care.The emotional state of intensive care unit nurses can have a significant impact on the quality of nursing care. It is recommended that nursing managers should promote relevant training in deep acting and instruct nurses to manage emotions during patient interactions, to decrease missed nursing care.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Nurses experience high levels of stress while providing end-of-life care, which puts them under emotional pressure, stress and conflict. Therefore, this study aimed to explain the experiences of nurses during the provision of end-of-life care in Iran. Methods: A qualitative descriptive study conducted using a conventional content analysis approach in Gorgan in 2023. A total of 11 nurses participated in this study, who were selected purposefully with maximum variation. Data were collected using semi-structured interviews and analysed using the five-step conventional content analysis method of Graneheim and Lundman (2004). Results: From the data analysis, three categories and seven subcategories emerged. The categories include: 'caring nature', 'structural challenges of the care system' and 'communication challenges'. Conclusion: Generally speaking, different types of stresses influence the performance of nurses that are involved in end-of-life care. By identifying some of these stressors, nurses, nursing managers and health policymakers can adopt supportive strategies to reduce the perceived stress and, consequently, improve the quality of end-of-life care by reducing the consequences of stress, such as burnout, moral distress and high job turnover. [ABSTRACT FROM AUTHOR]

Objective: This study's purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years' experience were significantly more likely to consider sedation scores helpful (P =.04) and also significant more likely to agree that delirium scores are used effectively (P =.01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years' experience were significantly less likely to express concerns to attending (P =.001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist. [ABSTRACT FROM AUTHOR]

Objective: To map nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in the context of intensive care. Design: Scoping review according to the Joanne Briggs Institute methodology. Methods: The search was carried out in the databases PubMed, CINAHL via EBSCO, Joanna Briggs Institute Database of Systematic Reviews, COCHRANE Database of Systematic Reviews, Repositório Científico de Acesso Aberto de Portugal, Dans Easy, and Dart-Europe. Published and unpublished studies (gray literature) were considered. This review integrates articles focused on nursing interventions that contribute to preventing posttraumatic stress in people hospitalized in intensive care in English, Portuguese, and Spanish. Studies with quantitative, qualitative, or mixed designs are covered, as well as systematic reviews and guidelines. The research has 3 eligibility criteria, following the PPC mnemonic: participants (studies involving adults hospitalized in intensive care), concept (studies that address nursing interventions that prevent posttraumatic stress), and context (studies developed in any contextual settings). Results: The present scoping review included 11 articles. Autonomous, nonpharmacologic, pharmacologic, and interdependent nursing interventions were identified, capable of contributing to prevent posttraumatic stress in people hospitalized in intensive care. Conclusion: Identifying nursing interventions that prevent posttraumatic stress in people hospitalized in intensive care allows nurses to develop care plans that include these interventions in the context of intensive care, with a view to improving the quality of nursing care provided. Implications for Clinical Practice: This scoping review demonstrated that nurses have a crucial role in the prevention of posttraumatic stress in the context of intensive care. It is intended to make nurses aware of this issue, specifically to obtain highly significant and clinically relevant results, sensitive to nursing interventions. It is hoped that this review will be the precursor of research studies, centered on evaluating the degree of effectiveness of the nursing interventions mapped in this review. [ABSTRACT FROM AUTHOR]

Background: The family support person role during resuscitation is complex and requires role preparation; however, there is a lack of guidance on preparing nurses for this crucial role. Objectives: To examine how critical care nurses prepared for the role of supporting families during resuscitation and their perceptions of the preparation needed to fulfill this role. Method: An exploratory-descriptive qualitative design guided the study. Individual, semistructured interviews with 16 critical care nurses yielded data for thematic analysis. All participants had been in the family support person role. Results: Three themes emerged: who should perform the family support person role, why role preparation is important, and how to prepare for the role. The themes captured participants' views about identifying and preparing individuals to support families during resuscitation. Discussion: Nurses are the ideal health care team member to support families during resuscitation. However, participants felt unprepared for this role, especially for communicating with families. Education and experience are important to prepare nurses to effectively enact the role to ensure positive outcomes for family members. [ABSTRACT FROM AUTHOR]

Background: Guideline-based care of patients requiring extracorporeal membranous oxygenation, a form of life support for patients with refractory respiratory and/or cardiac failure, requires a multidisciplinary approach, yet a detailed description of the ideal integration of teams of physicians, acute care nurse practitioners, critical care nurses, and other disciplines is lacking in the literature. Objectives: We sought to define team-based care of the patient receiving venovenous extracorporeal membrane oxygenation with an emphasis on the roles of the critical care nurse and the acute care nurse practitioner. Methods: A narrative literature review was conducted using the keywords or MeSH terms "team-based care" AND "ECMO" and "nurse practitioner" AND "ECMO." Electronic databases searched included PubMed, Cumulative Index for Nursing and Allied Health Literature, and PsycINFO. Results: Sixty-five articles met the search criteria, with 21% (n = 10) focusing on characteristics of team-based care for patients receiving ECMO. Articles describe the ideal composition of teams and their education and training, frameworks for the formation of ECMO teams, and aspects of communication. One article details the role of the acute care nurse practitioner in managing ECMO, but several omit or barely describe the nurse's role as a team member. Discussion: No articles were found that specifically define the key elements, structure, and dynamics of effective team-based care of the patient receiving ECMO. A holistic definition of team-based care of the patient receiving ECMO is proposed. Further research is warranted to correlate aspects of team-based care that optimize patient, team, and organization outcomes. [ABSTRACT FROM AUTHOR]

Background: The neonatal stage is critical due to the high risk of mortality. The Neonatal Intensive Care Unit (NICU) is essential for preterm infants but can also increase the risk of developmental disorders. Various early intervention programs for preterm babies are being tested and combined into a developmental care model. This study aims to identify the components, content, and interventions of a developmental care model for preterm babies suitable for implementation in Indonesia. Methods: A modified Delphi study with three survey rounds was conducted. In the first round, six experts, including practitioners and academics, were selected. Practitioners were NICU nurses with over 10 years of experience, speakers on developmental care, and those applying it in practice, with research and publications on neonates. Academics were pediatric lecturers, researchers on preterm infant care, and those with relevant training. In the second and third rounds, 30 panelists (nurses or midwives with over 5 years of NICU experience) participated. Results: The first-round expert panel consisted of six experts (100% female) with 13-25 years of service: practitioners (66.7%) and academics (33.3%). For the second and third rounds, the panel included 30 experts (100% female): nurses (73.3%) and midwives (26.7%). Consensus was achieved in the third survey round with 75% cumulative agreement on interventions and training materials. The developmental care model comprised eight components with 126 interventions and 26 training materials. Conclusion: The study identified components, content, interventions, and training metrics for developmental care in NICU nursing practice for preterm babies. Future research should observe neonatal nurses implementing the seven basic developmental care interventions. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Nurses working in intensive care units experience insomnia and accompanying psychosocial problems due to working conditions.This study explores with a phenomenological approach the psychosocial problems experienced by intensive care nurses regarding sleep patterns within the scope of working conditions.In this phenomenological study, semi‐structured in‐depth interviews were conducted with 16 nurses working in the surgical intensive care unit of a state hospital in Türkiye. Criterion sampling method, one of the purposive sampling methods, was used to reach the sample group. Researchers' interviews continued until they reached data saturation. All interviews were recorded on a voice recorder after obtaining the necessary permissions from the nurses and then transcribed. The study data were evaluated using thematic analysis. The current manuscript was reported following the COREQ checklist.Data analysis revealed three main themes (how working as an intensive care nurse changes sleep patterns, the relationship between shift work, work performance, patient care and how working as an intensive care nurse changes individual life and coping strategies) and nine subthemes (mental, physical, social, work performance, patient care, nutrition, family life, social life and coping).The study's findings revealed that nurses working in intensive care experienced psychosocial difficulties related to sleep patterns and had trouble coping. In particular, it was determined that sleep problems of intensive care nurses cause difficulties in family life, nutrition and social life. It is recommended that the number of personnel in workplaces be increased, overtime hours should be limited, and professional development and training on the importance of sleep for all nurses should be provided.Nurses working in intensive care units may experience psychosocial problems due to working conditions, which may negatively change their coping skills. Therefore, organizing the working conditions of nurses positively changes their coping skills. [ABSTRACT FROM AUTHOR]

Background: Person-centered care focuses on individualized care that respects patients' values, preferences, and autonomy. To enhance the quality of critical care nursing, institutions need to identify the factors influencing ICU nurses' ability to provide person-centered care. This study explored the relationship between clinical judgment ability and person-centered care among intensive care unit (ICU) nurses, emphasizing how the ICU nursing work environment moderates this relation. Methods: A cross-sectional survey was conducted between September 4 and September 18, 2023, with 192 ICU nurses recruited from four general hospitals with a convenience sample (valid response rate = 97.4%). Participants completed online self-report structured questionnaires. The collected data were analyzed using hierarchical multiple regression and PROCESS macro Model 1, with a 95% bias-corrected bootstrap confidence interval to verify moderating effects. Results: Clinical judgment ability (β =.24, p <.001) and ICU nursing work environment (β =.50 p <.001) were found to be significant predictors of person-centered care. These two predictors explained the 47.0% of person-centered care in the final hierarchical regression model. Additionally, Clinical judgment (B = 0.28, p <.001, Boot. 95%CI = 0.13~0.42) and the ICU nursing work environment (B = 0.41, p <.001, Boot. 95%CI = 0.30~0.52) positively affected person-centered care, and the interaction term of clinical judgment and ICU nursing work environment (B = 0.16, p =.026, Boot. 95%CI = 0.02~0.30) also positively affected person-centered care. The moderating effect was particularly significant when the ICU nursing work environment score was 2.90 points (below 14.6%, above 85.4%) or higher on a scale of 1–5 and As the ICU nursing work environment score increased, the positive moderating effect also increased. Conclusions: The ICU nurses' clinical judgment ability positively affected person-centered care, and the nursing work environment moderated the relationship between clinical judgment ability and person-centered care. Therefore, strategies for enhancing person-centered care among ICU nurses should focus on developing educational programs to improve clinical judgment ability and implementing comprehensive efforts to effectively improve and manage the nursing work environment. [ABSTRACT FROM AUTHOR]

Objectives: This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil. Introduction: The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs. Methods: This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit, and (7) consideration of the sustainability of changes in practice. Results: Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement. Conclusion: This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients. http://links.lww.com/IJEBH/A175 [ABSTRACT FROM AUTHOR]

Background: Effective pain assessment in neonatal care is crucial for ensuring the well-being of newborns. However, barriers to its successful implementation persist. This study aims to identify the obstacles that hinder effective neonatal pain assessment by Neonatal Intensive Care Units (NICUs) nurses. Materials and Methods: This qualitative study was conducted using the method of conventional content analysis. Purposive sampling was employed from February to September 2023, selecting 14 female nurses working in NICUs of hospitals in Tehran and Karaj as participants. Indepth, semistructured interviews were conducted to collect the data. The software "MAXQDA" version 2016 was utilized for managing qualitative data. Results: Four main themes and eleven subthemes were identified: "Overtasked," "Discordant atmosphere," "Soulless care," and "Lack of awareness." Each of these main themes is further elaborated through the subsequent subthemes. Conclusions: This study found that the lack of knowledge and understanding of neonatal pain assessment tools, the busyness of nurses, lack of time, excessive documentation, and the inadequacy of staff relative to the number of newborns were the most significant obstacles to the assessment of newborn pain. Addressing these challenges is critical for optimal neonatal pain assessment and management, promoting the well-being of newborns. [ABSTRACT FROM AUTHOR]

Background: Nurses working in Intensive Care Unit (ICU) for COVID-19 are more at risk as they interact more with infected patients. Therefore, this study aimed to explore the experience of Indonesian nurses who work in ICU for COVID-19 patients. Materials and Methods: A qualitative hermeneutic phenomenological approach was used. A total of 20 nurses working in the respective ICUs of eight COVID-19 referral tertiary hospitals in Indonesia were recruited using purposive sampling. Semistructured individual video call interviews were conducted in June–September 2021; then, Diekelmann's hermeneutic phenomenological approach was used to analyze and interpret the data. Results: Thirteen subthemes describing the following four themes, namely, the pleasing and bad feelings, new challenges of working, nursing professional growth, and nurse resource management for COVID-19. Conclusions: This study describes nurses' experiences working in ICUs during the COVID-19 crisis, such as their feelings, perceived challenges, and received support. Nurse leaders play a significant role in providing adequate Personal Protective Equipment (PPE), flexible work shifts, and a caring and healing work environment. However, being aware of the limit of pressure that an individual can manage and providing adequate allowance as rewards for work in risky areas are essential to avoid burnout. [ABSTRACT FROM AUTHOR]

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Critical care nursing is considered one of the most challenging and demanding fields in nursing. Critical care nurses work in high-stress environments, tending to patients who are experiencing acute illness and necessitate intensive care. Nurses play a crucial role in providing nursing care for critically ill patients, encompassing duties such as assessment, administration of medications, ventilator management, diligent monitoring, and responding to life-saving situations. Despite the significance of their contributions, there are limited assessment tools used to assess critical care nurses' perceptions about their roles and responsibilities in intensive care units (ICU). The main aim of this study was to develop a tool to assess the critical care nurses' knowledge, awareness, and perception of their roles and responsibilities in the critical care units. The researcher developed the Critical Care Nurses' Roles and Responsibilities Assessment Tool. Subsequently, the tool underwent content validity assessment by five nursing experts, resulting in a final tool with 17 Likert-scale items. The scores ranged from 17 to 85, with intervals indicating varying levels of awareness. To assess the nurses' perception of the roles and responsibilities identified in the tool, a study was conducted on 120 registered nurses working in the ICU units across 9 governmental hospitals in Jordan. Data were collected through an online questionnaire covering demographical data and the roles and responsibilities of critical care nurses in the ICU. The collected data were subjected to quantitative analysis using appropriate statistical methods. Regarding the results among the experts, the content validity index (CVI) of the tool was 0.93. Among the participants, Cronbach alpha was measured to assess the reliability and internal consistency of the tool and the result was 0.912. Regarding the nurses' perception, a small percentage of participants, specifically (9%), demonstrated a moderate level of agreement with the roles and responsibilities mentioned in the tool (mean of scores = 40 – 63). Conversely, a substantial majority of participants (91%), exhibited a high level of agreement (mean of scores = 64 – 85). In conclusion, the results of this study revealed a powerful and reliable tool that has earned widespread acclaim among experts and participants alike. [ABSTRACT FROM AUTHOR]

The concept of intensive care is emerging in Bangladesh, but it needs more attention. The aim of this study is to determine the knowledge and implementation practices of standard intensive care services among healthcare providers in Bangladesh. From February to May 2023, a cross-sectional research of doctors and nurses running the intensive care unit (ICU) in Bangladesh’s Barisal district was carried out. Participants filled out confidential, self-administered knowledge and practice questionnaires. There were 80 respondents, including 86.3% of young people (aged less than 40) and 73.8% of female respondents. It was found that physicians (AOR/p=13.16/0.02; 95% CI: 1.41-122.92) who had less ICU work experience (5 years) (AOR/p=13.98/0.01; 95% CI: 2.35-83.26) were found to have significantly poor knowledge. It was found that doctors with less than five years of experience working in an intensive care unit (AOR/p=6.07/0.03; 95% CI: 1.16-31.64) and no ICU training (AOR/p=5.82/0.04; 95% CI: 1.09-30.81) performed poorly when providing ICU services. Standard intensive care education to gain better knowledge should be strengthened. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore tutoring experiences related to a high-risk newborn care simulation among nurses and nursing students to derive insights into developing effective neonatal nursing practice. Methods: A qualitative content-analysis study was conducted in March 2023. Data were collected through narrative surveys and focus group interviews with four neonatal intensive care unit nurses and 12 senior nursing students participating in a 1-day high-risk newborn care simulation program. A content analysis was performed on the collected data. Results: Three categories ("efforts to foster a sense of presence," "efforts to promote positive awareness of the neonatal intensive care unit," and "establishing one's role as an educator") and six subcategories were derived from the nurses' responses. Three categories ("growth through a realistic virtual simulation," "improved learning effects," and hope for continued development") and six subcategories were derived from the nursing students' responses. Conclusion: The nursing students experienced realistic practice with their nurse tutors in the high-risk newborn care simulation, which helped them form their professional identity as future nurses. After tutoring, the nurses' perceptions of nursing students changed positively, which affected their teaching methods. [ABSTRACT FROM AUTHOR]

Background: Complexity of care, adequate staffing levels, and workflow are key factors affecting nurses' workloads. There remain notable gaps in the current evidence regarding clinical complexity classification and related staffing adjustment, limiting the capacity for optimal staffing practices. This study aimed to adapt and validate the Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool (WANNNT-SC) for an Italian context to allow the assessment of newborns admitted to NICUs. Methods: This was a validation study. Results: To evaluate the reliability of the tool among different professionals, a correlation test was performed using Pearson's correlation, which revealed a strong correlation (r = 0.967, p = 0.01). In the test–retest phase, there was a significant correlation (r = 0.910 and p = 0.01). Using an analysis of variance, we found that the higher the I-WANNNT-SC score was, the higher the predicted death rate (F = 13.05 and p < 0.001). Conclusions: The Italian Winnipeg Surgical Complex Assessment of Neonatal Nursing Needs Tool represents the first tool available for an Italian context that aims to measure the nursing workload in neonatal intensive care. It could allow adjustments in nursing staffing based on NICU activities and patient needs. This study was prospectively approved by the local Ethics Committee "Palermo 1" (Protocol CI-NICU-00). [ABSTRACT FROM AUTHOR]

Background/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the complexity and critical nature of the care elevate the risks. Nurses play a pivotal role in preventing medication errors and require strategies and methods to enhance patient safety. This study aims to develop a comprehensive and evidence-based intervention to minimize medication errors by nurses in ICUs. Methods: This qualitative case study forms a part of a broader research project that commenced with a scoping review. Building on the review findings, a complex intervention was designed to address nurses' medication errors. A focus group of experts was conducted to validate the intervention designed, evaluating its contextual feasibility and relevance. Results: This study led to the development of a complex intervention whose relevance lies in its potential implementation within the studied context. The resulting intervention was structured around four main components—educational interventions, verification and safety methods, organizational and functional modifications, and an error reporting system—meticulously designed to leverage the ICU's existing resources. Conclusions: In conclusion, the proposed intervention has the potential to positively impact healthcare quality by reducing errors and promoting a culture of safety. Furthermore, this study's findings provide a relevant foundation for future research and practical applications, driving advancements in healthcare service excellence. [ABSTRACT FROM AUTHOR]

Amaç: Bu araştırma cerrahi yoğun bakım hemşirelerinde psikolojik dayanıklılık, algılanan stres ve tükenmişlik arasındaki ilişkinin incelenmesi amacıyla yapıldı. Gereç ve Yöntemler: Tanımlayıcı tipte olan araştırma Haziran-Aralık 2020 tarihleri arasında İzmir ilinde dört farklı hastanenin üçüncü düzey cerrahi yoğun bakım ünitelerinde yürütüldü. Araştırmanın örneklemini araştırmanın yürütüldüğü yoğun bakım ünitelerinde çalışan, deneyimi en az 6 ay olan 167 hemşire oluşturdu. Veriler birey tanılama formu, Psikolojik Dayanıklılık Ölçeği, Algılanan Stres Ölçeği ve Tükenmişlik Ölçeği aracılığı ile toplandı. Verilerin analizi için varyans analizi, Student’s t-testi, Mann–Whitney U testi, Kruskal Wallis ve korelasyon analizleri kullanıldı.Bulgular: Araştırma sonucunda yoğun bakım hemşirelerinin psikolojik dayanıklılık ölçeği puan ortalamasının 57.20±8.55, algılanan stres ölçeği puan ortalamasının 27.67±6.93 ve tükenmişlik ölçeği puan ortalamasının 3.44±1.04 olduğu bulundu. Bu araştırmada psikolojik dayanıklılık ve algılanan stres (r=-0.526, p:0,000), psikolojik dayanıklılık ve tükenmişlik (r=-0.557, p:0,000), algılanan stres ve tükenmişlik (r=0.723, p:0,000) arasında istatistiksel olarak anlamlı ilişki bulundu. Sonuç: Bu araştırmada yoğun bakım hemşirelerinin psikolojik dayanıklılık ve algılanan stres seviyelerinin orta düzeyde, tükenmişlik seviyelerinin tehlike sinyalinde olduğu bulundu. Araştırmaya göre yoğun bakım hemşirelerinde psikolojik dayanıklılık düzeyi arttıkça algılanan stres ve tükenmişlik düzeyinin azaldığı, tükenmişlik düzeyi arttıkça algılanan stres düzeyinin arttığı görüldü. Anahtar Kelimeler: Cerrahi yoğun bakım üniteleri, psikolojik dayanıklılık, stres, tükenmişlik, yoğun bakım hemşireliği.

Abstract Background Intensive care units are critical environments where various alarm systems play a pivotal role in patient monitoring and safety. Alarm fatigue can lead to slower response times and missed alarms, compromising patient safety and increasing stress and burnout among intensive care unit nurses. Understanding how intensive care unit nurses respond to and manage these alarms is crucial in evaluating their impact on patient care and nursing well-being. Methods This descriptive qualitative study explored the experiences of intensive care unit nurses in alarm management. Conducted in the medical and surgical intensive care units of a Northern Taiwan medical center, the study involved 15 nurses. Semi-structured interviews were utilized to investigate the working experiences of ICU nurses in alarm management and to identify their coping strategies for dealing with the constant inundation of medical device alarms. The interviews were transcribed, and content analysis was applied to identify key themes in the responses. Results The study revealed five main themes in intensive care unit nurses’ strategies for managing alarms: (1) Mastering alarm signals and acting; (2) Team monitoring for life preservation; (3) Enhancing senses and distinguishing carefully; (4) Learning from the lessons of incidents for vigilant reflection; and (5) Detach alarms’ influence on daily life. These coping strategies are effective in alarm management, safeguarding patients’ lives, enhancing the serenity of the clinical environment, and mitigating the physical and mental exhaustion caused by alarm fatigue. Conclusions Intensive Care Unit nurses develop various coping strategies to manage medical device alarms, based on their experience. These strategies are crucial in maintaining patient safety and reducing nurse alarm fatigue. They can also be used for nursing education and clinical training.

Objective: To analyse the interrater reliability of the NEUMOBACT checklist and verify whether consistent results are reproducible. Methods: A validation study with a cross-sectional design, compliant with the GRRAS checklist, among ICU nurses attending a SIMULAZERO course with an Objective Structured Clinical Evaluation simulation format, to verify transfer from theory to clinical practice of knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention. A minimum sample size of 111 pairs of nurse raters was calculated. Interrater agreement was analysed using Gwet's AC1 for each item and as a total for each of the three checklists in the NEUMOBACT instrument. Results: A total of 95 pairs of valid NEUMOBACT checklists were completed by 190 raters with a median age of 29 [25–35] years, 93.7% were female. At the Central Venous Catheter insertion station, Gwet's AC1 was 0.934 (95% CI [0.919–0.949]). Only 2 of the 17 items scored below 0.9. At the Endotracheal Suctioning station, Gwet's AC1 was 0.869 (95% CI [0.851–0.886]). Of the 26 items that made up this station, 16 had an agreement percentage above 0.9, a further 9 were between 0.821 and 0.884, and item 13 had a value of 0.789. At the Patient Care station, Gwet's AC1 was 0.911 (95% CI [0.896–0.927]). Of the 21 items, 17 showed an agreement percentage above 0.9 and 4 were between 0.810 and 0.894. Conclusions: The interrater reliability of the NEUMOBACT checklist shows substantial agreement between pairs of raters and is therefore validated in this large sample of ICU nurses. Relevance to clinical practice: The NEUMOBACT checklist can be useful for assessing skills before and after training in VAP and CRB prevention measures and during debriefing (post-simulation feedback), to reinforce the scientific evidence behind actions and decisions for items that have been performed incorrectly, thus consolidating training already received. [ABSTRACT FROM AUTHOR]

Background: Increasing the level of resilience and happiness of intensive care nurses can lead to an improvement in their psychological health. This study aimed to extract the possible effectiveness of mHealth application utilizing the micro-learning method on a mobile phone platform on the intensive care nurses' resilience and happiness. Materials and methods: This single-blind randomized controlled trial was conducted in 2022-24. Sixty nurses working in intensive care units at two hospitals in Tehran, Iran were recruited using purposive sampling and randomly assigned to either the intervention or control group. Techniques of resilience and increasing happiness were taught to the intervention group using the mHealth application based on the micro-learning method. No training was provided to the control group. For data collection, questionnaires of individual characteristics, Connor-Davidson Resilience, and Oxford Happiness were used. Results: Before the intervention, there was no significant difference between the mean of the subscales and the total score of resilience and happiness of the intervention and control groups (P < 0.05). However, after the intervention, there was a significant difference (P < 0.05). After using the mHealth application, the total resilience score of the intervention group increased from 67.30 ± 10.12 to 79.27 ± 5.87 (P < 0.0001), while the resilience of the control group changed from 68.80 ± 9.09 to 65.93 ± 8.44 (P = 0.548). Similarly, using the mHealth educational application based on micro-learning led to an increase in the happiness score of the intervention group from 38.50 ± 11.10 to 67.83 ± 8.84 (P < 0.0001), whereas the happiness score of the control group nurses after the intervention (38.93 ± 14.33) compared to the baseline (41.40 ± 14.51) did not change significantly (P = 0.388). Conclusions: The use of the mHealth application based on the micro-learning method played an effective role in training resilience and happiness skills in nurses. It is recommended to conduct more studies using this new educational approach. Trial registration: The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023). [ABSTRACT FROM AUTHOR]

The heightened focus on patient safety and the quality of nursing care in intensive care units underscores the necessity for reliable tools to evaluate nurses’ ethical awareness. This study was aimed to evaluate the psychometric properties of the Turkish version of the Ethical Awareness Scale in a sample of intensive care nurses. Data were collected from 249 intensive care nurses in Türkiye using the Turkish version of the 18-item Ethical Awareness Scale. The data were then analyzed using Rasch analysis. The Turkish version of the Ethical Awareness Scale demonstrated unidimensionality and an acceptable fit for the Rasch model. The person reliability and item reliability were 0.63 and 0.92, respectively. The Turkish version of the Ethical Awareness Scale was found to be a psychometrically valid and reliable instrument for measuring the ethical awareness levels of intensive care nurses. [ABSTRACT FROM AUTHOR]

Background: Patients in critical care units who are connected to mechanical ventilators (MV) often face the risk of ventilator‐associated pneumonia (VAP). Therefore, the aim of current study is to describe critical care nurses' knowledge and adherence to evidence‐base guidelines (EBGs) for preventing the occurrence of VAP. Methodology: A cross‐sectional study was applied. Data were collected through a self‐administered questionnaire completed by all critical care nurses (n = 213) working at Palestinian hospitals. Descriptive and inferential statistic was utilized to describe ICU nurse's knowledge and adherence to VAP prevention EBGs. Results: The study revealed that the mean knowledge score for critical care nurses was (50.8%). Overall, the findings indicated that nurses' knowledge of VAP guidelines was at an average level. A statistically significant difference (p value = 0.049) in the knowledge level was observed based on nurses' qualifications. On the other hand, the study found that nurses' adherence to EBGs was an acceptable (mean = 8.3, 69.2%). No substantial differences in adherence level were identified based on respondents' characteristics. Conclusion: Critical care nurses possess an average level of knowledge regarding EBGs for preventing VAP, alongside demonstrating an acceptable level of adherence to these guidelines. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims and Objectives Background Design Methods Results Conclusions To investigate the barriers experienced by intensive care nurses and registered nurses and to provide optimal nursing for adult patients with a temporary tracheostomy in intensive care and general wards.Tracheostomy is widely used in intensive care units, around 20% of intensive care unit patients undergo tracheostomy insertions and expect high quality of care. Caring for patients with a tracheostomy is complex and challenging task. An investigation of barriers to care for adult patients with a temporary tracheostomy in a hospital setting is essential to ensure that these patients receive the highest quality of care and to identify areas for improvement.This paper applied secondary analysis to data from two qualitative studies, including narrative interviews and maximum variation sampling.Secondary analysis of primary qualitative datasets is appropriate when the analysis extends rather than exceeds the primary. The analysis was based on interview data collected from six intensive care nurses and six registered nurses from two university teaching hospitals in Norway. The interviews were audio‐recorded and transcribed. The data was analysed using the qualitative analysis suggested by Graneheim and Lundman. This study adhered to the consolidated criteria for reporting in a qualitative research (COREQ) checklist.Four main themes were identified as barriers to care for adult patients with a temporary tracheostomy in the hospital: encountering ambivalence, inadequate staffing levels, lack of patient continuity of care and lack of systematic follow‐up.Understanding barriers to care is crucial for hospitals and healthcare organisations to develop targeted interventions and educational programs to address these barriers and improve the care provided to adult patients with tracheostomies in hospital settings. [ABSTRACT FROM AUTHOR]

Introduction: The evolving landscape of healthcare in Jordan presents unique challenges and opportunities for nursing professionals. With a focus on critical care nurses, understanding the dynamics of professional autonomy and professionalism within this context is crucial for advancing nursing practice and improving patient care. Objectives: This study aimed to investigate the relationships between perceived nursing professional autonomy and professionalism among critical care nurses in Jordan. Methods: A descriptive correlation design was used among critical care nurses from five major Jordanian governmental hospitals. A total of 227 questionnaires were distributed, with a final sample size of 200 participants. Data were collected between August and September 2023. Professional autonomy and professionalism were measured using the Dempster Practice Behaviors Scale and the Nurses' Professionalism Inventory, respectively. We used the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines in the current study. Results: The study revealed moderate levels of perceived professional autonomy (mean DPBS total score: 103.94) and professionalism (mean NPI total score: 119.12) among participants. A significant positive correlation (r =.49, p <.001) was observed between these two constructs. However, demographic and work-related factors showed minimal influence on these perceptions. Conclusion: The study highlights the importance of professional autonomy and professionalism in improving nursing care in Jordan. It recommends targeted approaches like ongoing education and supportive workplace policies to bolster these aspects. These findings have significant implications for nursing policy and education across various healthcare settings. [ABSTRACT FROM AUTHOR]