A Collaborative Critical Care Preceptorship for APRN Students

Advanced practice registered nurses (APRNs) increasingly are caring for critically ill patients as a part of interprofessional teams, but new APRNs may have limited critical care exposure in their training. We created a 12-week critical care preceptorship for APRN students as well as a curriculum composed of daily case-based teaching. Student assessment methods included direct observation, pretests and posttests of critical care knowledge, and presurveys and postsurveys of perceptions about critical care skills. The average score on the knowledge pretest was 50% and increased to 74% on the posttest (N = 10). Students reported increased comfort in several aspects of managing critically ill patients after the preceptorship. Descriptive feedback noted that the preceptorship is distinctive, comprehensive, and focused on student education. The evolving intensive care unit will have increasing numbers of APRNs, and a collaborative preceptorship can improve critical care know-ledge and perceptions of critical care skills in APRN students.

To explore the effectiveness of a digital learning management system in enhancing intensive care unit nurses' critical care knowledge and critical thinking tendency. Learning intensive care unit knowledge and skills is essential for the continuing education of nurses, and impacts patient health outcomes. Enhancing intensive care unit nurses' critical care abilities is a medical care quality concern in clinical practice. A cross-sectional study was conducted with 212 participants to investigate the effects of a digital learning system on care quality. After the implementation of the digital learning system, intensive care unit nurses' critical care knowledge and critical thinking skills increased significantly. High-level nurses had higher critical thinking scores. All participants associated critical care knowledge with improved quality of care. The digital learning management system enhanced intensive care unit nurses' critical care knowledge. Optimizing nursing care safety and quality requires that nursing staff to be at an adequate level, which improves their critical care ability. A well-designed digital learning management system with structured classes may allow intensive care unit nurses to learn effectively and can be used for continuing education. These results are of interest to nursing management staff who want to invest in the continued professional development of intensive care unit nurses to improve critical care knowledge, critical thinking skills, care quality, and health care value.

Introduction: As demand for nurse practitioners in all types of intensive care units continues to increase; ensuring successful integration of these nurses into general and specialty intensive care units poses several challenges. Adding nurse practitioners in critical care requires strategic planning to define critical aspects of the care delivery model, acceptability and autonomy before the practitioners are hired or utilized. Autonomy can be achieved when NPs’ ability to deliver care independently is encouraged, they are well accepted in critical care units by the health care professionals and other stakeholders and when NPCC perceive they are viewed and Treated by administrators as integral members of the care teams. Multiple quantitative studies revealed the attributes of NPs’ practice autonomy and roles. However, researcher has not come across any study to assess the critical care skills performed by Nurse Practitioner in critical Care (NPCC) in India. Methodology: A quantitative descriptive research approach was used to conduct study among 35 NPCCs, 80 healthcare professionals (excluding physician) and 15 physicians through purposive sampling techniques. An expressed checklist was used to assess the critical care skills performed by NPCCs after taking formal permission from the competent authority. Results: Majority of the NPCCs (71%) had good critical care skills whereas (29%) had average critical care skills. None of the NPCCs had poor critical care skills views from NPCCs Out of 15 physicians, majority of the subject (87%) revealed that NPCCs had good critical care skills whereas (13%) had average critical care skills. None of the NPCCs had poor critical care skills. Majority of the health care professionals (excluding physicians) & other stakeholders (86%) said that NPCCs had good critical care skills, (14%) had average critical care skills. None of the NPCCs had poor critical care skills. Majority of the physicians refuse to participate in the research study, only 15 physicians participated from selected institute of the research. Out of the15 physicians accept the NPCCs but found the curriculum not appropriate as per the need of the NPCCs. Conclusion: Nurse practitioners need to become more visible to both the public and other health care professionals. Continuing to educate and expose the public and other health care professionals to nurse practitioners will influence perceptions which, in turn, may increase interest in learning more about the role and affect acceptance of the role and utilization of the nurse practitioner in critical care. The utilization of NPCCs continues to have much room for expansion, allowing NPs more autonomy and involvement in the care of critical care patients, it is important for physicians and other health care providers to be familiar with the capabilities of a NPCCs in order for them to be utilized to their maximum potential

Previous research shows that gaps exist in internal medicine residents' critical care knowledge and skills. The purpose of this study was to compare the bedside critical care competency of first-year residents who received a simulation-based educational intervention plus clinical training with third-year residents who received clinical training alone. During their first 3 months of residency, a group of first-year residents completed a simulation-based educational intervention. A group of traditionally trained third-year residents who did not receive simulation-based training served as a comparison group. Both groups were evaluated using a 20-item clinical skills assessment at the bedside of a patient receiving mechanical ventilation at the end of their medical intensive care unit rotation. Scores on the skills assessment were compared between groups. Simulator-trained first-year residents (n = 40) scored significantly higher compared with traditionally trained third-year residents (n = 27) on the bedside assessment (91.3% [95% confidence interval, 88.2%-94.3%] vs. 80.9% [95% confidence interval, 76.8%-85.0%]; P < 0.001). First-year residents who completed a simulation-based educational intervention demonstrated higher clinical competency compared with third-year residents who did not undergo simulation training. Critical care competency cannot be assumed after clinical intensive care unit rotations; simulation-based curricula can help ensure residents are proficient to care for critically ill patients.

During the first COVID-19 pandemic wave, non-intensive care unit (non-ICU) nurses were deployed to temporary ICUs to provide critical care for the patient surge. A rapid critical care training program was designed to prepare them to care for patients in either temporary or permanent ICUs. To evaluate the effectiveness of this training program in preparing non-ICU nurses to provide critical care for COVID-19 patients in temporary ICUs. A survey was used to evaluate the impact of rapid critical care training on nurses' critical care skills and compare the experiences of nurses deployed to temporary versus permanent ICUs. Data were analyzed with χ2 and Spearman ρ tests with α = .05. Compared with nurses in other locations, nurses deployed to temporary ICUs were less likely to report improved capability in managing mechanical ventilation; infusions of sedative, vasoactive, and paralytic agents; and continuous renal replacement therapy. Nurses in temporary ICUs also reported being less prepared to care for critically ill patients (all P < .05). The rapid training program provided basic critical care knowledge for nurses in temporary ICUs, but experiences differed significantly between those deployed to temporary versus permanent ICUs. Although participants believed they provided safe care, nurses with no critical care experience cannot be expected to learn comprehensive critical care from expedited instruction; more formal clinical support is needed for nurses in temporary ICUs. Rapid critical care training can meet emergency needs for nurses capable of providing critical care.

Acquiring nursing skills in critical care requires the planning and implementation of carefully structured educational interventions. These interventions must be based on proven teaching methods that support the achievement of the expected educational objectives for students. Integrating traditional classroom teaching with interactive methodologies, such as gamification and role-playing, is essential to enhancing students' knowledge. These knowledge levels need to be measured through structured tools. To validate the questionnaire needed to assess nursing students' knowledge in the critical care area, a feasibility pilot study was conducted. A pilot study was carried out, enrolling a total of 30 third-year nursing students from the University of Rome "La Sapienza". The questionnaire was administered at two time points: T0 and 48 hours later (T1) in April 2024. The results did not show significant differences in the questionnaire administration at T0 and T1. Based on statistical analysis of the data using Cronbach's alpha, which yielded a value of 0.606, an adequate level of reliability and good internal consistency of the tool was found. These findings demonstrate the usefulness of the tool in assessing the learning of nursing students regarding the care of critically ill patients. The results from the statistical analysis of the data allowed for the validation of the administered questionnaire.

Plugging the gap--critical care skills are the current universal commodity.

The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? We have been training emergency physicians (EPs) alongside surgeons in our country's largest Trauma/Surgical Critical Care Fellowship Program annually for more than a decade. We reviewed our Society of Critical Care Medicine Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP, critical care in-training examination) scores from 2006 to 2009 (4 years). The MCCKAP, administered during the ninth month of a Critical Care Fellowship, is the only known standardized objective examination available in this country to compare critical care knowledge acquisition across different specialties. Subsequent workforce outcome for these Emergency Medicine Critical Care Fellowship graduates was analyzed. Over the 4-year period, we trained 42 Fellows in our Program who qualified for this study (30 surgeons and 12 EPs). Surgeons and EP performance scores on the MCCKAP examination were not different. The mean National Board Equivalent score was 419 ± 61 (mean ± standard deviation) for surgeons and 489 ± 87 for EPs. The highest score was achieved by an EP. The lowest score was not achieved by an EP. Ten of 12 (83%) EP Critical Care Fellowship graduates are practicing inpatient critical care in intensive care units with attending physician level responsibilities. EPs training in a Surgical Critical Care Fellowship can acquire critical care knowledge equivalent to that of surgeons. EPs trained in a Surgical Critical Care paradigm can potentially expand the intensive care unit workforce for Surgical Critical Care patients.

The aim of this study was to explore midwives' recognition and management of critical illness in obstetric women in order to inform service provision. Critical illness is not confined to Intensive Care. Limited published work was located examining factors affecting critical care provision by midwives. A multi-method design incorporating a paper and pencil simulation (n = 11) and in-depth interviewing (n = 5) was conducted with midwives from a large London National Health Service Trust. This study details and discusses the findings. Findings indicated that frequency and type of critical illness experience impact upon midwives' critical care knowledge and skills. Midwives, especially those who were more junior, expressed anxiety regarding this aspect of practice, and considered the support of senior midwives, medical and nursing staff as crucial to effective client management. This study has yielded important insights into midwives' management of critical illness. Possible mechanisms to enhance the quality of service provision, and midwife support in this area are highlighted.

Various approaches facilitate mentoring for critical care nurses. Mentoring is an important strategy to help recruit, retain, and develop nurses with critical care expertise. Mentoring benefits nurses at all career stages, from novice to expert. Effective mentoring programs benefit not only mentors and mentees but also organizations and patients by ensuring adequate numbers of nurses with critical care knowledge and skills. Mentoring programs require careful planning to ensure that the objectives of the program align with the needs of the target audience, and that adequate resources are available to support the mentor-mentee relationship. This article identifies opportunities for mentoring in critical care nursing and provides recommendations from the literature for developing an effective program. Various objectives for mentoring programs are described, including supporting retention, providing clinical development, and planning succession. Program logistics are explored, such as selecting mentors, matching mentors with mentees, setting goals and expectations, and evaluating the program. In addition, the article identifies strategies for overcoming common barriers to mentoring, which include a lack of time and poor access to qualified mentors.

Background Improved access to healthcare, increasing elderly population, growing incidence of chronic diseases, combined with the high prevalence of accidents and infectious diseases are driving the demand for critical care services in acute hospitals. However, low and middle-income countries not only have a shortage of critical care nurses, but there are also gaps in their graduate, post-graduate, and specialized training as well as in their continuing education to support them in their role. Methods This quality improvement project aimed to assess the effect of a web-based group study program on knowledge acquisition and skills and competency development of critical care nurses at seven private,not-for-profit hospital sites within a hospital system in Vietnam. The Essentials of Critical Care Orientation 4.0 course from the American Association of Critical Care Nurses was delivered to two cohorts of ICU nurses who worked in critical care. Course content was translated in Vietnamese. The program leveraged a preceptor-facilitator-learner model that depended on group discussions and self-learning. Program effectiveness was evaluated using quantitative pre- and post-test design, combined with a post-program survey. ResultsAverage post-test scores of the first cohort increased by 34.0% over pre-test while those of the second cohort increased by an average 41.0%.Post-program survey revealed that all learners were satisfied with the quality of content, the web-based delivery system, content translation and the overall teaching methodology. Learners also demonstrated greater confidence in delivering safe, proactive patient care. Conclusion The utilization of an online, standardizedwestern education program, translated to Vietnamese,delivered through a facilitator-group learning model is successful in increasing the knowledge level of Vietnamize critical care nurses.

Critical Care Skill Triad for Tactical Evacuations

Alternative cardiac intensive care unit locations during the COVID-19 pandemic at an academic medical center

To explore relationships between the training background of cardiac critical care attending physicians and self-reported perceived strengths and weaknesses in their ability to provide clinical care. Cross-sectional observational survey sent worldwide to ~550 practicing cardiac ICU attending physicians. Hospitals providing cardiac critical care. Practicing cardiac critical care physicians. None. We received responses from 243 ICU attending physicians from 82 centers (14 countries). The primary training background of the respondents included critical care (62%), dual training in critical care and cardiology (16%), cardiology (14%), and other (8%). We received 49 responses from medical directors in nine countries, who reported that the predominant training background for attending physicians who provide cardiac intensive care at their institutions were critical care (58%), dual trained (18%), cardiology (12%), and other (11%). A greater proportion of physicians trained in either critical care or dual-training reported feeling confident managing multiple organ failure, neurologic conditions, brain death, cardiac arrest, and performing procedures like advanced airway placement and inserting chest- and abdominal-drains. In contrast, physicians with cardiology and dual-training reported feeling more confident managing intractable arrhythmias, understanding cardiopulmonary interactions, and interpreting echocardiogram, electrocardiogram, and cardiac catheterization. Overall, only 57% of the respondents felt comfortable based on their current training background to manage patients with complex cardiac issues without collaboration with other specialists. Our survey demonstrates that intensivists trained in critical care are more comfortable with critical care skills, cardiology-trained intensivists are more comfortable with cardiology skills, and dual-trained physicians are comfortable with both critical care skills and cardiology skills. These findings may help inform future efforts to optimize the educational curriculum and training pathways for future cardiac intensivists. These data may also be used to shape continuing medical education activities for cardiac intensivists who have already completed their training.

The redeployment of staff which involves moving staff from one clinical setting to another is a key feature of health care management. Rising demand associated with chronic disease and seasonal variation makes redeployment increasingly commonplace. During the COVID-19 pandemic preparation for the influx of patients included sourcing equipment and resources and the redeployment of staff to respiratory wards and critical care. The aim of this study was to explore the lived experience of redeployment to critical care during the COVID-19 pandemic from the perspective of those individuals who were moved to help and critical care core staff. A transcendental phenomenological study involving semi-structured interviews with staff redeployed and critical care core staff was conducted. Data were collected from staff in one critical care department of a large NHS Trust in England between the second and third pandemic wave (April-June 2021). Analysis of the data led to the identification of seven meaning units: intention, apprehension, expectations, familiarity, preparation, support, and own work. Intention related to the decisions made by managers regarding whom to redeploy and the reasons why people were chosen. Apprehension and expectations were closely linked and related to critical care skills and knowledge as well as anxiety about infection risk. Familiarity was a key element of people feeling comfortable and the confidence core staff had in colleagues who had come to help. Support and preparation helped but staff were anxious about their own work and concerned about the open-ended nature of redeployment. Familiarity and recency of critical care experience played a significant role in how useful redeployed staff were. Redeployed staff were concerned about assumptions being made and expectations of themselves as well as detachment from their usual support network. Continued shortages of registered nurses globally combined with the need to create additional critical care capacity during emergencies such as infection outbreaks means that redeployment of staff will continue for some time. Identifying the impact of redeployment on staff will enable services to better prepare and support registered nurses who are redeployed to critical care.