Greening the intensive care unit: The ethical responsibility of ICU nursing.

Pediatric cardiac intensive care is a rapidly developing specialty that caters to the needs of children with heart disease. Communication in this intensive care unit is challenging because of complexity, high patient acuity, uncertainty, and ethical issues. Unfortunately, conflict is common, as several studies and reviews confirm. Good communication in the critical care area is an expectation from patients, their families, and professional societies. Good communication is also an important concept in family-centered care that warrants deliberate ongoing communication. The ICU nurse is poised to be a key contributor of efforts to improve communication with patients and families in the ICU because they have always been strong advocates to meet the patients' needs. Indeed, because of the time spent in constant attendance at the bedside of the critically ill patient, ICU nurses build relationships with patients and their families. Often, the ICU nurse has in-depth knowledge of the patients' or families' concerns that has not been realized by other providers. As bedside caregivers, the ICU nurses are the professionals who have the most interaction with patients and their families in formal and informal ways. Armed with knowledge and skills of effective intensive care strategies, such as proactive communication, the ICU nurse is poised to be a major advocate to improve communication in the ICU with patients and their families. The purpose of this article is to review the issue of communication in the PCICU, highlight strategies that may improve communication in the PCICU, and further stimulate the discussion about integrating how nurse can use the mind mapping concepts to improve communication in PCICU. Conclusion: communication in the ICU is challenging and complex. The nurse's role is important in any strategy to improve communication. Developing ICU nurses' mastery of communication skills is gaining momentum as an effective strategy. The ICU nurse can be a key contributor to good, effective communication for PCICU patients and their families.

Objective To investigate current situation of compassion fatigue of ICU nurses and to analyze its influencing factors. Methods By convenient sampling, a self-designed general information questionnaire, Chinese version of the Compassion Fatigue Short Scale (C-CFSS) , Ego-Resilience Scale (ERS) and Perceived Social Support Scale (PSSS) were used to investigate 194 ICU nurses in a ClassⅢ Grade A hospital in Yantai from May 2019 to June 2019. The t-test, one-way ANOVA, Pearson correlation analysis and multiple linear regression were used for statistical analysis. Results The total C-CFSS score of ICU nurses is (58.85±36.2) . ICU nurses had a moderate compassion fatigue level. The ICU nurse's ERS score was (39.96±7.65) , the PSSS score was (61.15±14.65) . The univariate analysis showed that there were statistically significant differences in C-CFSS scores among nurses of different ages, department beds, final education, self-perceived health status, monthly income, parenting (P<0.05) ; Correlation analysis showed that ICU nurse ERS score was negatively correlated with C-CFSS score (r=-0.200, P<0.01) ; PSSS score was negatively correlated with C-CFSS score (r=-0.278, P<0.01) . The results of multivariate analysis showed that age, the number of beds in the department, final education, self-perceived health status, and understanding of social support were the main influencing factors of compassion fatigue among ICU nurses, which together explained 30.1% of the total variation of compassion fatigue (F=9.673, P<0.01) . Conclusions The overall degree of compassion fatigue of ICU nurses is moderate. As nursing managers, they should pay attention to ICU nurses with different characteristics such as age, educational background and health status, carry out lectures and training on compassion fatigue, increase the social support of ICU nurses and formulate corresponding preventive intervention measures, so as to reduce the occurrence of compassion fatigue. Key words: Intensive care unit; Nurses; Compassion fatigue; Ego-resilience; Social support

Objectives: Health care workers are exposed to hazardous substances. A previous study reported that respiratory therapists had an increased risk of asthma. The object of this study was to confirm the finding that respiratory therapists are associated with asthma in Taiwan. Methods: We conducted a cross-sectional questionnaire survey comparing respiratory therapists with ICU nurses. The subjects were given a questionnaire in Chinese that included questions on standard respiratory history and symptoms. Subjects who reported physician-diagnosed asthma were considered as having asthma. Results: In all 151 respiratory therapists (response rate 45%) and 157 ICU nurses (response rate 90%) responded to the questionnaire. Eleven male respiratory therapists were excluded. The respiratory therapists were older (29.6 vs 24.6 years) and had more working experience (5.5 vs 3.1 years) compared to the ICU nurses. Six (3.8%) ICU nurses and two (1.4%) respiratory therapists reported having physician-diagnosed asthma. ICU nurses had a higher rate of reported cough (23% vs 8.6%, p＜0.01) and wheezing (6% vs 0.7%, p＜0.05) symptoms than the respiratory therapists. Odds ratios for the risk of respiratory symptoms among ICU nurses compared to respiratory therapists were cough 4.41 (95CI, 1.9-10.1), and wheezing 9.38 (95CI, 1.09-80.6). Conclusion: We did not find that respiratory therapists were associated with an increased risk of physician-diagnosed asthma in Taiwan. ICU nurses, however, had an increased risk of having frequent cough and wheezing compared to respiratory therapists. Clinical Implications: Further investigations into the etiologies of excess coughing and wheezing in ICU nurses are needed.

Objective To investigate the level of aspiration knowledge and the influencing factors of ICU nurses in Foshan area, so as to provide basis for completing the clinical training schemes for ICU nurses. Method A self-designed aspiration risk assessment questionnaire was applied to investigate the ICU nurses from 6 hospitals in Foshan area. Results The total score of aspiration knowledge of ICU nurses was (25.98±6.82). Multivariate regression analysis showed that aspiration knowledge score of ICU nurses were affected by their working age, professional title, and the fact whether they had received ICU specialized theoretical training (P<0.05). 72.17% of the nurses had never received aspiration knowledge training, and aspiration knowledge training was greatly demanded by them. Conclusions ICU nurses’ level of aspiration knowledge was low and there was lack of ways by which ICU nurses could systematically acquire aspiration-related knowledge. ICU nurses’ level of aspiration knowledge can be improved by establishing norms and guidelines for preventing aspiration and carrying out systematic training. Key words: Intensive Care Unit; Nurse; Aspiration; Investigation and analysis

Sedation Scales in the ICU

Objective To understand the degree of resilience of emergency nurses and ICU nurses, and analyze the effects of resilience on work engagement of nurses working in the emergency and ICU departments in tertiary hospitals in Chengdu city. Methods This was a cross-sectional survey. A total number of 660 nurses from7 hospital in Chengdu were selected by a convenient sampling method. Results The mean resilience score of the emergency and ICU nurses in Sichuan province was (123.07±23.76) points, the mean score of work engagement was(2.70±1.20) points. There was a positive relationship between emergency and ICU nurses' resilience score and nurses' work engagement (r=0.394, P < 0.01). Nurses with higher level of resilience indicated higher work engagement score (F=35.77, P < 0.05). Conclusions The resilience score of the emergency and ICU nurses in tertiary hospitals of Chengdu city was at a low level. Higher resilient emergency and ICU nurses tended to have the higher level of work engagement. Key words: Tertiary hospital; Emergency medical service; Intensive care unit; Resilience; Work engagement

Objective To explore the mediating effect of emotional labor between professional values and job burnout among ICU nurses, and to provide a reference for reducing ICU nurses' job burnout and motivating their work enthusiasm. Methods From June to July 2017, 276 ICU nurses from 3 comprehensive ClassⅢ Grade A hospitals in Nanchang were selected as the subjects by convenience sampling. The General Information Questionnaire and Nurses' Emotional Labor Scale, Professional Values Scale and Job Burnout Scale were used to investigate. Structural equation model was used to explore the mediating effect of emotional labor between professional values and job burnout. Results A total of 276 questionnaires were issued and 249 valid questionnaires. The average score of the Nurses' Emotional Labor Scale of 249 ICU nurses was (3.55±0.45) , the average score of the Professional Values Scale was (3.63±0.41) , and the dimensions scores of the emotional exhaustion, depersonalization and personal accomplishment of the Job Burnout Scale were (2.77±1.07) , (1.54±1.26) , and (3.78±1.16) . The structural equation fitting indexes were as follows: χ2/df=1.155, GFI=0.976, AGFI=0.942, RMSEA=0.027. Professional values and emotional labor of ICU nurses had direct predictive effect on job burnout. Professional values also used emotional labor as an intermediary variable, which indirectly affected job burnout. Conclusions Nursing managers should pay attention to reducing the job burnout of ICU nurses by improving the level of ICU nurses' professional values and optimizing their emotional labor strategies from the individual factor level. Key words: Intensive Care Unit; Nurse; Emotional labor; Professional values; Job burnout; Mediating effect

Systematic Intensive Respiratory Care

Who Should Supervise Respiratory Intensive Care Units?

The aim of this study was to gain an understanding of the experiences and perspectives of intensive care nurses caring for critically ill obstetric patients. Current literature suggests critically ill obstetric patients need specialised, technically appropriate care to meet their specific needs with which many intensive care nurses are unfamiliar. Furthermore, there is little research and evidence to guide the care of this distinct patient group. This study used a descriptive qualitative design. Two focus groups were used to collect data from 10 Australian intensive care units nurses in May 2007. Open-ended questions were used to guide the discussion. Latent content analysis was used to analyse the data set. Each interview lasted no longer than 60 minutes and was recorded using audio tape. The full interviews were transcribed prior to in-depth analysis to identify major themes. The themes identified from the focus group interviews were competence with knowledge and skills for managing obstetric patients in the intensive care unit, confidence in caring for obstetric patients admitted to the intensive care unit and acceptance of an expanded scope of practice perceived to include fundamental midwifery knowledge and skills. The expressed lack of confidence and competence in meeting the obstetric and support needs of critically ill obstetric women indicates a clear need for greater assistance and education of intensive care nurses. This in turn may encourage critical care nurses to accept an expanded role of clinical practice in caring for critically ill obstetric patients. Recognition of the issues for nurses in successfully caring for obstetric patients admitted to an adult intensive care setting provides direction for designing education packages, ensuring specific carepaths and guidelines are in place and that support from a multidisciplinary team is available including midwifery staff.

Background: Constant pressure on certain body regions can cause bedsores, also called pressure ulcers, which are lesions to the skin or soft tissues that can have fatal implications if left untreated. This study highlights areas where nurses' competencies are lacking. It demonstrates how evidence-based interventions, targeted education, and institutional support can effectively reduce the prevalence of pressure ulcers and enhance patient safety in intensive care units. Purpose: The purpose of this review is to summarize and critically evaluate the body of research on ICU nurses' knowledge, attitude, and practice regarding pressure ulcer prevention. Methods: This review analyzed pressure ulcer prevention studies among ICU nurses using keywords like “prevalence, incidence, risk factors, complications, knowledge, attitude, and practice”. Relevant peer-reviewed articles were retrieved from multiple databases, including PubMed (via Medline), ScienceDirect, Google Scholar, ResearchGate, and the Cochrane Library. Methodological quality was ensured to maintain reliability and validity. The articles were retrieved from the period between 2015 and 2025. Results: The study identified 515 articles, screened 477, and selected 19 for inclusion in a narrative review. The studies examined nurses' knowledge, attitude, and practice regarding pressure ulcer prevention in intensive care settings. Conclusion: Nurses play a critical role in preventing pressure ulcers, and educating them about risk assessment and prevention can improve patient outcomes. Best practices include routine skin exams, systematic risk assessments, care planning, continuous pressure mapping, and the use of prophylactic dressings. Implications for Nursing: The review highlights the importance of ongoing education and competency-based training in nursing practice for preventing pressure ulcers in ICUs. It suggests integrating standardized guidelines, ensuring adequate staffing, and fostering accountability roles, can advocate for improved water management policies that prioritize health outcomes. Keywords: Nurses’ knowledge, Intensive care, Pressure ulcer prevention, Jordan.

Objective To develop the knowledge-attitude-practice scale for evaluating intra-abdominal pressure measurement in ICU nurses and assess its reliability and validity preliminary. Methods Applied the methods of literature review and Delphi expert consultation to form the knowledge-attitude-practice scale for evaluating intra-abdominal pressure measurement in ICU nurses on the basis of the knowledge-attitude-practice framework. A total of 165 nurses from ICU department were finally involved. Items analysis, exploratory factor analysis, content validity, internal consistency test and split-half reliability were used to evaluate the scale. Results Factor analysis revealed five factors (23 items), accounting for 52.5% of the total variance. The Cronbach a coefficient was 0.869 for the total scale and 0.612, 0.749 and 0.848 for the subscales of knowledge, attitude and practice. The split-half coefficient was 0.784. Conclusions The knowledge-attitude-practice scale has good reliability and validity, and can be used to assess the intra-abdominal pressure measurement in ICU nurses. Key words: Intensive care unit; Nurses; Intra-abdominal pressure; Knowledge-attitude-practice; Reliability and validity

Objective To describe the current status of recovery of nursing errors by ICU nurses, so as to explore its influencing factors. Methods Totally 220 nurses from 14 ICUs of 4 Class Ⅲ grade A hospitals in Guangzhou were selected by random sampling and investigated in their recovery of nursing errors with the recovery of nursing error questionnaire designed with reference to Recovered Medical Error Inventory (RMEI) between October and December 2014. Results The top three errors most often found among ICU nurses were improper fixing or displacement of tube, nurses' failure to restrain restless patients or inappropriate restraints, and unplanned extubation. According to the multivariate linear analysis, the number of working years, title and department, when included into the regression equation, could account for 21.7% of the nursing error variation by ICU nurses. Conclusions ICU nurses can promptly recover nursing errors. The job title, department and length of service can affect nurses' behavior in recovery of nursing errors, and nursing managers can train nurses with related knowledge to timely recovery of nursing errors and enhance their ability to recover nursing errors. Key words: Nurses; Intensive care units; Recovery of nursing errors

To explore the perspectives of nurse educators, clinical nurse educators and nurse specialists with regard to supporting the deployed registered nurses in Australian intensive care units during the COVID-19 pandemic surge. A qualitative-descriptive study design was used. Intensive care nurse educators, clinical nurse educators and nurse specialists who had been involved with the preparation and support of nurses for deployment to intensive care units for COVID-19 surge were purposively recruited from around Australia. Data were collected through 18 semi-structured interviews and examined using thematic framework analysis of NVivo software. Participants described a number of challenges related to surge deployment including the varied skill sets and inadequate preparation for deployed staff, lack of a clear scope of practice and their general reluctance to deploy to intensive care units. Mixed communication from hospital managers about the mandatory or voluntary nature of deployments and the plans for return of nurses to their usual place of work were also considered problematic. Conversely, factors that supported effective deployment included consistently deploying the same staff, scope of practice guides, task cards and colour coding to identify the experience of nurses. The burden of the pandemic, including variable waves of surge, infection control complexities and fear of caring for patients with COVID-19, influenced the participants' experiences and perspectives. Additionally, there was a significant personal toll for participants because of the increased load of supervising deployed staff and concerns related to accountability for nursing care, and personal and patient safety. The deployment of nursing staff to intensive care units to support increased patient numbers is necessary during surge events. Having clarity about what role those nurses perform within intensive care units is essential in order to design training and support strategies that prepare them adequately so as not to place undue burden on an already strained intensive care nursing workforce. The toll of the COVID pandemic on ICU nurses was immense. This was further compounded by inadequate preparation and the strain of supporting deployed nurses in surged intensive care units. This research outlines the lessons learned from deploying nurses into surged intensive care units in the Australian setting. Supporting deployed nurses places a significant burden on the intensive care team; this is heavier when there is uncertainty about the scope of deployed staff and accountability for patient safety. These findings contribute to the body of evidence that will assist in for planning more effective deployment strategies for future intensive care surge events. Reporting complied with the COREQ criteria for qualitative research. There was no patient or public contribution.

Breaking Silos: The Team-Based Approach to Coronavirus Disease 2019 Pandemic Staffing.