Critical Care Areas Research Articles

Formal Quality and Compliance of Informed Consent Forms in Critical Care and Surgical Areas in Spain: An Observational Study

(1) Background: The informed consent form must contain all the relevant information about the procedure to be performed to guarantee the patient's freedom to choose. (2) Objective: To analyze the formal quality of, and compliance with informed consent forms in critical care and surgical areas in a county hospital in Spain. (3) Methods: The formal quality of informed consent forms in critical care and surgical areas from the hospital were analyzed, following the established formal quality criteria for informed consent forms. The compliance with specific criteria for each of the operated patients during the period of study was also evaluated. (4) Results: The formal quality of 224 informed consent forms was analyzed from 8 disciplines observing a median of non-compliances of 4 with a minimum of 1 and a maximum of 5, with the most breaches being in verifying the delivery of a copy to the patient and showing contraindications. The compliance of 376 documents from 188 operated patients were assessed, highlighting that the non-complied items were: the personalized risks and complete identification of the patient and the physician. A significant association was found between disciplines analyzed and the identification of the physician and personalized risks, with anesthesia and critical care showing the best compliance. (4) Conclusions: The informed consent forms in critical care and surgical areas were shown to have a deficient formal quality and an inadequate compliance. These deficiencies should be corrected to improve the information received by the patients and to guarantee their freedom to choose. As nurses have a responsibility to ensure that patients are adequately informed about both nursing interventions and care, as well as the surgical treatments they receive, consideration should be given to the possibility of nursing professionals taking the lead in obtaining informed consent.

Prediction of Electric Power Demand of HVACs for Operating Rooms in Case of Dynamic Set Points of Temperature: A Case Study

In healthcare settings, particularly in areas such as operating rooms and intensive care units, there is a need for a dynamically controlled temperature environment that can adapt to the changing needs of both patients and healthcare workers. This is due to the fact that the desired temperature can vary depending on the condition of the patient and the specific requirements of surgical and treatment procedures. To address this need, our objective is to develop a tool for predicting the electric power needed to maintain a desired temperature in these critical care areas. Previous research has employed artificial learning algorithms and mathematical equations to predict electric power for various types and sizes of buildings, with promising results. However, our study focuses specifically on critical care areas within hospitals and utilizes fluctuating temperature set-points to predict power demand using historical weather data and Building Management System (BMS) data. We employed both Multi-Layer Artificial Neural Network (ML-ANN) and Long short-term memory (LSTM) models for this purpose and found that ML-ANN outperformed LSTM. The results showed that the ML-ANN model performed better than the LSTM model, with a testing accuracy of 96% compared to 78% for the LSTM model. This indicates that the ML-ANN model was more accurate in predicting the power consumption for the desired temperature in the operating room.

Nurses’ Experience of Ethical Dilemma at the End-Of-Life Care in the Intensive Care Unit

One of the aims of the care service in the Intensive Care Unit (ICU) is to prepare patients in end-of-life conditions to die in a dignified manner. This can be challenging due to decision-making problems and result in a dilemma. Therefore, this study explores the ethical dilemmas experienced by nurses that provide end-of-life care in the ICU. The qualitative phenomenological methodology was used to describe the ethical dilemmas nurses face during these conditions. The data were collected through in-depth interviews and were analyzed using Colaizzi. Purposive sampling was used to select a total of eight participants, i.e., ICU nurses, who have treated end-of-life patients. Four themes were obtained from this study, namely, “the dilemma between the family’s decisions and continuing care”, “patient’s life expectancy and the family’s hope”, “DNR decisions and the nurse’s confidence”, and “the family’s understanding of the information provided”. This study recommends that the assessment of end-of-life status in critical care areas, especially the ICU, should be conducted as soon as possible to have a clearer purpose for the care provided.

Decreasing the Nursing Documentation Burden During the Covid-19 Surge

During the Covid-19 pandemic, nurses requested a clean, streamlined, intuitive view of the adult nursing assessment(s) within the electronic medical record (EMR). We created a more efficient method during a national disaster to reduce duplicative efforts and allow additional time with patients. This project was added as part of the Clinically Led EMR Optimization (CLEO) strategy to eliminate unnecessary EMR assessment data elements in the adult medical-surgical and critical care areas. This was completed in a 5-month period and decreased 20% of the data points entered by nursing. 433 data points were excluded or relocated to achieve the desired result.

Comparison of Three Phenotypic Methods of Carbapenemase Enzyme Detection to Identify Carbapenem-resistant Enterobacterales

The prevalence of multidrug-resistant gram-negative bacilli has increased worldwide. Critical care areas of most hospitals use carbapenem antibiotics for the empirical treatment of gram-negative bacterial (GNB) infections. In the last decade, there have been reports of the detection of carbapenem-resistant Enterobacterales (CRE). This rise in the spread of CRE presents a great challenge in the treatment of GNB infections and poses a serious threat to global health. To detect the burden of CRE and to characterize CRE, we used three phenotypic methods for the detection of carbapenemase enzymes. Using conventional aerobic bacterial culture methods, 150 Enterobacterales strains were isolated from various clinical samples. Identification of CRE was performed using multiple phenotypic detection methods, such as the Kirby Bauer disc diffusion method for meropenem (10 mcg) using the CLSI 2021 interpretation for meropenem, modified Hodge test (MHT), Carba NP test, and modified carbapenem inactivation method (mCIM) test. A total of 150 Enterobacterales strains were isolated over a period of 1 year. Among these, 66/150 (44%), 63/150 (43%), 64/150 (43%), and 65/150 (43%) were identified as CRE using the Kirby Bauer disc diffusion method, MHT, mCIM test, and Carba NP test, respectively. The sensitivity and specificity of MHT, mCIM, and Carba NP tests within 95% CI were 93.94%/100%, 96.97%/100%, and 98.48%/100%, respectively. The positive and negative predictive values of MHT, mCIM, and Carba NP tests were 100%/95.45%, 100%/97.67%, and 100%/98.82%, respectively. The accuracies of the MHT, mCIM, and Carba NP tests were 97.33%, 98.67%, and 99.33% respectively indicating a high burden of carbapenem resistance in Enterobacterales. Therefore, given the current statistics of carbapenem resistance, use of carbapenem as empiric treatment in the intensive care units of hospitals may not be beneficial. Identification of carbapenem resistance can help in the initiation of appropriate antimicrobial therapy. This study compares the accuracy and efficiency of Carba NP, mCIM, and MHT in detecting carbapenem-resistant Enterobacterales.

Study of pattern and etiological factors of nosocomial infections in critical care unit in a multispecialty, tertiary care hospital in Central India

Background: Nosocomial infection is a key factor determining the clinical outcome, especially among patients admitted in critical care areas. The objective of the study was to ascertain the pattern and risk factors of nosocomial infections in Critical Care Unit in a tertiary care hospital.Methods: This prospective, observational clinical study included patients admitted in intensive care unit over a period of one and a half years. Routine surveillance of various nosocomial infections such as catheter‑associated urinary tract infections, central‑line‑associated blood stream infections, and ventilator‑associated pneumonias was done through specific infection surveillance proforma.Results: Out of 679 patients, 166 suffered 198 episodes of device‑associated infections. The infections included CAUTI, CLABSI, and VAP. The number of urinary tract infection episodes was found to be 73 (10.75%) among the ICU patients who had indwelling urinary catheter. In addition, for 1 year CAUTI was calculated as 9.08/1000 catheter days. The number of episodes of blood stream infection was 86 (13.50%) among ICU patients having central line catheters. Also, CLABSI was found to be 13.86/1000 central line days. A total of 39 episodes (6.15%) of VAP was found in ICU patients over 18 months and VAP present for 6.04/1000 ventilator days.Conclusions: The organisms most commonly associated with nosocomial infections were Pseudomonas Aeruginosa and Acinetobacter species. The risk factors identified as being significantly associated with device associated infections in our ICU were diabetes, COPD and ICU stay for ≥8 days (p<0.05).

Knowledge about Enteral Feeding Among Cardiac Nurses at CCH

Background: Patients need enough food to recover from any disease. Patients with serious illnesses have high nutritional requirements and can become malnourished very quickly. Research findings suggest that early nutrition is important for patient outcomes. The nutritional needs of all patients are reviewed daily and nutrition is initiated as soon as possible, usually on the first day of admission. In critical care areas, enteral feeding is used to overcome malnutrition conditions and to keep patient in the safety side. Therefore, enteral nutrition is considered an easier method and cheaper when compared to parenteral nutrition which has more complications and costlier, additionally, having enough knowledge about enteral nutrition by the nurses is considered very crucial to administer the enteral feeding to patients in the proper way at the critical care units. Method: Non-experimental, cross-sectional research design which will identify nurses’ knowledge regarding enteral feeding among cardiac nurses at CCH. The study will describe knowledge by using a quantitative method. The research will be conducted in Cardiac Center Hail, Ha’il Region, Kingdom of Saudi Arabia, and will focus on all cardiac nursing care units. Results: The data obtained from this study were analyzed using the Statistical Package for Social Science (SPSS) 25.0 program. A descriptive statistical analysis using means, frequencies, percentages, and standard deviations was used to describe the demographic variables and answer question 1. Kruskal-Wallis was used to determine if there are significant differences among the means of the groups (more two groups) and Mann-Whitney (independent-samples) for questions 2, because the data doesn’t follow normality distribution, where of the Table 2, we find that the significance level of the Kolmogorov-Smirnov test was less than 0.05. This leads us to reject the null hypothesis that the data follow the normal distribution, so we used nonparametric tests. Conclusion: The nurses’ knowledge regarding enteral nutrition at the cardiac nursing units were enough under safe practices. The in-short activities of Continuing Nursing Education had a positive effect in improving the nurses’ knowledge and practices regarding enteral nutrition in the in-patients’ departments at Cardiac Center Hail.

Oncology-specific Qualified Clinical Data Registry (QCDR) measures to advance cancer care and achieve Merit-Based Incentive Payment System (MIPS) performance.

435 Background: Quality measurement is one of the four pillars of the Centers for Medicare and Medicaid (CMS) MIPS program. Few MIPS quality measures are specific to oncology. The US Oncology Network (USON) in collaboration with McKesson created a QCDR to align quality improvement reporting with oncology-specific measures to improve cancer care. Methods: The Practice Insights QCDR application was developed and submitted to CMS for approval in 2017. Integrated with an oncology-specific EHR (iKnowMed Generation 2), the QCDR leverages clinical content to automate calculation of quality measures. A multidisciplinary team was created to develop targeted oncology-specific measures that are clinically relevant, improve patient care, and reduce unnecessary healthcare costs. Results: The QCDR has been approved by CMS since 2017 allowing development of oncology-specific measures to monitor critical areas of cancer care. USON practices reported these measures as part of their MIPS participation. CMS established national MIPS program performance benchmarks for 4 measures due to measure feasibility, reporting ease, and high clinician adoption rates. PIMSH4 Pain Improvement (patient-reported outcome) was selected for public reporting through CMS Care Compare. CMS approved all 7 submitted QCDR measures for the 2022 MIPS program year. USON average performance (25 practices, representing 1,787 clinicians) from 2019-2022 YTD demonstrates significant improvement ranging from 4%-10%. Conclusions: Creating an oncologic-specific QCDR allowed USON practices to report more meaningful quality measures through the MIPS program. QCDR measures provide insight for care teams and trends from 2019-2022 YTD demonstrate that USON practices achieved significant performance improvements in key areas of cancer care. Future development will refine and identify new measures that align with our patient care improvement activities to enable clinicians and care teams to focus on measures that matter.[Table: see text]

P085 Prevalence and antifungal susceptibility of Candida spp. from the sputum sample of patients in a tertiary care hospital in Sikkim

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesThe role of Candida in sputum culture is unclear and is generally not treated when present in sputum samples. The objective of this study is to describe the clinical findings of patients with Candida spp. in sputum and their antifungal susceptibility pattern to know the local epidemiology of antifungal resistance.MethodsPatients with respiratory symptoms attending the tertiary care hospital during the study period of 6 months from June 2021 to December 2021. A total of 23 sputum samples were processed in the microbiology laboratory. Samples were processed following conventional mycological procedures including direct microscopy (visualization of budding yeast cell on grams stain), growth on sabouraud dextrose agar, Germ tube test, and CHROMagar. The isolates were identified by rapid identification (ID) of yeast and yeast-like organisms in the BD PhoenixTM Automated Microbiology System.Antifungal Susceptibility Testing (AFST) was carried out by disk diffusion susceptibility testing, Zone interpretation criteria as per M44/A2 protocol of CLSI were used. Antifungal used were amphotericin B (20 mcg), itraconazole (10 mcg), fluconazole (25 mcg), and voriconazole (1 mcg). Results of tests done on 23 isolates were collated and analyzed retrospectively.Clinical profile of the patients was taken retrospectively from record section and analyzed.ResultsOf the 23 patients, most common presentation was fever followed by cough and dyspnea. A total of 34% patients were receiving some form of steroid (injectable or inhalational). Only 2 patients were COVID positive by RT-PCR and 7(30%) patients had some radiological findings like consolidation, emphysematous changes, etc. Immunodeficiency condition was seen in 4 (17%) patients like tuberculosis and diabetes mellitus.Of the 23 samples, C. albicans showed prevalence of 91% as compared with C. tropicalis (5%) and C. glabrata (4.8%). AFST showed Candida spp. was found to be mostly sensitive to voriconazole and fluconazole. Resistance to amphotericin B was seen in most Candida spp. Itraconazole was not susceptible to even one isolate only 4 samples were intermediate (Fig. 1).ConclusionsInfections with Candida spp. are usually of low virulence and are associated with a few well-defined risk factors as immunocompromised state, malignancy, and steroid therapy. Understanding these risk factors, identifying the species with changing trends in antifungal resistance, instituting infection control practices to reduce morbidity and mortality in critical care areas can improve outcomes.Surveillance of the rates of Candida infection in critical areas, reporting of outbreaks and continuous monitoring of antifungal susceptibility patterns will help in choosing the best therapeutic management of complicated cases. Comparison of trends in infection rates amongst hospitals between various Indian cities and their resistance patterns can reveal vital information regarding the breakdown of infection control measures. Most Candida infections are of low virulence and only become significant in the vulnerable critical care areas. With the rise in prevalence of inherently azole-resistant species and rising use of echinocandins in ICUs, identifying risk factors and controlling the infection early can improve patient outcomes.

Validation of Malay Language Translated Questionnaire on Adult Intensive Care Unit Nurses’ Perception and Involvement in End-of-life Care

Introduction: The study’s objective was to validate a Malay language translated questionnaire on end-of-life care to be used among nurses practicing in critical care areas. Methods: The English language questionnaire underwent forward and backward translations by four experts. The translated Malay language questionnaire was pilot tested on 30 subjects and revised accordingly. The validation of the revised questionnaire was carried out on 250 nurses. The reliability of the translated questionnaire was checked. Cronbach alpha value of at least 0.70 suggests adequate internal consistency. The validity of the questionnaire was explored using Confirmatory Factor Analysis (CFA) and model fit tests were run to achieve fit test specific cut off values. The CFAs were run repeatedly with iterative item reductions until acceptable goodness of fit for the model was achieved. Results: All domains of the translated questionnaire showed reasonable to excellent reliability (Cronbach Alpha 0.687 to 0.922). Multiple CFAs were run and 13 out of 46 items were excluded, and the final model fit improved substantially with the indices were within the acceptable threshold of good or reasonably fit, cut off values are in brackets [Chi-Square statistics 1.635 (≤ 2.0), Root Mean Square Error of Approximation 0.050 (< 0.05), Standardised Root Mean Square Residual 0.059 (≤ 0.08), Comparative Fit Index 0.911 (0.90-0.94), Tucker Lewis Index 0.900 (0.90-0.94), Akaike Information Criteria 13024, Bayesian Information Criteria 13334]. Conclusion: The psychometric properties of the final model indicated the Malay language translated questionnaire is reliable and valid to investigate nurses’ perspective and involvement in end-of-life care.

The CHARTER-Ireland trial: can nebulised heparin reduce acute lung injury in patients with SARS-CoV-2 requiring advanced respiratory support in Ireland: a study protocol and statistical analysis plan for a randomised control trial

BackgroundCOVID-19 pneumonia is associated with the development of acute respiratory distress syndrome (ARDS) displaying some typical histological features. These include diffuse alveolar damage with extensive pulmonary coagulation activation. This results in fibrin deposition in the microvasculature, leading to the formation of hyaline membranes in the air sacs. Well-conducted clinical trials have found that nebulised heparin limits pulmonary fibrin deposition, attenuates progression of ARDS, hastens recovery and is safe in non-COVID ARDS. Unfractionated heparin also inactivates the SARS-CoV-2 virus and prevents entry into mammalian cells. Nebulisation of heparin may therefore limit fibrin-mediated lung injury and inhibit pulmonary infection by SARS-CoV-2. Based on these findings, we designed the CHARTER-Ireland Study, a phase 1b/2a randomised controlled study of nebulised heparin in patients requiring advanced respiratory support for COVID-19 pneumonia.MethodsThis is a multi-centre, phase 1b/IIa, randomised, parallel-group, open-label study. The study will randomise 40 SARs-CoV-2-positive patients receiving advanced respiratory support in a critical care area. Randomisation will be via 1:1 allocation to usual care plus nebulised unfractionated heparin 6 hourly to day 10 while receiving advanced respiratory support or usual care only. The study aims to evaluate whether unfractionated heparin will decrease the procoagulant response associated with ARDS up to day 10. The study will also assess safety and tolerability of nebulised heparin as defined by number of severe adverse events; oxygen index and respiratory oxygenation index of intubated and unintubated, respectively; ventilatory ratio; and plasma concentration of interleukin (IL)-1β, IL6, IL-8, IL-10 and soluble tumour necrosis factor receptor 1, C-reactive protein, procalcitonin, ferritin, fibrinogen and lactate dehydrogenase as well as the ratios of IL-1β/IL-10 and IL-6/IL-10. These parameters will be assessed on days 1, 3, 5 and 10; time to separation from advanced respiratory support, time to discharge from the intensive care unit and number tracheostomised to day 28; and survival to days 28 and 60 and to hospital discharge, censored at day 60. Some clinical outcome data from our study will be included in the international meta-trials, CHARTER and INHALE-HEP.DiscussionThis trial aims to provide evidence of potential therapeutic benefit while establishing safety of nebulised heparin in the management of ARDS associated with SARs-CoV-2 infection.Trial registrationClinicalTrials.govNCT04511923. Registered on 13 August 2020.Protocol version 8, 22/12/2021Protocol identifier: NUIG-2020-003EudraCT registration number: 2020-003349-12 9 October 2020

A Descriptive Phenomenological Study on Professional Role Transition of New Graduate Nurses in Selected Hospital, Bangalore

Background: Nursing is the largest, the most diverse, and one of the most respected among the health care professions. Nurses play an integral role in the healthcare system and they have been correctly referred to as the heart of healthcare. The climate and culture have perhaps the largest impact on a new graduate nurse’s transition into the workforce. New graduates often have a difficult time distinguishing between prioritizing patients and prioritizing care. Objective: The objective of this research was to describe the experiences of new graduate nurses during their professional role transition in their first twelve to eighteen months of experience in critical care areas. Methods: A Descriptive phenomenological approach was selected for the study. Based on the Descriptive phenomenological approach four step was used: bracketing, intuiting, analysis and describing. The investigators identified and clarified their interest in the study and maintained initial reflective note and memoing. Results: The initial stage, (1-3 months) of professional roles transition of new graduate nurses was marked by a high level of stress, fear and disappointment with the disparity between what is anticipated and what is expected from them. Through their professional journey during next 4-5 months, they found themselves moderately stressful, confident and being trusted by their seniors. By the end of 12 months all the graduates have gained confidence and higher level of decision-making abilities and wanted to empower themselves through higher education. Interpretation and Conclusion: The findings of the study shown that life experiences of newly graduate nurses gradually change as they transit from novice to skilled nurse. Keywords: Transition, Professional role transition, and new graduate nurse.

The Three-Component Feedback System of Nurses' Power, Empowerment, and Job Performance

Quality service provision depends on the performance of the service providers; therefore, enhancing an empowering work environment is crucial to achieving excellence. This study examined the intercorrelation between structural empowerment, nurses perceived formal and informal power, and their job performance. Nurses perceived only a moderate level of power in their work environment with the highest performance quality in the area of critical care. The model “the three-component feedback system of power, empowerment, and job performance” was tested using the structural equation model. The data from 200 nurses strongly fit with the proposed model. This study proposed that job performance, power, and empowerment are involved in a loop of feedback system in which each variable in the loop affects other variables either directly or through other variables in the loop. Applying staff improvement plans can begin in one component of the system, and the progress will eventually enhance the other components.

Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.

Facial hair under a tight fitting P2/N95 respirator diminishes respiratory protection. There is limited guidance with respect to the threshold to be clean shaven in readiness to wear N95 respirators. We performed a cross sectional audit in late August 2021 to observe whether staff had facial hair that could decrease respiratory protection of tight fitting respirators. The audit was conducted in three critical care areas at a major tertiary public hospital in Australia during a period of moderate-to-high community prevalence of COVID-19. All staff observed had previously successfully completed quantitative fit testing with a clean shaven face in the preceding 12 months. 110 consecutive male critical care staff were observed including thirty staff who were required to wear a N95/P2 respirator at the time. Forty - five percent of male staff observed were not clean shaven in the face seal zone of their respirators. The readiness to wear a tight-fitting respirator and hence the need to be clean shaven, should be guided by both state and local COVID-19 risk ratings, as well as the specific respiratory biohazard risks present in the clinical area at that time. During periods of significant community transmission of COVID-19, critical care clinical staff should be clean shaven, so they are fit-for-purpose and ready to wear a tight fitting respirator at short notice. Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia.

“Hear Me Out, Please…”: The Experience of the Novice Critical Care Nurse When Embarking in the Critical Care Areas

Introduction: The readiness of novice critical care nurses (NCCN) to perform efficiently has been doubted globally. Studies have reported that novice nurses have issues with their confidence and competence in handling critical patients in ICU. Their lack of confidence and competence may promote more harm to the patient’s condition study aim is to explore the experience of novice critical care nurses when embarking in critical care areas.Methods: This study was carried out using a general qualitative design. Data were collected through an in-depth interview in exploring NCCN experiences, challenges, and needs while working in the critical care setting. They were recruited from a teaching hospital located in East Coast Malaysia. Data were organised and analysed manually using the thematic analysis approach. Finding: A total of 20 participants was recruited for the study. The majority of the participants are Malay, female, and graduated with Diploma in Nursing from Malaysia. The study reported three main themes; (1) Handling complex patients (2) Familiarised with the equipment and environment, and (3) Mixed feelings during the transition. Themes revealed in the study have proposed that NCCN is eager for support when embarking in the areas.Conclusion: Acknowledge the struggle faced by the NCCN may seem small to others. But it can free up some space in their mind to continue the growth expected and needed from them. Therefore, it could be beneficial to the health setting and patients’ care.

The patient safety in extracorporeal blood purification treatments of critical patients.

Today, health systems are complex due to both the technological development in diagnostic and therapeutic procedures and the complexity of the patients that are increasingly older with several comorbidities. In any care setting, latent, organizational, and systematic errors can occur causing critical incident harmful for patients. Management of patients with acute kidney injury (AKI) requires a multidisciplinary approach for the diagnostic-therapeutic-rehabilitative path that can also require an extracorporeal blood purification treatment (EBPT). The complexity of these patients and EBPT require a clinical risk analysis and the introduction of protocols, procedures, operating instructions, and checklists to reduce clinical risk through promotion of the safety culture for all care providers. Caregivers must acquire a series of tools to evaluate the clinical risk in their reality to prevent incidents and customize patient safety in a proactive and reactive way. Established procedures that are made more needed by the COVID-19 pandemic can help to better manage patients in critical care area with intrinsic higher clinical risk. This review analyzes the communication and organizational aspects that need to be taken into consideration in the management of EBPT in a critical care setting by providing tools that can be used to reduce the clinical risk. This review is mostly addressed to all the caregivers involved in the EBPT in Critical Care Nephrology and in the Intensive Care Units.

The Use of Simulation-Based Education With New Graduate Nurses in Emergency Department and Acute Care Settings: A Scoping Review.

Background The literature questions if newly graduated nurses are truly ready to practice at the bedside. Simulation has been shown to bridge the gap between theory and practice. The purpose of this study was to investigate what is known about the use of simulation education with novice graduate nurses in critical care settings in the hospital. Method A scoping review was conducted using the PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Articles published in English between 2015 and September 2021 that focused on simulation education with novice graduate nurses in a critical care setting were included. Results The review yielded six articles. Conclusion The literature is scant on the use of simulation in critical care areas with novice graduate nurses. Additional inquiry is needed related to the role of learners, cost, timing, setting, and educational practices. More studies with stronger research designs and valid and reliable measurement instruments are also needed. Finally, there is a need to better understand the effects of simulation on novice nurse graduates' knowledge and skills as well as patient outcomes. [J Contin Educ Nurs. 2022;53(7):301-306.].

Recomendaciones para la realización de broncoscopia en pacientes pediátricos en la pandemia COVID-19

Introduction: a bronchoscopy is a fundamental tool in respiratory clinical conditions, but it can be a source of transmission of infectious agents such as SARS-COV-2. Therefore, it is urgent to adopt international recommendations for our environment. In this study, we need indications, contraindications, and biosafety measures to perform bronchoscopy in patients with SARS-COV-2 infection.Methods: the first phase consists of an analysis of the state of scientific research with a source of exploration on an academic basis. Subsequently, the elaboration of questions with the PICO methodology, using the PRISMA strategy. These were voted on by 18 Pediatric Bronchoscopist Pulmonologists who answered a survey and defined the agreement strength as strong, moderate and weak, based on expert agreement.Results: the indications with the highest level of an agreement are suspicion of foreign body aspiration and massive hemoptysis. The contraindications with the highest level of an agreement are non-urgent conditions, thermoplasty, stent placement. The general recommendations with the highest degree of agreement are a notification to the anesthesiologist and surgical team. The recommendations during and after the procedure are to use personal protective equipment, proper removal of it, and disinfection of equipment with 75% alcohol.Conclusions: bronchoscopy is a procedure inherent to critical care areas, the high training of the personnel assigned to these tasks is a fundamental principle for the success of its execution. Our project reaches a high level of agreement among the participating experts, which allows the elaboration of the Mexican Bronchoscopy Consensus.

Moral distress among critical care nurses: A cross-cultural comparison.

Although, moral distress presents a serious problem among critical care nurses in many countries, limited research has been conducted on it. A validated scale has been developed to evaluate moral distress and has enabled cross-cultural comparison for seeking its root causes. This study aimed to (1) clarify the current status of moral distress among nurses who worked in critical care areas in Japan, (2) compare the moral distress levels among nurses in Japan with previously reported results from the United States (US), and (3) explore the factors associated with moral distress. A nationwide cross-sectional study was conducted. We conducted a self-administered questionnaire survey using the Measure of Moral Distress-Healthcare Professionals (MMD-HP) among critical care nurses who were randomly selected from hospitals across Japan. The mean differences between the two countries were compared using a Student's t-test with summary statistics. The factors associated with higher levels of moral distress were examined using a multiple regression analysis. The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214 and M2019-045). We obtained 955 valid responses from 94 facilities. In Japan, the items with the highest moral distress scores were those related to aggressive/inappropriate treatment. The total MMD-HP score was significantly higher in Japanese nurses compared to US nurses (122.8 ± 70.8 vs 112.3 ± 73.2). Some factors, such as leadership experience, were associated with higher moral distress. The top root causes of moral distress were similar to potentially inappropriate treatments in both countries. This study revealed the factors associated with higher moral distress and its characteristics in each country. These results can be used for reducing moral distress in the future.

Does spirituality mitigate critical carers’ moral distress and strengthen their resilience? A scoping review protocol

Abstract Objective The objective of this scoping review (Registration DOI:10.17605/OSF.IO/UYV9G) is to understand how critical care professionals’ (CCP) moral distress and spiritual resources impact on their resilience. Introduction Previous reviews failed in obtaining evidence for tailored intervention reducing CCPs’ moral distress. Although frequently mentioned, spiritual resources were not thoroughly explored. Inclusion criteria In order to describe elements of the inclusion criteria, the PCC-framework (Population, Concept, Context) will be applied. Participants are all CCP (nurses, physicians, physiotherapists, psychologists …). The concept is resilience, taking into account moral distress and spirituality. The context is critical care (preclinical emergency care, emergency room, intensive care unit). Other contexts such as palliative care wards are excluded. Methods We will search 13 databases and grey literature published in 2020–2022. A two-stage screening process by at least two independent reviewers will be used. First titles and abstracts will be scanned and then a full-text review of relevant articles will be done. The extracted data will be independently discussed by at least two reviewers. Ethics and Dissemination Ethical approval is not required for scoping reviews. Dissemination will include submission to peer-reviewed journals and presentations in conferences and workshops in the area of critical care.