ICU Healthcare Workers Research Articles

Nurses’ perception of troubled conscience in intensive care units: a qualitative study

BackgroundTroubled conscience results from the lack of attention to the voice of conscience. Regarding the fact that ICU healthcare workers are constantly faced with stressful and challenging situations, they often experience a troubled conscience.AimThis study aimed to explain the factors leading to troubled conscience and identify the consequences of troubled conscience among ICU nurses.MethodsQualitative content analysis was used to answer the research question. A total of 18 ICU nurses were selected to participate in this study using purposive sampling. Data were collected using face-to-face, semi-structured interviews.FindingsFour categories of “carelessness”, “contextual challenges”, “non-supportive and unpredictable structure” and “whirlpool of troubled conscience” were shown to constitute the main causes of troubled conscience among ICU nurses.ConclusionTroubled conscience negatively impacts nurses and is associated with psychological/behavioral changes among them. The identification and explanation of troubled conscience help healthcare providers to confront it and manage its causes.

Use of Topical Lavender Essential Oils to Reduce Perceptions of Burnout in Critical Care

Intensive care unit (ICU) health care workers face increased burnout. The purpose of this project was to evaluate burnout after implementing lavender essential oils. To assess the effectiveness of topical lavender essential oils in decreasing the instance of burnout in frontline ICU health care workers during the COVID-19 pandemic. A predesign and postdesign evidence-based practice project was conducted to evaluate the implications of an 8-week topical lavender oil intervention on health care worker burnout. The Maslach Burnout Inventory, including subscales of emotional exhaustion, depersonalization, and personal accomplishment, was administered before and after the intervention. Health care workers' compliance and satisfaction with the intervention were also measured. Thirty-four ICU health care workers participated. Results showed significant improvements in the personal accomplishment subscale (mean [SD], 3.86 [0.81] before vs 4.14 [1.01] after intervention; P = .04). Improvements in depersonalization were not significant. Most participants were satisfied (n = 23 [67.6%]) and compliant (n = 23 [67.6%]) with the intervention. The use of topical lavender essential oils is a cost-effective intervention that can be used to decrease components of burnout in frontline ICU workers.

The Continuing Effect of COVID-19 Pandemic on Physical Well-Being and Mental Health of ICU Healthcare Workers in Turkey: A Single-Centre Cross-Sectional Later-Phase Study.

BackgroundThis study aimed to evaluate the effect of COVID-19 pandemic on physical well-being and mental health of ICU healthcare workers (HCWs).MethodsA total of 51 ICU HCWs working at a tertiary care hospital were included in this cross-sectional study conducted before (January 2019-January 2020) and during (January 2021-April 2021) COVID-19 pandemic. Data on sociodemographic and work-related characteristics, COVID 19 history and current mental health issues via Hospital Anxiety-Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI), Eating Attitudes Test (EAT-40), Suicidal Ideation Scale (SIS) and Maslach Burnout Inventory (MBI) were recorded.ResultsOverall, 62.7% of participants were nurses, heavy workload (working ≥200 h/month) was reported by 76.5% of participants and previous history of COVID-19 was confirmed by 62.7%. Current mental health issues involved poor sleep quality in majority (96.1%) of participants, anxiety (51.0%), depression (51.0%) in at least half of them and a moderate degree of emotional exhaustion Heavy workload was associated with more remarkable decrease in sleep duration (median change: −0.5 vs. −1.0 h/day, P = .020), Vit B12 (median change: 60[−48-293] vs. −65[−371-262] pg/mL, P < .001) and Vit D (median change: −1.6[−13.1-20] vs. −9.7[−39.7-21.8] ng/mL, P = .004) during pandemic, while working hours per month were also significantly higher in those with versus without anxiety (264[150-390] vs. 240[150-264] h, P = .003) and with versus without depression (264[150-390] vs. 240[150-264] h, P = .037).ConclusionOur findings indicate high prevalence of mental health issues including anxiety and depression as well as poor sleep quality and emotional burnout among ICU HCWs, particularly those with heavy workload.

French ICU's health care workers have a poor knowledge of the cost of the devices they use for patient care: A prospective multicentric study

PurposeICU patient's care may require the use of onerous devices, which contributes to make this department one of the most expensive in the hospital. It seemed us relevant to assess healthcare workers' (HCWs) knowledge of the cost of the devices daily used in ICU. Materials and methodsAn anonymous questionnaire was administered on a voluntary basis to HCWs of 3 ICUs. Measurements and main resultsCost estimations were expressed as percentage of the real cost; an estimation was considered correct if it was ±50% of the true price. 107 HCWs (66 physicians and 41 nurses and nurse aids) answered the survey. Only 29% of estimations were within 50% of the real cost. The prices of the cheapest devices were overestimated, while the costs of the most expensive ones were underestimated. In multivariate analysis, cost less than50 euros [OR = 3.2; CI 95%(1.6–6.3)], professional experience <10 years [OR = 1.5; CI 95%(1.1–2.1)], being a medical student [OR = 2.0; CI 95%(1.3–3.0)], and working in a university affiliated hospital [OR = 0.6; CI 95%(0.4–0.9)] were associated with an incorrect estimation. ConclusionsICU's HCWs have a poor knowledge of the price of devices they regularly use for the care of their patients.

Prevalence, associated factors, and consequences of burnout among ICU healthcare workers: an Egyptian experience

Background Burnout is considered an epidemic in modern society, and the issue of occupational stress and burnout is receiving increasing attention worldwide. Aim The aim was to detect the prevalence of burnout syndrome (BO) among ICU health care workers in Canal health sector and to clarify its determinants and consequences. Patients and methods A cross-sectional study was conducted on 147 physicians and 234 nurses. To detect the determinants of BO, data on sociodemographic variables, job-related issues, work environment, health problems, bad social habits as an outlet for job stress, committing unintended job-related mistakes, and infection control measures were collected. Burnout was assessed using the Maslach burnout inventory and its subscales. Results Regarding the total burnout scale, 68.2% of the study participants reported having a moderate level of burnout, with significant difference between physicians and nurses. More than half of the nurses had high emotional exhaustion compared with 38.8% of physicians. For the depersonalization subscale, 59.8% of nurses had higher scores compared with 70.1% of physicians (P Conclusion Approximately one-quarter of nurses and physicians have high levels of BO syndrome. Being resident, sleep deprivation, and lack of appreciation were significant predictors of BO.

Multi Drug Resistant bacteria: prevalence and associated risk factors amongst ICU health care workers of a tertiary care hospital

Background: MDR bacteria pose serious threat to patient safety worldwide.HCW is an important source of dissemination and transmission of these organisms to patients. Although many studies have been carried out in India which have determined the prevalence of one or two MDR bacteria colonizing the HCW, but no study so far has determined the prevalence and common risk factors for acquisition of the most prevalent type of MDR. Methods: Hand swabs from 198 HCW were obtained, processed and isolates identified by automated method using Vitek II (Biomerieux, Durham,NC).Risk factor assessment was done based on a questionnaire using Fischer’s exact /Chi square test. Result : A total of 24 HCWs (12.1%) were found positive for MDR bacteria.MDR Acinetobacter baumanii 10(5.1%), MDR Pseudomonas aeruginosa 7(3.4%) MRSA were 5(3.2%), and Vancomycin Resistant Enterococcus 2(0.6%).Majority of MDR (16.1%) was isolated from hands of doctors. Male sex, presence of chronic /open wound and close contact with patients were factors found significantly associated with colonization of hands of HCW. Conclusion: HCAI in the vulnerable ICU patient population can be linked to the MDR bacterial flora of the HCWs. The contamination of healthcare workers’ hands during patient care with multidrug- resistant organisms is most frequent with A. baumannii. Compliance with contact precautions and more aggressive environmental cleaning may decrease transmission. DOI:10.21276/APALM.1485

Prevention of Ventilator-Associated Pneumonia: Can Knowledge and Clinical Practice Be Simply Assessed in a Large Institution?

User-friendly scores to assess knowledge of guidelines for prevention of ventilator-associated pneumonia (VAP) are scarce and have mainly evaluated nurses, but not students or physicians. Gaps between knowledge and actual clinical practice have not been sufficiently analyzed. We assessed knowledge of and adherence to guidelines for prevention of VAP among physicians, nurses, and students in adult ICUs. All adult ICU healthcare workers were invited to complete a 20-point questionnaire. The first part assessed personal knowledge of international guidelines for prevention of VAP; the second part assessed daily clinical practice. Personal knowledge and daily practice were scored from 0 to 10 points. We invited 257 ICU healthcare workers to participate in the study, and 167 (65%) accepted (32/54 physicians, 108/176 nurses, and 27/27 students). The median (IQR) personal knowledge scores for physicians, nurses, and students were 6 (5-7), 5 (4-6), and 5 (4-7), respectively. The median scores for daily clinical practice for physicians and nurses were 5 (4-6) and 4 (3-5), respectively. Healthcare workers with more than 1 year of ICU experience scored significantly better in personal knowledge than those with less experience: 6 (5-7) versus 4 (3-6), P = .004. A simple, easy-to-complete questionnaire enabled us to rapidly evaluate personal knowledge and reported clinical practice in prevention of VAP in large teaching institutions. These scores will be used as baseline figures to assess the impact of educational and intervention campaigns.

Épuisement professionnel en réanimation

Burnout syndrome (BOS) is a psychological state resulting from prolonged exposure to job stressors. Because intensive care units (ICUs) are characterized by a high level of work-related stress, we reviewed the available literature on BOS among ICU-healthcare workers. Recent studies suggest that severe BOS (measured with the Maslach Burnout Inventory) is present in about half of all critical care physicians and one-third of critical care nurses. Interestingly, the determinants of BOS difer between the two groups of caregivers. Intensivists with severe BOS tend to be those with a large number of working hours (number of night shifts, and time since last vacation), whereas severe BOS among ICU nurses is mainly related to ICU organization and end-of-life care policy. ICU conflicts were independent predictors of severe BOS in both groups. Recent studies also identify potential preventive measures, such as ICU working groups, better communication during end-of-life care, and prevention and management of ICU conflicts.

Survey Study of the Knowledge, Attitudes, and Expected Behaviors of Critical Care Clinicians Regarding an Influenza Pandemic

Intensive care units (ICUs) are potential high-risk areas for the transmission of respiratory viruses such as influenza. An influenza pandemic is expected to result in a dramatic surge of critically ill patients, and ICU healthcare workers (HCW) are likely to be at high risk of infection. To characterize the knowledge, attitudes, and expected behaviors of ICU HCWs concerning the risk of and response to an influenza pandemic. A survey was distributed to 292 HCWs (ie, internal medicine house staff, pulmonary and critical care fellows and faculty members, nurses, and respiratory care professionals) at 2 hospitals in Baltimore, Maryland. Of the 292 HCWs, 256 (88%) completed the survey. Just over one-half of the respondents believed there is at least a 45% chance of an influenza pandemic within the next 5 years. However, only 41% reported knowing how to protect themselves during an outbreak. Despite this common belief that a pandemic is likely in the near future, 59% of those surveyed reported only minimal knowledge of the risks of and protective strategies for an influenza pandemic, and 20% reported being unlikely to report to work during a pandemic or being unsure about whether they would do so. The odds of reporting to work varied on the basis of race and responsibility for child care. ICU HCWs reported having minimal knowledge concerning the risk of and response to an influenza pandemic, even though more that one-half of HCWs expect that a pandemic will occur in the near future. This finding in a high-risk setting is of concern, given that lack of knowledge among HCWs may result in increased nosocomial transmission to HCWs and patients. Interventions to improve knowledge of pandemics and understanding of risks among ICU HCWs are essential.

Burnout syndrome among critical care healthcare workers

Burnout syndrome is a psychological state resulting from prolonged exposure to job stressors. Because ICUs are characterized by a high level of work-related stress, a factor known to increase the risk of burnout syndrome, we sought to review the available literature on burnout syndrome in ICU healthcare workers. Based on most recent studies, severe burnout syndrome (as measured using the Maslach Burnout Inventory) is present in about 50% of critical care physicians and in one third of critical care nurses. Strikingly, determinants of burnout syndrome are different in the two groups of caregivers. Namely, intensivists who have severe burnout syndrome are those with a high number of working hours (number of night shifts and time from last vacation) but determinants of severe burnout syndrome in ICU-nurses are related to ICU organization and end-of-life-related characteristics. ICU conflicts, however, were independent predictors of severe burnout syndrome in both groups. Recent studies reported high levels of severe burnout syndrome in ICU healthcare workers and identified potential targets for preventive strategies such as ICU working groups, communication strategies during end-of-life care and prevention and management of ICU conflicts.

Protecting healthcare workers from SARS

There are only limited data from which to estimate the risk to ICU healthcare workers of acquiring SARS. We describe our experience of infection of healthcare workers in our SARS ICU.

Withdrawing Life Support in Canada and the United States-Reply

In Reply. —We thank Dr Whittaker for her thoughtful comments interpreting our study in the framework of the US health care system. There is no direct evidence about differences between United States and Canadian intensivists in decision making about the withholding and withdrawing of life support. In contrast to Whittaker, colleagues in the Canadian Critical Care Trials Group who have worked in both countries have found more similarities than differences in approach. At the same time, there are definite cultural issues that may affect the care that is delivered, including individualist vs socialist perspectives, financial incentives for health care providers, technological access, and the threat of litigation. By design, we focused on the attitudes and beliefs of ICU health care workers, in isolation of patient advance directives, family wishes, ability to pay, or other resource constraints. We agree that consideration of these issues would be important in any research program