Intensive Care Nurses Research Articles

Decision Fatigue and Neurosurgeons' Clinical Decision Making: An Enemy in the Shadow

Decision fatigue is a recognized phenomenon in healthcare psychology. Prolonged activities can lead to stress and fatigue, a familiar term in neurocognition. This is called decision fatigue; it is related to the ability to make the best decisions that decline with the course of the day. There are three key attributes to be included in this process; behavioral, cognitive, and physiological.[1] The management of the neurosurgical patient is a complex process. Multiple fields of medicine have shown that there is this decision fatigue due to multiple complex processes in place to practice medicine. As the US president correctly said, “… I am trying to pare down decisions. I don't want to make decisions about what I am eating or wearing. Because I have too many other decisions to make. You need to focus your decision-making energy…”.[2] The pandemic of COVID-19 has shown that this enemy is real and bedside intensive care nurses were the most impacted.[3]

The Impact of an Educational Programme on Jordanian Intensive Care Nurses' Knowledge, Attitudes, and Practice Regarding Delirium and their Levels of Self-Efficacy: A Quasi-Experimental Design.

Delirium is a common problem among patients in Intensive Care Units (ICUs); however, it remains underdiagnosed. We aimed to determine the impact of a nursing education program on Jordanian nurses' knowledge, practice, attitudes, self-efficacy, and ability to detect delirium among ICU patients. We conducted a nonequivalent, quasi-experimental design from January 2019 to January 2020. A total of 175 nurses who work in an ICU were included at the baseline and divided into two groups: (1) intervention (86 nurses), who received education for 6 hours each day across two different days and (2) a control group (89 nurses), who maintained their usual routine of care. Data were collected by means of a booklet of questionnaires about the nurses' knowledge and practice, attitudes, and self-efficacy. Data from 160 nurses were included in the analysis. The education program intervention (n = 81) significantly increased nurses' knowledge and practice, positive attitudes, and self-efficacy compared with the control group (n = 79, p < 0.001). In addition, nurses who received the educational intervention were able to detect more cases of delirium (28%, from a total of 51 patients) than the controls, who detected three (6.50%) out of a total of 31 patients (p = 0.003). The ICU nurses who received the delirium-focused educational program increased their knowledge and practice, positive attitudes, and their self-efficacy; in addition, their ability to detect delirium was increased. The implementation of such a program is recommended for the health policymakers and stakeholders.

Medication Errors among Iranian Intensive Care Nurses: A Systematic Review.

Medication Error (ME) is a major patient safety concern in Intensive Care Units (ICUs). Critical care nurses play a crucial role in the safe administration of medication. This study was conducted to comprehensively review the literature concerning the prevalence of ME and associated factors and outcomes in Iranian ICU nurses. An extensive search of the literature was carried in international databases including PubMed, Web of Science, Scopus, and Google Scholar, as well as Persian databases such as Magiran and Scientific Information Database (SID) using ME-related keywords and the Persian equivalent of these keywords, from the first article written in this field to artcles published on March 30, 2021. The appraisal tool (AXIS tool) was used to assess the quality of the included studies. Fifteen studies were included in this systematic review. The prevalence of MEs made by ICU nurses was 53.34%. The most common types of MEs were wrong infusion rate (14.12%), unauthorized medication (11.76%), and wrong time (8.49%) errors, respectively. MEs occurred more frequently in morning work shifts (44.44%). MEs happened more frequently for heparin, vancomycin, ranitidine, and amikacin. The most important influential factor in the occurrence of MEs in ICUs was management and human factors. The prevalence of MEs made by Iranian ICU nurses is high. Therefore, nurse managers and policymakers should develop appropriate strategies, including training programs, to reduce the occurrence of MEs made by nurses in ICUs.

Prolonged Intermittent Kidney Replacement Therapy.

Kidney replacement therapy (KRT) is a vital, supportive treatment for patients with critical illness and severe AKI. The optimal timing, dose, and modality of KRT have been studied extensively, but gaps in knowledge remain. With respect to modalities, continuous KRT and intermittent hemodialysis are well-established options, but prolonged intermittent KRT is becoming more prevalent worldwide, particularly in emerging countries. Compared with continuous KRT, prolonged intermittent KRT offers similar hemodynamic stability and overall cost savings, and its intermittent nature allows patients time off therapy for mobilization and procedures. When compared with intermittent hemodialysis, prolonged intermittent KRT offers more hemodynamic stability, particularly in patients who remain highly vulnerable to hypotension from aggressive ultrafiltration over a shorter duration of treatment. The prescription of prolonged intermittent KRT can be tailored to patients' progression in their recovery from critical illness, and the frequency, flow rates, and duration of treatment can be modified to avert hemodynamic instability during de-escalation of care. Dosing of prolonged intermittent KRT can be extrapolated from urea kinetics used to calculate clearance for continuous KRT and intermittent hemodialysis. Practice variations across institutions with respect to terminology, prescription, and dosing of prolonged intermittent KRT create significant challenges, especially in creating specific drug dosing recommendations during prolonged intermittent KRT. During the coronavirus disease 2019 pandemic, prolonged intermittent KRT was rapidly implemented to meet the KRT demands during patient surges in some of the medical centers overwhelmed by sheer volume of patients with AKI. Ideally, implementation of prolonged intermittent KRT at any institution should be conducted in a timely manner, with judicious planning and collaboration among nephrology, critical care, dialysis and intensive care nursing, and pharmacy leadership. Future analyses and clinical trials with respect to prescription and delivery of prolonged intermittent KRT and clinical outcomes will help to guide standardization of practice.

"Train the Trainers" Program to Improve Knowledge, Attitudes and Perceptions About Organ Donation in the European Union and Neighbouring Countries: Pre- and Post- Data Analysis of the EUDONORGAN Project.

EUDONORGAN, a European Union-funded project to improve organ and tissue donation, included a blended-based "Train the Trainers" program, which was implemented with the support of an international consortium from Croatia, Italy, Slovenia, and Spain. The web-based training included seven modules for which medical aspects, educational tips, and practical activities were scored using a 5-point Likert scale. The overall mean scores of satisfaction were higher than 4 for each module, without significant differences between HCPs and OKPs. In the face-to-face training survey similar scores above 4 were obtained for most items. Knowledge acquisition improved significantly in both HCPs and OKPs, as well as in transplant/donor coordinators, medical doctors, registered nurses, anesthesiologists/intensivists, and intensive care nurses. Improvements in attitudes and perceptions regarding organ donation were also observed, particularly among HCPs. In the accomplishment of the learning process, a successful pass mark of 95% was obtained. The "Train the Trainers" program was associated with an improvement in learning and attitudes of healthcare and non-healthcare professionals for the benefit of organ and tissue donation.

Quality of life as a mediating factor in the relationship between fatigue and perception of safety among critical care nurses in the United Arab Emirates

BackgroundA scientific understanding of the relationships between intensive care unit nurses’ well-being and patient safety will allow nurse managers, administrators, and policymakers to simultaneously manage crucial organisational goals of nurses’ health and patient safety. Understanding predictors of fatigue among intensive care unit nurses may help to balance personal and organisational impacts (e.g., turnover intention, sick leave) and provide a way to positively influence their safety perception. ObjectiveThe aim of this study was to explore the association between work fatigue and perception of patient safety among nurses working in critical care units and determine whether their quality of life levels mediated this relationship. MethodsThis study used a cross-sectional correlational comparative design. Participants were a sample of 250 intensive care unit nurses recruited conveniently from three large hospitals in the United Arab Emirates. The self-reported questionnaire included the Nursing Quality of Life Scale, the Fatigue Severity Scale, and the Safety Attitudes Questionnaire (SAQ)-ICU version, as well as sociodemographic characteristics and work-related information. ResultsOf the 250 participating nurses, 76.8 % reported low QoL. There was a statistically significant correlation between nurses’ Quality of Life and fatigue levels (r = 0.234, P = 0.000). Overall, 52.8 % of the sample had high fatigue and 49.6 % had poor safety perception. Multiple regression analysis using the Baron and Kenny approach showed that QoL, marital status, gender, and work environment were predictors of nurses’ perception of safety. ConclusionIntensive care unit nurses had high levels of fatigue and poor Quality of Life. High Quality of Life and a favourable work environment were independent predictors of good patient safety perception. Efforts should be directed to maximize staffing resources that positively impact patient safety. These findings are comparable with international studies, suggesting that these issues may be ubiquitous. Implications for clinical practiceIntensive care practitioners, managers and policymakers should adopt measures to modify intensive care nurses’ exhausting working conditions and provide a supportive environment. these interventions might improve nurses’ perception of patient safety and consequently prevent safety incidents.

The effect of job motivation on job engagement in intensive care nurses

The effect of job motivation on job engagement in intensive care nurses

Experiences of nurses during COVID-19 pandemic: An interpretative phenomenological analysis study

Purpose: The aim of this study was to determine the experiences of intensive care nurses who cared for patients with suspected or confirmed COVID-19.&#x0D; Material and Methods: The research was carried out with nurses. Data collection included in-depth interviews conducted between June-August 2020. Interviews were audio recorded, transcribed verbatim, and analysed using the Interpretative Phenomenological Analysis&#x0D; Results: Three main themes emerged: (a) nurses' compliance with the process; (b) factors affecting motivation; and (c) emotional responses observed in patients. While challenging situations, increase in workload, and situations that cause anxiety were the factors that negatively affected nurses' motivation to work, awareness/empathic behavior and flexible working hours were the factors that positively affected the motivation to work.&#x0D; Conclusion: Intensive care nurses make great efforts to prevent transmission from patients with COVID-19. It is thought that nurses should be supported in terms of the factors that negatively affect their motivation to work. It is considered that nurses' awareness/empathic behaviors affected their perceptions of the patients' fear of death and feeling of helplessness.

The Nurses’ Perspectives About Barriers of Nurse-Physician Collaboration in Intensive Care Units: A Q-Methodology Study

Background: Nurse-physician collaboration is essential for providing effective and safe patient care in intensive care units. Objectives: This study aimed to determine the different viewpoints of nurses working in intensive care units about the barriers to nurse-physician collaboration in Kashan/Iran by 2020. Methods: This was a cross-sectional study that employed a Q-methodology approach. Thirty intensive care nurses sorted the 24 statements into a 9-column Q-sort diagram ranging from -4 as not important to +4 as very important. The data were analyzed with PQMethod 2.35 software. The centroid factor analysis and varimax rotation were used for data analysis. The corresponding people for each extraction factor in the Q methodology were grouped and classified, and distinguishing statements were determined. Results: Four viewpoints were determined that could explain the 52.95% variance in the barriers to nurse-physician collaboration. The factors were named as different professional interests and lack of trust between nurses and physicians (26.77% of variance), goal confusion (10.74% of variance), systemic barriers to collaboration (8.17% of variance), and personal differences (7.25% of variance). Conclusions: Nurses had different viewpoints about barriers to nurse-physician collaboration. Different strategies and solutions are needed to improve collaboration, such as education, defining common goals, enhancing collaborative culture, and reaching mutual respect and understanding. Effective teamwork is essential for patient safety and a healthy work environment.

The early impact of COVID-19 on intensive care nurses’ personal and professional well-being: A qualitative study

ObjectiveTo describe the impact of the COVID-19 pandemic on intensive care nurses personal and professional well-being. Research Methodology/DesignA descriptive, qualitative design was used. Two nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a semi-structured interview guide. SettingThirteen nurses who were working in an intensive care unit in the United States participated in the study. A convenience sample of nurses who completed a survey in the larger parent study provided an email and were contacted by the research team to participate in interviews to discuss their experiences. Main Outcome MeasuresAn inductive approach to content analysis was used to develop categories. FindingsFive major categories emerged from the interviews: (1) We are not heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses the second victim. ConclusionThe COVID-19 pandemic has taken a physical and mental health toll on intensive care nurses. The impact of the pandemic on personal and professional well-being has serious implications for retaining and expanding the nursing workforce. Implications for clinical practiceThis work highlights the importance for bedside nurses to advocate for systemic change to improve the work environment. It is imperative for nurses to have effective training including evidence-based practice and clinical skills. There needs to be systems in place to monitor and support nurses’ mental health and encourage bedside nurses to use self-care methods and practices to prevent anxiety, depression, post-traumatic stress disorder and burnout.

Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study.

Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece. A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software. The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment. The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.

Analysis of the Relationship Between Neonatal Intensive Care Nurses’ Team Work and Parent Participation Attitudes

Analysis of the Relationship Between Neonatal Intensive Care Nurses’ Team Work and Parent Participation Attitudes

The Relationship Between Stress and Resilience of Nurses in Intensive Care Units During the COVID-19 Pandemic.

The coronavirus infection COVID-19 has been a risk to world health, particularly for individuals who are vulnerable to it. Critical care nurses have described experiencing extremely high levels of stress under these struggling conditions. This study aimed to assess the relationship between stress and resilience of intensive care unit nurses during the COVID-19 pandemic. A cross-sectional study was conducted on 227 nurses who are working in the intensive care units in the West Bank hospitals, Palestine. Data collection utilized the Nursing Stress Scale (NSS) and the Brief Resilient Coping Scale (BRCS). Two hundred twenty-seven intensive care nurses completed the questionnaire; (61.2%) were males, and (81.5%) had documented COVID-19 infection among their friends, family, or coworkers. Most intensive care nurses reported high levels of stress (105.9 ± 11.9), but low levels of resilience (11.0 ± 4.3). There was a moderate negative correlation between nurses' stress and their resilience (P < .05) and a small to moderate negative correlation between nurses' stress sub-scales and resilience (P < .05). Also, the results revealed a statistically significant difference between the stress score mean and the nurses who had documented COVID-19 infection among their friends, family, or coworkers (P < .05), and between the resilience mean score and the nurses' gender (P < .05). During the COVID-19 outbreak, intensive care nurses' stress levels were high, and their resilience was low. Thus, controlling nurses' stress levels and identifying possible stress sources related to the COVID-19 pandemic are important to maintain patients' safety and improve the quality of care.

Intensive care nurses’ experiences with organ donors at non-donor hospitals

Intensive care nurses’ experiences with organ donors at non-donor hospitals

Effectiveness of nursing virtual training courses based on the Kirkpatrick Model.

Educational evaluation is one of the most significant programs of any organization. In fact, evaluating training effectiveness allows managers and staff of the organization to get a clear picture of the qualities of training activities. The purpose of this study was to evaluate virtual nursing intensive care training courses at Shariati Hospital based on the Kirkpatrick Model in 2020. The current cross-sectional study is an evaluation of the outcome-oriented program to evaluate the results of the e-learning course on nursing intensive care at Shariati Teaching Hospital from March 20, 2020 to September 20, 2020. The total number of nurses working in intensive wards was 168, of whom 150 participated in this research study with convenience sampling. The data collection tool consisted of four-part questionnaires including demographic information and three levels of the Kirkpatrick Model. The mean age of participants was 34.41 ± 6.63 years. The mean score of participant satisfaction was 76.77, indicating that they showed good reaction to virtual training courses. Virtual training course for intensive care nurses was statistically significant at the levels of learning (P < 0.0001) and behavior (P < 0.0001). Virtual training courses are effective educational method based on three levels of Kirkpatrick's Model in intensive care nurses and it can be used along with traditional training approaches.

Advocacia do paciente na valorização do ser social e da família em tempos de COVID-19

Abstract Objective to understand the strategies used by intensive care nurses in the face of situations that required patient advocacy, involving the appreciation of social and family being during the COVID-19 pandemic. Method this is a qualitative, descriptive and exploratory study, carried out in the five regions of Brazil. A total of 25 intensive care nurses participated in the study. Data were collected through a semi-structured interview and subsequently subjected to discursive textual analysis. Results nurses advocated before the health team and for the family’s presence within the Intensive Care Unit. With the COVID-19 pandemic, new strategies were established to advocate, promoting virtual rapprochement between nurses, patients and family members as well as the permanence of family members in intensive care environments when necessary so that nurses could know patients better and integrate the family into care. Conclusion and implications for practice the strategies used to act on behalf of patients were carried out for rapprochement between nurses and family members; for instructing family members to advocate for patients; and for the defense of family presence within the Intensive Care Unit.

Exercise of professional autonomy of intensive care nurses in the pandemic scenario

RESUMO Objetivo: Analisar o exercício da autonomia profissional de enfermeiros intensivistas em tempos de pandemia do novo coronavírus. Método: Estudo descritivo, de natureza qualitativa, realizado com 19 enfermeiros de Unidades de Terapia Intensiva de dois hospitais públicos e um privado. As informações foram produzidas de outubro de 2020 a janeiro de 2021, mediante entrevistas semiestruturadas, utilizando a análise de conteúdo na modalidade temática, à luz da Sociologia das Profissões de Eliot Freidson. Resultados Os enfermeiros argumentaram que houve dificuldade, em meio à pandemia, de atuarem com todas as prerrogativas que seu mandato social lhes atribui, devido a várias causas,tais como: o conhecimento limitado acerca da doença, a comunicação frágil no trabalho em equipe e a escassez de recursos materiais e humanos. Conclusão: O exercício da autonomia profissional se configura a partir do enfrentamento de múltiplos fatores que impactam a atuação dos enfermeiros intensivistas, sobretudo numa conjuntura de crise pandêmica.

Knowledge Levels of Neonatal Intensive Care Nurses in Retinopathy of Prematurity and Affecting Factors

Knowledge Levels of Neonatal Intensive Care Nurses in Retinopathy of Prematurity and Affecting Factors

Evaluation of The Fear of COVID-19 and Professional Professionalism of Intensive Care Nurses

Evaluation of The Fear of COVID-19 and Professional Professionalism of Intensive Care Nurses

Exercise of professional autonomy of intensive care nurses in the pandemic scenario.

To analyze the exercise of professional autonomy of intensive care nurses during times of the new coronavirus pandemic. A descriptive, qualitative study, conducted with 19 nurses from Intensive Care Units of two public hospitals and one private hospital. The information was produced from October 2020 to January 2021, through semi-structured interviews, using content analysis in thematic modality, guided by Eliot Freidson's Sociology of Professions. Nursesargued that it was difficult, amidst the pandemic, to act with all the prerogatives assigned to them by their social mandate, for various reasons, such as limited knowledge about the disease, fragile teamwork communication, and scarcity of material and human resources. The exercise of professional autonomy is shaped by the confrontation of multiple factors that impact the performance of intensive care nurses, especially in a context of pandemic crisis.