Intensive Care Unit Staff Research Articles

Effects of the “ICU Support” team meeting concept on patient-centered and staff-centered outcomes: study protocol for a randomized controlled multicenter study

BackgroundProviding optimal care for critically ill patients is an extremely important but also highly demanding task, both emotionally and physically. The “ICU Support” team meeting concept aims to support intensive care unit (ICU) teams by promoting interprofessional communication, peer support, and patient safety by providing a structure for daily team meetings. This protocol describes a study to explore the effectiveness of “ICU Support” for patient- and staff-centered outcomes.MethodsICU Support will be implemented at nine university hospitals located in Germany, following a two-arm randomized parallel group design with an intervention and a control condition and three data collection periods. In the intervention arm, leading ICU personnel (physicians and nurses) will be trained in ICU Support and implement the ICU Support elements into the daily work routine of their units upon completion of data collection period T0 (baseline). In the control arm, ICU Support will not be implemented until the completion of the data collection period T1 (1 month after study start). Until then, the regular daily schedule of the ICU teams will be maintained. The final data collection period (T2) will take place 4 months after the start of the study. Primary outcomes include the number of intensive care complications per patient during their ICU stay during T1 and the sick-related absence of ICU staff during T1. Secondary outcomes include, among others, the average severity of intensive care complications per patient and employee self-reported data regarding their teamwork and patient safety behaviors.DiscussionThe need for healthy and well-trained ICU staff is omnipresent; thus, structured and evidence-based interventions aimed at supporting ICU teams and facilitating patient safety are required. This multicenter study aims to explore the effectiveness of ICU Support for patient- and staff-centered outcomes. The insights derived from this study have the potential to significantly improve ICU patient safety, staff communication, and connectedness and decrease sickness-related expenses and social costs associated with high work demands among ICU staff.Trial registrationGerman Clinical Trials Register DRKS00028642. Registered on 4 April 2022.

Construction of a standardized training system for hospital infection prevention and control for new medical staff in internal medicine ICUs based on the Delphi method

In China, studies have shown nosocomial infections contribute to increased mortality rates, prolonged hospital stays, and added financial burdens for patients. Previous studies have demonstrated that effective infection control training can enhance the quality of infection control practices, particularly in intensive care unit (ICU) settings. However, there is currently no universally accepted training mode or program that adequately addresses the specific needs of ICU medical staff regarding nosocomial infection control. The objective of this study was to develop a standardized training system for preventing and controlling hospital-acquired infections among new medical staff in the internal medicine ICU. Our methodology encompassed an extensive literature review, technical interviews focusing on key events, semi-structured in-depth interviews, and two rounds of Delphi expert correspondence. We employed intentional sampling to select 16 experts for the Delphi expert consultation. Indicators were chosen based on an average importance score of >3.5 and a coefficient of variation of <0.25. The weight of each indicator was determined using the analytic hierarchy process. The efficacy of the two rounds of questionnaires was also evaluated. Our findings revealed that the questionnaires achieved a 100% effective recovery rate, with expert authority coefficients of 0.96 and 0.90. The Kendall coordination coefficients for the first-, second-, and third-level indicators in the initial round of expert consultation questionnaires were 0.440, 0.204, and 0.386 (P < 0.001), respectively. In the second round of expert consultation questionnaires, the Kendall coordination coefficients for the first, second, and third-level indicators were 0.562, 0.467, and 0.556 (P < 0.001), respectively. The final training model consisted of four first-level indicators (hospital infection prevention and control training content, training methods/forms, assessment content, and evaluation indicators), 26 second-level indicators, and 44 third-level indicators. In conclusion, the proposed standardized training system for infection prevention and control among new medical staff in the internal medicine ICU is both scientifically sound and practical, which can contribute to improved patient safety, reduced healthcare costs, and enhanced overall quality of care in internal medicine ICUs. Moreover, it can serve as a framework for future training projects.

A Single-center Exploration of Attitudes to Deceased Organ Donation Over Time Among Healthcare Staff in Intensive Care.

Changes to deceased organ donation in the United Kingdom, including establishment of the specialist nurse for organ donation (SNOD) role, have resulted in increased numbers of donations. Have increasing numbers of donations altered attitudes among intensive care unit (ICU) healthcare professionals (ICU staff) to organ donation over time? A written survey of ICU staff at Nottingham University Hospitals National Health Service Trust was conducted across 2 wk in 2015, 2018, and 2020 (pre-COVID-19). Participants were asked to submit descriptors (words/phrases) they associated with 3 aspects of donation: donation after brain death (DBD), donation after circulatory death (DCD), and SNOD role. Three independent and blinded assessors categorized the descriptors as positive or negative in favorability. Thematic analysis was used to identify trends within each group of descriptors. Across the 3 surveys, 281 responses were returned, containing a total of 2095 descriptors. Positive descriptors were found in 65% of DBD responses, 46% of DCD responses, and 92% of SNOD role. Over time, there was some evidence of increased polarization of opinion for DCD and to a smaller degree DBD. Attitude toward the SNOD role remained consistently highly favorable over time. Thematic analysis was correlated with the assessor favorability ratings to identify specific factors for positive or negative attitudes; this demonstrated the themes that were the most common causes of positive or negative attributions for each aspect of organ donation. ICU staff were found to be highly favorably positive toward the SNOD role, positive toward DBD, and negative toward DCD. Although we found broadly positive perceptions of the benefits of deceased organ donation, negative attitudes toward DCD centered on timescale and complexity of the donation process. Measurement of staff attitudes to organ donation may allow targeted interventions that support staff and improve patient and family care through the organ donation process.

Becoming futile: the emotional pain of treating COVID-19 patients.

The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers. This article draws from 40 interviews conducted with intensive care unit (ICU) staff in units that were overwhelmed with COVID-19 patients. The study participants were recruited from two suburban community hospitals in Massachusetts and the interviews were conducted between January and May 2021. The results show that the uncertainty over how to treat critically ill COVID-19 patients, given the absence of standard protocols combined with ineffective treatments that led to an unprecedented number of deaths caused significant emotional pain, characterized by a visceral, embodied experience that signaled moral distress, emotional exhaustion, depersonalization, and burnout. Furthermore, ICU workers' occupational identities were undermined as they confronted the limits of their own abilities and the limits of medicine more generally. The inability to save incurable COVID-19 patients while giving maximal care to such individuals caused health care workers in the ICU an immense amount of emotional pain, contributing to our understanding of the social processes that generated the well-documented increase in moral distress and related measures of work-related psychological distress. While recent studies of emotional socialization among health care workers have portrayed clinical empathy as a performed interactional strategy, the results here show empathy to be more than dramaturgical and, in this context, entailed considerable risk to workers' emotional wellbeing.

The Value of Nursing Competence and Staffing for Patients in Critical Care: A Scoping Review

Background: Nurse competence and staffing in critical care are of interest to hospital managers and politicians, especially if a relationship exists between educated nurses and patient outcomes. Observational data can describe and measure the impact of critical care nursing practices in intensive care units and may be linked to outcomes. Objective: The aim of this study was to provide an understanding of how levels of nursing competence and staffing in intensive care units are described and associated with nurse-sensitive outcomes. Methods: A scoping review was conducted. Electronic databases, including CINAHL, Medline, Embase, the British Nursing Index, and SweMed+, were searched for English language studies from 2006 to 2023. The inclusion criteria were nurses working in critical care, nurse staffing ratio or assessment, and nurse-sensitive outcomes for intensive care patients. Results: Twenty-one studies were included. As only few studies mentioned the educational level of nurses and the studies used several job titles, it was difficult to interpret nursing competence. Studies that used valid tools for workloads often reported significant results of nursing staffing related to nurse-sensitive outcomes. Adverse events increased with higher levels of nurse workload, and some events were also affected by the level of competence. Lower mortality rate was linked to more nursing hours per patient. Conclusion: We found associations between education, nurse staffing, and nurse-sensitive outcomes in intensive and critical care units. To highlight its effects, advanced nursing competence in critical care and research must be better described. Patients’ need for nursing competence must be assessed using validated tools.

Literature Review of Burnout Syndrome in Intensive Care Unit (ICU) Staffs During The COVID-19 Pandemic

Introductions: Burnout syndrome becomes a special concern for health workers during COVID-19 pandemic that has been exposed to increased workload and intense working hours with COVID-19 patients, stating having a high risk of getting infected with COVID-19 as well. Methods: This literature review paper reviewed scientific journals with prevalence and burnout syndrome profile data. The journals were obtained through the search engines GoogleScholar, the MEDLINE (PubMed) database and PsychINFO. From the search, there are 13 articles in total that meet the required data criteria. Results: Prevalence of burnout syndrome were found severely high in ICU settings, it reached more than 50% from most of the survey. Burnout syndrome rate can be influenced by working conditions, age and gender, time of work and working experience. Burnout syndrome can manifest as higher fatigue level and decrease of cognitive function that can increase the risk of medical mistake. Conclusions: High prevalence and severity of burnout syndrome oblige us to pay attention to symptoms that can affect professional intensive care unit staff and its service to patients. Further research should review prevention therapy and how to apply to health workers and also the prevalence of prevention that has been done in other studies.

Grieving Children' Death in an Intensive Care Unit: Implementation of a Standardized Process.

Background: The grief that accompanies witnessing the death of a child puts health care professionals at risk of secondary trauma, burnout, and turnover when left unaddressed. Objective: Support staff well-being and promote resiliency. Methods: Descriptive implementation of a structured, peer-to-peer bereavement support program for intensive care unit (ICU) staff at a tertiary children's hospital. Results: Thirty-five virtual sessions were held over the period of one year.Through these sessions, participants shared perspectives and normalized reactions, and explored potential coping strategies. Post-session feedback surveys demonstrated the negative impact of a death on the personal or work life of ICU staff. Additionally, nearly all reported some level of burnout. Conclusions: The sessions were feasible and positively impacted staff coping and well-being. Barriers and facilitators to session attendance, as well as suggestions for improvement, were also explored. Implications for practice and future research are discussed. No clinical trial registration is applicable.

ANALISA JARAK AMAN PAPARAN RADIASI BAGI PETUGAS RUMAH SAKIT ICU CENTRAL DI RSUD ARIFIN ACHMAD PROVINSI RIAU

The Intensive Care Unit (ICU) is a room in a hospital with specialized staff and equipment. The patient in the ICU is unstable, so he needs the help of intensive equipment. The ICU patients' limitations require that X-ray examinations be carried out using an X-ray mobile. When an X-ray examination occurs, hospital staff, such as doctors, nurses, and staff, must maintain a certain distance from the radiation source (mobile X-ray aircraft). This study aimed to determine which distances and areas are safe from radiation exposure for hospital medical staff in the Central ICU room at Arifin Achmad Hospital, Riau Province. This research is quantitative with experimental methods. Retrieval of data in research by measuring exposure to radiation doses from 4 different points. The study was conducted from March to July 2023. The data obtained will be analyzed by comparing the results of measurements with NBD based on BAPETEN Regulation No. 15 of 2015 to explore safe areas for hospital staff in the ICU room. Measures at 4-point places show that all-point measurements are safe. Point 1 is the distance from the radiation source to the main door at 11m with a scatter radiation value of 0.9 mSv/y. Point 2 is the distance from the radiation source to the shielding at a distance of 12 m with a scatter radiation value of 0 mSv/y. The most recommended point for the safest medical staff at point 2 (behind the shielding) is the ICU staff room. Keywords: intensive care unit (ICU), safety distance, radiation exposure, X-ray mobile.

Info-NAS: A Computer Program for the Calculation of Intensive Care Unit Nurse Workload.

The purpose of this study was to design an algorithm that allows automatic calculation of nursing workload in intensive care units, based on the Nursing Activities Score scale, through a computer program. Three methodological steps were used: (1) Delphi method (group of experts); (2) identification of the correspondence: Nursing Activities Score items-variables in the EHR, namely, standardized terminology, laboratory values, and prescriptions; and (3) weighting of variables independently by a group of experts. Finally, the algorithm of the computer program was tested. The results showed an algorithm that calculates the nursing workload in an ICU. The calculation is objective and automatic through the EHRs. This study shows the feasibility of the algorithm as a rapid and objective strategy to quantify adequate nurse staffing in intensive care units. Moreover, it provides nurses with a practical resource for the correct completion of records and is thus an incentive to maintain or improve their quality.

Plasma Aβ level alterations after sleep deprivation correspond to brain structural remodeling in medical night shift workers

The relationship between brain structure alteration and metabolic product clearance after night shift work with total sleep deprivation (SD) remains unclear. Twenty-two intensive care unit staff on regularly rotating shift work were implemented with structural and diffusion MRI under both rest wakefulness (RW) and SD conditions. Peripheral blood samples were collected for the measurement of cerebral metabolites. Voxel-based morphometry and diffusion tensor imaging analysis were used to investigate the alterations in the gray matter density (GMD) and mean diffusivity (MD) within the participants. Furthermore, correlation analysis was performed to investigate the relationship between the neuroimaging metrics and hematological parameters. A significant increase in the GMD values was observed in the anterior and peripheral areas of the brain under SD. In contrast, a decrease in the values was observed in the posterior regions, such as the bilateral cerebellum and thalamus. In addition, a significant reduction in the total cerebrospinal fluid volume was observed under SD. The Aβ42/Aβ40 levels in participants under SD were significantly lower than those under RW. The mean MD increment values extracted from the region of interest (ROI) of the anterior brain were negatively correlated with the increment of plasma Aβ42/Aβ40 levels (r = −0.658, P = 0.008). The mean GMD decrement values extracted from the posterior ROI were positively correlated with the increment of plasma Aβ-40 levels (r = 0.601, P = 0.023). The findings of this study suggest that one night of shift work under SD induces extensive and direction-specific structural alterations of the brain, which are associated with aberrant brain metabolic waste clearance.

Recurrent Harlequin Ichthyosis in a Family: A Case Report

Introduction: Harlequin ichthyosis is a severe form of erythrodermic ichthyosis that manifests in a distinctive and distressing appearance at birth. The newborn baby is covered in thick, plate-like scales with distorted surface features, resulting in limited mobility. Fortunately, this condition is rare, with an estimated incidence of approximately 1 in 300,000 births. It is inherited in an autosomal recessive manner and is caused by a mutation in the adenosine triphosphate binding cassette subfamily A member 12 (ABCA12) gene. This mutation affects lipid transport, and the activity of ABCA12 is crucial to produce long-chain ceramides, which are essential for the development of a normal skin barrier. Methods: We present a case report of a newborn who presented with thick, firmly adherent dense plaques covering the entire body, accompanied by deep fissures that extended into the dermis. The facial features included severe ectropion, conjunctival chemosis, eclabium, tethered ears, and a rudimentary nose. In addition, there was flexion contracture of the arms, legs, and digits, along with hypoplastic nails. Results: The baby experienced respiratory difficulty, poor sucking, and a severe cutaneous infection. Unfortunately, the baby’s condition deteriorated and passed away on the 20th day after delivery. Conclusion: Previously considered universally fatal, harlequin ichthyosis now has reported cases of survivors, although it remains a challenging condition. It is crucial to provide parents and family with comprehensive information about the implications of the condition. They should be encouraged to explore all available options and receive psychological support throughout the process. It is essential for the neonatal intensive care unit staff to be trained in providing specialized care for these babies. In addition, parents should be offered the option of antenatal counseling, particularly in cases where there is a previously affected sibling or a history of consanguinity.

Intensive Care Managers’ Experiences of the COVID-19 Pandemic: A Dramatic Change of the Intensive Care Landscape

Aim. To describe intensive care managers’ experiences of premises and resources of care in intensive care units during the COVID-19 pandemic. Background. Intensive care units (ICUs) were enormously pressured during the COVID-19 pandemic from many ill patients, requiring advanced care. Hospital and community volunteers increased staff strength. Obligatorily, recruitments were also conducted using transfer of staff from different hospital departments. However, there is little knowledge about intensive care managers’ (ICMs) experiences of leadership during the COVID-19 pandemic. Methods. A qualitative descriptive study was conducted from March to April 2022. Semistructured interviews were held with 12 ICMs who were purposively sampled from the ICU in ten Swedish hospitals. Data were analysed using qualitative content analysis. Results. Two themes emerged: a dramatic change of the intensive care landscape and we could handle more than we thought, but at a steep price. Participants described that the ICUs had to perform extraordinary changes at a very fast pace, which initially created a sense of cohesion. Training and introduction to war-like conditions associated with uncertainty meant that ICMs had to support ICU staff in prioritising interventions. Participants described how ICUs stood strong against a pandemic, but stress, worries, and anxiety took a heavy toll on ICU staff and ICMs. The pandemic eroded the resilience in ICUs. Participants described a deterioration in health and said that sick leaves and resignations occurred. Conclusion. Our findings show ICMs’ experiences as a field of tension between resources and demands, whereby the changes created a heavy burden that left intensive care weakened. Implications for Nursing Management. Findings emphasised the importance of creating working conditions using human resources and materials in order to rebuild resilience in intensive care with the ability to conduct safe patient care.

Resilience index and mental stress of nursing staff working in intensive care units during the SARS-CoV-2 coronavirus pandemic

Background. Resilience, or mental toughness, is the ability to effectively cope in challenging circumstances. High resilience levels allow for faster adaptation in extreme situations. Aim of the study. An assessment of resilience, mental stress, and self-reported work environment among nursing staff in intensive care units (ICUs) during the SARS-CoV-2 pandemic. Material and methods. The study involved 102 nursing staff working in ICUs. Data collection used the Resilience Coping Scale (RCS-25), Meister’s psychological strain scale, and an original work environment self-assessment scale. Results. The overall mean score of the respondents on the resilience scale was 74.11 points out of a possible 100, while they scored an average of 24.36 points out of 50 on the mental stress scale. Staff working in hospitals converted into infectious disease sites (p = 0.000) or in infectious hospitals with a third level of referral (p = 0.012) assessed their working environment significantly better in the context of the coronavirus disease 19 (COVID-19) pandemic. Medical staff who worked longer at their current workplace, those with longer seniority in the profession, and those who were older scored higher in the resilience areas. The younger the respondent, the more mentally stressed they were in general (rho= -0.200), in non-specific areas (rho= -0.217), and in monotony (rho= -0.211). Those who did not feel well equipped with personal protective equipment showed lower resilience. Conclusions. Respondents were characterized by average resilience and second-level mental stress, while those with higher resilience suffered lower mental stress. We recommend organizing training to strengthen mental toughness, the identification of resilience factors, and the assessment of mental stress in the work environment in the context of the ongoing pandemic. The data obtained could be used to adjust working conditions during the next pandemic. Keywords: nurse, intensive care unit, resilience, mental stress, mental strain, COVID-19.

The Prevalence and Contributing Factors of Burnout Among Anesthesiologists and Intensive Care Unit Staff in Morocco: A Cross-Sectional Analysis.

Introduction Burnout is a common issue in the medical field, particularly in specialties like anaesthesiology and intensive care. It carries significant personal and professional consequences for healthcare providers and can impact the relationship between caregivers and patients. Despite its seriousness, there's been limited research on its causes in North Africa. In this study, our aim was straightforward: we wanted to find out how prevalent burnout is among Moroccan healthcare workers in anaesthesiology and intensive care and identify the main factors contributing to it. Methods To achieve this, we conducted a comprehensive multicenter cross-sectional study that included hospitals from different regions of Morocco. We focused on anesthesiologists and nurse anesthetists currently practicing in these settings. We measured burnout using the French version of the Maslach Burnout Inventory. Results We distributed 500 questionnaires and received and analyzed 396 of them, accounting for an 84% response rate. The results were striking: 48% of participants experienced high emotional exhaustion, 43.2% had a significant level of depersonalization, and 21% exhibited a low sense of personal accomplishment. When we looked at various factors, such as age, income, on-call duties, years of experience, and work location, our analysis showed statistically significant differences in all three dimensions of burnout. In our more complex multivariate analysis, we found that the risk factors for all three dimensions of burnout were practicing for 5 to 15 years and participating in on-call rotations. Surprisingly, practicing for over 25 years seemed to be a protective factor against all dimensions of burnout. Conclusion Our study clearly indicates that burnout is a shared issue among healthcare professionals in anaesthesiology and intensive care units in Morocco. Importantly, we've pinpointed specific risk factors that should be the foundation for a national strategy to prevent burnout in these critical healthcare sectors.

Student nurses’ experiences of their first clinical placement in intensive care unit: A descriptive phenomenology study

ABSTRACT Background: Technical complexity of patient care and the critical environment at the intensive care unit (ICU) provides a favorable setting for acquiring complicated and comprehensive skills among nursing students. Aims: The current research aims to explore the nursing students’ experiences of their first clinical placement in the ICU and identify the factors that facilitate or hinder their learning. Settings and Design: A study using a qualitative descriptive phenomenological approach was conducted in one of the Oman College of Health Sciences branches. Materials and Methods: A purposive sampling technique was used to recruit 12 Year II students enrolled in the Adult Health Nursing practicum course for in-depth face-to-face interviews. The data were collected in July 2020 following approval of the Ethical Review Board. Statistical Analysis Used: All the interviews were transcribed verbatim and analyzed using Colaizzi’s descriptive phenomenological method. Results: The study results revealed three themes with several subthemes under each. The “experience,” “challenges,” and “the facilitating and hindering factors for learning” were the themes that emerged from the data analysis. Conclusions: Overall, students showed unfavorable responses toward the ICU experience. In addition, the unsupportive interaction with ICU staff contributed significantly to the overall impression. Therefore, strategies to enhance communication and interaction with the ICU staff are essential for a positive ICU learning experience, as students rely on the ICU staff for patient-specific information beyond their academic needs. Therefore, curriculum designers must consider these experiences to facilitate a positive experience in future clinical placements.

Modifications in family centered developmental care and in neonatal intensive care during the COVID-19 pandemic in a hospital in Spain: A qualitative study

IntroductionFamily centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. ObjectivesTo understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. MethodsA qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses’ narratives and discourses. ResultsThree open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1) changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2) changes in interpersonal relationships in the context of a pandemic, and 3) transition to normality. ConclusionsThe nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

Reducing intrusive memories after trauma via an imagery-competing task intervention in COVID-19 intensive care staff: a randomised controlled trial

Intrusive memories (IMs) after traumatic events can be distressing and disrupt mental health and functioning. We evaluated the impact of a brief remotely-delivered digital imagery-competing task intervention on the number of IMs for intensive care unit (ICU) staff who faced repeated trauma exposure during the COVID-19 pandemic using a two-arm, parallel-group, single-blind randomised controlled trial, with the comparator arm receiving delayed access to active treatment (crossover). Eligible participants worked clinically in a UK NHS ICU during the pandemic and had at least 3 IMs of work-related traumatic events in the week before recruitment. Participants were randomly assigned (1:1) to immediate (weeks 1–4) or delayed (weeks 5–8) intervention access. Sequential Bayesian analyses to optimise the intervention and increase trial efficiency are reported elsewhere [1]. The primary endpoint for the pre-specified frequentist analysis of the final study population compared the number of IMs experienced in week 4 between the immediate and delayed access arms. Secondary outcomes included clinical symptoms, work functioning and wellbeing. Safety was assessed throughout the trial by scheduled questions and free report. All analyses were undertaken on an intention-to-treat basis (86 randomised participants). There were significantly fewer intrusive memories during week 4 in the immediate (median = 1, IQR = 0–3, n = 43), compared to the comparator delayed arm (median = 10, IQR = 6–17, n = 43), IRR 0.31, 95% CI: 0.20–0.48, p < 0.001. After crossover, the delayed arm also showed a significant reduction in IMs at week 8 compared to week 4. There were convergent findings for symptoms of PTSD, insomnia and anxiety, work engagement and burnout, general functioning and quality of life. The intervention was found safe and acceptable to participants. All adverse events were unrelated to the study. Our study provides the first evidence of a benefit on reducing IMs, improving other clinical symptoms, work functioning and wellbeing, as well as safety of a brief remotely-delivered digital imagery-competing task intervention. An efficacy trial with an active control and longer follow-up is warranted. The trial is registered at ClinicalTrials.gov (NCT04992390).

Modificaciones de los cuidados centrados en el desarrollo y la familia en cuidados intensivos neonatales durante la pandemia por COVID-19 en un hospital de España: un estudio cualitativo

IntroductionFamily centered developmental care (FCDC) are a philosophy of care in the neonatal care units (NICU), based on the control of sensory stimulation the adequate position and of newborn and the family involvement of cares. Nursing staff are the main providers of this care. Sanitary measure to control of the COVID-19, such as the use of masks, isolation of positive cases and capacity limit, conditioned the implementation of FCDC. ObjectivesTo understand the meaning of the experience of the nursing staff of a neonatal intensive care unit (NICU) on the implementation of the FCDC, under the sanitary measures imposed for the containment of COVID-19. MethodsA qualitative study was conducted from the descriptive phenomenological paradigm in which NICU nurses were recruited. The qualitative data collection was carried out through open-ended and semi-structured interviews. These were analyzed respectively through a preliminary narrative analysis and a thematic analysis of the informant nurses’ narratives and discourses. ResultsThree open-ended and 7 semi-structured interviews were conducted from which three main topics emerged: 1)changes in the FCDC derived from the sanitary restrictions implemented for the containment of COVID-19; 2)changes in interpersonal relationships in the context of a pandemic, and 3)transition to normality. ConclusionsThe nurses of NICU perceived changes in the implementation of the FCDC due to the containment of COVID-19, that modified the relationship with the parents of NB, accelerating their training as caregivers, and involved the implementation of new measures such as video calls.

A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units

When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.

The Initial Experiences of intensive care unit staff during the COVID-19 pandemic in Turkey: A qualitative study

Objective: This study aimed to explore the initial experiences of intensive care unit (ICU) staff during the COVID-19 pandemic.