Intensive Care Nurses Research Articles

Compassion fatigue and palliative care in neonatal nurses.

Neonatal intensive care units (NICUs) emerge as one of the areas where palliative care is most needed. This study was conducted to examine the attitudes and compassion fatigue levels of NICUs nurses working in Şanlıurfa, where the fertility rate and infant mortality are highest in Turkey, toward palliative care. This study was conducted in descriptive type. The research was carried out with 204 (85%) nurses who agreed to participate in the research between October 2022 and February 2023, out of 240 neonatal intensive care nurses working in the NICU of 2 training and research hospitals and a university hospital in Şanlıurfa. The data of the study were collected using an Introductory Information Form, the Neonatal Palliative Care Attitude Scale, and the Compassion Fatigue Short Scale. Nurses; compassion fatigue scale mean score was 61.46 ± 26.64, palliative care scale mean score was 3.13 ± 0.74 for organization subdimension, 2.85 ± 0.73 for resources subdimension, and 3.08 ± 0.89 for clinician subdimension. In the results of the study, 8 barriers (parents do not participate in decisions, there is not enough staff, lack of time to spend with the family, lack of policies/rules in institutions for palliative care, lack of education and communication, society's beliefs, nurses' personal attitudes toward death, and lack of appreciation of past experiences with palliative care) and 6 facilitators (Nurses' ability to express their perceptions, views and beliefs about palliative care, to participate and support palliative care, to inform parents, to provide counseling, adequate physical conditions) for palliative care were determined. While it was determined that nurses had a slightly below moderate level of compassion fatigue and a close attitude toward organization and resources toward palliative care, it was determined that ethical conflict toward palliative care was high in clinical subdimension scores. It is recommended that all nurses working in the NICU obtain certificates, improvements in resources such as personnel and equipment, improvements in the shift work system and development of policies/rules in institutions for palliative care.

Application of fine nursing mode in nursing management of blood oncology department

Objective: To explore the effect of fine nursing on cancer-related fatigue (CRF), anxiety, and depression in patients with hematological tumors undergoing chemotherapy, and to provide a feasible intervention plan for clinical management of these symptoms. Methods: A quasi-experimental study was conducted on patients with hematological tumors undergoing chemotherapy, admitted to our hospital from June 2018 to November 2021. A total of 84 eligible patients were randomly divided into two groups: 44 in the experimental group and 40 in the control group. The control group received routine nursing care, including psychological support, diet guidance, catheter care, bleeding prevention, and chemotherapy guidance. The experimental group received an additional 4 weeks of intensive nursing care on top of the routine care. Results: Three patients withdrew from the study, leaving 42 in the experimental group and 40 in the control group. No significant differences were observed between the two groups in terms of demographic and clinical baseline characteristics. Before the intervention, there were no significant differences in CRF, anxiety, and depression scores between the groups. After the intervention, the experimental group showed significantly lower scores in CRF, anxiety, and depression compared to the control group and their own baseline scores. Conclusion: Fine nursing can effectively reduce cancer-related fatigue, anxiety, and depression in patients with hematological tumors undergoing chemotherapy.

Identification and Validation of an Instrument to Measure Physicians‘and Nurses' Knowledge, Attitudes, and Practices Regarding Antibiotic Resistance and Antimicrobial Stewardship

Background: In Italy, the presence of a suitable instrument to measure the knowledge, attitudes, and practices of intensive care physicians and nurses with respect to antibiotic resistance and antimicrobial stewardship could not be identified Objectives: To validate the Italian version of the Ashiru-Oredope tool used by the European Centre for Disease Prevention and Control (ECDC) in 2019 to investigate intensive care nurses' and physicians' knowledge, attitudes, and practices (KAP) regarding antibiotic resistance. Methods: Content validity was assessed using the Item-Content Validity Index (I-CVI), Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score, Scale Level-Content Validity Index/Average (S-CVI/Ave) score, and Average Content Validity Ratio (CVR). Multiple correspondence analysis (MCA) was then carried out together with cluster analysis (CA) to check the correspondence of the items with the eight subdivision domains of the scale. Results: The final version consisted of 55/60 deemed relevant items, with Item-Content Validity Index (I-CVI) scores ranging from 0,625 to 1. The Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score was 0.43; the Scale Level-Content Validity Index/Average (S-CVI/Ave) 0.90. The mean CVR of the scale was 0.43. The inter-rater reliability (Cohen's K) was between good and excellent. The combination of MCA and CA confirmed the correspondence of the items with the domains. Conclusion: The Italian version is a reliable and valid instrument for investigating antibiotic resistance and antimicrobial stewardship among Italian intensive care nurses and physicians.

Healthcare professionals' experiences of the usefulness and ease of using a digital medical translation tool in communicating with minority language-speaking hospitalized heart surgery patients

Abstract Background/Introduction Healthcare professionals are required to deliver high-quality care while adhering to the human right to equity for all patients. Language barriers often result in miscommunication between healthcare professionals and patients, leading to decreased patient satisfaction, compromised patient safety (such as increased adverse events), and diminished healthcare quality. Studies focusing on implementing digital medical translation tools and measuring their usefulness during patients’ hospitalization are highly warranted. Purpose To survey and explore healthcare professionals' experiences of the usefulness and ease of using a digital medical translation tool in communicating with minority language-speaking heart surgery patients during hospitalization. Methods Participants completed an internationally published six-item, study-specific questionnaire on health care professionals' experiences regarding perceived usefulness and ease of use from October 2022 to February 2023. The first three items, namely: (1) 'The digital tool was easy to use,' (2) 'The languages were easy to understand,' and (3) 'The digital tool was useful,' were measured on a 5-point Likert scale ranging from 1 ('totally agree') to 5 ('totally disagree'). The last three items were open-ended: (4) 'What they liked best,' (5) 'What they liked the least,' and (6) 'Suggestions for improvement'. Results Health care professionals (i.e., registered nurses, intensive care nurses, operating room nurses, anaesthesia nurses and physiotherapists) (n=53) aged, mean 35 (SD, min-max 9.7, 25-58). They reported the digital medical translation tool was easy to use ("totally agree/agree" 15/33, 91%), easy to understand ("totally agree/agree" 30/22, 97%), and useful ("totally agree/agree" 24/25, 92%) as illustrated in figure 1. Illustrative citations from the open responses: What health care professionals liked best: "Enabling communication with minority language-speaking patients feels safe in terms of patient safety" and "The opportunity to form a clinical picture of the patient at the beginning of the shift gives me confidence. The possibility to meet the patient's psychosocial needs and the opportunity to more easily clarify situations and pains and discomforts." They liked the least that it "Took some time to find my way around between questions at the beginning of using the tool" and suggestions for improvement were cited as "Split up the phrases in the tool in several categories (icons) e.g., intubation phase" and "Add more phrases specific for our heart surgery patients". Conclusions Healthcare professionals found a digital medical translation tool to be useful and easy to use in meeting the needs of patients and improving patient safety during communication with minority-speaking heart surgery patients.

Registered Nurses' Familiarity With Delegation Standards and Confidence Delegating to Unlicenced Care and Support Workers: A Cross-Sectional Study.

To survey registered nurses' familiarity with delegation standards and confidence to delegate to unlicenced workers within their practice. Cross-sectional exploratory survey design. The survey focused on Australian registered nurses (n = 420). Initial descriptive analysis was undertaken. Additionally, inferential analysis was undertaken between two independent variables focused on familiarity of delegation policy, and confidence to delegate, and several demographic and workplace variables. Stepwise linear regression was undertaken to determine predictors of the two delegation variables. The cross-sectional study was undertaken according to the STROBE reporting checklist. The majority of respondents were somewhat familiar, or not familiar at all with delegation standards. This pattern was followed for results relevant to confidence delegating to unlicenced workers. Nurses working in adult acute, intensive care and emergency department reported the lowest levels of familiarity with delegation. Additionally, intensive care nurses were significantly less likely to feel very confident delegating to unlicenced support workers. Stepwise regression revealed identifying as male, and working in the public sector were less likely to be confident delegating. Nurses working in the acute setting and public sector were less familiar with delegation standards. The findings of this study highlight the nuanced nature of delegation to unlicenced workers in Australian nursing settings, with nurses from certain contexts being far less likely to be familiar with or confident undertaking the practice. The findings of this study have significant implications to increase understanding of nurses diverse contexts of practice and how delegation standards might not be implemented in practice in a confident manner.

A cross-country comparison of the organisation and reimbursement of intensive care in Europe

Abstract Background During the pandemic, intensive care capacity was a heavily discussed topic in Europe. Many European countries have increased their intensive care capacities to ensure treatment of all COVID-19 patients. A study, however, revealed that organisational characteristics, among other factors, were associated with in-hospital mortality. Our study thus aimed at reviewing international models for the organisation and reimbursement of intensive care. Methods Based on a scoping review, a number of European countries (Denmark, England, France, Germany, Italy, the Netherlands, Sweden) was selected for a questionnaire-based expert survey. Results In most countries, intensive care is defined by law, while the definition in two countries has a recommendatory character and/or is driven by reimbursement. In line with the European Society of Intensive Care Medicine’s recommendations, the majority of countries has organised intensive care around 2-3 different (heterogeneously defined) levels of care for which reimbursement sometimes differs according to the level. For most countries, the number of physical (i.e., number of operable beds) as well as human resources (i.e., nurses) in intensive care is unknown. Many countries have an intensive care register which, in the case of Germany, was only implemented as a response to the pandemic. However, comparability is limited due to differences in indicators used. Although promising telemedical approaches in intensive care do exist, their use is not yet formalized in most countries. Conclusions Most countries rely on a level-based organisation of intensive care, even though clear evidence on their effect is missing. Heterogeneity of definitions as well as quality monitoring makes a comparison difficult. Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. Telemedical interventions could elevate (access to) high-quality care, especially in times of crises. Key messages • Further research is needed to better understand best practices and thus increase resilience as well as pandemic preparedness. • Telemedicine could elevate (access to) high-quality intensive care, especially in times of crises.

The Effect of Perceptions of Evidence-Based Practice on Endotracheal Cuff Pressure Management in Critical Care Nurses: A Correlational Cross-Sectional Multicentre Study.

This correlational cross-sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence-based practice leadership and work environment. A correlational cross-sectional multicentre study design. This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence-Based Practice Leadership Scale and Evidence-Based Practice Work Environment Scale. Descriptive statistics, chi-square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study. The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence-based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence-Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence-Based Practice Leadership Scale and the cuff pressure management. Adherence by nurses to current evidence-based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence-based practice. Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure. Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies. No patient or public contribution.

Spiritual care competences of healthcare workers in emergency and intensive care-aprospective questionnaire study

In intensive and emergency care, patients and their relatives are confronted with potentially existential crises. Spiritual care can be an additional resource to address related psychosocial and physical symptoms and to support patients and their relatives. Accordingly, healthcare workers need spiritual skills to recognize and respond to these needs. What spiritual competencies do healthcare workers in intensive and emergency care have? Are there differences between professions and genders? What factors influence spiritual competencies? The prospective questionnaire study included physicians participating in intensive care and emergency medicine courses and nurses who were training or working in intensive and emergency care. Self-reported spiritual competencies were assessed using the Spiritual Care Competence Questionnaire (SCCQ), which captures the following areas: perceptual competence, team-spirit, documentation competence, self-awareness and proactive opening, knowledge about other religions, competence in conversation techniques and proactive empowerment-competence. We included 465 physicians (50% female, years in profession: mean = 4.0, standard deviation [SD] = 3.5) and 86nurses (80% female, years in profession: mean = 12.7, SD = 10.7). The average SCC was2.3 (SD 0.4) out of amaximum of 4points, with higher spiritual competences among spiritual and religious respondents. There were differences in specific competencies between the professions and genders. Women indicated ahigher level of competence in the area of perception and conversation skills, physicians in documentation skills. Overall, there is aclear need to train healthcare staff in the field of intensive care and emergency medicine.

The effect of end-of-life care awareness education on the knowledge, attitudes and behaviours of intensive care nurses: A randomized controlled trial.

Education in end-of-life care (EoLC) is essential for improving the knowledge, attitudes and behaviours of intensive care nurses. This study aimed to evaluate the effect of online awareness education, based on the End-of-Life Nursing Education Consortium, on the knowledge levels, attitudes and behaviours of intensive care nurses. This single-centre randomized controlled study. This study was performed in a tertiary intensive care unit in a university-affiliated hospital. Seventy-six intensive care nurses were selected and equally randomized. In the education, the group was given an EoLC awareness education programme on an online platform as 40-60-min sessions once a week for 4 weeks. The descriptive Information Form, EoLC Knowledge Test and the Nurses' Attitudes and Behaviours towards the EoLC Scale were used. In the study, intensive care nurses' knowledge, attitude and behaviour levels towards EoLC were evaluated before and after 4 weeks (±3 days) following the education. When the mean post-education scores of the nurses in the education group were compared with the control group, it was found that their mean scores on the EoLC Knowledge Test (p = .001, Cohen's d = 1.354, 95% CI = 3.240-6.549), the attitude sub-dimension (p = .001, Cohen's d = 1.520, 95% CI = 4.510-7.858), the behaviour sub-dimension (p = .001, Cohen's d = 1.425, 95% CI = 3.206-6.214) and the total attitude and behaviour (p = .001, Cohen's d = 1.927, 95% CI = 8.408-13.643) were statistically significantly higher than those of the control group. This study showed that EoLC awareness education positively affected nurses' knowledge, attitudes and behaviours. Accordingly, planning EoLC awareness education online at regular intervals may be recommended for intensive care nurses. Intensive care nurses may be given online EoLC awareness education to positively affect their knowledge, attitudes and behaviours about EoLC. Online EoLC education can be effective in terms of reaching a large number of nurses, time and cost.

The effect of posture regulation training on musculoskeletal disorders, fatigue level and job performance in intensive care nurses

BackgroundIntensive care units (ICUs) are one of the high-risk working areas in terms of musculoskeletal disability and ergonomic risks including the environment and posture factors. Correct posture technique is often ignored by nurses working in these units. This study was conducted to determine the effect of posture regulation training on work-related musculoskeletal disorders, fatigue level and job performance in nurses working in ICUs.MethodsThis quasi-experimental study with one-group pretest-posttest design included 64 intensive care nurses. The nurses received posture regulation training in three different sessions. The post-test was administered four months after the posture regulation training.ResultsThe nurses reported to frequently have aches, pains and discomfort in the neck, upper back and lumbar regions. After the posture regulation training, their level of pain, ache and discomfort in the neck, right and left shoulder, upper back, lower back and right/left foot areas decreased significantly (p < 0.05). The posture regulation training reduced the levels of behavior/severity and affect, which are sub-dimensions of fatigue, and increased the level of contribution to work, which is a sub-dimension of job performance (p < 0.05).ConclusionThe posture regulation training decreased the level of symptoms in the neck, shoulder, upper back, lower back and foot regions of intensive care nurses and partially improved their fatigue level and job performance. Therefore, posture regulation training should be added to in-service training programs and permanent measures should be taken for ergonomic risks in ICUs.

Physician-led healthcare structures for patients in out-of-hospital intensive care nursing: a cross-sectional survey by the German Society for Out-of-Hospital Ventilation

Patients in out-of-hospital intensive care are usually provided with a tracheal cannula and often additionally receive mechanical ventilation. Less frequently, they receive non-invasive ventilation. Their potential to be weaned from the ventilator and to have their tracheostomy tubes removed must be evaluated twice per year from January 1, 2025 on. If there is a potential for weaning from mechanical ventilation or removal of the tracheostomy tube, referral to a specialized facility is required. The study aimed at characterizing the specialized institutions which can evaluate the potential of patients to be weaned from the ventilator and to have their tracheostomy tubes removed, and which can perform these tasks as well. Under the auspices of the German Interdisciplinary Society for Out-of-Hospital Ventilation (DIGAB) and with support from the Working group early neurological-neurosurgical rehabilitation (ENNR) a crosssectional online survey took place. Of 18 participating institutions, 11 (61.1%) were certified by professional societies representing neurorehabilitation, respiratory medicine, anaesthesiology and intensive care or paraplegiology. Most leading physicians were specialists in neurology, followed by pulmonology, anaesthesiology and paediatrics. Many professions with a variety of qualifications worked in these institutions. According to n=10 (55.6%) of the participating instituions, regional treatment capacities for patients from out-of-hospital intensive care, who need hospital admission for weaning from mechanical ventilation or a tracheal cannula, were not sufficient. About one third of the institutions offered televisits. Patients in out-of-hospital intensive care need interdisciplinary care, interconnecting out- and inpatient care structures due to medical complexity and participation restrictions. While interdisciplinary teams and a wide spectrum of diagnostic and therapeutic methods were provided in the participating institutions, their structure differed considerably. Quality criteria should be established for centres evaluating the patients' potential to be weaned from the ventilator and to have their tracheostomy tubes removed and performing weaning from mechanical ventilation and tracheal cannulas. Further research is needed to specify those criteria, to quantify inpatient treatment capacities for patients from out-of-hospital intensive care to be weaned from mechanical ventilation or tracheal cannulas,to evaluate the feasibility of weaning from mechanical ventilation and tracheal cannulas in an out-of-hospital setting and to understand the role of telemedicine in the treatment of patients in out-of-hospital intensive care.

Validity and reliability of the Endotracheal Suction Assessment Tool© in adult ICU patients: A methodological study

BackgroundNovice nurses often find endotracheal suctioning signs unfamiliar. The Endotracheal Suction Assessment Tool© (ESAT©) aids pediatric nurses in suctioning but lacks an adult equivalent. A valid and reliable ESAT© for assessing intensive care unit patients’ suction needs across different populations is necessary. AimTo test the validity and reliability of the ESAT© in adult ICU patients. MethodsThis methodological study assessed suction needs in patients at a tertiary adult ICU of a university hospital. Two independent observers used the ESAT© to determine suction needs. Data from 106 suction procedures were collected using a patient characteristics form, the ESAT©, and a suction monitoring form. The ESAT© includes eight respiratory and ventilation parameters and seven clinical consideration parameters. Hemodynamic and respiratory parameters were measured before, and one and five minutes after suction. Linguistic validity, content validity, and pilot testing were conducted. Interobserver agreement was evaluated, and psychometric evaluation was done using content validity index (CVI) and intraclass correlation coefficient (ICC). Data were analyzed with paired samples t-test and ANOVA. ResultsItem CVI ranged from 0.80 to 1.00, and scale CVI was 0.96. Inter-item correlation and ICC for inter-rater reliability were both 0.933 (95 % CI = 0.903–0.954, p < 0.001 for ICC). Cohen’s Kappa coefficients ranged from 0.690 to 1.000 (p < 0.001), indicating high consistency between raters for all tool items. All scale items showed near-perfect agreement except SpO2, which showed substantial agreement. ConclusionThe S-CVI was good, indicating near-perfect agreement among raters. ESAT© is highly reliable and valid for determining suction needs in adult intensive care patients. Implications for PracticeThe ESAT© aids autonomous decision-making for suctioning needs. Originally for novice pediatric nurses, the ESAT© was adapted for adult intensive care nurses. The ESAT© is valid and reliable for adult intensive care patients.

Mental workload as a predictor of burnout in intensive care nurses.

Nurses face a high level of mental workload while performing their duties. High levels of mental workload can negatively impact nurses. The aim of this research was to determine the relationship between mental workload and burnout levels of intensive care nurses. Descriptive-correlational design has been adopted in this research. The sample consisted of 156 nurses working in the intensive care units of a hospital in the south of Turkey between September and December 2023. Research data were collected with the 'Participant Information Form', which includes socio-demographic characteristics, 'Mental Workload Scale' and 'Maslach Burnout Scale'. Almost all (95.5%) of the nurses participating in the study reported that their mental workload was high. It has been determined that there is a strong positive relationship between mental workload and burnout. According to the regression model obtained from the research, being a woman (β = .165, p = .008) and emotional workload (β = -695, p < .001) are determinants of emotional exhaustion. These variables explain emotional exhaustion at a rate of 50.1% (adjusted R2 = .501). Emotional workload (β = .399, p = .003) is the most important determinant of personal accomplishment. This variable explains 19.0% (adjusted R2 = .190) of personal accomplishment. The most important determinant of depersonalization is emotional workload (β = .324, p < .001). It was determined that this variable explained 24.4% (adjusted R2 = .244) of depersonalization. This research revealed that there is a strong positive relationship between mental workload and burnout and that increasing mental workload can increase burnout. Nurses' risk of emotional exhaustion increases as mental workload increases. Reducing cognitive workload, temporary workload and emotional workload increases the personal accomplishment experienced by nurses. In addition, as temporary workload, emotional workload and performance-related workload increase, the depersonalization experienced by nurses also increases.

Determining the relationship between moral intelligence and compassion fatigue in intensive care nurses.

Compassion and moral intelligence occupy a very significant place in ensuring quality in health care services, increasing patient satisfaction, reducing side effects, increasing patient safety and accelerating the healing process. This study was conducted to determine the relationship between moral intelligence and compassion fatigue in nurses working in intensive care units. In this descriptive and cross-sectional study, 180 nurses working in intensive care units of a hospital comprised the population of the study. Of them, 114 who agreed to participate in the study were included in the study sample. The Personal Information Form, Yakut Moral Intelligence Scale (YMIS) and Compassion Fatigue-Short Scale were used as data collection tools. The scales and forms used in the study were created on Google Form. Nurses were visited in intensive care units, and the forms were given to them. Then the participating nurses filled in the forms. Of the nurses participating in the study, 69.3% were women and 65.4% had a bachelor's degree. The analysis of the correlation between the scores obtained from the sub-dimensions of the YMIS by the nurses participating in the study demonstrated that there was a negative, low-level significant relationship between the self-control and kindness sub-dimensions of the YMIS. As the nurses' compassion fatigue levels increased, their self-control and kindness levels decreased. It can be said that as compassion fatigue levels increase in nurses, their moral intelligence levels decrease. Therefore, diagnosing compassion fatigue in nurses and taking precautions to prevent them from suffering from fatigue are of significant importance. By determining the healthy intelligence and compensation spending levels of health workers, organizing maid training will increase the service and care provided.

Psychometric properties of the Turkish version of the developmental care scale for neonates with congenital heart disease.

Developmental care for newborns with congenital heart disease (CHD) improves cardiac and respiratory patterns. According to the American Heart Association, developmental care in newborns with CHD is important for improving neurodevelopmental outcomes. This study aimed to evaluate the validity and reliability of the Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease. This was a methodological, descriptive study conducted with 169 nurses from a tertiary-level NICU. The Demographical Information Form and the Developmental Care Scale for Neonates with Congenital Heart Disease were used to collect the data. The scales' language and content validity, construct validity, and internal consistency were also assessed. The scale consists of 31 items and four subscales. Factor loadings ranged from 0.44 to 0.82 and explained 65% of the total variance. Fit indices indicate that the model is acceptable. Cronbach's α was 0.95 for the entire instrument, 0.91 for developing the external environment subscale, 0.94 for assessing family well-being, 0.86 for the caregiver activities toward the neonate, and 0.82 for the basic need subscale. Item-total correlations ranged between 0.34 and 0.75, according to the item analysis results. The Turkish version of the Developmental Care Scale for Neonates with Congenital Heart Disease is valid and reliable. The use of this scale could improve the performance of neonatal intensive care nurses in providing developmental care to newborns with CHD as well as the quality of care.

How does the training given to intensive care nurses affect their attitudes toward preventing pressure ulcers?

ObjectiveThe study aimed to determine the effect of training in the prevention/treatment of pressure ulcers on nurses' attitudes. Material methodThe study was conducted experimentally in a pretest-posttest design. Training was given to nurses participating in the study with content prepared by "Wound and Ostomy Incontinence Nurses Association" guide. The study was conducted between August and October with nurses working in Level 3 intensive care units. The study was completed with 79 nurses. Before the training was given, the "Nurse Introduction Form" and " Attitude Towards Pressure Ulcer Prevention Instrument (ATPUPI)" form were applied to those. All nurses were re-administered the ATPUPI scale three months after the training to evaluate their attitudes. Frequency analysis, descriptive statistics, one-way ANOVA, and independent sample tests were used in statistical analyses. ResultsThe mean age of the nurses was 29.62 ± 5.74 years, the mean length of service was 71.77 ± 77.19 months, 94.9 % were graduates, and 82.3 % worked in shifts. The mean scores before the training were 44.53 ± 4.13 and 45.12 ± 2.53 after the training. It was determined that there was a significant difference between the nurses who did not receive training on pressure ulcers other than undergraduate education and those who obtained training in terms of the mean score of ATPUPI. Still, after the training, the mean scores reached a similar level, and this difference disappeared. The increase in the mean scores of those who did not receive any education other than undergraduate education was found to be statistically significant. ConclusionAs a result of our study, intensive care nurses' attitudes toward preventing pressure ulcers were found to be at a high level. It was found that the training given to nurses who had not received training on pressure ulcers other than undergraduate education had a significant positive effect on their attitudes. According to this result, it is recommended that in-service training should be given from the moment they start intensive care and repeated at regular intervals to ensure continuity in knowledge, attitude, and care behavior.

Intensive care nurses' knowledge and practices regarding medical device-related pressure injuries: A descriptive cross-sectional study.

This study aims to determine the levels of knowledge and practices of intensive care nurses regarding medical device-related pressure injuries (MDRPIs). This descriptive cross-sectional study was carried out between September 2023 and February 2024, involving 143 nurses working in intensive care units across three hospitals in Türkiye. The data were collected using the demographic form and the Medical Device-related Pressure Injuries Knowledge and Practice Assessment Tool (MDPI-ASSET). Of the nurses, 74.1% have encountered MDRPIs in their unit, 63.6% feel that their knowledge about MDRPIs is insufficient and 90.2% express a desire to receive training about MDRPIs. The participants' total mean MDPI-ASSET score was 11.12 (out of 21). The nurses achieved the highest mean score on the Aetiology/risk factors sub-scale and the lowest mean score on the Staging sub-scale. The analysis revealed significant differences in the mean MDPI-ASSET total scores among nurses based on the status of previous encounters with MDRPIs (t = 2.342; p = 0.021) and their feelings of responsibility for the development of MDRPIs (t = -2.746; p = 0.007). In this study, the knowledge and practices of intensive care nurses regarding medical device-induced pressure injuries were found to be inadequate. Given the frequent occurrence of MDRPIs in intensive care units, it is necessary to support nurses with continuous organizational-level training to improve the quality of care for critically ill patients.

Infection control nursing competency model for nurses in intensive care units: A Delphi study

Intensive care unit (ICU) nurses require advanced expertise and skills in critical care and need infection control nursing competency (ICNC). Given the lack of research on it, this study aimed to develop a model of ICU nurses' ICNC. A Delphi panel consisting of experts in intensive care nursing and infection control was organized to provide discerning and professional perspective on ICNC. Approved by the Institutional Review Board, a 3-round Delphi survey was conducted via email from July to December 2023. The content validity ratio and the coefficient of variation were calculated for panel responses. Among 17, 15 nurses (88.2%) participated and completed the surveys. About80% were female, and the panel had an average working experience of 14.2years specifically in theICUs or infection control departments at hospitals. After the initial round, a preliminary model was developed, consisting of 10 main components and 59 subelements. After eliminating 5 elements with content validity ratio values below 0.49 in the second survey, the final model, consisting of 10 main components and 54 subelements, was confirmed in the third survey. ICU nurses' ICNC can be understood based on this study's results, and further research can be designed to improve this competency.

Critical care nurses’ experiences on environmental sustainability: A qualitative content analysis

BackgroundIntensive care units (ICUs) are the primary producers of greenhouse gas emissions within hospitals, due to the use of several invasive materials. Nurses represent a large portion of the healthcare workforce and can be pivotal in promoting sustainability practices. Several international reports have suggested that nursing can help achieve the sustainable development objectives set by the United Nations. AimsThe purpose is to explore behaviour related to environmental sustainability in intensive care nurses. Study designA qualitative content analysis comprised of in-depth interviews involving 27 ICU nurses, who were each asked the same open-ended question. The transcripts collected were then analyzed and organized by a team of independently-working researchers. The analysis of the extrapolated concepts was carried out following the Neem M. (2022) method. The study is supported by a grant from the Centre of Excellence for Nursing Scholarship, Rome, July 2024. FindingsThe main recurring themes are as follows: (1) concepts of environmental sustainability in ICUs, (2) critical issues related to sustainable intervention in the ICUs (3) proactive environmental sustainability attitudes in ICUs. Time to know, define criticality, and improve is the conceptualization of sustainable behaviors experienced by ICU nurses. ConclusionsTaking the time to know and define the critical issues for implementing sustainable behaviours in the ICU, turned out to be the key to enforce the mindset of green nursing thinking. Implications to clinical practiceSustainability behaviours need to be proposed and verified by ICU managers by creating sustainability teams and promoting a good working environment, founding the progression to green ICUs by focusing on health impact education and mindfulness.

What Enables Implementation of Pain Management Interventions in Intensive Care Units and Why: A Realist Evaluation to Refine Program Theory.

To uncover perspectives and refine 12 initial program theories concerning the implementation of pain management interventions in intensive care units. Contexts enabling implementation are delineated, and causal mechanisms within these contexts are described. A realist evaluation approach was employed. Fourteen purposively selected Australian nurses of variant roles were virtually and individually interviewed between July and September 2023. Participants were presented with initial program theory, and their perspectives were collated. Data were analysed using an integrated approach of context (C), mechanism (M), outcome (O) categorisation coding, CMO configurations connecting and pattern matching. Pain management interventions work if perceived to be beneficial, precise, comprehensive and fit for purpose. Nurses should be willing to change attitudes and update knowledge. Unit leaders should nurture the development of nurses' professional identity, access to learning, autonomy and self-determination. Organisations should change the infrastructure, provide resources, mitigate barriers, develop shared mental models, update evidence and institute quality assurance. Adherence to interventions is affected by the outcomes of implementation and intrinsic merits of interventions. In these contexts, confidence is boosted; feelings of empowerment, self-efficacy, reflective motivation, trust, awareness and autonomy are developed; and capacity is built. Furthermore, frustration from the variability of practices is reduced, accountability and ownership are augmented, yielding positive implementation outcomes. Findings have implications on nurses, team leaders and organisations concerned with implementation. The findings provided a fortified understanding of conditions favouring successful implementation of pain management interventions. Actions should be undertaken at an individual, unit and organisation level to ensure successful implementation. RAMESES II Reporting Standards for Realist Evaluations informed presentation of study. Intensive care nurses contributed insights to refine the program theory.