ICU Nurses Research Articles

Visibility, Physical Work Environment, and Stress in ICU Nurses

OBJECTIVE Relationships among coworker and patient visibility, reactions to physical work environment, and work stress in ICU nurses are explored. BACKGROUND Millions of dollars are invested annually in the building or remodeling of ICUs, yet there is a gap in understanding relationships between the physical layout of nursing units and work stress. METHODS Using a cross-sectional, correlational, exploratory, predictive design, relationships among variables were studied in a diverse sample of ICU nurses. RESULTS Visibility had a direct effect on work stress (P < 0.01). The ViPES (Visibility, Physical Environment and Stress) model can help explain relationships among study variables. The findings from this study support the notion that high visibility is a job resource and low visibility is a job demand. CONCLUSIONS Design features supporting a sense of connection may be especially important to less experienced ICU nurses. Elements of the built environment that allow nurses to see not only patients, but also their coworkers, may help mitigate work stress.

Abstract 4114994: Nursing Management Practice Variations related to Externalized Ventricular and Lumbar Drains

Introduction/Background: Nursing management of neurologic patients may include placement of externalized ventricular drains (EVDs) or lumbar drains (LDs) to monitor/drain cerebrospinal fluid (CSF), but knowledge and practice related to EVD management varies widely, despite a high potential for life-threatening complications. Limited data exists relative to the relationship between intracranial pressure (ICP) and CSF drainage. These gaps may undermine patient safety. Research Question: What are the nursing practices and perspectives regarding management of EVDs and LDs? Methods/Approach: A 16-question multiple-choice/text entry survey was distributed electronically to nurses and advanced practice nurses who were members of the American Association of Neuroscience Nurses. Data analysis included chi-square test for multiple choice responses, and qualitative data was analyzed using a six-step thematic analysis and an inductive approach. Results/Data: Of 219 participants, 42.8% reported roles as Neuroscience ICU nurses, and 39.2% managed an EVD at least 75% of the time. Neuro ICU nurses were most likely to have a patient with an EVD ( p =.002). Approximately 63% of respondents reported consulting with colleagues about EVDs nearly every time they cared for a patient with an EVD. Nurses reported a very high care burden, including re-leveling the transducer 4 or more times per shift (n=76), and re-zeroing every 8 hours (n=72) to assure accurate calibration. Of these 82.2% reported that they re-zeroed the EVD more often to obtain an accurate reading. Approximately 25% reported accidental over-drainage, some with negative outcomes. Many (79.3%) reported caring for patients with LDs, 47.4% to diagnose normal pressure hydrocephalus. The nursing care workload was described as 30-120 minutes each shift. Conclusion: A wide heterogeneity of nursing practices was revealed in EVD and LD management. No standardized nursing care practices have been adopted by nurses for the management of CSF. The complications of these practice variations have been shown to result in untoward patient outcomes. Increased patient morbidity and mortality are linked to catheter infection and over/under drainage of CSF and may be directly related nursing practice. This reveals critical need for improved, standardized care nursing practices in the management of EVDs and LDs, and an empiric understanding of the relationship between intracranial pressure and the volume and rate of CSF drainage.

Prevention of deep vein thrombosis in patients with aneurysmal subarachnoid hemorrhage: a best practice implementation project

IntroductionDeep vein thrombosis (DVT) is a common complication observed in aneurysmal subarachnoid hemorrhage (aSAH) patients, which significantly increases the survival risks and reduces the patient’s quality of life. However, preventive clinical measures for DVT have not been standardized; therefore, the scientific basis and effectiveness of these measures require further validation.ObjectiveThis study aims to employ evidence-based practices to effectively prevent the occurrence of DVT in aSAH patients.MethodsThis study was performed from June 2023 to March 2024 in the neurosurgical intensive care unit of a Grade III Class A general hospital in Nanchang, China. Furthermore, it was based on the healthcare model published by the Joanna Briggs Institute Library (JBI) in 2016, which emphasizes the use of previous evidence-based practices while considering appropriateness, feasibility, clinical significance, and validity. In this research study, 15 review indicators were developed, and baseline assessments on 47 nurses and 49 patients were conducted. Furthermore, factors promoting and obstructing implementation were analyzed, and targeted strategies to address these obstacles were formulated. Moreover, a follow-up audit was performed to identify best practices.ResultsThe baseline review results indicated that the incidence of DVT in aSAH patients was 16.3%. Furthermore, the implementation rates of six review indicators (1, 2, 4, 5, 8, 13) were all < 100.0%, with indicators 2, 5, and 8 indicating < 60.0% implementation rates. After the project implementation, a subsequent audit revealed that the best practice initiative yielded significant improvements compared to the baseline data. Moreover, the incidence of lower limb DVT in aSAH patients decreased from 16.3% before the evidence-based practices to 6.1% after their implementation. At the nursing level, the DVT prevention knowledge and practice questionnaire scores increased from 63.62 ± 11.48 to 74.77 ± 9.98 after the evidence-based practices (t = -5.03, p < .001). In addition, the implementation rates of the six review indicators improved to varying degrees after the implementation of evidence-based practices (p < .050).ConclusionsThis project implemented evidence-based practices and indicated a reduced incidence of lower limb DVT in patients with aSAH. Furthermore, this study improved the knowledge, provided evidence for DVT prevention for the neurosurgical ICU nurses, promoted the implementation rate of review indicators for DVT prevention, standardized the behavior of neurosurgical ICU nurses for preventing DVT in aSAH patients, and ensured the safety of patients.Trial registrationThis study has been registered at the EvidenceBased Nursing Center of Fudan University in China. Clinical trial number ER20230578.

Learning by Visualize a Nurse-Led CCOS Using the Functional Resonance Analysis Method.

Quality improvements (QIs) in dynamic and complex health care contexts require resilience and take variability into account in quality improvement. The Functional Resonance Analysis Method (FRAM) helps us understand resilience and gain insight into (un)desirable variability in the complex system of daily practice. We explored how using FRAM in the Deming cycle of a QI project can help professionals and researchers learn from, reflect upon, and improve complex processes. We used FRAM in a Dutch hospital to study a QI: Critical Care Outreach Service (CCOS). The aim was to use FRAM before and after implementation to create a FRAM model and reflect to health care professionals the mismatch between Work As Imagined (WAI) and Work As Done (WAD). The WAI FRAM model was co-created with professionals before the implementation of CCOS. We used descriptions of tasks and processes for ICU nurses and verified them in 30-minute semistructured interviews (N = 2). WAD was created by input of semistructured interviews with key professionals in CCOS (N = 21) and 3 nonparticipant observations of trained CCOS nurses. We validated WAD in 2 dialogue sessions with key professionals (N = 11). Data collection continued until saturation. Juxtaposing the WAI and WAD models showed that WAD contained additional functions and highlighted unexpectedly complex functions. Reflecting on the application of FRAM with health care professionals revealed opportunities and challenges, especially time investment. FRAM helps professionals outline processes and tasks (WAI), learn from, and reflect upon their daily practice (WAD). FRAM models help professionals identify variability proactively to improve practices that enhance resilient performance.

Assessment of ICU nurses' competency towards delirium among critically ill patients.

ICU nurses play a critical role in managing delirium in critically ill patients, yet their competency in this area remains under-explored. To assess ICU nurses' competency including their knowledge, practice, and attitudes toward delirium among critically ill patients. A correlational descriptive study was conducted with 67 nurses in the medical intensive care unit at Suez Canal University Hospitals. Data was collected using an online survey and analyzed using descriptive statistics, ANOVA, and Pearson's correlation. Nurses showed a moderate knowledge level (M = 8.55), a low practice level (M = 6.62), and positive attitudes (M = 21.65) toward ICU delirium. ANOVA results indicated significant differences in practice scores based on educational level, F (2, 64) = 3.361, p = .041, and in knowledge scores based on ICU experience, F(3, 63) = 6.455, p < .001. Nurses with Master of Science in Nursing (MSN) degrees had higher practice scores than those with diplomas or Bachelor of Science in Nursing (BSN) degrees. There were no significant differences in knowledge and attitude scores based on educational level or age. Gender differences were minimal, with male nurses slightly outperforming female nurses. Correlation analysis showed positive relationships between age, education, ICU experience, and ICU nurses' levels of knowledge and practice. ICU nurses demonstrate a knowledge-practice gap in delirium management. Targeted educational interventions, mentorship programs, and a focus on practical skills are essential to enhance delirium care. These findings highlight the urgent need for comprehensive delirium education and training programs for ICU nurses. By improving nurses' knowledge and practice, healthcare organizations can significantly enhance the early detection, prevention, and management of delirium, ultimately leading to improved patient outcomes and reduced length of stay in the ICU.

Navigating post-ICU care: understanding family members’ experiences - a qualitative study

ABSTRACT Background: Comprehending and addressing the needs of caregivers during the post-intensive care unit (ICU) phase is vital for establishing sustainable support systems and improving the overall quality of life (QoL) for both patients and caregivers. Objective: To explore the experiences of family members (FMs) caring for loved ones three-months after ICU discharge and their related QoL. Methods and measures: A qualitative, descriptive research was conducted. Participants were recruited from two general ICUs in an Italian Academic Hospital. Data collection lasted two months and was performed with telephonic interviews led by ICU nurses. Thematic analysis was conducted using a hybrid approach, incorporating both deductive and inductive coding strategies. This process has been facilitated by Atlas.ti software. Results: Twenty-four FMs participated, representing a diverse range of familial relationships with the patients. Thematic analysis revealed four overarching themes: 1) QoL underwent transformations; 2) Positive emotions laden with significance; 3) Supporting role taken on by a caregiver; and 4) Life’s transience through the meaning-making of the illness event. These themes highlighted the multifaceted nature of the caregiving experience. Conclusions: This study provides valuable insights into the challenges and dynamics faced by FMs following ICU discharge. Findings underscore the importance of addressing environmental challenges, cultivating positive emotions, and strengthening caregiver-patient relationships to enhance the caregiving experience and promote overall QoL. FMs can adapt their personal concepts and reach their full potential by learning to coexist with the demanding role of caregiver and achieve a new level of resilience and fulfillment.

Coping strategies of intensive care units nurses in alarm management: a qualitative research study

BackgroundIntensive care units are critical environments where various alarm systems play a pivotal role in patient monitoring and safety. Alarm fatigue can lead to slower response times and missed alarms, compromising patient safety and increasing stress and burnout among intensive care unit nurses. Understanding how intensive care unit nurses respond to and manage these alarms is crucial in evaluating their impact on patient care and nursing well-being.MethodsThis descriptive qualitative study explored the experiences of intensive care unit nurses in alarm management. Conducted in the medical and surgical intensive care units of a Northern Taiwan medical center, the study involved 15 nurses. Semi-structured interviews were utilized to investigate the working experiences of ICU nurses in alarm management and to identify their coping strategies for dealing with the constant inundation of medical device alarms. The interviews were transcribed, and content analysis was applied to identify key themes in the responses.ResultsThe study revealed five main themes in intensive care unit nurses’ strategies for managing alarms: (1) Mastering alarm signals and acting; (2) Team monitoring for life preservation; (3) Enhancing senses and distinguishing carefully; (4) Learning from the lessons of incidents for vigilant reflection; and (5) Detach alarms’ influence on daily life. These coping strategies are effective in alarm management, safeguarding patients’ lives, enhancing the serenity of the clinical environment, and mitigating the physical and mental exhaustion caused by alarm fatigue.ConclusionsIntensive Care Unit nurses develop various coping strategies to manage medical device alarms, based on their experience. These strategies are crucial in maintaining patient safety and reducing nurse alarm fatigue. They can also be used for nursing education and clinical training.

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.

Validation of the Effectiveness of the Emergency Coping Education Program Using Mobile Application for ICU Nurses

Validation of the Effectiveness of the Emergency Coping Education Program Using Mobile Application for ICU Nurses

Impact of aromatherapy on anxiety among ICU nurses: A randomized, blinded, placebo-controlled trial.

The purpose of this study was to examine the effect of aromatherapy with an essential oil blend containing lavender, bergamot, ylang-ylang, and sweet orange, compared with placebo, on perceptions of anxiety in ICU RNs. Nurses recruited from six adult ICUs and a neonatal ICU participated in this blinded, randomized, placebo-controlled study, which took place over a 30-day intervention period. Although there were no statistically significant changes in anxiety pre- to postintervention or between the intervention and placebo groups, there were also no adverse events or untoward effects. The results of this study may support aromatherapy as an evidence-based strategy to reduce anxiety in ICU nurses. Additional research is needed.

Intrahospital Handovers before and after the Implementation of ISBAR Communication: A Quality Improvement Study on ICU Nurses' Handovers to General Medical Ward Nurses.

Research finds a lack of structure as well as varying and incomplete content in intrahospital handovers. This study aimed to improve intrahospital handovers by implementing structured ISBAR communication (identification, situation, background, assessment and recommendation). This quality improvement study was conducted observing 25 handovers given by nurses from the intensive care unit to nurses from general medical wards at baseline and after the implementation of the ISBAR communication tool. The 26-item ISBAR scoring tool was used to audit the handovers. In addition, the structure of the ISBAR communication and time spent on the handovers were observed. There were no significant improvements from baseline to post-intervention regarding adherence to the ISBAR communication scoring tool. The structure of the handovers improved from baseline to post-intervention (p = 0.047). The time spent on handovers declined from baseline to post-intervention, although not significantly. The items in the ISBAR communication scoring tool can act as a guide for details that need to be reported during intrahospital handovers to strengthen patient safety. Future research calls for studies measuring satisfaction among nurses regarding using different handover tools and studies using multifaceted training interventions.

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

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

Augmenting intensive care unit nursing practice with generative AI: A formative study of diagnostic synergies using simulation-based clinical cases.

As generative artificial intelligence (GenAI) tools continue advancing, rigorous evaluations are needed to understand their capabilities relative to experienced clinicians and nurses. The aim of this study was to objectively compare the diagnostic accuracy and response formats of ICU nurses versus various GenAI models, with a qualitative interpretation of the quantitative results. This formative study utilized four written clinical scenarios representative of real ICU patient cases to simulate diagnostic challenges. The scenarios were developed by expert nurses and underwent validation against current literature. Seventy-four ICU nurses participated in a simulation-based assessment involving four written clinical scenarios. Simultaneously, we asked ChatGPT-4 and Claude-2.0 to provide initial assessments and treatment recommendations for the same scenarios. The responses from ChatGPT-4 and Claude-2.0 were then scored by certified ICU nurses for accuracy, completeness and response. Nurses consistently achieved higher diagnostic accuracy than AI across open-ended scenarios, though certain models matched or exceeded human performance on standardized cases. Reaction times also diverged substantially. Qualitative response format differences emerged such as concision versus verbosity. Variations in GenAI models system performance across cases highlighted generalizability challenges. While GenAI demonstrated valuable skills, experienced nurses outperformed in open-ended domains requiring holistic judgement. Continued development to strengthen generalized decision-making abilities is warranted before autonomous clinical integration. Response format interfaces should consider leveraging distinct strengths. Rigorous mixed methods research involving diverse stakeholders can help iteratively inform safe, beneficial human-GenAI partnerships centred on experience-guided care augmentation. This mixed-methods simulation study provides formative insights into optimizing collaborative models of GenAI and nursing knowledge to support patient assessment and decision-making in intensive care. The findings can help guide development of explainable GenAI decision support tailored for critical care environments. Patients or public were not involved in the design and implementation of the study or the analysis and interpretation of the data.

Positive Impact on Critical Care Knowledge Acquisition and Skills of VietnameseNurses through an Online Standardized Training Program

Background Improved access to healthcare, increasing elderly population, growing incidence of chronic diseases, combined with the high prevalence of accidents and infectious diseases are driving the demand for critical care services in acute hospitals. However, low and middle-income countries not only have a shortage of critical care nurses, but there are also gaps in their graduate, post-graduate, and specialized training as well as in their continuing education to support them in their role. Methods This quality improvement project aimed to assess the effect of a web-based group study program on knowledge acquisition and skills and competency development of critical care nurses at seven private,not-for-profit hospital sites within a hospital system in Vietnam. The Essentials of Critical Care Orientation 4.0 course from the American Association of Critical Care Nurses was delivered to two cohorts of ICU nurses who worked in critical care. Course content was translated in Vietnamese. The program leveraged a preceptor-facilitator-learner model that depended on group discussions and self-learning. Program effectiveness was evaluated using quantitative pre- and post-test design, combined with a post-program survey. ResultsAverage post-test scores of the first cohort increased by 34.0% over pre-test while those of the second cohort increased by an average 41.0%.Post-program survey revealed that all learners were satisfied with the quality of content, the web-based delivery system, content translation and the overall teaching methodology. Learners also demonstrated greater confidence in delivering safe, proactive patient care. Conclusion The utilization of an online, standardizedwestern education program, translated to Vietnamese,delivered through a facilitator-group learning model is successful in increasing the knowledge level of Vietnamize critical care nurses.

Relationship between moral resilience and secondary traumatic stress among ICU nurses: A cross-sectional study.

Since the outbreak of COVID-19, researchers worldwide have focused more on the issue of secondary traumatic stress (STS) experienced by nurses. This stress has an adverse effect on the health of nurses and the quality of nursing care, potentially undermining the stability of the nursing team and hindering the ability to meet the growing demand for nursing services. The impact of the COVID-19 pandemic, and the rise in global demand for ICU nursing, has placed a significant strain on ICU nurses, severely damaging their mental and physical health. Notably, ICU nurses also face high levels of moral distress, and moral resilience can effectively alleviate this distress and improve the quality of care. This study aimed to examine the levels of moral resilience and STS among ICU nurses, to explore their relationship and identify the factors influencing STS. This cross-sectional study involved 229 ICU nurses from two tertiary hospitals in Xi'an, China, who participated between November and December 2023. The data were collected through email using anonymous electronic questionnaires, encompassing a self-designed demographic- and work-life-related characteristic questionnaire; the Rushton Moral Resilience Scale; and the Secondary Traumatic Stress Scale. Descriptive statistics, t-tests, analysis of variance and hierarchical regression analysis were performed to analyse the data. The findings of the study indicated that ICU nurses' moral resilience and STS scores were at an intermediate level. Hierarchical regression analysis indicated that STS was negatively correlated with the subscales of the Rushton Moral Resilience Scale, specifically moral adversity coping (β, -0.156; 95% CI, -1.241 to -0.039) and relational integrity (β, -0.245; 95% CI, -1.453 to -0.388), which are significant predictors of STS. Additionally, good sleep quality (β, -.396; 95% CI, -14.948 to -7.117) and seeking psychological counselling because of work difficulties (β, .107; 95% CI, 0.237-9.624) emerged as significant predictors of STS among ICU nurses, with the model's explanation of the variance in STS increasing to 45.5%, △R2 = .167, F = 16.482 (p < .001). This study found that ICU nurses have moderate levels of moral resilience and STS, which are negatively correlated. This suggests that improving the moral resilience of ICU nurses may help reduce their STS levels. The study revealed that ICU nurses' moral resilience and secondary traumatic stress levels were at a moderate level, indicative of the need to take measures to enhance their moral resilience and reduce their secondary traumatic stress, as their presence not only affects the health of ICU nurses but also diminishes the quality of care and increases turnover rates.

Families’ Perceptions of Support from ICU Nurses in Teaching Hospital, Karapitiya, Sri Lanka

Families’ Perceptions of Support from ICU Nurses in Teaching Hospital, Karapitiya, Sri Lanka

An online supportive music and imagery intervention to promote ICU nurses’ stress management: Preliminary study

Nurses in intensive care units are subjected to high levels of work-related stress and must cope with psychological distress. This preliminary study explored the effects of an online supportive music and imagery intervention on these nurses’ perceived stress, psychological distress, and sleep quality. A prospective pre–post design was employed to investigate the effectiveness of online supportive music and imagery interventions. The intervention comprised five weekly sessions, each lasting 50–60 min, which included verbal interactions and listening to music, and were facilitated by trained music therapists. Perceived stress and psychological distress were measured before and after the five-week program to investigate its effectiveness, and the current stress level and emotional state were measured before and after each session to explore changes over the intervention period. Sleep quality was measured weekly. In total, 29 participants completed the program. The results showed a significant decrease in perceived stress (d = 0.45, p = .045) and psychological distress (d = 0.53, p = .045) after the intervention. Regarding changes over the intervention period, the findings demonstrated a significant main effect of the number of sessions on perceived stress (p = 0.001), energy (p = 0.001), and tension (p = 0.023), whereas the effects on perceived valence and scores on the Korean version of the Insomnia Severity Index were not significant. Moreover, a significant post-session main effect was observed for all perceived stress and emotion ratings (p < 0.001). Online supportive music and imagery interventions may help reduce stress levels and enhance positive emotional states among nurses in intensive care units. Integrating self-work into supportive music imagery interventions may increase adherence to the intervention and extend its effect.

Education and Career Advancement Opportunities in Polish and English Nursing-A Comparative Study of Intensive Care Unit Nurses.

The aim of this study was to comparatively investigate education, job, and professional development satisfaction among intensive care unit nurses in Poland and England. A total of 258 ICU nurses from both countries were interviewed (72 Polish nurses working in Poland and 186 of various national backgrounds in England, including 50 of Polish origin). We used an 11-item structured survey followed by an open-ended qualitative interview retrospectively coded for statistical analysis. Regardless of national origin, nurses in England report significantly higher education satisfaction, attributed to better theoretical knowledge gain but not to other dimensions (such as practical knowledge or personal satisfaction). They also express greater satisfaction with job conditions regarding professional development, a state-of-the-art work environment, teamwork, and finance. The UK system is also considered significantly superior in promotion opportunities and participation in post-graduation training. In conclusion, systemic factors play a crucial role in career satisfaction and advancement in nursing, with the British band system having a clear advantage over the Polish one.

Association between self-assessed empathic skills, depressive symptoms and job satisfaction: A descriptive correlational study in Greek-speaking critical care nurses in Cyprus

Background: Critical care nurses face occupational hazards impacting their psychological well-being, job satisfaction, and ability to perform clinical duties effectively, including fostering empathic relationships with healthcare users. Aim: To assess in nurses employed in Emergency Departments, Cardiovascular Care, Intensive Care and Neonatal Intensive Care Units in the Republic of Cyprus: a) the degree of self-assessed depressive symptoms, job satisfaction, and empathic skills, and b) the relationship between these variables, and possible correlations with demographic characteristics. Methods: A correlational, cross-sectional design was employed in 150 critical care nurses (RR: 39.68%). In 2018, a self-reported questionnaire captured socio-demographic and educational/vocational details, alongside measurement tools for depressive symptoms (CES-D), empathic skills (JES-HP), and work satisfaction (IWS-Part B) among participants. Results: Mean scores for CES-D, IWS-Part B, and JES-HP were 14.4(±9.7), 184(±18.6), and 99(±14.7). respectively. Self-assessed depressive symptoms correlated negatively with job satisfaction (r=-0.296, p&lt;0.001) and empathic skills (r=-0.270, p&lt;0.001). Neonatal ICU nurses showed 5.7 points lower depressive symptoms than ED counterparts (b=-5.7, p=0.052). ICU nurses scored 10.4 points higher on IWS-Part B than ED nurses (b=10.39, p=0.015). Participants with 4-5 years of current work experience reported 12.7 points lower on IWS-Part B compared to &lt;1 year (b=-12.7, p=0.042). Similarly, 10-13 years of experience correlated with 16.8 points lower empathic skills (b=-16.8, p=0.015). Conclusion: The relationship between depressive symptoms, job satisfaction and empathic skills was confirmed but is required in-depth qualitative and quantitative exploration for informed longitudinal and interventional studies.

Nurses Experience of Prone Position in The Absence of Positioning Tool, and Suggestion of Prone Position Tool: A Phenomenology Study

During the COVID-19 pandemic which is a non-natural disaster, the ARDS cases (Acute Respiratory Disease Syndrome) rocketed. Despite the advantages of prone positioning for ARDS care, ICU staff seldom use it due to the unavailability of positioning tools, making it a challenging task for nurses. This study aims to investigate nurses' experiences with manual prone positioning and propose ICU-friendly prone position tools. This research method used a qualitative phenomenology theory study to 15 ICU nurses who were experienced in prone positioning at least 10 times to intubated patients and had complaints about the intervention. The experience was gathered using structured questions and recorded. The data was analyzed following Colaizzi’s thematic method, and all the emerged themes were collected and reported. The research results show that fifteen interviewed nurses noted that prone positioning is physically demanding and requires a coordinated team with a minimum of three staffs, 2 handles patient positioning, 1 leader securing the intubation tube. Before starting, the team assesses the difficulty level. Recommended tools include a slide sheet with handles, a modified Vollman prone positioner, and a crane-like prone harness. The conclusion is nurses find tools highly beneficial for prone positioning but will improvise with available resources like underpads as a ring-shaped pillow if tools are unavailable.