Intensive Care Nurses Research Articles

Enhancing patient safety culture and examining adverse events in intensive care units: a comparative analysis

Background and Purpose: The global emphasis on fostering a patient safety culture is a priority for many countries, including those in the Middle East. Hospitals worldwide are dedicated to enhancing the quality of patient care and safety, with an increasing recognition by hospital management of the role played by a robust patient safety culture. This study compares intensive care nurses' perceptions of patient safety culture and adverse events. Method: A comparative study was conducted in the intensive care units (ICUs) of four private and teaching hospitals utilizing The Hospital Survey on Patient Safety Culture (HSOPSC)-two in Riyadh and two in Cairo. Nonprobability sampling was employed across all registered nurses working in ICUs. Results: The study revealed that the highest percentage of errors occurred in patients' acquired infections (61.5%), while the lowest percentage was associated with patients' falls (7.8%). The strengths of the composites were continuous organizational learning improvement (85.9%) and management support for patient safety (81.4%). Areas for improvement were identified in composites such as handoffs and transitions (40.3%) and teamwork across units (49.5%). Notably, nurses in Cairo hospitals reported a higher frequency of adverse events compared to their counterparts in Riyadh hospitals. Implications for practice: The views of nurses working in both cities emphasized the importance of organizational learning to achieve ongoing improvement, teamwork within specific units, and managerial backing for ensuring patient safety. Moreover, the research emphasized the necessity for additional improvements in collaboration between different units, as well as in the processes of handoffs and transitions.

Exploring the impact of OSA on short-term survival in patients with AECOPD admitted to the ICU.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is characterized by a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms, which significantly contributes to hospitalizations related to COPD symptoms. Previous research has mainly focused on the correlation between obstructive sleep apnea (OSA) and COPD. However, there were few studies that investigated the short-term mortality rate of AECOPD patients with or without OSA. Data for our research was taken from the Medical Information Mart for Intensive Care Database IV. A total of 1332 patients were included in the study based on well-defined criteria for selection and exclusion. By analyzing the characteristics of AECOPD patients, we compared those with and without OSA. There were 1122 AECOPD patients without OSA, 210 patients with OSA. In comparison to those without OSA, patients with OSA exhibited lower 30-day and 90-day ICU mortality with unadjusted HR, as well as lower hospital mortality with unadjusted OR. However, after adjustments were made, there were no significant associations observed between OSA and short-term mortality, including 30-day ICU mortality, 90-day ICU mortality, ICU mortality, and hospital mortality in AECOPD patients. Subgroup analysis revealed that OSA may act as a risk factor for AECOPD patients with a BMI lower than 30 kg/m2. There is no impact on short-term survival in AECOPD patients with OSA under intensive care unit (ICU) management and nursing.

An evaluation of the capabilities of language models and nurses in providing neonatal clinical decision support

AimTo assess the clinical reasoning capabilities of two large language models, ChatGPT-4 and Claude-2.0, compared to those of neonatal nurses during neonatal care scenarios. DesignA cross-sectional study with a comparative evaluation using a survey instrument that included six neonatal intensive care unit clinical scenarios. Participants32 neonatal intensive care nurses with 5–10 years of experience working in the neonatal intensive care units of three medical centers. MethodsParticipants responded to 6 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 neonatal nurse practitioners for accuracy, completeness, and response time. ResultsBoth models demonstrated capabilities in clinical reasoning for neonatal care, with Claude-2.0 significantly outperforming ChatGPT-4 in clinical accuracy and speed. However, limitations were identified across the cases in diagnostic precision, treatment specificity, and response lag. ConclusionsWhile showing promise, current limitations reinforce the need for deep refinement before ChatGPT-4 and Claude-2.0 can be considered for integration into clinical practice. Additional validation of these tools is important to safely leverage this Artificial Intelligence technology for enhancing clinical decision-making. ImpactThe study provides an understanding of the reasoning accuracy of new Artificial Intelligence models in neonatal clinical care. The current accuracy gaps of ChatGPT-4 and Claude-2.0 need to be addressed prior to clinical usage.

The effects of using heel protectors on the prevention of heel pressure injuries and plantar flexion contractures.

Immobilization in the intensive care unit can lead to pressure injuries and plantar flexion contractures. This study was conducted to evaluate the effectiveness of heel protectors applied for the prevention of heel pressure injuries and plantar flexion contractures in intensive care units. This study was conducted as a randomized controlled trial in two adult intensive care units of a teaching and research hospital. The study sample consisted of 84 patients admitted to intensive care units between January 2022 and December 2022. Patients who had been in the intensive care unit for at least 5 days, scored 16 or less on the Braden Pressure Ulcer Risk Assessment Scale and scored 4 or more on the Ramsey Sedation Scale, were included in the study. Heel protector boots were applied to the heels of the patients in the intervention group, while standard positioning with a pillow and ROM exercises were continued in the control group. A sociodemographic data form, the Ramsey Sedation Scale and the Braden Pressure Ulcer Risk Assessment Scale were used to collect data. While pressure injuries were evaluated with the International NPUAP-EPUAP Pressure Ulcer Classification System, goniometric measurements were made to evaluate joint ROM. In the intervention group, heel pressure injuries did not develop during the study, whereas five patients in the control group developed heel pressure injuries. The risk of pressure injury development that was seen in the control group was 1.7 times higher compared with the risk for the intervention group (log 95% CI: 0.91-2.59). There were significant differences between the right foot (99%; F = 99.229; p = .000) and left foot (99%; F = 100.519; p = .000) in range of motion measurement values of the patients in the intervention group according to the measurement times. According to the results of the multiple comparison test (Bonferroni) performed to determine the range of motion measurement periods showing significant differences, it was observed that each measurement for both feet yielded lower results than the previous measurement (seven measurements from day 1 to day 13). The use of heel protector boots was found to be effective in preventing the development of heel pressure injuries and plantar flexion contractures in intensive care unit patients. This study provides evidence that intensive care nurses can use heel protector boots to prevent the development of heel pressure injuries and plantar flexion contractures.

Intensive Care Nurses' Knowledge and Perception Regarding Artificial Intelligence Applications

Intensive Care Nurses' Knowledge and Perception Regarding Artificial Intelligence Applications

Workload reduction through automated documentation in intensive and intermediate care - a monocentric observational study.

The global coronavirus pandemic has placed an unprecedented and enormous burden on health systems worldwide. In addition to a shortage of resources, nurses were also confronted with high levels of sick leave and an increasing exodus from the profession. Automating documentation obligations is an effective way of reducing the burden on the workplace. The study was conducted at a tertiary university hospital. The time required for the manual documentation of administered medication and dose changes of syringe and infusion pumps was recorded using the patient data management system (PDMS) representing all intensive and intermediate care wards (n = 6). Subsequently, all medication administration - grouped into five classes - was evaluated from January 1st, 2019, until December 31st, 2022. A total of 1,373,340 drug applications were studied, treating 32,499 patients. Data were obtained from ICUs (68%) and IMC wards (32%). This corresponds to an overall time of 2,901 ± 233 hours per year. Based on publicly known national rates for intensive care nurses, an annual financial expenditure of approximately 83,300 € (~ USD 89,300) per year was estimated. A non-negligible part of the daily working time in the medical sector is spent on documentation duties. This aggravates the high workload, which has increased in recent years. Automated documentation systems can lead to considerable relief and the possibility of focusing primarily on the patient and on other core competencies and activities. This is even more important, as available staff will be a key resource in patient care for the foreseeable future.

Knowledge, Attitude, and Practice of Iraqi Intensive Care Nursing Staff Regarding Pressure Ulcer Prevention

Knowledge, Attitude, and Practice of Iraqi Intensive Care Nursing Staff Regarding Pressure Ulcer Prevention

Evaluation of the relationship between intensive care nurses' pain management self-efficacy and perceptions of opioid drug administration

Evaluation of the relationship between intensive care nurses' pain management self-efficacy and perceptions of opioid drug administration

Determination of Covid-19 stress level in intensive care nurses after pandemic

Determination of Covid-19 stress level in intensive care nurses after pandemic

Nursing Practice of Airway Care Interventions and Prone Positioning in ICU Patients with COVID-19-A Dutch National Survey.

Background: Airway care interventions and prone positioning are used in critically ill patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) to improve oxygenation and facilitate mucus removal. At the onset of the COVID-19 pandemic, the decision-making process regarding the practice of airway care interventions and prone positioning was challenging. Objective: To provide an overview of the practice of airway care interventions and prone positioning during the second wave of the pandemic in the Netherlands. Method: Web-based survey design. Seventy ICU nurses, each representing one intensive care in the Netherlands, were contacted for participation. Potential items were generated based on a literature search and formulated by a multidisciplinary team. Questions were pilot tested for face and construct validity by four intensive care nurses from four different hospitals. Results: The response rate was 53/77 (69%). This survey revealed widespread use of airway care interventions in the Netherlands in COVID-19 patients, despite questionable benefits. Additionally, prone positioning was used in invasively and non-invasively ventilated patients. Conclusions: The use of airway care interventions and prone positioning is time consuming and comes with the production of waste. Further research is needed to assess the effectiveness, workload, and environmental impact of airway care interventions and prone positioning.

Determination of the Intensive Care Nurses’ Attitudes towards Evidence-Based Practices

Objective: This research was carried out to determine the attitudes of intensive care nurses towards evidence-based nursing.
 Methods: This descriptive study was conducted with 134 nurses working in the intensive care units of a university hospital between January and June 2021. Research data were collected by online data collection technique using “Descriptive Form for Nurses” and “Evidence-Based Nursing Attitude Questionnaire (EBNAQ)”. The obtained data were analyzed by using descriptive statistics (number, percentage, mean) and Mann Whitney U tests in the computer-aided SPSS package program.
 Results: It was determined that the intensive care nurses’ mean total score in the Evidence-Based Nursing Attitude Questionnaire (EBNAQ)was 66.35±6.22. Evidence-Based Practice Intentions Subscale was found to be higher in female nurses than in male nurses (p

Individualized Developmental Care Practices of Nurses Working in Neonatal Intensive Care Units: A Qualitative Study

Aim: This study aimed to identify and compare neonatal intensive care nurses who received training in individualized developmental care practices with nurses who did not. Material and Methods: This study was conducted with a qualitative design in the third-level neonatal intensive care units of two tertiary hospitals. Seven nurses from each hospital participated in the study. A semi-structured interview form was used. The interviews were recorded with a voice recorder and then transferred to a computer. Content analysis was used to analyze the interview data. Results: Seven themes, 14 sub-themes, and 78 codes were created for the nurses who received training, and 7 themes, 13 sub-themes, and 30 codes were created for the nurses who did not receive training. Since the themes of the two groups were common, the results of the two groups were compared and discussed. Conclusion: It was found that nurses who received training in individualized developmental care approached the newborn and family more holistically, planned, implemented, and evaluated their care more comprehensively than the nurses who did not receive training.

Evaluation of the Effect of Compassion Fatigue on Medical Error Tendency in Intensive Care Nurses

Objective: This study was conducted to evaluate the relationship between compassion fatigue and tendency to medical errors in critical care nurses.
 Methods: This descriptive study was conducted in the intensive care units of 16 hospitals (n=420) belonging to a private health group in Turkey between December 2021 and March 2022. Data were collected using the Compassion Fatigue-Short Scale and the Tendency to Medical Error in Nursing Scale (r=-0.252). 
 Results: The nurses’ mean score on the Compassion Fatigue-Short Scale was 56.20±26.77 and their mean score on the Tendency to Medical Error in Nursing Scale was 4.82±0.28. There was a statistically significant negative correlation between total scale scores.
 Conclusions: The results suggest that the nurses in this study had moderate compassion fatigue and a low tendency to medical errors. A weak relationship was observed between higher compassion fatigue and a greater tendency to medical errors. Determining the factors that cause nurses to make medical errors is crucial to enable the necessary precautions to be taken. We recommend conducting multidimensional studies to evaluate the effects of compassion fatigue on patient safety and nursing outcomes.

Blood Transfusion Procedure: Assessment of Serbian Intensive Care Nurses' Knowledge.

Many patients require administering one or more blood components during hospitalisation in the Intensive Care Unit (ICU). Therefore, nurses' knowledge of who is responsible for immediately administering blood transfusions, monitoring patients, and identifying and managing transfusion reactions is crucial. This cross-sectional descriptive-analytical study aimed to assess the knowledge of ICU nurses in tertiary healthcare institutions about blood transfusion procedures. The questionnaire about the transfusion procedure was designed and reviewed by experts. The questionnaire consisted of 29 items divided into three domains. The scores on the knowledge test ranged from 10 to 27. Generally, 57.7% of nurses had moderate, 23.4% low, and 18.9% high levels of knowledge about the transfusion procedure. Most nurses answered correctly about refreezing fresh frozen plasma, verifying the transfusion product, and identifying the patient. Of the nurses, 91.0% would recognise mild allergic reactions, and 98.2% knew about the supervision of sedated patients. Nurses showed poor knowledge of the length of usage of the same transfusion system for red blood cells, labelling, and transfusion administration in febrile patients. Nurses with higher education and longer working experience had significantly better outcomes (p = 0.000) on the knowledge test. Continuous education of ICU nurses on safe transfusion usage is recommended.

Yenidoğan Yoğun Bakım Hemşirelerinde Karşılanamayan Bakım Nedenleri ve Vicdan: Kalitatif ve Kantitatif Bir Araştırma

Amaç: Bu çalışma, yenidoğan yoğun bakım hemşirelerinde karşılanamayan bakım nedenlerinin ve vicdan deneyimlerinin kalitatif ve kantitatif olarak incelenmesini amaçlamaktadır.
 Yöntem: Araştırmanın tipi tanımlayıcı ve fenomonolojiktir. Araştırmanın evrenini; 15 Şubat-15 Mart 2022 tarihleri arasında bir kadın doğum ve çocuk hastalıkları hastanesinde çalışan yenidoğan yoğun bakım hemşirelerinden oluşmaktadır. Araştırmanın örneklem sayısı gelişigüzel örnekleme yöntemi ile 106 hemşireden oluşturmaktadır. Nitel verilerin örneklemini ise 106 hemşire içerisinden rastgele kura yöntemi seçilen 15 hemşireden oluşmaktadır. Veri toplama araçları; yenidoğan yoğun bakım hemşirelerinin sosyo-demografik özellikleri ve mesleki özelliklere ilişkin bir soru formu, Pediatri hemşireliğinde karşılanamayan bakım ve nedenleri-pediatrik versiyon anketi, Vicdan Algısı Ölçeği ve 6 maddeli yarı yapılandırılmış görüşme formundan oluşmaktadır. 
 Bulgular: Vicdan algısı ölçeğinin toplam puan ortalaması ile karşılanamayan bakım nedenleri arasında negatif yönde anlamlı olmayan ilişki olduğu belirlendi. Görüşmelerin sonucunda elde edilen veri analizleri hemşirelerin karşılayamadıkları bakım nedenlerinin vicdan deneyimlerine yönelik 4 ana tema ve bunların alt temaları belirlendi. 
 Sonuç: Araştırmada karşılanamayan bakım nedenleri ile vicdan arasında anlamlı olmayan ilişki bulunmasına rağmen, hemşirelerin bakımdaki vicdan deneyimlerinin çarpıcı olduğu ve yenidoğan yoğun bakım hemşirelerinin bebek bakımı esnasındaki vicdan deneyimlerinin neler olduğu bulundu.

Determination of attitudes and behaviours towards end-of-life care and psychological well-being levels of intensive care nurses

Aims: This study was conducted to determine the attitudes and behaviors of intensive care nurses towards end-of-life care and their psychological well-being levels. Methods: This descriptive study was conducted using a face-to-face interview technique with 101 nurses working at Aksaray University Training and Research Hospital between March and July 2023. Data were collected using the Nurse Introductory Information Form, Intensive Care Nurses’ Attitudes and Behaviors Towards End-of-Life Care Scale, and Psychological WellBeing Scale. The relationship between the variables was investigated with the Spearman correlation test. Results: It was determined that 74.3% of the nurses were women, 60.4% were single, and 61.4% had worked in the profession for 1-5 years. It was determined that nurses’ attitudes and behaviors towards end-of-life care scale scores showed a significant difference depending on whether they received information about end-of-life care and that there was a significant difference between the psychological well-being scale score and satisfaction with the department they worked in (p<0.05). There is a moderate and positive relationship between the behavioral scale and the psychological well-being scale mean scores (r=0.368, p<0.001). Conclusion: The study found that as nurses’ attitudes and behavior levels towards end-of-life care increased their psychological well-being levels also increased. It is recommended that nurses evaluate their psychological well-being and quality of life within the scope of holistic care and that studies be carried out to provide training and consulting services to nurses in this direction.

Ethical Decision-Making Level of Intensive Care Nurses

Aim: A crucial skill for nurses is the understanding of ethics and ethical dilemmas, which enables them to make ethical decisions. This study aimed to assess the ethical decision-making abilities of intensive care nurses employed at a university hospital.
 Materials and Methods: 
 In this descriptive study, the population comprised 265 nurses employed in the hospital's intensive care units. The sample for the study, on the other hand, consisted of 56 intensive care nurses. Data were collected using a “Nurse Information Form” and the “Nursing Dilemma Test”.
 Results: Intensive care nurses scored above the moderate level in Principled Thinking (29.95±10.34) and Practical Considerations (17.79±4.73). The study indicated that these nurses were acquainted with dilemmas similar to those in the Nursing Dilemma Test (15.71±4.47).
 Conclusion: The most common ethical dilemmas faced by intensive care nurses included the conflict between true procedures that should be done and the physician's request, the decision not to perform cardiopulmonary resuscitation, and telling the truth to the patient. It was concluded that intensive care nurses tried to take ethical principles into account when making decisions about ethical dilemmas, but that they did not make use of ethical principles adequately and were affected by environmental factors. To increase intensive care nurses’ level of consideration of ethical principles when they make decisions about ethical dilemmas, it is necessary to determine the ethical dilemmas they encounter and to increase and develop the knowledge and skills of nurses about the ethical decision-making process by supporting ethics education with in-service training.

Analysis of the Relationship Between Job, Life Satisfaction and Teamwork Attitudes of Intensive Care Nurses Working in a Turkish Public Hospital

Objective: The aim of this study was to determine the relationship between work, life satisfaction levels, and teamwork attitudes of intensive care nurses who work in a public hospital in Turkey.
 
 Methods: This was a descriptive and correlational study. The sample consisted of nurses working in intensive care units. Tools used to collect data were the “Sociodemographic Question Form,” “Nurse Job Satisfaction Scale” “Life Satisfaction Scale” and “Teamwork Attitudes Questionnaire” were used to collect the data.
 
 Results: A total of 217 nurses participated. In the study were a mean age of 35.32 ± 7.70. Most, 78.2% of the participants (n=170) were female, 65.90% (n=143) were graduates, 67.70% (n=147) were married, and 62.7% (n=136) had children. In this study, the LSS, NJSS, and T-TAQ scores for Intensive Care Nurses (ICNs) were determined to be 14.21 ± 4.28, 84.34 ± 16.71, and 99.11 ± 21.48, respectively. The respondents reported moderate and high scores on all three scales, and these scores positively correlated at the same time.
 
 Conclusion: In this study, which explores the interrelationships among these three distinct domains, is unusual in this regard. There was a positive correlation between the scores on the LSS, NJSS and T-TAQ in this study. It was determined that there was a positive relationship between LSS, NJSS and T-TAQ. Each scale score affects the scores of other scales. In our study, it can be said that ICNs' job satisfaction, life satisfaction and teamwork attitude levels are at medium level and above. Academicians, chief nurses, institution managers, and health system managers play important roles in the satisfaction of nurses whose satisfaction level is high.

Service Quality Implications of Long Periods of Consecutive Working Days: An Empirical Study of Neonatal Intensive Care Nursing Teams

Problem definition: We examine the effects of prolonged consecutive working days without breaks on care quality and explore its association with daily staffing levels in neonatal intensive care nursing teams. Academic/practical relevance: Healthcare organizations typically base staffing guidelines on safe daily metrics like nurse-to-patient ratios. However, in response to unforeseen demand spikes or staff shortages, managers often depend on staff working additional consecutive days to bridge staffing gaps. This approach, although addressing immediate staffing needs, can inadvertently impact care quality and safety, potentially undermining the benefits of higher staffing levels. Methodology: Using longitudinal data from 62 German neonatal units, we analyze the effect of nursing teams’ consecutive working days on the time from admission to full enteral feeding for 847 low-birth-weight babies, considering nurse-to-patient ratios and patient complexity. Results: Longer consecutive working periods harmfully affect care quality, especially during staffing shortages. The detrimental impact on days with low staffing is particularly pronounced in patients with less complex medical needs. Limiting the team-average number of consecutive working days to two days would have reduced the time to full enteral feeding in our study by 6.4%. Shifting from half a day less to half a day more than the average number of consecutive working days has an impact equal to 20% of the difference in time taken to reach full enteral feeding between low- and high-birth-weight babies. Managerial implications: Limiting consecutive working days could significantly improve intensive care outcomes. Management should monitor consecutive working days alongside daily staffing levels. Policy makers should consider introducing limits on the number of consecutive working days for intensive care nurses. Funding: This work was supported by the Federal Ministry of Education and Research in Germany [Grant 01GY1152]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0021 .

Nurses' decision-making around gastric residual volume measurement in UK adult intensive care: A four-centre survey.

Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. To explore adult intensive care nurses' decision-making around the practice of GRV measurement to guide enteral feeding. A cross-sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. Two hundred and seventy-three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4-6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision-making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). Factors affecting the nurses' decision-making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding.