Care Unit Nurses Research Articles

Physical restraint training for nurses in English and Welsh psychiatric intensive care and regional secure units

Background: The physical management of violence in psychiatric in-patient settings is of great concern and interest. However, there are no guidelines concerning training providers, course content, or course length, and little is known about injuries to staff during training. Aim: To investigate training in physical restraint in Psychiatric Intensive Care Units (PICUs) and Regional Secure Units (RSUs) in England and Wales, with a view to comparing course content and length, and injuries in training across the training providers cited by respondents. Method: Questionnaires were completed by randomly selected PICU and RSU nursing staff on 63 participating wards (of a total of 112 such wards in England and Wales). Results: 338 nurses (47% response rate) replied. Training in a wide variety of techniques was reported, although in practice a core curriculum can be identified. Few respondents were able to state which provider conducted their initial training. The reported length of initial training courses and required frequency of refresher training was variable, and refresher training had not always been conducted within the previous year. Less frequently used techniques were reported as taught to a large number of respondents that were infrequently used in practice. Some key aspects of patient safety (e.g. positional asphyxia) were reported as not covered by some respondents. Nearly a third of respondents reported being hurt in training, although injuries requiring medical treatment were rare. Discussion: It appears that in practice a core curriculum is taught despite a lack of course standardisation. When these core elements are taught, training is also more likely to include theoretical aspects of the prevention and management of violence, as well as safety and ethical aspects. Reported confidence in the respondents' ability to use in practice the techniques that they have been taught was found to be related to whether they had been trained in the core curriculum and not to duration of training. Conclusion: Further research needs to be conducted on a wider range of adult inpatient nursing staff, preferably of a prospective nature, before a sufficient evidence base will be available to guide purchasers and upon which national guidance and standards can be based.

Is nurse-led thrombolysis clinically safe, beneficial and acceptable?

This study examined the sensitivity and specificity of coronary care unit (CCU) nurses' ability to diagnose acute myocardial infarction (AMI) and to make an independent clinical decision about thrombolysis. The effectiveness of this simulated nurse-led thrombolysis was compared with the sensitivity and specificity of subsequent senior house officer diagnosis and actual treatment. A blinded, retrospective gold standard was provided by consultant cardiologists. Predictions were that: nurse-led thrombolysis would be no worse than current practice; it would lead to a significant time-saving in CCU door-to-needle times; CCU nurses would accept this potential development in their role. The first and second predictions were upheld. Regarding the third prediction, most nurses felt confident about diagnosing AMI and administering thrombolytics, but only half of those who completed an anonymous questionnaire said that nurse-led thrombolysis should be part of the nursing role. The comments against nurse-led thrombolysis related to extra responsibility, legal cover, professional and organisational support and backup, and financial reward. The results of this simulation study suggest that, providing these concerns are addressed, nurse-led thrombolysis may be clinically safe, beneficial and acceptable to nurses.

Assistance to parents of preterm newborns at neonatal units

The purpose of this study is to reflect about the assistance to be given to parents of preterm and low weight babies, born in neonatal units, based on existing literature and the authors' practical experiences. Although mothers right to be close to their babies is assured by law, most of the nurseries still keep strict visit schedules to parents. However, there are some units where mothers' permanency is allowed. The question, in these cases, is if parents effective involvement in the care of the baby should or should not be allowed. For the nursing care unit, the authors suggest some intervention strategies to adapt parents to the new situation, and to strengthen the relationship between them and the baby. The recommendations are as follows: parents free access to the nurseries; motivation of early physical contact between parents and baby; implementation of multi-professional support groups to help parents during the different stages of clinical evolution; incentive for breastfeeding, and direct care of the babies; structuring of formal and informal groups of support for parents during and after hospitalization.

Skin protection and breakdown in the ELBW infant. A national survey.

The purpose of this study was to learn how neonatal intensive care unit (NICU) nurses describe the problem of skin breakdown in the extremely low birth weight (ELBW) infant, examine interventions currently used to prevent and treat ELBW infant skin breakdown, and to learn how nurses describe and measure skin breakdown. Questionnaires were sent to 482 NICUs in the United States, and a response was requested from a registered nurse with at least 2 years NICU experience currently employed in the NICU who regularly managed ELBW infants. Questionnaires were returned from 215 NICUs (45%). Analysis revealed that an average of 21% of ELBW infants suffered skin breakdown during the 1st week of life. Nurses who reported the least problems with ELBW infant skin breakdown followed skin-care protocols that limited use of tape and made liberal use of Aquaphor to protect fragile skin. Recommendations from this study include the development of an objective tool to rate skin breakdown and further study of product efficacy used in the treatment of skin breakdown.

A survey of bedside methods used to detect pulmonary aspiration of enteral formula in intubated tube-fed patients

BACKGROUND: The most frequently recommended methods to assess for pulmonary aspiration of enteral formula in intubated, tube-fed patients are (1) adding dye to enteral formulas and observing for dye-stained tracheal secretions and (2) testing tracheal secretions with glucose oxidase reagent strips to detect the presence of glucose-rich formula. Reportedly, the glucose method is more sensitive than the dye method, and the dye method may have greater potential for harm. It is not known if this information has resulted in wider use of the glucose method in practice settings. OBJECTIVES: To describe the frequency with which nurses in intensive care units use the dye and glucose methods to detect pulmonary aspiration of enteral formula in tube-fed, intubated patients. METHODS: One registered nurse in the medical intensive care unit at 285 acute-care facilities was contacted by telephone and asked about the methods used to detect pulmonary aspiration of enteral formula in tube-fed, intubated adult patients. RESULTS: Responses were obtained from 281 facilities. More than 73% of the respondents reported using only the dye method; about 1% reported using only the glucose method. Approximately 13% used both methods; another 13% did not use either method. CONCLUSIONS: The dye method is used far more often than is the glucose method. Two probable reasons are that the dye method is easier to implement, and it is recommended in commonly used basic nursing textbooks.

Nurse staffing and patient outcomes.

Nursing studies have shown that nursing care delivery changes affect staff and organizational outcomes, but the effects on client outcomes have not been studied sufficiently. To describe, at the level of the nursing care unit, the relationships among total hours of nursing care, registered nurse (RN) skill mix, and adverse patient outcomes. The adverse outcomes included unit rates of medication errors, patient falls, skin breakdown, patient and family complaints, infections, and deaths. The correlations among staffing variables and outcome variables were determined, and multivariate analyses, controlling for patient acuity, were completed. Units with higher average patient acuity had lower rates of medication errors and patient falls but higher rates of the other adverse outcomes. With average patient acuity on the unit controlled, the proportion of hours of care delivered by RNs was inversely related to the unit rates of medication errors, decubiti, and patient complaints. Total hours of care from all nursing personnel were associated directly with the rates of decubiti, complaints, and mortality. An unexpected finding was that the relationship between RN proportion of care was curvilinear; as the RN proportion increased, rates of adverse outcomes decreased up to 87.5%. Above that level, as RN proportion increased, the adverse outcome rates also increased. The higher the RN skill mix, the lower the incidence of adverse occurrences on inpatient care units.

Exploring dichotomies of caring, gender and technology in intensive care nursing: a qualitative approach.

Intensive care nursing involves combining caring, seen as a feminine trait, with the ability to work with technology, often viewed as masculine. This study explored nurses perceptions of their work, particularly in relation to whether there are differences between the sexes in caring ability and the planned career paths of female and male nurses. It was also designed to investigate the attractions of intensive care nursing and what nurses disliked most about their jobs. The results challenge previous studies which state that male nurses are attracted to these areas because of the technology and that they wish to climb the career ladder more quickly than their female colleagues. Nurses in intensive care units generally chose such work because they were able to provide, in their own opinions, a high standard of nursing care to patients and were able to maintain direct patient contact if they wished to achieve sister/charge nurse posts.

Withdrawing treatment from a critically-ill child.

In this paper the ethical and legal implications of withdrawing treatment from a critically-ill child are examined. Paediatric nurses in intensive care units often rely on intuition for resolving emotive issues such as the withdrawal of treatment from a child. To enhance their contribution in the decision-making process nurses need knowledge of ethical theories and principles, and the law. Advances in technology, together with political and economic factors, could well result in more attention being placed on ethical and legal issues in paediatric intensive care units. For the purpose of this paper pseudonyms have been used.

Neonatal intensive care nurse stressors: an American study.

The purpose of this study was to determine the frequency of selected stressors and the level of associated stress experienced by neonatal intensive care unit (NICU) nurses in the USA, and to identify their responses/coping mechanisms. The research instrument consisted of demographic data (education, location of practice, age, years in practice, gender) and a modification of the Stress Audit tool developed by Popoff and Funkhouser (1975). Participants were randomly chosen from health-care units located in the upper Midwest of the USA. Fifty-nine nurses (35%) responded to the postal survey. In terms of scale items, floating out of the unit (ability to staff other units when necessary) was the most stressful item and routine procedures the least stressful item. From a subscale perspective, knowledge was the least stressful and management the most. Subscale scores did not differ by marital status, number of years of practice as a registered nurse, or years of practice in NICU. Coping with stress was best facilitated by discussion with coworkers. Consistency of care, inservice education, mental health days (time off for stress relief, paid or unpaid) and staff support groups were reported as helpful in coping with job-related stress.

A long-term study of elderly people in nursing homes with visiting and resident dogs

Three nursing homes in the Brisbane area took part in the study. The Moreton Bay Nursing Care Unit (20 females, 11 males) had a visiting dog (each week), the Returned Services League War Veterans Home (24 females, eight males) had a resident dog and the Wheeler Garden Settlement (25 females, seven males) the visiting researcher only (control). A desexed female whippet, 11 months old was used in this study.Tension and confusion were reduced in the nursing home with a resident dog (x2 = 21.18, d.f. = 10, P = 0.02; x2 = 35.42, d.f. = 10, P = 0.0001, respectively).The resident dog group showed significant decreases in depression (x2 = 31.19, d.f. = 10, P = 0.0005) as did the control group (x2 = 29.8, d.f. = 10, P = 0.0009; x2 = 23.4, d.f. = 10, P = 0.009).Significant increases in vigour were found in all three nursing homes (visiting dog, x2 = 43.91, d.f. = 10, P = 0.0005; resident dog, x2 = 42.92, d.f. = 10, P = 0.0005; control, x2 = 38.52, d.f. = 10, P = 0.0005).Fatigue decreased significantly in the visiting and resident dog groups (x2 = 21.58, d.f. = 10, P = 0.02; x2 = 19.45, d.f. = 10, P = 0.03, respectively).This long-term study indicates that there are many benefits from having a resident dog in a nursing home. However, if this is not an option, visiting dogs and/or visiting people improve the lives of nursing home residents.

Valuing Authority/Responsibility Relationships

Central to the practice of professional nursing are the elements of accountability, autonomy, direct communication, and authority. The value that nursing work groups place on authority affects their level of acceptance of responsibility and accountability for clinical decision making. The authors examined the value that nurse managers and staff nurses on primary nursing and total patient care units place on authority/responsibility relationships. Results indicated that nurse managers and staff nurses on primary nursing units valued accountability, authority, and autonomy more than the nurse managers and staff nurses on total patient care units, a finding consistent with the professional practice model of primary nursing.

A Cognitive task Analysis of Nicu Nurses' Patient Assessment Skills

A study is presented utilizing cognitive task analysis (CTA) methods to elicit knowledge from Neonatal Intensive Care Unit (NICU) nurses regarding the assessment of infants at risk for Necrotizing Enterocolitis (NEC). Researchers were successful in eliciting knowledge not available in current nursing texts. Knowledge elicited includes a framework for considering NEC and problem-solving strategies used by experienced nurses. Implications for nurse instruction and potential applications of this information for decision support are discussed.

Infection control: a survey to determine knowledge of nurses in a clinical setting.

This study set out to discover whether nurses with an understanding of the theoretical principles of microbiology know more about the clinical aspects of infection control than those without. Two vignettes were developed depicting typical situations. They were presented to 130 nurses in intensive care, surgical or medical units in two similar hospitals, one with updated guidance and one without. Results showed that most subjects would not perform optimally in the everyday situations depicted, nor would they have sufficient knowledge of microbiology to understand the theoretical principles underpinning infection control.

Pain as a quality management initiative.

A 320-bed surgical nursing department's pain management quality improvement initiative is presented. Clinical indicators were designed through literature review and consultation with pain management experts. Results for pain assessment compliance, patient perception of relief, and the perceived impact of pain on activity--analyzed by nursing care unit, physician service, and pain medication type--are detailed, as are selected strategies to improve pain management outcomes.

Neonatal and pediatric critical care: a call for collaboration.

Neonatal and pediatric critical care units are growing in size and complexity. Each unit is staffed by a highly specialized group of nurses. Although the units share many commonalities, the relationship between nurses in the neonatal and pediatric critical care units often is characterized by rivalry and antagonism rather than by cooperation. The purpose of this report is to identify similarities and differences between the two units and to describe the benefits of collaboration between units.

Pain and pain-related side effects in an ICU and on a surgical unit: nurses' management

Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. To determine the extent to which nurses manage pain effectively without side effects related to narcotic analgesics in an intensive care and a surgical unit. The sample consisted of 44 patients, 20 from an intensive care unit and 24 from a surgical unit. Patients completed a Visual Analogue Scale to measure pain intensity three times in 24 hours. The narcotic side effects of constipation and sedation were measured using the Constipation Assessment Scale and a sedation scale. Documentation was assessed using the Chart Audit for Pain. Patients in both units continued to experience pain even with pain management interventions. The critical care nurses administered an average of 30% of the maximum narcotic dose ordered and the surgical unit nurses, 36.8%. Documentation of the effect of the pain medication was scant on both units. Although sedation was not a problem in either unit, the majority of patients reported symptoms of constipation. Documentation of this problem was scant in both units. Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.

Nutritional support for critically ill patients.

The incidence of malnourishment in medical and surgical patients is well documented, yet it is obvious that sufficient and appropriate nourishment is as vital to life as the maintenance of effective respiration. The effects of malnourishment are seen in all systems of the body, and cause diminutions in mental and emotional well-being. The highly compromised states of critically ill patients places them at great risk from the adverse effects of sub-nutrition, and much responsibility lies with nurses in intensive care units (ICUs) to ensure such patients are protected. This article considers the key aspects of the nurse's role in the provision of artificial nutrition to adult patients in ICUs who are, by definition, critically ill.

Labeling effects of infant health and parent demographics on nurses' ratings of preterm infant behavior

Nurses in neonatal intensive care units (NICU) provide early influences on hospitalized infants' neurobehavioral and social-emotional development. Hence it is important to examine their perceptions of preterm infants. This research employed a 2 × 2 factorial design to examine the labeling effects of infant health status and parent demographics on 52 NICU nurses' ratings of premature infant behavior, attractive ness, general health, and responsiveness to developmental intervention. Behavioral descriptors were provided to orient participants to the infant behaviors they were to observe. MANCOVA and univariate ANCOVAs revealed significant differences as a function of the infant health variable, but not parent demographics, on the Premature Infant Behavior, Attractiveness, and General Health scales. Ratings were significantly more positive for the infant described as healthy compared with the one identified as having lung damage. The results extend the prematurity prejudice literature and highlight the need to recognize the operations of stereotypes and the possibility of self-fulfilling prophecies. Future research directions are outlined.

Education and staffing in the ICU: past, present and future.

This article discusses the history of intensive care education in the UK and the impact of recent developments and their effect on the education of nurses in intensive care units.

Distress in cancer patients and primary nursesʼ empathy skills

This descriptive, correlational study was designed to explore the relationship between the empathy skills of primary nurses and the distress level of their primary patients. Data on empathy skills were generated from the La Monica Empathy Profile. Data on patient distress were generated from the Profile of Mood State Inventory and a Visual Analogue Scale. A nonprobability convenience sample of 65 primary nurses employed on surgical primary nursing care units of a large teaching hospital participated in the study. Sixty-five cancer patients assigned to the participating primary nurses also took part in the study. Descriptive statistics of each variable were examined. Pearson product-moment correlations were used to examine the hypothesis and the demographic variables for nurses and patients. Analysis of variance was used to assess relationships among many of the demographic variables. A significant correlation (but not in the expected direction) was found between the perceiving/feeling/listening empathy skill and patient distress. Nurses' age, years of experience, and education were significantly correlated with some empathy skills. Distress levels of female patients were higher than those of male patients. In general, nurses scored low in the use of empathy skills, and patients scored low in distress. The complex nature of defining and measuring communication skills and relating these skills to outcomes in patient care, such as distress, requires more study. Research questions exploring how and why nurses' interpersonal skills make a difference to patients and their health care outcomes must be generated by nurse administrators, nurse educators, nurse researchers, and practicing nurses.