Practices Of Critical Care Nurses Research Articles

Nurses' Knowledge, Attitude, and Practice on Enteral Feeding of Critically ill Patients at Kenyatta National Hospital Critical Care Unit

Enteral feeding/nutrition is the most efficient nutritional support strategy used by critical care nurses to feed patients in critical care units (CCUs) who are unable to meet their dietary demands orally. In developing countries, most critically ill patients continue to receive low amounts of their dietary needs in the CCUs. Therefore, it is necessary to carry out investigations on the levels of knowledge, attitudes, and practices of critical care nurses attending to extremely ill patients. This study's objective was to determine the levels of knowledge, attitudes, and practices of critical care nurses on enteral feeding of critically ill patients at Kenyatta National Hospital (KNH) CCUs. The study adopted a cross-sectional quantitative study design. Using a stratified sampling design and proportionate sampling technique, a sample size of 135 critical care nurses was recruited. Data was collected using a standardised questionnaire. Inferential statistics, Pearson Chi-square (χ2) or Fisher's exact tests were used to analyse the relationship between independent and dependent variables. A p-value of <0.05 was set as the significance criterion. Approximately 65.9% of the study participants noted adequate level of knowledge on enteral nutrition, followed by moderate (23.0%) and inadequate (11.1%) levels of knowledge. Most of the respondents (96.3%.) had positive attitudes toward enteral feeding. About 54.7% of the study subjects had competent enteral feeding practices. The gender, age group, terms of service, level of qualification and work experience were not significantly associated with the levels of knowledge, attitudes, and practices on enteral feeding among critical care nurses. This study concluded that the critical care nurses had adequate knowledge, positive attitudes, and competent practices on enteral nutrition. The study recommends that critical care nurses must be provided with regular, continuous medical training on enteral nutrition to maintain a high level of knowledge, positive attitudes, and competent practices on enteral nutrition

Effect of using the "SPIKE'' protocol on feelings, attitudes, and practices of critical care nurses for breaking bad news

Effect of using the "SPIKE'' protocol on feelings, attitudes, and practices of critical care nurses for breaking bad news

"Patient Comfort Can Be Sacrificed for Patient Safety"-Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study.

Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.

Effect of an Educational Program on Critical Care Nurses' Knowledge, and Practice about Central Venous Catheter Bundle.

Abstract Introduction: Educational program about central venous catheter bundle plays an important role on critical care nurses’ knowledge and practice. Educating, and training health care providers who are inserting and maintaining central venous catheter is must. Aim: To evaluate the effect of educational program on critical nurses' knowledge and practice about central venous catheter bundle. Subjects and Method: Quasi-experimental research design was used. The study executed at General ICU (18 beds), at main Assiut University Hospital. A sample of 60 critical care nurses’ working in General ICU was selected. Two tools were used for this study: knowledge assessment tool, and practice assessment tool. Results: There was a significant increase in the percentage of satisfactory knowledge and practice of critical care nurses after educational program compared with that before educational program (86.7% and 100% Vs. 0.00% and 15%) for knowledge and practice, respectively with minimal decline of satisfactory knowledge at follow up to 75 % and 81.7% for knowledge and practice, respectively. Conclusion: A significant improvement in the knowledge and practice of critical care nurses regarding central venous catheter after educational program was noted. Recommendation: Training programs for critical care nurses to keep up with updated knowledge and evidence practice.

Nurses' Practice of Documentation in Critical Care Units: An observation from Egypt

Background: Critical care nurses' are involved in many activities in critical care units from patient admission to discharge. Each nursing activities should be completely and accurately documented. Aim: This study aimed to assess critical care nurses’ practice of documentation in the critical care units. Setting: The study was carried out in three critical care units affiliated to a university hospital in Egypt. Method: A descriptive research design was utilized to conduct this study. Tool of the study: One tool was developed by the researcher after strength review of the relevant literature to assess critical care nurses’ practice regarding the documentation and consisted of two parts as follows: Part I: Nurses' socio-demographic characteristics, Part II: Critical Care Nurses’ Observational Checklist regarding Documentation: This tool was used to assess critical care nurses’ practice in critical care units during providing care for patients. Results: Revealed that most nursing interventions were either not or incompletely document and there were highly statistically significant p < 0.001 were found between documentation of nursing intervention in relation to routine care, changing position, range of motion exercises, and endotracheal tube care. Conclusion: The results of this study revealed that the practice of critical care nurses’ on nursing documentation were either not or incompletely document. Poor documentation may threaten the safety of patient care and needs urgent improvement. Recommendations: Improving nursing documentation in the critical care units through nursing practice supervision, evidence based practice, staff development and provide continuing training programs for nurses', and the handover should take place in the intensive care unit by educating critical care nurses’ to use the handovers checklists to improve the handover process.

Giving nurses a voice during ethical conflict in the ICU.

Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit. There is a gap in our understanding of nurses' perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. This study was approved by the Institutional Review Board at the organization where the study took place. Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing.

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person-centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.

Bridging the Gap Between Clinical Practice and the AACN Practice Alert on Pulmonary Artery/Central Venous Pressure Monitoring in Adults

Measuring and documenting accurate data from pulmonary artery and central venous pressure catheters is an important responsibility of critical care nurses. The American Association of Critical-Care Nurses Practice Alert titled Pulmonary Artery/Central Venous Pressure Monitoring in Adults provides evidence-based standards against which nurses can compare their practice related to obtaining valid hemodynamic data. Identifying and acting on improvement opportunities is also a nursing responsibility and helps to ensure that patients with pulmonary artery or central venous pressure catheters receive high-quality care. This article reviews various strategies to compare nursing practice to the Pulmonary Artery/Central Venous Pressure Monitoring in Adults Practice Alert and to close identified gaps in clinical practice.

The effect of performance feedback and educational video on endotracheal-suctioning practices of critical care nurses.

INTRODUCTION:Majority of critical care nurses do not have desirable skills in performing endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed to investigate and compare the effect of education through video and performance feedback (PF) on nurses' skills in performing ETS.METHODS:This was a quasi-experimental study. The sample size comprised of all nurses (n = 49) working in the intensive care unit of one of the educational hospital located in one of the western cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data were collected using a 25-item structured best practices information sheet. Data were analyzed using SPSS software version 20 (SPSS Inc., Chicago, IL, USA).RESULTS:After the interventions, no significant difference was found in the total mean score of nurses' practice in ETS between those who received education through EV and those who received through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement was observed in the total mean score and other dimensions of nurses' practice in endotracheal suctioning (P < 0.0001).CONCLUSIONS:The results showed that both of methods through feedback and EV are useful in improving nurses' ETS practice. However, further studies are required to examine the effects of such interventions in the long term.

Effect of an Educational Program on Nurses’ knowledge &amp;Practices Regarding Assessment of Acute Coronary Syndrome

Background: Acute coronary syndrome (ACS) refers to a group of conditions due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies. Aim: To evaluate the effect of implementing an educational program on knowledge and practices of critical care nurses regarding acute coronary syndrome. Sampling: convenient samples of 30 nurses recruited from coronary and Emergency care unit at Manfalout’s Reproductive Health Hospital. Research design: quasi-experimental research design (one-group pretest-posttest design) was used for implementation this study. Result: Most of nurses (66.7%) had unsatisfactory level of knowledge regarding acute coronary syndrome, Most of nurses (36.7%) had unsatisfactory level of practice regarding acute coronary syndrome and no significant statistical relation between knowledge and practice level of studied nurses. Data collection: Data were collected in six months. Conclusion: empowerment of emergency nurses' knowledge and practices would have a positive impact upon their knowledge and practice related to acute coronary syndrome. Recommendations: All nurses should be equipped with the necessary knowledge and practice regarding acute coronary syndrome.

Thinking about strengths in end-of-life nursing practice: the case of intensive care unit nurses.

The intensive care unit (ICU) is a care context that is sometimes described as being unconducive to the values and ideals of a good death in end-of-life care. Such assumptions render the ICU emblematic of a troubling discourse about end-of-life care in this clinical context. To stimulate a reflective examination of intensive care nursing practice with respect to end-of-life care. The work of contemporary nursing scholar Laurie Gottlieb is used to perform a strengths-based relational ethical examination of previously published literature that describes critical care nurses' experiences of providing end-of-life care in the ICU. This literature suggests that the relational ethical value of authentic engagement, which is fundamental to the disciplinary ethos of expert palliative care nursing, is reflected in the everyday practice of intensive care nurses whose patients die while under their care. A strengths-based approach can make visible the relational ethical practice of critical care nurses who care for dying patients and their families in the ICU.

A Vision for Excellence by Design.

Generating evidence for care improvement has characterized my program of research spanning 20 years. Six domains are highlighted to advance the science and practice of critical care nurses in today’s complex health care systems. Employee well-being and taking care of our teams are key priorities for successful leaders. Understanding that patient and staff outcomes are inextricably linked makes it even clearer that care environments need to be healing and holistic for staff and patients. The healthy work environment framework provided by the American Association of Critical-Care Nurses empowers staff and optimizes the experience for patients, their families, and care teams. Appropriate staffing, guided by contemporary acuity measurement, recognizes the cognitive workload and complexity of nursing. Committing to a culture of certification and ensuring staffing models with appropriately educated and experienced nursing staff will continue to be important. During the past decade, we have established the relationship of these specific nursing characteristics to improved patient outcomes. Understanding the attributes of empathic and empowered teams is requisite for authentic leadership. Interventions to mitigate moral distress are necessary to foster moral resiliency among critical care nurses. The challenge for the future will be to support organizational health through the coexistence of highly reliable processes and clinical innovation. Excellence is achieved when systems are designed to support professional practice, clinical teams, and environments.

The status and influencing factors of the methods used by nurses verifying the blinded inserted nasogastric tube placement

Objective To investigate the status and influencing factors of the methods used by nurses verifying the nasogastric tube placement blinded inserted in adult, and to explore the best practice of nursing staff to verify the nasogastric tube placement. Methods We designed the questionnaire and conducted survey to the clinical nursing staff in accordance with the American Association of Critical-Care Nurses practice alert. Results Air bolus auscultation (70.53%, 675/957) and aspirate appearance(68.97%, 660/957) were the most used method during insertion procedure. There was insufficient in the cognition of X-ray as the gold standard and the use in clinical.The department, work years, specialist nursesand hospitallevel impact X-ray use (all P <0.05) .Age, education,title,hospital level, specialist nurses and department impact the cognition of X-ray as the gold standard (all P <0.05) . Conclusions Nurses still use the traditional methods to verify the nasogastric tube placement. There is a certain gap between clinical practice and AACN practice alert in themethods used to verify nasogastric tube placement.As the gold standard to verify gastric tube placement, the use and cognition of X-ray are impacted by many factors, including the department, specialist nurses, hospital level, et al. Therefore, hospital should establish a knowledge sharing platform, which will help to spread the advantages and disadvantages of various methods used in verifying the nasogastric tube placement, and then to strengthen the cognition with different people. Furthermore, based on potential influencing factors, it is necessary to further explore new bedside effective method of verifying the nasogastric tube placement and seek the best practice to validate the method of blind intubation of nasogastric tube. Key words: Nurses; Nasogastric tube; Intubation

Critical care nurses' knowledge and practice of delirium assessment.

The aim of this study was to examine perceived barriers to assessment of delirium for critical care nurses, and the impact of education on their knowledge and practice. Delirium is a significant problem in critical care, leading to increased morbidity and mortality. Many authors have found variations in assessment by critical care nurses, but there has been limited analysis of the reasons for this. Education on the topic improves knowledge and practice, but the best approach has not been examined. A questionnaire survey design. A self-reported questionnaire was distributed to critical care nurses (n=31) at a district general hospital. Data were analysed with descriptive statistics. Knowledge and practice were variable, but correlation was seen between nursing band and years of experience with better scores. Any type of education led to significantly improved scores. Several barriers to assessment were found, with the most common being lack of knowledge and difficulty in assessing intubated patients. It is essential to improve practice in delirium assessment and management. Education is vital to improve the knowledge and practice of critical care nurses regarding delirium.

Knowledge and practices of critical care nurses regarding palliative care of cancer patients and suggestion for nursing guidelines booklet

Palliative care is care for patients with serious illness that focuses on relieving suffering and improving quality of life for patients and their families. Aim of the study: assess knowledge and practices of critical care nurses regarding palliative care of cancer patients, and suggest nursing guidelines booklet about palliative care for cancer patients. Sample: The study subjects consist of all available nursing staff (60) at medical intensive care unit (30), surgical intensive care (30) unit. Research design: Descriptive exploratory research design was used to conduct this study. Tools: Two tools were included nurses' structured interview sheet, and nurse observational checklist sheet. Results: the majority of studied nurses (97%) had unsatisfactory knowledge scores regarding palliative care with Mean+SD 21 + 3.2., more than half of studied nurses (63.3%) had unsatisfactory level of practice regarding palliative care with Mean+SD 19.8 + 2.7., there were no statistically significant relation between practices and knowledge. Conclusion: The majority of studied nurses (97%) had unsatisfactory knowledge, as well more than half (63%) of studied nurses had unsatisfactory level of practices regarding palliative care of patients with cancer Recommendations: Enrichment of all nurses about knowledge and practices related to palliative care will be helpful to achieve quality of life, and reading nursing guidelines booklet.

The Obstacles Perceived by Critical Care Nurses in Performing Endotracheal Suctioning

A descriptive exploratory study to identify the performance obstacles perceived by critical care nurses in performing end tracheal suctioning was conducted in eight intensive care units of AIMS, Kochi. Objectives : The objectives of the study were to; (1) Identify the performance obstacles perceived by critical care nurses while performing ET suctioning (2) Find out the opinion of critical care nurses on overcoming the performance obstacles identified in ET suctioning (3) Prepare a strategy to improve the practices of critical care nurses on ET suctioning. Research methodology : The design used for the study was exploratory descriptive design with non-probability convenience sampling technique (N=50). Results : The performance obstacles during suctioning as perceived by nurses were; difficult procedure without assistance (84%), restless patient (84%), distractions (52%), inadequate training either during student period (78%) or as a staff nurse (46%) or before practicing in the unit (62%) and unaware of research finding on ET suctioning (76%). All of them suggested the need for; training at the beginning of clinical posting in the unit, clear cut guideline/protocol on ET suctioning and updating of guideline/equipment. Conclusion : The performance obstacles were categorized into knowledge, skill, technology and tool and organization and were rated by the nurses as minimum , medium and many. The performance obstacles perceived by nurses were mostly related to skill in ET suctioning. The major knowledge related performance obstacles perceived by nurses' was inadequate training on ET suctioning in a real patient as a student (78%). Training on ET suctioning should be given in the beginning of clinical posting in critical care unit.

Intravenous fluid bolus therapy: a bi-national survey of critical care nurses' self-reported practice.

Knowledge of critical care nurses' intravenous fluid bolus therapy (FBT) practice remains underexplored. Using a multi-choice online survey conducted between September and October 2014, we sought to describe the self-reported practice of critical care nurses located in Australia and New Zealand. Two hundred and ninety-five critical care nurses responded to the survey with most practising in adult ICUs. Overall, 0.9% saline solution was the preferred solution for FBT. However, more Australian than New Zealand respondents preferred 'albumin 4%' (31% versus 3.6%, P <0.01) for FBT. In contrast, more New Zealand respondents preferred 'Plasma-Lyte®' (33.3% versus 6.4%, P <0.01). Half of the respondents defined FBT as 250 ml administered as quickly as possible. However, FBT volumes ranged from 100 ml to >1000 ml and administration duration from as quickly as possible to 60 minutes. In response to FBT, almost half of the respondents expected an increase in mean arterial pressure of between 11 to 20 mmHg. Similarly, >40% expected a central venous pressure increase >3 mmHg, >70% expected a urinary output increase of 0.5 to 1.0 ml/kg/hr, and >60% expected a decrease in heart rate of >11 /min. Overall, 0.9% saline remains the most common solution for FBT, but there are significant national differences in the preference for albumin and Plasma-Lyte. A volume of 250 ml defines a fluid bolus, with a range from 100 ml to >1000 ml, and speed of delivery from stat to 60 minutes. Most nurses expect substantial physiological effects with FBT.

End-of-life care practices of critical care nurses: A national cross-sectional survey

BackgroundThe critical care context presents important opportunities for nurses to deliver skilled, comprehensive care to patients at the end of life and their families. Limited research has identified the actual end-of-life care practices of critical care nurses. ObjectiveTo identify the end-of-life care practices of critical care nurses. DesignA national cross-sectional online survey. MethodsThe survey was distributed to members of an Australian critical care nursing association and 392 critical care nurses (response rate 25%) completed the survey. Exploratory factor analysis using principal axis factoring with oblique rotation was undertaken on survey responses to identify the domains of end-of-life care practice. Descriptive statistics were calculated for individual survey items. ResultsExploratory factor analysis identified six domains of end-of-life care practice: information sharing, environmental modification, emotional support, patient and family centred decision-making, symptom management and spiritual support. Descriptive statistics identified a high level of engagement in information sharing and environmental modification practices and less frequent engagement in items from the emotional support and symptom management practice areas. ConclusionsThe findings of this study identified domains of end-of-life care practice, and critical care nurse engagement in these practices. The findings highlight future training and practice development opportunities, including the need for experiential learning targeting the emotional support practice domain. Further research is needed to enhance knowledge of symptom management practices during the provision of end-of-life care to inform and improve practice in this area.

Effect of an Educational Program on Nurses’Knowledge and Practice Regarding management of Diabetic Crisis in the Emergency Medical Unit at Assiut University Hospital.

Abstract Diabetic crisis is life threatening complications of Diabetes mellitus . The nurse plays a vital role in the efforts to resuscitate these types of patients., the nursing staff are in need for continuous education. the Aim of the present study was to evaluate the effect of implementing an educational program on knowledge and practice of critical care nurses regarding diabetic crisis .Method A convenient sample of all nurses working in the Emergency Medical Unit at Assuit university hospital .A structured interview questionnaire sheet and observational check list tools used to collect the data .Results the present study revealed that total scores of the nurses’ knowledge and practice were improved from a pre-program level of (18.060±3.76)for knowledge and( 20.08±0.34)for practice to an immediate post of (49.766±2.99)for knowledge and (44.7±0.05)for practice. However the mean scores of total knowledge and practice have decline in the follow up phase ,it still statically significant higher than the pre –program level Conclusion The educational program for nurses was significantly upgrading their knowledge and practice concerning diabetic crisis . Recommendation -Orientation program should be utilized for newly graduated nurses. Nurses in these types of units should upgrading their knowledge and practice through frequent attending seminars, and conferences.

Turkish critical care nurses' views on end-of-life decision making and practices.

Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. This was a cross-sectional study. The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.