Intensive Care Unit Professionals Research Articles

Avaliação da qualidade de vida dos profissionais de enfermagem em Unidade de Terapia Intensiva Adulto

O presente estudo objetivou conhecer a qualidade de vida dos profissionais de enfermagem de Unidades de Terapia Intensiva Adulto. Trata-se de uma pesquisa de cunho exploratório e descritiva de natureza quantitativa, que foi realizada com profissionais de enfermagem atuantes em Unidades de Terapia Intensiva da região Centro-oeste do estado do Rio Grande do Sul. A coleta de dados foi realizada por meio do instrumento que mensura a qualidade de vida, denominado Whoqol-bref. Dentre os resultados deste estudo, destaca-se que dos quatro domínios avaliados, todos obtiveram resultados regulares, juntamente com as facetas de número um e dois, que foram avaliadas separadamente. A importância da investigação da qualidade de vida do profissional da saúde, em especial, da equipe de enfermagem, se deve ao fato de que a mesma pode contribuir para minimização de riscos inerentes ao contexto da terapia intensiva reduzindo problemas de saúde física e mental que possam vir a prejudicar o estilo de vida do indivíduo. Conclui-se que os profissionais de enfermagem, tanto enfermeiros, quanto técnicos de enfermagem que participaram da pesquisa apresentaram uma qualidade de vida regular, achado que corrobora com estudos já encontrados na literatura.

Development and Evaluation of a Tele-Education Program for Neonatal ICU Nurses in Armenia

PurposeNeonatal mortality currently accounts for more than 60% of all infant mortality in Armenia. The majority of health professionals in Neonatal Intensive Care Units (NICU) however, have had no specialized training in neonatology. Local and global agencies have emphasized the need for improvement in the education and skills of NICU health professionals. The objective of this study was to design, implement, and evaluate an innovative tele-education program for NICU nurses in Armenia. Design and methodsSeven online tele-education courses were designed on various neonatal nursing topics using Final Cut Pro and translated professionally to Armenian. The videos were uploaded to YouTube. All NICU nurses employed in two hospitals (n = 35) in Yerevan, Armenia, completed a diagnostic pretest, course viewing, a posttest, and a satisfaction survey for each topic. A difference in knowledge was defined as the number of correct test answers obtained before and after the course. Participant satisfaction was measured using a Likert scale. ResultsThe combined average for completed pre-tests for all courses was 45% and 71% for post-tests, which was statistically significant for each course (p < 0.05). A majority of the nurses either agreed or strongly agreed with all of the satisfaction parameters of the course. ConclusionsThese results support a tele-education model for effectively providing continuing education to NICU nurses in Armenia. A similar platform could be used to establish nationwide certification programs for neonatal nurses. Practice implicationsTele-education technology can be used effectively by nursing educators working in global health as part of international learning collaboratives.

Grupos de discusión como abordaje para valorar conocimiento, actitudes y prácticas de higiene de manos en profesionales de la unidad de cuidados intensivos de adultos de un hospital de referencia

ObjectivesThe adherence to hand hygiene practices among the adult Intensive Care Unit (ICU) professionals in this hospital has not improved substantially in the last years, regardless of the theoretical training sessions conducted. A study was made of the knowledge, attitudes, and practices of the ICU personnel in this field. MethodsSeveral small discussion groups with ICU staff organised by preventive medicine professionals were scheduled in March 2018. Semi-structured questions on hand hygiene and use of gloves were included. The points discussed were listed into strengths and weaknesses. Knowledge was then assessed using an anonymous questionnaire, after the sessions. ResultsThirteen 60-minute sessions were carried out with 157 participants from all professional categories (82% from ICU, median=11 participants / session). The majority perceived hand hygiene as a priority issue of personal responsibility for patient safety. They identified factors that limit their ability to improve their adherence. Certain habits have more to do with personal preferences than with theoretical knowledge or technical indications. ConclusionsThe discussion groups have helped to make a diagnosis of the situation that will be useful to strengthen those areas of improvement that have been identified. If we aim for a cultural change, and eliminate incorrect habits, it seems more useful to carry out adequate continuing education as part of the daily routine of professionals.

Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation

ObjectiveWe aimed to explore: the exposure of healthcare workers to a delirium guidelines implementation programme; effects on guideline adherence at intensive care unit (ICU) level; impact on knowledge and barriers,...

The Moderator Role of Passion for Work in the Association between Work Stressors and Secondary Traumatic Stress: A Cross-Level Diary Study among Health Professionals of Intensive Care Units.

Secondary traumatic stress (STS), a construct formed by compassion fatigue, shattered assumptions, and symptomatology, has been scarcely studied in intensive care units (ICU). In these units, healthcare workers encounter daily work stressors which impact on their health and well-being. Also, previous literature revealed a passion for caring among these workers, finding two types: harmonious passion, which may protect them against negative outcomes, and obsessive passion, which may boost negative consequences. We aim to study whether both types of passion could moderate the relationships between daily work stressors and STS. In all, 265 assessments were collected at ICUs from different hospitals in Spain through a diary approach (53 health workers×5days at two time points per day). First, daily work stressors were positive predictors of symptomatology; secondly, dispositional harmonious passion was a negative predictor of both compassion fatigue and shattered assumptions, also presenting a buffering effect between daily work stressors and daily shattered assumptions. Finally, dispositional obsessive passion showed positive relationships with both shattered assumptions and symptomatology, also presenting a boosting effect between daily work stressors and daily symptomatology. This study allows us to deepen our understanding of STS in ICUs and to boost preventive proposals. Practical implications are discussed.

Algorithm for the classification of COVID-19 rashes

Up to 20% of patients with coronavirus disease 2019 develop cutaneous manifestations such as erythematous rash, rash with petechiae, vesicular rash, acral ischemia, livedo reticularis, and widespread urticaria.1,2 The appropriate classification of these manifestations, crucial for accurate scientific research, depends on physical examination and cannot be correctly assessed with teledermatology. To make classification easier, our suggestion is a simple algorithm that can be easily performed by patients, general practitioners, and intensive care unit professionals on the front lines who are confronting coronavirus disease 2019 and not used to dermatologic examination (Fig 1).

Nursing Workload, Knowledge about Pain, and Their Relation to Pain Records

PurposeTo study the relationship between frequency of pain assessment and nursing workload, and also to analyze the frequency of pain assessment and its relation to knowledge and attitudes toward pain on nursing professionals in intensive care unit. MethodsAn ambispective study was conducted in a Spanish tertiary-level intensive care unit between October 2017 and April 2018. For measurement of workload, the Nursing Activities Score scale was used, and for measurement of pain knowledge, the Knowledge and Attitudes Survey Regarding Pain was used. ResultsThere were 1,207 measurements among 41 nurses and 1,838 among 317 patients. The average nursing workload was high (70.97 points). We found statistically significant positive association between nursing workload and the frequency of assessment (p < .001), as well as frequency of assessment and patients with communicative capacity (p = .008). ConclusionsNursing workload affects the registration and assessment of patients’ pain, resulting in a greater number of records as the workload performed by nurses increases. It is necessary to study in greater depth how the severity of pain, gender of the patients, and workload of nurses influence pain registration and assessment.

Effect of preoperative education and ICU tour on patient and family satisfaction and anxiety in the intensive care unit after elective cardiac surgery: a randomised controlled trial

BackgroundPreoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care...

Factors Associated with Burnout Syndrome Among Intensive Care Unit Professionals

Objective: Burnout syndrome (BS) is characterized by emotional exhaustion (EE), depersonalization (DEP) and reduced personal accomplishment (PA). Maslach Burnout Inventory (MBI) is a questionairre based on 22 questions to determine these three dimensions, seperately. In this study, our aim was to evaluate the prevelance and risk factors of BS in intensive care unit (ICU) employees by using MBI.Material and Methods: A survey involving demographical data, working years, level of ICU and profession, and MBI was applied to the ICU personnel. A total of 115 employees attended to the study.Results: When MBI results of 115 participants were evaluated, it was determined that 68.7% had high level of MBI-EE, 62.6% had high level of MBI-PAand 38.3% had moderate level of MBI-DEP. When subgroups were evaluated those with male gender, over 40 years of age, working in level 2 ICU, over 20 years of working year were found to be more vulnerable to experience BS. When professions were considered, physicians were found to be more prone to BS than nurses. Conclusion: Older and experienced professionals working in level 2 ICU are under risk of BS. Physicians were determined to be under more risk of BS when compared to nurses.

Parental experience of hope in pediatric palliative care: Critical reflections on an exemplar of parents of a child with trisomy 18.

The purpose of this study is to analyze the experience of hope that appears in a parent's blog presenting everyday life while caring for a child with Trisomy 18 (Edwards syndrome). The author, Rebekah Peterson, began her blog on 17 March 2011 and continues to post information on her son Aaron's care. The analysis of hope in the blog is carried out using a mixed methodology: initial and focused coding using Charmaz's constructed grounded theory and elements of Colaizzi's method. Each aspect of hope is coded through the blog author's statements, from which three main aspects of hope emerge: hope for the longest possible presence of Aaron with his family, hope for control over situations, pain, and symptoms, and existential facets of hope. These various aspects reveal to what extent the experience of hope is unique. Additionally, analyzing the experience of parental hope uncovers the additional problem of inappropriate communication by health care professionals (HCPs) in intensive care units, particularly when discussing the termination of causal treatment. The problem may be solved through proper education for HCPs and serious consideration of parental involvement in order to properly elaborate guidelines on this issue. The three main aspects of parental hope discussed in this paper might expand knowledge on the issue, helping HCPs to better understand the parents' experience of care and to help sustain parental hope in pediatric palliative care.

Burnout syndrome among healthcare professionals in intensive care units: a cross-sectional population-based study.

ObjectiveTo assess the prevalence of and factors associated with Burnout syndrome among intensive care unit professionals.MethodsIn this cross-sectional population-based study, a questionnaire assessing sociodemographic, behavioral, and occupational data was administered to 241 nurses and physicians working in 17 public intensive care units in São Luis (MA), Brazil. The Maslach Burnout Inventory - Human Services Survey was used to identify Burnout syndrome based on Maslach’s and Grunfeld’s criteria. The prevalence of each dimension of the syndrome was estimated with a 95% confidence interval. Associations were estimated by the odds ratios via multiple logistic regression analyses (α = 5%).ResultsThe prevalence of Burnout syndrome was 0.41% (0.01 - 2.29) according to Maslach’s criteria and 36.9% (30.82 - 43.36) according to Grunfeld’s criteria. Infant intensive care unit professionals were more likely to develop emotional exhaustion than other intensive care professionals (OR = 3.16). Respondents over the age of 35 were less likely to develop emotional exhaustion (OR = 0.32) and depersonalization (OR = 0.06). Longer working hours in intensive care units were associated with a reduced sense of personal accomplishment (OR = 1.13). Among nurses, males had a lower sense of professional accomplishment, and not exercising regularly was associated with more emotional exhaustion and less depersonalization. Among physicians, working in infant and cardiology intensive care units made them less likely to have a reduced sense of personal accomplishment, and physicians without a postgraduate degree who worked in intensive care units had a higher chance of having a lower sense of personal accomplishment.ConclusionThis study demonstrated the low prevalence of Burnout syndrome. Most of the professionals reported low levels for each dimension of Burnout, including low levels of emotional exhaustion, low levels of depersonalization, and a lower likelihood of having a reduced sense of personal accomplishment. Nurses and physicians have different characteristics associated with Burnout syndrome.

Central Venous Catheter bundle: professional knowledge and behavior in adult Intensive Care Units.

To evaluate knowledge and behavior of professionals in Intensive Care Units regarding the actions recommended in the bundle on preventing central venous catheter-related bloodstream infection. Cross-sectional descriptive quantitative study, conducted in three Intensive Care Units. The data were collected through a face-to-face questionnaire applied to health professionals. The software R 3.3.1 was used for data analysis. Two-hundred and ninety-two professionals participated. Regarding knowledge, the hand hygiene item presented a higher level both for the insertion (92.46%) and maintenance (97.27%) moments. Usage of chlorhexidine as an antiseptic, followed by alcohol (47.94%) and providing a date for hub or connectors (19.87%) were the least known items. As for behavior, the professionals reported: using always the correct attire for catheter insertion (84.25%), never waiting for the antiseptic to dry before catheter insertion (25.34%) and never cleaning hub or connectors with 70% alcohol (23.86%). Results show that the professionals' knowledge and behavior regarding the central venous catheter bundle present deficiencies, revealing the importance of promoting training programs for this knowledge domain.

Interprofessional relationships of a patient assistance team in critical care.

to identify perceptions of teamwork according to the professionals of an Adult Intensive Care Unit. descriptive research with qualitative approach. The methodological framework was thematic content analysis. The theoretical framework of the work process was used to guide the interpretation of the data. Data collection: A semi-structured interview was conducted with 38 professionals in a public teaching hospital in the state of Minas Gerais. Results: three thematic categories emerged from the interviews: Work Organization, which is related to work performed through tasks/routines, with or without coordinated actions; Non-material Work Instruments, which reveal that teamwork is based on communication/collaboration; Insufficient Material Resources, which indicate that lack of material creates conflicts between professionals. Teamwork requires effective communication and collaboration, integrated work and appropriate professional training. On the other hand, fragmentation and rigidity at work, poor collaboration/communication and lack of material make teamwork difficult. We emphasize the need to revise the curriculum of health courses, with a view to including and/or improving discussions about teamwork in order to train professionals for a more integrated and perhaps even sympathetic health practice.

Cumplimiento de las normas de bioseguridad. Unidad de Cuidados Intensivos. Hospital Luis Vernaza, 2019

Las normas de bioseguridad son lineamientos operativos que se aplican en las instituciones de salud con el objetivo de prevenir accidentes laborales y disminuir el riesgo de infecciones cruzadas. Se realizó una investigación descriptiva, transversal, con enfoque mixto, en la que se trabajó con la totalidad de la población (93 profesionales de la Unidad de Cuidados Intensivos del Hospital Luis Vernaza). Se utilizaron métodos teóricos, empíricos y estadísticos, los que guiaron los pasos del proceso de investigación. Como técnica para la recolección de los datos se empleó un cuestionario dirigido a identificar el cumplimiento de las normas de bioseguridad por parte de los profesionales de la salud del contexto de estudio, conformado por preguntas abiertas y cerradas, el que fue diseñado por el investigador y validado durante el proceso investigativo utilizando el método cuali-cuantitativo de Validación de Contenido y de Constructo y de la Confiabilidad mediante la determinación del Coeficiente Alfa de Cronbach (α = 1). Los integrantes de la población de estudio comparten similares características sociodemográficas que favorecen el incumplimiento de las normas de bioseguridad, siendo la falta de capacitación, la sobre carga asistencial y la baja experiencia de trabajo en UCI considerados como factores conducentes a esa problemática. Se observó desconocimiento de esta normativa, lo que causa insuficiente uso de equipos de protección personal y manejo inadecuado de desechos corto-punzantes. La insuficiente disponibilidad de insumos se asocia de forma negativa a estos resultados.

Meaning and comfort factors in the paediatric intensive care unit from an adult perspective: a descriptive phenomenological study

To explore the meaning of comfort and know the factors that contribute to it from the point of view of the young adults who received care in a paediatric intensive care unit, the family of the patient and the interdisciplinary team attending the patient. A total of 30 people were invited to participate in the focus groups; 24 did so. Thematic analysis yielded the following common categories: meaning of comfort, environmental factors in paediatric intensive care unit, family accompaniment during paediatric intensive care unit stay, management of information in the paediatric intensive care unit and, finally, the intimacy and privacy of the critically ill paediatric patient and their family. Paediatric intensive care unit professionals need to consider not only the environmental input that may lead to discomfort but also aspects such as continuous family accompaniment, the sharing of complete information with the family and the promoting of privacy.

Single-Bed or Multibed Room Designs Influence ICU Staff Stress and Family Satisfaction, But Do Not Influence ICU Staff Burnout.

To compare the impact of single-bed versus multibed room intensive care units (ICU) architectural designs on the stress and burnout of ICU staff and on the stress and satisfaction of family visitors. There are countless architectural variations among ICUs, but all involve single-bed or multibed rooms. Although it is well known that ICU design affects important patient outcomes, the effect of ICU design on family and staff has been insufficiently studied. Among ICU staff and family visitors, stress was evaluated with Lipp's Inventory of Stress Symptoms. ICU staff burnout was evaluated with the Maslach Burnout Inventory. Family visitor satisfaction was evaluated with Molter's Critical Care Family Needs Inventory. Among 156 ICU professionals who were interviewed, similar burnout rates were observed between ICU staff who worked single-bed versus multibed rooms. However, stress reported by ICU staff within the previous 24 hr was higher among the ICU staff who worked in single-bed rooms (14.3% vs. 4.7%, p = .04). Among 176 family visitors who were interviewed, a similar level of stress was reported by family members who visited patients in single-bed or multibed rooms. However, the satisfaction of family members visiting patients in single-bed rooms was higher (96.0% vs. 84.6%, p = .02). Single-bed ICU design was associated with greater satisfaction of family visitors yet with higher levels of stress for ICU staff. Meanwhile, similar burnout levels were observed for ICU staff who worked in single-bed or multibed rooms.

INSERTION OF THE FATHER IN THE CARE OF THE HOSPITALIZED PRETERM INFANT: PERCEPTION OF THE MULTIPROFESSIONAL TEAM.

ABSTRACTObjective: To understand the perception of the multiprofessional health care team regarding the inclusion of fathers in the care of preterm infants who are in Intensive Care Units (ICUs).Methods: This is a descriptive study with a qualitative approach, using a semi-structured interview with 12 health care professionals of a neonatal ICU, from February to July 2017. The data were analyzed according to the Discourse of the Collective Subject.Results: Seven main ideas (MI) emerged from the text analysis, which were grouped into two themes: 1) the role of the father according to the multiprofessional health care team views (MI1: parent provider, MI2: shared care, MI3: supportive father); 2) perception of the father caring for the hospitalized preterm infant (MI4: father does not change diapers; MI5: father conquering new spaces; MI6: strengthening the bonding; MI7: father providing maternal security.Conclusions: The results of this study point out to the importance of including the father figure in the humanized care of preterm infants. Professional health care team should be more aware of fathers’ importance in the care of hospitalized preterm infants.

An international survey of the nutrition management of chylothorax: a time for change.

Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research. A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration. In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians' preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001). This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.

Importance of stabilization of the neonatal transport network in critically ill neonates.

ObjectiveThis study aimed to investigate how to stabilize the condition of critically ill neonates within the neonatal transport network.MethodsA total of 243 critically ill newborns in four hospitals involved in the transport network were enrolled. The newborns were divided into the research and control groups. In the research group, medical staff underwent theoretical training, and neonatal intensive care unit (NICU) professionals participated and provided on-site guidance on delivery of high-risk infants. Delivery of high-risk neonates in the control group was conventionally managed in local hospitals, and neonates were transferred after a phone call to the NICU.ResultsGestational age and body weight were lower, and dexamethasone use was higher in the research group than in the control group. The proportions of neonates who underwent mask pressure, endotracheal intubation, pulmonary surfactant application, and chest compressions were higher, and those with dyspnea and nervous system abnormalities were lower in the research group than in the control group. Blood gas and sugar levels were better in the research group than in the control group.ConclusionStrengthening professional training and participation of professional NICU staff in childbirth can improve the conditions of high-risk neonates and increase safety of their transportation.

Understanding of Brain Death Among Health-Care Professionals at a Transplant Center.

There is considerable variation in brain death understanding and policies between medical institutions, however, studies have not yet compared different health-care professionals working in the same hospital. The overall aim of this study was to evaluate understanding of brain death among health-care professionals within intensive care units (ICUs) at a single institution. Study participants included 217 attending physicians, residents, nurses, medical students, and other ICU team members in 6 ICUs. Participants completed a 21-question survey pertaining to knowledge of brain death and related institutional policies as well as opinions about brain death. We found a wide range of brain death understanding among health-care professionals in ICUs. Attending physicians have the greatest understanding (94.7%), followed by nurses (72.4%). In contrast, approximately half of the students and residents do not have a basic understanding of brain death. Brain death understanding was correlated to health-care role, years of experience, and whether the participant had formal training in brain death. Although most participants had been involved in cases of brain death, a much smaller number had received formal training on death by neurological criteria. The present study observed a paucity of clinical training in brain death among health-care professionals in the study ICUs. There is an opportunity for improved clinical education on brain death that could improve communication with families about brain death and potentially increase the number of organs transplanted.