Sample Of Critical Care Nurses Research Articles

A National Survey of Stress and Burnout in Critical Care Nurses: A Prepandemic Study.

Critical care nurses (CCNs) experience a higher level of stress and burnout than nurses in other specialties. Approximately 50% of CCNs are mildly stressed, and almost 20% are moderately stressed. Prolonged periods of stress can lead to burnout, which has been shown to have deleterious effects on quality and patient safety. The purpose of this study is to determine the prevalence of burnout among a national sample of CCNs and the association with environmental factors. A national survey of CCNs working in the United States was implemented using an exploratory descriptive design. The anonymous survey was developed iteratively according to best practices of survey design. The survey included the Perceived Stress Scale and the Copenhagen Burnout Inventory tool. Pretesting and pilot testing were conducted with CCN specialists, and the survey was revised based on their feedback. An anonymous link was distributed to respondents using convenience sampling through social media and further disseminated via snowball sampling. Two hundred seventy nurses responded to the survey. The mean (SD) Perceived Stress Scale score in the study population was 18.5 (6.4), indicating moderate stress. The mean (SD) Copenhagen Burnout Inventory score was 61.9 (16.5), indicating moderate burnout. Our study found that the overall health of the work environment was one of the most important factors associated with both stress and burnout. This study has demonstrated the relationship between the health of the work environment and burnout among CCNs. It is imperative that health care organizations evaluate and implement strategies to optimize the health of the work environment to mitigate burnout and its negative sequelae on the nurse, patient, and system.

Examining the Rates of Anxiety, Depression, and Burnout Among Providers at a Regional Burn Center.

Burnout, defined by feelings of inefficacy, cynicism, and emotional exhaustion, affects the performance and well-being of health care providers. Burn care exposes providers to factors known to cause or worsen burnout, but no research has presented prevalence rates of burnout in this population. We estimate the rates of anxiety, depression, and burnout among nonphysician providers in a regional burn center and compare those rates to a reference population of critical care nurses. In our sample of 22 providers, 64% screened positive for anxiety; 32% for depression; 82% for emotional exhaustion; 18% for personal achievement burnout; and 54% for depersonalization. When compared with a national sample of critical care nurses, burn center providers demonstrated a significantly higher rate of anxiety (risk difference [RD]: 0.453, 95% confidence interval [CI] [0.244, 0.622]), a significantly higher rate of emotional exhaustion (RD: 0.207, 95% CI [0.001, 0.323]), and a significantly lower rate of personal achievement burnout (RD: -0.325, 95% CI [-0.442, -0.119]). These findings constitute the first evidence that many burn care providers meet criteria for burnout and that burnout in burn care providers may qualitatively differ from burnout in other critical care providers. Future research should identify burn care-specific predictors of burnout and determine the feasibility and efficacy of interventions to prevent and reduce burnout in burn care providers.

Evidence-Based Review and Discussion Points

Evidence-Based Review and Discussion Points

Infection Control Measures for Patient with Central Line: Nurses' Performance

Background: Central venous catheters (CVCs) are vascular infusion tools utilized for studying hemodynamic variables, dialysis, administration of medication, and nutrition. Catheter related blood stream infection (CRBSI) is a complication of central venous catheter (CVC) use. Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). Aim of the study: to assess nurses’ performance regarding infection control measures for patient with central line in critical care unit. Research design: A descriptive exploratory design was utilized. Subjects: Purposive sample of critical care nurses working in the ICU, at El-Fayoum University Hospital, 40 nurses from both genders, with different ages, educational levels and years of experience were selected for this study. Tool: Data were obtained through three main tools; Nurses' Self-administered questionnaire, Nurses' observational checklist and Nurses' attitudes questionnaire tool. Results: this study revealed that about more than two thirds of studied nurses had unsatisfactory knowledge and practice regarding infection control measures related to central line. Also, about (77.5%) of them had negative attitude regarding infection control measures for patient with central line. There were statistically significance correlation between nurses' level of knowledge, practice and their attitude .there were statistical significant relations between nurses' performance and their socio-demographic characteristics as regards age, education and experience Conclusion: Nurses had unsatisfactory level of knowledge, practice and negative attitude regarding infection control measures related to central line. Knowledge, practice &attitude were found to differ significantly in relation to socio-demographic data. Recommendation: Designing nurses’ infection control program to improve their knowledge and practice regarding infection control measures related to central line. The study should be replicated on large sample & in different hospitals setting in order to generalize the results.

Critical care nurses’ knowledge of alarm fatigue and practices towards alarms: A multicentre study

ObjectivesTo determine critical care nurses’ knowledge of alarm fatigue and practices toward alarms in critical care settings. Research methodology/designA cross-sectional survey using an adaptation of The Health Technology Foundation Clinical Alarms Survey. SettingA sample of critical care nurses (n = 250) from 10 departments across six hospitals in Ireland. ResultsA response rate of 66% (n = 166) was achieved. All hospital sites reported patient adverse events related to clinical alarms. The majority of nurses (52%, n = 86) did not know or were unsure, how to prevent alarm fatigue. Most nurses (90%, n = 148) agreed that non-actionable alarms occurred frequently, disrupted patient care (91%, n = 145) and reduced trust in alarms prompting nurses to sometimes disable alarms (81%, n = 132). Nurses claiming to know how to prevent alarm fatigue stated they customised patient alarm parameters frequently (p = 0.037). Frequent false alarms causing reduced attention or response to alarms ranked the number one obstacle to effective alarm management; this was followed by inadequate staff to respond to alarms. Only 31% (n = 50) believed that alarm management policies and procedures were used effectively. ConclusionAlarm fatigue has the potential for serious consequences for patient safety and answering numerous alarms drains nursing resources.

Predictors of Moral Distress in a US Sample of Critical Care Nurses.

Moral distress in registered nurses causes decreased job satisfaction, turnover in staffing, burnout, and heightened states of psychological distress. To date, investigation of modifiable factors, such as perceptions of the practice environment and patient safety, among a diverse sample of critical care nurses has been limited. To explore the relationships among the severity of moral distress, the practice environment, and patient safety in a national sample of critical care nurses. Critical care nurses experienced in working with adults (> 1 year of intensive care unit experience) and who were subscribers to the American Association of Critical-Care Nurses' e-mail listserv and social media sites anonymously participated in this descriptive study. Participants completed a demographic questionnaire, the Moral Distress Scale-Revised, and the Practice Environment Scale of the Nursing Work Index. Descriptive statistics, bivariate correlation coefficients, and a hierarchical regression analysis were used to describe the sample characteristics and to assess relationships among the study variables. Of a national sample of 328 critical care nurses, 56% had less than 20 years of experience as a registered nurse. Moral distress was modestly associated with negative perceptions of the practice environment and patient safety. Job satisfaction, practice environment, and the participant's age were statistically significant predictors of moral distress in this sample. Modifications of organizational factors such as the development of healthy work environments that promote collegial relationships could reduce moral distress among critical care nurses.

Nursing Practices and Policies Related to Family Presence During Resuscitation.

Despite its shown benefits, family presence during resuscitation (FPDR) is a controversial topic among critical care nurses and is not routinely implemented. The objective of this study was to describe FPDR practices among critical care nurses, as well as the prevalence of FPDR policies and education. The study used a descriptive survey design. Data were collected from a convenience sample of critical care nurses obtained at a national level. A 25-item demographic and professional attribute survey was administered to all participants. There were 124 critical care nurses who participated. Results indicated critical care nurses have vast resuscitative care experience; however, FPDR is not a routine component. In the past year, 23% (n = 29) had never experienced FPDR, and only 17% (n = 21) had experienced it more than 5 times. Furthermore, 48% (n = 59) had never invited FPDR, and 45% (n = 56) had invited it only 1 to 5 times. A lack of FPDR policy was noted, with 73% (n = 91) indicating their facility or unit did not have a policy or they were unsure if one existed. Only 38% (n = 47) had ever received education on FPDR. Despite the shown benefits of FPDR, it is not a routine component of resuscitation in critical care settings. Nurse managers and educators should focus on policy creation and education to help guide nurses at the bedside. The impact of policy and education on critical care nurses' support for and implementation of FPDR requires further study.

EXPLORING AWARENESS ON EVIDENCE-BASED PRACTICE AND RESEARCH UTILISATION IN CRITICAL CARE NURSES IN SELECTED HOSPITALS IN THE ETHEKWINI DISTRICT KWAZULU-NATAL

In the critical care context, the complexity of patients’ conditions necessitates an evidence based approach to care that involves critical appraisal of available research and an amalgamation of research findings with clinical expertise and patient preferences to provide best care practices. Despite the rapid growth in research on best care practices in the critical care setting, the translation of these findings into practice has been slow. For an EBP culture to prevail in critical care areas, critical care nurses need to champion this practice and challenge traditional practices. This article explores the awareness of critical care nurses (CCNs) regarding evidence-based practice (EBP) and research utilisation in selected hospitals in the Ethekwini district in KwaZulu-Natal. A quantitative exploratory study design was used. A questionnaire, which included structured and open-ended questions, was used to collect data from a convenient clustered sample of CCNs from one tertiary public hospital and one private hospital. Of the 80 CCNs, 78.7% were familiar with the term EBP and 21.3% were unfamiliar with the term. The majority, 63%, of the CCNs responded positively regarding the importance of EBP. However they acknowledged many barriers, both personal and organisational, towards research utilisation. For a culture of EBP to prevail within critical care settings, hospital management must be committed to this initiative by providing all nurses with opportunities for training and incentives to nurses who are involved in EBP activities and research utilisation.

Factors Influencing Critical Care Nurses' Perception of Their Overall Job Satisfaction: An Empirical Study.

The aim of this study was to explore the factors influencing critical care nurses’ perception of their overall job satisfaction. Nurses’ job satisfaction is a key issue to consider in the retention of critical care nurses. Shortages of nurses result in unsafe patient care, increased expense, and increased stress levels among other nurses. The Leadership Practices Inventory was used among a sample of critical care nurses to measure perceived leadership practices, the Organizational Commitment Questionnaire measured nurses commitment, and the Job in General scale was used to measure nurses’ overall job satisfaction. Four different hypotheses were tested using bivariate and multivariate statistical analytical techniques. Statistically significant relationships were found among the following hypotheses: (a) perceived leadership and job satisfaction; (b) organizational commitment and job satisfaction; and (c) perceived leadership practices, organizational commitment, and job satisfaction. No significant relationships were found among critical care nurses’ demographic variables and job satisfaction. Organizational commitment was the strongest predictor of job satisfaction. Encourage the heart (B = 0.116, P = .035) and organizational commitment (B = 0.353, P = .000) were found to be significantly associated with job satisfaction. These findings have implications for nurse educators, preceptors, administrators, recruiters, and managers in promoting satisfaction.

Factors influencing the provision of end-of-life care in critical care settings: development and testing of a survey instrument.

To develop and psychometrically test a survey instrument to identify the factors influencing the provision of end-of-life care by critical care nurses. Following a decision to withdraw life-sustaining treatment, critical care nurses remain with the patient and their family providing end-of-life care. Identification of factors influencing the provision of this care can give evidence to inform practice development and support nurses. A cross-sectional survey of critical care nurses. An online survey was developed, reviewed by an expert panel and pilot tested to obtain preliminary evidence of its reliability and validity. In May 2011, a convenience sample of critical care nurses (n = 392, response rate 25%) completed the survey. The analytical approach to data obtained from the 58 items measured on a Likert scale included exploratory factor analysis and descriptive statistics. Exploratory factor analysis identified eight factors influencing the provision of end-of-life care: emotional support for nurses, palliative values, patient and family preferences, resources, organizational support, care planning, knowledge and preparedness. Internal consistency of each latent construct was deemed satisfactory. The results of descriptive statistics revealed a strong commitment to the inclusion of families in end-of-life care and the value of this care in the critical care setting. This paper reports preliminary evidence of the psychometric properties of a new survey instrument. The findings may inform practice development opportunities to support critical care nurses in the provision of end-of-life care and improve the care that patients and their families receive.

Development and psychometric testing of ventilator bundle questionnaire and observation schedule

There is a current lack of valid and reliable instruments that can be used to examine critical care nurses' knowledge and skills in adhering to ventilator bundles. The aim of this study was to develop and psychometrically test a ventilator bundle questionnaire (VBQ) and ventilator bundle observation schedule (VBOS). The VBQ and VBOS consisted of a list of pharmacologic and nonpharmacologic nurse-led interventions taken from the literature and supported by various levels of evidence. After content validation, stability and equivalence reliabilities of the VBOS were determined in a randomly selected sample of critical care nurses from a single academic center in Finland. The final VBQ contained 49 multiple-choice questions, and the VBOS had 86 dichotomous items, whose overall content validity ranged from 0.99 to 1.0. The overall intraclass correlation coefficient of the VBOS ranged from 0.93 to 1.0. The VBQ and VBOS have acceptable psychometric properties and could be used to objectively assess whether evidence-based guidelines regarding ventilator bundles are being used in clinical practice. Further testing with diverse samples is needed to strengthen the validity and reliability of these instruments.

Gender and the experience of moral distress in critical care nurses

Nursing practice is complex, as nurses are challenged by increasingly intricate moral and ethical judgments. Inadequately studied in underrepresented groups in nursing, moral distress is a serious problem internationally for healthcare professionals with deleterious effects to patients, nurses, and organizations. Moral distress among nurses has been shown to contribute to decreased job satisfaction and increased turnover, withdrawal from patients, physical and psychological symptoms, and intent to leave current position or to leave the profession altogether. Do significant gender differences exist in the moral distress scores of critical care nurses? This study utilized a quantitative, descriptive methodology to explore moral distress levels in a sample of critical care nurses to determine whether gender differences exist in their mean moral distress scores. Participants (n = 31) were critical care nurses from an American Internet nursing community who completed the Moral Distress Scale-Revised online over a 5-day period in July 2013. Institutional review board review approved the study, and accessing and completing the survey implied informed consent. The results revealed a statistically significant gender difference in the mean moral distress scores of participants. Females reported statistically significantly higher moral distress scores than did males. Overall, the moral distress scores for both groups were relatively low. The findings of a gender difference have not previously been reported in the literature. However, other findings are consistent with previous studies on moral distress. Although the results of this study are not generalizable, they do suggest the need for continuing research on moral distress in underrepresented groups in nursing, including cultural and ethnic groups.

The Critical Care Work Environment and Nurse-Reported Health Care-Associated Infections

Critically ill patients are susceptible to health care-associated infections because of their illnesses and the need for intravenous access and invasive monitoring. The critical care work environment may influence the likelihood of infection in these patients. To determine whether or not the critical care nurse work environment is predictive of nurse-reported health care-associated infections. A retrospective, cross-sectional design was used with linked nurse and hospital survey data. Nurses assessed the critical care work environment and provided the frequencies of ventilator-associated pneumonias, urinary tract infections, and infections associated with central catheters. Logistic regression models were used to determine if critical care work environments were predictive of nurse-reported frequent health care-associated infections, with controls for nurse and hospital characteristics. Results The final sample consisted of 3217 critical care nurses in 320 hospitals. Compared with nurses working in poor work environments, nurses working in better work environments were 36% to 41% less likely to report that health care-associated infections occurred frequently. Health care-associated infections are less likely in favorable critical care work environments. These findings, based on the largest sample of critical care nurses to date, substantiate efforts to focus on the quality of the work environment as a way to minimize the frequency of health care-associated infections.

Factors Influencing Critical Care Nurses’ Perception of Their Overall Job Satisfaction

The aim of this study was to explore the factors influencing critical care nurses' perception of their overall job satisfaction. Nurses' job satisfaction is a key issue to consider in the retention of critical care nurses. Shortages of nurses result in unsafe patient care, increased expense, and increased stress levels among other nurses. The Leadership Practices Inventory was used among a sample of critical care nurses to measure perceived leadership practices, the Organizational Commitment Questionnaire measured nurses commitment, and the Job in General scale was used to measure nurses' overall job satisfaction. Four different hypotheses were tested using bivariate and multivariate statistical analytical techniques. Statistically significant relationships were found among the following hypotheses: (a) perceived leadership and job satisfaction; (b) organizational commitment and job satisfaction; and (c) perceived leadership practices, organizational commitment, and job satisfaction. No significant relationships were found among critical care nurses' demographic variables and job satisfaction. Organizational commitment was the strongest predictor of job satisfaction. Encourage the heart (B = 0.116, P = .035) and organizational commitment (B = 0.353, P = .000) were found to be significantly associated with job satisfaction. These findings have implications for nurse educators, preceptors, administrators, recruiters, and managers in promoting satisfaction.

The factors which influence nurses when weaning patients from mechanical ventilation: Findings from a qualitative study

The aim of the study was to describe the factors that influence critical care nurses when deciding to wean patients from mechanical ventilation. The study adopted a qualitative methodology, using semi-structured interviews and a vignette. An invited sample of critical care nurses (n=24) from one Irish intensive care unit was employed. Each nurse was interviewed once and a vignette was used to structure the interview questioning. The findings were analysed using thematic content analysis. Six major themes influencing nurses' decision to wean emerged, as follows: physiological influences; clinical reassessment and decision making; the nurse's experience, confidence and education; the patient's medical history and current ventilation; the intensive care working environment; and use of protocols. The findings highlight the complex nature of weaning patients from mechanical ventilation and the major role of the nurse in this process.

Napping During Night Shift: Practices, Preferences, and Perceptions of Critical Care and Emergency Department Nurses

Nurses working night shifts are at risk for sleep deprivation, which threatens patient and nurse safety. Little nursing research has addressed napping, an effective strategy to improve performance, reduce fatigue, and increase vigilance. To explore nurses' perceptions, experiences, barriers, and safety issues related to napping/not napping during night shift. A convenience sample of critical care nurses working night shift were interviewed to explore demographics, work schedule and environment, and napping/ not napping experiences, perceptions, and barriers. Transcripts were constantly compared, and categories and themes were identified. Participants were 13 critical care nurses with an average of 17 years' experience. Ten nurses napped regularly; 2 avoided napping because of sleep inertia. The need for and benefits of napping or not during night shift break were linked to patient and nurse safety. Ability to nap was affected by the demands of patient care and safety, staffing needs, and organizational and environmental factors. Nurses identified personal health, safety, and patient care issues supporting the need for a restorative nap during night shift. Barriers to napping exist within the organization/work environment.

Personality, stress and coping in intensive care nurses: a descriptive exploratory study

The aim of the study was to investigate the relationship between personality traits, perception of workplace stress and coping among intensive care unit (ICU) nurses. Research has indicated that ICUs are stressful environments. There is a tendency for research studies to investigate causes of stress and ways of coping, but few studies, particularly in recent years, have considered the personality traits of the staff who thrive in this challenging environment, the work stress they perceive and the coping strategies they use. A convenience sample of critical care nurses (n = 46) completed three standardised questionnaires during September 2007: the revised NEO personality inventory (NEO-PI-R); the nurses stress scale (NSI) and the Brief Coping Orientations to Problems Experienced (COPE) scale. ICU nurses did not perceive their workplaces to be stressful. Certain personality traits, openness, agreeableness and conscientiousness, were associated with problem-solving coping strategies such as active planning and reframing. Openness and extraversion were associated with less perceived stress from the 'patients and relatives' dimension of the NSI; there were also negative correlations between conscientiousness and the 'workload stress' and stress from lack of 'confidence and competence' dimensions of the NSI. Certain personality traits may have a buffering effect on workplace stress. Pre-employment screening to identify staff that exhibit personality and coping traits associated with low perceived stress may be considered as part of the recruitment strategy to address problems relating to stress, sickness and retention. The retention and recruitment of staff who have lower perceived workplace stress and who utilise problem-focused coping may result in less reported absences and fewer critical incidents and errors.

A grounded theory model of on‐duty critical care nurses' information behavior

PurposeCritical care nurses' work is rich in informative interactions. Although there have been post‐hoc self report studies of nurses' information seeking, there have been no observational studies of the patterns of their on‐duty information behavior. This paper seeks to address this issue.Design/methodology/approachThis study used participant observation and in context interviews to describe 50 hours of the observable information behavior of a representative sample of critical care nurses in a 20‐bed critical care unit of a community (non‐teaching) hospital. The researcher used open, in vivo and axial coding to develop a grounded theory model of their consistent pattern of multimedia interactions.FindingsThe resulting Nurse's Patient‐Chart Cycle describes their activities during the shift as centering on a regular alternation between interactions with the patient and with the patient's chart (in various record systems), clearly bounded with nursing “report” interactions at the beginning and the end of the shift. The nurses' demeanor markedly changed between interactions with the chart and interactions with the patient. Their attention was focused on patient‐specific information. They had almost no time or opportunity to consult published sources of information while on duty.Originality/valueLibraries often provide nurses with information services that are based on academic models of information behavior. Clinical information systems are designed more for medico‐legal record keeping than for nursing care. Understanding the reality of nurses' on‐duty information behavior may guide librarians and systems designers in the provision of more appropriate systems and services.

Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety

To minimize the occurrence of adverse events among patients, critical care nurses must be alert to subtle changes in patients' conditions, perform accurate clinical assessments, and respond expediently. However, little is known about the effects of the nurses' work hours on vigilance and patients' safety. To describe the work patterns of critical care nurses, determine if an association exists between the occurrence of errors and the hours worked by the nurses, and explore whether these work hours have adverse effects on the nurses' vigilance. Data were obtained from a random sample of critical care nurses in the United States. Nurses eligible for the study were mailed two 14-day logbooks to fill out. Information collected included the hours worked, the time of day worked, overtime hours, days off, and sleep-wake patterns. On days worked, the respondents completed all work-related questions and questions about difficulties in remaining awake while on duty. Space was provided for descriptions of any errors or near errors that might have occurred. On days off, the nurses completed only those questions about sleep-wake patterns, mood, and caffeine intake. The 502 respondents consistently worked longer than scheduled and for extended periods. Longer work duration increased the risk of errors and near errors and decreased nurses' vigilance. The findings support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses' work hours to no more than 12 consecutive hours during a 24-hour period.

A measure of critical care nurses' post-code stress.

The purpose of this research was to develop an instrument to measure critical care nurses' post-code stress and then to examine the psychometric properties. Critical care nurses experience stress from multiple sources. One source of stress may arise from participation in resuscitation attempts and this has been labelled post-code stress; however, no means exist for measuring this source of stress. In phase 1, 47 items were developed and submitted to a panel of experts for content validity. Based on content experts' ratings, 20 items were retained for phase 2 instrument testing. To test the instrument, a convenience sample of critical care nurses was obtained from four institutions in north-eastern United States. Each nurse received the Post-Code Stress Scale and completed it anonymously. A subsample completed the Post-Code Stress Scale a second time to assess stability reliability. The Nursing Stress Scale was also administered to assess construct validity. An exploratory principal components factor analysis with varimax rotation suggested five dimensions to post-code stress. These five dimensions accounted for 66% of the variance and indicated that stress arose from feeling discomposed, oppressed, uncertain, burdened and morally conflicted. The Pearson product moment correlation between the Post-Code Stress Scale and the Nursing Stress Scale was 0.46, providing preliminary evidence of construct validity. Internal consistency reliability estimates for the five-factor subscales ranged from 0.57 to 0.77 with only one factor being <0.70. The internal consistency reliability estimate for the final 14 items on the scale was 0.79. The instrument shows promise as a measure of post-code stress based on the evidence obtained in this study; however, further psychometric testing is warranted.