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Hepatic arterial infusion chemotherapy in conjunction with the combination therapy of atezolizumab (T) and bevacizumab (A) is widely used in hepatocellular carcinoma. Some adverse events such as hypertension, weakness and elevated transaminase levels occurred during treatment, while there is currently no reported case about thrombocytopenia with concomitant HLA antibody‐positive PTR. We summarize the critical care nursing experience of a patient with PTR because of HLA antibody positivity during hepatic arterial infusion chemotherapy in conjunction with atezolizumab plus bevacizumab (T + A) regimen. This paper explains the nursing measures for patients with severe thrombocytopenia and proposes nursing measures for situations where conventional treatments are ineffective. Key nursing points include the administration of intravenous immunoglobulin (IVIG) and HLA‐compatible platelets, prevention of complications, psychological care, oral care, and skin management. Through systematic treatment and targeted nursing care, the patient's platelet count rebounded after 9 days, leading to a successful recovery and discharge. Subsequent follow‐up assessments revealed the patient's sustained well‐being. Thrombocytopenia is a potential adverse reaction during the treatment of liver cancer. When platelet transfusion is ineffective, vigilance is necessary for the possibility of HLA positivity, and prompt symptomatic management is warranted. [ABSTRACT FROM AUTHOR]

Background: Moral distress is recognized as an international problem that contributes to decreased work productivity, job dissatisfaction and intent to leave for adult Critical Care nurses. Aim: To explore Critical Care nurses moral distress levels using the Moral Distress Scale Revised (MDS‐R) and its relationship with intention to stay. The study reported in this paper was part of a larger study that also investigated Critical Care nurses' work environment in Canada and the Midlands region of the UK. Study design: During January to August 2017 a cross‐sectional survey was distributed to adult Critical Care nurses in the Midlands region of the UK. Methods: Surveys were distributed to adult Critical Care Registered Nurses in the Midlands region of the UK examining moral distress levels and intention to stay in Critical Care, the organization (NHS Trust) and in the nursing profession. Results: Two hundred sixty‐six number of a potential sample of 1066 Critical Care nurses completed the survey (25% response rate). Age and moral distress were significantly positively correlated with intention to stay on their current unit (r = 0.16, P =.05), indicating older nurses were more likely to stay in the critical care unit. Moral distress was negatively correlated with intent to stay scores, showing critical care nurses with higher levels of moral distress were less likely to stay on their unit (r = −0.20, P =.02). Moral distress was also significantly negatively correlated with intention to stay with their current employer (r = −0.28, P <.001). Nurses that stated they had high rates of moral distress were more likely to consider leaving their current employer. Conclusion: Moral distress appears to be an issue among adult Critical Care nurses requiring further exploration and development of effective strategies to reduce this phenomenon and stabilize the workforce by reducing turnover. Relevance to clinical practice: By identifying the top causes of moral distress, tools and strategies can be developed to allow the Critical Care nurse to work within an ethically safe clinical environment and reduce the turnover of experienced adult Critical Care nurses. [ABSTRACT FROM AUTHOR]

An introduction is presented in which author discusses articles on topics including focuses on conducting a systematic review with network meta-analysis comparing effectiveness of different durations of pressure support ventilation and T-piece among patients weaned from mechanical ventilation.

Background: The COVID‐19 pandemic placed unprecedented stress on the National Health Service and critical care units including those with Extracorporeal Membrane Oxygenation (ECMO) facility as this intervention had proved successful with H1N1 patients in 2009. To successfully care for the influx of ECMO patients, an ECMO clinical support team (ECST) formed by redeployed staff was created to assist critical care nurses. Aim: This service evaluation aims to review the experience of critical care nursing staff working with an ECST during the period of increased provision of ECMO care. Study Design: A UK‐based single‐site qualitative service evaluation was followed. Method: Critical care nursing staff's feedback was anonymously collected using a paper questionnaire designed for this project. Data were analysed using inductive content analysis. Findings: Approximately 40 critical care nurses were invited to complete a questionnaire, 19 (48%) of whom completed it within the available timeframe. A variety of themes were identified including 'Prior knowledge of ECST', 'Management matters', 'ECST in action', 'ECST response', 'Emotions' and 'Overall experience of the ECST'. Staff initially reported apprehension regarding a new team and training responsibilities. Following the rollout of the ECST, nurses' accounts described the utilization of the ECST and subsequent stress relief. Feedback commented on the ECST's positive attitude, effective team working with the critical care team and provision of moral support. Nurses' gratitude was strongly conveyed throughout, with many expressing the positive effect of the ECST on staff emotional well‐being. Conclusion: The implementation of the ECST provided clinical and emotional support to nurses. The ECST demonstrated the effective use of redeployed health care staff to support the critical care unit at a time of a significant increase in patients requiring ECMO. This could be used as a model to enhance staffing levels in the event of future viral outbreaks. [ABSTRACT FROM AUTHOR]

Background: Patients intoxicated after abusing illicit drugs constitute a significant proportion of patients cared for in intensive care units. Intensive critical care nurses who nurse accidentally intoxicated patients face complex and demanding situations, and there is a lack of studies regarding this topic. Aims and objectives: To illuminate Swedish intensive critical care nurses' experiences of nursing accidentally intoxicated patients after abuse of illicit drugs. Design: A qualitative design with an inductive approach was used. Methods: Semi‐structured interviews were conducted with eight intensive critical care nurses at an intensive care unit in Sweden. Data were analysed using qualitative content analysis. Findings: The themes found illuminate intensive critical care nurses' experiences of nursing accidentally intoxicated patients after their abuse of illicit drugs: feeling empathy and a wish to provide dignified care; dreading nursing the patient and feeling a lack of empathy; feeling frustration and questioning the care; lacking knowledge about a complex and challenging situation. Conclusions: It is essential to respond to intoxicated patients with empathy and dignity. Intensive critical care nurses should learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations in intensive care units. Relevance to clinical practice: To create a caring environment where the interaction becomes more positive and harmonious, an intensive care nurse needs a deep understanding of what a drug abuse disorder means. Moreover, the ability to see the person behind the abuse and to provide non‐judgemental support is required. What is known about this topicPatients intoxicated after abuse of illicit drugs constitute a significant proportion of patients cared for in ICUs worldwide.Intensive critical nurses who nurse accidentally intoxicated patients face complex and demanding situations, and few studies have addressed this topic.What this paper contributesIt is essential to respond to intoxicated patients who are admitted to the ICU with empathy and dignity, as well as to learn how to identify factors that lead to provocation and agitation in order to reduce the occurrence of dangerous situations.Education is warranted and must be enhanced, including knowledge about drug abuse and training in communication and empathyNursing should include an understanding of what the disease of drug abuse means and the development of the ability to see the person behind the abuse and to provide non‐judgemental support. [ABSTRACT FROM AUTHOR]

The article provides information on rehabilitation during and after critical care, with a focus on improving long-term quality of survivorship. It discusses the current evidence, barriers, and patient perspectives related to rehabilitation in critical care, emphasizing the importance of addressing gaps in research and providing psychological support.

Background: Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown. Aim: To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff. Study design: A cross‐sectional survey study among staff from seven PICUs in the Netherlands has been carried out. Results: Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient. Conclusion: Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups. Relevance to clinical practice: We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work. [ABSTRACT FROM AUTHOR]

Background: The intensive care unit has a much higher pressure ulcers incidence than general wards. Predicting and eliminating the risk of pressure ulcer development is thus of utmost importance in health care, including clinical nursing practice. Aim: The meta‐analysis aimed to examine the predictive validity of the Jackson–Cubbin Scale. Methods: This study is a systematic literature review and meta‐analysis. Research articles published in periodicals indexed targeted the critical care patients and offered sufficient data(true‐positive, false‐positive, true‐negative and false‐negative results) in the EBSCO, PubMed, Ovid, Web of Science and Cochrane databases, as well as those from two journals indexed in a Chinese database (Wangfang Data and China National Knowledge Infrastructure) were reviewed. Preferred reporting items for systematic reviews and meta‐analyses were used; the internal validity of the diagnostic studies was analysed using Quality Assessment of Diagnostic Accuracy Studies 2. Sensitivity, specificity, positive and negative likelihood ratios were counted by STATA 15.0. Results: Nine diagnostic studies with high methodological quality, involving a total of 7684 patients, were retrieved and assessed. This meta‐analysis showed that the pooled sensitivity, specificity and area under the symmetric summary receiver operating characteristic curve of the Jackson–Cubbin Scale were 0.81 (95% confidence interval [CI], 0.58–0.88), 0.76 (95% CI, 0.51–0.95) and 0.84 (95% CI, 0.81–0.87), respectively. Conclusions: The study suggests that the Jackson–Cubbin Scale has a moderate level of predictive validity. Moreover, Jackson–Cubbin's predictive validity could be increased if it was implemented differently based on the attributes of the research participants. Relevance to Clinical Practice: The Jackson–Cubbin Scale has a moderate level of predictive validity with good sensitivity and specificity for the determination of the risk of PUs in adult ICU patients. Bedside nurses could use the Jackson–Cubbin scale for dailly assesment for ICU patients. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary resuscitation (CPR) is an essential skill required by critical care nurses. Evidence has shown that the use of a novel method called simulation‐based flipped classroom (SBFC) can save training time in nursing laboratories and, to some extent, enhance social distancing during the current COVID‐19 pandemic. Aim: To evaluate the effects of SBFC on nursing students' acquisition of CPR skills. Study Design: A two‐parallel prospective, single‐centre, simulation‐based, randomized, controlled trial. Methods: The total sample size was 326 students. A CPR video was recorded and uploaded on Microsoft Teams channel for the SBFC group only. Thereafter, both groups demonstrated and redemonstrated the CPR procedure. Both groups were then compared according to the simulation experience satisfaction scale and CPR skills acquisition checklist. Results: Two equally randomly selected groups of 163 undergraduate nursing students completed the study. The SBFC group had a significantly better satisfaction with the simulation experience than the traditional simulation (TS) group (p = 0.03). As regards the mean score of the CPR checklist after simulation, the SBFC group had a significantly higher score than TS group (p = 0.01). Conclusions: SBFC using a pre‐recorded video can be an effective method that can reduce the time needed for CPR clinical simulation and can be used for the CPR simulation among critical care nurses. Relevance to Clinical Practice: This study provides critical care nursing educators with a deep understanding regarding the benefits and value of utilizing the SBFC method in the clinical training of CPR skills. SBFC can be used to increase critical care nurses' satisfaction and skill acquisition during CPR training. [ABSTRACT FROM AUTHOR]

Background: Patients in intensive care units require comprehensive care. Hence, improving health care quality depends on accurate assessment and documentation. Aim: To develop and validate the content of an assessment sheet for critically ill patients. Study Design and Methods: A Delphi design study was conducted between January and March 2020. The content validity index (CVI) was used to calculate the degree of agreement among the experts to analyse the instrument and the entire set of items. Content validity was determined by seven experts (three critical care nursing professionals, two critical care doctors, and two anaesthesiologists) using a four‐point Likert scale. They evaluated the items in terms of the following: 1 = "irrelevant," 2 = "somewhat relevant if the phrasing is profoundly adjusted," 3 = "relevant with some adjustment as to phrasing," and 4 = "very relevant." The CVI was applied, and the accepted value was ≥0.50. Results: Three rounds of evaluation were required to achieve the minimum index. The items were reviewed for content and face validity. The instrument was validated with 86 items with a total CVI of 0.90, a face validity of 1, and a scale‐level content validity index/universal agreement calculation method (S‐CVI/UA) value of 0.813. Conclusion: This instrument can help nurses, doctors, academics, and students assess patients in intensive care units. Relevance to Clinical Practice: The daily assessment tool may provide a systematic and consistent approach to critically ill patients' assessment to guide interventions. [ABSTRACT FROM AUTHOR]

Background: Central line‐associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. Aim: The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence‐based guidelines in practice. Design: A cross‐sectional study. Methods: Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. Results: A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence‐based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. Conclusions: Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. Relevance to Clinical Practice: The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence‐based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. [ABSTRACT FROM AUTHOR]

Background: Oral care is one of the fundamental nursing care procedures used to decrease oral colonization, dental plaque, respiratory infections, and patient stay and cost. Aims: This study aimed to identify intensive care unit (ICU) nurses' self‐assessment of oral care frequency, skill competency, documentation, oral care tools, and obstacles to oral care quality. In addition, it proposed exploring associations between nurses' attitudes about the importance of oral care and the priority of other interventions. Study design and setting: A cross‐sectional descriptive study was conducted in two ICUs (trauma and general) in the main teaching hospital in Upper Egypt. Of 105 nurses selected using convenience sampling, 91 completed the questionnaire. Results: About 60.4% of ICU nurses did not attend any oral care training programme, 40.7% reported performing oral care four times per shift in intubated patients, 62.6% reported that their skills needed improvement, 37.4% saw themselves as competent, and 86.8% documented oral care in patients' records. Significant positive correlations were found, indicating that nurses' attitudes towards the importance of oral care showed the same tendency as the priority given to other interventions, such as eye care, bowel care, documentation, hygiene, catheters, feeding, and wound care (correlation coefficient [r] = 0.290, 0.511, 0.333, 0.425, 0.431, 0.345, and 0.337, respectively). Furthermore, a toothbrush (84.6%) was often used, while chlorhexidine was not used (90.1%). The major obstacles to the provision of oral care as perceived by the nurses were the fear of aspiration and life‐threatening interventions (95.6%), inadequate nurse–patient ratios (94.5%), irregular competency evaluations (92.3%), unavailability of oral care guidelines (92.3%), and shortage of time (84.6%). Conclusion: The participating nurses were mindful of the importance and priority of oral care. Many of them did not attend oral care training programmes and considered that their skills needed improvement. Moreover, ICU nurses reported many obstacles hindering oral care quality. Relevance to clinical practice: This research identifies the importance of developing in‐service oral care training programmes to improve ICU nurses' skill competency. High‐quality oral care can be provided by focusing on and overcoming obstacles that hinder nurses' oral care practice. [ABSTRACT FROM AUTHOR]

An introduction is presented in which author discusses articles on topics including focuses on several valuable insight into the landscape of intensive care for the future and highlight areas that need attention and understanding in the field.

Background: Intensive care is one of the most resource‐intensive forms of care because seriously ill patients are cared for in units with high staffing levels. Studies show that the number of registered nurses (RNs) per patient and nurse education level affects patient outcome. However, there is a lack of studies that consider how nurses/patient ratio with an advanced educational level of specialized nurses in intensive care, affect the intensive care performed in different patient populations. Aim: To investigate if differences in patient characteristics and nurse–patient ratio have an impact on the quality of care. Study Design: This is a retrospective observational study with a review of all patients >15 years receiving care at two general intensive care units with different nurse/patient ratio (unit A, 1:1 nurse/patient ratio and unit B, 0.5:1 nurse/patient ratio). Results: There was no significant difference in the initial severity of illness between the units. However, younger patients, male patients and patients requiring surgery entailed a higher workload and a longer intensive care unit (ICU) stay despite a 1:1 critical care nurse/patient ratio. A small difference, but not significant, with more unplanned re‐intubations occurred at unit A compared with unit B. Conclusion: The differences in the nurse/patient ratio did not reflect a difference in the severity of illness among admitted patients but might be explained by patient characteristics with different needs. Relevance to Clinical Practice: Health care managers should consider not only the number of nurses but also their educational level, specific competencies and skills mix and nursing‐sensitive measures to provide high‐quality ICU care in settings with different patient characteristics. Nursing‐sensitive patient outcomes should be considered in relation to nurse/patient ratio, as important to measure to ensure a high quality of patient care in the ICU. [ABSTRACT FROM AUTHOR]

Background: Since the start of the global COVID‐19 pandemic in 2019, critical care nurses across the world have been working under extreme levels of pressure. Aim: To understand critical care nurses' experiences of and satisfaction with their role in the pandemic response across the United Kingdom (UK). Study Design: A cross‐sectional electronic survey of critical care nurses (n = 339) registered as members of the British Association of Critical Care Nurses. Anonymous quantitative and open‐ended question data were collected in March and April 2021 during the height of the second surge of COVID‐19 in the UK via an online questionnaire. Quantitative data were analysed using descriptive statistics and free text responses were collated and analysed thematically. Results: There was a response rate of 17.5%. Critical care nurses derived great satisfaction from making a difference during this global crisis and greatly valued teamwork and support from senior nurses. However, nurses consistently expressed concern over the quality of safe patient care, which they perceived to be suboptimal due to staff shortages and a dilution of the specialist skill mix. Together with the high volume of patient deaths, critical care nurses reported that these stressors influenced their personalwell‐being. Conclusions: This study provides insights into the key lessons health care leaders must consider when managing the response to the demands and challenges of the ongoing COVID‐19 pandemic. COVID‐19 is unpredictable in its course, and what future variants might mean in terms of transmissibility, severity and resultant pressures to critical care remains unknown. Relevance to Clinical Practice: Future responses to the challenges that critical care faces must consider nurses' experiences and create an environment that engenders supportive teamwork, facilitates excellent nursing practice and effective safe patient care where critical care nursing may thrive. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, intensive care nurses may experience ethical issues related to fear of transmission, limited resources, and increased workload. Nurses' moral sensitivity and courage may have a role in dealing with these problems. Aim: The purpose of this study was to assess intensive care nurses' moral sensitivity and moral courage during the COVID‐19 pandemic. Design: Descriptive cross‐sectional survey. Methods: A total of 362 nurses working in the intensive care units of pandemic hospitals in Turkey participated in the study between January and March 2021. Data were obtained using a personal information form, the Moral Sensitivity Questionnaire, and the Nurses' Moral Courage Scale. A link to the online data collection tools was sent to the management of participating institutions, who forwarded it to nurses. Reporting followed the CHERRIES guidelines. Results: In this study, the response rate of nurses was 89%. The nurses' total mean moral sensitivity score was 90.70 ± 28.89 and their mean moral courage score was 82.08 ± 13.51. A weak inverse correlation was found between the nurses' moral sensitivity and moral courage scores (r = −.176, p =.001). Total moral sensitivity score differed significantly according to years of Intensive care unit (ICU) experience (p =.007). Total moral courage scores increased significantly with education level (p =.012), years of nursing experience (p =.016), and willingness to work in the ICU (p <.001). Conclusion: The study suggests that nurses working in the intensive care unit during the pandemic had moderate moral sensitivity and high levels of moral courage. Nurses' sociodemographic characteristics and ICU work conditions may affect their moral sensitivity and moral courage. Relevance to Clinical Practice: The results of this study can help guide efforts to improve moral courage and sensitivity and address ethical issues among ICU nurses. [ABSTRACT FROM AUTHOR]

Background: Stress is an integral part of daily work for nurses, especially those who work in intensive care units (ICUs). However, chronic stress can affect nurses' mental and physical well‐being, increasing their risk of burnout and decreasing the quality of care. A higher emotional intelligence (EI) level may be correlated with greater use of effective coping strategies, leading to a reduction of the adverse effects of stress. Aim: This study aimed to examine the relationship between EI and coping strategies among adult ICU nurses in Poland. Study Design: A cross‐sectional survey design was used. Current adult ICU nurses in nine Polish hospitals were invited to participate. The survey instruments used were: the Polish version of the Schutte Self‐Report Emotional Intelligence Test, the Inventory to Measure Coping Strategies with Stress (Brief‐COPE), and a self‐constructed questionnaire. Results: 114/543 (21%) nurses completed the survey. ICU nurses showed an average level of EI (70.2%). The main stress coping strategies were active coping and planning, the rarest being substance use, behavioural disengagement, and denial. For nurses with a higher EI level, the most frequently used strategies included positive reframing (R = 0.43; p <.001), active coping (R = 0.38; p <.001), planning (R = 0.37; p <.001) and religion (R = 0.25; p =.006). Nurses were less likely to utilize strategies of behavioural disengagement (R = –0.32; p =.001) and self‐blame (R = –0.40; p <.001). Conclusions: EI may have an impact on coping strategies, as a higher EI level was correlated with the greater use of effective coping strategies in ICU nurses. Relevance to Clinical Practice: Training in coping with stress and increasing EI may have a positive impact on reducing the risk of burnout in nurses and thus improving the quality of care delivered. [ABSTRACT FROM AUTHOR]

Background: The history of critical care nursing is intertwined with that of battlefield nursing, where for almost 200 years, nurses worked to save injured soldiers' lives, risking their own physical and emotional injuries. Today, with nurses increasingly deployed to provide critical care during natural, man‐made and public health crises that can resemble battlefield situations, there is much to learn from battlefield nurses. Aim: This qualitative study aims to explore the lessons of the experiences of civilian nurses deployed to Israeli battlefields in three wars between 1967 and 1982. Methods: Qualitative, semi‐structured, in‐depth interviews were conducted with twenty‐two former military nurses who were deployed in three wars between 1967 and 1982. We analysed interview transcripts using a content analysis approach. COREQ, a 32‐item checklist, guided method selection, data analysis and the findings' presentation. Findings: Data analysis revealed three main themes, with ten related subthemes: Field Service Challenges, Coping with Challenges, and Nurses' Need for Recognition. Conclusion: The findings identify mental, emotional, and organizational issues resulting from nurses' wartime experiences, revealing numerous opportunities for better preparing and supporting critical care nurses before, during, and after crises. Relevance to Clinical Practice: Critical care nursing during crises, such as wartime, is unique but increasingly common. The memories and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders planning for future deployments during wartime or other disasters such as the COVID‐19 pandemic and the Russo‐Ukrainian war. [ABSTRACT FROM AUTHOR]

Background: Employee bullying and burnout are two crucial, prevalent and challenging concepts that adversely affect organizational staff behaviours. Also, adverse patient care is associated with nurse bullying and burnout. Aim: This study aimed to assess the incidence and association between workplace bullying and occupational burnout among nurses in critical care units in Iran. Study design: A cross‐sectional descriptive study. Methods: The subjects were 184 nurses from critical care units in 6 teaching hospitals in Iran. Three questionnaires were distributed among the study population; (a) demographic characteristics questionnaire, (b) Maslach Burnout Inventory (MBI) and (c) bullying at Workplace Questionnaire. Descriptive statistics were used to present the workplace bullying and occupational burnout status among nurses. Linear and logistic regression analyses were conducted to estimate the relationship between workplace bullying with MBI and nurses' demographic characteristics, respectively. Results: 62% of the nurses had moderate emotional exhaustion, 59.8% had moderate depersonalization and 46.2% had a moderate individual achievement. 75.5% faced workplace bullying. There was a positive and significant association between bullying scores and burnout in total (Pearson's r = 0.598, p < 0.001). Linear regression test showed a positive and significant relationship between bullying with MBI dimensions (R = 0.613, p < 0.001) for emotional exhaustion, (R = 0.679, p < 0.001) for depersonalization and (R = −0.417, p < 0.001) for individual achievement. Conclusions: Among Iranian nurses, bullying is a prominent and substantial issue that significantly correlates with their negative performance by enhancing job burnout. Relevance to Clinical Practice: It is suggested that some measures are adopted to avoid workplace bullying and to reduce occupational burnout for nurses. Managers should create an environment that encourages nurses to voice their concerns – informing nurses about their rights and creating a positive atmosphere in the hospital. [ABSTRACT FROM AUTHOR]

Background: Frontline nurses dealing with the coronavirus disease‐2019 (COVID‐19) pandemic face various mental health challenges ranging from excessive stress and anxiety to severe depression. Aims: To study the comparative prevalence of anxiety and depression, and their contributing factors, between nurses working in intensive care units (ICU) with COVID‐19 patients (COVID ICU) and nurses working in ICU with patients admitted for other reasons (non‐COVID ICU). Design: Quantitative comparative cross‐sectional study. Methods: All frontline nurses working in COVID and non‐COVID ICUs at a tertiary care university hospital in Nepal were included. The data were collected using Google Forms. The groups were evaluated and compared in terms of various relevant variables with self‐designed socio‐demographic questionnaire, the validated Nepali version of the Hospital Anxiety and Depression Scale (HADS), and the General Health Questionnaire 12 (GHQ‐12). Results: The response rate was 100%. Of the 99 nurses who met the inclusion criteria, three were excluded. Out of the 96 nurses included, psychiatric caseness was present in 82 (85.4%). There was no statistically significant difference in the prevalence of psychiatric caseness, anxiety, and depression between the COVID ICU and non‐COVID ICU nurses (caseness of 90.4% vs 79.5%, P =.134; anxiety of 36.5% vs 27.3%, P =.587; and depression of 21.2% vs 9.1%, P =.214, respectively). Among the factors that could potentially lead to psychiatric caseness, anxiety, and depression, statistically significant differences were observed only in relation to sleep disturbances, confidence in caring for patients with COVID‐19 and intentions to discontinue current job, all being significantly higher in COVID ICU nurses. Conclusion: Anxiety and depression are common in nurses working in both the COVID and non‐COVID ICUs, although the difference is not statistically significant. Relevance to clinical practice: Early assessment of anxiety and depression in nurses working in all ICUs and their active medical and behavioural interventions are important in protecting this vital work force dealing with the pandemic. [ABSTRACT FROM AUTHOR]

Background: Intensive care settings are characterized by their structure, which constantly changes in parallel with scientific and technological developments, the uncertainty of the lifeline between birth and death, the challenges in the fair distribution of limited resources, the participation of individuals in medical decisions, and witnessing the pain experienced by individuals. These characteristics also affect the level of moral distress, which can make it difficult for ICU nurses to provide the most appropriate individualized care for their patients. Aims: The purpose of this study was to determine the moral distress levels and individualized care perceptions of intensive care nurses. Study design: This study employed a cross‐sectional descriptive survey design. Methods: This descriptive study was conducted with 128 nurses working in the intensive care units of a university hospital in Turkey. Data were collected using an 'Information Form', 'the Moral Distress Scale', and 'the Individualized Care Scale‐Nurse Version'. Results: 78.9% of the nurses stated that there was staff shortage, and 36.0% stated that the physical conditions were not suitable for care in the intensive care units in which they worked. The mean score on the Moral Distress Scale was 79.2 ± 46.4. The mean total score on the Individualized Care Scale‐Nurse Version was 3.5 ± 0.8. Conclusion: This study revealed that the intensive care nurses had moderate levels of moral distress and good levels of individualized care perceptions although there was no significant relationship between their moral distress levels and individualized care perceptions. Also, the nurses adopted care behaviours supporting patients' feelings and autonomy. Relevance to clinical practice: In our study, the intensive care nurses did not reflect their moderate‐level moral distress in the individualized care provided. It could be beneficial to measure intensive care nurses' moral distress and care levels at frequent intervals so that early precautions could be taken to prevent the accumulation of moral distress and care difficulties among intensive care nurses. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic directly affects the psychological well‐being of critical care nurses. Several studies had investigated the psychological impact of the pandemic on nurses caring for patients with COVID‐19, but few were conducted to identify the predictors of this impact. Aims: The objective of this study is to identify the predictors of critical care nurses' stress, anxiety, and depression in response to the COVID‐19 pandemic. Design: A cross‐sectional survey was conducted in five intensive care units in five hospitals in Alexandria, Egypt. Methods: An online questionnaire was distributed. It included socio‐demographic and work‐related data and the depression, anxiety, and stress scale scores of the nurses under study. A multiple linear regression model was developed to identify the predictors of critical care nurses' stress, anxiety, and depression in response to the COVID‐19 pandemic. Results: Two hundred (64%) of 308 nurses completed the electronic questionnaire. Significant predictors of stress included the number of infected colleagues (P <.001) and availability of hospital resources (P =.01). Significant predictors of anxiety were age, gender, satisfactory income (P <.001), years of experience, time spent caring for patients with COVID‐19 (P =.04), continuous training, number of infected colleagues (P =.01), and availability of hospital resources (P =.02). Finally, significant predictors of depression included gender, history of physical problems (P =.04), educational attainment, availability of hospital resources, history of psychological problems (P <.001), and number of infected colleagues (P =.001). Conclusion: The hospital's lack of human and physical resources and the number of colleagues infected with COVID‐19 were the strongest predictors of stress, anxiety, and depression among nurses. Relevance to clinical practice: Identifying the predictors of stress, anxiety, and depression among nurses who care for patients with COVID‐19 is a vital step in developing mental health promotion strategies to support nurses during this pandemic. [ABSTRACT FROM AUTHOR]

Background: Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID‐19) travel restrictions have exacerbated this staffing issue. Aims: To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. Design: Cross‐sectional correlational (observational) design. Methods: Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. Results: A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs =.287, P <.01). A significant negative relationship was found between NPE and ITL (rs = −0.277**, P <.01). However, job satisfaction was associated with ITL (rs = −.007, P =.930). Conclusions: Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. Relevance to clinical practice: Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay. [ABSTRACT FROM AUTHOR]

Background: Muted or controlled alarms resulting from alarm fatigue have become a threat to patient safety and several institutions are aware of this risk. Aims: This study aimed to investigate critical care nurses' perceptions of medical device alarms, alarm fatigue, and alarm management practices. Methods: This descriptive study investigated 48 nurses working at two intensive care units (ICUs) within a single university hospital, in South Korea. They were asked to complete a self‐administered questionnaire about their perception of the ICU medical device alarm, alarm fatigue, and related management practices. The response rate was 100%. Results: Critical care nurses experienced a moderate or higher level of alarm fatigue, scoring 29.1 out of 40. Participants identified the items "Frequent false alarms, which lead to reduced attention or response to alarm when they occur," and "Inadequate staff" as the most important issues for alarm management. The most frequently involved item in alarm management practice was "I only use infusion pumps for drugs that require precise dose." Alarm management practices among the nurses differed significantly according to ICU clinical career and experience of patient safety accidents. Conclusions: This study highlights the need to develop a standardized medical device alarm management protocol that can help identify different alarms correctly and respond to them rapidly and appropriately. Relevance to Clinical Practice: It is necessary to reduce alarm fatigue and promote safe and effective alarm management practices among critical care nurses through sufficient education and steady training. Alarm fatigue should also be mitigated by employment of sufficient nursing personnel in ICUs. [ABSTRACT FROM AUTHOR]

Background: Physical assessment skills are essential to clinical decision‐making in nursing as they help nurses to identify and respond to patients' deterioration. Nurses develop confidence and can detect any out‐of‐range parameters in diagnosing and treating patients. Prior studies surveyed 120 skills but did not explicitly assess critical care. Aim: To determine the range of physical assessment skills practised by critical care nurses and their adoption factors. Study design: This study uses a cross‐sectional survey design. A self‐administered questionnaire evaluating 40 physical assessment skills was conducted with 133 staff nurses (response rate: 96.4%) in three critical care units at a Malaysian government hospital between November 2019 and January 2020. Results: Most nurses applied 32 (80%) skills during every working shift, involving the vital signs and all body systems except the gastrointestinal system. Five skills (12.5%) were occasionally applied, while three skills (7.5%) were rarely applied or not part of most nurses' clinical practice. About 20% of the nurses did not routinely check the respiration rate. Medical and surgical intensive care unit nurses (U = 1129, p <.001) and nurses who had served over 10 years (H (2) = 9.60, p =.008) used more physical assessment skills than others. Nurses felt that continuing nursing education, participating in relevant courses and implementing standardised forms to record physical assessments would improve the application of such skills. Conclusion: Clinical practice in these critical care settings challenges the assertion that physical assessment is vital to critical care nursing roles. Concerns highlighted by the nurses should be addressed by nursing management so that the application of physical assessment skills can be enhanced, especially in critical care settings. Relevance to Clinical Practice: The findings indicated that physical assessment skills in critical care need to be improved. Education and training should emphasise these skills. [ABSTRACT FROM AUTHOR]

Background: Nurses in intensive care units (ICUs) play a crucial role in providing palliative care. Effective provision of palliative care in the ICU requires nurses' active engagement, yet little is known about the confidence for palliative care that ICU nurses hold in China. Aim: To explore confidence in performing palliative care among ICU nurses in China and factors related to nurses' level of confidence. Study design: A cross‐sectional design was implemented. Methods: This study utilized convenience sampling to recruit ICU nurses from nine hospitals in Wuhan, China. Data were collected via an online survey. Multiple regression was conducted to identify the predictors of the ICU nurses' confidence in performing palliative care. Results: A total of 231 ICU nurses participated in the study, resulting in a response rate of 78% (231/296). Participants reported a relatively low level of confidence for carrying out palliative care (mean score = 2.60 ± 0.53; range = 1‐4). Nurses who had more positive attitudes toward palliative care communication (P <.001), higher levels of formal training on palliative care (P <.001), more years of working as an ICU nurse (P <.05) and those working in integrated ICU (P <.001) showed a higher level of confidence in carrying out palliative care. Conclusion: Participants' lack of confidence in performing palliative care makes for increased challenges, particularly in uncertainty about family assessments, palliative care discussions and lack of palliative care training. Strengthening palliative care curricula in nursing education and professional training is imperative to enhance ICU nurses' confidence. Relevance to clinical practice: Strengthening palliative care education and training, particularly in relation to palliative care communication, is critical. Implementing and tailoring culturally relevant palliative care call for attention to practice and for policy changes in palliative care delivery in China. [ABSTRACT FROM AUTHOR]

Background: Prototype analyses of well‐being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well‐being of nurses. What has not yet been explored is the broad construct of well‐being in intensive care nurses. Aims: To identify intensive care nurses' conceptions of general well‐being and investigate whether their general well‐being is prototypically organized. Design: Prototype analysis. Methods: Three linked studies conceptualize well‐being in this prototype analysis. In study 1, nurses reported features of well‐being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization. Results: Sixty‐five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well‐being included physical health (n = 26), work‐life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work‐life balance, and love. Work‐life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P <.005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P =.15). Conclusions: Physical health, work‐life balance, and personal relationships are key characteristics of well‐being for intensive care nurses. Mental, emotional, and general health and work‐life balance were considered most important for well‐being. Relevance to clinical practice: Physical health, work‐life balance, and personal relationships are key characteristics of well‐being for intensive care nurses. These characteristics of the broad construct of well‐being are helpful in both defining and identifying conceptual models of well‐being that may be used to inform the development and measurement of well‐being programmes. [ABSTRACT FROM AUTHOR]

Background: Nurses in intensive care units (ICUs) experience more stressful workplace conditions, making them more vulnerable to high levels of depression compared with those working in other healthcare settings. Objectives: This meta‐analysis aimed to estimate the pooled prevalence of depression in ICU nurses. Methods: A systematic search was conducted in Medline, EMBASE, CINHO, and Web of Science databases. Studies that reported depression among ICU nurses measured by a validated tool were synthesized using a random‐effects model. Differences in prevalence of depression by study‐level characteristics were estimated using sub‐group analysis. Heterogeneity was investigated using standard Chi‐squared tests and the I2 statistic. Results: Data were extracted from 19 cross‐sectional studies (2003‐2020) from 11 countries involving 7196 ICU nurses. The overall pooled prevalence of depression or depressive symptoms among ICU nurses was 24.99% (95% CI, 17.9%‐32.7%) with high between‐study heterogeneity (χ2 = 812, τ2 = 0.03, I2 = 98%, P <.01). Conclusion: Depression appears to be common among ICU nurses. Considering its negative impact on the quality of life of staff, patient care, and the overall critical care work environment, effective interventions should be designed and implemented to improve psychological health in this population. Relevance to clinical practice: Findings of this review indicate that regular screening for depressive symptoms might be helpful, and access to professional help and supportive care should be provided if necessary. [ABSTRACT FROM AUTHOR]

Background: Self‐esteem can be described as negative or positive beliefs people have about themselves. It is an important personal source to combat stress and protect health, and related to job satisfaction. Aims and objectives: The aim of this study was to examine the relationship between self‐esteem and psychological distress in critical care nurses. Design A cross‐sectional study. Methods: The research population of study consisted of 121 critical care nurses working at a university hospital in Edirne, Turkey between January and April 2017. A questionnaire consisting of 26 questions was used to obtain the personal and demographic information. The Symptom Check List‐90‐R test was used to determine the emotional status and the self‐esteem scale was used to determine the self‐esteem status of the participants. Participants were divided into two groups according to the self‐esteem scale median score (Group 1: below 60, and Group 2: 60 and above). Results: The general severity index of the nurses was 1.11 (95% confidence interval [CI] 1.00‐1.21). The general severity index of those with a self‐esteem scale score below 60 was 1.47 (95% CI 1.37‐1.57), while for those who with a self‐esteem score of 60 and above, it was 0.73 (95% CI 0.59‐0.87). The general severity index of the nurses in Group 1 was statistically significantly higher than that for those in Group 2. The number of nurses with a high symptom level in Group 1 was statistically significantly higher than those in Group 2. Conclusions: The study showed that the general severity index and poor symptom level ratios associated with mental well‐being are high in critical care nurses. However, critical care nurses with high self‐esteem had fewer psychological problems than those with lower self‐esteem. Relevance to clinical practice: Critical care nurses with low self‐esteem should be given assertiveness, resilience, and interpersonal communication skills training, even outside of health care. [ABSTRACT FROM AUTHOR]

Background: Retaining experienced critical care nurses (CCNs) remains a challenge for health care organizations. Nursing practice environment and resilience are both seen as modifiable factors in ameliorating the impact on CCNs' intention to leave and have not yet been explored in Malaysia. Aims and objectives: To assess the association between perceived nursing practice environment, resilience, and intention to leave among CCNs and to determine the effect of resilience on intention to leave after controlling for other independent variables. Design This was a cross‐sectional survey. Methods: The universal sampling method was used to recruit nurses from adult and paediatric (including neonatal) critical care units of a large public university hospital in Malaysia. Descriptive analysis and χ2 and hierarchical logistic regression tests were used to analyse the data. Results: A total of 229 CCNs completed the self‐administrated questionnaire. Of the nurses, 76.4% perceived their practice environment as being favourable, 54.1% were moderately resilient, and only 20% were intending to leave. The logistic regression model explained 13.1% of variance in intention to leave and suggested that being single, an unfavourable practice environment, and increasing resilience were significant predictors of nurses' intention to leave. Conclusion: This study found that an unfavourable practice environment is a strong predictor of intention to leave; however, further exploration is needed to explain the higher likelihood of expressing intention to leave among CCNs when their resilience level increases. Relevance to clinical practice: Looking into staff allocation and equality of workload assignments may improve the perception of the work environment and help minimize intention to leave among nurses. [ABSTRACT FROM AUTHOR]

Aim: To measure key aspects of the critical care nursing workforce across the National Health Service (NHS) and compare these with recommended standards where they exist. Background: The provision of high‐quality and safe critical care services is dependent on adequate numbers of highly skilled nurses. Understanding the issues and challenges within critical care services across the NHS is key to future planning and policy in this area. Design A stakeholder‐driven consensus development approach was adopted to design a workforce survey by members of the Critical Care National Network Nurse Leads (CC3N) Forum. Methods: The survey was conducted across all the critical care units in England, Northern Ireland, Wales, and Scotland. Data were collated to enable presentation of descriptive statistics. Results: Data returns were received from 240 of the 272 units in England and Northern Ireland. Scotland and Wales data were excluded from analysis and reporting. Differences in the sample and data returns limited comparison with the previous survey in some aspects. Stability was seen in vacancy and sickness rates. Improvements were seen in safe nurse: patient ratios, supernumerary "nurse in charge," critical care outreach service cover, use of national competency framework, and agency use. Dependency on overseas nurses in some units remains high. Specialist critical care training levels in many units do not meet current required standards. Conclusion: Clear improvements have been made. There is significant stability. Some challenges remain. Continued review of resource allocation is important in the coming years, as is policy and strategy to ensure recruitment, appropriate training, and support for staff well‐being. Relevance to clinical practice: The reader will gain insight into the critical care nursing workforce in the NHS in England and Northern Ireland. The results are useful for nurses, nurse managers, and policymakers. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has resulted in an increased number of interhospital transfers of patients with artificial airways. The transfer of these patients is associated with risks and has been experienced as highly challenging, which needs to be further explored. Aims and objectives: To describe critical care nurses' experiences of caring for critically ill patients with artificial airways during interhospital transfers. Design: A cross‐sectional study using a qualitative approach was conducted during spring 2020. Participants were critical care nurses (n = 7) from different hospitals (n = 2). Methods: The data were collected through semi‐structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed. Results: The analysis resulted in one main theme, "Preserving the safety in an unknown environment," and three sub‐themes, "Being adequately prepared is essential to feel secure," "Feeling abandoned and overwhelmingly responsible," and "Being challenged in an unfamiliar and risky environment." Conclusions: Critical care nurses experienced interhospital transfers of critically ill patients with artificial airways as complex and risky. It is essential to have an overall plan in order to prevent any unpredictable and acute events. Adequate communication and good teamwork are key to the safe transfer of a critically ill patient in that potential complications and dangers to the patient can be prevented. Relevance to clinical practice: Standardized checklists need to be created to guide the transfers of critically ill patients with different conditions. This would prevent failures based on human or system factors, such as lack of experience and lack of good teamwork. [ABSTRACT FROM AUTHOR]

Background: The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive. Aim: The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it. Study design: A cross‐sectional knowledge test survey with critical care nurses in Finland was used. Methods: Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics. Results: Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum‐variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit. Conclusion: The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care. Relevance to clinical practice: Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career. [ABSTRACT FROM AUTHOR]