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ABSTRACT Background Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. Aim To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. Design Questionnaire survey. Methods A postal questionnaire was distributed to all nurses ( n = 192) within two purposefully selected large adult intensive care units in the UK. Results Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% ( n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. Conclusion Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. Relevance to clinical practice Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Nurse-led (protocol-directed) ventilation weaning ( NLVW) is utilized in adult intensive care and has shown to be safe and reduce ventilation times. Our paediatric intensive care unit ( PICU) implemented a NLVW (and extubation) protocol in 2004, yet it was observed that some NLVW-trained nurses were not undertaking the role in practice. Aims To explore PICU nurses' and doctors' perceptions of and barriers to NLVW on a UK PICU, with the aim of facilitating more NLVW on our PICU by reducing these barriers. Methods A cross-sectional electronic survey was used to collect data from both nurse ventilation weaners and all medical staff and advanced nurse practitioners ( ANPs) on one PICU. Results Our survey response rates were 90% (36/40) nursing and 54% (20/37) medical. The four top reasons cited for nurses not being able to wean by protocol were not being allocated to a 'weanable' patient, being in an in-charge or runner role, high clinical workload and a perceived lack of support from medical staff/ ANPs. The restrictive nature of our protocol also emerged as a key issue by all staff. The medical survey revealed an overwhelming positive response to NLVW with 90% believing that experienced PICU nurses should be allowed to wean ventilation. In contrast to the nurses perceived lack of support or encouragement for NLVW, medical staff rated their encouragement for the nurses to undertake this role as high. Conclusions NLVW is a complex process, and factors that impair or facilitate this process relate not only to the weaning protocol itself, but also organizational processes and structural factors in a PICU. Relevance to clinical practice This paper highlights the complexities involved in instituting and establishing a nurse-led, protocol-driven ventilation weaning process within a PICU. Further, in depth research is required to examine both PICU nurses and doctors attitudes to NLVW both in the UK and across Europe. [ABSTRACT FROM AUTHOR]

Aims: To develop a questionnaire to identify Intensive Care survivor needs at key transitions during the recovery process, and assess its validity and reliability in a group of ICU survivors. Methods: Development of the Support Needs After ICU (SNAC) questionnaire was based on a systematic scoping review, and analysis of patient interviews (n = 22). Face and content validity were assessed by service users (n = 12) and an expert panel of healthcare professionals (n = 6). A pilot survey among 200 ICU survivors assessed recruitment at one of five different stages after ICU discharge [(1) in hospital, (2) < 6 weeks, (3) 7 weeks to 6 months, (4) 7 to 12 months, or (5) 12 to 24 months post‐hospital discharge]; to assess reliability of the SNAC questionnaire; and to conduct exploratory data analysis. Reliability was determined using Cronbach's alpha for internal consistency; intraclass correlation coefficients for test–retest reliability. We explored correlations with sociodemographic variables using Pearson's correlation coefficient; differences between questionnaire scores and patient demographics using one‐way ANOVA. Results: The SNAC questionnaire consisted of 32 items that assessed five categories of support needs (informational, emotional, instrumental [e.g. practical physical help, provision of equipment or training], appraisal [e.g. clinician feedback on recovery] and spiritual needs). ICU survivors were recruited from Northern Ireland, England and Scotland. From a total of 375 questionnaires distributed, 202 (54%) were returned. The questionnaire had high internal consistency (0.97) and high test–retest reliability (r = 0.8) with subcategories ranging from 0.3 to 0.9. Conclusions: The SNAC questionnaire appears to be a comprehensive, valid, and reliable questionnaire. Further research will enable more robust examination of its properties e.g. factor analysis, and establish its utility in identifying whether patients' support needs evolve over time. Relevance to clinical practice: The SNAC questionnaire has the potential to be used to identify ICU survivors' needs and inform post‐hospital support services. [ABSTRACT FROM AUTHOR]

Background: A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. Aim and objectives: Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. Design: A descriptive cross‐sectional survey was used. Methods: As part of the DEPICT study, a 17‐item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12‐month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. Results: Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty‐eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine‐item experience measure. Conclusion: Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. Relevance to clinical practice: Being able to measure experience provides an opportunity to understand how to make services better to improve experience. [ABSTRACT FROM AUTHOR]

Aims and objectives: The cumulative time that critical care nurses spend implementing a tight glycaemic control (TGC) protocol was estimated in a time-in-motion (TiM) study conducted in a hospital in the UK. Background: TGC protocols were introduced to the critical care setting to reduce hyperglycaemic events in high-risk patients. The time burden to critical care nurses of implementing such protocols has not yet been studied in the UK. Design: A prospective TiM pilot study was conducted in an eligible UK intensive care unit by four protocol-trained observers over five consecutive weekdays from 3 to 7 November 2008. Three nurses were also interviewed on site to gather their attitudes and perceptions about the benefits of and time associated with administering a TGC protocol. Methods: Independent observers shadowed nurses, observing when a blood glucose measurement was taken, when each predefined subtask was completed and the duration of each task. Semistructured interviews with nurses were conducted in-person and one-on-one by a trained study member. Results: Considered together, the episodic median duration of all TGC activities was 6·65 min. Across a total shift, nurses devoted approximately 7% of their time to administering a TGC protocol. Nurses perceived that a TGC protocol is beneficial to patient safety and outcomes in a critical care setting but acknowledged that the tasks can be mildly to moderately tedious. Conclusions: This TiM analysis indicated that the additional responsibility of implementing a TGC protocol represents a substantive commitment of nursing time in a critical care setting. Relevance to clinical practice: The episodic data of our pilot study in the UK contributes further evidence that TGC protocols may be arduous to maintain and constitute a substantial investment of nursing time. [ABSTRACT FROM AUTHOR]

Background Issues around the deterioration of hospitalised children are known: the failure to observe and monitor patients adequately, a failure to recognise the deteriorating patient, a failure to communicative effectively within the healthcare team and a failure to respond appropriately or in a timely manner (Pearson, 2008; NPSA, 2009). In response to this, a new 1-day course called RESPOND (Recognising Signs of Paediatric hOspital iNpatients Deterioration) was developed. Objectives To describe the development of the RESPOND course and present a preliminary evaluation of the first four courses. Methods A written postcourse survey was completed by participants (junior doctors, medical students, nurses and health care assistants) immediately after the course and an electronic survey completed three months later in a large children's hospital in the North West of England. Data were analysed descriptively and by simple thematic analysis of free text responses. Results Sixty-five participants undertook the RESPOND course over four separate days. Overwhelmingly participants found the course positive, with the most frequently cited benefit being improved multidisciplinary communication. Despite a poor response to the second survey, 18% (12 of 65) of respondents remained positive about the impact of the course. Conclusions and relevance to practice This preliminary evaluation combined with a reduction in hospital cardiac arrest rates suggest that the multiprofessional RESPOND course (in conjunction with an early warning tool and response system) is successful as part of a targeted strategy to promote patient safety within a children's hospital. [ABSTRACT FROM AUTHOR]