Search

Background: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. Aim: To provide an evidence‐based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. Design: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. Methods: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non‐ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non‐ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. Results: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. Conclusion: Oral care is an important part of the care of critically ill patients, both ventilated and non‐ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. Relevance to Clinical practice: Effective oral care is integral to safe patient care in critical care. [ABSTRACT FROM AUTHOR]

The article explores the poster "Life at Home After Intensive Care: The Family Caregiver Experience," by Sarah Holling of University of Surrey, which described a literature review that examined the carer experience supporting a patient after discharge from an intensive care unit.

The article calls for clinical experts to submit clinically focused papers to the British Association of Critical Care Nurses' (BACCN) journal "Nursing in Critical Care."

The article calls for clinically focused papers to be published in the journal.

The article announces awards given at the 2013 conference of the British Association of Critical Care Nurses (BACCN), which includes the Best Concurrent Paper to Caroline Wilson and Lucy Mummery of East Kent Hospitals University National Health Service (NHS) Foundation Trust.

The article discusses changes in the publication "Nursing in Critical Care" (NICC) from 1996 to 2010. The author looks at research authorship over 15 years and discusses multi-professional authorship of papers. She notes the difference between the goal of the publication in 1996 to 2010, and comments that NICC looks at critical care nursing in Britain as well as other countries.

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]

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: Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. Aim and objectives: To measure anxiety that teenagers report 48‐96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. Design: Two‐phase mixed methods, explanatory sequential design. Methods: This single‐site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13‐18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS‐A) was administered on paper and completed with the researcher present. Semi‐structured interviews were conducted in‐person and over the telephone, audio‐recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Results: Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48‐96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut‐off level for the HADS‐A‐1 Teenagers described their experiences on PICU within three themes:Memories of treatments, side effects, and the PICU environmentLosing a sense of selfFeeling cared for Conclusions: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. Relevance to clinical practice: Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial. [ABSTRACT FROM AUTHOR]

The article focuses on the evolution of post-intensive care recovery and rehabilitation. It highlighting the shift from minimal awareness and evidence in the past to increased recognition and support in recent years, especially due to the COVID-19 pandemic; the challenges and improvements in providing long-term care for critical care survivors; and emphasizes the need for individualized, patient-centered approaches and increased funding for these services in the future.

ABSTRACT Background Health care associated infections are a major contributor to avoidable harm experienced by patients in modern health care settings. Recent reports suggest that electronic checklists for the documentation of a central line bundle may significantly enhance documented process compliance and help to reduce catheter-related bloodstream infection rates. Aims This paper describes the use of our electronic tool to monitor and feedback process compliance in conjunction of introducing bespoke central line insertion packs to tackle catheter-related bloodstream infections in our intensive care unit in a medium-sized district general hospital. Design and methods Continuous quality improvement programme with 'Plan-Do-Study-Act' cycles was implemented. The central venous catheter insertion and maintenance bundle was rolled out in 2007. To monitor compliance with the bundle elements, an electronic tool was designed as part of our bedside Clinical Information System. From 2009, regular quarterly feedback was provided on the number of central venous catheter lines inserted, compliance with the insertion and maintenance bundle and catheter-related bloodstream infection rate using the data collected through the Clinical Information System. We have also introduced dedicated line insertion trolleys and factory-prepared insertion packs. We used segmented regression analysis to assess the changes in the catheter-related bloodstream infection rate before and after implementation of the central venous catheter bundle. Results Bundle compliance increased during the implementation period and reached over 95% within 6 months. We observed a significant reduction in the catheter-related bloodstream infection rate from 15·6/1000 days to 0·4/1000 days. Regression analysis showed that only the compliance had significant effect on the number and prevalence of catheter-related bloodstream infections. Conclusion/Implications Implementation of evidence-based care bundles reinforced by real-time feedback on the performance of caregivers can significantly reduce the rate of catheter-related bloodstream infection in the intensive care unit. Ensuring that change processes are seamlessly integrated in the workflow with minimal administrative burden is crucial to the quality improvement process. [ABSTRACT FROM AUTHOR]

Background: Since 1967 the gold standard for nurse staffing levels in intensive care and subsequently critical care units has been one nurse for each patient. However, critical care has changed substantially since that time and in recent years this standard has been challenged. Previously individual nursing organisations such as the British Association of Critical Care Nurses (BACCN) and the Royal College of Nursing have produced guidance on staffing levels for critical care units. This paper represents the first time all three UK Professional Critical Care Associations have collaborated to produce standards for nurse staffing in critical care units. These standards have evolved from previous works and are endorsed by BACCN, Critical Care Networks National Nurse Leads Group (CC3N) and the Royal College of Nursing Critical Care and In-flight Forum. Aim: The aim of this paper is to provide an overview of the much more detailed document 'Standards for Nurse Staffing in Critical Care', which can be found on the BACCN web site at . The full paper has extensively reviewed the evidence, whereas this short paper provides essential detail and the 12 standard statements. Methods: Representation was sort from each of the critical care associations. The authors extensively reviewed the literature using the terms: (1) critical care nursing, (2) nursing, (3) nurse staffing, (4) skill mix, (5) adverse events, (6) health care assistants and critical care, (7) length of stay, (8) critical care, (9) intensive care, (10) technology, (11) infection control. Outcomes: Comprehensive review of the evidence has culminated in 12 standard statements endorsed by BACCN, CC3N and the Royal College of Nursing Critical Care and In-flight Forum. The standards act as a reference for nursing staff, managers and commissioners associated with critical care to provide and support safe patient care. Conclusion: The review of the evidence has shown that the contribution of nursing can be difficult to measure and consequently support nurse staffing ratios. However, there is a growing body of evidence which associates higher number of registered nursing staff to patient ratio relates to improved safety and better outcomes for patients. The challenge for nurses is to produce accurate and meaningful outcome measures for nursing and collect data that accurately reflect the input of nursing on patient outcomes and safety. [ABSTRACT FROM AUTHOR]

The article offers information on the British Association of Critical Care Nurses (BACCN) conference which will be held virtually on the BACCN Web site, at www.baccn.org/conference, in September 2020.

Aim: The aim of this paper was to increase international collaboration on end of life care (EoLC) in critical care. Objectives included highlighting key challenges for critical care nurses in EoLC through a transcribed interview between a clinician, an educationalist and a researcher who all hold an EoLC focus. Background: EoLC continues to hold high profile within international health care arenas, including critical care units. Whilst end of life care remains well debated, it still presents many challenges for everyday practitioners. Dialogue with international colleagues and disciplines may provide opportunity for further understanding of this complex and sensitive area. Conclusions: A key issues to arise from this venture of shared learning was that futility of treatment is problematic for all. This is further complicated in the USA where the concept of (family) autonomy strongly shapes EoLC decision making. Relevance to clinical practice: This paper demonstrates that there are opportunities for nurses within health care teams which could be addressed through education and professional development initiatives. Furthermore, knowledge from other disciplines can provide a useful lens through which to improve our understanding of EoLC. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Jane Buswell on the impact an aging population will have on critical care services, one by Eldaha, Leo, Kovach, Morales, Pepe, Fakioglu and Declampli report on how their paediatric cardiac care services reduced morbidity and mortality and improved patient care, and one by de Melo, de Oliveira Lopes, de Araujo, de Fatima da Silva, Santos and Moorhead on decreased cardiac output.

ABSTRACT Background The first independent paediatric retrieval nurse practitioners ( RNP) in the UK and Europe were appointed in 2006 in one hospital Trust. Since then, many have been appointed around the UK but the range of responsibility and scope of the role is unknown as well as possible geographical variability. Aim The aim of this paper is to explore the role and scope of paediatric retrieval nurse practitioners in the United Kingdom ( UK). Method A two part questionnaire was sent to all RNPs identified by the regional retrieval/transport centres. Information was sought about the role and scope of RNPs and how the role may have changed since appointment. RNPs were asked to self-assess their own ability in a variety of technical and leadership skills. Conclusion The majority of respondents felt their role had expanded since appointment. RNPs reported that they would now lead the team for any critically ill infant or child where previously they were retrieving stable or high dependency patients. Other expansions of their role included being on a middle grade tier of the medical rota, asked to undertake aeromedical transfers, providing the withdrawal of care at referring centres and non-medical independent prescribing. Relevance to Practice This survey has revealed the changing role and scope of RNPs in the UK but most importantly, the increased responsibility of the roles. Over 80% of RNPs rated their leadership skills between proficient and expert on Benner's Novice to Expert Continuum (Benner, 1984). [ABSTRACT FROM AUTHOR]

The article offers information on the 32nd Annual British Association of Critical Care Nurses (BACCN) Conference to be held on September 4 and 5, 2017 in London, England, and mentions the themes and topics of the seminars, keynotes and workshops.

The article offers information on the 2014 National Conference of the British Association of Critical Care Nurses (BACCN) to be held in Cardiff, Wales from September 8-9, 2014.

Background: Withdrawal of life saving medical treatment is a common modality of death within UK paediatric intensive care units (PICUs). The majority of treatment withdrawals are carried out by medical staff, usually the consultant in charge of the child's care. Aim: To assess current practice of experienced PICU nurses performing the key tasks in treatment withdrawal once the decision has been made and its legal implications. Design and Method: The study was divided into three chronologically successive phases. In phase 1, a 12-item paper survey was circulated to nursing staff on a UK PICU. In phase 2, a three-item survey regarding current practice was sent to nurse managers on 22 UK PICUs. In phase 3, analysis of legal issues related to nurses withdrawing treatment was undertaken. Results: Poor response rates to both surveys limited their value; however, they may stimulate discussion of the issue within nursing. Phase 1 received 15 of 100 (15%) responses; open-ended questions highlighted practitioner concerns. Eight of twenty-two (36%) responses for phase 2 showed no consistent approach to the issue nationally. Legal analysis indicated that the law was untested in this area and nurses would be advised to withdraw treatment only if following a documented medical plan. Risks of legal and regulatory action could be reduced by formulating clear guidelines. Conclusion: PICU nurses could potentially enact withdrawal, but discussion is needed to resolve uncertainties. Relevance to Clinical Practice: National Guidelines from within the PICU community could assist nurses participating in treatment withdrawal. [ABSTRACT FROM AUTHOR]

Background: The National Institute for Health and Clinical Excellence (NICE) Clinical Guideline (CG) 83: Rehabilitation after Critical Illness was published to focus attention on a group of patients who can potentially endure a multitude of physical and non-physical complications following a serious illness. Historically the sequelae of critical illness have not been adequately assessed or managed despite growing knowledge in this area of health care. Aim: To share the lessons learned during the ongoing implementation of NICE CG83 across five hospitals within one critical care network in a single county. Design: The critical care network director appointed a passionate and experienced champion to examine the current position within each hospital, make recommendations and provide expert knowledge and practical assistance to improve the rehabilitation of patients in accordance with the NICE guideline. The 'Quick wins' were successfully addressed to encourage the implementation process whilst allowing time for new services and processes to be developed. Results: Success was achieved by addressing the patient, relative and inter-professional communication issues as a network. All hospitals introduced discharge booklets and improved their discharge information and then chose different strategies to address the recommendations of the guideline in the most effective way possible. Strategies such as early intervention physiotherapy, the assessment and management of delirium, follow-up clinics and outpatient rehabilitation classes were among those implemented. Conclusion: This paper outlines the processes developed, the difficulties encountered and showcases the valuable work that has been achieved. Relevance to clinical practice: Increasingly, hospitals have an obligation to comply with NICE guidelines for the benefit of patients. Rehabilitation following critical illness is important for patients to regain their former or best possible quality of life in a timely manner. [ABSTRACT FROM AUTHOR]

The article profiles Kathy Dalley, a dedicated member of the Southern Region chapter of the British Association of Critical Care Nursing, and discusses the 2012 plans that Dalley has to relocate abroad for several years.

Background: A significant proportion of hospital deaths occur in intensive care units (ICU) and often follow a decision to limit or withdraw life‐sustaining treatment. Facilitating the preferred choice in place of death for babies/children is increasingly being advocated, although the literature on a home death is often limited to case reports. Aims and objectives: To examine (a) health care professionals' (HCPs) views and experience of transferring babies/children home to die from intensive care, (b) patient clinical characteristics that HCPs would consider transferring home and (c) barriers to transferring home. Design: A cross‐sectional descriptive web‐based survey. Methods: A total of 900 HCPs from paediatric and neonatal ICU across the United Kingdom were invited to participate. Results: A total of 191 (22%) respondents completed the survey; 135 (70.7%) reported being involved in transferring home to die. However, most (58.4%) had just transferred one or two patients in the last 3 years. Overall, respondents held positive views towards transfer, although there was some evidence of divided opinion. Patients identified as unsuitable for transfer included unstable patients (57.6%) and those in need of cardiovascular support (56%). There was statistically significant difference in views between those with and without experience, in that those with experience had more positive views. The most significant barrier was the lack of access to care in the community. Conclusions: HCPs view the concept of transferring critically ill babies/children home to die positively but have infrequent experience. Views held about transfers are influenced by previous experience. The clinical instability of patients and access to community care are central to decision‐making. Relevance to clinical practice: A home death for critically ill babies/children is occurring in the United Kingdom but infrequently. Experience of a transfer home positively influences views and increases confidence. Improved multi‐organizational collaboration between ICU and community care teams would assist decision‐making and facilitation for a transfer home. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nurses in the UK are now one group of non-medical staff who can prescribe. This practice is evolving for critical care nursing staff who care for critically ill patients during their stay in hospital through ward and outpatient follow-up after admission to critical care. AIM: The purposes of this paper were to present existing information regarding prescribing to support nurses in critical care currently prescribing and to inform those who are intending to prescribe. METHODS: To develop the position statement, a search of the literature was conducted using key databases. To ascertain the current level and type of prescribing in critical care, a short questionnaire was sent by email to British Association of Critical Care Nursing members, and the results of this are presented in Appendix A. OUTCOMES/RESULTS: Evidence was found in relation to the history, context in critical care, educational requirements and issues of consent related to non-medical prescribing. CONCLUSIONS: The position statement is based upon evidence from the literature, National Health Service policy and the Nursing and Midwifery Council regulations. It takes account of the critical care patient pathway before, during and after an admission to critical care. [ABSTRACT FROM AUTHOR]

Aim: This paper discusses end-of-life care (EoLC) in critical care through exploration of what is known from the international literature and what is currently presented within UK policy. Background and context: EoLC is an important international critical care issue, and currently provides a key focus for health care policy in the UK. While society holds that critical care is delivered in a highly technical area with a strong focus on cure and recovery, mortality rates in this speciality remain at approximately 20%. When patient recovery is not an outcome, discussions with patient, family and extended care teams turn towards futility of treatment and end-of-life management. However, there are specific barriers to overcome in EoLC for the critically ill. Conclusion: A key issue for EoLC in critical care is a lack of robust systems to prospectively identify individuals who are most at risk of dying. A further challenge is divergent perspectives within and across clinical teams on treatment withdrawal and limitation practices. To streamline patient management and underpin a hospice approach to care, EoLC policies are currently being used within the UK. While this provides a national framework to address some key critical care clinical issues in the UK, there is a need for further refinement of the tool to reflect the reality of EoLC for the critically ill. It is important that international best practice exemplars are examined and clinicians actively engage and contribute to ensure that any local EoLC frameworks are fit for purpose. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of the role and contribution of outreach in the management of the critically ill ward patient using Stake's Responsive Model (Stake, 1975) and case study methodology (Simons, 1980). Twenty cases were examined, purposefully sampling all staff involved in the case identified by an initial interview with the outreach nurse. In total, 80 interviews were carried out, 20 with the outreach nurses and 54 with other members of health care teams involved in the cases, and six further targeted in-depth interviews with senior anaesthetic and nursing staff. The outreach contribution which emerged from the data analysis consisted of four core categories: action (getting things done, getting decisions made and following through), focus and vision (concentrating on one patient and having a vision of what action was needed to meet their care needs), orchestration (a communication and co-ordinating role) and expertise (bringing critical care skills and experience to the bedside). These categories were validated and developed in the six in-depth interviews. Three themes emerged from the data describing aspects of the acute care context in which outreach operates. The interviews revealed a battleweary workforce overwhelmed by the complex and increased demands of the critically ill ward patient. The medical and nursing teams at the bedside are inexperienced and often unsupported by senior clinical decision-makers. This is dealt with by 'passing the buck' creating gaps and delays in care management which are the problems addressed by the outreach contribution. Outreach may solve problems for the critically ill ward patient, but the underlying causes remain poorly understood. [ABSTRACT FROM AUTHOR]

The article reports on various developments related to nursing practice. According to new research by insurer Zurich, Great Britain's shift workers are susceptible to sleep-related car crashes as a result of long and inconsistent working hours. The pressure of irregular hours is having a negative impact on the nation's nurses, with one quarter stating that it is the worst part of their job. British Association of Critical Care Nurses and World Federation of Critical Care Nurses held their first joint international conference, which was attended by delegates from all over the world.

This paper describes the introduction and subsequent evaluation of a 12-h shift system in a large ITU in the northeast of UK. To date, only a small number of studies has evaluated nurses working the 12-h shifts in critical care areas. To evaluate the level of staff satisfaction, data were collected by means of a questionnaire involving 41 nurses, at 3 months following the introduction of the 12-h shifts. The responses from the evaluation advocated the continuation of 12-h shifts with alternative shift patterns for nurses who felt dissatisfied with the current system. Twelve-hour shifts can be seen as a flexible system for nurses working in intensive care and may assist with staff satisfaction and improving nurse recruitment and retention. [ABSTRACT FROM AUTHOR]

Background: The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. Aim: This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. Study Design: A national one‐day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. Results: Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24‐h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24‐h period and variable assessment methods were used. Conclusion: There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient‐relevant practice. Relevance to Clinical Practice: Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources. [ABSTRACT FROM AUTHOR]

Background: The British Association of Critical Care Nurses (BACCN) published its first position statement on non‐medical prescribing (NMP) in critical care in 2009 (Bray et al., Nurs Crit Care. 2009;14:224‐234). Over the years, more nurses and other health care professionals have become non‐medical prescribers, and the BACCN have thus revisited and updated the statement. Aim: To update the 2009 position statement on NMP in critical care to reflect contemporary guidance and practice. Study design: A working group was established following an expression of interest to BACCN members, and the original BACCN position statement and literature review were updated using key databases. An electronic questionnaire was developed by the working group to describe current NMP practises and the authorization and prescribing of blood and blood components. It was distributed via email to 1861 BACCN members and on BACCN social media in October and November 2021. Results: Two hundred and fifty nine health care professionals from the four countries of the United Kingdom completed the survey, and of these 136 (52.5%) respondents were BACCN members. One hundred and five (40.4%) of the respondents described themselves as non‐medical prescribers, and of these, 57 (54.8%) were independent prescribers and 47 (45.2%) were supplementary and independent prescribers, with one respondent not revealing. The remaining 154 (59.4%) respondents were not registered as non‐medical prescribers. Ninety‐one (86.7%) of the respondents who were non‐medical prescribers reported making prescribing decisions on every clinical shift, and 67 (64.4%) of these audited their prescribing practises. Of the 105 who described themselves as non‐medical prescribers, 71 (67.6%) had been in their area of practice for more than 5 years before they became non‐medical prescribers, with 3 (2.8%) being in the practise area for less than 1 year. All seven statements from Bray et al's (2009) position statement were revised and updated following the survey results and review of the literature search. Conclusions: The updated position statement is based upon new policy documents from a range of sources, including the Nursing and Midwifery Council, the Faculty of Intensive Care Medicine, the Royal College of Emergency Medicine and the Royal Pharmaceutical Society. It takes account of the adult critical care patient pathway before, during and after an admission to critical care. Relevance to clinical practice: Non‐medical prescribing (NMP) should only be implemented to improve the safety and quality of care for the critically ill or deteriorating patient. The requirement for NMP needs to be determined locally by organizations, ensuring that the care of the critically ill and deteriorating patient is the main reason. NMP must not be used as a substitute for unsafe medical practice or poor medical prescribing practice. Non‐medical prescribers must adhere to the current Royal Pharmaceutical Society's Prescribing Competency Framework and must be registered with their professional regulatory body. Non‐medical prescribers must audit and evaluate their practice as well as ensuring continuing professional development. Non‐medical prescribers in critical care must consider how their own professional codes of conduct, scope of practice, standards and guidelines impact their prescribing decisions. Non‐medical prescribers must work collaboratively to ensure that continuity and transfer of care between care settings consider deprescribing and medicines reconciliation. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve injuries (PNIs) can be acquired by patients in intensive care unit (ICU) who are critically unwell with Covid pneumonitis. Prone position ventilation has been linked to this life‐changing complication. Aim: To reduce the occurrence and severity of PNIs for patients with Covid pneumonitis requiring prone positioning whilst sedated and ventilated in ICU. Study Design: This study is a quality improvement project that evolved over the course of the first two surges of Covid pneumonitis admissions within the ICU at the Queen Elizabeth Hospital Birmingham (Surge 1: March 2020–July 2020, 93 prone ventilation survivors; Surge 2: September 2020–May 2021, 309 prone ventilation survivors). Implementation of updated prone positioning guidelines that aimed to reduce the risk of PNI. This was supplemented by face‐to‐face teaching for ICU professionals. The number of patients who sustained PNI and the severity of such injuries were recorded. Results: During the first surge 21 patients (22.6%) had at least one high grade PNI. During the second surge there were 12 patients (3.9%) sustaining an intermediate or high grade PNI. For PNI patients, there was an increase in the mean proning episodes (6–13) and duration (17.8–18.6 h). This represents an 82% reduction in PNI cases. High grade injuries reduced from 14/21 (66%) to 4/12 (33%). Conclusions: Optimizing the position of patients in the prone position in ICU with Covid pneumonitis may be key in reducing the development of PNI. Changes to pharmacological management may have influenced the results seen in this study. Relevance to Clinical Practice: Clinicians working within ICU with acutely unwell patients with Covid pneumonitis should acknowledge the heightened risk of PNI and take relevant steps to reduce the risk of injury acquisition. [ABSTRACT FROM AUTHOR]

The article offers information on the 5th International British Association of Critical Care Nurses (BACCN) Conference to be held at Park Plaza Riverbank in London, England, from September 7 to 8, 2015.

Background: As survivorship following critical illness improves, there is greater focus on maximizing recovery. As well as physical effects, critical illness often results in cognitive impairments such as delirium, anxiety, or disorientation. In other populations, such as delirium, non‐pharmacological approaches to manage these conditions are preferred, including re‐orientation and ensuring personal care needs are met. Cognitive rehabilitation is also well documented for patients with neuropsychological deficits. Treatments include memory aids, compensation strategies, and functional execution. In other hospital populations, games and activities have been utilized to optimize patient engagement, stimulation, and aid recovery, but it is considered an emerging therapy in intensive care. Aims: This service evaluation aimed to gather multidisciplinary team members' perceptions of the use of games based therapy (GBT) in critical care, including patient engagement and acceptability in clinical practice. Study design: A UK‐based single‐centre qualitative service evaluation. Purposive sampling was used to identify interviewees within an adult intensive care who had experience of using a recently implemented GBT intervention. Qualitative data were collected through semi‐structured interviews, which were recorded and transcribed verbatim. Data were analysed using thematic analysis. Results: Eight staff members across the multidisciplinary team were interviewed. One overarching theme of humanizing health care was identified, with three sub‐themes of enhancing recovery, non‐physical components of care, and bespoke tailoring. In addition, further recommendations for development of the service were summarized. Conclusion: GBT was well received by staff in clinical practice. It was described as a supportive adjunct to traditional care and rehabilitation, enhancing staff‐patient relationships. While it was recognized it may not suit all patients, GBT has the potential to enhance cognitive and physical recovery. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of the coronavirus disease 2019 (COVID‐19) outbreak, the Critical Care Outreach Team (CCOT) remained operational to provide critical care support to acutely ill and deteriorating patients on the wards. Aim: We aimed to evaluate the demand and efficacy of the critical care outreach service during the COVID‐19 pandemic. Method: We prospectively evaluated all patients referred to critical care outreach enrolled during a twelve‐month period. We reported the cumulative number of activities and interventions and baseline characteristics, acuity level and patients' clinical outcome. The rate of ICU admissions, activity plan, patients' acuity and mortality are compared to historical data pre‐pandemic. Results: Amongst 4849 patients referred, 3913 had a clinical review and of those 895 were COVID‐19 positive. Non‐invasive ventilation was mostly delivered to COVID‐19 patients (COVID‐19 +VE: 853/895, 95% vs. COVID‐19 −VE: 119/3018, 4%) alongside awake prone positioning (COVID‐19 +VE: 232/895, 26% vs. COVID‐19 −VE: 0/3018, 0%). Compared to pre‐pandemic, the cumulative number of patients assessed increased (observed: 3913 vs. historical: 3615; p = 0.204), patients meeting Level 2 acuity were higher (observed: 51% vs. historical: 21%; p = 0.003), but ICU admission rate did not increase significantly (observed: 12% vs. historical: 9%; p = 0.065), and greater mortality rate (observed: 14% vs. historical: 8%; p = 0.046) was observed. Conclusion: Critical care outreach bridges the gap between the intensive care unit and general wards and supports the concept of 'critical care without walls' acting as a valuable resource in optimizing and triaging acutely unwell patients and potentially averting critical care admissions. Relevance to Clinical Practice: The COVID‐19 pandemic has generated an unprecedented surge of deteriorating and critically ill patients with has caused severe and sustained pressures on intensive care units (ICUs) and general wards. Acutely ill patients can deteriorate quickly, and early recognition is vital to commence critical intervention on the wards or transfer timely to ICU. The Critical Care Outreach Team can help staff and optimize acutely ill and deteriorating patients by providing timely critical care interventions at the patient bedside. [ABSTRACT FROM AUTHOR]

An introduction is presented for this issue of "Nursing in Critical Care" periodical that mentions articles on topics such as do not resuscitate orders, ventilator-associated pneumonia (VAP), and the information needs of ICU (intensive care unit) charge nurses.

The article profiles critical care nurse Kathy Dalley, who in 2012 received honorary membership in the British Association of Critical Care Nurses.

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]

The article reports on topics which were discussed at the 2011 conference of the British Association of Critical Care Nurses, which was held in Newcastle, England. Topics included nursing practice, the changing roles of nurses and nurse practitioners and patient safety. The event was attended by several association members, nurses and other medical professionals.

In the article the author reflects on the 15th anniversary of the journal "Nursing in Critical Care." He comments on the the pilot issue of the journal and the originals editors' aspirations and goals for the publication. The evolution of critical care nurses in Great Britain and an analysis of research and content in "Nursing in Critical Care" are also discussed.

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]

The article reports that nurse Mark Wilson had a paper published in the March 2012 issue of "Nursing in Critical Care" and discusses an article on Kurt Lewis' three stages of change model which appeared in the March/April 2012 issue of the same journal.

The article presents information that members of regional chapters of the British Association of Critical Care Nursing can use to ensure that their annual general meetings are stress free and informative.

Information about several papers discussed at a symposium sponsored by the British Association of Critical Care Nurses is presented. Topics include the difference between evidenced-based nursing and nursing practice, the shortages of organs for donation and the ways in which collaboration can enhance patient outcomes through power sharing.

Background: People who are experiencing a period of critical illness frequently experience severe agitation. The presence of agitation can pose risks to the patient, family, and clinical team. Aims and objectives: To capture the views and opinions of critical care multidisciplinary teams concerning the approaches in the management of agitation, and to understand and identify the perceived risks and benefits of current management strategies. Design: A descriptive qualitative design. Methods: Data were gathered using semi‐structured interviews with multidisciplinary teams from adult critical care units from one region in the United Kingdom. Findings: A total of 19 participants participated between February to September 2017. There were two group interviews (GIs) (n = 12, GI 1 n = 8, GI 2 n = 4) and seven one‐to‐one interviews, across four hospital organisations with one participant working via an agency. The mean length (± SD) of each interview, one to one or group, was 58.86 minutes (5.81 minutes). Three major themes were generated about the complex clinical decision‐making required to manage an agitated patient. These themes represented: the burden of care, continuity of clinical decision‐making, and uncertainty and indecision experienced by participants. Conclusion: Participants described caring for an agitated patient as challenging and stressful. Staff sought clarification on what level of restrictive practice is allowed. Feelings of anxiety and stress generated by the decisions made may have an impact on staff, particularly those who are more inexperienced, which in the longer term could lead to fatigue or moral distress. Relevance to clinical practice. The study has emphasised the challenges faced by multidisciplinary teams and how decision‐making may impact on individuals within the team. [ABSTRACT FROM AUTHOR]

From 1st August 2004, doctors in training will be subject to the weekly working time limits enacted by the 1998 Great Britain working time regulations and extended to include medical staff in 2003. The current system of cover within the medical profession has retained a traditional dependence on junior staff 'resident on-call' systems with a requirement to continue work the next day. The significance of point 3 was determined by the SiMAP ruling. SiMAP, a Spanish doctors' union, brought a case to the European Court of Justice that clarified that time spent 'on call' in residence at the place of work constituted working time whether awake or asleep.

In the article the author discusses changes in critical care nursing from 1997 to 2010. The author was the chair of the "British Association of Critical Care Nurses" (BACCN) from 1997-1999, and notes that the National Health Service initiated a modernization agenda which focused on expert practice and clinical leadership during her time as chairperson. She comments on nursing issues that remain unchanged in 2010.

The article offers information on the 31st Annual Conference of the British Association of Critical Care Nurses (BACCN) to be held in Glasgow, Scotland from September 19 - 20, 2016.

The objective of this study was to examine the characteristic, content, and role of Paediatric Intensive Care Units (PICUs) in the provision of follow‐up for children and their families' post‐intensive care discharge in the United Kingdom (UK) and Republic of Ireland (RoI). The study followed a descriptive self‐reported, web‐based survey design. "In‐hospital PICU follow‐up" was defined as follow‐up delivered by the PICU team following PICU discharge but before hospital discharge and "post‐discharge PICU follow‐up" was defined as follow‐up delivered by the PICU team following hospital discharge. The survey was administered to all 28 PICUs in the UK and RoI. Paediatric intensive care medical directors or delegated individuals participated. Data were collected between September 2017 and January 2018 with a response rate of 79% (n = 22/28). Twelve units provided either in‐hospital and/or post‐discharge PICU follow‐up. Ten (45%) PICUs reported providing in‐hospital follow‐up, with half (n = 5) using an eligibility criteria for in‐hospital follow‐up, which related to disease groups. The most frequently reported form of in‐hospital PICU follow‐up consisted of face‐to‐face patient consultation (n = 8) by a PICU doctor (n = 5) and/or nurse (n = 4). The time at which initial contact was made was usually not predetermined (n = 4) and the assessment of care needs included are tracheostomy care (n = 4), respiratory care (n = 4), and sedative medication weaning plan (n = 5). Four PICUs reported to provide post‐discharge follow‐up. This involved telephone (n = 2), follow‐up clinic consultations (n = 1) or home visits (n = 1), provided predominantly by PICU doctors (n = 2), with their activity directed by patient needs (n = 3). Despite increasing evidence to suggest PICU survivors and their families experience negative sequalae post‐PICU discharge, less than half of PICUs surveyed provide in‐hospital follow‐up and only a minority provide post‐discharge follow‐up. There is variation in the delivery, content, and format of in‐hospital and post‐discharge PICU follow‐up in the UK and RoI. [ABSTRACT FROM AUTHOR]

Background: Despite the known benefits of mobilising critically ill patients, bed rest is still a common practice in intensive care units. The reasons for this are not fully understood. Early mobilisation can reduce the length of stay in the intensive care unit and in hospitals as well. However, the decision to mobilise a patient can be delayed while health professionals decide whose role it is to implement it. Aim and objectives: The aim of this study was to explore the ways in which nurses make decisions to mobilise critically ill patients and what factors influence the decision‐making process. Study design and method: This was a qualitative study involving semi‐structured interviews with 12 critical care nurses at a large urban district hospital. Interpretative phenomenological analysis was used to analyse verbatim transcripts of the interviews. Results: The findings demonstrated inconsistencies in the nurses' knowledge of the benefits to mobilising patients and that mobilisation was deemed to be a low priority. Decision‐making was influenced by time constraints, staffing levels, and unit demands. A lack of communication and collaborative working was identified, along with uncertainty and role ambiguity, with regard to who decides to mobilise a patient. Mobilisation was found to be complicated by existing cultural influences and by previous experiences of complex mobilisation. Conclusion: Re‐education strategies are needed to re‐enforce the benefits of mobilisation, along with multidisciplinary training sessions to clarify roles and overcome collaborative working issues. Relevance to clinical practice: This study has provided a greater understanding of the influencing factors on nurses' decision‐making with regard to mobilising critical ill patients. [ABSTRACT FROM AUTHOR]

The article reports on several developments relevant to critical care nurses and intensive care nursing in Great Britain in 2006. Key issues discussed include a cycling event for critical care nurses organized by the British Lung Foundation on June 21-25, 2006, and the parliamentary reception event of the Tissue Viability Nurses Association to address legislators about the medical issue of pressure ulcers.

Aim: The aim of the study was to explore the incidence, use, and scope of patient diaries in paediatric intensive care units (PICUs) in the United Kingdom and Ireland. Design: This was an electronic survey sent to 30 PICUs in the United Kingdom and Ireland. Results: All PICUs (n = 30) responded, and 43% (n = 13) offered diaries. For those units that did not supply diaries, the reasons given were concerns around the legal and professional implication of using diaries. Parental/carer consent to use a diary was obtained informally (79%, n = 11), and once there was agreement to provide a diary to parents, diaries were usually started immediately (72%, n = 12). Parents were the main contributors to the diaries (94%, n = 17), and the diaries were populated with photographs (94%, n = 15), drawings (100%, n = 16), and stickers (94%, n = 15). The reasons for offering diaries were to fill gaps in memories, to engage with families, and to explain what has happened in lay language. The owner of the diary was reported to be the family (82%, n = 14) and the child (12%, n = 2). Conclusions: The use of patient diaries is an evolving intervention in paediatric intensive care settings in the United Kingdom and Ireland. This national survey has provided a clearer picture of how this intervention is used in the United Kingdom and Ireland. PICU patient diaries are used in a significant number of units, and how these are used is relatively standardized, although in some different ways from general ICUs. Relevance to clinical practice: This survey provides a baseline for future exploration, understanding, and promotion of patient diaries, as a well evaluated tool for the critically ill child and his or her family. [ABSTRACT FROM AUTHOR]