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Background: The COVID-19 pandemic highlighted the negative impact of moral injury on nurses' well-being. However, there is a lack of research about generational differences among nurses, particularly on newer nurses who have been identified as having a higher rate of intention to leave. Objective: This study examines generational differences among nurses on moral injury, well-being, resilience, and intention to leave their nursing position and profession. Methods: This is a secondary analysis of cross-sectional data from registered nurses in clinical practice in Ohio between July and August 2021. Data on demographics, moral injury, resilience, and well-being were collected using an online survey. Participants were categorized into 4 generational groups based on their age in 2021: Baby Boomers (57-75 years old), Generation X (42-56 years old), Generation Y (27-41 years old), and Generation Z (12-26 years old). Descriptive and inferential statistics, including logistic regression and analysis of variance, were employed for analysis. Results: Significant generational differences were found in years of clinical experience, moral injury, resilience, and well-being. Baby Boomers reported higher well-being and resilience and lower moral injury. Notably, the intention to leave the profession was more strongly associated with well-being and moral injury levels than with the years of experience or generational group. Conclusions: The findings suggest that interventions to improve nurse retention should prioritize enhancing well-being and addressing the root causes of moral injury. Tailored strategies addressing the needs of different generations are necessary for mitigating the adverse effects of current healthcare challenges on nurse attrition. [ABSTRACT FROM AUTHOR]

Background: Supporting the sleep health of surrogate decision-makers of patients in the intensive care unit is a research priority. However, few studies have approached sleep health as a multidimensional construct, instead focusing on 1 or 2 dimensions in isolation. Objective: To holistically examine the sleep health (satisfaction, timing, efficiency, duration) of surrogate decision-makers of critically ill patients. Methods: This secondary analysis involved surrogate decision-makers of incapacitated intensive care unit patients at a tertiary medical center in northeastern Ohio (n = 19). Sleep-health data were captured by means of a subjective scale (satisfaction) and objectively (timing, efficiency, duration) by means of a wrist-worn accelerometer (Actiwatch Spectrum Plus; Philips Respironics). Upon enrollment, participants completed the satisfaction scale and wore the Actiwatch Spectrum Plus for 3 consecutive days. Descriptive statistics of the study variables were evaluated. Results: A minority (15%) of the sample reported poor sleep satisfaction. Sleep timing variables were comparable to those found in other adult studies. Participants averaged approximately 6 hours of sleep per day with an average sleep efficiency of 83.7%. Conclusions: Despite adequate satisfaction scores, intensive care unit surrogate decision-makers' sleep duration is inadequate and sleep efficiency is suboptimal. Sleep-health interventions may be needed in this at-risk population. Future research should consider the impact of surrogate decision-maker sleep health on their capacity to serve in the surrogate decision-maker role. [ABSTRACT FROM AUTHOR]

A review of the article "Factors Associated With Parent-Perceived Miscommunication in the Pediatric Intensive Care Unit," which appeared in the periodical's November 2024 issue, is presented.

Background: Family intensive care unit (ICU) syndrome, a comorbid response to another person's stay in the ICU, is characterized by emotional distress, poor sleep health, and decision fatigue. Objectives: This pilot study examined associations among symptoms of emotional distress (anxiety and depression), poor sleep health (sleep disturbance), and decision fatigue in a sample of family members of patients in the ICU. Methods: The study used a repeated-measures, correlational design. Participants were 32 surrogate decision makers of cognitively impaired adults who had at least 72 consecutive hours of mechanical ventilation within the neurological, cardiothoracic, and medical ICUs at an academic medical center in northeast Ohio. Surrogate decision makers with a diagnosis of hypersomnia, insomnia, central sleep apnea, obstructive sleep apnea, or narcolepsy were excluded. Severity of symptoms of family ICU syndrome was measured at 3 time points in 1 week. Zero-order Spearman correlations of the study variables were interpreted at baseline and partial Spearman correlations of study variables were interpreted 3 days and 7 days after baseline. Results: The study variables showed moderate to large associations at baseline. Baseline anxiety and depression were associated with each other and with decision fatigue at day 3. Baseline sleep disturbance was associated with anxiety, depression, and decision fatigue at day 7. Conclusions: Understanding the temporal dynamics and mechanisms of the symptoms of family ICU syndrome can inform clinical, research, and policy initiatives that enhance the provision of family-centered critical care. [ABSTRACT FROM AUTHOR]

Summary: We investigated whether sleep health (each individual dimension and a composite measure) was associated with better glycaemia among a cohort of young adults with type 1 diabetes (mean age 21.5 years, mean body mass index 24.55 kg m−2). Multiple validated self‐report questionnaires were completed, and raw continuous glucose monitor data were shared. One self‐reported sleep characteristic for each of the five sleep health dimensions was selected. A composite score was calculated by summing the number of "good" sleep health dimensions. We evaluated the associations between sleep health and glycaemia, and whether covariates, including age, type 1 diabetes duration and sleep apnea risk, influenced the relationships among the study variables using multivariable linear regression. Individual dimensions of sleep satisfaction (β = 0.380, p = 0.019; β = −0.414, p = 0.010), timing (β = 0.392, p = 0.015; β = −0.393, p = 0.015) and sleep efficiency (β = 0.428, p = 0.007) were associated with higher achievement of glycaemic targets (J‐index and time in range); however, these associations did not persist after considering covariates. A better Sleep Health Composite score was associated with higher achievement of glycaemic targets even after considering covariates. Using a multidimensional framework can guide future research on causal pathways between sleep and diabetes health, interventions to target sleep health profiles, and may improve sleep screening in routine diabetes care. [ABSTRACT FROM AUTHOR]

Uptake of the COVID-19 vaccine by nurses lags behind that of other health care professionals with minimal empirical evidence to understand this phenomenon. In this secondary analysis, we examined nurses' individual and work-related characteristics and their association with COVID-19 vaccination status. Alumni of three Ohio nursing colleges and members of a professional organization were invited to complete questionnaires from June through August 2021. Logistic regression models were used to evaluate associations between nurse characteristics and vaccination status. Among 844 respondents, 754 (80.30%) had received at least one dose of the vaccine. Older age, having a bachelor's degree or higher, and working in critical care were associated with vaccination. Providing direct care for COVID-19 patients in the last 7 days and a higher perception of one's work being affected by COVID-19 were significantly associated with being vaccinated, whereas prior COVID-19 infection was inversely associated with vaccination status. Our findings suggest that COVID-19 vaccine uptake among nurses is influenced by a host of factors related to virus knowledge, beliefs, and risk perceptions. Awareness of these factors can aid the development of interventions to increase nurses' acceptance of vaccines. [ABSTRACT FROM AUTHOR]

A discussion guide for nurse-researcher Anna E. Krupp's article on a support tool for early mobility of critical ill patients is presented.

A review of the article "Noninvasive Ventilation for Moderate to Severe Acute Respiratory Distress Syndrome Due to COVID-10" by Alexander A. Botsch and colleagues which appeared in the July 2024 issue of the "American Journal of Critical Care" is presented.

Coping with a loved one's critical illness as a surrogate decision-maker (SDM) elicits intense psychological distress. Emotion regulation (ER) may mitigate psychological distress. However, ER tendencies and their effects on psychological distress vary by racial and gender identity, which can inform the tailoring of ER-focused interventions. For this study, we examined between-group differences and the moderating effects of race and gender on ER (reappraisal and suppression) and psychological distress. We recruited 274 SDMs from a Midwestern academic medical center. Men reported a greater tendency to use suppression than women, and SDMs identifying as non-White reported a greater tendency to use reappraisal and suppression. Reappraisal resulted in greater psychological distress for non-White men and less psychological distress for White women. Incorporating tailored ER skill building into supportive interventions may improve the short- and long-term psychological well-being of SDMs, which may improve their ability to make value-concordant decisions and fulfill other informal caregiving responsibilities. [ABSTRACT FROM AUTHOR]

The article comments on Amanda C. Moale's study which examined the perspectives of family caregivers, health care providers and administrators about family caregiving following critical illness. Topics discussed include perspectives on post-intensive care syndrome (PICS), the impact of social determinants of health (SDOH) on caregivers' experiences, and the need for health care systems to transition toward more inclusive care models.

We conducted a systematic review on the state of the science related to sleep interventions for informal caregivers of persons with Alzheimer's disease or related dementia (ADRD). This review included English-written, peer-reviewed articles that studied the effect of an intervention on sleep health outcomes for informal caregivers of persons with ADRD. Our search yielded 15 articles that met our a priori inclusion criteria. We categorized interventions into four categories: environmental, physical, cognitive, and collaborative. Intervention effects were heterogeneous, with most yielding nonsignificant sleep health effects. There is a need for theoretically sound and robust sleep health interventions for informal caregiver samples. Future research in this area could benefit from the use of more controlled, pragmatic, and adaptive research designs, and the use of objective measures that conceptually represent the multiple domains of sleep health to enhance intervention quality. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has imposed pervasive stress and significant disruptions in sleep health in young adults. The purpose of this study was to describe the perceived facilitators and barriers of sleep health among young adults with type 1 diabetes during the COVID-19 pandemic. Thirty-two young adults with T1D (87.5% female; mean age = 21.5, SD = 2.0) participated in an online survey between January and July 2021. Young adults between the ages of 18–25 years with T1D for at least 6 months were eligible to participate, while those who had a previous OSA diagnosis, were currently pregnant, or worked the night shift were not eligible to participate. A qualitative descriptive approach was used to explore the perceived facilitators and barriers to sleep among a convenience sample. Qualitative content was analyzed and coded for themes using qualitative content analysis. Responses were coded using an in vivo approach. Young adults with T1D identified changes in facilitators and barriers of sufficient sleep from before the COVID-19 pandemic to during the pandemic. Three overarching barriers and facilitators were identified: (1) general, (2) diabetes-specific, and (3) COVID-19 specific. Our findings can inform future educational and cognitive-behavioral interventions to promote sleep health in young adults with T1D and other complex chronic conditions. When designing sleep-promoting interventions for young adults with T1D in the COVID-19 pandemic and post-pandemic, researchers should consider T1D as well as COVID-specific barriers and facilitators. [ABSTRACT FROM AUTHOR]

Aims and objectives: The purpose of this study was to report the psychometric properties, including validity and reliability, of the decision fatigue scale (DFS). Background: Decision fatigue may impair nurses' ability to make sound clinical decisions and negatively impact patient care. Given the negative impact of the COVID‐19 pandemic on psychological well‐being and the workplace environment, decision fatigue may be even more apparent among clinical nurses. Valid assessment of this condition among clinical nurses may inform supportive interventions to mitigate the negative sequelae associated with states of decision fatigue. Design: This study was a secondary analysis of a parent study using a cross‐sectional descriptive design. Methods: A convenience sample of 160 staff nurses was recruited online from across the United States. Participants completed a demographic questionnaire and subjective measures of decision fatigue, nursing practice environment scale and traumatic stress. Exploratory factor analysis (EFA), correlation coefficients and internal consistency reliability coefficients were computed to examine the DFS's validity and reliability within this sample. Results: The EFA yielded a single factor, 9‐item version of the DFS. The DFS scores were strongly correlated with traumatic stress and moderately correlated with the nursing practice environment, and the scale displayed appropriate internal consistency. Conclusions: This is the first known study to provide evidence of the DFS's validity and reliability in a sample of registered nurses working during the COVID‐19 pandemic. The results of this study provide evidence of a reliable and valid assessment instrument for decision fatigue that can be used to measure the burden of decision‐making among registered nurses. Relevance to clinical practice: Given the relationship between traumatic stress and the nursing work environment, decision fatigue may be a modifiable target for interventions that can enhance the quality of decision‐making among clinical nurses. [ABSTRACT FROM AUTHOR]

The article offers a discussion guide for the study "Hyporexemia Induced by Oxygen Therapy in Nonsurgical Critically Ill Patients." Topics of the study include association of oxygen-therapy-induced hyperoxemia with hospital mortality in nonsurgical critically ill patients, factors related to oxygen-therapy-induced hyperoxemia upon hospital admission and its association with the need for mechanical ventilation, vasopressors and renal replacement therapy.

Background: The Hospital Anxiety and Depression Scale (HADS) is commonly used clinically and scientifically among surrogate decision makers for critically ill patients. The validity of the HADS has been scrutinized, but its use among surrogate decision makers has not been examined. Objective: To examine the structural validity of the HADS. Methods: This study was a secondary analysis of data obtained from a 3-arm randomized controlled trial of a decision support intervention. Participants were recruited from 6 intensive care units at a tertiary medical center in Northeast Ohio. Participants were adult surrogate decision makers for critically ill, cognitively impaired adults who were not expected to be discharged from the intensive care unit within the subsequent 48 hours. The fit of 2-factor, 3-factor, and bifactor structures of the HADS was tested with confirmatory factor analysis. Results: The bifactor structure, possessing a general psychological distress factor and anxiety and depression group factors, showed a superior fit and met a priori thresholds for acceptable model fit. The general psychological distress factor accounted for more than 75% of the common variance in the HADS items. Conclusion: Confirmatory factor analysis provided evidence supporting a bifactor structure of the HADS. In this sample, the instrument validly measures psychological distress rather than distinct symptoms of anxiety and depression. Replication of these results is encouraged, and use of alternative measures is recommended when measuring distinct symptoms of anxiety and depression among surrogate decision makers for critically ill patients. [ABSTRACT FROM AUTHOR]

The article presents a discussion guide for the research "Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices" by Kristin A Tuozzo. It summarizes the effects of evidence-based bed rest practice change including groin complications and hospitalization, as well as the importance of a multidisciplinary approach to implementing changes. It considers the clinical implications of the evidence-based implementation of bed rest reduction after cardiac catheterization.

Objectives: The purpose of this study was to report the psychometric properties, in terms of validity and reliability, of the Unconscious Version of the Family Decision-Making Self-Efficacy Scale (FDMSE). Methods: A convenience sample of 215 surrogate decision-makers for critically ill patients undergoing mechanical ventilation was recruited from four intensive care units at a tertiary hospital. Cross-sectional data were collected from participants between days 3 and 7 of a decisionally impaired patient's exposure to acute mechanical ventilation. Participants completed a self-report demographic form and subjective measures of family decision-making self-efficacy, preparation for decision-making, and decisional fatigue. Exploratory factor analyses, correlation coefficients, and internal consistency reliability estimates were computed to evaluate the FDMSE's validity and reliability in surrogate decision-makers of critically ill patients. Results: The exploratory factor analyses revealed a two-factor, 11-item version of the FDMSE was the most parsimonious in this sample. Furthermore, modified 11-item FDMSE demonstrated discriminant validity with the measures of fatigue and preparation for decision-making and demonstrated acceptable internal consistency reliability estimates. Significance of results: This is the first known study to provide evidence for a two-factor structure for a modified, 11-item FDMSE. These dimensions represent treatment and palliation-related domains of family decision-making self-efficacy. The modified FDMSE is a valid and reliable instrument that can be used to measure family decision-making self-efficacy among surrogate decision-makers of the critically ill. [ABSTRACT FROM AUTHOR]

Decision fatigue is an applicable concept to healthcare psychology. Due to a lack of conceptual clarity, we present a concept analysis of decision fatigue. A search of the term "decision fatigue" was conducted across seven research databases, which yielded 17 relevant articles. The authors identified three antecedent themes (decisional, self-regulatory, and situational) and three attributional themes (behavioral, cognitive, and physiological) of decision fatigue. However, the extant literature failed to adequately describe consequences of decision fatigue. This concept analysis provides needed conceptual clarity for decision fatigue, a concept possessing relevance to nursing and allied health sciences. [ABSTRACT FROM AUTHOR]

The article discusses a study which recruited 107 pediatric intensive care unit (ICU) PICU nurses to explore the factors that influence the nurses' decision-making when assessing and managing pain in a child requiring neuromuscular blockade (NMB). Cited are a wide variety of methods used by the nurses to assess and manage pain at the bedside, the odds of a nurse intervening for pain management, and the clinical implications of the study.

A discussion guide for the article "Written Communication, Visitation Policies, and Awareness of Meidcal Issues Among Intensive Care Unit Families" by Jared Greenberg is presented. It suggests written communication strategies as a promising method to enhance a surrogate decision maker's understanding of the clinical condition of the patient. Intensive care unit problems identified among the patients include respiratory failure, hypotension/shock, encephalopathy and renal failure.

A discussion guide for the article "The Mindful Ethical Practice and Resilience Academy: Sustainability of Impact" is presented. It states the objective of the study to evaluate the effects of Mindful Ethical Practice and Resilience Academy (MEPRA) on promoting ethical confidence, moral competence, resilience, work engagement, mental health, mindful attentiveness and burnout among nurses. Also noted is the significance of building evidence base around the impact of multidimensional programs.

Surrogate decision makers (SDMs) of the critically ill experience intense emotions and transient states of decision fatigue. These factors may increase the cognitive load experienced by electronic decision aids. This cross-sectional study explored the associations of emotion regulation (expressive suppression and cognitive reappraisal) and decision fatigue with cognitive load (intrinsic and extraneous) among a sample of 97 SDMs of the critically ill. After completing subjective measures of emotion regulation and decision fatigue, participants were exposed to an electronic decision aid and completed a subjective measurement of cognitive load. Multiple regression analyses indicated that decision fatigue predicted intrinsic cognitive load and expressive suppression predicted extraneous cognitive load. Emotion regulation and decision fatigue represent modifiable determinants of cognitive load among SDMs exposed to electronic decision aids. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the factors that may contribute to the development of delirium in patients confined in intensive care units (ICU). Topics mentioned include a description of predicting models to determine a patient's risk of developing ICU delirium, the exclusion of the presence of mechanical ventilation due to its possible impact on patients, and the use of multivariable regression and interpreted receiver operating curve characteristics.

The article provides a discussion guide for the study "How Patients and Families Describe Major Medical Treatments: They Are No Longer Living, Just Existing." It presents a definition of life support and offers an overview of the scope of the study to clarify the concept of life support to maximize the provision of value-concordant care in the intensive care unit (ICU). Three categories of discourse related to major medical treatments (MMT).

The article discusses research led by Daniela Fernanda dos Santos Alves on the implementation of interprofessional rounding checklists within the pediatric intensive care unit (PICU). The study describes a five-step process to develop and validate an interprofessional rounding checklist (R-PICniC) for a 20-bed PICU. Research findings indicate the association of the quality of interprofessional communication in the PICU practice environment to positive appraisals of overall safety climate.

A review of the article "Epidemiology of Organ Failure Before and During COVID-19 Pandemic Surge Conditions" that was published in the July 2022 issue is presented.

The article discuses the results of a study on the use of sedation for patients in the intensive care unit. Topics mentioned include the circumstances that critically ill patients can receive heavy sedation, the relation of sedation-agitation scale (SAS) and Richmond agitation-sedation scale (RASS) scores to light sedation occurrence, and the accuracy of SAS and RASS in determining the light sedation occurrence.

The article provides instructions and tips on how to effectively assess the article about the measurement of acuity and pediatric critical care nursing workload using the intensive care unit complexity assessment and monitoring to ensure optimal outcomes (ICU CAMEO) acuity tool. The measurement results are used to establish standardized guidelines for pediatric ICU (PICU) staffing models.

The article offers information on the hospital-acquired pressure injuries risk assessment model developed by Phillip Kim, chief resident of general surgery at New York Presbyterian-Columbia University Medical Center, and investigators. Limitations in risk assessment and prevention methods for HAPI prevention and treatment is cited. The Braden Scale as a risk assessment tool depends on the subjective judgment of a clinician. Variables considered as risk factors for HAPI are cited.

A review of the article "Delivering Cognitive Behaviorial Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App" in an issue is presented.

A review of the article "Moral Distress in Clinicians Caring for Critically Ill Patients Who Require Mechanical Circulatory Support" in a 2021 issue is presented.

A review of the article "Racial/Ethnic Differences in Stress, Coping, and Distress Among Mothers With a Child in the ICU" in a 2021 issue is presented.

The article discusses a report on the gap between the intensive care unit (ICU) and the acute medical care unit. Topics mentioned include the potential benefit of implementing early ICU aftercare interventions, the lack of evidence to guide the care of ICU survivors, and difficulties with managing ICU survivors in the hospital setting.

A review of the article "Nurses' Perceptions of Workload Burden in Pediatric Critical Care" that is published within the issue is presented.

A review of the article "Migration of Feeding Tubes Assessed by Using an Elevtromagnetic Device: A Cohort Study" is presented.

The article discusses a study that examined the safety of biweekly chlorhexidine gluconate (CHG) baths in a sample of infants who were 36 to 48 weeks' post-menstrual age and had a central venous catheter. Highlights include measurement of blood levels of CHG at regular intervals for up to 12 weeks, routine skin assessments and safety checks conducted by bedside providers, and future animal studies on the impact of CHG on organ system development.