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Abstract Aim To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. Design A qualitative study was performed following the consolidated criteria for reporting qualitative research. Methods Semi‐structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well‐known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. Results A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. Relevance to clinical practice This framework can be a reference for the assessment and training of ECMO nurses.

Abstract Aim To understand the experience of critical care nurses when performing common, yet error‐prone, programming tasks on two unfamiliar intravenous smart pumps. Design A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods Following completion of common intravenous programming tasks each participant was interviewed using a semi‐structured interview guide. All interview data were coded line‐by‐line and thematic analysis revealed themes across all participants' interviews. Results The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety.

Background: Compassion and moral intelligence occupy a very significant place in ensuring quality in health care services, increasing patient satisfaction, reducing side effects, increasing patient safety and accelerating the healing process., Aim: This study was conducted to determine the relationship between moral intelligence and compassion fatigue in nurses working in intensive care units., Study Design: In this descriptive and cross-sectional study, 180 nurses working in intensive care units of a hospital comprised the population of the study. Of them, 114 who agreed to participate in the study were included in the study sample. The Personal Information Form, Yakut Moral Intelligence Scale (YMIS) and Compassion Fatigue-Short Scale were used as data collection tools. The scales and forms used in the study were created on Google Form. Nurses were visited in intensive care units, and the forms were given to them. Then the participating nurses filled in the forms., Results: Of the nurses participating in the study, 69.3% were women and 65.4% had a bachelor's degree. The analysis of the correlation between the scores obtained from the sub-dimensions of the YMIS by the nurses participating in the study demonstrated that there was a negative, low-level significant relationship between the self-control and kindness sub-dimensions of the YMIS. As the nurses' compassion fatigue levels increased, their self-control and kindness levels decreased., Conclusions: It can be said that as compassion fatigue levels increase in nurses, their moral intelligence levels decrease. Therefore, diagnosing compassion fatigue in nurses and taking precautions to prevent them from suffering from fatigue are of significant importance., Relevance to Clinical Practice: By determining the healthy intelligence and compensation spending levels of health workers, organizing maid training will increase the service and care provided., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Patients in delirium require trustful communication and re-orientation. We developed a flyer with positive, re-orientating suggestions for families of delirious patients in intensive care units. Suggestions include creating a safe environment, interpreting unusual behaviours positively and fostering mental resilience. Additionally, families are encouraged to prioritize their own well-being, recognizing their crucial role in supporting their loved ones. This flyer offers practical strategies across four key areas: ensuring security and orientation, reframing noises and body experiences, managing agitation and reshaping perceptions. By equipping families with knowledge and tools, this resource aims to promote understanding, resilience and strength to humanize delirium care., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The visit restrictions imposed as a result of COVID-19 precluded the entrance of the patient's family into the confines of the intensive care unit., Aim: This study evaluated the experiences of intensive care nurses (ICNs) regarding COVID-19 visit restrictions and their opinions on these restrictions., Study Design: From May 2023 to July 2023, semi-structured interviews with 15 ICNs from intensive care units in a tertiary public hospital in Türkiye were conducted. Data were analysed using qualitative content analysis with an inductive approach. Reporting of the study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist., Results: The analysis revealed two main themes, 'widespread negative impacts of visit restrictions' and 'adaptive strategies to the visitation ban', and seven sub-themes supporting the main themes. Nurses perceived that the visit restrictions imposed during the COVID-19 pandemic had a severe negative effect on patients, their relatives, themselves and the care environment. They also did not support visit restriction in future pandemics., Conclusions: The COVID-19 visitation policy weakened the involvement of family members in patient care and created serious challenges in the intensive care setting. The study revealed an urgent need for patient-centred, family-sensitive and consistently applied protocols in future pandemics., Relevance to Clinical Practice: In future pandemics, strategies such as the benefit-benefit ratio of the visit, the provision and use of adequate personal protective equipment, and vaccination requirements should be considered in visiting decisions of patients hospitalized because of infection. Participation of nurses responsible for patient care in decisions regarding visitor practices should be supported., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Intensive care units (ICUs) are environments where nurses are open to emotional interactions because of complex structures and dynamic relationships. Nurses' susceptibility to emotional contagion and their spiritual care competence may affect the quality of care by influencing their ability to manage and respond to the emotional dynamics present in these environments., Aim: This study aimed to determine the level of emotional contagion and spiritual care competence in intensive care nurses., Study Design: This study is a descriptive cross-sectional study conducted with 199 nurses working in the ICUs of a training and research hospital in Turkey. The data were collected between December 2021 and June 2022 using the Emotional Contagion Scale (ECS) and the Spiritual Care Competence Scale (SCCS)., Results: The mean score of the nurses was 50.29 ± 15.36 on the ECS and 90.29 ± 29.53 on the SCCS. A statistically significant difference was found between the ECS and SCCS and gender, marital status, weekly working hours and some approaches about spiritual care (p < .05). It was determined that there was a statistically significant positive correlation between the total scales and sub-dimensions of the ECS and SCCS (p < .05). In this study, it was found that intensive care nurses' susceptibility to emotional contagion was high, and that their spiritual care competence was at a moderate level. The results show that gender, marital status, weekly working hours, type of ICU and some approaches about spiritual care are crucial factors in nurses' emotional contagion and spiritual care competence. In addition, as the intensive care nurses' susceptibility to emotional contagion increased, their spiritual care competence also increased., Conclusions: The results of this study will guide the planning of interventions to protect intensive care nurses from the negative effects of emotional contagion and increase their spiritual care competence., Relevance to Clinical Practice: It is necessary to protect intensive care nurses from the negative effects of emotional contagion and to increase their competences in spiritual care., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Patient diaries are a supportive intervention aiding intensive care unit (ICU) survivors and their families post-critical illness. Despite their growing acceptance, ICU diary usage varies across settings., Aim: This study explored themes in nurse-written ICU diaries and their impact on nursing work and communication., Study Design: This qualitative study employed an interpretative narrative methodology to explore the experiences of ICU nurses. The narrative approach enabled the synthesis of diverse events and impressions into coherent stories, facilitating a deeper understanding of participants' perspectives. Data collection involved thematic analysis of diaries following Braun and Clarke's methodology. The analysis included familiarization, coding, theme identification and validation by the research team. The findings were reviewed by participants and translated into English using the WHO's cultural adaptation guidelines, ensuring reliability and credibility in the study's outcomes., Results: The sample consisted of 28 ICU nurses, each with professional experience ranging from 1 to 23 years. The hospitalized subjects for whom our sample wrote the diary consist of 13 participants aged 23-79 years. Two main themes emerged from the analysis: (1) simplifying the intensive care situation with specific minimization strategies and (2) attention to nonverbal communication., Conclusions: This study highlights the role of nurse-written ICU diaries in making the ICU environment more understandable and less intimidating for patients. Nurse-written ICU diaries contribute to improved communication and emotional support within the ICU environment. Further research is needed to explore these effects more fully and to assess the broader implications of ICU diaries on patient outcomes., Relevance to Clinical Practice: Nurse-written intensive care unit (ICU) diaries have a significant impact on both patient care and nursing practice in ICUs. ICU diaries serve as a crucial tool for enhancing communication, emotional support and empathetic care within these high-stress environments. By simplifying complex medical information and focusing on nonverbal communication, nurses can make the ICU experience more comprehensible and less intimidating for patients. This approach reduces patient anxiety and psychological stress while fostering a stronger nurse-patient relationship, ultimately improving care quality., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Moral sensitivity may play a role in dealing with ethical issues in ICUs. However, the moral sensitivity of adult ICU nurses in China and its predictors have not been well investigated., Aim: To analyse the moral sensitivity of intensive care unit (ICU) nurses and its predictors., Study Design: A cross-sectional study through convenience sampling was conducted in the ICUs of five hospitals in China between November and December 2022. A total of 331 ICU nurses were recruited. Data were obtained using a self-developed socio-demographic characteristic questionnaire, the Moral Sensitivity Questionnaire, the Jefferson Scale of Empathy-Health Professionals and the Organizational Climate Scale for Nursing. The participating institutions received a link to the tools used for online data collection, which they then forwarded to nursing staff., Results: The valid response rate was 96.98% (n = 321). The total mean moral sensitivity score of nurses was 43.04 ± 5.95. The mean scores for empathic ability and organizational climate for nursing were 91.97 ± 17.88 and 101.28 ± 14.77, respectively. Regression analyses revealed that the primary factors associated with moral sensitivity among critical care nurses included work tenure (p < .05), empathic ability (p < .001) and organizational climate (p < .001)., Conclusions: High levels of moral sensitivity were found in critical care nurses in China. Work tenure, empathic ability and organizational climate were significant predictors of moral sensitivity in critical care nurses., Relevance to Clinical Practice: To enhance the ethical sensitivity of ICU nurses, we suggest to strengthen the training of novice nurses so that they can better face the moral dilemma in clinical practice. In addition, organizational managers should also take measures to create a positive and harmonious working atmosphere, promote the application of moral knowledge in nursing practice and enhance their moral sensitivity., (© 2024 British Association of Critical Care Nurses.)

Background: Dysphagia, as a geriatric syndrome, is prevalent in the intensive care unit (ICU). Malnutrition resulting from swallowing disorders is likely to correlate with adverse ICU outcomes, including delirium, thereby escalating the costs of care and hospitalization. However, malnutrition has not received the attention it deserves in ICU clinical nursing practice. As two preventable and correctable conditions-malnutrition and delirium-the advantages of early identification and intervention are substantial. Exploring the relationship between malnutrition and delirium, starting from the high-risk group of elderly patients with swallowing difficulties in the ICU, will aid us in managing patients promptly and effectively., Aim: To investigate the relationship between malnutrition and the incidence of delirium in elderly patients with dysphagia in the ICU., Study Design: This is a retrospective study. Data for this study were obtained from the Medical Information Mart for Intensive Care-IV. All 2273 patients included were dysphagia older patients over 65 years of age admitted to the ICU, and logistic regression was used to explore the relationship between malnutrition and delirium. We also used propensity score matching (PSM) for sensitivity analysis., Results: Among the included patients with swallowing difficulties, 13% individuals (297/2273) exhibited malnutrition, with a delirium incidence rate of 55.9% (166/297). In the non-malnutrition group (1976/2273), the delirium incidence rate is 35.6% (704/1976). After adjusting for 31 covariates, multifactorial logistic regression showed that malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.47-2.62). The results remained stable after analysis by PSM., Conclusion: Malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU. Malnutrition should be given adequate attention in the ICU., Relevance to Clinical Practice: ICU nurses should pay particular attention to malnutrition, especially among the high-prevalence group of patients with dysphagia. Early identification and nutritional intervention for these patients may help reduce the costs of care and health care expenditures., (© 2024 British Association of Critical Care Nurses.)

Background: Ventilator-associated pneumonia (VAP) is a significant concern in low-middle-income countries (LMICs), where the burden of hospital-acquired infections is high, and resources are low. Evidence-based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs., Aim: This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines., Study Design: The review was conducted using Arksey and O'Malley's (2005) five-stage framework and the PRISMA-ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies., Results: After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities., Conclusions: This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC., Relevance to Clinical Practice: IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Since the outbreak of COVID-19, researchers worldwide have focused more on the issue of secondary traumatic stress (STS) experienced by nurses. This stress has an adverse effect on the health of nurses and the quality of nursing care, potentially undermining the stability of the nursing team and hindering the ability to meet the growing demand for nursing services. The impact of the COVID-19 pandemic, and the rise in global demand for ICU nursing, has placed a significant strain on ICU nurses, severely damaging their mental and physical health. Notably, ICU nurses also face high levels of moral distress, and moral resilience can effectively alleviate this distress and improve the quality of care., Aim: This study aimed to examine the levels of moral resilience and STS among ICU nurses, to explore their relationship and identify the factors influencing STS., Study Design: This cross-sectional study involved 229 ICU nurses from two tertiary hospitals in Xi'an, China, who participated between November and December 2023. The data were collected through email using anonymous electronic questionnaires, encompassing a self-designed demographic- and work-life-related characteristic questionnaire; the Rushton Moral Resilience Scale; and the Secondary Traumatic Stress Scale. Descriptive statistics, t-tests, analysis of variance and hierarchical regression analysis were performed to analyse the data., Results: The findings of the study indicated that ICU nurses' moral resilience and STS scores were at an intermediate level. Hierarchical regression analysis indicated that STS was negatively correlated with the subscales of the Rushton Moral Resilience Scale, specifically moral adversity coping (β, -0.156; 95% CI, -1.241 to -0.039) and relational integrity (β, -0.245; 95% CI, -1.453 to -0.388), which are significant predictors of STS. Additionally, good sleep quality (β, -.396; 95% CI, -14.948 to -7.117) and seeking psychological counselling because of work difficulties (β, .107; 95% CI, 0.237-9.624) emerged as significant predictors of STS among ICU nurses, with the model's explanation of the variance in STS increasing to 45.5%, △R 2  = .167, F = 16.482 (p < .001)., Conclusion: This study found that ICU nurses have moderate levels of moral resilience and STS, which are negatively correlated. This suggests that improving the moral resilience of ICU nurses may help reduce their STS levels., Relevance to Clinical Practice: The study revealed that ICU nurses' moral resilience and secondary traumatic stress levels were at a moderate level, indicative of the need to take measures to enhance their moral resilience and reduce their secondary traumatic stress, as their presence not only affects the health of ICU nurses but also diminishes the quality of care and increases turnover rates., (© 2024 British Association of Critical Care Nurses.)

Background: The surge in critically ill COVID-19 patients caused a shortage of intensive care unit (ICU) beds. Some hospitals temporarily transformed general wards into ICUs to meet this pressing health care demand., Aim: This study aims to evaluate and analyse the risk factors in temporary ICU from the perspective of nurses. By identifying these factors, the goal is to provide actionable insights and recommendations for effectively establishing and managing temporary ICUs in similar crisis scenarios in the future., Study Design: The study was conducted in China within a public hospital. Specifically, it focused on examining 62 nurses working in a temporary ICU that was converted from an infectious disease ward. The research utilized the Hazard Vulnerability Analysis (HVA) scoring method to identify potential threats, evaluate their probability, estimate their impact on specific organizations or regions and calculate the relative risk associated with such occurrences., Results: Staff demonstrated the highest risk percentage (32.74%), with Stuff (16.11%), Space (15.19%) and System (11.30%) following suit. The most critical risk factors included insufficient knowledge and decision-making competence in critical care (56.14%), lacking decision-making abilities and skills in renal replacement therapy care (55.37%), inadequate decision-making capacity and relevant skills in respiratory support care (50.64%), limited decision-making capability in circulatory support care (45.73%) and unfamiliarity with work procedures or systems (42.09%)., Conclusions: Urgent implementation of tailored training and support for temporary ICU nurses is paramount. Addressing capability and skill-related issues among these nurses supersedes resource availability, infrastructure, equipment and system considerations. Essential interventions must target challenges encompassing nurses' inability to perform critical treatment techniques autonomously and ensure standardized care. These measures are designed to heighten patient safety and elevate care quality during emergencies. These findings offer a viable avenue to mitigate potential moral distress, anxiety and depression among nurses, particularly those transitioning from non-critical care backgrounds. These nurses swiftly assimilate into temporary ICUs, and the study's insights offer practical guidance to alleviate their specific challenges., Relevance to Clinical Practice: The study on risk factors for converting traditional wards into temporary ICU during the COVID-19 pandemic, especially from the perspective of nurses, provides crucial insights into the challenges and requirements for effectively establishing and managing these emergency settings. The findings highlight several key areas of concern and opportunities for improvement directly related to clinical practice, particularly in situations where there is a rapid need to adapt to increased demands for critical care. By addressing the identified risk factors through enhanced training, support systems, resource management, process improvements and cultivating a culture of adaptability, not only can the quality of care in temporary ICUs be improved, but also can the health care system be better prepared for future emergencies. These actions will help mitigate the risks associated with such conversions, ultimately benefiting patient safety, staff well-being and the overall effectiveness of health care services in crises., (© 2024 British Association of Critical Care Nurses.)

Background: Intensive care unit (ICU) patients are at an increased risk of ocular surface injuries because of various factors such as reduced tear production and impaired protective mechanisms. Despite the significance of ocular care in ICU settings, there is a lack of consensus on effective interventions, leading to inadequate prevention of ocular surface disease (OSD)., Aim: This systematic review aimed to assess the effectiveness of nursing eye care in preventing OSD in ICU patients. Secondary objectives included identifying primary risk factors for ocular injuries and examining the most effective preventive methods., Study Design: A systematic review following PRISMA guidelines was conducted, encompassing a literature search, article selection, quality assessment and data synthesis. Studies meeting inclusion criteria were observational studies and clinical trials, focusing on adults admitted to ICUs under sedation and receiving mechanical ventilation., Results: Of 3545 initially identified articles, 12 studies met inclusion criteria. These studies involved a total of 1853 participants. Various interventions were assessed, including saline rinsing, lubricating drops, gel lubricants, occlusion with polyethylene dressing, passive blinking and eyelid closure with tape. Moist chamber occlusion every 6 h combined with gel lubrication emerged as the most effective method in preventing OSD., Conclusions: Gel lubrication along with moist chamber occlusion proved to be the most effective strategy in preventing ocular injuries in ICU patients. Conversely, the routine use of physiological saline was associated with increased severity of corneal lesions. Properly defined protocols and well-trained nursing teams are crucial for reducing ocular injuries in ICU settings., Relevance to Clinical Practice: The findings underscore the importance of implementing evidence-based eye care protocols in ICUs, emphasizing the use of gel lubrication and ocular surface protection to mitigate the risk of OSD. This highlights the need for comprehensive training programmes for ICU nursing staff to ensure optimal ocular care delivery., (© 2024 British Association of Critical Care Nurses.)

Background: During the COVID-19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life., Aim: This study aimed to investigate how piloting and watch over were revealed in end-of-life care for patients with COVID-19 in intensive care COVID-19., Study Design: A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi-structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed., Results: The findings are presented based on four categories: The road to the decision, End-of-life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end-of-life care of patients with COVID-19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end-of-life care., Conclusions: Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient., Relevance to Clinical Practice: Collaboration with family members is essential for the intensive care nurse to be able to provide a person-centred and dignified end-of-life care., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium., Aim: To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open-heart surgery., Study Design: A mixed-method sequential explanatory design. A non-probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed., Results: In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium., Conclusions: Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care., Relevance to Clinical Practice: Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in-service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high-quality care, thereby reducing the care burden of nurses., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The care processes of cardiac surgery patients are difficult, complex and stressful. Nurses, who have an important role in the care of these patients, may experience burnout or poor quality of work life may be affected because of difficult care processes, and professional difficulties., Aim: This study analysed burnout and quality of work life in cardiac surgery nurses., Study Design: This cross-sectional study was conducted with 68 nurses in the clinic and intensive care unit of a university hospital's cardiovascular surgery department. Clinical nurses care for inpatients in this department, while intensive care nurses care for patients in the intensive care unit. The 'Sociodemographic and Descriptive Characteristics of Nurses Form', 'Maslach Burnout Inventory' and 'Nursing Work Quality of Life Scale' were used to collect the data., Results: The mean score of emotional exhaustion sub-dimension of Maslach Burnout Inventory was 15.25 ± 5.08 (min: 7, max: 27), the mean score of the personal accomplishment sub-dimension was 17.48 ± 4.90 (min: 8, max: 27), and the mean score of depersonalization sub-dimension was 5.60 ± 2.70 (min: 0, max: 13). The mean scores of the emotional exhaustion sub-dimension (t: -2.380, p: .020, risk ratio [RR]: 1.67, confidence interval [CI]: [14.21, 18.82]) and the personal accomplishment sub-dimension (t: -2.604, p: .011, RR: 1.00, CI: [16.08, 19.92]) were higher in intensive care nurses. The mean total score of the nursing quality of work life scale was 107.20 ± 14.60 (min: 72, max: 149). A negative statistically significant relationship was found between the mean scores of emotional exhaustion (r: -0.243, p: .045) and depersonalization sub-dimension (r: -0.325, p: .007) of the Maslach Burnout Scale and the mean total score of the nursing quality of work life scale., Conclusion: In this study, it can be said that cardiac surgery nurses had moderate levels of emotional burnout, personal accomplishment and quality of work life, and low levels of depersonalization. At the same time, it can be seen that intensive care nurses have higher levels of emotional burnout. The increased emotional burnout and depersonalization in nurses decreased the quality of work life., Relevance to Clinical Practice: This study provided an understanding of burnout and quality of work life of cardiac surgery nurses. Strategies can be developed to reduce burnout and improve the quality of the work life of cardiac surgery nurses. Particular attention should be paid to intensive care nurses who experience more burnout on several sub-dimensions. This may be a good approach to improving the quality of patient care., (© 2024 British Association of Critical Care Nurses.)

Background: Hyperglycaemia is common in intensive care units (ICUs), with a prevalence of up to 86.2%, increasing mortality. Technology has evolved towards continuous glucose monitoring (CGM), and its use in ICUs began especially during the coronavirus pandemic (COVID-19). Various studies have evaluated the reliability of CGM, indicating that it is safe for use in critically ill patients., Aims: The aim of this study was to compare the use of CGM with point-of-care glucose (POC-G) testing in ICU. Specific objectives include evaluating the glycaemic control, the frequency of POC-G measurements, the incidence of hyperglycaemia, hypoglycaemia and morbidity and mortality at 90 days., Study Design: An experimental, controlled and randomized clinical trial with a single-blind design will be conducted at Hospital Clinic of Barcelona (HCB). A sample size of 376 participants will be recruited and randomly assigned to two groups: an experimental group, where glycaemic management will be based on CGM; and a control group, where glucose will be managed through POC-G testing, with a blinded CGM., Results: The primary variable considered will be time in range (TIR), with secondary outcomes including, time above range (TAR), time below range (TBR), number of POC-G measurements, incidence of hyperglycaemia and hypoglycaemia, and mortality. Hypothesis testing will use the Kolmogorov-Smirnov test to assess data normality, with appropriate statistical tests applied, considering a p-value <.05., Relevance to Clinical Practice: The results obtained will help us understand the impact of CGM on critically ill patients. CGM could potentially reduce the workload of nurses and improve the efficiency of decision-making by the ICU team, enabling early identification and treatment of glucose complications, thereby enhancing safety. Patient safety, a reduction in patient fingerstick and a decreased care burden are the criteria that add value to this research., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Nurses face a high level of mental workload while performing their duties. High levels of mental workload can negatively impact nurses., Aim: The aim of this research was to determine the relationship between mental workload and burnout levels of intensive care nurses., Study Design: Descriptive-correlational design has been adopted in this research. The sample consisted of 156 nurses working in the intensive care units of a hospital in the south of Turkey between September and December 2023. Research data were collected with the 'Participant Information Form', which includes socio-demographic characteristics, 'Mental Workload Scale' and 'Maslach Burnout Scale'., Results: Almost all (95.5%) of the nurses participating in the study reported that their mental workload was high. It has been determined that there is a strong positive relationship between mental workload and burnout. According to the regression model obtained from the research, being a woman (β = .165, p = .008) and emotional workload (β = -695, p < .001) are determinants of emotional exhaustion. These variables explain emotional exhaustion at a rate of 50.1% (adjusted R 2  = .501). Emotional workload (β = .399, p = .003) is the most important determinant of personal accomplishment. This variable explains 19.0% (adjusted R 2  = .190) of personal accomplishment. The most important determinant of depersonalization is emotional workload (β = .324, p < .001). It was determined that this variable explained 24.4% (adjusted R 2  = .244) of depersonalization., Conclusions: This research revealed that there is a strong positive relationship between mental workload and burnout and that increasing mental workload can increase burnout., Relevance to Clinical Practice: Nurses' risk of emotional exhaustion increases as mental workload increases. Reducing cognitive workload, temporary workload and emotional workload increases the personal accomplishment experienced by nurses. In addition, as temporary workload, emotional workload and performance-related workload increase, the depersonalization experienced by nurses also increases., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood., Aim: The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting., Study Design: A cross-sectional, multi-centre, survey-based study., Results: The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings., Conclusions: Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings., Relevance to Clinical Practice: This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes., (© 2024 British Association of Critical Care Nurses.)

Background: Nursing care dependency is a key, yet under-studied, nursing phenomenon. Patients in intensive care units are highly dependent on nursing care. Patients find dependency challenging, experiencing feelings of powerlessness and shame. The nurse-patient care relationship can influence patients' perception of dependency. Understanding how nurses experience their care for dependent patients is crucial, as nurses might not always grasp the impact of their actions on patients' dependency experiences., Aim: To explore and interpret ICU nurses' perceptions of patients' nursing care dependency and their experiences in caring for nursing care-dependent patients., Study Design: A qualitative interpretative phenomenological study inspired by Merleau-Ponty's philosophical stance was conducted using focus groups with nurses who had been caring for adult patients for at least 6 months in ICUs of two hospitals. Data analysis followed Smith et al.'s guidance. Researchers immersed themselves in the transcripts, noted individual's experiences before transitioning to shared insights, coded significant phrases and generated themes and superordinate themes., Results: Four focus groups were conducted with 18 nurses with widely ranging ages and work experience. Four superordinate themes emerged: 'Time and context define dependency', 'Empathetic relationships help nurses understand patients' experience of dependency', 'Trusting nurse-patient relationships change the dependency experience' and 'Nurses' skills help patients to recover independence'., Conclusion: This study increases critical care nurses' awareness of the overlooked phenomenon of caring for nursing care dependent patients and offers them an opportunity to reflect on their care for dependent patients and adapt it to patients' experiences. Further studies are needed with nurses and patients in different ICUs, cultures and countries, to gain a broader picture of experiences of nursing care dependency., Relevance to Clinical Practice: ICU nurses need strong relational skills to offer high-quality care for dependent patients, facilitating meaningful nurse-patient relationships based on empathy and trust. These relationships can significantly impact the patient's experience of dependence., (© 2024 British Association of Critical Care Nurses.)

Background: Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses., Aims: This study investigated nurses' experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium., Study Design: This cross-sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium-related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage., Results: A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1-5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium-related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium-related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium., Conclusions: Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium-related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced., Relevance to Clinical Practice: Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool., Aims: Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use., Study Design: A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect., Results: During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ 2  = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2])., Conclusion: The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial., Relevance to Clinical Practice: The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint., (© 2023 British Association of Critical Care Nurses.)

Background: Bleeding following cardiac surgery is common and serious, yet a gap persists in understanding how experienced intensive care nurses identify and respond to such complications., Aim: To describe the clinical decision-making of experienced intensive care unit nurses in addressing bleeding after cardiac surgery., Study Design: This qualitative study adopted the Recognition-Primed Decision Model as its theoretical framework. Thirty-nine experienced nurses from four adult intensive care units participated in semi-structured interviews based on the critical decision method. The interviews explored their clinical judgements and decisions in bleeding situations, and data were analysed through dimensional analysis, an alternative to grounded theory., Results: Participants maintained consistent vigilance towards post-cardiac surgery bleeding, recognizing it through a haemorrhagic dimension associated with blood loss and chest drainage and a hypovolemic dimension focusing on the repercussions of reduced blood volume. These dimensions organized their understanding of bleeding types (i.e., normal, medical, surgical, tamponade) and necessary actions. Their decision-making encompassed monitoring bleeding, identifying the cause, stopping the bleeding, stabilizing haemodynamic and supporting the patient and family. Participants also adapted their actions to specific circumstances, including local practices, professional autonomy, interprofessional dynamics and resource availability., Conclusions: Nurses' decision-making was shaped by their personal attributes, the patient's condition and contextual circumstances, underscoring their expertise and pivotal role in anticipating actions and adapting to diverse conditions. The concept of actionability emerged as the central dimension explaining their decision-making, defined as the capability to implement actions towards specific goals within the possibilities and constraints of a situation., Relevance to Clinical Practice: This study underscores the need for continual updates to care protocols to align with current evidence and for quality improvement initiatives to close existing practice gaps. Exploring the concept of actionability further, developing adaptability-focused educational programmes, and understanding decision-making intricacies are crucial for informing nursing education and decision-support systems., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Physical restraint is applied in pediatric intensive care units to carry out certain painful procedures and to ensure the maintenance and continuity of life support devices. There is a need to analyse the factors that influence the behaviour or intention to use physical restraint., Aim: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint., Study Design: A psychometric study. Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties., Results: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75., Conclusions: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs., Relevance for Clinical Practice: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research-based PR protocol to support decision-making for nurses, especially for neurocritical patients., Aim: This study developed a restraint decision tree for neurocritical patients (RDT-N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events., Study Design: This study employed a baseline and post-intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two-hundred and thirty-seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT-N. PR use and adverse events between the baseline and post-intervention periods were compared., Results: Post-intervention, total number of restrained patients decreased (20.7%-16.3%; χ 2  = 7.68, p = .006), and the average number of PR applied per restrained patient decreased (2.42-1.71; t = 5.74, p < .001). The most frequently used PR type changed from extremity cuff to mitten (χ 2  = 397.62, p < .001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high-risk group and 5.78 cases per 1000 patient days in the moderate-risk group; however, no URD cases were reported post-intervention., Conclusions: The RDT-N effectively reduced PR use and adverse events. Its application can enhance patient-centred care based on individual condition and potential risks in NCUs., Relevance to Clinical Practice: Nurses can use the RDT-N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events., (© 2024 British Association of Critical Care Nurses.)

Background: Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs., Aim: To assess the current practices of the ABCDEF care bundle as reported by ICU nurses., Study Design: A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members., Results: A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits., Conclusions: While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation., Relevance to Clinical Practice: Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom., Aim: To explore adult intensive care nurses' decision-making around the practice of GRV measurement to guide enteral feeding., Study Design: A cross-sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales., Results: Two hundred and seventy-three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4-6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision-making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%)., Conclusions: Factors affecting the nurses' decision-making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols., Relevance to Clinical Practice: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice., Aim: This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses., Study Design: This study adopted a mixed-methods approach., Methods: Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics., Results: Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training)., Conclusion: IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care., Relevance for Clinical Practice: The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The goal of health care systems is to ensure high quality of medical services provided, including patient safety. The intensive care unit (ICU) is an environment conducive to the occurrence of adverse events and medical errors because of the complexity of the care provided, the severity of the conditions of patients treated in these units and work often performed under stressful conditions., Aim: Assessment of attitudes of nurses working in ICUs towards patient safety., Study Design: A cross-sectional, descriptive study was conducted in a group of 214 nurses employed in ICUs in hospitals located in the southern part of Poland. The study used the Polish version of the Attitudes towards safety: (SAQ-SF PL) questionnaire and an original questionnaire consisting of questions on socio-demographic and professional data., Results: The overall SAQ score for the whole group was 61.89, 57.29 for adult ICU nurses and 68.20 for children's ICU. The surveyed nurses in general obtained the highest average results in terms of teamwork climate (TC)-66.92, while the lowest scores were given to the management-hospital management (PM)-45.08 and working conditions (WC)-57.56. job satisfaction (JS) positively correlated with the assessment of the TC, the assessment of the safety climate (SC), the assessment of the management staff (Head of Department) (PM), the assessment of the management staff (hospital management) (PM) and the assessment of work conditions (WC). A statistically significant, negative correlation was found between the assessment of JS and the assessment of stress recognition (SR) (r = -.20; p < .01)., Conclusions: In the surveyed ICU branches, there is a low SC, and it is related, among others, to the perception of WC and the role of the management staff. The level of JS among nursing staff mainly depends on the SC, the TC, WC and the support of the management staff., Relevance to Clinical Practice: The results of the research presented here provide valuable assistance in identifying areas related to patient safety in ICUs. Managers' awareness of the importance of coping with occupational stress, WC or effective teamwork can help to improve staff attitudes and attitudes towards patient safety. When shaping a safe culture in a health care organization, it is important to remember that ensuring safe patient care is not only about programmes, standards or procedures, but safety is primarily about human resources-the staff involved in the treatment process-doctors, nurses, paramedics and physiotherapists. High awareness of safety at work, cooperation in an interdisciplinary team, assessment of safety culture at work and analysis and drawing conclusions may result in a real increase in quality and safety, and the patient will feel safer in 'XX' hospitals., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The debriefing phase is the simulation phase where performance improves and learning occurs., Aim: This study examined the effects of the learning conversation (LC)-based, 3D (defusing, discovering and deepening) model-based and unstructured debriefing methods on satisfaction and debriefing experience after in-situ simulation among intensive care unit (ICU) nurses., Study Design: In this randomized controlled experimental study, three debriefing methods were compared, according to which 119 ICU nurses were divided into the following groups: LC group (n = 38), 3D group (n = 40) and control group (n = 41). In- situ simulation was performed with an intensive care patient scenario. p < .05 was considered statistically significant., Results: The total Debriefing Experience Scale-Experience with Debriefing part scores were 89.76 ± 8.10 in the LC group, 88.90 ± 8.70 in the 3D group and 88.29 ± 7.28 in the control group. No significant difference was found in debriefing experience and satisfaction between the groups (p > .05), but a significant difference was observed in the LC group. The groups showed a homogeneous distribution regarding participant characteristics., Conclusion: Debriefing experience and satisfaction do not differ between the methods., Relevance to Clinical Practice: Implementation of the simulation in the ICU in - situ with ICU nurses is beneficial in obtaining a fidelity experience. Performing the debriefing application after simulation in line with the model supports the International Nursing Association for Clinical Simulation and Learning (INACSL) debriefing standards., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: The cultural competence of nurses is crucial in providing nursing care for patients from different cultures. The absence of cultural competence can negatively impact the entire course of care; however, implementing cultural competence in critical care unit can be complicated., Aim: This study aimed to determine nurses' perceptions regarding cultural competence in critical care units., Study Design: This study used a qualitative design with semi-structured interviews with nurses (n = 10) working in critical unites. Data were collected from February to June 2022 and then categorized and evaluated. Atlas.ti was used for the inductive thematic content analysis., Results: Three key areas identified were as follows: (1) nurses and culturally competent care in critical care, (2) cultural challenges in practice and (3) suggestions for improving culturally competent care. The participants expressed that culturally competent care in critical care units has specific limitations because of the nature of the intensive care units (ICUs). Additional learning included opportunities to improve culturally competent care, such as raising cultural awareness, developing language skills and promoting culturally competent care., Conclusions: Providing culturally competent care in critical care units is an understudied area. Identifying barriers and cultural challenges is one strategy nurses can use to improve culturally competent ICU care., Relevance to Clinical Practice: Creating cultural awareness by training nurses in their own culture, in cultural diversity, and in overcoming prejudices and stereotypes is an essential step towards increasing cultural competence. Understanding nurses' perceptions on this topic can provide valuable insights into the challenges and opportunities for providing culturally sensitive care in a critical care setting., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Aim: The purpose of this systematic review was to determine the levels and influencing factors of mental workload in intensive care unit nurses., Background: Intensive care unit nurses have a high mental workload level. To our knowledge, no meta-analytic research investigating the levels of mental workload in intensive care unit nurses and related factors has yet been performed., Design: This article is a systematic review and meta-analysis., Methods: Eleven electronic databases were searched from the database setup dates until 31 December 2022. The research team independently conducted study selection, quality assessments, data extractions and analysis of all included studies. The PRISMA guideline was used to guide reportage of the systematic review and meta-analysis., Results: Seventeen studies were included. In these studies, the pooled mean score of mental workload was 68.07 (95%CI:64.39-71.75). Furthermore, subgroup analyses indicated that intensive care unit nurses' mental workload differed significantly by countries, sample size and publication year. The mental workload influential factors considered were demographic, work-related and psychological factors., Conclusion: Hospital administrators should develop interventions to reduce mental workload to enhance the mental health of intensive care unit nurses and nursing care quality. Hospital managers should pay attention to the mental health of nurses and guide them to correctly relieve occupational stress and reduce mental workload., (© 2023 John Wiley & Sons Australia, Ltd.)

Background: Healthcare workers are at high risk of developing occupational hand dermatitis (HD) due to their frequent exposure to wet-work and use of gloves. Complaints of HD may interfere with work and cause loss of work productivity, or sick leave, and may have impact on job pleasure and performing daily activities. The prevalence of HD among intensive care unit (ICU) nurses is unknown., Objectives: To investigate the point prevalence and the 1-year prevalence of HD among ICU nurses, and to determine the impact of HD on work and daily activities., Method: A questionnaire-based cross-sectional study was performed among ICU nurses. Participants were recruited in the Amsterdam University Medical Centre. A symptom-based questionnaire was used to determine HD and atopic predisposition, and an additional questionnaire was used concerning the influence of HD. ICU nurses with an atopic predisposition or symptoms suiting HD were invited for the hand dermatitis consultation hour (HDCH). Data were analysed with logistic regression., Results: A total of 184 ICU nurses were included. The point prevalence of HD was 9.8% (95% CI: 5.9-15.0) and the 1-year prevalence was 26.6% (95% CI: 20.4-33.6). Sick leave was reported by 0.5%. HD seemed to have more impact on job pleasure than on work productivity., Conclusion: The high prevalence rate of HD resulting from our study highlights the need for the prevention of occupational HD among healthcare workers., (© 2024 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.)

Background: No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses., Aim: We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables., Study Design: This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model., Results: Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, β = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, β = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, β = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R 2  = 0.350)., Conclusions: This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours., Relevance to Clinical Practice: Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Moral distress (MD) occurs when clinicians are constrained from taking what they believe to be ethically appropriate actions. When unattended, MD may result in moral injury and/or suffering. Literature surrounding how unit-based critical care nurse leaders address MD in practice is limited., Aim: The aim of this study was to explore how ICU nurse leaders recognize and address MD among their staff., Study Design: Qualitative descriptive with inductive thematic analysis., Results: Five ICU nurse leaders participated in a one-time individual interview. Interview results suggest that (1) ICU nurse leaders can recognize and address MD among their staff and (2) nurse leaders experience MD themselves, which may be exacerbated by their leadership role and responsibilities., Conclusions: Further research is needed to develop interventions aimed at addressing MD among nurse leaders and equipping nurse leaders with the skills to identify and address MD within their staff and themselves., Relevance to Clinical Practice: MD is an unavoidable phenomenon ICU nurse leaders are challenged with addressing in their day-to-day practice. As leaders, recognizing and addressing MD is a necessary task relating to mitigating burnout and turnover and addressing well-being among staff within the ICU., (© 2024 British Association of Critical Care Nurses.)

Background: War has always been a part of human life, and nurses are among the first people to attend to the battlefield alongside the soldiers. Nurses' experiences of being in war zones have long been of interest to researchers. In the conflicts in Syria, Iranian nurses have played a crucial role in saving the lives of many people., Aim: This qualitative study aims to explore the lived experience of Iranian critical care nurses deployed to battlefields in Syria between 2014 and 2020., Study Design: This qualitative study adopted a hermeneutic phenomenology approach using Van Manen's methodology. The data was obtained through semi-structured in-depth interviews with 15 nurses who experienced war zones. Purposive sampling was used and interviews with the participants were conducted at the agreed place. Interviews were recorded, wrote verbatim and analysed with MAXQDA10 software. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation., Results: The four main themes that emerged include 'blossoming of talents on the battlefield', 'capable nurses at war', 'nursing jihad' and 'mental preoccupations'. These themes include 12 subthemes and 32 primary subthemes that explain the meaning of Iranian nurses being in war zones in Syria., Conclusions: Nurses in the war zones of Syria gained valuable experiences of the blossoming of talents in themselves and others. The lived experiences of the nurses revealed that working in the war zones of Syria is a concept of nurses' capabilities. They considered being in the war zones of Syria as a form of nursing jihad. In spite of the many positive aspects of their experience, the nurses expressed their mental preoccupations during their deployment., Relevance to Clinical Practice: Nursing care in a war zone for the critically wounded is a unique experience. The experience and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders who are planning future deployments., (© 2023 British Association of Critical Care Nurses.)

Background: Intensive care units (ICUs) in China primarily focus on active rescue efforts, and it is not common to provide palliative care services within the ICU. As nurses play a primary role as caregivers for end-of-life patients in the ICU, it is necessary to explore the factors that impede or facilitate palliative care from their perspective., Aim: To explore the barriers and facilitators associated with implementing palliative care in Chinese adult ICUs from nurses' perspectives., Study Design: This study utilized a descriptive phenomenological research approach and purposive sampling to conduct face-to-face semi-structured interviews with nurses working in adult ICUs from three comprehensive hospitals in China during the period between February and May 2023. A total of 17 nurses were interviewed, and the collected data were transcribed, coded, and synthesized thematically., Results: Two themes of barriers and facilitators of palliative care in the Chinese adult ICU were extracted. The three sub-themes of hindering factors are as follows: (1) The influence of Chinese traditional culture. (2) The specificity of the ICU context. (3) Lacking sufficient attention in the ICU. The three sub-themes of the promoting factors are as follows: (1) Government and society value palliative care. (2) Patients and their families have palliative care needs. (3) Nurses view palliative care positively., Conclusion: Currently, integrating palliative care into the ICU may face challenges such as cultural factors, the specificity of the ICU context, and insufficient attention. However, it is worth noting that as the government and society place more emphasis on palliative care, more and more people are gradually paying attention to the palliative care needs of critically ill patients and their families., Relevance to Clinical Practice: This study serves as a reference for exploring an ICU palliative care service model that is suitable for China's national conditions, such as education and training, resource allocation, service processes, and the palliative care environment, among others., (© 2024 British Association of Critical Care Nurses.)

Background: Paediatric critical care (PCC) is a high-pressure working environment. Staff experience high levels of burnout, symptoms of post-traumatic stress, and moral distress., Aim: To understand challenges to workplace well-being in PCC to help inform the development of staff interventions to improve and maintain well-being., Study Design: The Enhanced Critical Incident Technique (ECIT) was used. ECIT encompasses semi-structured interviews and thematic analysis. We identified 'critical incidents', challenges to well-being, categorized them in a meaningful way, and identified factors which helped and hindered in those moments. Fifty-three nurses and doctors from a large UK quaternary PCC unit were consented to take part., Results: Themes generated are: Context of working in PCC, which examined staff's experiences of working in PCC generally and during COVID-19; Patient care and moral distress explored significant challenges to well-being faced by staff caring for increasingly complex and chronically ill patients; Teamwork and leadership demonstrated the importance of team-belonging and clear leadership; Changing workforce explored the impact of staffing shortages and the ageing workforce on well-being; and Satisfying basic human needs, which identified absences in basic requirements of food and rest., Conclusions: Staff's experiential accounts demonstrated a clear need for psychologically informed environments to enable the sharing of vulnerabilities, foster support, and maintain workplace well-being. Themes resonated with the self-determination theory and Maslow's hierarchy of needs, which outline requirements for fulfilment (self-actualization)., Relevance to Clinical Practice: Well-being interventions must be informed by psychological theory and evidence. Recommendations are flexible rostering, advanced communication training, psychologically-informed support, supervision/mentoring training, adequate accommodation and hot food. Investment is required to develop successful interventions to improve workplace well-being., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Two earthquakes of magnitude 7.7 and 7.6 occurred in the Turkish province of Kahramanmaraş in 2023. The earthquakes resulted in serious losses of life and property in 11 provinces, and the injured were transferred to other provinces for treatment and care. To date, no studies on the experiences of intensive care nurses providing care to earthquake victims after the Kahramanmaraş earthquake sequence have been identified., Aim: The aim of the present study is to explore the experiences of intensive care nurses providing care to earthquake victims who were transferred to other provinces., Study Design: A qualitative descriptive research design with conventional content analysis was used. Snowball sampling was used in the selection of intensive care nurses. Data saturation was achieved with 20 nurses. In-depth interviews were conducted with the participants through phone between March 8 and March 15, 2023. MAXQDA 20 software was used for data analysis. The COREQ checklist was used to guide the reporting of the study., Results: Twenty nurses were recruited. Four themes emerged from the data: challenges in caregiving processes; psychological challenges; ethical situations; urgent need for training and support., Conclusions: After the Kahramanmaraş earthquake sequence, described by some as the disaster of the century, nurses encountered patients with unique needs that they had never encountered before and tried to cope with the constantly changing health conditions. For this reason, they were affected psychologically and experienced challenges in caregiving processes., Relevance to Clinical Practice: Conducting comprehensive training for diseases common among earthquake victims, developing new protocols for providing care to earthquake victims, developing more action plans for nurses, and psychologically supporting intensive care nurses would facilitate the caregiving processes., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Backgorund: Conscience is a concept that is the foundation of nursing, guiding nurses to ethical practices, and helping them to provide the best professional care possible. Conscience enables nurses to be understanding and careful in patient care., Aim: The study had three aims: (1) to determine the level of conscientious intelligence and palliative care practice of intensive care nurses; (2) to determine the effect of sociodemographic and occupational variables on conscientious intelligence and palliative care practices; and (3) to examine the relationship between conscientious intelligence and palliative care practice., Methods: This study was designed as a descriptive-correlative study. The sample consisted of 157 nurses from a university hospital. The data were collected using questionnaire form, Conscientious Intelligence Scale and the Palliative Care Self-Reported Practices Scale between February and March 2021., Results: By the general multivariate linear model, while age, educational level, professional experience, total term of employment in the clinic, and training in palliative care were important predictors of palliative care practices, age and gender were significant predictors of conscientious intelligence. It was concluded that the level of palliative care practice of intensive care nurses with a high level of conscientiousness was also higher., Conclusion: The conscientious intelligence levels of intensive care nurses positively affected palliative care practices. It can be said that it is important for nurses to combine their conscience with their professional knowledge and skills while providing care services., Relevance to Clinical Practice: In the realm of nursing, it is imperative for professionals to not only possess knowledge and competence, but also to act with conscience when caring for patients. This study demonstrated that nurses with heightened conscientious awareness are more adept at providing palliative care. Consequently, it is vital to support practices and training that foster conscientiousness among nurses, who must exercise patience and diligence in their careers., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Caring for bereaved families is an important aspect of the nursing role in critical care. Memory making practices are one way in which dying, death and bereavement can be acknowledged and supported within critical care. Memory making was introduced into the care of stillborn babies and neonatal deaths to improve parents' experiences of bereavement, and has since become common practice in adult critical care., Aims: The aim of this qualitative thematic synthesis was to explore families' experiences of memory making in critical care, with a view of gaining greater understanding of the ways in which memory making impacts bereaved families., Methods: A systematic search strategy was developed, and five databases were searched (Medline, CINAHL, PsychINFO, Embase and ASSIA). Seven qualitative studies were included: four were conducted in adult and three in paediatric critical care settings in which memory making was initiated between 2014 and 2020. Memory making practices included, patient diaries, general keepsakes, word clouds and photography., Results: The thematic synthesis generated four main themes to describe families' experience of memory making in critical care: 'connection', 'compassion', 'engagement and creation' and 'continuation'., Conclusions: Memory making is a meaningful activity for families whose loved one dies in critical care; it brings focus and meaning during a devastating process in a highly technical environment. Families rely heavily on nursing staff for support and guidance. The creation of memories and/or keepsakes can have a positive impact on the bereavement experience for families and can facilitate a continuing bond with their loved one., Relevance to Clinical Practice: Memory making is a worthwhile practice to support and guide family bereavement within critical care. It can provide structure and purpose during an emotionally challenging transition, by supporting families to focus on a meaningful activity during a devasting time., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Using extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts., Aim: The study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses., Methods: Four focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis., Results: Unlike "miracle machine" stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end-of-life decision-making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment., Conclusion: The creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress., Relevance for Clinical Practice: The creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well-being and the quality of patient care in PICU/NICU., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Hospitals can improve how they learn from patient safety incidents. The Green Cross method, a proactive reporting and learning method, is one strategy to meet this challenge. In it, nurses play a key role. However, describing its impact on learning from the users' perspective is important., Aim: This study aimed to describe nurses' experiences of learning from patient safety incidents before and 3 months after implementing the Green Cross method in a postanaesthesia care unit., Study Design: A qualitative study with an inductive descriptive design with focus group interviews was conducted before and 3 months after implementing the Green Cross method to assess its impact. The data were analysed using qualitative content analysis. The study was conducted in a postanaesthesia care unit in a Norwegian hospital trust., Results: Before implementing the Green Cross method, participants indicated limited openness and learning, including the subcategories 'Lack of openness hampers learning', 'Adverse events were taken seriously' and 'Insufficient visible improvements'. After implementing the Green Cross method, participants indicated the emergence of a learning environment, including the subcategories 'Transparency increases learning', 'Increased patient safety awareness' and 'Committed to quality improvements'., Conclusions: Implementing the Green Cross method in a postanaesthesia care unit positively impacted openness and nurses' patient safety awareness, which is crucial for learning and improving quality., Relevance to Clinical Practice: The Green Cross method could be useful for organizational learning and facilitating learning from patient safety incidents through transparency, discussion and involvement of nursing staff., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Abstract Aim Despite remarkable theoretical evidence of positive outcomes of patient and family‐centred care, it is rarely performed in the intensive care setting. The aim of this review was to assess the barriers to patient and family‐centred care among healthcare providers, patients and family members in adult intensive care units. Design A systematic review of both qualitative and quantitative studies. Methods The search strategy sought for published peer‐reviewed research papers limited to English language from conception to 2018. The review protocol was registered in the CRD Prospero database (CRD42018086838). Literature search was carried out in four databases: EMBASE, Cochrane Library, PubMed and Scopus where keywords “barriers,” “patient and family centered care,” “patient‐centered care” and “intensive care unit” appeared in any part of the reference. Hand search of reference lists of identified papers was also done to capture all pertinent materials. Each study was assessed by three independent reviewers against the inclusion criteria. Evidence was graded according to sampling quality, quantity and measurement of intended outcomes. Screening of studies and citations resulted in seven studies that were included in the analysis. Results Barriers to patient and family‐centred care broadly fall under four categories; lack of understanding of what is needed to achieve patient and family‐centred care, organizational barriers, individual barriers and interdisciplinary barriers.

Background: Shortage and retention of experienced nurses are crucial matters and internationally acknowledged, particularly in specialty areas such as Critical Care., Aim: To explore the experiences of registered nurses in their first and fourth years of practice in an adult intensive care unit., Study Design: This descriptive phenomenological study was conducted over 4 years. Eligible participants were interviewed at two different points in their career. Ten registered nurses were interviewed after three to 6 months of employment in an adult intensive care unit (Phase One). Five of the same participants were interviewed in their fourth year of practice (Phase Two)., Findings: Findings related to factors influencing the participants' choice of specialty and their retention are reported in this paper. Two themes emerged from Phase One: a unique environment, positive and negative emotions, unclear expectations, and the journey of a registered nurse. Two themes generated from data collected in Phase Two included a unique environment and being a proficient nurse. In both phases, nurses considered the Intensive Care Unit a stimulating learning environment., Conclusions: This paper highlights that the registered nurse's perception of the Intensive Care Unit and Intensive Care Nursing influenced their choice of specialty, and learning opportunities influenced their decision to remain in the Intensive Care Unit., Relevance to Clinical Practice: The findings of this study inform action areas for healthcare organizations and nursing managers. Challenges, learning opportunities and the nature of critical care nursing should be considered target areas for organizations to promote and develop as part of critical care nurses' retention strategies. Education not only for new graduate nurses but also for all registered nurses should be ongoing., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background: Nurses are often the first responders to in-hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures., Aim: To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients., Study Design: A two-round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post-operative cardiac surgical patients., Results: The two rounds of the modified eDelphi generated 55 responses. A consensus of >80% agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre- and post-arrest phases reached consensus. In contrast, only 29% (n = 4/14) of items related to peri-arrest, and 36% of those related to nurse scope of practise in CALS arrest (n = 4/11) reached consensus., Conclusion: The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce., Relevance to Clinical Practise: Uncertainty about nurses 'roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)