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Background A multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses. Objectives The aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline. Methods Nurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers. Results Seventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [−3.1 (−5.8, −0.5); p = .022] and in the knowledge [−5.1 (−8.9, −1.3); p = .010] and attitudes [−3.9 (−7.3, −0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [−3.8 (−6.5, −1.1); p = .007] and in the knowledge [−6.9 (−11.0, –2.7); p = .001] and attitude [−4.3 (−8.1, –0.5); p = .027] subscale scores. Conclusions Using a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.

Objective To explore critical care clinicians’ knowledge, attitudes and perceptions toward early mobilization of critically ill patients in ICUs. Design A cross-sectional national survey was conducted. From January to August 2020, ICU nurses in 11 hospitals were surveyed by using a questionnaire on the knowledge, attitudes and perceptions of ICU early mobilization. Results Totally 512 nurses completed the questionnaire. The respondents’ mean score for knowledge of early mobilization was 6.89 ± 2.91. The level of knowledge was good in 2.5% (13/512), fair in 52.3% (268/512). The attitudes toward early mobilization were positive in 31.4% (161/512). In terms of perceived implementation of ICU early mobilization, 42.9% (220/512) of nurses did not believe that this should be a top priority in intensive care. The attitudes of nurses from different ICUs were significantly different (F = 3.58, P

The continuing rise in the incidence of multidrug-resistant organism infections has made combating this grave threat a national imperative. One of the most potent weapons in our arsenal against such organisms is the prudent use of antibiotics. Antimicrobial stewardship (AMS) programs aim to slow the development of antimicrobial resistance through judicious, monitored use of antibiotics. Traditionally, AMS programs have included pharmacists and physicians with training in AWS, infectious disease physicians, hospital leadership, microbiologists, and infection prevention professionals. Nurses are missing from AMS programs, especially intensive care nurses. Critical care nurses provide the majority of patient care to ICU patients and monitor the progress of the patient's condition. The ICU nurse is an obvious asset to the AMS programs. ICU nurses are well-educated autonomous professionals with a unique role in coordinating with the critical care team. Critical care nurses already perform numerous nursing tasks with AWS functions. This, together with their unique perspective makes them a valuable asset that has often been overlooked. Traditionally, perceived barriers have kept ICU nurses from joining AMS teams. By removing these barriers and engaging critical care nurses in the important work of AWS, we can strengthen our AMS team and achieve optimal outcomes for our patients.

Latar Belakang: Corona virus disease-19 (COVID-19) menjadi wabah dunia yang menimbulkan beban psikologis bagi masyarakat dan tenaga kesehatan yang memberikan perawatan pada pasien dengan COVID-19. Perawat ICU merupakan salah satu tenaga kesehatan yang menjadi garda terdepan pemberian asuhan keperawatan pada pasien. Tujuan: untuk mengeksplorasi dampak psikologis perawat ICU dimasa pandemi Covid-19. Metode Penelitian: Penelitian ini menggunakan pendekatan literature review dengan 3 database elektronik yaitu Pub Med, Science Direct dan Sage Pub, antara tahun 2019-2021. Kata kunci yang digunakan yaitu Dampak Psikologis, Efek Psikologis, Perawat ICU, COVID-19, dari 308 artikel yang diidentifikasi, 6 yang memenuhi inklusi. Artikel yang di review didapatkan dari hasil diskusi dan validasi antara peneliti dan pembimbing dengan menggunakan Prisma Guideline. Hasil: Berdasarkan hasil dari 6 artikel menunjukkan bahwa dampak psikologis perawat ICU di masa pendemi COVID-19 adalah kecemasan, depresi, gangguan stres pasca trauma dan gangguan tidur (insomnia). Kesimpulan: Didapatkan 4 dampak psikologis perawat ICU dimasa pandemi COVID-19, diakibatkan karena perasaan tidak didukung, kekhawatiran tentang kesehatan pribadi, takut membawa infeksi dan menularkannya kepada anggota keluarga atau orang lain, diisolasi, perasaan tidak pasti, stigmatisasi sosial, beban kerja yang berlebihan, dan merasa tidak aman ketika memberikan layanan perawatan dan kesehatan pada pasien COVID-19.

Li Hu,1,2 Wipa Sae-Sia,2 Luppana Kitrungrote2 1Breast Surgery Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China; 2Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, ThailandCorrespondence: Li Hu Email 13765156895@163.comBackground: Pressure injury (PI) remains a critical health issue worldwide. The global incidence of hospital-acquired PI is 8.4%, and among intensive-care unit (ICU) patients, it is even higher, ranging from 6.60% to 36.80%. It is important to investigate ICU nurses’ PI prevention knowledge, attitudes, and practices (KAP).Aim: The aim of this study was to describe the level of Chinese ICU nurses’ knowledge, attitudes, and self-reported practices of PI prevention.Materials and Methods: From March 31 to April 30, 2019, we recruited a total of 510 ICU nurses into the current study using convenience sampling. The Modified Pressure Ulcer Knowledge Assessment Tool version 2.0, Attitudes toward Pressure Ulcer Prevention instrument, and Questionnaire to evaluate nurses’ Adherence to Recommendations for Preventing Pressure Ulcers were used for data collection. We used one-way analysis of variance, Student’s t-test, and the Mann–Whitney U-test to assess differences in knowledge, attitudes, and self-reported practices of PI prevention among ICU nurses, whom we categorized by their demographic characteristics.Results: Mean scores of participants’ knowledge, attitude, and their self-report practice were 65.82 ± 9.29, 76.65 ± 8.62, and 83.35 ± 13.55, respectively. Participants with bachelor’s degrees or higher, who worked in tertiary hospitals, and who had received training on PI prevention over the last year had higher scored on PI prevention knowledge (all P < 0.05). Participants who had received training on PI prevention over the last year scored higher on attitude than those who had not received such training over the last year (P = 0.001).Conclusion: ICU nurses surveyed in this study did not demonstrate an acceptable level of knowledge about PI prevention, while their attitudes and self-reported practices were acceptable. Continuing education or in-service training should be provided to enhance ICU nurses’ knowledge of PI prevention.Keywords: intensive-care unit nurse, knowledge, attitude, practice, pressure injury prevention

Aim of the study: to investigate chest compression parameters by city hospital staff under simulated conditions with and without the use of a sensor device for quality control of chest compressions.Materials and Methods. The study was conducted in Moscow's multidisciplinary hospitals. The study included 359 medical staff members. The participants were divided into 4 groups: physicians (n=97) and nurses (n=82) from intensive care units (ICU) and physicians (n=92) and nurses (n=88) from specialized departments. Participants performed 2 minutes of chest compressions without a chest compressions quality control (CCQC) sensor, followed by 2 minutes of chest compressions using a defibrillator sensor with audiovisual prompts from the device turned on. The percentage of target compressions, rate and depth of compressions were analyzed.Results. Compression parameters in the group of ICU doctors were outside the reference range (% target compression — 0.5 (0.0; 14.5)%, rate 124.1±17.8 per minute, depth 5.6±1.1 cm), in the group of ICU nurses, the percentage of target compressions was 0.0 (0.0; 3.5)%, rate — 123.6±23.7 per minute, depth — 5.3±1.2 cm, in the group of specialist doctors the percentage of target compressions was 0.0 (0.0; 1.2) %, rate — 123.8±23.2 per minute, depth — 5.8±1.2 cm, in specialized nurses group the percentage of target compressions was 0.0 (0.0; 6.1)%, rate — 119.7±29.5 per minute, depth — 5.6±1.2 cm. There was a significant improvement in compression performance in all groups when the sensor device was used: in ICU physicians the percentage of target compressions was 81.6 (64.80; 87.90)%, rate — 124.1±17.8 per minute, depth — 5.5±0.2 cm; in ICU nurses the percentage of target compressions was 69.1 (47.4; 80.6), rate — 123.6±23.7 per minute, depth — 5.3±0.3 cm, in specialist doctors the percentage of target compressions was 69.30 (50.50; 78.70), rate — 123.8±23.2 per minute, depth — 5.4±0.3 cm, in specialized nurses the percentage of target compressions reached 63.70 (42.90; 75.80), rate — 119.7±29.5 per minute, depth — 5.4±0.3 cm. There were no differences in analysed compression parameters between staff in different departments or positions.Conclusion. Compression parameters (percentage of target compressions, rate, depth) were not influenced by the department where the staff member worked and the position held (doctor or nurse). The use of a compression quality sensor device has improved compression parameters by reducing rate and normalizing depth. The use of the sensor does not increase the percentage of target compressions to the maximum values, indicating the need for training by an instructor.

OBJECTIVE This study aimed to compare the use of the Turkish versions of the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) Score by intensive care nurses in neurological evaluation. MATERIALS AND METHODS This cross-sectional study was conducted between July 2018 and March 2019 with 92 patients in the general intensive care unit (ICU) of the training and research hospital of a private university. Data were collected using nurse and patient information forms, the GCS and the FOUR Score. The patients were evaluated by 27 intensive care nurses. To evaluate interrater reliability of the GCS and FOUR Score, each patient in the study was evaluated using both scales by two nurses who were blinded to each other's responses. RESULTS Comparison of the patients' mean GCS and FOUR Score values from the two nurses revealed no significant difference in subscale or total scores (p > 0.05). Evaluation of interrater reliability demonstrated very good agreement (κ = 0.935, p

Objectives The aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure. Subjects and methods A survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey. Results The majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate. Conclusions The results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.

ObjectivesThe purpose of this pilot descriptive survey was to evaluate occupation-related MSDs in nurses in the adult intensive care unit (ICU) compared to those in neonatal intensive care unit nurses (NICU).BackgroundNursing research has focused on heavy patient handling however; there is a gap in the literature that examines musculoskeletal disorders (MSDs) among neonatal intensive care nursesMethodsThe survey utilized Standardized Nordic Musculoskeletal Questionnaire. This survey was disseminated to members of Academy of Neonatal Nursing and the American Association of Critical Care Nurses. It was a convenience sample but with low response rate. The inclusion criteria consisted of critical care nurses working or have worked full time.ResultsA total of 38 responders completed the survey. General demographics among groups were similar. Risk factors for MSDs in each group were similar with the exception of a history of depression which was more common among NICU nurses, (p = .0052). Knee problems seem more common among adult ICU nurses, (p = .0002). Ankle/foot problems seem more common among NICU nurses, (p = .0202). Sixty-three percent of adult ICU nurses reported that MSDs were definitely related to work versus, 47.4% of NICU nurses.ConclusionBoth groups of nurses experienced MSDs, with adults experiencing lower extremity MSDs and NICU nurses experiencing upper extremity MSDs. These pilot results need to be interpreted with caution due to the small sample size. Depression, stress, and ethical dilemmas were more prevalent in the NICU nurses which may a contributing factor for MSDs Both groups expresses a need for additional staffing and a need for improving the quality of work/life issues.

Background Maintaining the patency of arterial catheters-routinely inserted in critically ill patients in intensive care units (ICUs)-is essential for obtaining physiological measurements and enabling blood sampling. Aim This study aims to evaluate current ICU nurse knowledge and practice of maintaining the patency of arterial catheters and explore the factors that influence nurses' knowledge level. Design This was a cross-sectional survey conducted in China. Methods This research was conducted in 20 tertiary hospitals in Beijing, China between March and June 2020. The data were collected by electronic questionnaire, which was designed in accordance with the literature and consisted of 28 questions. Descriptive and inferential statistics were used to analyse the data. Results A total of 576 completed questionnaires were returned. The mean score of nurses' knowledges was 3.66 ± 1.35, which is a moderate level. There was a statistically significant difference between the mean scores of nurses with different professional titles and work experiences (mean 3.58 vs 4.04/7; mean 3.50 vs 3.58 vs 3.94/7). Considering ICU nurses' practice of maintaining the patency of arterial catheters, 376(65.3%)nurses replaced the pressure transducer as per the manual, and 347 (60.2%) nurses zeroed the pressure transducer once per shift. More than 90% ICU nurses aligned the transducer with the heart surface marker during zeroing procedures. Furthermore, 79.9% of nurses performed fast-flush tests routinely, 459 (85.9%) nurses flushed the arterial catheter routinely, and 80% of nurses evaluated the patency of the arterial catheter every shift. Conclusions This study found that the practices of ICU nurses varied, and their knowledge of how to maintain the patency of arterial catheters was moderate and could be improved. ICU nurses should be trained effectively to develop a unified standard of arterial catheter management. Relevance to clinical practice Training programmes on arterial catheter management for ICU nurses are essential for improving knowledge and practice.

Background and Aim: Vigilance is an essential element in intensive care nursing. This study was conducted to determine nursing vigilance in nurses working in the intensive care units of educational and medical centers in Ardabil, Iran. Methods: This was a cross-sectional descriptive-analytical study with 192 ICU nurses as the participants. The data were obtained through questionnaires regarding demographic characteristics and nursing vigilance. SPSS software version 24 was used for the statistical analysis. Results: The mean total vigilance score was 3.86 ± 0.23 of 5. The mean scores of the timely diagnosis of changes, pattern recognition, and clinical decision-making subscales were 4.07 ± 0.26, 04.04 ± 0.41, and 3.44 ± 0.25, respectively. No significant relationships were observed between the total or subscale vigilance scores and other demographic characteristics. Conclusion: We assessed ICU nurses’ vigilance behaviors and found that their mean vigilance score was higher than the expected average, indicating our participants had a high level of clinical vigilance. These results suggest a need for effective educational interventions to boost clinical decision-making skills in ICU nurses, especially younger nurses.

Background Central line-associated bloodstream infections (CLABSI) are largely preventable when evidence-based guidelines are followed. However, it is not clear how well these guidelines are followed in intensive care units (ICUs) in China. This study aimed to evaluate Chinese ICU nurses’ knowledge and practice of evidence-based guidelines for prevention of CLABSIs issued by the Centers for Disease Control and Prevention, US and the Department of Health UK. Method Nurses completed online questionnaires regarding their knowledge and practice of evidence-based guidelines for the prevention of CLABSIs from June to July 2019. The questionnaire consisted of 11 questions, and a score of 1 was given for a correct answer (total score = 0–11). Results A total of 835 ICU nurses from at least 104 hospitals completed the questionnaires, and 777 were from hospitals in Guangdong Province. The mean score of 11 questions related to evidence-based guidelines for preventing CLABSIs was 4.02. Individual total scores were significantly associated with sex, length of time as an ICU nurse, educational level, professional title, establishment, hospital grade, and incidence of CLABSIs at the participant’s ICU. Importantly, only 43% of nurses reported always using maximum barrier precautions, 14% of nurses reported never using 2% chlorhexidine gluconate for antisepsis at the insertion site, only 40% reported prompt removal of the catheter when it was no longer necessary, and 33% reported frequently and routinely changing catheters even if there was no suspicion of a CLABSI. Conclusion Chinese ICU nurses in Guangdong Province lack of knowledge and practice of evidence-based guidelines for the prevention of CLABSIs. National health administrations should adopt policies to train ICU nurses to prevent CLABSIs.

This study reports objective measurements of lower extremity activity (amount of walking, standing, sitting) in nurses working in medical/surgical (M/S) and intensive care units (ICU), and explores nurses’ perceptions of nursing unit design impact on workload, lower extremity activity, and musculoskeletal discomfort. Nursing units are expanding in size, leading to nurses spending more time on their feet. Though limited in number, studies consistently report elevated prevalence of lower extremity discomfort/injury in nurses. This was a mixed method approach using physical activity measurement and semi-structured interviews of M/S and ICU nurses. Lower extremity discomfort was prevalent in the study participants. Time on feet and step counts differed between nursing units with different layouts. Average hours on feet ranged from 7.3 to 9.5 across units over 12-hour shifts. Nurses’ comments explained ways in which walking and standing activities were influenced by unit layout design and culture. Nurse leaders must advocate for unit designs that maximize patient safety, promote a culture of team spirit, and provide a physically safe working environment for staff.

Background Multi-drug intravenous (IV) therapy is one of the most common medical procedures used in intensive care units (ICUs), operating rooms, oncology wards and many other hospital departments worldwide. As drugs or their solvents are frequently chemically incompatible, many solutions must be administered through separate lumens. When the number of available lumens is too low to facilitate the safe administration of these solutions, additional (peripheral) IV catheters are often required, causing physical discomfort and increasing the risk for catheter related complications. Our objective was to develop and evaluate an algorithm designed to reduce the number of intravenous lumens required in multi-infusion settings by multiplexing the administration of various parenteral drugs and solutions. Methods A multiplex algorithm was developed that schedules the alternating IV administration of multiple incompatible IV solutions through a single lumen, taking compatibility-related, pharmacokinetic and pharmacodynamic constraints of the relevant drugs into account. The conventional scheduling procedure executed by ICU nurses was used for comparison. The number of lumens required by the conventional procedure (LCONV) and multiplex algorithm (LMX) were compared. Results We used data from 175,993 ICU drug combinations, with 2251 unique combinations received by 2715 consecutive ICU patients. The mean ± SD number of simultaneous IV solutions was 2.8 ± 1.6. In 27% of all drug combinations, and 61% of the unique combinations the multiplex algorithm required fewer lumens (p CONV, the reduction in number of lumens by the multiplex algorithm further increased (p 3 lm, versus 12% using the conventional procedure. Conclusion The multiplex algorithm addresses a major issue that occurs in ICUs, operating rooms, oncology wards, and many other hospital departments where several incompatible drugs are infused through a restricted number of lumens. The multiplex algorithm allows for more efficient use of IV lumens compared to the conventional multi-infusion strategy.

Purpose To describe the organizational characteristics of functional ICUs in Uganda. Methods A descriptive survey of 12 ICUs in Uganda; ICU organisation, structure, staffing, and support facilities. A functional ICU was defined as one that admitted critically ill patients and had the ability to provide mechanical ventilation. ICUs were selected based on information of their existence. Direct structured interviews were carried out with the ICU directors. Results Of the fourteen ICUs reviewed, 12 were functional, and a majority were located in the central region. There were 55 ICU beds making up a ratio of 1.3 ICU beds per million population. The ICU beds comprised 1.5 % of the total bed capacity of studied hospitals. Most of the ICUs [11] were mixed (paediatric-adults), anaesthesia-led (nine) and five operated in a closed model. There were 171 ICU nurses, of whom 13 had formal training in critical care nursing. The majority of the ICUs had a nurse to patient ratio ≥ 1.2; nine during the day and seven at night. Conclusions This study shows limited accessibility to critical care services in Uganda. With a high variability in the ICU operational characteristics, there is a need for standardization of ICU care in the country.

Co-administration of multiple intravenous (IV) medicines down the same lumen of an IV catheter is often necessary in the intensive care unit (ICU) while ensuring medicine compatibility. This study explores ICU nurses' views on the everyday practice surrounding co-administration of multiple IV medicines down the same lumen. Qualitative study using focus group interviews. Three focus groups were conducted with 20 ICU nurses across two hospitals in the Thames Valley Critical Care Network, England. Participants' experience of co-administration down the same lumen and means of assessing compatibility were explored. All focus groups were recorded, transcribed verbatim, and analysed using thematic analysis. Functional Resonance Analysis Method was used to provide a visual representation of the co-administration process. Two key themes were identified as essential during the process of co-administration, namely, venous access and resources. Most nurses described insufficient venous access and lack of compatibility data for commonly used medicines (eg, analgesics and antibiotics) as particular challenges. Strategies such as obtaining additional venous access, prioritizing infusions, and swapping line of infusion were used to manage IV administration problems where medicines were incompatible, or of unknown or variable compatibility. Nurses use several workarounds to manage commonly encountered medication compatibility problems that may lead to delays in therapy. Organizations should review and tailor compatibility resources towards commonly administered medicines using an interdisciplinary approach. Developing a clinical decision-making pathway to minimise variability while promoting safe co-administration practice should be prioritised. This study highlights several ways ICU nurses are able to manage challenges associated with co-administration and the need for the development of a more robust and comprehensive compatibility resource that is relevant to everyday practice through collaboration between nurses and pharmacists.

OBJECTIVE To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management. METHODS This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semistructured interviews. The content analysis method was used to analyze, summarize, and refine the interview data. RESULTS The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD. CONCLUSIONS The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.

Objective To explore the predictors of knowledge of pressure injury (PI) prevention, attitudes on PI prevention, organization support for PI prevention, and the influence of a healthy work environment (HWE) on PI prevention practices among ICU nurses in China. Methods A descriptive, predictive, online survey was conducted among 510 ICU nurses in Guizhou province, China. A PI prevention knowledge questionnaire, PI prevention attitude questionnaire, organizational support for PI prevention questionnaire, HWE assessment tool, and PI prevention practice questionnaire were used for data collection. A hierarchical regression analysis was used to determine the influence of certain predictive factors. Results An HWE, organizational support for PI prevention, and positive attitudes toward PI prevention were significant predictors of good practice regarding PI prevention. However, knowledge of PI prevention was not a significant predictor. Conclusions To achieve optimal nursing quality in terms of PI prevention, hospital and nursing administrators should develop strategies or interventions to create and sustain an HWE and supportive organizational culture for ICU nurses and enhance positive attitudes toward PI prevention.

Background Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses’ level of knowledge regarding chest drain care. Methods Anon-experimental descriptive design using cross-sectional survey was used for evaluating nurses’ knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion. Data was analysis using the Statistical Package for Social Sciences (SPSS) program. Results The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n = 134) followed by pleural effusion (6.3%, n = 10). The results revealed that the mean score for nurses’ knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n = 107 vs. 51.1%, n = 115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%). Nurses from private hospitals had significantly higher (M = 16, SD ± 2.77) level of knowledge (F[2, 222] = 8.467, p < .001) than nurses from other sectors. Conclusions Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended., Chest drain; Prevalence; ICU nurses; Knowledge; Jordan.

Introduction: The Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) was derived from the original CPOT to assess pain in brain-injured patients in the adult intensive care unit (ICU). Objective: This study aimed to describe the nurses’ evaluations of the feasibility and clinical utility of the use of the French and English versions of the CPOT-Neuro in critically ill brain-injured adults. Methods: Fifty-nine ICU nurses from two university affiliated trauma centres (Montreal, Canada) were trained to use the CPOT-Neuro. Those who used it at the bedside during the study were invited to complete a self-administered questionnaire about its feasibility and clinical utility. Results: Twenty-seven of the trained ICU nurses (46 %) used the CPOT-Neuro during the study and completed the questionnaire. Feasibility: All nurses agreed that the training duration was sufficient, that the directives of use were clear, and that the tool content was simple to understand. Some nurses disagreed that the tool was quick to use (11.1 %), and easy to complete (7.7 %). Clinical utility: The tool was found useful by most nurses, but some of them disagreed that it was helpful for practice (7.7 %), that it influenced their practice (15.4 %) and that they would recommend it routinely (11.1 %). Responses did not differ between nurses from the two trauma centres who used either the French or the English version of the CPOT-Neuro (Mann-Whitney U tests, p>.05). Discussion and conclusion: The CPOT-Neuro was found to be feasible and useful by ICU nurses. Its implementation into daily practice could optimize pain assessment in critically ill brain-injured patients., Introduction : Le Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro) a été élaboré à partir du CPOT original pour évaluer la douleur chez des patients adultes cérébrolésés à l’unité de soins intensifs. Objectif : Cette étude visait à décrire les évaluations des infirmières sur la faisabilité et l’utilité clinique de l’utilisation du CPOT-Neuro pour évaluer la douleur chez les adultes cérébrolésés à l’unité de soins intensifs. Méthodes : Cinquante-neuf infirmières de deux centres universitaires de traumatologie (Montréal, Canada) ont été formées à l’utilisation du CPOT-Neuro. Les infirmières ayant utilisé l’outil lors de l’étude ont été invitées à compléter un questionnaire auto-administré sur sa faisabilité et son utilité clinique. Résultats : Vingt-sept infirmières (46 %) formées ont utilisé le CPOT-Neuro durant l’étude et complété le questionnaire. Faisabilité : Toutes les infirmières ont jugé la durée de la formation suffisante, les directives d’utilisation claires et le contenu de l’outil simple à comprendre. Toutefois certaines d’entre elles n’étaient pas d’accord que l’outil soit rapide à utiliser (11,1 %) et facile à compléter (7,7 %). Utilité clinique : La majorité des infirmières ont trouvé l’outil utile, mais certaines n’étaient pas d’accord quant à son utilité pour la pratique (7,7 %), que l’outil avait influencé leur pratique et qu’elles en recommanderaient l’utilisation systématique (11,1 %). Les réponses ne différaient pas entre les infirmières des deux centres de traumatologie utilisant la version française ou anglaise du CPOT-Neuro (tests U de Mann-Whitney, p>,05). Discussion et conclusion : La faisabilité et l’utilité clinique du CPOT-Neuro ont été évaluées positivement par les infirmières. Son implantation dans la pratique clinique pourrait optimiser l’évaluation de la douleur des patient cérébrolésés à l’unité de soins intensifs.

Introduction: Staff nurses are exposed to many blood and other fluids in the course of their day to day activities in Intensive Care Unit. Purpose of this survey is to assess the level of knowledge, attitudes and practices of standard precaution among nurses in Intensive Care unit, in Middle East Hospital. Method: This was a cross-sectional study and undertaken among nurses by self-administered and anonymous questionnaire that randomly selected in Intensive Care Unit, Middle East Hospital. Results: Female nurses accounted for majority of the respondents which covered 66.7% (n = 44) while male nurses make up around 33.3% (n = 22) of the nursing workforce in the study. 53% (n = 35) of the respondents reported not having any basic exposure or training in infection control practices, while the other 47% (n = 31) respondents received their training or basic exposure in infection control practices. Majority of the participants had high level of knowledge. Conclusion: In accordance to the self-reported questionnaires, 77% (n = 51) of the respondents practice good practices of standard precaution. The knowledge, attitude and compliance among ICU nurses in the middle-east hospital towards standard precaution was adequate.

Assessment is the initial nursing process. In the nursing assessment obtained information about patient data used as a baseline and determine the next stage. Patients in intensive rooms with ventilators often received nursing actions that cause pain. Pain assessment in patients using ventilators must use special assessment techniques. Patients with ventilators require standardized assessment methods because they cannot communicate the pain they feel verbally. Payen in 2001 developed the Behavioral Pain Scale (BPS). Critical patients who are fitted with ventilators need a systematic and consistent assessment of pain. Understanding is the ability to explain correctly and in detail about something. Before performing an action properly one needs to understand the action. This study aimed to determine the experience and understanding of ICU nurses about pain assessment using BPS at M Yunus Bengkulu General Hospital. This study used the qualitative study that focus on disclosing nurses' understanding of pain assessment using BPS. Themes that emerged in this study were 1. use BPS, 2. Three items in the BPS assessment, 3. Indicators assessing pain, 4. Maximum minimum scoring, 5. Range of pain values. Nurse’s understanding about BPS was very necessary.

Background:The effectiveness of alcohol-based hand rub (ABHR) is correlated with drying time, which depends on the volume applied. Evidence suggests that there is considerable variation in the amount of ABHR used by healthcare providers.Objective:We sought to identify the volume of ABHR preferred for use by nurses.Methods:A prospective observation study was performed in 8 units at a tertiary-care hospital. Nurses were provided pocket-sized ABHR bottles with caps to record each bottle opening. Nurses were instructed to use the volume of ABHR they felt was best. The average ABHR volume used per hand hygiene event was calculated using cap data and changes in bottle mass.Results:In total, 53 nurses participated and 140 nurse shifts were analyzed. The average ABHR dose was 1.09 mL. This value was greater for non-ICU nurses (1.18 mL) than ICU nurses (0.96 mL), but this difference was not significant. We detected no significant association between hand surface area and preferred average dose volume. The ABHR dose volume was 0.006 mL less per use as the number of applications per shift increased (P = .007).Conclusions:The average dose of ABHR used was similar to the dose provided by the hospital’s automated dispensers, which deliver 1.1 mL per dose. The volume of ABHR dose was inversely correlated with the number of applications of ABHR per shift and was not correlated with hand size. Further research to understand differences and drivers of ABHR volume preferences and whether automated ABHR dosing may create a risk for people with larger hands is warranted.

Background: Occupational stress can have seriously negative effects on the physical, psychological, and economic dimensions of nurses working in the intensive care units (ICUs). Objectives: Thus, this study was conducted to determine occupational stress in nurses who work in ICUs. Methods: This cross-sectional study was carried out on 120 nurses in three hospitals in Kerman, southeastern Iran. Data were gathered by Socio-Demographic Information and Osipow Occupational Stress questionnaires. Results: The mean of occupational stress and all its constructs were at the moderate-high level. The highest mean score was related to role overload (37.11±3.63) while the lowest mean score belonged to role boundary (30.32±3.66). No statistically significant differences were found between the mean of occupational stress and participants’ characteristics. Conclusion: Considering the moderate-high level of occupational stress in ICU nurses, we recommend hospital authorities to take appropriate measures to prevent and manage stressors in ICU nurses to improve the quality of care and patients’ satisfaction

Research problem/aim: There are many factors in ICU that prevent nurse-patient communication. These can be classified as environmental, personal and the obstacles related to nurses and work environment. In this study, it is aimed to determine the factors that affecting third level ICU nurses’communication with their patients.Method: The study was conducted with 47 ICU nurses who were working in state hospital and volunteered to participate in to this study. SPSS 22.0 package program was used for statistical analysis.Findings: 97.9% of the nurses reported that establishing communication with the patient contributes to the process of treatment and recovery and 93.6% of the nurses stated using non-verbal communication technques in their communication with their patients. The nurses reported having difficulty with the unconscious patients.Conclusions: It was determined that factors related to patients and their relatives, ICU and factors related to nurses influence the communication of nurses with their patients. ÖzetAraştırma problem/amaç: Yoğun Bakım Ünitelerinde (YBÜ) hasta-hemşire iletişiminin sağlıklı bir biçimde yürütülmesini engelleyen pek çok faktör vardır. Bunlar; çevresel, bireysel, çalışan hemşireler veya çalışma ortamı ile ilişkili olabilir. Bu çalışmanın amacı; bir üçüncü basamak yoğun bakım ünitesinde görev yapan hemşirelerin hastalar ile iletişimini etkileyen faktörlerin belirlenmesidir.Method: Araştırma bir devlet hastanesinin üçüncü basamak yoğun bakım ünitesinde çalışan 47 hemşire ile gerçekleştirilmiştir. Verilerin analizinde SPSS 22.0 paket program kullanılmış, tanımlayıcı veriler sayı ve yüzde olarak verilmiş, istatistiksel analizlerde Kruskall Walli, Mann Whitney U testi, Sperman korelasyonu kullanılmıştır.Bulgular: Hemşirelerin %97.9’u hasta ile iletişim tedavi ve iyileşme sürecine katkıda bulunduğuna inandığını belirtmiş, %93.6’sı iletişim kurarken sözel olmayan iletişim yöntemlerini kullandıklarını ifade etmişlerdir. Yoğun bakım ünitesinde çalışan hemşirelerin iletişimde en fazla güçlük yaşadıkları hasta grubu bilinci kapalı olan hastalardır.Sonuçlar: Çalışmada hemşirelerin hasta iletişiminde hasta ve hasta yakınları, YBÜ’ne ve hemşirlerle ilişkin bazı özelliklerden etkilendiği belirlenmiştir.

Background Nurses can be exposed to hundreds of alarms during their shift, contributing to alarm fatigue. Purpose The purposes were to explore similarities and differences in perceptions of clinical alarms by labor nurses caring for generally healthy women compared with perceptions of adult intensive care unit (ICU) and neonatal ICU nurses caring for critically ill patients and to seek nurses' suggestions for potential improvements. Methods Nurses were asked via focus groups about the utility of clinical alarms from medical devices. Results There was consensus that false alarms and too many devices generating alarms contributed to alarm fatigue, and most alarms lacked clinical relevance. Nurses identified certain types of alarms that they responded to immediately, but the vast majority of the alarms did not contribute to their clinical assessment or planned nursing care. Conclusions Monitoring only those patients who need it and only those physiologic values that are warranted, based on patient condition, may decrease alarm burden.

Background The exponential spread of COVID-19 has caused a huge threat to public health worldwide. Providing care for patients with COVID-19 is a stressful experience for ICU nurses, which can affect their protective reactions. The present study was conducted to explore the protective reactions of ICU nurses providing care for patients with COVID-19. Methods This qualitative descriptive study was conducted to discover the protective reactions of nurses providing care for patients with COVID-19. A total of 14 ICU nurses were selected by purposive sampling. Data were collected using individual semi-structured face-to-face interviews. All interviews were recorded, and then codes and themes were extracted using content analysis method. Finding Seventeen subcategories, six categories and two themes were extracted from the analysis of data. These themes include “Unbalanced self-protective reactions” and “Responsible self-protective reactions”. Conclusion During the COVID-19 epidemic and crisis, ICU nurses exhibit different self-protective reactions when providing care for patients with COVID-19, which include unbalanced and responsible reactions. Nursing managers can mitigate these unbalanced reactions by identifying them and their roots. Identifying the protective reactions of ICU nurses in providing care for patients with COVID-19 could assist in developing the necessary interventions to promote positive reactions and reduce unbalanced reactions by finding their root causes.

Purpose: This study aims to compare the perceptions of nurses and families on the needs of the relatives of the patients in Intensive Care Unit (ICU). Methods This cross-sectional study was conducted in the ICU of a university hospital. The study comprised 213 critical care patients’ relatives and 54 nurses working in the same ICU. Data were collected using the Turkish version of Critical Care Family Needs Inventory (CCFNI) and a questionnaire on the characteristics of the participants. The difference between the perceptions of families and nurses was analyzed using Student t-test. Results: CCFNI’s assurance/proximity subscale mean scores ranked first among bothpatients and nurses. The item “To be assured the best care possible is being given to the patient” was the top priority for both groups. Mean assurance/proximity and information dimensions of relatives were significantly higher compared to nurses (p p Conclusion The needs of the relatives of patients are underestimated by nurses. This inhibited the performance of ICU nurses in line with the holistic care approach. Educational objectives that include the needs of ICU patients’ relatives should be incorporated into the undergraduate and in-service training of nurses. Policies should be established to create space and time for effective relative-nurse communication.

Delirium is a critical issue in the intensive care unit (ICU), and the correct diagnosis and treatment of this disorder by the ICU team are doubtful on many occasions due to a lack of information. This research is intended to test the awareness and control of ICU delirium by the ICU nurses. A nonexperimental, quantitative, descriptive, cross-sectional study was conducted using a previously adopted and translated to Arabic and validated questionnaire. The sample include nurses who work in ICUs of 10 Palestinian hospitals (private and public) located in the West Bank and Jerusalem participated in this study; each gave consent to be part of this study. Approval was received from the Palestinian Ministry of Health and the Ethical Committee at Birzeit University. Version 19 of the Social Sciences Statistical Package (SPSS) software was used to analyze the data. The results showed that ICU nurses hold moderate to low levels of knowledge and lack of adequate clinical experience to handle delirium. Delirium is a common complication in the ICU that increases morbidity and mortality and increases the length of ICU stay, therefore the cost of health care rise and the quality of life is decreased. In clinical practice, there are no assessment guidelines and protocols for patients with delirium.

The primary object of this study is to analyze the different patterns of medication administration in a medical intensive care unit (MICU) using an electronic medical record (EMR) log data and how these patterns can be different inside and outside the patient room in terms of average process time. To analyze ICU nurses’ workflow related to the EMR documentation, the real-time measurement system (RTMS) data was used, and multiple hierarchical task analysis (HTA) charts were developed. The results revealed that there was no significant different pattern between the medication administration inside and outside the patient room. However, we found a significant difference in medication administration’s average process time between inside and outside the patient room. The findings of this study highlight the behavioral differences in performing medication administration in an ICU.

Few patients are as helpless and totally dependent on nursing as long-term intensive care (ICU) patients. How the ICU nurse relates to the patient is crucial, both concerning the patients’ mental and physical health and well-being. Even if nurses provide evidence-based care in the form of minimum sedation, early mobilization, and attempts at spontaneous breathing during weaning, the patient may not have the strength, courage, and willpower to comply. Interestingly, several elements of human connectedness have shown a positive influence on patient outcomes. Thus, a shift from technical nursing toward an increased focus on patient understanding and greater patient and family involvement in ICU treatment and care is suggested. Accordingly, a holistic view including the lived experiences of ICU care from the perspectives of patients, family members, and ICU nurses is required in ICU care as well as research.Considerable research has been devoted to long-term ICU patients’ experiences from their ICU stays. However, less attention has been paid to salutogenic resources which are essential in supporting long-term ICU patients’ inner strength and existential will to keep on living. A theory of salutogenic ICU nursing is highly welcome. Therefore, this chapter draws on empirical data from three large qualitative studies in the development of a tentative theory of salutogenic ICU nursing care. From the perspective of former long-term ICU patients, their family members, and ICU nurses, this chapter provides insights into how salutogenic ICU nursing care can support and facilitate ICU patients’ existential will to keep on living, and thus promoting their health, survival, and well-being. In a salutogenic perspective on health, the ICU patient pathway along the ease/dis-ease continuum reveals three stages; (1) The breaking point, (2) In between, and (3) Never in my mind to give up. The tentative theory of salutogenic long-term ICU nursing care includes five main concepts: (1) the long-term ICU patient pathway (along the salutogenic health continuum), (2) the patient’s inner strength and willpower, (3) salutogenic ICU nursing care (4), family care, and (5) pull and push. The salutogenic concepts of inner strength, meaning, connectedness, hope, willpower, and coping are of vital importance and form the essence of salutogenic long-term ICU nursing care.

BACKGROUND Intensive care nurses play an important role in the management of critically ill patients including identification of cardiac arrhythmias. Interventions to improve arrhythmia identification can be expensive, time-consuming, and are not always successful. AIMS This study aimed to explore the effectiveness of using short message service (SMS) messaging to improve intensive care nurses' cardiac arrhythmia interpretation skills. DESIGN This study was a prospective, two-group, assessor-blinded, randomized controlled trial with a pretest-posttest experimental design. METHODS The study was conducted from February 2020 to February 2021 for the intervention as well as the control group, in a teaching hospital in northwest Turkey. The intervention group was sent the one-way SMS messages on cardiac arrhythmias via WhatsApp during an 8-week period, whereas the control group did not receive any intervention. The Cardiac arrhythmias assessment questionnaire (CAAQ) was used to measure outcomes. The data were analysed using ANCOVA and an independent t-test. RESULTS A total of 66 intensive care nurses were randomly assigned to either the intervention or the control group. The ANCOVA analysis indicated that ICU nurses who received SMS messages about cardiac arrhythmias two times a week had significantly increased CAAQ scores (P

ObjectiveTo identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.DesignQualitative study.SettingTwo Dutch tertiary centres.Participants19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.ResultsThree themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.ConclusionsInterviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.

Objectives To examine the effect of motivational messages on optimism, hopelessness, and life satisfaction of intensive care nurses during the COVID-19 pandemic. Study Design This is a multicenter, randomized controlled, open-label study. Research Methodology/Design The study was conducted with a total of 87 nurses working in the COVID-19 intensive care units of three hospitals in Istanbul. Motivational messages were sent via SMS to the participants in the motivational group (n=41) for 21 days. The data were obtained using a Personal Information Form, the Life Orientation Test, Beck Hopelessness Scale, and the Satisfaction with Life Scale. Results The nurses’ mean age in the motivational and control groups was 28.4±7.6 and 26.9±3.7 years, respectively. Before the messages, no statistically significant difference was found between the two groups in terms of life orientation (p=0.059), hopelessness (p=0.214), and satisfaction with life (p=0.898) scores. After the messages, life orientation (p=0.042) and life satisfaction (p=0.040) scores were significantly higher in the motivational group compared with the control group, and the hopelessness score was significantly lower (p=0.005). Conclusion According to our study, motivational messages sent to intensive care nurses during the pandemic increased their level of optimism and life satisfaction and decreased their level of hopelessness. Trial registration: blinded for review

BACKGROUND The SBAR (situation, background, assessment, and recommendation) is a standardized handover tool that has been utilized in health care settings. It has positive impacts on staff communication and patient quality of care. In Jordan, few reports are available about handover tools' impacts. PURPOSE To evaluate the implementation of the SBAR among nurses in intensive care units (ICUs) in Jordan. METHODS A pretest-posttest quasi-experimental design was used. A convenience sample of 71 ICU nurses participated. The 43-item ICU physician-nurse questionnaire was used to measure SBAR effectiveness as measured by the following subscales: general relationship and communication, teamwork and leadership, and job satisfaction. RESULTS There was a significant improvement in posttest knowledge scores and in "general relationships and communication" and "satisfaction" scores. There was a significant improvement in both "general relationships and communication" and "satisfaction" posttest scores compared with their pretest scores (t = 16.709, 2.656; P < .001, P < .01) consecutively. CONCLUSIONS This study revealed a strong indicator to encourage the SBAR utilization among nurses in health care settings. The SBAR has a positive impact on enhancing communication between nurses and increasing their job satisfaction. Thus, the utilization of such a standardized tool that maintains and assures good communication relationships shall increase level of satisfaction. Future studies are recommended to provide further evidence on its feasibility and efficacy as compared with traditional handover tools and among different health care contexts.

Ventilator associated pneumonia (VAP) is the most common nosocomial infection acquired by patients in an intensive care unit (ICU). However, there is scarce clinical data, particularly from Pakistani ICUs, regarding existing practices to prevent it.

Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.

Background: The purpose of this study was conducted to evaluate the knowledge, attitude, and practice of intensive care unit (ICU) nurses about oral and dental care in hospitalized patients. Materials and Methods: In this descriptive-analytic study, the statistical population included 214 nurses working in the ICU of the affiliated hospitals of Isfahan University in 1394. The level of knowledge, attitude, and practice of ICU nurses was assessed using questionnaires whose justifiability and stability were verified at the beginning of the study with a pilot study. Data were entered into SPSS software and tested by t-test, Spearman, one-way variance, and least significant difference test. The significance level was < 0.05. Results: The data of this study showed that the score of knowledge and performance in male nurses was significantly different from female nurses. There was a significant relationship between nurse's education and their knowledge score (P < 0.001). Furthermore, the performance score of nurses working in different parts was different too (P < 0.001). Conclusion: The findings showed that the knowledge and performance of female nurses about oral care were higher than men, but the attitude of the two sexes is almost the same. Nurses with lower educational degree had less knowledge, but their attitude and performance did not differ. The performance score of nurses working in ICU was different, but they had similar knowledge and attitudes.

Introduction: Safe and aseptic endotracheal suctioning has been a major health challenge in ICU setting, Endotracheal suction is a procedure to insert a suction catheter into the endotracheal tube to remove the secretion. Where endotracheal tube suctioning is essential for a patient with mechanical ventilation to keep their airway clean and infection free, it has also been associated with some adverse effect like hypoxia and ventilator associated pneumonia.in this regard ICU nurses knowledge and competences should be according to set criteria of ETT suctioning procedure. Methods: Target population of this study was ICU nurses of one of the children hospital, Lahore. Sample size was 98. Results: The findings of this research was beyond our expectation as nurses practices was good and their knowledge was fair. Conclusions: This study gives an overview of the ICU nurses knowledge and performance related to ETT suctioning and demonstrates that intensive care nurses' performance regarding endotracheal suctioning is good enough despite fair knowledge. With concerning to these finding there is a need for educational courses, especially theoretical education and motivational session to follow the standard protocol for ETT suction. Keywords: Pediatric, ICU, Knowledge, Performance DOI: 10.7176/JHMN/73-09 Publication date: April 30 th 2020

Objectives To assess the capacity of intensive care units (ICUs) in Australia to respond to the expected increase in demand associated with COVID-19. Design Analysis of Australian and New Zealand Intensive Care Society (ANZICS) registry data, supplemented by an ICU surge capability survey and veterinary facilities survey (both March 2020). Settings All Australian ICUs and veterinary facilities. Main outcome measures Baseline numbers of ICU beds, ventilators, dialysis machines, extracorporeal membrane oxygenation machines, intravenous infusion pumps, and staff (senior medical staff, registered nurses); incremental capability to increase capacity (surge) by increasing ICU bed numbers; ventilator-to-bed ratios; number of ventilators in veterinary facilities. Results The 191 ICUs in Australia provide 2378 intensive care beds during baseline activity (9.3 ICU beds per 100 000 population). Of the 175 ICUs that responded to the surge survey (with 2228 intensive care beds), a maximal surge would add an additional 4258 intensive care beds (191% increase) and 2631 invasive ventilators (120% increase). This surge would require additional staffing of as many as 4092 senior doctors (245% increase over baseline) and 42 720 registered ICU nurses (269% increase over baseline). An additional 188 ventilators are available in veterinary facilities, including 179 human model ventilators. Conclusions The directors of Australian ICUs report that intensive care bed capacity could be near tripled in response to the expected increase in demand caused by COVID-19. But maximal surge in bed numbers could be hampered by a shortfall in invasive ventilators and would also require a large increase in clinician and nursing staff numbers.

Background: Pain is one of the main complaints of many patients in intensive care units. However, most nurses and physicians are unable to properly monitor and relieve pain in these patients. Factors such as patients' inability to describe their pain and insufficient knowledge of nurses and physicians have made pain management difficult. Given that the knowledge and attitude of nurses play an important role in the effective implementation of the pain management process, this study aimed to investigate the effect of comprehensive pain management training program on the awareness and attitude of intensive care unit nurses. Methods: This quasi-experimental single-group study was conducted in two phases (pre and post-intervention) to investigate the awareness and attitude of all nurses employed in the intensive care unit of Tehran Modarres Hospital, based on the determined inclusion and exclusion criteria. In the pre-intervention phase, the awareness and attitudes of the nurses were assessed using a questionnaire. After conducting the pain management training course, an executive program and algorithm were implemented for pain management in ICUs. Then, the nurses’ awareness and attitude toward pain management were assessed again. Finally, changes in the scores of the nurses’ awareness and attitude were analyzed by SPSS V. 22 software in two phases before and after applying the interventions using the Wilcoxon test. The relationship between some demographic variables and the level of awareness and attitude of nurses was also investigated using the Kruskal-Wallis and Mann-Whitney tests. Results: The results of this study indicated that the mean score of the nurses’ awareness was significantly different in pre- and post-intervention phases (P < 0.05). Despite an increase in the post-intervention mean score of the nurses’ attitude (71.03), no statistically significant change was observed. Additionally, among the demographic variables, there was only a significant relationship between the nurses' job experience in ICUs and their attitudes. Conclusions: Based on the results of this study, teaching and implementing a comprehensive program for pain management can play an effective role in promoting the nurses’ awareness. Therefore, it is proposed to use pain management models to improve the nurses' knowledge and attitude toward pain management in ICU patients.

The ICU team gathers for their morning rounds. One of their patients died the day before. The team members look at the room where the patient had been; perhaps it is empty, or perhaps it has already been filled with another patient and family. The day the patient died may have been filled with escalating therapies and vigorous resuscitation attempts that failed to save her, or perhaps the staff had been gently supporting a child and family through the night as technology was removed and comfort assured. For some on the team (maybe a student or resident) this could be the first patient they have cared for who died.1 For others (fellow, attending, ICU nurses), this may have become a more-common experience. Multiple team members may still be thinking about the events of the day before, remembering the patient or wondering about the outcome and why certain decisions were made. Our ICU teams have developed a practice of debriefing a patient death at the beginning of patient-care rounds the following day. In effect, we “round” on the patient for one final day after the death. The patient’s primary resident or nurse practitioner begins with a 1- to 2-sentence description of the patient and events of the previous day, and then the attending facilitates a group discussion. We typically spend

BackgroundCaring behaviors are crucial in intensive care units (ICU) because patients in these wards require high levels of care. Effective communication with patients is one of the most important factors in caring behaviors of nurses working in ICUs. Therefore, the aim of this study was to evaluate the effect of therapeutic communication skills training on the caring behaviors of ICU nurese.Materials and MethodsThis experimental pre-test/post-test study was carried out on 105 nurses working in ICUs of hospitals affiliated to Yazd University of Medical Sciences in Iran in 2019. Nurses were randomly assigned into control (52 nurses) and intervention (53 nurses) groups. A two-day therapeutic communication training workshop was conducted for the participants. Data were collected using demographic information questionnaire and caring behaviors questionnaire before and one month after the intervention.ResultsThe findings showed no significant difference between the control and intervention groups regarding the nurses’ caring behaviors in the pretest (P = 0.148). However, after implementation of the training program, a significant difference was observed in the mean scores of caring behaviors between the two groups. In the control group, the mean scores of caring behaviors decreased significantly after the intervention (P = 0.001); whereas, the mean scores of intervention group increased significantly after the intervention (P = 0.001).ConclusionAccording to the results, ICU nurses’ training in therapeutic communication skills had a positive effect on their caring behaviors. Therefore, we suggest the authorities prepare and implement educational packages of therapeutic communication skills as a coherent program for other nurses. As a result, the caring behaviors and the quality of cares can be improved for patients.

Background Medication dosage calculation errors are among the most common errors of nurses in intensive care unit (ICU). Information technologies, particularly mobile devices, can advance drug dosage calculation processes. The objective of this study was to develop a medication dosage calculation application for nurses in intensive care units. Methods This study was performed in the ICUs of teaching hospitals in Kerman University of Medical Sciences in 2018. First, a need assessment survey of nurses was conducted to determine the required features of the application. As well two specialists were interviewed to determine the medications used in the ICUs. Second, a medication dosage calculation application was developed using formative usability testing. Results Overall, 80% of the participants (n=120) answered the need assessment questionnaire. Of 29 features determined in the needs assessment, 19 were selected to develop the application. Moreover, 25 medications were selected by specialists and participants for the development of the application and its prototype. The usability test of the prototype found 15 problems. After fixing these problems 2 problems were identified, which were fixed in the final version. Conclusion According to the participants, development of the medication dosage calculation application increases the accuracy of drug dosage and reduces the errors. The user-identified features were developed in-app. User-centered usability testing in this study improved development based on needs of users. The method used in this study can be used by developers of health applications to develop applications which are consistent with user needs.