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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 (R² = 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. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) have been overwhelmed by the increasing number of coronavirus disease 2019 (COVID‐19) cases, causing psychological burdens, stress, and various types of conflict among nurses. Aim: To examine the occurrence, type, and intensity of conflict and preferred management styles among ICU nurses during the COVID‐19 pandemic. Study Design: This cross‐sectional descriptive study was conducted in a government hospital in Saudi Arabia using a convenience sample of 95 nurses from three ICUs. Data were collected using an e‐questionnaire comprising the Nursing Conflict Scale, Rahim Organizational Conflict Inventory‐II, and sociodemographic variables. Results: Most participants reported exposure to moderately (64.2%) or highly (34.79%) intense conflict during the pandemic. The competitive (2.23 ±.472) and intragroup (2.23 ±.385) types of conflict were the most frequently reported. The preferred conflict management style was collaborating (21.85 ± 5.49), followed by accommodating (18.39 ± 4.03). Pearson's correlation analysis showed that age, years of experience, and education were significantly associated with conflict type and management style. Preparedness to care for suspected or confirmed COVID‐19 cases was associated with interpersonal conflict (r =.20, p =.04). Conclusions: The participants experienced moderate‐ to high‐intensity conflict; however, they employed constructive rather than destructive management styles. Relevance to Clinical Practice: Nurse leaders, policymakers, and educators must initiate transformational intervention programmes to enhance and sustain nurses' competencies in constructive conflict management strategies. Interpersonal communication and crisis management training programmes should be formulated to raise nurses' awareness and enhance their competencies vis‐à‐vis taking a positive approach to overcoming various conflict types and levels, particularly during crises. [ABSTRACT FROM AUTHOR]

Background: An increasing number of studies persistently demonstrate that prone position ventilation can significantly improve the oxygenation index and blood oxygen saturation for most patients (70–80%) with acute respiratory distress syndrome (ARDS). Studies have also shown that the awake prone position was both safe and effective in helping patients with coronavirus disease 2019 (COVID‐19) breathe spontaneously. However, the prone position is not widely adopted when treating patients with COVID‐19 or ARDS from other causes. Basic knowledge, positive attitudes, and correct practices among the nursing staff are necessary to increase the use of prone positions, reduce the incidence of complications associated with prone positions, and improve the quality and safety of health care. Aim: This study aimed to investigate the knowledge, attitudes, and practice of prone positioning of patients among intensive care unit (ICU) nurses working in COVID‐19 units and provide suggestions for improvement. Study design: ICU nurses were recruited from two designated tertiary hospitals for COVID‐19 treatment in Shanghai, China, in April 2022, using convenience sampling. A questionnaire survey focusing on the dimensions of knowledge, attitudes, and practice of the prone position with 42 items, was conducted. Results: A total of 132 ICU nurses participated. The scores on the overall questionnaire and the dimensions of knowledge, attitudes, and practice of prone position were 167.28 (95% CI, 161.70–172.86), 78.35 (95% CI, 76.04–80.66), 32.08 (95% CI, 31.51–32.65), and 56.85 (95% CI, 52.42–61.28) respectively. The overall average score was 79.66% (95% CI, 0.77–0.82). The results of multiple linear regression analysis showed that prior experience in treating patients with COVID‐19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Conclusions: The ICU nurses strongly believed in the effectiveness of prone positioning, but their knowledge and practice levels need improvement. The experience in treating patients with COVID‐19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Nursing managers should ensure that ICU nurses are well trained in prone positioning and help enhance the knowledge and attitudes toward prone positioning to promote its widespread use. Relevance to clinical practice: Clinical guidelines and in‐service training modules need to be developed to promote the use of prone positioning and reduce prone position‐related complications. [ABSTRACT FROM AUTHOR]

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 < 0.001) with a large effect size (partial eta‐squared = 0.588). Conclusion: This study concluded that using SMS messages as a training tool has a positive influence on cardiac arrhythmias interpretation skills among ICU nurses. Relevance to clinical practice: Using SMS messages could be an alternative, effective, and innovative approach to improve nurses' clinical practice skills. [ABSTRACT FROM AUTHOR]

Background: The outbreak of the Corona virus (COVID‐19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID‐19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses. Aim: To examine: (a) the challenges of operating and managing intensive care units during the COVID‐19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID‐19 pandemic. Design: This mixed‐methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February–May 2021. Methods: The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross‐sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire. Results: Qualitative data analysis revealed two main themes: (a) challenges of the COVID‐19 pandemic and (b) positive aspects of the COVID‐19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID‐19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. Conclusions: The intensity of the experiences and psych‐social phenomena, is not affected by exposure to treatment of COVID‐19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses' professional functioning and their work life well‐being. Clinical relevance: We have therefore identified a need to formulate policies and implement interventions to bolster morale and hope, and can recommend systematic provision and sharing of up‐to‐date information with ICU nurses during prolonged emergencies. [ABSTRACT FROM AUTHOR]

Background: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their well‐being. Intensive care unit nurses' pain practices are affected by several barriers and enablers. Aims and objectives: To explore intensive care unit nurses' pain education, perceived barriers, and enablers of pain assessment and management practices among critically ill patients. Design: A cross‐sectional descriptive design was used in the study. Methods: Convenience sampling technique was used, including 300 nurses recruited from 22 intensive care units in Jordan. The Pain Assessment and Management for Critically Ill Adults Survey was used to collect data. Descriptive statistics, spearman correlation, and chi‐square tests were used to analyse the data. Results: Only 127 (42.3%) of the nurses reported moderate to extreme satisfaction about receiving professional development education related to pain among critically ill patients. Nurse workload (65.3%), patient instability (54.4%), patient inability to communicate (53.3%), and sedation interfering with pain assessment (50%) were reported by nurses as the most frequent barriers impacting pain assessment and management. Enablers of pain assessment and management reported most frequently were "pain assessment and management is a unit priority" (63.7%), "enthusiastic and motivated staff" (61.3%), "protocols and guidelines are in use" (57.4%), and "standardized assessment tools are in use" (57%). Some barriers and enablers to pain assessment and management and pain education differed significantly according to nurses' experience and hospital type. Conclusion: This study identified a range of enablers and barriers to pain assessment and management practices perceived by intensive care unit nurses. Nurse workload was an important barrier while making pain assessments, and management a unit priority was an important enabler for pain assessment and management. Frequent assessment of barriers and enablers of pain assessment and management is needed in critical care units to improve nurses' practices. Pain education should be included in the hospitals' continuous educational program. [ABSTRACT FROM AUTHOR]

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Background: Nurses play a key role in the proper management of endotracheal tube (ETT) cuff pressure, which is important for patients' safety, so it is vital to improve nurses' knowledge on safe cuff management practices. Aims and objectives: This study aimed to evaluate the effectiveness of an educational intervention related to ETT cuff pressure management on improving and retaining critical care nurses' knowledge. Design: A single group pre‐post interventional study was conducted involving 112 registered nurses (RNs) from a 24‐bed adult general intensive care unit at a teaching hospital in Malaysia. Methods: The educational intervention included a theoretical session on endotracheal cuff pressure management and demonstration plus hands‐on practice with the conventional cuff pressure monitoring method. Nurses' knowledge was measured using a self‐administered questionnaire pre‐ and post‐intervention. Data were analysed using repeated measure analysis of variance and bivariate analysis. Results: In this study, 92% of the total number of RNs in the unit participated. A significant difference in mean knowledge score was noted between the pre‐ (mean = 8.13; SD = 1.53) and post‐intervention phases (3 months [mean = 8.97; SD = 1.57) and 9 months post‐intervention [mean = 10.34; SD = 1.08), P <.001), indicating significant knowledge acquisition and retention between the phases. Knowledge gained between the pre‐ and 9 months post‐intervention phases significantly differed according to nurses' educational level. Conclusions: This study supports existing evidence that ongoing educational interventions are essential to improve nurses' knowledge. However, further exploration is suggested to assess how well this knowledge is translated into clinical practice. Relevance to clinical practice: Regular educational programmes with current updates would enhance nurses' knowledge through proper practice and clinical decision‐making skills; this, in turn, would help to standardize cuff management practices. [ABSTRACT FROM AUTHOR]

The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work‐related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co‐workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self‐identity. Work‐related critical incident stress has implications for nurses, the discipline, and the health care system. [ABSTRACT FROM AUTHOR]

Background: Core competencies of intensive care unit (ICU) nurses were defined as the essential capability to influence patient safety and interdisciplinary collaboration; however, there has been no research conducted that relates to core competencies of ICU nurses at Chinese tertiary‐A hospitals in Shanghai. Aims and objectives: To investigate the current state of core competencies and the factors that influence this key capability in ICU nurses in Chinese tertiary‐A hospitals. Design This was a multicentre, cross‐sectional study. Methods: A convenient sampling method was used to investigate 451 ICU nurses at five tertiary‐A hospitals in Shanghai. Data were collected using self‐administered questionnaires. Results: The core competencies of ICU nurses were above average, and the scores of seven dimensions, ranked from first to last, were medical ethics, clinical practice, nurse–nurse co‐operation, assessment and decision‐making, personal and professional development, teaching and research and nurse–physician co‐operation. Multivariate linear regression analysis showed that the factors exerting an influence on the core competencies of ICU nurses were title, role incumbent and ICU department. Conclusion: This study showed an above‐average level of core competencies among ICU nurses in tertiary‐A hospitals in Shanghai; however, competencies related to nurse–physician co‐operation and the translation of research into practice were underdeveloped. Relevance to clinical practice: Nursing managers should implement targeted interventions to improve nurse–physician co‐operation and translate research into practice competencies, such as high‐fidelity simulation, inter‐professional education, scientific research training and innovative skills tutorials. Moreover, this study demonstrated the influencing factors that can be used to improve core competences of ICU nurses. [ABSTRACT FROM AUTHOR]

Pulmonary artery catheters (PACs) are invasive devices placed in critically ill patients to monitor hemodynamic data. They are a high-risk, and in some settings a low-volume, medical device due to the complex insertion procedure and potentially lethal complications. Smaller intensive care units (ICUs) have large variances in exposure to PACs, therefore strengthening ICU nurses' belief in their ability to manage these hemodynamic monitoring devices is of utmost importance. The design is a single-group, pre/posttest study conducted on a 15-bed ICU to survey nurses' self-efficacy, knowledge, and satisfaction of an e-learning educational module. Both PAC and noninvasive cardiac output monitor patient application data were collected prior to and following the intervention. Fifteen ICU nurses completed all components of the module. Confidence in ability to accurately interpret hemodynamic data increased from pre- to postintervention (JP < .001), and knowledge also increased from pre- to postintervention, albeit not statistically significantly (P = 088). Overall, nurses reported satisfaction with the educational module. With increased self-efficacy, nurses can feel empowered and motivated to further improve patient care management. Thus, workplaces should continue to advocate for additional educational tools for high-risk, low-volume devices. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Inappropriate sedation assessment can jeopardize patient comfort and safety. Therefore, nurses' abilities in assessing and managing sedation are vital for effective care of mechanically ventilated patients. Aims and objectives This study assessed nurses' sedation scoring and management abilities as primary outcomes following educational interventions. Nurses' perceived self-confidence and barriers to effective sedation management were assessed as secondary outcomes. Design A post-test-only quasi-experimental design was used. Data were collected at 3 and 9 months post-intervention. Methods A total of 66 nurses from a 14-bed intensive care unit of a Malaysian teaching hospital participated. The educational interventions included theoretical sessions, hands-on sedation assessment practice using the Richmond Agitation Sedation Scale, and a brief sedation assessment tool. Nurses' sedation scoring and management abilities and perceived self-confidence level were assessed at both time points using self-administered questionnaires with case scenarios. Sedation assessment and management barriers were assessed once at 9 months post-intervention. Results Median scores for overall accurate sedation scoring (9 months: 4·00; 3 months: 2·00, p = 0·0001) and overall sedation management (9 months: 14·0; 3 months: 7·0, p = 0·0001) were significantly higher at 9 months compared to 3 months post-intervention. There were no significant differences in the perceived self-confidence level for rating sedation level. Overall perceived barrier scores were low ( M = 27·78, SD = 6·26, possible range = 11·0-55·0). Patient conditions ( M = 3·68, SD = 1·13) and nurses' workload ( M = 3·54, SD = 0·95) were the greatest barriers to effective sedation assessment and management. Demographic variables did not affect sedation scoring or management abilities. Conclusions Positive changes in nurses' sedation assessment and management abilities were observed, indicating that adequate hands-on clinical practice following educational interventions can improve nurses' knowledge and skills. Relevance to clinical practice Educational initiatives are necessary to improve ICU practice, particularly in ICUs with inexperienced nurses. [ABSTRACT FROM AUTHOR]

Background Sedation management is an integral component of critical care practice. It requires the greatest attention of critical care practitioners because it carries significant risks to patients. Therefore, it is imperative that nurses are aware of potential adverse consequences of sedation therapy and current sedation practice recommendations. Aims and objectives To evaluate the impact of an educational intervention on nurses' knowledge of sedation assessment and management. Designs and methods A quasi-experimental design with a pre- and post-test method was used. The educational intervention included theoretical sessions on assessing and managing sedation and hands-on sedation assessment practice using the Richmond Agitation Sedation Scale. Its effect was measured using self-administered questionnaire, completed at the baseline level and 3 months following the intervention. Results Participants were 68 registered nurses from an intensive care unit of a teaching hospital in Malaysia. Significant increases in overall mean knowledge scores were observed from pre- to post-intervention phases (mean of 79·00 versus 102·00, p < 0·001). Nurses with fewer than 5 years of work experience, less than 26 years old, and with a only basic nursing education had significantly greater level of knowledge improvement at the post-intervention phase compared to other colleagues, with mean differences of 24·64 ( p = 0·001), 23·81 ( p = 0·027) and 27·25 ( p = 0·0001), respectively. A repeated-measures analysis of variance revealed a statistically significant effect of educational intervention on knowledge score after controlling for age, years of work and level of nursing education ( p = 0·0001, ηp2 = 0·431). Conclusion An educational intervention consisting of theoretical sessions and hands-on sedation assessment practice was found effective in improving nurses' knowledge and understanding of sedation management. Relevance to clinical practice This study highlighted the importance of continuing education to increase nurses' understanding of intensive care practices, which is vital for improving the quality of patient care. [ABSTRACT FROM AUTHOR]