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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.

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.

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.

Aims: To determine nurses' job stress and its relationship with professional autonomy and nurse-physician collaboration in intensive care unit (ICU). Background: Low professional autonomy, high job stress and lack of nurse-physician collaboration can affect nursing care in ICU and the main reasons ICU nurses leave the occupation or transfer to other clinical units. Methods: A cross-sectional, correlational study was conducted on 398 nurses in teaching hospitals in Urmia, Iran, in 2020. Data were collected using the Dempster Practice Behaviors Scale, the Health and Safety Executive tool and the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration. Results: The mean job stress (115.53 ± 12.42) and professional autonomy (102.19 ± 11.88) of ICU nurses were 'moderate', and nurse-physician collaboration (74.25 ± 5.10) was 'good'. There was a positive relationship between professional autonomy and job stress (r = .506) and nurse-physician collaboration (r = .242). Professional autonomy was a predictor of job stress in nurses (p Conclusion: Increasing nurses' professional autonomy causes an increase in job stress and improves nurse-physician collaboration in ICU. Implications for nursing management: Nursing managers should implement practical strategies to improve nurses' autonomy, enhance nurse-physician collaboration and decrease their job stress.

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.

Objective To assess intensive care unit (ICU) nurses’ demands for specialized experiential training and to provide inputs for developing an experiential training program for ICU nurses. Methods A questionnaire for assessing ICU nurses’ demands for experiential specialty training was distributed to 360 ICU nurses, selected through purposive sampling from two secondary hospitals and six tertiary hospitals in Hunan Province, China. Results Of the survey participants, 63.6% had undergone a specialty training program for ICU nurses. Of these individuals, 53.0% were satisfied with the training. Certification as a qualified nurse was considered an essential criterion for admission of trainees into the program by 81.8% of respondents, while 77.1% of respondents considered clinical working experience to be a critical requirement for selecting trainers. A total of 48.1% of the respondents preferred part-time training, and 36.1% considered a training cycle of 9–12 weeks to be reasonable. Moreover, they felt that the training methods should be tailored to different stages of the experiential learning cycle. Demands for experiential training among ICU nurses were quantified, with high demand reflected in an overall score of 4.41 ± 0.48. The “intensive care technology” experiential training module was ranked highest in terms of demand, with the top five sub-modules being specialty operating technology (4.67 ± 0.53), care of critically ill patients (4.66 ± 0.55), critical patient rescue procedures (4.65 ± 0.56), assessing monitoring indexes (4.63 ± 0.56), and the application of relevant instruments (4.61 ± 0.57). Conclusion Nearly half of the respondents indicated that their experiences of specialty training programs were not satisfactory, and they had high demands for experiential training. Thus, to optimize training outcomes, continuous updating of training methods is essential. Moreover, a systematic, comprehensive, and multilevel experiential training program that targets the specific needs of ICU nurses is essential.

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 investigate the current status and influencing factors of the quality of work life of nurses in Intensive Care Unit (ICU). Methods: A total of 243 ICU nurses from 6 general hospitals in Jingzhou were selected by convenient sampling method. Questionnaires were conducted with the general information questionnaire, Connor-Davidson Resilience Scale (CD-RISC) and Work-Related Quality of Life Scale-2 (WRQoL-2). Results: The total average score of the quality of work life of ICU nurses was (3.35 ± 0.44), which was at a medium level. Department, professional title, frequency of night shift, experience of workplace violence and psychological resilience were the influencing factors of the quality of work life of nurses in ICU, accounting for 39.4% of the variance. Conclusion: The quality of work life of ICU nurses needs to be improved. Nursing managers should pay attention to the work environment of ICU nurses, rationally allocate manpower, and improve the status of psychological resilience of nurses, so as to improve their quality of work life.

Background: Caring practice for critically ill patients refers to the actions/behaviors/performance of nurses while caring for critically ill adult patients in the intensive care unit (ICU). Although the caring practice is vital in ICUs and complex due to the multitude of availabletechnologies, research on ICU nurses’ caring practice and its predictive factors are lacking. Objective: This study aimed to explore the level of nurses’ caring practice for critically ill patients in critical technological environments in China and its predictors. Methods: This was a cross-sectional online survey study with 218 ICU nurses in 29 tertiary hospitals of Guizhou province, China, from 1st to 30th April 2020. Data were collected by using e-questionnaires made in the Questionnaire Star program, including the Demographic Data Questionnaire (DDQ), Practice of Technological Competency as Caring in Nursing Instrument (P-TCCNI), Influence of Technology Questionnaire (ITQ), and Nurses’ Professional Value Scale (NPVS). The questionnaires were content validated by three experts. Cronbach’s alpha coefficient was 0.96 for the P-TCCNI, 0.70 for the ITQ, and 0.95 for the NPVS. Links to the questionnaires were distributed by research assistants to WeChat groups including target participants. Statistical Package for the Social Science (SPSS) program version 26 (IBM Corporation, Armonk, NY, USA) was used for data analysis. Descriptive and inferential statistics were used to analyze the data. Multiple linear regression analysis using stepwise solution analysis was performed to identify unique predictors of nurses’ caring practice. Results: The level of nurses’ caring practice for critically ill patients was high (mean = 87.30, standard deviation = 13.73). The professional value was a significant predictor of nurses’ caring practice (β = 0.41, p = 0.00). Conclusion: ICU nurses exhibited a high level of caring practice. Professional value was a significant predictor of ICU nurses’ caring practice. Nursing administrators should understand the current situation of caring practice in critical technological environments and design strategies to maintain and improve ICU nurses’ professional value to increase the level of caring practice. Funding: This study was financially supported by a thesis grant from Thailand’s Education Hub for Southern Region of ASEAN Countries (TEH-AC) Scholarship through Prince of Songkla University, Thailand.

Purpose: Understand the effects of the COVID-19 pandemic on depression in intensive care unit (ICU) nurses, analyze high-risk factors, and propose appropriate measures to maintain physical and mental health.Methods: A total of 78 nurses in ICU of Beijing Ditan Hospital affiliated with Capital Medical University (Beijing area, COVID-19 patient designated hospital) were investigated with self-rating depression scale (SDS). The Cronbach'sαcoefficient was 0.874, the content validity was 0.853, and the internal consistency was good. General information for the questionnaire: gender, marriage, education, age, title, length of service, ICU years of service, COVID-19 pandemic training, concerns about the COVID-19 pandemic, and current health status.Results: According to the SDS scale score, ICU nurses had a total depression score of 51.36 ± 11.667, and the prevalence rate of depression was 44.9% (35/78). Multi-line regression analysis shows that stress perception, work experience in critical diseases, education and other total scores are risk factors for the occurrence of depression.Conclusion: Work experience in critical illness (β = 9.930, P < 0.001) had a positive predictive effect on the total score of depression, while stress perception (β = −0.884, P < 0.001) and education (β = −6.061, P < 0.001) had a negative predictive effect on the total score of depression, and explained 52.7% variation. These findings point to the need for interventions to address psychological distress and provide the necessary support.

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.

Job satisfaction is a complex psychological phenomenon and an extremely important factor of work quality and employees' work motivation. Considering that factors contributing to job (dis)satisfaction also affect work motivation, the level of job satisfaction is used in this psychometric cross-sectional study as an indicator of work motivation among a sample of 71 intensive care units (ICU) nurses in one of universities hospitals in Belgrade, Serbia. The level of job satisfaction was assessed by adapted and customized survey in Serbian language, based on famous Spector's Job Satisfaction Survey (JSS). Analyzing collected data, a high level of job dissatisfaction among participants of our study was founded. Taking into account the high degree of correlation between job satisfaction and work motivation, we concluded that the level of work motivation in the observed sample of ICU nurses was low at the moment of conducting this study, which could point to the existence of serious motivation problems in this field of the nursing profession, even though it is an employee sample from one institution, like in our study.

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.

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

The primary objective of this study is to analyze the different patterns of electronic medical record (EMR) documentation corresponding to updating assessment results and how these patterns would be different inside and outside the patient room in a medical intensive care unit in terms of average process time. In this study, the real-time measurement system data was used to analyze ICU nurses’ workflow related to the EMR documentation. After that, multiple hierarchical task analysis charts were developed to find different EMR documentation patterns for assessment results. The results revealed that the patterns of EMR documentation were significantly different in terms of average process time. The findings from this study might identify the areas of EMR where improvements can be made by preventing disruptions, incompleteness, and optimizing the EMR process efficiency in a medical ICU.

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.

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.

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

Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan. A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale. Participants’ rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge ( r = 0.739, P < .01) and attitudes ( r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (β = 0.245) and knowledge (β = 0.563). The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. Also, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students’ competencies in research utilization and statistical skills.

Background: COVID-19 is an emerging diseases caused by SARS CoV-2 virus which primarily affects the respiratory system. 15% of the people who acquire this disease becomes critically ill and require an intensive care. However, the emergency posed a huge lack of trained ICU staff to care for these patients; therefore, nurses from other specialties were asked to come and serve in the COVID ICU. Method: An online cross-sectional survey was administered in a tertiary care hospital in Pakistan to all the nurses dealing with COVID patients who were on ventilator (see appendix 1). A total of 60 nurses participated in the study with a diverse group including Registered Nurses (RNs), Nursing Interns (NIs), and Trainee Nurse Interns (TNIs). Results: 19 (31.7%) participants reported them being novice, 21 (35%) participants reported them being advance beginners, 14 (23.3%) participants reported them being competent, 4 (6.7%) participants reported them being proficient, and 2 (3.3%) participants reported them being expert in dealing with COVID ICU patients before. When asked about dealing with COVID patients now, none reported themselves as being novice. However, 8 (13.3%) participants reported them being advance beginners, 27 (45%) participants reported them being competent, 15 (25%) participants reported them being proficient, and 10 (16.7%) participants reported them being expert in dealing with COVID ICU patients now. Conclusion: Some nurses were not very confident in dealing with COVID patients before gained a lot of confidence while working in the set up. Their level of satisfaction also changed before and after working in the COVID ICU. These findings are of great importance in proposing effective strategies to train staff, so that they can serve in COVID ICU while maintaining quality outcomes for the patients.

Background : Death is a psychological and physical event that affects patients caring for, especially in Emergency Departement (ED) and the Intensive Care Unit (ICU). Patients and families need the end of life care from a health professional, including nurses. Nurses need to have knowledge, skill, attitude, and interpersonal competencies to provide end of life care. Objective : This study aimed to explored differences of attitudes towards dying care between ED and ICU ward nurses in a rural hospital. Method : Variable in this study was the nurse's attitude. This study used a quantitative comparative cross-sectional research design. The samples were 24 nurses from the emergency ward and 16 from the intensive care unit who were recruited by total sampling. Data were collected to use Frommelt Attitudes Towards the Care of the Dying Care Form B Indonesian version (FATCOD-BI). Result : The results revealed that nurses' attitudes toward caring for dying patients in the ED were 101.42±6.646 (30-150) on average, and in the intensive care unit was 106.44±7.633 (30-150) on average. Nurses in the ICU had a more positive attitude than the ED (p = 0.034). There are differences between the proportion of respondents based on gender, level of education, length of time working in the emergency ward, and ICU. The result showed gender, level of education, and range of time working could influence nurses' attitudes towards caring for dying patients in the emergency ward and ICU. Conclusion: There is a difference between nurses' attitudes towards EOLC in the ED and ICU room at rural hospitals. Moreover, the ICU nurses have a more positive attitude than ED nurses.

Background: Research and evidence supporting open and liberalized visiting policy has resulted in many hospitals adopting these policies. But, ICU nurses’ beliefs and attitudes about flexible and open visiting policy vary. Hence open visitation has not always been implemented by nurses who are the ward owners. It is vital to evaluate nurses’ beliefs about and attitudes towards visiting policy. Methods: A descriptive, cross-sectional quantitative survey was conducted in 4 public hospitals in Ghana, with a sample of 140 nurses. Data were collected with a validated scale – BAVIQ to assess the nurses’ beliefs and attitudes toward visitation. Results: Generally, nurses’ preferred restricted visiting policy based on their attitudes however, the beliefs of nurses about visiting policy were skeptical (neither agree nor disagree). The study also showed a meaningful relationship between nurses’ beliefs and their sex (p=0.02), experience (p= 0.00), educational level (p= 0.00), employment status (p=0.00) and executive position (p=0.00). It also indicated a meaningful relationship between nurses’ attitudes and their sex (p=0.00), experience (p=0.00), educational level (p=0.00), and executive position (p=0.00). Chi - square was used to compute the test. Conclusions: Based on the findings, ICU nurses’ beliefs and attitudes toward visitation support the universal concern of restricted visiting policy in Ghana. These are important factors in the implementation of flexible visiting policy in the intensive care units; the beneficial effects of open visiting policy for the nurse, the patient and the family because it enhances patient centered care and optimal health. Therefore the need for drafting a protocol and guidelines for intensive care units visiting policy in Ghana is recommended. A qualitative research in specific areas of visiting policy is recommended.

Introduction: Medical and para-medical education is one of the key points of healthcare strategy. Training and education based on high-fidelity simulation is one of the gold standards in modern healthcare institutions. We describe a model of training dedicated to ICU nurses in charge of patients with ECMO. The aim of our educational tool was to teach ICU nurses ECMO basic knowledge and skills. Methods: An ECMO Specialist Course Committee implemented the training programme. It was on two consecutive days and consisted of theoretical, practical and high-fidelity, simulation-based teaching. A content expert implemented each scenario and learning objectives were defined. Participants were assessed pre- and post-test (Group 1 and Group 2). Results: In two years, seven sessions took place and 40 volunteers were enrolled. High-fidelity, simulation-based teaching consisted of seven scenarios. There was a significant improvement in mean score between pre- and post-test. Moreover, we noticed that the basic level (pre-test) of participants was improving over the time. The mean pre-test scores of Group 2 were significantly higher than Group1. Conclusion: The implementation of education and training course for ICU nurses in charge of patients on ECMO is feasible and reliable. It improves nurse personal levels, but also shares in improving the global level of the team to which they belong.

BackgroundCompared to other countries, Germany has the highest number of intensive care unit (ICU) beds, but, despite this, ashortage in ICU care is evident. Currently, little comprehensive data on ICU staffing and on subsequent closure of ICU beds are available. The current survey therefore aimed to systematically investigate the closure of ICU beds.MethodAsurvey was performed among authorized professional trainers in ICU medicine.ResultsOverall, ashortage of ICU beds following bed closure was evident in 76% of all ICU floors with 22% reporting daily ICU bed closure. In 47%, two ICU beds were not available. Emergency care was unrestricted in only 18%, while restrictions were reportedly frequent or even constant in 30%. The main reasons for ICU bed closure were the unavailability of ICU nurses (44%) and the co-existing unavailability of nurses and physicians (19%). On average, the nurse/patient ratio was 1:2.5 in the morning, 1:2.6 in the afternoon, and 1:3.1 in the night shift.ConclusionsICU bed closure regularly occurs in Germany. The underlying main reason has been identified to be the unavailability of ICU nursing staff. This is suggested to directly interfere with emergency care. For this reason, an action plan is urgently needed.

In an intensive care unit (ICU), the environment is highly technological and staff are constantly present. The aim of this study was to describe environmental elements of an ICU room that nurses consider central for their provision of care. Data were collected using photovoice – photographs and in-depth interviews – and analysed using a qualitative content analysis approach. The care environment highly affected ICU nurses, in particular some elements such as medical equipment, work stations and beds. These were considered as an aid, but due to confined space some care was abstained from, maintaining privacy and confidentiality were a challenge, which led to frustration and stress. To provide care in an environment with good lightning, reduced noise and adequate space increases the wellbeing of the nurses, which indicates that an investment in a better care environment would be worthwhile.

It can be a challenge to prepare intensive care unit (ICU) nurses to recognize and care for the complex needs of deteriorating patients, especially in patients with gastrointestinal (GI) complications, who often present with vague but serious issues. Tools such as the sequential organ failure assessment tool and the GI failure tool have been used to assist nurses in decision making. This article discusses how to incorporate such tools into an algorithm for simulation training for ICU nurses that integrates a clinical judgment model to shape care for patients with GI complications.

Background: Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care. Materials and Methods: The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation. Results: According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73). Conclusions: Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.

Purpose: We described the association between Intensive care units (ICU) characteristics and ICU Length of stay (LoS), after correcting for patient characteristics. We also compared the predictive performances of models including either patient and ICU characteristics or only patient characteristics. Materials and methods: We included all admissions of 38 ICUs participating in the Dutch National Intensive Care Evaluation registry (NICE) between 2014 and 2016. We performed mixed effect regression including, one ICU characteristic in each model and a random intercept per ICU. Furthermore, we developed a prediction model containing multiple ICU characteristics and patients characteristics. Results: We found negative associations for the number of hospital beds; number of ICU beds; availability of fellows in training for intensivist; full-time equivalent ICU nurses; and discharged in a shift with 100% bed occupancy. Furthermore, we found a U-shaped association with the nurses to patient ratio as spline function. The performance based on R-2 was between 0.30 and 0.32 for both the model containing only patient characteristics and the model also containing ICU characteristics. Conclusion: After correcting for patient characteristics, we found statistically significant associations between ICU LoS and six ICU characteristics, mainly describing staff availability. Furthermore, we conclude that including ICU characteristics did not significantly improve ICU LoS prediction. (C) 2017 Elsevier Inc. All rights reserved

Purpose: The aim of the study was to present the level of knowledge and practice patterns regarding exposure keratopathy in mechanically ventilated patients among Intensive Care Unit (ICU) nurses in Chhattisgarh state. Methods: A previously validated semi-structured questionnaire was administered in the ICU of six multispecialty hospitals in Chhattisgarh in 2014–2015. Demography included age, gender, level of education, and months of working in ICU. Most of the questions dealt with frequency of eyelid closure assessment, frequency of cleaning of eyes with saline gauze, using a protocol-based approach for eye care, and documentation of ophthalmic complications. Common barriers to delivery of eye care such as shortage of time and too much writing tasks were also inquired. Results: Our study included 120 nurses. They worked for mean 22.9 ± 17.8 months in ICU. Knowledge about high risk of exposure keratopathy in ventilated patient was present in 93% (78%; 95% confidence interval [CI]) nurses. Only six nurses (5%) followed a strict protocol for eye care, 52 nurses (43%) checked for eyelid closure in the ventilated patients, and 58 (48%) cleaned the eyes frequently. Those who were aware of exposure keratopathy checked eyelid closure (73% vs. 48%) and cleaned eyes with saline gauze more frequently (24% vs. 4%). Nurses in cardiac ICU were significantly lesser aware of exposure complications compared to medical ICU nurses (40% reduction in awareness, 95% CI = 0.37–0.98, P = 0.04). Conclusion: Although there is high awareness, practice patterns of ICU nurses were less than desired. Educational initiatives should focus on weaknesses in knowledge and practice noted to improve eye care of patients in ICU.

The concept of caring is vague and complex, especially in critical environments such as the intensive care unit (ICU), where technological dehumanisation is a challenge for nurses. ICU nursing care includes not only patients but also extends to patients’ families, nurses, other health team members and the unit’s environment. Caring in critical care settings is affected by enabling and impeding factors. To explore these enablers and challenges factors, a focused ethnographic study was conducted in an Australian ICU. The data was collected from 35 registered nurses through various resources: participants' observations, documents reviews, interviews, and additional participants’ notes. Data were analysed inductively and thematically. The study outlines comprehensively and widely a wide range of enablers and challenges affecting caring in the ICU - which originate from different sources such as patients, families, nurses, and the ICU environment. This paper is the second in a two-part series which explores the ICU nurses’ experiences and perspectives of the enablers and challenges of caring in the ICU. Part 1 was concerned with the enablers and challenges to caring that are related to ICU patients, families, and environment. While Part 2 introduces readers to the enablers and challenges factors that are concerned with the nurses in ICU. These factors include nurses’ educational backgrounds and professional experience, employment working factors, leadership styles, relationships, and personal factors. Nurses and other stakeholders such as clinicians, educators, researchers, managers, and policymakers need to recognize these factors and their implications for providing quality care, in order to enhance and maintain the optimal level of caring in the ICU.

This study examined the effect of zinc supplementation on the sleep quality (SQ) of intensive care unit (ICU) nurses. In a double-blind, randomized controlled trial, 54 ICU nurses were randomly assigned to the intervention group ( n = 27) that received 220 mg zinc sulfate capsules every 72 hours for 1 month and the control group ( n = 26) that received placebo. Sleep quality of ICU nurses was measured by calculating the total quality sleep score using the Pittsburgh Sleep Quality Index (PSQI). The serum zinc level was a secondary outcome. All measurements were calculated at both baseline and 1 month after intervention. The total PSQI, subjective SQ, and sleep latency scores for the intervention group were significantly lower than the control group, which means that the SQ of ICU nurses in the intervention group improved from baseline. The serum zinc level of the intervention group at the end of the study was significantly higher than the control group, which means that zinc supplementation improved participants’ serum zinc level. Based on these findings, the researcher suggested that zinc supplementation could be associated with better SQ, subjective SQ, and sleep latency in this group of workers.

Aim: To explore the perceptions of patient advocacy among Saudi Arabian intensive care unit (ICU) nurses. Background: Despite advocacy being a crucial role for nurses, its scope is often limited in clinical practice. Although numerous studies have identified barriers to patient advocacy, their recommendations for resolution were unclear. Method: The study employed a constructivist grounded theory methodology, with 13 Saudi Arabian registered nurses, working in critical care, in a tertiary academic teaching hospital. Semi-structured interviews, with broad open-ended questions, and reflective participant journals were used to collect data. All interviews were concurrently analysed and transcribed verbatim. Results: Gender, culture, education, subjugation, communal patronage, organisational support and repercussions, and role-associated risks were all revealed as factors affecting their ability to act as advocates for critically ill patients. Conclusion: Saudi Arabian ICU nurses in the study believed that advocacy is problematic. Despite attempting to advocate for their patients, they are unable to act to an optimal level, instead choosing avoidance of the potential risks associated with the role, or confrontation, which often had undesirable outcomes. Patient advocacy from a Saudi Arabian nursing perspective is contextually complex, controversial and remains uncertain. Further research is needed to ensure patient safety is supported by nurses as effective advocates.

Families ('family' will be used in this article to refer to anyone the patient considers significant, whether they are an actual family member or not) of patients who are critically ill have heightened communication needs. Nurses are an important source of information, particularly about day-to-day patient events and progress. Intensive care unit (ICU) nurses are valued by families because they provide clear, jargon-free information about the patient and their condition. However, they have sometimes been criticised for focusing on short-term issues while avoiding potentially difficult conversations about long-term outcomes and prognosis. A family conference or meeting is held when bad news has to be communicated to families, prognosis discussed or major decisions made, particularly about treatment withdrawal or resuscitation. These meetings should involve physicians and ICU nurses. Despite family conferences, family members' understanding of patient prognosis, diagnosis and treatment is often suboptimal. A planned and structured approach for these meetings, using quantitative statements for prognostic information, recording and communicating what has been said, and supporting meetings with written information, can improve their effectiveness. These supportive strategies increase understanding and consensus, and prevent the provision of conflicting information. It is important for nurses to be willing to follow up these meetings by supporting families to clarify their understanding and encouraging them to raise concerns and ask questions.

Background Because suspecting nurses could alter hand hygiene (HH) behavior when observed, the goal of this article was to describe how the Hawthorne effect (HE) was measured and accounted for in a direct observational prospective study. Methods Observations were made 8 h/d for 3-5 days in 5 intensive care units (ICUs) (4 hospitals) on a convenience sample of 64 ICU nurses in Texas. The HE was measured so if hand hygiene adherence rates of the first 2 hours were 20% higher than the last 6 hours, the first 2 hours would be dropped and an additional 2 hours would be added at the end of the observation period. Hourly rates were recorded during the observation period, using room entry and room exit. Results The difference between aggregated rates of the first 2 hours and last 6 hours was 0.56% (range, 0.02%-15.74%) and not significant . On 12 observation days, higher rates were observed during the first 2 hours. On 6 days, higher rates were observed in the last 6 hours, with difference in rates of 1.43% (day 1), 2.97% (day 2), and 1.42% (day 3). Conclusions The attempt at measuring and accounting for the HE showed little difference in HH rates throughout the observation period. Based on these results, necessity of the observer moving locations during HH surveillance after 10-20 minutes, because of a feared HE, might not be necessary.

The purpose of this article was to provide information identified during hand hygiene (HH) surveillance periods at 5 intensive care units (ICUs) (4 hospitals) in Texas.Using room entry and room exit, overt observation periods were 8 consecutive hours for 3-5 days on 64 ICU nurses.A total of 3,620 HH opportunities were recorded during 18 days of observation (144 hours). The average hand hygiene compliance (HHC) rate was 64%, with 19% of the nurses participating in HH in the 60%-69% range. Male nurses had a rate of 67%, whereas female nurses had a rate of 62%. Having a HHC rate of29%, 6% of the nurses were identified as low gelers, whereas 14% were identified as high gelers (HHC rate 80%-89%), and 13% were classified as super gelers (HHC rate 90%-100%). Four barriers to HHC were identified: carrying something in their hands, talking on mobile phones, donning gloves or personal protective equipment, and pushing or pulling the workstation on wheels; all were statistically significant. Accounting for 18% noncompliance, barriers identified present teaching opportunities to increase compliance.Average HHC rates recorded during 10- to 20-minute periods with random sampling may not show the complete picture of HHC. Barriers to HHC were identified that can be used as teaching interventions.

OBJECTIVE: The paper aims to explore the status of intensive care unit (ICU) nurses' self-esteem, job satisfaction, and subjective well-being and to investigate the relationship among the three elements. METHODS: A cross-sectional survey of 224 nurses from five teaching hospitals in Tianjin, China, was conducted. Self-esteem scale, job satisfaction scale, and subjective well-being scale were used to explore the status of ICU nurses' self-esteem, job satisfaction, and subjective well-being. Correlation among the three elements was calculated by SPSS 17.0. RESULTS: The scores of three scales (i.e., ICU nurses' self-esteem, job satisfaction, and subjective well-being) were 27.67 ± 3.41, 43.57 ± 9.04, and 69.73 ± 11.60, respectively. The subjective well-being was significantly positively correlated with self-esteem and job satisfaction (r = 0.454, P

Background Physical restraint is mainly used in intensive care units (ICUs) to prevent delirious or agitated patients from removing tubes and lines connected to them. However, inappropriate use of physical restraint could have many detrimental physical effects on the patient, such as nerve damage, asphyxiation or even death. Aim The aim of the study is to investigate nurses' knowledge, attitude and practice of physical restraint in ICUs in Jordanian hospitals, about which little is known. Design A descriptive and cross-sectional design was used. Methods A convenience sample of 400 nurses working in three public hospitals and one university-affiliated hospital from different geographical regions in Jordan was selected. An Arabic version of the Physical Restraint Questionnaire (PRQ) was used to collect the data. Results A total of 300 completed questionnaires were returned, with a response rate of 75%. Of the total sample, 51% were males, 65.7% were from public hospitals and 80.3% held a bachelor's degree. The mean score in the knowledge section was 9.7 (SD =1.7) out of 15; in the attitude section, it was 24.7 (SD = 4.8) out of 33; and in the practice section, it was 30.9 (SD = 3.5) out of 42. Nurses who reported previous related education scored higher on the knowledge section (mean = 10.7; SD = 1.4) than nurses who reported no previous related education (mean = 9.1; SD = 1.6; p

Background: Intensive care unit (ICU) nurses must think critically in order to identify and deal with patients problems and thus provide better care. Currently, however, no existing research has explored ICU nurses’ critical thinking skills and caring behaviors. Purpose: To investigate the associations among the personal characteristics, critical thinking skills, and caring behaviors of ICU nurses in Taiwan. Methods: A cross-sectional correlational study was conducted. A convenience sample of 352 ICU nurses was recruited from three hospitals in southern Taiwan. Data were collected using self‐report measures including a Personal Characteristics Questionnaire, the Critical Thinking Skills Scale, and the Caring Behaviors Scale. Results: (a) The critical thinking skills and caring behaviors of the ICU nurses were found to be “moderate”, with index scores of 52.5 and 65.6, respectively. (b) The nurses’ overall critical thinking skills were associated by their clinical ladder, with their “Inference skills” being affected by their seniority and their “Interpretation skills” being affected by their position titles. (c) Their caring behaviors were affected by their age, marital status, clinical ladder, hospital work seniority, and ICU work seniority. (d) Their critical thinking skills and caring behaviors were not associated. Conclusions: In the healthcare sector, managers should seek to enhance ICU nurses’ critical thinking skills and teach them specific behaviors to help them better care for ICU patients.

Background It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. Aim The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. Design A descriptive and cross-sectional design was used. Methods A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. Results As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). Conclusions Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. Relevance to clinical practice Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.

BackgroundThe purpose of this study was to compare the effect of the two training methods: educational workshop and electronic package on the knowledge, attitude and practice of nurses in intensive care units (ICUs).Materials and MethodsIn this experimental study, 64 nurses working in ICU at Imam Hossein and Bahar Hospitals in 2017 in Shahroud were randomly selected into two groups of training: workshops and educational package. At first, knowledge, attitude and performance of the two groups were measured and then 2 weeks after the post-test training. Data were analyzed by Fisher exact, Wilcoxon, independent t-test, Mann–Whitney test with a significance level ≤0.05.ResultsA significant difference was found between knowledge score in the workshop (10.40 ± 1.41) and educational package (11.25 ± 0.95) (p=0.007). However, No significant difference was found between the nurses attitude in the workshop group (28.59 ± 2.74) and the trained by educational package (28.25 ± 2.85) (p=0.617). Also, no significant difference was found between the mean practice scores in two groups (p=0/143).ConclusionThe results of this study indicated that the educational package was more effective than the workshop on improving the level of knowledge of nurses about physical restriction, but both methods increased the attitude and practice of nurses.

Objectives To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit. Research design A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous. Setting A metropolitan intensive care unit located in Melbourne, Australia. Main outcome measures Intenisve care nurses completed a 76-question self-administered questionnaire. Results Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%). ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness. Conclusion This sample of nurses felt they require education and support in order to care for patients with mental illness in the intenisve care unit. Further education may also help to reduce negative perceptions of this patient group.

The modern intensive care unit (ICU) contains increasingly numerous, varied and sophisticated equipment for the support and monitoring of critically ill patients. Auditory alarms are most often used in the ICU ‘because hearing is a primary warning sense’ and has ‘generally omni-directional characteristics'. The difficulty of accurate recognition of auditory warnings in the ICU is known to have had fatal consequences; for instance, a patient death attributed to confusion between the ventilator and ECG alarms. The majority of auditory warnings emitted in an ICU are in fact false alarms, triggered by interference. The chapter highlights the problems facing operators of medical equipment and their associated auditory alarms. Two experiments are designed to investigate aspects of the learning, retention and confusion of ICU alarms. Experiment 1 measured the identification of auditory warnings by experienced ICU nurses, using stimulus sounds recorded in their own unit. Experiment 2 examined the effect of urgency mapping on the learning of paired auditory warnings/clinical situations.

Objetivos: O objetivo deste estudo foi caracterizar o conhecimento sobre medicamentos de alta vigilância (MAV’s) entre profissionais da enfermagem que atuam em uma unidade de terapia intensiva (UTI). Métodos: Foi realizado um estudo transversal em fevereiro de 2019. Por meio de amostragem por conveniência, foram incluídos 100 enfermeiros e técnicos de enfermagem atuando na UTI de um hospital universitário de grande porte, nos três turnos de trabalho. Os participantes responderam questionário de autopreenchimento sobre auto avaliação e experiência com MAV’s, obstáculos encontrados no processo de utilização, conhecimento sobre administração e procedimentos clínicos envolvendo MAV’s. O conhecimento foi pontuado por meio de escores de acerto (menor que 70 pontos, de 70-89 e acima de 90). Foram realizadas análises descritivas por meio de frequência relativa, media e desvio padrão, ou mediana e intervalo interquartílico. O teste Exato de Fisher foi utilizado para verificar as associações entre o escore obtido e variáveis sociodemográficas e laborais, considerando um nível de significância de 5%. As análises foram realizadas no SPSS versão 18.0.0. Resultados: O escore médio de conhecimento de MAV’S foi de 73,2 (+16,4); 36% dos participantes apresentaram escore abaixo de 70, 54% de 70 a 89, e 10% acima de 90. Os principais obstáculos foram prescrição verbal (50%), prescrição médica confusa (39%) e conhecimento insuficiente (35%). Conclusão: Apenas um em cada 10 profissionais apresentaram escore acima de 90 pontos, sugerindo uma situação de fragilidade na prática assistencial na UTI envolvendo MAV’s.

Background End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment. Objectives The purpose of this paper is to critically review the literature related to end-of-life decision making among ICU doctors and nurses and focuses on three areas: (1) Who is involved in end-of-life decisions in the ICU?; (2) What challenges are encountered by ICU doctors and nurses when making decisions?; and (3) Are these decisions a source of moral distress for ICU doctors and nurses? Review method This review considered both qualitative and quantitative research conducted from January 2006 to March 2014 that report on the experiences of ICU doctors and nurses in end-of-life decision making. Studies with a focus on paediatrics, family/relatives perspectives, advance care directives and euthanasia were excluded. A total of 12 papers were identified for review. Results There were differences reported in the decision making process and collaboration between doctors and nurses (which depended on physician preference or seniority of nurses), with overall accountability assigned to the physician. Role ambiguity, communication issues, indecision on futility of treatment, and the initiation of end-of-life discussions were some of the greatest challenges. The impact of these decisions included decreased job satisfaction, emotional and psychological ‘burnout’. Conclusions Further research is warranted to address the need for a more comprehensive, standardised approach to support clinicians (medical and nursing) in end-of-life decision making in the ICU.