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Purpose: To examine the status of critical care nursing internationally, assess the impact of the COVID‐19 pandemic, and identify research priorities by surveying professional critical care nursing organizations (CCNOs) worldwide. Design A descriptive survey methodology was used. This study is the sixth worldwide quadrennial review to assess international critical care nursing needs and provide evidence to inform critical care nursing policy, practice and research priorities globally. Methods: The sixth World Federation of Critical Care Nurses survey of CCNOs was emailed to potential participants from countries with CCNOs or known critical care nurse leaders. Data were collected online using Survey Monkey™. Responses were entered into SPSS version 28 software (IBM Corp.) and analyzed by geographical region and national wealth group. Findings Ninety‐nine national representative respondents participated in the survey (70.7% response rate). The most important issues identified were working conditions, teamwork, staffing levels, formal practice guidelines, wages, and access to quality education programs. The top five CCNO services that were of most importance were providing national conferences, local conferences, workshops and education forums, practice standards and guidelines, and professional representation. Important pandemic‐related services and activities provided by CCNOs included addressing emotional and mental well‐being of nurses, providing guidance related to nurse staffing/workforce needs, assisting to coordinate efforts to obtain personal protective equipment supplies, serving as a country liaison with the World Health Organization's COVID‐19 response activities, and assisting in the development and implementation of policies regarding standards of care. The most important contributions expected from the World Federation of Critical Care Nurses were standards for professional practice, standards for clinical practice, website resources, professional representation, and providing online education and training materials. The top five research priority areas were: stress levels (inclusive of burnout, emotional exhaustion and compassion fatigue); critical care nursing shortage, skill mix and workforce planning; recruitment, retention, turnover, working conditions; critical care nursing education and patient outcomes; and adverse events, staffing levels, patient outcomes. Conclusions: The results highlight priority areas for critical care nursing internationally. The COVID‐19 pandemic impacted critical care nurses as direct care providers. As a result, addressing the ongoing needs of critical care nurses remains a priority area of focus. The results also highlight important policy and research priorities for critical care nursing globally. Results of this survey should be incorporated into strategic action plans at the national and international levels. Clinical Relevance: Issues of importance to critical care nurses including research and policy priorities during and following COVID‐19 are now clarified through this survey.The impact and importance that COVID‐19 has had on critical care nurses and their preferences and priorities are provided.Clear guidance to leaders and policy makers on where critical care nurses would like to see greater focus and attention to help strengthen the contribution of critical care nursing practice to the global healthcare agenda. [ABSTRACT FROM AUTHOR]

Purpose: To examine the activities, concerns, and expectations of critical care nurses and professional critical care nursing organizations worldwide. Design: A descriptive survey methodology was used. This study is the fifth worldwide quadrennial review of its type to monitor variations in critical care nursing needs and provide robust evidence to inform policy related to critical care nursing practice. Methods: The fifth World Federation of Critical Care Nurses international survey of critical care nursing organizations was emailed to potential participants from countries with critical care nursing organizations or known critical care nurse leaders. Data were collected online. Responses were entered into SPSS version 23 software (IBM Corp., Armonk, NY, USA) and analyzed by geographical region and national wealth group. Findings: Eighty‐two national representative respondents participated in the survey, of whom two thirds (n = 56, 68%) had an established critical care nursing organization in their country. The five most important issues identified were working conditions, teamwork, staffing levels, the need for formal practice guidelines and competencies, and wages. The top five critical care nursing organization services that were considered to be of most importance were professional representation, as well as provision of workshops and education forums, national conferences, practice standards and guidelines, and local conferences. The most important contributions expected from the World Federation of Critical Care Nurses were standards for clinical practice and professional practice, international conferences, professional representation, and study and education grants. Conclusions: The results highlight priority areas for critical care nursing and reinforce the need to address factors that can inform critical care nursing policy and practice. Results of this survey should be incorporated into strategic action plans at the national and international levels. Clinical Relevance: Nursing leaders, policymakers, and other interested stakeholders should consider these findings when planning critical care workforce requirements. Interested parties should work collaboratively to inform recommendations for further policy and action. [ABSTRACT FROM AUTHOR]

Background: Priority setting and decision-making in relation to self-management of multiple conditions is particularly challenging for both patients and health professionals. The aim of this study was to validate a conceptual model of self-management priority setting and decision-making in multimorbidity and confirm factors that influence self-management prioritizing and decision-making in a sample of patients with acute coronary syndrome and type 2 diabetes mellitus. Methods: This was a qualitative study using deductive directed content analysis. A purposive sample of 21 participants with acute coronary syndrome and type 2 diabetes mellitus that were admitted to a Shanghai hospital were interviewed. Results: Participants provided evidence to confirm all but one of the factors from the conceptual model. Internal factors influencing self-management predominated. Agreement with recommended treatment, functional capacity and perceived synergies, antagonistic effects, or interactions among the conditions and prescribed treatments, was emphasized. The facilitators and barriers to priority setting and decision-making were related to available resources, provider communication and, to a lesser extent, confusion about recommendations, and treatment complexity. Some participants were also concerned about treatment side effects. Conclusions: Internal factors (personal beliefs, preferences, and attitudes) and facilitators and barriers (knowledge, finances, social support, and transportation) were related to changes in priority setting and decision-making and self-management behavior in this sample. Health education, which includes case studies with shifting self-management priorities is recommended, rather than a unique disease-specific focus. Further research, exploring the relationship between these factors and changes in the dominant condition and related management, using valid and reliable instruments that capture these key factors, is recommended. [ABSTRACT FROM AUTHOR]

The purpose of this study was to provide a rich description of the lived experiences of parents whose child had received care in a new paediatric emergency department. A descriptive phenomenological design was used. Semistructured interviews were conducted with 18 parents. Participants were asked to describe their experience of having a sick or injured child treated at the paediatric emergency department, recounting the story of their journey from when their child was first sick or injured, through to their experience within the emergency department, until discharge home. Data were analysed using Colaizzi's phenomenological approach. Following analysis, six themes emerged: I can't imagine my life without her; Keeping me up to date with what was happening; They treated my child in a way that was toddler friendly; They had our child's best interest at heart; We were working as a team; and There are games and books in the waiting room. The findings demonstrated that parents' experience of having an ill or injured child treated by the paediatric emergency department was a positive experience and highlighted factors that contributed to this experience. These included open communication, competent and skilled staff, being seen in a timely manner and being cared for in a thorough, family inclusive and child-friendly way. [ABSTRACT FROM AUTHOR]

This exploratory, descriptive study aimed to identify and describe the pressure injury preventative interventions prescribed by nurses following the assessment of a patient's pressure injury risk and to compare the prescribed interventions relative to the assessed risk level. A total of 200 inpatients in a tertiary Australian hospital were included. Patients' charts were audited within 24 hours of admission. Data collected included patient characteristics, pressure injury risk assessment score and level, and preventative interventions prescribed. Most patients were assessed as not being at risk, with the largest group of at‐risk patients assessed as being at high risk. Some not‐at‐risk patients were prescribed interventions intended for those at risk, while prescription rates of preventative interventions recommended for those at any level of risk were variable (6%–64%). Significant associations were found between assessed pressure injury risk and preventative intervention prescription. Preventative intervention prescription was inadequate, potentially exposing some patients to pressure injury. However, the association between intervention prescription and risk level suggests that nurses are prescribing interventions relative to risk. A more structured approach to intervention prescription according to risk level, such as a care bundle, may help to improve nurses' preventative intervention prescription and ensure that all at‐risk patients receive appropriate preventative interventions. [ABSTRACT FROM AUTHOR]

To identify paediatric emergency department nurses' perceptions of factors influencing parents' understanding of discharge information. Content analysis was used to analyse data from three semi-structured focus groups with nurses from a paediatric ED. Findings were interpreted within the three domains of structure , process , and outcomes from the Donabedian model. Within the structure domain, barriers to effective provision of discharge information included inexperienced emergency department staff and time policies. Enablers included availability of interpreter services. Process-related barriers included parents' health related behaviour and health literacy, while enablers included ensuring parents understood discharge information. Nurses' perceptions of ineffective outcomes involved the risk of parents receiving incomplete or inappropriate information. Nurses perceived effective outcomes in quality of care were related to their professional experience and competence in being able to provide useful information to parents. This study investigated ED nurses' perceptions of factors that influence parents' understanding of discharge information. Interpreting findings within the Donabedian model provided important directions for future improvements to structure, processes and outcomes for provision of discharge information to parents leaving a paediatric ED. Ultimately, the findings from this study could inform future research to maximise the role of ED nurses in providing a high quality of discharge care for children discharged from the ED. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the experiences of men and women with cystic fibrosis in becoming parents. Background: As lifespan for people with cystic fibrosis increases, and reproductive technology advances, having a child of their own becomes a possibility. Design: This study used a phenomenological framework. Methods: Seven Australian adults with cystic fibrosis were invited to describe their experiences of becoming parents in the context of a semi‐structured interview. Analysis of the data involved highlighting recurrent phrases and isolating emergent themes. Results: Two overarching themes characterised the participants’ experience: Counting the cost, as they recalled Concentric communication and Pathways to pregnancy; and Living the dream, as they cast a retrospective view over this, their major achievement, in the light of their Reaction: a dream comes true, Coping: a question of balance, Conjecture: the future redefined and Confidence: recalibrating. Conclusions: While advances in cystic fibrosis care and reproductive technology have increased the possibility of individuals with cystic fibrosis becoming parents, the passage to becoming a parent is a complex process. Relevance to clinical practice: These findings can inform health professionals to support the adaptive work necessary for families that include members with cystic fibrosis. A contemporary understanding of this phenomenon is necessary for facilitating clinically relevant communication. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore Indigenous people's experiences of hospitalisation for acute cardiac care. Background Indigenous Australians suffer a higher burden of cardiovascular ill health and hospitalisation rates in comparison with other Australians, but there is little research that explores their perspectives of hospitalisation. Design Narrative inquiry. Methods Interviews were undertaken using storytelling to facilitate participants' descriptions of their hospital experience. Data were collected during 2014-2015. A purposive sample of Indigenous cardiac patients that were admitted to hospital and their relatives participated. Findings The narrative revealed three linked themes that characterised Indigenous people's hospitalisation experiences: The impact of the past; The reality of the present; and Anticipating the future. Hospitalisation was challenging for participants due to their sense of dislocation and disorientation, a lack of cultural and spiritual aspects to care practices, and the poor interpersonal relationships they experienced. Conclusions Findings revealed that there were many unmet needs during hospitalisation for Indigenous people. Past experiences and future expectations were connected in a way that impacted on participants' current hospitalisation experience. Understanding this context, with incorporation of cultural and spiritual aspects of care may help nurses and other healthcare professionals to provide more positive interactions that in turn may contribute to improved cardiac care experiences of Indigenous people during hospitalisation. Healthcare professionals need to be aware and focused on person-specific and contextualised aspects of Indigenous people's experience of hospitalisation for cardiac care in order to impact outcomes. Relevance to clinical practice Healthcare professionals need to understand Indigenous people's perspectives that contribute to improved health outcomes. Stories of participants' experiences may assist in the identification of aspects which might further the development of culturally appropriate continuity models that could effectively provide support throughout Indigenous people's hospital journeys, and beyond the hospital, and help improve associated health outcomes. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to explore Indigenous people’s experiences and perceptions of hospitalisation and acute care. Methods Systematic procedures were used for the literature search covering the period from 2000 to 2016. Final search was conducted in early September 2016. Quality of the selected studies was assessed using the Critical Appraisal Skills Program. Data extraction was conducted using the data extraction tool from the Joanna Briggs Institute. A thematic approach to synthesis was taken. Statements were assembled to produce aggregated data of the findings, which were then categorised based on similarity of meaning, and the categories were used to produce comprehensive synthesised findings. Data sources The literature search was conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature, Google scholar, Medline, Psychology and Behavioural Sciences, and PsycINFO. Manual searches of the International Journal of Indigenous Health, Menzies website and references of reviewed papers were also conducted. Inclusion criteria were qualitative articles, published in English from across the world, in peer-reviewed journals, that investigated acute health care experiences of Indigenous people. Review methods A metasynthesis of qualitative research studies was conducted following Joanna Briggs Institute guidelines. Findings A total of 21 primary studies met the inclusion criteria. Three themes emerged from the metasynthesis: Strangers in a strange land ; Encountering dysfunctional interactions ; and Suffering stereotyping and assumptions . These themes emphasised the importance of meaningful relationships for Indigenous people and highlighted their cultural marginalisation in hospital settings. Conclusion The findings indicate that healthcare experiences of Indigenous patients and their relatives in acute settings can fall well short of their expectations and needs. It behoves healthcare professionals to firstly be aware of such discrepancies, and secondly to implement strategies that enable inclusive and individualised care. [ABSTRACT FROM AUTHOR]

Background Provision of paediatric specific service areas within a hospital servicing both adult and paediatric populations is relatively novel. In Australia this is an emerging model for service delivery that takes into account the specific health needs of paediatric patients. To date, information related to the practice transition required by staff when adopting this model of care is lacking. Such information can contribute to informing service quality and identify staff perceived barriers and enablers during adoption of the model. The potential benefit of such knowledge is the early mitigation of issues and delineation of professional development requirements. The aim of this study was to investigate staff experiences of transitioning from an essentially adult emergency department with minimal paediatric presentations to a new co-located paediatric emergency department. Methods A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 emergency department staff (10 Nursing, 8 Medical) before and after the opening of the paediatric emergency department. Data were analysed thematically. Results Five themes emerged from the data analysis, these were: (1) I am really scared that I won’t have the skills necessary, (2) Having a good knowledge base helps, (3) Open, transparent communication is definitely the best thing, (4) Personality plays an important role and (5) Perceptions regarding need to separate the services. Conclusions The findings demonstrated the complexity of the change process and highlights various factors that staff found contributed positively to the change process. These included the need for clear and open communication at all levels, focused educational opportunities, and employment of staff with a positive attitude towards change. Relevance to practice Clear organisational communication and professional support are central components identified by staff to enable a more successful transition from one type of service to another. [ABSTRACT FROM AUTHOR]

Aim To test the psychometric properties of the COMHON (Conscious level, Mobility, Haemodynamics, Oxygenation, Nutrition) Index. Background Pressure injury risk assessment is a crucial aspect in determining the relative risk of patients and the need for preventative intervention. In the intensive care setting there are few risk assessment scales that have been developed specifically for critically ill patients. Design Instrument development. Methods A convenience sample of 26 intensive care patients was used. Data were collected in December 2012. Five intensive care nurses scored each patient with all four scales. Intraclass correlation coefficients and standard errors of measurement were used to assess inter-rater reliability and agreement of the sum, risk category and item scores. Convergent validity of the COMHON Index was investigated by examining correlations between the sum scores and similar constructs of the scales. Results Inter-rater reliability of the COMHON Index was higher than the other scales and strong correlations were found between it and the Braden and Norton scales but not the Waterlow score. Two items common to all scales (mobility; neurological status) demonstrated significant correlations between the COMHON, Braden and Norton scales but not the Waterlow score. One item (nutrition) was significantly correlated between the COMHON and Braden scales. Conclusion Inter-rater reliability and agreement of the COMHON Index were the highest of the four scales, with the Norton and Braden performing similarly and the Waterlow score the least well. The strong and significant associations between the Braden, COMHON and Norton scales suggest they are measuring similar constructs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to validate a modified version of the Paddington Alcohol Test for use in the Australian emergency department (ED) setting. Methods: A cross sectional survey was used to screen patients attending an Australian tertiary hospital ED. Datawere collected over a three-month period at randomly allocated time periods and days. Consenting participants were screened using the Alcohol Use Disorders Identification Test (AUDIT) and a modified-for-Australia version of the Paddington Alcohol Test (AusPAT). The association between the two tools was investigated, as well as the sensitivity and specificity of AusPAT at various AUDIT cut-off scores and by gender and age group. Results: The sample comprised 637 ED attendees. Their mean age was 49.9 (SD 20.0) years with a mean AUDIT score of 5.21 (SD 6.58). Most (73.2%) consumed alcohol, and a quarter was AusPATpositive (n = 153, 24.0%). AusPAT demonstrated a moderate fit with AUDIT at a cut-off score of 8 (Kappa = 0.63, P < 0.001). At this cut-off 23.4% (n = 149) were identified by AUDIT as problematic drinkers. AusPAT sensitivity was 72.5% (95% CI 65.3–79.7) with a specificity of 90.8% (95% CI 88.3–93.4). Conclusion: Our results indicate that AusPAT was moderately well associated with AUDIT. When used universally in the ED setting, its sensitivity and specificity were moderate. [ABSTRACT FROM AUTHOR]

Background: Sleep is a dynamic and essential part of human life and health. In healthcare settings, nurses are strategically placed to promote sleep and sleep health. In this regard, nursing actions should be based upon effective methods of assessment of patient sleep. Standardised sleep assessment does not currently occur in the care of acute hospitalised patients. Use of an appropriate measurement tool would help evaluate inpatient sleep. An effective, efficient sleep assessment tool is needed to aid clinicians. Such assessment would enable specific nursing intervention to be tailored to individual patients. Objective: The objective of this paper was to examine the literature on sleep measurement to identify subjective sleep assessment tools that may be suitable for routine use with hospitalised patients, and to evaluate their reliability and validity. Method: A review of existing literature was undertaken to identify and evaluate subjective sleep measurement tools. Results: The initial literature searches identified 402 articles, of which ten met the criteria for review. These reported on three subjective sleep measurement scales: the Richards- Campbell Sleep Questionnaire; the St Mary’s Hospital Sleep Questionnaire; and the Verran Snyder-Halpern Sleep Scale. The Richards-Campbell Sleep Questionnaire is brief and easy to use. In specific samples, its items correlate with domains reflecting sleep quality and has shown excellent internal consistency. Equivocal results and scoring challenges were found with the St Mary’s Hospital Sleep Questionnaire. The Verran Snyder-Halpern Sleep Scale captured sleep disturbance and total sleep time, but time-to-complete is more burdensome than the Richards-Campbell Sleep Questionnaire. Conclusions: The current use of sleep assessment instruments in the acute hospital setting is restricted mainly to research activities. Of the three tools identified that could be used clinically to measure inpatient sleep, and although it was developed for use in the intensive care setting, the Richards-Campbell Sleep Questionnaire held greatest potential due to its ease and rapidity of use. However, it has yet to be validated for use with general hospital inpatients, and further research is required in this area. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential. [ABSTRACT FROM AUTHOR]

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Abstract: Background: The application of knowledge to the care of critically ill patients is a hallmark of professional nursing practice. However, the educational preparation of intensive care nurses varies from country to country, and there has been little research that has investigated knowledge levels of European critical care nurses. Objective: The aim of this study was to examine the knowledge levels of European intensive care nurses. Design: The study was an international cross-sectional survey, with data collected from 20 European countries. Setting and participants: 318 European intensive care units participated, and data were collected from 1142 intensive care nurses. Methods: Data were collected between May and December 2009 using a 100-item multiple choice online questionnaire to assess intensive care nursing knowledge. The questionnaire was available in 16 languages, and data were collected in 11 knowledge areas. Results: A response rate of 60% was achieved; the majority of participants was female (77%). The largest groups of nurses had more than five years’ experience and were under 30 years of age. The overall mean knowledge score was 66% (SD 12). The main factor that contributed to variance in scores was nurses’ length of intensive care experience; in ten categories knowledge scores were progressively higher according to experience. If 50% is considered to be a pass mark, 90% of participants would have passed. However, in only six countries did all participants achieve a ‘pass’ score, and in five countries more than 10% of participants failed to meet this ‘pass’ criterion. The knowledge category which scored lowest was respiration and ventilation (mean score 56%, SD 15). Conclusions: Although knowledge levels differed among countries, there were no major differences. However, the relatively low scores achieved in the respiration/ventilation category are a cause of concern, and suggest that this is an education area that should be prioritised. The results should be considered within the context of each country''s healthcare and professional education systems, and strategies should be developed to improve knowledge in several key areas. [Copyright &y& Elsevier]