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The aim of this study is to explore intensive care nurses' perceptions and experiences about death and dying patient. This study included 15 nurses from a university hospital's intensive care units (paediatric and internal medicine). Data were collected through face-to-face, in-depth and individual interviews using the "Nurse Information Form" and "Semi-Structured Interview Form". Six major themes and sixteen sub-themes were identified on the nurses' perceptions and experiences with death. After the nurses described their perceptions of death, their responses, approaches, coping mechanisms, and effects on the dead and dying patient in care and factors affecting perceptions of death were defined. Our findings suggest that nurses, particularly those working in intensive care, should be educated/trained on death, and dying patient care. Thus, orderly psychological support should be provided to nurses. [ABSTRACT FROM AUTHOR]

Background: No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses. Aim: We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables. Study Design: This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model. Results: Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, β = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, β = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, β =.241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R² = 0.350). Conclusions: This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours. Relevance to Clinical Practice: Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care. [ABSTRACT FROM AUTHOR]

Background: The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context. Aims: The objective of this study was to identify the factors associated with an unfavourable outcome in this population. Design: Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital. Methods: Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6‐months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta = 6‐months ADL – ICU admission ADL) was between 0 and −0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge. Results: Fifty‐six patients—32 (57%) male—aged 79 [77; 83] y were included. ICU mortality was 19%; 6‐month mortality was 22%. Median ADL delta was −0.5 [−0.5–0] points. A low ADL score (P =.0438) and a low albumin level (P =.0213) at admission were the two independent factors associated with an unfavourable outcome. Conclusion: Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied. Relevance to clinical practice: There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

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

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

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Background: The organ donor process is challenging, not at least for intensive care nurses. The situation changes radically, from intensively working to save the patient's life to instead caring for the donor patient's organs so that those, in turn, can save another patient's life. The donation process challenges nurses' view on what dignified caring at end-of-life entails. The inner core of caring comprises love, mercy and compassion. Dignified caring is related to treating the patient as a unique human being and respecting human value, rooted in the theory of caritative caring that is the framework for this study. Aim: The aim was to illuminate intensive care nurses' experiences of caring during the organ donor process, from a caring science perspective. Methodology: A descriptive research design including inductive qualitative content analysis of interviews with twelve intensive care nurses in Sweden about their experiences of caring during the donor process. Results: The theme The complexity of caring during the organ donor process with two categories and five subcategories was generated. Intensive care nurses experienced caring during the donor process as being complex in relation to the potential donor patient and patient's family as well as communication, teamwork and organization. Caring affects not only the patient and families, but also the nurses and receivers of the donated organs. Intensive care nurses perceive the other's life situation as if it were their own and recognize the importance of shared humanity. Conclusion: The present study can increase knowledge from intensive care nurses and the caring team, in order to provide better conditions such as the development of effective intervention strategies in the process of organ donor care as well as caring for the families and members of the team. [ABSTRACT FROM AUTHOR]

Aim: To explore the perceptions and experiences of nurses in communicating the care and caring in the intensive care unit (ICU). Design: A focused ethnography. Methods: This study was conducted in an Australian metropolitan hospital, in which data were gathered from multiple sources: participant observations, document reviews, interviews, and participant's additional written information ‐ over six months (April‐September, 2014). The data were analysed thematically. Findings: This study addressed inclusively communicating care and caring to patients, families, nurses and other health professionals in ICU. The findings identified main themes concerning the changing patterns of communicating the care and caring in ICU, various patterns of communication used, enablers and barriers of communicating care and caring, and significant issues in communicating care and caring in ICU. Documentation of patients' psychological and emotional needs, and nurses' caring behaviours are crucial. These findings need further consideration from all stakeholders. [ABSTRACT FROM AUTHOR]

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

Background. Advances in technology have facilitated the implementation of improved alarm management systems in the healthcare sector. There is a need to identify challenges encountered by intensive care unit (ICU) nurses with clinical alarm management systems in South Africa (SA) to ensure utilisation of these technological resources for patient safety. Objective. To investigate how intensive care nurses respond to clinical alarms for patient safety in a selected hospital in KwaZulu-Natal Province, SA. Methods. A descriptive, non-experimental research design using the census sampling strategy was used to invite 120 nurses from four ICUs to complete an adapted, structured questionnaire. Descriptive statistics were used to analyse the data. Results. We had 91 respondents who completed the questionnaires (response rate of 75.8%). The majority of the respondents (85.7%) strongly knew the purpose of clinical alarms and 45.1% strongly felt confident about adjusting and monitoring the clinical alarms. More than half of the nurses (53.8 %) agreed to the existence of nuisance alarms that disrupted patient care (46.7%) and contributed to lack of responses (52.7%). While 76.9% strongly agreed with alarm sounds and displays to differentiate the priority of the alarms, 75.8% strongly agreed to the existence of proper documentation on setting alarms that are appropriate for each patient. The most frequent barriers were difficulty in setting alarms properly (51.6%) and lack of training on alarm systems (47.8%). Conclusion. The complexity in setting the alarms, limited training and existence of false alarms was evident. Alarm-specific training is required to keep intensive care nurses updated with changes in technology to ensure patient safety. [ABSTRACT FROM AUTHOR]

Background: An intensive care unit (ICU) features high mortality rates. Witnessing subsequent deaths may affect nurses psychologically and spiritually. Islam has an influence on Muslims' life and death. Nevertheless, little is known about Muslim intensive care nurses' experiences of grief in dealing with the deaths of patients. Aim and objectives: This study aimed to describe the grief reactions and coping strategies of Muslim nurses in dealing with the death of patients. Design: This is a qualitative study with a phenomenological approach. Methods: Semi‐structured individual interviews were conducted. Fourteen participants from an ICU in an Indonesian tertiary public hospital participated in this study. Data were analysed by thematic analysis. Trustworthiness was established by Lincoln and Guba's criteria. Results: The findings identified four reactions of grief, four factors influencing reactions of grief, and three coping strategies used in dealing with death in an ICU. The reactions of nurse's grief were crying, being sad, feeling disappointed, and feeling guilty. These reactions were related to several factors including the circumstances of the patient's death, nurse's expectation of patient's recovery, relationships with the patient, and the reactions of family. Coping management strategies used by nurses in dealing with their grief comprised: sharing with colleagues, avoiding dying and death situations, and engaging in spirituality. Conclusions: The Muslim ICU nurse participants experienced their grieving through a variety of psychological reactions influenced by several factors. Personal coping strategies were revealed in dealing with their grief. However, avoiding dying and death situations affected their duty. Relevance to Clinical Practice: Attention to nurses' grief should be paid to maintain their psychological well‐being and quality of end‐of‐life care. Providing formal support to enhance grief management is recommended. [ABSTRACT FROM AUTHOR]

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

Background and Aim: Nurses who are working in all areas, particularly in the intensive care unit may experience end-stage renal failure (ESRD) patients. This study was conducted to assess the information requirements of the intensive care nurses in caring of end-stage renal failure patients. Materials and Methods: This descriptive study was conducted in a teaching and research hospital between 3 February 2014 and 30 April 2014. The practice has been completed with 133 nurses (84.17%) of 158 nurses working in the intensive care unit (ICU) who match the search criteria and agreed to participate in the study. Ethical and institutions approval was obtained. Data collection form developed as a result of the literature review consists of 54 questions. At least 70% (n=30) of the questions (n=42) that determine the level of knowledge in the ESRD patient care are expected to give the right answer from nurses. Descriptive statistics were given as number, percentage, mean and standard deviation. In the evaluation of the obtained data, characteristics and the total number of correct answers of nurses were compared using Independent T test and One-Way Analysis of Variance (ANOVA) test, p<0.05 was accepted as meaningful. Findings: Twenty participants are male, mean age 28.2 ± 5.6 and 60.2% of the participants works in the surgical ICU. Average correct count is 32.7 ± 4.5 (min=11-max=40), the most frequent correct answer count is 33 (n=25). More than half of the nurses (55.6%) know how to control the arteriovenous fistula. However,73.7% of the nurses do not feel competent themselves in ESRD patients care and 36.1% of the cases gave the wrong answer to the question about the need to use masks while doing hemodialysis catheter dressing. While 91% of participants gave the correct answer to the "There are drawbacks about the diet rich in potassium for ESRD patients" question, 14.3% of participants gave the wrong answer to the "There is nothing wrong to eat bananas and apricots for ESRD patients" question. Most of the participants gave the correct answer to the "I prefer back of the hand when drawing blood in ESRD patients" (69.2%) and "It is inconvenient to draw blood from the antecubital fossa" (72.9%) question. A statistically significant difference were found between total correct answers according to received training about ESRD (p=0.011). There is no statistically significant difference between total correct answers according to working time in intensive care unit, full operating time (p>0.05). Results: Most of the participants (80%) answered at least 70% of the knowledge questions about ESRD correctly. It is suggested that standards must be created utilizing clinical practice guidelines to increase the effectiveness of nursing care. trainingchanges perceptions about issues especially in critical units such as intensive care units and acts by increasing the knowledge. There should be multidisciplinary training programs about ESRD and training programs should be organized related to the subject to intensive care staff. [ABSTRACT FROM AUTHOR]

Aims and objectives. To explore the experiences of intensive care nurses who provided end-of-life care to adult patients and their families after a decision had been taken to withdraw treatment. Background. End-of-life care following treatment withdrawal is a common phenomenon in intensive care. Less is known about nurses' experiences of providing care for the dying patient and their family in this context, when compared to specialist palliative care. Design. Descriptive exploratory qualitative study. Methods. A purposive sample of 13 intensive care nurses participated in a semi-structured face-to-face interview. Transcribed data were analysed using the principles of interpretative phenomenological analysis. Results. The essence of nurses' experiences of providing end-of-life care after the withdrawal of treatment was interpreted as 'doing the best to facilitate a comfortable and dignified death'. Four master themes included the following: caring for the dying patient and their family; providing and encouraging presence; reconnecting the patient and family; and dealing with emotions and ambiguity. Uncertainties were evident on processes and actions involved in treatment withdrawal, how to reconnect patients and their family effectively and how to reduce the technological environment. Conclusions. Providing end-of-life care after a decision has been taken to withdraw treatment was a common aspect of intensive care. It was evident that nurses were doing their utmost to support patients and families at the end of life, despite the multiple challenges they faced. Relevance to clinical practice. The interpretive findings from this study should assist intensive care unit nurses to better understand and develop their role in providing high-quality end-of-life care after treatment withdrawal. Practice guidelines should be developed to reduce ambiguity and support the delivery of high-quality care for adults as they approach the final stages of life in intensive care units. [ABSTRACT FROM AUTHOR]

Introduction: The Quality of Working Life (QWL) is related to the balance between work demands and the perceived ability to carry them out, to ensure the full development of human beings in their work, family and personal spheres. Objective: To describe the QWL by nurses working in the adult intensive care units (ICU-A) and neonatal (ICU-N) of a private institution of Santa Marta (Colombia) in 2013. Methodology: A descriptive cross-sectional study with a quantitative approach. The QWL-35 questionnaire and a survey for demographic data of the personnel under investigation were used. The sample consisted of 34 workers of nursing from two ICU: 38.2% were nurses, and 61.7%, auxiliary personnel. Results: Differences regarding QWL were perceived according to the service in which personnel work and it placed the staff of the ICU-N within positive ranges in the measuring scale. It was found that there was perception of little support and commitment by relevant decision makers towards the lower staff in various hierarchies (managerial support: 4.3/10). The dimension perceived as the best was intrinsic motivation (6,7 / 10), which demonstrates motivated behavior directed to personal satisfaction and fulfillment of service activities for the pleasure of carrying them out, and decreased perception of workload (4,4/10), which demonstrates the quality of this field resources provided by the institution. [ABSTRACT FROM AUTHOR]

Identifying patients who would benefit from palliative care is a major barrier to providing palliative care. In acute care hospitals, physicians make palliative care referrals, but nurses identify and recommend patients for referral. Because nursing knowledge is essential to the appropriate utilization of palliative care, we assessed palliative care knowledge among 143 oncology, intensive care, and heart failure nurses. The overall mean percentage of correct responses was 67.6%, indicating that nurses were moderately but not fully knowledgeable about palliative care. Eight of 10 nurses correctly understood that patients do not need to be in acute decline to be appropriate for referral, but 7 of 10 did not understand that palliative care is compatible with curative treatment. The latter observation suggests that nurses may overlook patients who might benefit from palliative care. Variations in findings are examined in relation to experience in oncology and hospice, awareness of the palliative care program, having recommended a patient for palliative care, having had a recommendation result in a formal referral, and years of nursing experience. For palliative care to become a standard of care, nurses who often know patients and families best due to increased interpersonal exposure must understand palliative care. [ABSTRACT FROM AUTHOR]

Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients’ outcomes, as well as nurses’ moral distress and professional satisfaction. However, potential associations between collaboration and nurses’ mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel’s anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton’s Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps’ Index of Work Satisfaction for the appraisal of nursing personnel’s satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to physician interaction was negatively mildly correlated with participants’ (a) total anxiety score (τ = -0.160, P = .001), (b) tension (τ = -0.125, P = .015), and (c) depressive symptoms (τ = -0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants’ (a) total anxiety state (τ = -0.139, P = .003), (b) tension (τ = -0.137, P = .008), and (c) sleep disturbances (τ = -0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of anxiety symptoms among ICU nursing personnel (R2 = 0.046, β < -0.15). Nursing personnel in Greek ICUs seem to be satisfied with the quality of relationships among them, as well as with physicians. Despite that anxiety symptoms associate with the degree of satisfaction from professional interaction, the latter may not be a significant indicator of ICU nurses’ well-being. Further qualitative research is needed to identify mediating factors. [ABSTRACT FROM AUTHOR]