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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.

Background Customizing monitor alarm settings to individual patients can reduce alarm fatigue in intensive care units (ICUs), but has not been widely studied. Objectives To understand ICU nurses' approaches to customization of electrocardiographic (ECG) monitor alarms. Methods A convergent mixed methods study was conducted in 3 ICUs in 1 hospital. Data on the type and frequency of ECG alarm customization were collected from patient monitors (n=298). Nurses' customization clinical reasoning was explored through semi-structured interviews (n=27). Results Of the 298 patients, 58.7% had ≥1 alarm(s) customized. Heart rate limits, irregular heart rate, and atrial fibrillation were the most commonly customized alarms. Interviews revealed that customization practices varied widely and were influenced by factors including clinical expertise, lack of customization education, and negative experiences. Conclusion Alarm customization is nuanced and requires adequate support to develop safe and effective practices. The challenges identified can inform development of strategies to improve alarm customization.

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.

A valid and reliable instrument is needed to assess acute pain in critically ill patients unable to self-report and who may be transitioning between critical care and other settings.To examine the reliability, validity, and clinical utility of the Multidimensional Objective Pain Assessment Tool (MOPAT) when used over time by critical care nurses to assess acute pain in non-communicative critically ill patients.Twenty-seven patients had pain assessed at two time points (T1 and T2) surrounding a painful event for up to 3 days. Twenty-one ICU nurses participated in pain assessments and completed the Clinical Utility Questionnaire.Internal consistency reliability coefficient alphas for the MOPAT were .68 at T1 and .72 at T2. Inter-rater agreement during painful procedures or turning was 68% for the behavioral dimension and 80% for the physiologic dimension. Validity was evidenced by decreases (p .001) in the MOPAT total and behavioral and physiologic dimension scores when comparing T1 and T2. Nurses found the tool clinically useful.The MOPAT can be used in the critical care setting as a helpful tool to assess pain in non-communicative patients. The MOPAT is unique in that the instrument can be used over time and across settings.

Aims and objectives To explore the issues surrounding privacy during death in ICU. Background While the provision of ICU care is vital, the nature and effect of the potential lack of privacy during death and dying in ICUs have not been extensively explored. Design A literature search using CINAHL and Pubmed revealed articles related to privacy, death and dying in ICU. Method Keywords used in the search were "ICU," "Privacy," "Death" and "Dying." A combination of these terms using Boolean operators "or" or "and" revealed a total of 23 citations. Six papers were ultimately deemed suitable for inclusion in the review and were subjected to code analysis with Atlas.ti v8 QDA software. Findings The analysis of the studies revealed eight themes, and this study presents the three key themes that were found to be recurring and strongly interconnected to the experience of privacy and death in ICU: "Privacy in ICU," "ICU environment" and "End-of-Life Care". Conclusions Research has shown that patient and family privacy during the ICU hospitalisation and the provision of the circumstances that lead to an environment of privacy during and after death remains a significant challenge for ICU nurses. Family members have little or no privacy in shared room and cramped waiting rooms, while they wish to be better informed and involved in end-of-life decisions. Hence, death and dying for many patients takes place in open and/or shared spaces which is problematic in terms of both the level of privacy and respect that death ought to afford. Relevance to clinical practice It is best if end-of-life care in the ICU is planned and coordinated, where possible. Nurses need to become more self-reflective and aware in relation to end-of-life situations in ICU in order to develop privacy practices that are responsive to family and patient needs.

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 presence of a central venous catheter (CVC) leads to a high risk of blood infections, which are considered major causes of morbidity, mortality and high medical costs. The aim of this study was to assess the knowledge of nursing staff working in intensive care units (ICUs) regarding the prevention of central-line-associated bloodstream infections (CLABSIs). A nationwide survey was conducted among ICU nurses from August 2016 to April 2017. A modified Polish version of the questionnaire developed by Labeau et al. was used to assess the nurses’ knowledge. Of the 750 questionnaires distributed, 468 were returned. Women accounted for 95.73% of all respondents, and over 80% were university educated. Most of the nurses surveyed (85.9%) had previously received training in CVC guidelines, and thus over 82% rated their knowledge as good or very good. The guidelines introduced in hospitals were the main declared sources of information. In addition, more than half (68%) of respondents also knew the international guidelines. The knowledge of nursing staff in the study area is not sufficient. Studies show that the guidelines for the prevention of CLABSIs in ICUs should be standardized, and continuous training of personnel in this field should be provided.

Comparison of the prevalence of burnout riskbetween ICU and non-ICU nurses during theCOVID-19 outbreak in French-speaking Belgium

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.

Objetivo: Relatar a organização e o planejamento das frentes de trabalho junto à gestão do Serviço de Enfermagem e Medicina de um Centro de Terapia Intensiva (CTI) para a abertura dos novos leitos críticos. Método: Relato de experiência de enfermeiros do CTI, ocorrido no período de março a agosto de 2020. Para propor uma reflexão crítica, a experiência foi relatada com base nas ações de prática avançada em enfermagem. Resultados: Na pesquisa: grupos multidisciplinares foram criados para revisão e elaboração de fluxos e protocolos com base na prática baseada em evidências e readaptações às rotinas. Na educação: foram realizados treinamentos in loco das práticas assistenciais adotadas. As temáticas mais emergentes foram paramentação/desparamentação, manobra de prona, hemodiálise e oxigenação por membrana extracorpórea. Devido à contratação imediata de profissionais foram elaborados treinamentos presenciais e à distância e simulações realísticas. Quanto à prática assistencial: foram elaborados novos protocolos e fluxos de atendimento. Quanto à gestão: as unidades foram alocadas no anexo ao prédio principal, sendo abertos clusters de até 10 leitos, totalizando 105 leitos. A equipe foi redimensionada, grupos foram reestruturados, alocando enfermeiros e técnicos de enfermagem experientes em unidades novas para treinamento dos admitidos e segurança dos pacientes. Realizados Huddles diários para mapeamento de riscos ocupacionais e assistenciais. Conclusão: O relato de experiência pode propiciar aos enfermeiros diversas reflexões acerca da situação vivenciada nos CTIs diante da pandemia da COVID-19 e a certeza de um processo inacabado que ainda necessita de adaptações, pois o cenário da pandemia permanece desconhecido e imprevisível.

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.

Background: Several factors were detected in ICU nurses' work system that can hinder their activity. Aim: The aim of the study was to investigate performance obstacles in ICUs nurses at Assuit University Hospitals. Setting The present study was carried out in the intensive care units at seven specialties at Assiut University Hospitals. Subjects: The study sample was 194 staff nurses who were working as bedside nurses in seven ICUs and who were willing to participate in the study. Tools: Data of the present collected through utilizing the following two tools personal characteristic: performance obstacles ICUs questionnaire Results: influential performance obstacles items were that the nursing staff was not enough to handle the number of patient, had difficulty finding a space to sit down and do any paperwork in their unit nurses, complain of the equipment in bad condition and there was a delay in getting medicines for patients. Recommendations: It is recommended that: When planning for a new or renovated critical care units, the health care facility should consults an expert in the field of hospital design as well as taking consideration about nurses and patients needs related to infrastructure of the unit.

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.

Objectives: To examine awareness of holistic patient care by staff nurses in the intensive care units of hospitals in the city of Hail, Saudi Arabia. Methods : A quantitative correlational study design was used to investigate relationships between intensive care nurse’s awareness of holistic practices and nurses’ latest performance review. Intensive care staff nurses (n=99) from 4 public sector hospitals in Hail were surveyed on their awareness of variables across 5 holistic domains: physiological, sociocultural, psychological, developmental, and spiritual. Data were collected between October and December 2015 using written survey, and performance evaluations obtained from the hospital administrations. Results were statistically analyzed and compared (numerical, percentage, Pearson’s correlation, Chronbach’s alpha). Results : The ICU staff nurses in Hail City were aware of the secular aspects of holistic care, and the majority had very good performance evaluations. There were no demographic trends regarding holistic awareness and nurse performance. Further, awareness of holistic care was not associated with nurse performance. Conclusion : A caring-enhancement workshop and a mentoring program for non-Saudi nurses may increase holistic care awareness and enhance its practice in the ICUs. Saudi Med J 2017; Vol. 38 (8): 826-831 doi: 10.15537/smj.2017.8.20056 How to cite this article: Albaqawi HM, Butcon VR, Molina RR. Awareness of holistic care practices by intensive care nurses in north-western Saudi Arabia. Saudi Med J . 2017 Aug;38(8):826-831. doi: 10.15537/smj.2017.8.20056.

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.

Introduction : Work stress which is often experienced by ICU nurses may affects nurse’s performance, nurse’s health and wealth so that the factors which may affect work stress such as organizational role stressors must be noticed. This study was aimed to explain the correlation between organizational role stressors and work stress level in ICU Nurses.Methods : This study used cross-sectional design involved 13 respondents, taken by purposive sampling. The independent variable was organizational role stressors and the dependent variable was work stress. Data were collected by using questionnaires and analyzed using Spearman’s rho with level of significance α ≤ 0.05.Results : Results showed that there was no significant correlation between organizational role stressors and work stress level in ICU nurses with significance value p ≤ 0.139.Conclusion :It can be concluded that the organizational role stressors had no correlation with work stress level because there are so many factors that may affect work stress in ICU nurses. Discussion : Role overload however was experienced by ICU nurses as a mild stressors. This indicates the importance of increasing nurse’s quality and quantity by training and recruiting new nursing staffs.

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

Objectives In this study researchers are trying to analyse the personality factors related to social skills in nurses who work in: intensive care units, ICU, and hospitalisation units. Both groups are from the Madrid Health Service (SERMAS). Method The present investigation has been developed as a descriptive transversal study, where personality factors in ICU nurses (n = 29) and those from hospitalisation units (n = 40) were compared. The 16PF-5 questionnaire was employed to measure the personality factors associated with communication skills. Results The comparison of the personality factors associated to social skills, communication, in both groups, show us that nurses from ICU obtain in social receptivity: 5.6 (A+), 5.2 (C−), 6.2 (O+), 5.1 (H−), 5.3 (Q1−), and emotional control: 6.1 (B+), 5.9 (N+). Meanwhile the data does not adjust to the expected to emotional and social expressiveness, emotional receptivity and social control, there are not evidence. Conclusions The personality factors associated to communication skills in ICU nurses are below those of hospitalisation unit nurses. The present results suggest the necessity to develop training actions, focusing on nurses from intensive care units to improve their communication social skills.

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 Patients who are intubated in the ICU are at risk of developing pressure injuries to the mouth and lips from endotracheal tubes. Clear documentation is important for pressure wound care; however, no validated instruments currently exist for the staging of pressure injuries to the oral mucosa. Instruments designed for the assessment of pressure injuries to other bodily regions are anatomically unsuited to the lips and mouth. Objectives This study aimed to develop and then assess the reliability of a novel scale for the assessment of pressure injuries to the mouth and oral mucosa. Methods The Reaper Oral Mucosa Pressure Injury Scale (ROMPIS) was developed in consultation with ICU nurses, clinical nurse educators, Intensivists, and experts in pressure wound management. ICU nurses and portfolio-holders in pressure wound care from Peninsula Health (Victoria, Australia) were invited to use the ROMPIS to stage 19 de-identified clinical photographs of oral pressure injuries via secure online survey. Inter-rater reliability (IRR) was calculated using Krippendorff's alpha ( α ). Results Among ICU nurses ( n = 52), IRR of the ROMPIS was α = 0.307; improving to α = 0.463 when considering only responses where injuries were deemed to be stageable using the ROMPIS (i.e. excluding responses where respondents considered an injury to be unstageable). Among a cohort of experts in pressure wound care ( n = 8), IRR was α = 0.306; or α = 0.443 excluding responses indicating that wounds were unstageable. Conclusions An instrument for the assessment and monitoring of pressure injuries to the mouth and lips has practical implications for patient care. This preliminary study indicates that the ROMPIS instrument has potential to be used clinically for this purpose; however, the performance of this scale may be somewhat reliant on the confidence or experience of the ICU nurse utilising it. Further validation is required.

Job stress is an important factor to consider in improving the performance and quality of goal achievement nurses in nursing care The aim of the research was to find the factors related to work stress of ICU nurses. The research was a cross sectional study. The sample consisted of 30 nurses of all population in ICU. The data were obtained using queitionaire and analized using chi squere test with contuinity correction or Yates Correction. The result of multivariate analysis was used to see the most dominant factor releted to work stress of ICU nurses. The result of the research indicate that there are 13 (43.3%) people having a slight stress and 17 (56.7%) people having a severe stress. The result of bivariate analysis between independent variable and dependent variable indicate job intrinsic factor (p=0.001), job extrinsic factor (p=0.005), and individual factor (p=0.004). the analysis of multivariate analysis indicate that intrinsic factor is the most related factor with work stress of ICU nurses. It is concluded that there is correlation between work ontrinsic factor, work extrinsic factor, individual factor and work stress ICU nurses. It is expected that the improvement of job intrinsic factor such as work load, work rutinity, and work invorenment situation could become the program in avoiding the occurrence of work stress of ICU nurses.

Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.Convenience sample of 23 German ICUs.ICU nurses and physicians.None.A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived "sometimes." Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p ≤ 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p ≤ 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p ≤ 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p ≤ 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p ≤ 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06-0.18]).Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.

Background: Physical Restraint (PR) has been widely used in the intensive care units, which aims to protect patients and maintain their safety. With all benefits of PR, there are many complications and risks from improper utilization. Further, no Jordanian studies have found to educate nurses regarding the proper PR utilization. Purpose: To evaluate the impact of an educational program on nurses’ knowledge, attitude and practice regarding PR use in ICUs. Methods: A pre-experiment with one-group pretest-posttest design was used among 40 ICU nurses. A self-administered questionnaire was used to evaluate nurses before the education program and two weeks after its completion. Results: After implementation of the program, nurses demonstrated a significant difference in knowledge scores between pretest (M = 10.35 ± 1.73) and posttest (M = 13.30 ± 1.47) (t = 9.92; df = 39; P = 0.000), attitudes scores (M = 27.90 ± 2.79 vs. M = 30.40 ± 2.32) (t = 4.61; df = 39; P = 0.000), and practice scores (M = 36.85 ± 1.98 vs. M = 40.52 ± 1.60) (t = 11.59; df = 39; P = 0.000). Conclusion: Service-education program can improve ICU nurses’ knowledge, and enhance their attitudes and practices towards physical restraint. Such improvement is expected to be reflected in improving the quality of care delivered to the patients, and decreasing complications of malpractice regarding physical restraint.

Highlights • We discuss the importance of teamwork in the care of COVID-19 patients. • Recent data show a major disconnect between physicians and nurses regarding the benefits of prone positioning in ARDS. • We suggest a number of strategies to improve execution of prone positioning via multidisciplinary efforts., Despite proven benefits to prone positioning in ARDS, a disconnect exists regarding the impressions of its utility among members of the healthcare team. While the majority of physicians view prone positioning as beneficial in ARDS, recent data suggest that the minority of ICU nurses have the same impression. The COVID pandemic has raised particularly challenges in terms of availability of personnel and supplies at least in some institutions. We discuss various barriers to implementation of prone positioning and suggest a number of strategies to optimize patient care. We use a multidisciplinary team approach to execute prone positioning in COVID ARDS.

Background: Blood cultures are part of the evaluation of hospital patients with fever. Patients with central lines in place, frequently have blood samples for culture drawn through lines. We sought to assess blood culturing practices at our institution. Methods: Retrospective review of BCs performed in hospitalized patients over a 12-month period (August 2018–July 2019) at an academic, tertiary-care center with 1,297 licensed beds and >62,000 admissions a year. A specialized phlebotomy team is involved in all peripherally drawn blood samples; however, the patient’s nurse obtains a blood sample through a central line. Results: Overall, 35,121 blood cultures were performed for an incidence rate of 106 BC per 1,000 patient days or 566 blood cultures per 1,000 admissions. Most blood samples (67%) were collected via peripheral venipuncture. We detected significant variation in culturing rates and the proportion of blood samples obtained through central lines among collecting units (Table 1). Overall, the blood culture contamination rate was 1.6%. Blood samples obtained through a central line had a higher contamination rate (2.2%) compared to samples obtained through peripheral venipuncture (1.3%; P < .0001). Blood culture rates were highest in intensive care units (ICUs) compared with other types of patient care units (Table 1). The blood culture positivity rate was significantly lower in ICUs (8.8%) compared with hematology-oncology (10%; HR, 0.88; CI, 0.80–0.96; P = .006), general medicine (10%; HR, 0.88; CI, 0.80–0.97; P = .013), and pediatrics (12%; HR, 0.74; CI, 0.59–0.92; P = .008). The ICUs had the lowest rate of BC contamination at 1.3%. Conclusions: Blood samples obtained through central lines for culture are more likely to be contaminated than peripherally drawn blood samples. Despite a relatively high rate of line-drawn blood samples for culture, ICUs had the lowest BC contamination rate, possibly reflecting high familiarity of ICU nurses with line draws. Blood samples collected through lines were most frequently performed in pediatrics and hematology-oncology, and these units had correspondingly higher rates of contamination. This information will be used to inform institutional guidelines on blood culturing and to identify ways to minimize blood culture contamination, which often results in additional testing and/or unnecessary antimicrobial use.Funding: NoneDisclosures: Consulting fee- Merck (Priya Sampathkumar)

Advances have been made recently in neonatal nutrition in Japan, including a new donor human milk bank. However, little is known about the knowledge level of neonatal nutrition, donor human milk banks, and human milk fortifiers among Neonatal ICU (NICU) nurses. An anonymous survey was administered during an educational program to assess general knowledge. The overall response rate was 87.6% (219/250). About 60% reported working in the NICU for 1–5 years, and 42% reported that their NICU admitted more than 30 very low birth weight infants per year. Two-thirds (66.4%) acknowledged the existence of the new donor human milk bank. About half (46%) of NICU nurses incorrectly believed that the human milk fortifier available in Japan was derived from human milk rather than cow's milk. It would be beneficial to provide more education to NICU nurses on neonatal nutrition, donor human milk, milk banks, and the use of human milk fortifiers, both cow's milk-based and human milk-based.

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.

Aims and objectives To evaluate nurses' care coordination competency for mechanically ventilated patients in intensive care units (ICUs) of Saudi Arabia (SA). Background ICUs are increasingly using multidisciplinary approach to provide critical care. Functionality gaps remain within these teams preventing optimum performance, including a lack of adequate care coordination in the management of mechanically ventilated (MV) patients. Design A cross-sectional survey of ICU nurses working across 20 hospitals in SA. Methods The Nurses' Care Coordination Competency Scale (NCCCS) survey for MV patients was administered to all the nurses to assess their care coordination competence. The data were analysed using Student's t test, ANOVA and linear regression. Reporting of this research follows STROBE guidelines. Results A total of 254 nurses participated in the survey. The overall NCCCS mean score was 3.94 (±0.69) out of a 5-point scale. Also, the "promoting team cohesion factor (Factor 1)" had a mean score of 3.90 (±0.77), the "understanding care coordination needs factor (Factor II)" had a mean score of 4.00 (±0.77), the "aggregating and disseminating information factor (Factor III)" had a mean score of 4.05 (±0.76), and the "devising and clearly articulating the care vision factor (Factor IV)" had a mean score of 3.78 (±0.87). The mean overall NCCCS score was 4.10 among Indians, 3.98 among Filipinos and 3.81 among Saudi nationals. Conclusion There were a high overall score and subscale scores of nurses' care coordination competence for mechanically ventilated patients, but few gaps were identified in some of the items. Relevance to clinical practice The results provide information on the status and gaps in ICU nurses' care coordination competencies to address the needs of mechanically ventilated critically ill patients. The NCCCS can be utilised as an educational tool for nurses who are new to the ICU work environment.

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.