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Background: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care-associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature., Objective: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital., Methods: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting., Results: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience., Discussion: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures., Conclusions: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients., (©2024 American Association of Critical-Care Nurses.)

Operation Allies Refuge started in July 2021 with implications for critical care nurses, both military and civilian, serving at the US Army's Landstuhl Regional Medical Center in Landstuhl, Germany. Cultural and logistical concerns and complications were at the forefront of care provided to Afghan evacuees during the operation and were exacerbated by a mass casualty event on August 26, 2021, when a suicide bomber attacked the Abbey Gate of Hamid Karzai International Airport in Kabul, Afghanistan. This article discusses the issues that affected care, including language barriers, supply shortages, cultural differences, mass evacuation during a pandemic, and management of the mass casualty event by the critical care team. The information is compiled into a summary of lessons learned to assist in future management of emergency evacuee care within our military and civilian health care systems., (©2024 American Association of Critical-Care Nurses.)

Background: Decreases in size, capability, clinical volumes, case mixes, and complex care opportunities in military treatment facilities contribute to the atrophy of clinical skills among medical professionals in these facilities., Local Problem: The COVID-19 pandemic resulted in a 39% decline in admissions to a military critical care unit. The decrease in patient census contributed to skill sustainment challenges., Methods: To identify methods to combat skill atrophy, the CINAHL and PubMed databases were searched using the terms peacetime effect, military-civilian partnership, and skill sustainment. Active-duty critical care nurses stationed at a military treatment facility implemented a military-civilian partnership with a civilian medical facility for clinical skill sustainment., Results: One year after implementation, 39 critical care nurses had completed 511 shifts, gaining clinical experiences seldom achieved at the military facility. A survey of these nurses demonstrated that 8 of 17 (47%) gained experience treating patients requiring intra-aortic balloon pumps or continuous renal replacement therapy, 6 of 17 (36%) gained experience with patients requiring a ventricular assist device, 12 of 17 (71%) acquired hands-on experience with intracranial pressure monitoring, and 14 of 17 (82%) reported vasoactive intravenous infusion manipulation., Conclusions: This article highlights the importance of evaluating clinical practice within the military health system, developing military-civilian partnerships, and removing military-civilian partnership barriers for nurses and other health care professionals. Failure to implement military-civilian partnerships may adversely affect the clinical competency of the military nurse force., (©2024 American Association of Critical-Care Nurses.)

Background: The number of patients who have experienced violence is increasing worldwide. These patients have specific psychosocial and forensic needs and can present unique challenges to the health care workers caring for them., Objective: To identify best practices for the care of patients with injuries from violence in the emergency department or inpatient setting., Methods: The framework for integrative reviews by Whittemore and Knafl was used to conduct a literature search in MEDLINE, CINAHL, and ProQuest Nursing and Allied Health databases. Fourteen qualitative, quantitative, and mixed-methods studies from peer-reviewed journals were included in the review., Results: Themes included identifying patients as survivors of intimate partner violence or child abuse, the need to collect forensic evidence, the need for emotional support of patients and their loved ones, support for health care workers caring for patients with injuries from violence, prevention of further violence, and the challenges of caring for patients with injuries from violence with concurrent substance use disorders. Best practices for these aspects of care are summarized on the basis of literature analysis., Conclusion: Screening procedures are needed to identify survivors of intimate partner violence and child abuse. Forensic evidence preservation policies should be in place. For survivors of sexual assault, a sexual assault nurse examiner should be available. Hospital systems should provide psychosocial resources for patients' and health care workers' mental health, implement violence reduction programs, and provide bias training. More research is needed to determine efficacy of care models and best practice., (©2024 American Association of Critical-Care Nurses.)

Background: Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care., Local Problem: On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance., Methods: Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation., Results: Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues., Conclusions: Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity., (©2024 American Association of Critical-Care Nurses.)

Critical care nursing is a highly dynamic and demanding field, and critical care nurses play a vital role in the US military health care system. Although many critical care nurses are resilient to myriad occupational exposures, for some nurses the job leads to adverse psychological effects, including compassion fatigue and burnout. This article describes the evidence used to develop a psychoeducation program designed to mitigate burnout among health care professionals, particularly critical care nurses. Implementation considerations (including those in the context of disaster response) and future battlefield are discussed. Ultimately, supporting the psychological health of the US military's critical care nurse force is vital to ensure their well-being, the readiness of our armed forces, and the security of our nation., (©2024 American Association of Critical-Care Nurses.)

Background: Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines., Aim: To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses., Methods: A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis., Results: The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (β = .34, p = .002) and professional self-efficacy (β = .18, p = .011), while negatively affecting missed nursing care (β = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (β = .40, p = .003) and missed nursing care (β = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (β = -.32, p = .003). Care quality (β = -.10, p = .003) and professional self-efficacy (β = .13, p = .003) showed mediating effects between patient safety and missed nursing care., Linking Evidence to Action: ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes., (© 2024 Sigma Theta Tau International.)

Objectives: This study, which uses a randomized controlled design, aimed to determine the effect of foot reflexology on stress, fatigue, and low back pain (LBP) in intensive care unit (ICU) nurses., Methods: The study was conducted with intensive care unit nurses at two hospitals in a city between September 2022 and April 2023. The study sample consisted of 42 nurses, 21 of whom had low back pain for at least 3 months and 21 of whom were controls. In the study, foot reflexology was applied to the intervention group for 20 minutes (10 minutes on each foot) once a week for 4 weeks. There was no intervention applied to the control group. Data were collected using the Personal Information Form, the Perceived Stress Scale (PSS), the Fatigue Severity Scale (FSS), and the Visual Analog Scale (VAS)., Findings: Based on the change in the mean scores of the scale in the intervention and control groups over time, a statistically significant decrease was found between the pre-test (before foot reflexology) and post-test mean scores of the LBP-VAS (from 6.33 to 2.24, respectively) and the Fatigue Severity Scale (from 4.81 to 3.60, respectively) in the intervention group. Although there was no statistically significant difference between the perceived stress scale pre-test and post-test scores, it was found that there was a decrease in favor of the intervention group., Conclusion: Foot reflexology appears to offer promise as an effective method for ICU nurses to reduce lower back pain and fatigue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To describe the nursing strategies used to mitigate the impact of forced separation between hospitalized acute and critical care patients and their families during the COVID-19 pandemic., Research Methodology/design: A scoping review was performed in accordance with JBI methodology., Settings: Those acute and critical care areas in which sudden, often unexpected, emergent episodes of illness or injury were treated., Main Outcome Measures: Articles written in English and French between March 2020 and September 2023 in Medline, CINAHL Complete, APA PsycInfo, Embase and the Cochrane COVID-19 study register databases that met our inclusion criteria were included. Gray literature included dissertations, theses and Base Bielefeld Academic Search Engines., Results: Among the 1,357 articles screened, 46 met the criteria for inclusion. Most of the articles were published in North America. Adult critical care units were the most frequently reported settings, followed by neonatal intensive care units. The most frequently reported strategies were virtual telephone or video communications. A majority of the innovative strategies involved interprofessional collaboration at the unit level. Core components included the provision of relational nursing practices, virtual visits, tailored information, fostering relationships between family members, palliative care support regarding end of life, and general information about hospitalization and COVID-19. Pediatric care settings were more likely than adult care settings to accommodate physical visitation., Conclusion: Nurses used synchronous, episodic, and structured virtual interactions, either alone or as part of an interprofessional team, to mitigate separation between patients and families during the COVID-19 pandemic in acute and critical care settings., Implications for Clinical Practice: Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Nurses are vital partners in the development of pediatric neurocritical care (PNCC) programs. Nursing expertise is acknowledged to be an integral component of high-quality specialty patient care in the field, but little guidance exists regarding educational requirements to build that expertise. We sought to obtain expert consensus from nursing professionals and physicians on curricular priorities for specialized PNCC nursing education in pediatric centers across the United States., Methods: We used a modified Delphi study technique surveying a multidisciplinary expert panel of nursing professionals and physicians. Online surveys were distributed to 44 panelists over three rounds to achieve consensus on curricular topics deemed essential for PNCC nursing education. During each round, panelists were asked to rate topics as essential or not essential, as well as given opportunities to provide feedback and suggest changes. Feedback was shared anonymously to the panelist group throughout the process., Results: From 70 initial individual topics, the consensus process yielded 19 refined topics that were confirmed to be essential for a PNCC nursing curriculum by the expert panel. Discrepancies existed regarding how universally to recommend topics of advanced neuromonitoring, such as brain tissue oxygenation; specialized neurological assessments, such as the serial neurological assessment in pediatrics or National Institutes of Health Stroke Scale; and some disease-based populations. Panelists remarked that not all centers see specific diseases, and not all centers currently employ advanced neuromonitoring technologies and skills., Conclusions: We report 19 widely accepted curricular priorities that can serve as a standard educational base for PNCC nursing. Developing education for nurses in PNCC will complement PNCC programs with targeted nursing expertise that extends comprehensive specialty care to the bedside. Further work is necessary to effectively execute educational certification programs, implement nursing standards in the field, and evaluate the impact of nursing expertise on patient care and outcomes., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)

Background: Pain is a distressing problem which commonly occurs among critically ill patients. Nurses' knowledge of, attitudes, and perceived barriers to pain assessment and management can influence the effectiveness of nursing care., Objective: To explore the current knowledge of, attitudes, and perceived barriers to pain assessment and management among Thai critical care unit nurses., Methods: A cross-sectional survey conducted between November 2022 and January 2023 among 158 Thai nurses working in one of eight adult critical care units in a tertiary hospital, evaluated their knowledge of, attitudes, and perceived barriers to pain assessment and management., Results: Nurses possessed inadequate knowledge and negative attitudes regarding pain assessment and management. The most important barrier to pain assessment and management was "patients are unable to communicate their pain". The results showed a significantly weak positive correlation between nurses' attitudes toward pain assessment and management age (r = 0.26, p = 0.001), year of ICU experience (r = 0.29, p < 0.001), and obtaining a certificate in intensive care nursing (r = 0.37, P < 0.001)., Conclusions: Thai critical care unit nurses possessed inadequate knowledge and negative attitudes. Further training and education regarding pain assessment and management could include case studies or simulation and immersive virtual reality to improve critical care unit nurses' knowledge and attitudes as well as identifying potential barriers to pain assessment and management in the critical care settings., Implications for Clinical Practice: The implications for clinical practice recommend that continued quality assurance procedures should be implemented and maintained to evaluate the effectiveness of current pain assessment practices. Additionally, the perceived barriers to effective pain assessment and management should be considered and managed not only through continued education and training but could include using nursing case review, morbidity and mortality data identifying those patients that experience chronic pain post-ICU discharge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: To determine the knowledge levels of nurses working in the ICU about incontinence-associated dermatitis (IAD)., Methods: A descriptive cross-sectional study was conducted in adult ICUs at two private and three public hospitals in a province in Turkey. The study included 296 nurses who agreed to participate in the research. Researchers used the "Nurse Identification Form" and the "IAD Knowledge Test" to collect data on nurses' IAD knowledge. Data analysis included the use of percentage distribution and the Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests., Results: The mean age of the nurses was 26.55 ± 3.89 years (range, 20-47 years), and the duration of working in the ICU was 2.71 ± 2.55 years (range, 1-22 years). Of the nurses, 183 (61.8%) worked in general ICUs. Of those, 69 (23.3%) received IAD training. Nurses achieved a 49.8% correct response rate on the IAD knowledge test. Nurses working in tertiary and general ICUs demonstrated higher IAD knowledge levels (Ps = .003 and .047, respectively). There were no relationships between age, career length, institution, ICU type, and IAD knowledge level., Conclusions: Nurses' knowledge level of IAD was low in intensive care. To remedy this, IAD should be added to intensive care nursing certificate programs as content, and the use of IAD risk assessment and diagnosis scales in ICUs should be expanded., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience., Aim: The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms., Study Design: This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001)., Conclusion: The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology., Relevance to Clinical Practice: Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia., (© 2023 British Association of Critical Care Nurses.)

Nursing documentation is essential to communicate patient care delivery. This review explores available evidence on the contribution of nursing documentation toward quality care delivery during the COVID-19 pandemic. Nine articles were evaluated for at least one of the 6 factors of quality (eg, safe, timely, equitable, patient-centered, effective, and efficient). Analysis suggests that right-sizing documentation for optimal care quality requires continued efforts to reinforce the value and need of nursing documentation as a primary data source. Continued practice and research efforts are needed to reframe nursing documentation's essential role in benefiting a patient's current and future health care needs., Competing Interests: Disclosure The author has nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Delirium is an acute and fluctuating disturbance of cognition and is a common occurrence in critically ill patients. It is a manifestation of an acute brain dysfunction often attributed to higher survival rates and a subsequently aging population. Intensive Care Unit (ICU) treatment and survival often contributes towards development of delirium, and lack of or inappropriate management can translate into the development of long-term psychological effects that last even after discharge. While a lot is already known about this topic, and several assessment tools exist, these are not being consistently used by ICU nurses and as a result delirium often goes unrecognized, with unwarranted consequences., Aims: The study aimed to explore the perception of delirium among ICU nurses, and the extent of their awareness about guidelines to assess and prevent delirium in ICU patients. It also sought to understand the application of delirium guidelines in ICU practice., Study Design: A quantitative, exploratory, self-reporting survey was conducted among 145 ICU nurses from one critical care unit in the Republic of Ireland., Results: The overall response rate was 71% (103/145). Most nurses (85%) who participated in this survey believed delirium was expected. However, only 45% acknowledged it is a complication. Only 31% of nurses monitored delirium using a validated scale and few observed this as a part of routine care. Most nurses had received education; however, this did not translate to their clinical practice., Conclusions: Guidelines on managing delirium may not be routinely implemented in the ICU settings of hospitals in the Republic of Ireland., Relevance to Clinical Practice: As the findings suggest, a gap exists between theory and practice, necessary revision of policy or creating a new policy, supplemental educational sessions such as bedside sessions, e-learning module, study day or seminars need to be organized to improve nurses' awareness related to delirium and delirium prevention guidelines., (© 2024 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

In pediatric critical care, nurses are the primary caregivers for critically ill children and are particularly vulnerable to moral distress. There is limited evidence on what approaches are effective to minimize moral distress among these nurses. To identify intervention attributes that critical care nurses with moral distress histories deem important to develop a moral distress intervention. We used a qualitative description approach. Participants were recruited using purposive sampling between October 2020 to May 2021 from pediatric critical care units in a western Canadian province. We conducted individual semi-structured interviews via Zoom. A total of 10 registered nurses participated in the study. Four main themes were identified: (1) "I'm sorry, there's nothing else": increasing supports for patients and families; (2) "someone will commit suicide": improving supports for nurses: (3) "Everyone needs to be heard": improving patient care communication; and (4) "I didn't see it coming": providing education to mitigate moral distress. Most participants stated they wanted an intervention to improve communication among the healthcare team and noted changes to unit practices that could decrease moral distress. This is the first study that asks nurses what is needed to minimize their moral distress. Although there are multiple strategies in place to help nurses with difficult aspects of their work, additional strategies are needed to help nurses experiencing moral distress. Moving the research focus from identifying moral distress towards developing effective interventions is needed. Identifying what nurses need is critical to develop effective moral distress interventions., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

Introduction: Hepatic portal venous gas is an extremely rare symptom of gas accumulation in the portal venous system. This disease has an acute onset, a rapid progression, and an extremely high mortality rate. This report describes a patient with mesenteric and hepatic portal venous gas caused by intestinal microbiota disturbance-induced gut-derived infection after ileostomy. The patient recovered and was discharged after conservative treatment. Nursing management of patients with mesenteric and hepatic portal venous gas is discussed., Clinical Findings: A 76-year-old patient developed septic shock, paralytic intestinal obstruction, and mesenteric and hepatic portal venous gas after undergoing ileostomy., Diagnosis: Mesenteric and hepatic portal venous gas was diagnosed on the basis of abdominal contrast-enhanced computed tomography findings., Interventions: The treatment plan included early control of infection, early identification and nursing care of gut-derived infection caused by intestinal microbiota disturbance, early identification of paralytic intestinal obstruction, relief of intestinal obstruction and prevention of intestinal ischemia, and early nutritional support., Outcomes: On day 18 of hospitalization, the patient was transferred to the general ward and resumed eating, producing gas, and defecating. His abdominal signs and infection indicator levels were normal. On day 27, the patient was discharged home., Conclusion: This case provides an in-depth understanding of the care of patients with mesenteric and hepatic portal venous gas and emphasizes the important role of bedside nurses in evaluating and treating these patients. This report may help nurses care for similar patients., (©2024 American Association of Critical-Care Nurses.)

Background: The Society of Critical Care Medicine has established guidelines to manage pain, sedation, delirium, immobility, family participation, and sleep disruption in the intensive care unit, a set of interventions known as the intensive care unit liberation (ABCDEF) bundle. Adherence to these guidelines has shown positive results., Local Problem: In the intensive care units of a level I trauma academic teaching hospital in central Texas, the rate of bedside nursing staff adherence to the ABCDEF bundle was only 67.1% in January 2022. The aim of this quality improvement project was to improve adherence to the bundle., Methods: Knowledge gaps were found to be the driver of the low adherence rate. Two primary needs were identified: (1) education on the elements of the ABCDEF bundle and (2) increased awareness and recognition of incomplete and incorrect documentation. Interventions included focused education on intensive care unit liberation., Results: From February to June 2022, overall adherence to the ABCDEF bundle increased from 67.1% to 95.3%, ventilator use decreased by approximately 10%, and restraint use dropped by about 9%. The incidence of delirium increased, but this increase was due to incorrect patient assessment before the interventions., Conclusion: The results of this project are consistent with literature demonstrating that a multifaceted approach to improving ABCDEF bundle adherence can produce sustainable improvement in patient outcomes. This report may help other organizations facing similar challenges improve adherence to the bundle in a postpandemic environment., (©2024 American Association of Critical-Care Nurses.)

Objective: To explore intensive care unit (ICU) nurses' perceptions of their adherence to pressure injury prevention clinical practice guideline and identify the perceived barriers and facilitators that influence evidence-based pressure injury prevention practices in Chinese tertiary hospitals., Research Methodology/design: This was a multi-site, quantitative, cross-sectional study. Data were collected using a self-report questionnaire with three sections: participant demographic information, adherence to pressure injury prevention clinical practice guideline, and barriers to and facilitators of pressure injury prevention clinical practice guideline implementation., Setting: Thirty-three adult ICUs in 16 tertiary general hospitals in 5 major cities in Liaoning Province, China., Results: In total, 473 nurses responded to the survey. The mean score for adherence to pressure injury prevention clinical practice guideline was 159.06 ± 20.65, with 65.3 % reporting good adherence. Multiple stepwise regression analysis indicated that smaller ICU size (β = -0.114, p = 0.012) and having participated in training on pressure injury prevention clinical practice guideline (β = 0.149, p = 0.001) were statistically significantly associated with better adherence. ICU nurses identified the low priority given to pressure injury prevention as the top barrier. The top three facilitators were awareness of evidence-based practice, the current documentation format for pressure injury risk/nursing interventions, and leadership support., Conclusion: ICU nurses' adherence to pressure injury prevention clinical practice guideline was satisfactory, and they reported low-to-moderate barriers and moderate facilitators., Implications for Clinical Practice: Participating in training on pressure injury prevention clinical practice guideline was a predictor of ICU nurses' adherence. Therefore, it is highly recommended that healthcare organisations consider providing training to nurses and address the barriers identified to improve nurses' adherence to evidence-based pressure injury prevention guidelines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: Patients in intensive care units are exposed to many factors that can negatively affect the quality of their sleep., Objective: To describe the latest findings regarding sleep quality improvement in intensive care unit patients., Methods: An integrative literature review was conducted in the CINAHL, PubMed, Cochrane Library, and MEDLINE databases in April and May 2023. The following keywords were used: intensive care units, promotion, sleep quality, and sleep. The Critical Appraisal Skills Programme tool was used to assess the quality of individual studies., Results: Of 159 articles identified, 10 were included in the final analysis. The findings were grouped into 4 thematic categories: consequences of poor sleep quality, factors affecting sleep quality, pharmacologic ways to improve sleep quality, and nonpharmacologic ways to improve sleep quality., Discussion: Various pharmacologic and nonpharmacologic treatments are used in clinical settings. Nonpharmacologic interventions include sleep masks, earplugs, reductions in alarm volume, and reductions in nighttime interventions. Relaxation techniques include aromatherapy, music therapy, and acupressure., Conclusions: The most effective way to improve sleep for intensive care unit patients is to use a combination of pharmacologic and nonpharmacologic interventions. Among the latter, the use of earplugs and sleep masks is simplest., (©2024 American Association of Critical-Care Nurses.)

Objective: To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations., Background: Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB., Design: Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments., Methods: The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice., Results: Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC., Conclusion: NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation., Relevance for Clinical Practice: Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety., Patient or Public Contribution: Experts participated in the Delphi rounds and nurses in the pilot test., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Objective: To determine the effectiveness of a nursing intervention based on the Dynamic Symptom Model (DSM) and scientific evidence versus daily care in reducing the incidence and duration of delirium in intensive care patients., Method: We designed the intervention named "DyDel" (By Dynamic Delirium) based on the theoretical approach of the DSM and from scientific evidence. A double-masked clinical trial of parallel groups was developed to test DyDel, with 213 patients older than 18 admitted to the intensive care unit (ICU) randomized to the study groups. The intervention group received DyDel each shift from day 0 until discharged from the ICU, while the control group received daily care in the ICU. At the same time, all participants were followed to measure primary (incidence and duration of delirium) and secondary outcomes (level of sedation and pain, days of mechanical ventilation, stay in ICU, and physical restriction)., Results: Overall, the study population were older than 60 years (60.3 ± 15.2 years), the male gender (59.6 %), and the diagnosis of acute myocardial infarction (73.7 %) were predominant. Comparing groups of study, the incidence of delirium was lower in the intervention group (5.6 %) than in the control group (14.8 %) (p = 0.037). The intervention group had lower days with delirium (0.07 ± 0.308) than the control group (0.34 ± 1.28) (p = 0.016), lower pain intensity (p = 0.002) and lower days of physical restraints (p = 0.06)., Conclusion: Non-pharmacological care, like the DyDel intervention, includes the family and focuses on the different patient's needs, which can help to reduce the incidence and duration of delirium in patients admitted to adult ICUs., Implications for Clinical Practice: DyDel was non-pharmacological and included the family. The DyDel's activities were focused on physiological, psychological, spiritual, and social needs and the experience and trajectory of delirium. The nurse can give humanized care in the ICU by applying DyDel., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses., Methods: The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test., Results: The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15)., Conclusions: There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: High-quality sleep is important for optimal patient recovery. Sleep deprivation during hospitalization may lead to poor patient outcomes., Objective: To examine whether implementation of a sleep promotion bundle in the intensive care unit affects rates of delirium and agitation, restraint use, and length of stay., Methods: An evidence-based sleep promotion bundle was developed and implemented in 2 intensive care units in a 1025-bed level I trauma teaching hospital. Deidentified data from the electronic health record were obtained for patients hospitalized before and during the intervention. Data included scores on the Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation-Sedation Scale, and Glasgow Coma Scale; restraint use; and hospital and intensive care unit length of stay., Results: A total of 137 patients during the preintervention period and 149 patients during the intervention period were hospitalized in the intensive care units and met inclusion criteria. A 9-percentage-point decrease in the incidence of delirium from before to during the intervention was found, although it was not statistically significant (P = .07). Significant reductions were found in both intensive care unit (P = .04) and hospital (P = .03) length of stay. A significant decrease was found in Richmond Agitation-Sedation Scale high scores for patients requiring mechanical ventilation (P = .03). No significant differences were found in Richmond Agitation-Sedation Scale low scores, Glasgow Coma Scale scores, or restraint use., Conclusions: Critical care nurses are in an optimal position to implement evidence-based sleep promotion measures. Further research on sleep promotion bundles is needed., (©2024 American Association of Critical-Care Nurses.)

Critical care nurses' decision-making regarding verification of blindly inserted gastric tubes: A cross-sectional questionnaire study Abstract: Background: The placement and verification of the correct position of blindly applied gastric tubes is regularly performed by nurses in clinical practice. International guidelines recommend a radiological verification as a "first-line" method or if pH measurement is not possible. For Germany, neither evidence-based recommendations nor current data are available. Question: Which methods are used by nurses in German intensive care units for verification of the correct position of blindly applied gastric tubes and how do they assess the reliability of different methods? Methods: Multicenter questionnaire survey. Intensive care units in a non-probability, citeria-based sampling of hospitals in and around Cologne, Germany were included. One nurse was included per participating ward. Analyses were mostly descriptive. Results: In 22 hospitals, 38 wards agreed to participate and 32 (84%) responded to the survey. Auscultation of the upper abdomen with simultaneous air insufflation and aspiration of gastric secretions are frequently used methods for determining the position of gastric tubes. Participants consider auscultation, aspiration of gastric secretions, and radiological control as reliable methods. Conclusions: The findings are in contrast to international recommendations and support the need for evidence-based best practice recommendations and training. Likewise, there is a need for research on feasible bedside methods.

Background: Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce., Aim: To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making., Design: Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis., Setting and Participants: This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate., Findings: Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation., Conclusion: Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns., Implications for Clinical Practice: Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: One author is an Associate Editor for Intensive & Critical Care Nursing and was not involved in the editorial review or the decision to publish this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: In society, people live in a social reality where multiculturalism is an increasingly relevant and prevalent topic in their contexts. Facing this, caring for multicultural patients in an emergency service or intensive care unit setting requires a high level of cultural competence due to the complexity, vulnerability of the patient, rapid changes in hemodynamic status, involvement of the family, their informational needs., Objective: To map the strategies for nursing care of critically ill multicultural patients., Method: A Scoping Review was conducted following the Joanna Briggs Institute's recommendations, with the research question: What are the strategies for nursing care of critically ill multicultural patients? The study was guided by PRISMA. The research was conducted through the EBSCOHost platform, SciELO, Portugal's Open Access Scientific Repository, the Virtual Health Library and a search in grey literature. This was achieved by combining the descriptors DECS/MESH: cultural competence; critical care; emergency room; intensive care; and natural words: cultural care; nurs* interventions; nurs* strategies; within the time frame from 2012 to 2024. The study screening was performed by three independent reviewers through the reading of titles, abstracts and full texts, applying exclusion criteria. The study results were then subjected to content analysis, from which categories emerged., Results: The selected articles highlight various strategies that contribute to the improvement of nursing care for critically ill multicultural patients, focusing on care practice and cultural diversity training for both nurses and nursing students., Conclusion: Nurses with cultural competence possess more knowledge and strategies to provide tailored care for multicultural critically ill patients, thereby enhancing the quality of care delivered and contributing to the humanization of healthcare., Relevance to Clinical Practice: Nurses need to have knowledge of existing strategies for caring for multicultural critically ill patients., Patient or Public Contribution: No direct patient or public contribution to the review., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Despite implementation of central catheter bundles, central line [catheter]-associated bloodstream infections (CLABSIs) remain a preventable hospital-acquired infection., Local Problem: A new population of patients with pulmonary artery catheters was introduced to the cardiac progressive care unit, increasing central catheter days, device use, and CLABSI rate., Methods: A quality improvement project was conducted. Nursing staff implemented a standardized central catheter rounding process 3 days a week to critically assess all central catheter dressings, deter-mine the necessity of each central catheter, and educate patients on the importance of keeping central catheter dressings clean, dry, and intact. Data were collected during central catheter rounds for each patient, entered in an electronic survey tool via mobile devices, and analyzed., Results: From July 2019 through June 2022, a total of 2692 rounds were conducted for 707 individual patients with 3064 central catheters. Main interventions were dressing management, monitoring insertion site bleeding that extended beyond edges of the chlorhexidine gluconate pad, treating patients' allergies to products, and maintaining sustainability within the unit. Central catheter rounds decreased the CLABSI rate from 1.86 to 0.0 despite the continued increase in central catheter days., Conclusions: Central catheter dressing assessment, intervention, and education help reduce CLABSIs. Central catheter rounds are an important adjunct to the CLABSI bundle. A central catheter dressing management algorithm helps nurses decide when to change a dressing and which type of dressing to use., (©2024 American Association of Critical-Care Nurses.)

Aim: Advanced Practice Nurses are expected to provide lifesaving care to patients with complex acute illnesses in emergency and critical care settings. However, little is known about their competencies and barriers to practice in emergency and critical care settings. This review investigated these nurses' competencies to practice., Methods: A scoping review was conducted in accordance with Arksey and O'Malley's framework. Extensive research searches were conducted using seven electronic databases: MEDLINE, CINAHL, Scopus, Web of Science, Ichushi Web, Mednar and GreyNet International. Definitions and explanations of Advanced Practice Nurse competencies were categorized into elements and grouped according to similarity., Results: The database searches identified 2,483 studies, and data were extracted for 23 studies. Analysed studies were published between 2000 and 2021 and conducted in eight countries. Seven competencies were identified: performing advanced practice nursing, acute patient care, diagnostic assessment, interdisciplinary collaboration and consultation, leadership and system management, documenting patient care and supporting patient and family decision-making., Conclusion: This review identified competencies unique to Advanced Practice Nurses in emergency and critical care settings. Further research is required to facilitate understanding of the crucial roles of advanced care nurses among healthcare providers., (© 2023 John Wiley & Sons Australia, Ltd.)

Background: Pediatric patients receiving neurologic and neurosurgical critical care undergo many procedures that result in stimulation of the sympathetic nervous system, which increases their risk of poor outcomes. Nurses typically implement a variety of interventions to minimize such stimulation; however, minimal stimulation has not been specifically defined in the literature or described as a standardized bundle of care., Objective: To examine pediatric intensive care unit nurses' interpretation and practice of minimal stimulation in patients with neurologic and neurosurgical conditions and specifically to triangulate nurses' descriptions of this practice with related findings in the literature., Methods: This was a qualitative, descriptive, exploratory study that used naturalistic inquiry., Results: A total of 13 pediatric intensive care unit nurses participated in the study. Three primary themes were identified regarding minimal stimulation: (1) new knowledge and practice, (2) communication, and (3) impact of minimal stimulation., Conclusions: The findings of this study help to establish a working definition of the nursing practice of minimal stimulation and provide a basis for future research. More detailed study is needed on the concept of a standardized minimal stimulation bundle and its impact on patient outcomes., (©2024 American Association of Critical-Care Nurses.)

Healing is a difficult concept to describe, quantify, or replicate. It is a complex mixture of personal contributions from the professional providing care, including competence, compassion, and empathy, that conjoins with the needs, sensitivities, and receptivity of the one who is receiving the care. Although it may be difficult to predict all the elements that come together to initiate sustained healing, as well as the long-term impact, it is important to observe the moments that make a difference. For those who study the nature of healing, a patient's reflections can surface the kinds of elements that are present when healing is sustained. [ J Contin Educ Nurs . 2024;55(7):326-327.] .