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Background: Delirium is an acute confusional state characterized by inattention, cognitive dysfunction and an altered level of consciousness. Delirium causes negative outcomes in patients, and patients with delirium increase the workload of nurses. Therefore, it is important to recognize the challenges and burdens experienced by nurses caring for patients with delirium. Aim: To determine the subjective burden experienced by intensive care nurses caring for patients who have undergone open‐heart surgery. Study Design: A mixed‐method sequential explanatory design. A non‐probability purposive sampling method was used for the quantitative stage. Using OpenEpi, we employed the method of sample calculation with an unknown universe. The sample size of the quantitive study comprised 130 nurses. Quantitative data were collected with Google survey. For gathering qualitative data, online video interviews were conducted with 10 nurses, an interpretive phenomenological approach was used and content analysis was performed. Results: In the quantitative phase, we found that the subjective burden was high. In the qualitative phase, five main themes emerged: difficulty in recognizing delirium, physical burden, emotional burden, burden in care management of patients with delirium and the effect of patients with delirium on other patients. The nurses experienced physical and emotional burden in delirium management and felt lonely while caring for patients with delirium. Conclusions: Because nurses play a key role in the care of patients with delirium, reducing the burden nurses experience when caring for patients with delirium should be considered important in ensuring that this patient population receives adequate care. Relevance to Clinical Practice: Delirium patients create a care burden for intensive care nurses. To reduce this burden of care, in‐service training in patient management and bedside teaching support should be provided to nurses. Furthermore, the use of a valid scale to diagnose delirium should be integrated into health policies. Nurses should not be left alone in the management of delirium. Managing delirium patients with a team including physicians, nurses and professionals from other health disciplines will ensure that patients receive high‐quality care, thereby reducing the care burden of nurses. [ABSTRACT FROM AUTHOR]

Background: Dysphagia, as a geriatric syndrome, is prevalent in the intensive care unit (ICU). Malnutrition resulting from swallowing disorders is likely to correlate with adverse ICU outcomes, including delirium, thereby escalating the costs of care and hospitalization. However, malnutrition has not received the attention it deserves in ICU clinical nursing practice. As two preventable and correctable conditions—malnutrition and delirium—the advantages of early identification and intervention are substantial. Exploring the relationship between malnutrition and delirium, starting from the high‐risk group of elderly patients with swallowing difficulties in the ICU, will aid us in managing patients promptly and effectively. Aim: To investigate the relationship between malnutrition and the incidence of delirium in elderly patients with dysphagia in the ICU. Study Design: This is a retrospective study. Data for this study were obtained from the Medical Information Mart for Intensive Care‐IV. All 2273 patients included were dysphagia older patients over 65 years of age admitted to the ICU, and logistic regression was used to explore the relationship between malnutrition and delirium. We also used propensity score matching (PSM) for sensitivity analysis. Results: Among the included patients with swallowing difficulties, 13% individuals (297/2273) exhibited malnutrition, with a delirium incidence rate of 55.9% (166/297). In the non‐malnutrition group (1976/2273), the delirium incidence rate is 35.6% (704/1976). After adjusting for 31 covariates, multifactorial logistic regression showed that malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.47–2.62). The results remained stable after analysis by PSM. Conclusion: Malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU. Malnutrition should be given adequate attention in the ICU. Relevance to Clinical Practice: ICU nurses should pay particular attention to malnutrition, especially among the high‐prevalence group of patients with dysphagia. Early identification and nutritional intervention for these patients may help reduce the costs of care and health care expenditures. [ABSTRACT FROM AUTHOR]

Background: Ventilator‐associated pneumonia (VAP) is a significant concern in low‐middle‐income countries (LMICs), where the burden of hospital‐acquired infections is high, and resources are low. Evidence‐based guidelines exist for preventing VAP; however, these guidelines may not be adequately utilized in intensive care units of LMICs. Aim: This scoping review examined the literature regarding the use of nursing care bundles for VAP prevention in LMICs, to understand the knowledge, practice and compliance of nurses to these guidelines, as well as the barriers preventing the implementation of these guidelines. Study Design: The review was conducted using Arksey and O'Malley's (2005) five‐stage framework and the PRISMA‐ScR guidelines guided reporting. Searches were performed across six databases: CINAHL, Medline, Embase, Global Health, Scopus and Cochrane, resulting in 401 studies. Results: After screening all studies against the eligibility criteria, 21 studies were included in the data extraction stage of the review. Across the studies, the knowledge and compliance of nurses regarding VAP prevention were reported as low to moderate. Several factors, ranging from insufficient knowledge to a lack of adequate guidelines for VAP management, served as contributing factors. Multiple barriers prevented nurses from adhering to VAP guidelines effectively, including a lack of audit/surveillance, absence of infection prevention and control (IPC) teams and inadequate training opportunities. Conclusions: This review highlights the need for adequate quality improvement procedures and more efforts to conduct and translate research into practice in intensive care units in LMIC. Relevance to Clinical Practice: IPC practices are vital to protect vulnerable patients in intensive care units from developing infections and complications that worsen their prognosis. Critical care nurses should be trained and reinforced to practice effective bundle care to prevent VAP. [ABSTRACT FROM AUTHOR]

Background: Transplant nurse coordinators have close and long‐term interactions with organ donor families throughout the organ donation process. Due to the responsibilities and high sensitivity of organ transplant coordination, transplant nurse coordinators face several stressful challenges. This study aimed to explore the challenges faced by Iranian transplant nurse coordinators. Methods: This is a qualitative study conducted using qualitative content analysis. This study was conducted from February to September 2023. Semi‐structured face‐to‐face interviews were conducted with a total of 14 transplant nurse coordinators. Data were analyzed using conventional qualitative content analysis proposed by Graneheim and Lundman. Results: "Challenges of living as a transplant nurse coordinator" was identified as the main category, the subcategories of which included "consent‐obtaining obstacles," "exposure to violence," "compassion fatigue," "obsessive thoughts," "work–life imbalance," and "hardworking coordinators in the shadow." Conclusions: The challenges experienced by transplant nurse coordinators can lead to several negative consequences, including job burnout and turnover, reduced quality of family and marital life, additional healthcare costs, and reduced organ donation rate. To address these challenges, cultivating a culture of organ donation in society could involve public awareness campaigns and educational initiatives. Improving the working conditions and occupational incentives could include reducing work hours, providing psychological support, and increasing salaries. Implementing psychological interventions could involve regular counseling sessions and stress management programs. These measures can effectively reduce the challenges transplant nurse coordinators face and improve their overall well‐being and job satisfaction. [ABSTRACT FROM AUTHOR]

Pulmonary thromboembolismis a common cardiovascular disease, with high morbidity and mortality rates in hospitalized patients. Because of clotting disorders and hypoxemia caused by COVID-19, critically ill patients are highly susceptible to thrombotic complications. A study published in the Journal of the American Medical Association in 2022 showed that the incidence of venous thromboembolism(VTE) in critically ill COVID-19 patients was approximately 10%to 35%, whereas the incidence of VTE in autopsy cases was as high as 60%(JAMA Intern Med 182:1063-1070). Clinicians need increased awareness of VTE in COVID-19 patients, to reduce the risk of deep vein thrombosis and pulmonary thromboembolism and to be alert to life-threatening complications. [ABSTRACT FROM AUTHOR]

Background Aims Study Design Results Relevance to Clinical Practice Hyperglycaemia is common in intensive care units (ICUs), with a prevalence of up to 86.2%, increasing mortality. Technology has evolved towards continuous glucose monitoring (CGM), and its use in ICUs began especially during the coronavirus pandemic (COVID‐19). Various studies have evaluated the reliability of CGM, indicating that it is safe for use in critically ill patients.The aim of this study was to compare the use of CGM with point‐of‐care glucose (POC‐G) testing in ICU. Specific objectives include evaluating the glycaemic control, the frequency of POC‐G measurements, the incidence of hyperglycaemia, hypoglycaemia and morbidity and mortality at 90 days.An experimental, controlled and randomized clinical trial with a single‐blind design will be conducted at Hospital Clinic of Barcelona (HCB). A sample size of 376 participants will be recruited and randomly assigned to two groups: an experimental group, where glycaemic management will be based on CGM; and a control group, where glucose will be managed through POC‐G testing, with a blinded CGM.The primary variable considered will be time in range (TIR), with secondary outcomes including, time above range (TAR), time below range (TBR), number of POC‐G measurements, incidence of hyperglycaemia and hypoglycaemia, and mortality. Hypothesis testing will use the Kolmogorov–Smirnov test to assess data normality, with appropriate statistical tests applied, considering a p‐value <.05.The results obtained will help us understand the impact of CGM on critically ill patients. CGM could potentially reduce the workload of nurses and improve the efficiency of decision‐making by the ICU team, enabling early identification and treatment of glucose complications, thereby enhancing safety. Patient safety, a reduction in patient fingerstick and a decreased care burden are the criteria that add value to this research. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Design Methods Results Conclusion Relevance to Clinical Practice Reporting Method Patient or Public Contribution This correlational cross‐sectional multicentre study aims to achieve two objectives. Firstly, to assess nurses' knowledge and practice of endotracheal cuff pressure management. Secondly, to examine the relationship between endotracheal cuff pressure management knowledge and evidence‐based practice leadership and work environment.A correlational cross‐sectional multicentre study design.This study was conducted among 144 intensive care nurses in Turkey. Data collection included descriptive characteristics and cuff pressure management of nurses, the Evidence‐Based Practice Leadership Scale and Evidence‐Based Practice Work Environment Scale. Descriptive statistics, chi‐square test, Pearson correlation and receiver operating characteristics analysis were conducted. A STROBE checklist was the reporting guide for this study.The success status of nurses in terms of knowledge related to cuff pressure was found significantly different according to the type of intensive care unit working in and the status of receiving training on evidence‐based practice. A positive, strong relationship was found between nurses' mean scores on the Evidence‐Based Practice Leadership Scale and the Work Environment Scale. There was a very weak positive correlation between the mean scores of the Evidence‐Based Practice Leadership Scale and the cuff pressure management.Adherence by nurses to current evidence‐based practice for cuff pressure monitoring is essential for safe patient care and improved quality of care. It is recommended to provide both a supportive working environment and training programmes for intensive care nurses to perform cuff pressure management in line with evidence‐based practice.Providing educational programs, an appropriate clinical environment, support from health managers and access to appropriate tools are important considerations in increasing the knowledge and skills of intensive care nurses to effectively monitor and manage cuff pressure.Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross‐sectional studies.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background Aim Study design Results Conclusions Relevance to Clinical Practice Nurses face a high level of mental workload while performing their duties. High levels of mental workload can negatively impact nurses.The aim of this research was to determine the relationship between mental workload and burnout levels of intensive care nurses.Descriptive‐correlational design has been adopted in this research. The sample consisted of 156 nurses working in the intensive care units of a hospital in the south of Turkey between September and December 2023. Research data were collected with the ‘Participant Information Form’, which includes socio‐demographic characteristics, ‘Mental Workload Scale’ and ‘Maslach Burnout Scale’.Almost all (95.5%) of the nurses participating in the study reported that their mental workload was high. It has been determined that there is a strong positive relationship between mental workload and burnout. According to the regression model obtained from the research, being a woman (β = .165, p = .008) and emotional workload (β = −695, p < .001) are determinants of emotional exhaustion. These variables explain emotional exhaustion at a rate of 50.1% (adjusted R2 = .501). Emotional workload (β = .399, p = .003) is the most important determinant of personal accomplishment. This variable explains 19.0% (adjusted R2 = .190) of personal accomplishment. The most important determinant of depersonalization is emotional workload (β = .324, p < .001). It was determined that this variable explained 24.4% (adjusted R2 = .244) of depersonalization.This research revealed that there is a strong positive relationship between mental workload and burnout and that increasing mental workload can increase burnout.Nurses' risk of emotional exhaustion increases as mental workload increases. Reducing cognitive workload, temporary workload and emotional workload increases the personal accomplishment experienced by nurses. In addition, as temporary workload, emotional workload and performance‐related workload increase, the depersonalization experienced by nurses also increases. [ABSTRACT FROM AUTHOR]

Introduction: The integration of artificial intelligence (AI) in intensive care units (ICUs) presents both opportunities and challenges for critical care nurses. This study delves into the human factor, exploring how nurses with leadership roles perceive the impact of AI on their professional practice. Objective: To investigate how nurses perceive the impact of AI on their professional identity, ethical considerations surrounding its use, and the shared meanings they attribute to trust, collaboration, and communication when working with AI systems. Methods: An interpretive phenomenological analysis was used to capture the lived experiences of critical care nurses leading with AI. Ten nurses with leadership roles in various ICU specializations were interviewed through purposive sampling. Semi-structured interviews explored nurses’ experiences with AI, challenges, and opportunities. Thematic analysis identified recurring themes related to the human factor in leading with AI. Findings: Thematic analysis revealed two key themes which are leading with AI: making sense of challenges and opportunities and the human factor in leading with AI. The two main themes have six subthemes which revealed that AI offered benefits like task automation, but concerns existed about overreliance and the need for ongoing training. New challenges emerged, including adapting to new workflows and managing potential bias. Clear communication and collaboration were crucial for successful AI integration. Building trust in AI hinged on transparency, and collaboration allowed nurses to focus on human-centered care while AI supported data analysis. Ethical considerations included maintaining patient autonomy and ensuring accountability in AI-driven decisions. Conclusion: While AI presents opportunities for automation and data analysis, successful integration hinges on addressing concerns about overreliance, workflow adaptation, and potential bias. Building trust and fostering collaboration are fundamentals for AI integration. Transparency in AI systems allows nurses to confidently delegate tasks, while collaboration empowers them to focus on human-centered care with AI support. Ultimately, dealing with the ethical concerns of AI in ICU care requires prioritizing patient autonomy and ensuring accountability in AI-driven decisions. [ABSTRACT FROM AUTHOR]

Background: Diarrhea during enteral nutrition may induce various complications and increase the nursing workload. Local Problem: The diarrhea rate in our intensive care units (ICUs) was 37.14% from May to July 2021. Nurses reported a moderate to heavy burden regarding care for those with diarrhea. Methods: A pre-post implementation design was used to evaluate the impact of evidence-based interventions for diarrhea screening and prevention. Interventions: A diarrhea risk screening tool and countermeasures were developed through an extensive literature review. Tools were integrated into the electronic health record system. Results: The rate of diarrhea decreased from 37.14% to 17.33% (P = .000). Nurse's compliance with practice standards increased for diarrhea assessment, risk factor screening, agent choice, and countermeasures provision (P < .05). Conclusions: The evidence-based tools developed for this project helped decrease the diarrhea rate in our ICUs. [ABSTRACT FROM AUTHOR]

Critical care nurses have high workloads due to the severity of the disease and the complexity of the treatment and care. Understanding the factors that influence subjective workload as well as the association between subjective and objective workload could lead to new insights to reduce critical care nurses’ workload. (1) To describe critical care nurses’ subjective and objective workload per shift in a university-affiliated interdisciplinary adult intensive care unit in Switzerland and (2) to explore the association between objective and subjective workload. The study used a prospective longitudinal cohort design. Critical care nurses completed the adapted Questionnaire on the Experience and Evaluation of Work 2.0 (QEEW2.0) to assess the subjective workload after every shift for four weeks (0 = never loaded, 100 = always loaded). The objective workload was assessed with the Therapeutic Intervention Scoring System-28 (TISS-28), Nine Equivalents of Nursing Manpower Use Score (NEMS), Swiss Society for Intensive Care Medicine (SGI)-patients’ categories and Patient-to-Nurse Ratio (PNR). Data was analysed using multilevel mixed models. The workload of 60 critical care nurses with a total of 765 shifts were analysed. The critical care nurses experienced a subjective high mental load (66 ± 26), moderate pace and amount of work (30 ± 25) and physical load (33 ± 25), and low emotional-moral load (26 ± 22). The one-time baseline subjective workload values were higher than the day-to-day values. The mean objective shift load using the TISS-28 was 43 ± 16 points, the NEMS 36 ± 14 points, the SGI-category 1.1 ± 0.5 nurses needed per patient and the PNR 1.2 ± 0.4. We found positive associations between day-to-day objective variables with subjective pace and amount of work, with physical and mental load but not with emotional-moral load and performance. Measured objective workload is associated with only certain subjective workload domains. To promote and retain critical care nurses in the profession, nursing management should give a high priority to understanding subjective workload and strategies for reducing it. [ABSTRACT FROM AUTHOR]

Background: Bleeding following cardiac surgery is common and serious, yet a gap persists in understanding how experienced intensive care nurses identify and respond to such complications. Aim: To describe the clinical decision‐making of experienced intensive care unit nurses in addressing bleeding after cardiac surgery. Study Design: This qualitative study adopted the Recognition‐Primed Decision Model as its theoretical framework. Thirty‐nine experienced nurses from four adult intensive care units participated in semi‐structured interviews based on the critical decision method. The interviews explored their clinical judgements and decisions in bleeding situations, and data were analysed through dimensional analysis, an alternative to grounded theory. Results: Participants maintained consistent vigilance towards post‐cardiac surgery bleeding, recognizing it through a haemorrhagic dimension associated with blood loss and chest drainage and a hypovolemic dimension focusing on the repercussions of reduced blood volume. These dimensions organized their understanding of bleeding types (i.e., normal, medical, surgical, tamponade) and necessary actions. Their decision‐making encompassed monitoring bleeding, identifying the cause, stopping the bleeding, stabilizing haemodynamic and supporting the patient and family. Participants also adapted their actions to specific circumstances, including local practices, professional autonomy, interprofessional dynamics and resource availability. Conclusions: Nurses' decision‐making was shaped by their personal attributes, the patient's condition and contextual circumstances, underscoring their expertise and pivotal role in anticipating actions and adapting to diverse conditions. The concept of actionability emerged as the central dimension explaining their decision‐making, defined as the capability to implement actions towards specific goals within the possibilities and constraints of a situation. Relevance to Clinical Practice: This study underscores the need for continual updates to care protocols to align with current evidence and for quality improvement initiatives to close existing practice gaps. Exploring the concept of actionability further, developing adaptability‐focused educational programmes, and understanding decision‐making intricacies are crucial for informing nursing education and decision‐support systems. [ABSTRACT FROM AUTHOR]

Background: While there is a growing body of knowledge specific to understanding the experiences of nurses who work in various contexts in Canada’s northern territories, there continues to be a dearth of research specific to the care of critically ill patients and their families. Purpose: The purpose of this study was to further expand our understanding of how critical care nursing is experienced in the northern context. This study explored nurses’ experiences of providing critical care in all settings from purpose-built intensive care unit to community health centres. Study design: An interpretive descriptive approach was used. Methods: Telephone interviews were conducted with nine registered nurses currently employed in various settings, and three additional telephone interviews were used from an earlier pilot study. Interviews were transcribed and thematically coded. Findings: The following themes emerged: Always the Nurse; Working in Community; Must Haves and Managing Resources; Working Together – Even if We’re Not Together; and A Paradigm Shift: Working Up North. Conclusions: This study highlights the need to consider how nursing geography impacts nursing identity and how to best support nurses who provide critical care but, appropriately, may not identify as critical care nurses due to the expansive roles and responsibilities that some assume in nursing work outside of intensive care units. It also provides a strong incentive to establish relationships with those expanding our understanding of the northern context and what is required of nurses in this context to provide optimal care to patients, families and communities when and wherever critical illness is experienced. [ABSTRACT FROM AUTHOR]

The aim of this study was to comparatively investigate education, job, and professional development satisfaction among intensive care unit nurses in Poland and England. A total of 258 ICU nurses from both countries were interviewed (72 Polish nurses working in Poland and 186 of various national backgrounds in England, including 50 of Polish origin). We used an 11-item structured survey followed by an open-ended qualitative interview retrospectively coded for statistical analysis. Regardless of national origin, nurses in England report significantly higher education satisfaction, attributed to better theoretical knowledge gain but not to other dimensions (such as practical knowledge or personal satisfaction). They also express greater satisfaction with job conditions regarding professional development, a state-of-the-art work environment, teamwork, and finance. The UK system is also considered significantly superior in promotion opportunities and participation in post-graduation training. In conclusion, systemic factors play a crucial role in career satisfaction and advancement in nursing, with the British band system having a clear advantage over the Polish one. [ABSTRACT FROM AUTHOR]

Abstract Introduction The integration of artificial intelligence (AI) in intensive care units (ICUs) presents both opportunities and challenges for critical care nurses. This study delves into the human factor, exploring how nurses with leadership roles perceive the impact of AI on their professional practice. Objective To investigate how nurses perceive the impact of AI on their professional identity, ethical considerations surrounding its use, and the shared meanings they attribute to trust, collaboration, and communication when working with AI systems. Methods An interpretive phenomenological analysis was used to capture the lived experiences of critical care nurses leading with AI. Ten nurses with leadership roles in various ICU specializations were interviewed through purposive sampling. Semi-structured interviews explored nurses’ experiences with AI, challenges, and opportunities. Thematic analysis identified recurring themes related to the human factor in leading with AI. Findings Thematic analysis revealed two key themes which are leading with AI: making sense of challenges and opportunities and the human factor in leading with AI. The two main themes have six subthemes which revealed that AI offered benefits like task automation, but concerns existed about overreliance and the need for ongoing training. New challenges emerged, including adapting to new workflows and managing potential bias. Clear communication and collaboration were crucial for successful AI integration. Building trust in AI hinged on transparency, and collaboration allowed nurses to focus on human-centered care while AI supported data analysis. Ethical considerations included maintaining patient autonomy and ensuring accountability in AI-driven decisions. Conclusion While AI presents opportunities for automation and data analysis, successful integration hinges on addressing concerns about overreliance, workflow adaptation, and potential bias. Building trust and fostering collaboration are fundamentals for AI integration. Transparency in AI systems allows nurses to confidently delegate tasks, while collaboration empowers them to focus on human-centered care with AI support. Ultimately, dealing with the ethical concerns of AI in ICU care requires prioritizing patient autonomy and ensuring accountability in AI-driven decisions.

Background: Endotracheal Tube Suctioning (ETS), which involves either an open or closed suctioning system, is a crucial practice for mechanically ventilated patients. The nursing practice of airway suctioning is inevitable. This study was designed to compare the intensive care nurses’ performance of open versus closed endotracheal suction on critically ill patients in Ismailia City. Materials and Methods: A non-participant structured observational study design was conducted on a convenient sample (N = 63) at intensive care units at a teaching hospital through March and August 2022 to evaluate how nurses practice different procedures in open suctioning compared with the closed suctioning system of Endotracheal Suction (ES) through a 32-item structured checklist. Additionally, authors compared their levels of knowledge in both suctioning systems. Results: Approximately 75% and 65% of the study participants had a satisfactory level of knowledge about the open system compared with the closed system, respectively. The total percentage of patients who achieved a satisfactory level of practice was 72% for the open-system group, compared with 56% for the closed-system group. Overall, there were significant differences between total nurses’ performances in the open-system and closed-system systems. Independent sample t-tests revealed a statistically significant correlation between overall nurses’ performance in both systems (t = 6.04, p < 0.001). Conclusions: The findings revealed significant differences in nurses’ performance between open and closed-system suctioning. The researchers recommend in-service-led training programs to improve nurses’ performance, and other studies with larger sample sizes should be supported.

Abstract Critical care nurses have high workloads due to the severity of the disease and the complexity of the treatment and care. Understanding the factors that influence subjective workload as well as the association between subjective and objective workload could lead to new insights to reduce critical care nurses’ workload. (1) To describe critical care nurses’ subjective and objective workload per shift in a university-affiliated interdisciplinary adult intensive care unit in Switzerland and (2) to explore the association between objective and subjective workload. The study used a prospective longitudinal cohort design. Critical care nurses completed the adapted Questionnaire on the Experience and Evaluation of Work 2.0 (QEEW2.0) to assess the subjective workload after every shift for four weeks (0 = never loaded, 100 = always loaded). The objective workload was assessed with the Therapeutic Intervention Scoring System-28 (TISS-28), Nine Equivalents of Nursing Manpower Use Score (NEMS), Swiss Society for Intensive Care Medicine (SGI)-patients’ categories and Patient-to-Nurse Ratio (PNR). Data was analysed using multilevel mixed models. The workload of 60 critical care nurses with a total of 765 shifts were analysed. The critical care nurses experienced a subjective high mental load (66 ± 26), moderate pace and amount of work (30 ± 25) and physical load (33 ± 25), and low emotional-moral load (26 ± 22). The one-time baseline subjective workload values were higher than the day-to-day values. The mean objective shift load using the TISS-28 was 43 ± 16 points, the NEMS 36 ± 14 points, the SGI-category 1.1 ± 0.5 nurses needed per patient and the PNR 1.2 ± 0.4. We found positive associations between day-to-day objective variables with subjective pace and amount of work, with physical and mental load but not with emotional-moral load and performance. Measured objective workload is associated with only certain subjective workload domains. To promote and retain critical care nurses in the profession, nursing management should give a high priority to understanding subjective workload and strategies for reducing it.

The aim of this study was to comparatively investigate education, job, and professional development satisfaction among intensive care unit nurses in Poland and England. A total of 258 ICU nurses from both countries were interviewed (72 Polish nurses working in Poland and 186 of various national backgrounds in England, including 50 of Polish origin). We used an 11-item structured survey followed by an open-ended qualitative interview retrospectively coded for statistical analysis. Regardless of national origin, nurses in England report significantly higher education satisfaction, attributed to better theoretical knowledge gain but not to other dimensions (such as practical knowledge or personal satisfaction). They also express greater satisfaction with job conditions regarding professional development, a state-of-the-art work environment, teamwork, and finance. The UK system is also considered significantly superior in promotion opportunities and participation in post-graduation training. In conclusion, systemic factors play a crucial role in career satisfaction and advancement in nursing, with the British band system having a clear advantage over the Polish one.

Placing a nasogastric tube (NGT) is a frequent nursing technique in intensive care units. The gold standard for its correct positioning is the chest X-ray due to its high sensitivity, but it represents a radiation source for critically ill patients. Our study aims to analyze whether the ultrasound performed by an intensive care nurse is a valid method to verify the NGT's correct positioning and to evaluate the degree of interobserver agreement between this nurse and an intensive care physician in the NGT visualization using ultrasound. Its correct positioning was verified by direct visualization of the tube in the stomach and indirect visualization by injecting fluid and air through the tube ("dynamic fogging" technique). A total of 23 critically ill patients participated in the study. A sensitivity of 35% was achieved using direct visualization, increasing up to 85% using indirect visualization. The degree of interobserver agreement was 0.88. Therefore, the indirect visualization of the NGT by an intensive care nurse using ultrasound could be a valid method to check its positioning. However, the low sensitivity obtained by direct visualization suggests the need for further training of intensive care nurses in ultrasonography. According to the excellent degree of agreement obtained, ultrasound could be performed by both professionals. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: People during extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation find themselves in a high degree of physical and psychological vulnerability, which could cause additional problems for their health status. Therefore, this review aims to identify the interventions that shape critical nursing care to minimize patient vulnerability during ECMO as a bridge to lung transplantation. Method: A literature review was performed using CINAHL, MEDLINE, PubMed, Scopus and Web of Science databases with searches conducted in March 2023, with temporal restriction of articles published between 2013 and 2023. After selecting articles involving adults in critical situations on ECMO, their quality was assessed using the critical appraisal tools from the Joanna Briggs Institute. Articles with the pediatric population, reviews, and opinion articles were excluded. A spreadsheet was built for data extraction and a narrative analysis was performed. Results: Three articles were included involving 40 participants in total. Interventions that shape critical nursing care to minimize a person's vulnerability are in the physical domain (basic precautions to prevent infection) and in the psychological domain (trusting relationships, consistent and clear communication, physical presence of nurses and family members and the use of advocacy). The Awake ECMO strategy was identified as beneficial for reducing vulnerability. Conclusion: By recognizing and identifying the person's vulnerability during ECMO as a bridge to lung transplantation, nurses can implement effective interventions to minimize vulnerability in this population, thus contributing to the person's well-being through personalization and individualization of care. Additionally, the results of this review could be useful for developing tools to assess the degree of vulnerability and for implementing person-centered care measures and policies. However, further research is warranted given the scarcity of literature on these topics. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore factors influencing sleep in pediatric intensive care units as perceived by parents of critically ill children. This descriptive qualitative study used individual semistructured interviews. Parents were recruited through purposive sampling from two pediatric intensive care units at two locations in one university hospital in Norway. Ten parents were interviewed. The interviews were analyzed using a six-phase reflexive thematic analysis. The analysis produced 17 subthemes under four main themes: environmental factors in the pediatric intensive care unit disturb children's sleep, children need trust and safety to sleep, nurses' cooperation with parents influences children's sleep, and nurses' structuring of their practices is fundamental to sleep promotion. The parents found that the environment disturbed their children's sleep, and environmental factors were easier to control in single rooms than in multibed rooms. Children slept better when they felt safe and trusted the nurses, and parents desired more cooperation in promoting sleep for their children, which may be an essential and overlooked part of sleep promotion. Nurses varied considerably in how they prioritized sleep and structured their practices to promote sleep. Nurses should take parents' experiences into account to better promote sleep for patients. By limiting environmental disturbances, building relationships with children to make them feel safe, including parents in sleep promotion, and prioritizing sleep in their practices, nurses could improve sleep quality and limit the consequences of sleep disturbance. • Environmental factors in the Pediatric Intensive Care Unit disturb children's sleep. • Children's feeling of trust and safety and the involvement of parents improved children's sleep. • The way nurses structure their practice to avoid disturbing sleep is fundamental to sleep promotion. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusions Relevance to Clinical Practice Hospitals can improve how they learn from patient safety incidents. The Green Cross method, a proactive reporting and learning method, is one strategy to meet this challenge. In it, nurses play a key role. However, describing its impact on learning from the users' perspective is important.This study aimed to describe nurses' experiences of learning from patient safety incidents before and 3 months after implementing the Green Cross method in a postanaesthesia care unit.A qualitative study with an inductive descriptive design with focus group interviews was conducted before and 3 months after implementing the Green Cross method to assess its impact. The data were analysed using qualitative content analysis. The study was conducted in a postanaesthesia care unit in a Norwegian hospital trust.Before implementing the Green Cross method, participants indicated limited openness and learning, including the subcategories ‘Lack of openness hampers learning’, ‘Adverse events were taken seriously’ and ‘Insufficient visible improvements’. After implementing the Green Cross method, participants indicated the emergence of a learning environment, including the subcategories ‘Transparency increases learning’, ‘Increased patient safety awareness’ and ‘Committed to quality improvements’.Implementing the Green Cross method in a postanaesthesia care unit positively impacted openness and nurses' patient safety awareness, which is crucial for learning and improving quality.The Green Cross method could be useful for organizational learning and facilitating learning from patient safety incidents through transparency, discussion and involvement of nursing staff. [ABSTRACT FROM AUTHOR]

Serious illness communication can be especially distressing for patients who are critically ill and their loved ones who experience forms of discrimination based on identities such as their race, gender, sexual orientation, and other intersecting identities. In this article, we discuss the concept of intersectionality and its association with serious illness communication, decision-making, and care in the intensive care unit. Additionally, we present relevant concepts from clinical practice and contemporary nursing and health care literature to support critical care nurses in fostering more inclusive serious illness communication in the intensive care unit. [ABSTRACT FROM AUTHOR]

ObjectiveThe Certified Flight Registered Nurse (CFRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in the unique specialty of flight nursing. Introduced in 1993 and celebrating its 30th anniversary in July 2023, the CFRN is held by over 5,500 registered nurses. The purpose of the 2022 CFRN pulse survey was to better understand the ways CFRN-certified registered nurses value this national flight nursing specialty credential. The CFRN survey is a companion to the 2022 Certified Transport Registered Nurse pulse survey, which focused on the Certified Transport Registered Nurse critical care ground transport nursing credential.MethodsThe Board of Certification for Emergency Nursing e-mailed individuals in its database of CFRN credential holders and asked them to respond to a 14-question online survey between October 17, 2022, and November 8, 2022. Participation in the survey was voluntary. Of the 5,275 verified CFRN holders who received the survey, 992 responded, for a response rate of 18.8%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Counts and percentages were reported, and descriptive statistics were used.ResultsThe highest percentage of flight nurses who responded have more than 10 years of experience in flight nursing (35.3%) and are employed by a stand-alone transport program (42.7%). Flight nurses reported they spent a mean of 70% of their work hours transporting via rotor wing aircraft, with a predominantly adult patient population. The top perceived benefits of being a CFRN-certified nurse were a sense of accomplishment and pride (90.7%) followed by flight physiology knowledge (85.4%), flight nursing clinical knowledge (83.4%), and confidence as a flight nurse (80.6%).ConclusionThe 2022 CFRN pulse survey identified current CFRN demographics, practice environments including transport percentage by mode and patient population types, and perceived benefits of the CFRN credential. The findings suggest CFRNs are very experienced, provide care for patients across the age continuum, and perceive multiple intrinsic and extrinsic benefits of CFRN certification, all of which are essential to safe, evidence-based advanced nursing practice in the unique, complex, autonomous, and dynamic flight environment.

ABSTRACT Objective: To validate a risk rating scale for triaging of cancer patients in emergency rooms that can identify individuals needing urgent care or in imminent worsening of the clinical condition. Methods: This is a health instrument validation study developed in the emergency care ward of a Brazilian hospital, a referral center for cancer and hematological diseases. We built the Emergency Oncology Scale (EMOnco) based on literature review and a Delphi survey with 20 experienced oncologists (physicians and nurses). We validated the scale by assessing its construct validity, interobserver agreement and reliability after applying them in a convenience sample of all consecutive patients with cancer who visited the ward between August 2017 and January 2018. We compared the EMOnco Scores with those from other scales, used by six trained nurses: the Emergency Severity Index, the Manchester Triage System, and the Karnofsky Performance Status. We also recorded socio-demographic and clinical features and the Sequential Organ Failure Assessment (SOFA) results in the intensive care unit. Results: We included 250 patients with locally advanced or recurrent disease and undergoing chemotherapy. EMOnco screening took 2.24 (± 2.9) minutes in average. The interobserver correlation coefficient was 0.9. EMOnco was highly correlated with Emergency Severity Index (r=0.617) and also correlated with Karnofsky Performance Status (0.420) Manchester Triage System (0.491; p

ObjectiveTo examine the measurements on enteral feeding intolerance (EFI) in critically ill children.MethodsThe Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool.ResultsOf the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (n = 22), followed by diarrhea (n = 20), and vomiting (n = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32).ConclusionThis scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.

The department of critical care medicine, the clinical base of critical care medicine, is the centralized management unit for the treatment of critical patients. Medicine and nursing are independent disciplines, but both can be fully utilized from different perspectives when dealing with critically ill patients. With the development of critical care medicine understanding and technology, the concept of doctor-nurse integration construction in the department of critical care medicine has emerged. Doctor-nurse integration construction in the department of critical care medicine needs to take severe diseases as the core and academic development as the orientation. Clinical practice should be carried out through medical cooperation, based on critical cognition and unified thinking mode.

Abstract Background Learning in placement is essential to postgraduate critical care nursing students’ education. Assessment of students’ competence in placement is important to ensure highly qualified postgraduate critical care nurses. The placement model applied in Norway involves students being assessed by a preceptor in practice and a teacher from the university. The teacher has a more distant role in placement, and the aim of this study was to explore how the teachers experience the assessment of postgraduate critical care nursing students’ competence in placement. Additionally, to explore the content of assessment documents used for postgraduate critical care nursing placement education in Norway. Methods This study has a qualitative design with main data collection from individual interviews with 10 teachers from eight universities and colleges in Norway. Additionally, we performed a document analysis of assessment documents from all 10 universities and colleges providing postgraduate critical care nursing education in Norway. We followed the Consolidated Criteria for Reporting Qualitative Research. Results The teachers experienced the assessment of postgraduate critical care nursing students’ competence in placement as important but complex, and some found it difficult to determine what critical care nursing competence is at advanced level. A thematic analysis resulted in one main theme: “Teacher facilitates the bridging between education and practice.” Furthermore, three themes were identified: “Assessment based on trust and shared responsibility”; “The teacher’s dual role as judge and supervisor”; and “A need for common, clear and relevant assessment criteria”. Conclusions Teachers have a key role in placement as they contribute to the bridging between education and practice by providing valuable pedagogical and academic input to the assessment process. We suggest that more teachers should be employed in joint university and clinical positions to enhance the collaboration between practice and education. Clear and relevant assessment criteria are essential for providing assessment support for both students and educators. Education and practice should collaborate on developing assessment criteria. Further, there is a need to collaborate on developing, both nationally and internationally, common, clear, relevant and user-friendly assessment tools.

This study aimed to evaluate the correlation between nursing informatics (NI) competency and information literacy skills for evidence-based practice (EBP) among intensive care nurses. This cross-sectional study was conducted on 184 nurses working in intensive care units (ICUs). The study data were collected through demographic information, Nursing Informatics Competency Assessment Tool (NICAT), and information literacy skills for EBP questionnaires. The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills, respectively. They received a moderate score for the use of different information resources but a low score for information searching skills, different search features, and knowledge about search operators, and only 31.5% of the nurses selected the most appropriate statement. NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales (P < 0.05). Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making. Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

ObjectiveThe certified transport registered nurse (CTRN) credential independently validates a registered nurse's advanced knowledge, skills, and abilities in critical care ground transport nursing. After multiple years of mostly modest growth, the number of CTRNs surged in 2020 and 2021 and continues to post strong growth into 2022. The aim of the 2022 Certified Transport Registered Nurse Pulse Survey was to better understand the ways in which CTRN-certified registered nurses value this national ground transport specialty credential and gain insight into factors that may have contributed to the recent surge in CTRN certification.MethodsThe Board of Certification for Emergency Nursing e-mailed individuals in its database of CTRN credential holders and invited them to complete an 11-question online survey between March 15 and March 28, 2022. Participation in the survey was voluntary. Sixty-three of 297 verified CTRN holders who received the survey responded for a response rate of 21.2%. The survey instrument included discrete field and open-ended questions. Data were deidentified for analysis, and institutional review board exemption was received. Descriptive statistics were used, and counts and percentages are reported.ResultsThe highest percentage of respondents (42.9%) have 10 or more years of experience in ground transport nursing, and nearly half (46%) are employed by a stand-alone transport program. Forty-three percent of all respondents reported that ground transport makes up at least 50% of their current role, whereas one third (33.3%) indicated they do ground transport 100% of the time. Critical thinking (87.5%) in the ground transport environment, confidence as a ground transport nurse (87.5%), and a sense of accomplishment and pride (94.6%) were the top 3 perceived benefits of being a CTRN-certified nurse.ConclusionThe 2022 CTRN pulse survey identified current CTRN demographics, practice environments, and perceived benefits of the CTRN credential. The findings suggest CTRNs are highly experienced and perceive multiple intrinsic and extrinsic benefits of CTRN certification, many of which are essential to safe, evidence-based nursing practice in the autonomous, complex, and dynamic ground transport environment.

Background: Learning in placement is essential to postgraduate critical care nursing students' education. Assessment of students' competence in placement is important to ensure highly qualified postgraduate critical care nurses. The placement model applied in Norway involves students being assessed by a preceptor in practice and a teacher from the university. The teacher has a more distant role in placement, and the aim of this study was to explore how the teachers experience the assessment of postgraduate critical care nursing students' competence in placement. Additionally, to explore the content of assessment documents used for postgraduate critical care nursing placement education in Norway. Methods: This study has a qualitative design with main data collection from individual interviews with 10 teachers from eight universities and colleges in Norway. Additionally, we performed a document analysis of assessment documents from all 10 universities and colleges providing postgraduate critical care nursing education in Norway. We followed the Consolidated Criteria for Reporting Qualitative Research. Results: The teachers experienced the assessment of postgraduate critical care nursing students' competence in placement as important but complex, and some found it difficult to determine what critical care nursing competence is at advanced level. A thematic analysis resulted in one main theme: "Teacher facilitates the bridging between education and practice." Furthermore, three themes were identified: "Assessment based on trust and shared responsibility"; "The teacher's dual role as judge and supervisor"; and "A need for common, clear and relevant assessment criteria". Conclusions: Teachers have a key role in placement as they contribute to the bridging between education and practice by providing valuable pedagogical and academic input to the assessment process. We suggest that more teachers should be employed in joint university and clinical positions to enhance the collaboration between practice and education. Clear and relevant assessment criteria are essential for providing assessment support for both students and educators. Education and practice should collaborate on developing assessment criteria. Further, there is a need to collaborate on developing, both nationally and internationally, common, clear, relevant and user-friendly assessment tools. [ABSTRACT FROM AUTHOR]

Background: Patient and family engagement in the intensive care unit increases the quality of care and patient safety. Aim: The aim of our study was to describe current practice and experiences of contemporary patient and family engagement in the intensive care unit at the individual level, the organizational level, and in the research process according to critical care nurses. Design/Method: We conducted a national qualitative survey of intensive care units in Denmark from 5th May–5th June 2021. Questionnaires were piloted and sent to intensive care nurse specialists and research nurses at 41 intensive care units, allowing one respondent per unit. All respondents were provided with written information about the study by email, and by activating the survey link, they accepted participation. Results: Thirty‐two nurses responded to the invitation, 24 completed and 8 partially completed the survey, yielding a response rate of 78%. At the individual level, 27 respondents stated that they involved patients and 25 said they involved family in daily treatment and care. At the organizational level, 28 intensive care units had an overall strategy or guideline for patient and family engagement, and 4 units had established a PFE panel. And, finally, 11 units engaged patients and families in the research process. Conclusions: Our survey suggested that patient and family engagement was implemented to some degree at the individual level, organizational level, and in the research process, but only 4 units had established a PFE panel at the organizational level, which is key to engagement. Relevance to Clinical Practice: Patient engagement increases when patients are more awake, and family engagement increases when patients are unable to participate. Engagement increases when patient and family engagement panels are implemented. [ABSTRACT FROM AUTHOR]

BACKGROUND: The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. OBJECTIVES: This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. METHODS: The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days. RESULTS: From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p < .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01). CONCLUSIONS: We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL. [ABSTRACT FROM AUTHOR]

Background Aim Methods Findings Conclusion Nursing and health policy implications Disasters affect human health and well‐being globally. Nursing plays a vital role in disaster preparedness and response, ensuring efficient early care coordination and delivering effective field treatment.This study investigates the challenges an Israeli humanitarian delegation encountered during their response to major earthquakes in Turkey in 2023. It explicitly focuses on difficulties in preparation, operations, and collaboration with local teams. The study further analyzes the findings and extracts valuable lessons from the mission.Using a qualitative descriptive design, 22 out of 32 nurses involved in delegation participated in three focus group discussions within two months of returning to Israel. The discussions were recorded, transcribed verbatim, and analyzed thematically. The study followed the COREQ guidelines, ensuring comprehensive reporting and methodological rigor in qualitative research.The study's main findings spanned predeparture preparation, mission challenges in the disaster zone, and postmission lessons, each highlighted by subthemes and participant quotations. A strong sense of mission was evident among the participants, along with frustration at inefficient time management prior to deployment. Many participants noted additional challenges, related to the difficulty of working in multiple languages and across cultures, and the opportunities for resolution. Finally, participants called for better psychological support following the mission.Nurses in disaster zones offer valuable insights to enhance preparation, cross‐cultural communication, and postmission implementation.Nurse managers and healthcare policymakers can utilize this study's findings to develop future nursing training programs in disaster‐related skills. Additionally, it can help foster collaboration among international healthcare teams. [ABSTRACT FROM AUTHOR]

Aim: To examine the effectiveness of the feedback from the Nurses' Care Coordination Competency Scale (NCCCS) application (app) used for self‐assessing the care coordination competency of intensive care unit (ICU) nurses in managing patients on life support. Methods: A non‐randomized open‐label study was conducted in Japan from November 2021 to March 2022. Participants were 318 ICU nurses from acute hospitals in Japan. They were divided manually into two groups based on their certification status. The intervention was immediate feedback on the results of the care coordination competency self‐assessment through the NCCCS app; the control group performed the NCCCS survey with no feedback. The primary outcome was an increase in the NCCCS score 1 month after the intervention. Mann–Whitney U test was used to compare the scores of the intervention and control groups. Wilcoxon's signed rank sum test was used to compare the scores in the first and second NCCCS surveys. Results: Forty‐one participants were lost to follow‐up, leaving 277 participants (intervention = 141, control = 136) for analysis. One month later, NCCCS scores similarly increased in both groups. For nurses with at least 5 years of ICU experience (n = 152), the NCCCS score increased in the intervention group (n = 75) (rising point mean: 4.8, standard deviation [SD]: 9.8) compared with that in the control group (n = 77) (rising point mean: 1.3, SD: 8.3) (p =.048). Conclusions: Feedback from the NCCCS app can improve care coordination behavior. However, a certain level of ICU experience may be required to translate feedback into improved behavior. [ABSTRACT FROM AUTHOR]

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Background: Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. Aim: This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. Study Design: A qualitative study using an Interpretative Description approach was undertaken. Semi‐structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. Results: In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. Conclusions: This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post‐intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. Relevance to Clinical Practice: This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side‐effects can be managed, and that they can easily control their virtual exposure experience. [ABSTRACT FROM AUTHOR]

Background: Critical care nurses are vital in the care of patients with life-threatening illnesses in intensive care units. To optimize their effectiveness, it is crucial to enhance their proficiency in professional care techniques. Implementing evidence-based training standards can improve nurses' knowledge, skills, and attitudes, ultimately enhancing healthcare services for patients. Aim/purpose: The aim of this study protocol is to outline a series of quasi-experimental, non-randomized, single-group studies that assess the impact of standardized training courses on the development of competencies in diverse care techniques for critical care nurses. Methodology: A comprehensive checklist will be created to evaluate nurses' professional qualifications in the specific care techniques under investigation. This checklist will be used during three expert panel sessions for each study. Nurses will then undergo theoretical and practical training to enhance their competence in implementing these techniques. To assess the training effectiveness, each nurse's competency level will be evaluated before, during, and after the training using a checklist to track their learning curve. Results: This study will use the learning curve model to determine the optimal number of repetitions required for novice intensive care unit nurses to attain a satisfactory level of competence in each targeted care technique after training. Conclusion: These findings could standardize nursing education practices and optimize skill practice frequency, leading to improved quality of education in the field. Trial registration: This study is also registered at U.S. National Library of Medicine under "Clinicaltrials.gov" identifier NCT02830971, https://www.clinicaltrials.gov/ct2/show/NCT02830971, first date registered 13/07/2016 and last updated on 15/04/2021. [ABSTRACT FROM AUTHOR]

Background: Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. Aim: To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. Research design: Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. Participants and research context: Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. Ethical considerations: The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. Findings: Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. Conclusions: Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses. [ABSTRACT FROM AUTHOR]

Abstract Background Critical care nurses are vital in the care of patients with life-threatening illnesses in intensive care units. To optimize their effectiveness, it is crucial to enhance their proficiency in professional care techniques. Implementing evidence-based training standards can improve nurses' knowledge, skills, and attitudes, ultimately enhancing healthcare services for patients. Aim/purpose The aim of this study protocol is to outline a series of quasi-experimental, non-randomized, single-group studies that assess the impact of standardized training courses on the development of competencies in diverse care techniques for critical care nurses. Methodology A comprehensive checklist will be created to evaluate nurses' professional qualifications in the specific care techniques under investigation. This checklist will be used during three expert panel sessions for each study. Nurses will then undergo theoretical and practical training to enhance their competence in implementing these techniques. To assess the training effectiveness, each nurse's competency level will be evaluated before, during, and after the training using a checklist to track their learning curve. Results This study will use the learning curve model to determine the optimal number of repetitions required for novice intensive care unit nurses to attain a satisfactory level of competence in each targeted care technique after training. Conclusion These findings could standardize nursing education practices and optimize skill practice frequency, leading to improved quality of education in the field. Trial registration This study is also registered at U.S. National Library of Medicine under "Clinicaltrials.gov" identifier NCT02830971, https://www.clinicaltrials.gov/ct2/show/NCT02830971 , first date registered 13/07/2016 and last updated on 15/04/2021.

Introduction: Post-operative pain is the most prevalent type of acute pain. Nurses are the health care professionals who most frequently assess pain, as well as evaluating the patient's response to pain management treatment and monitoring for the occurrence of adverse events. Thus, to improve outcomes and quality of care, the interventions used by nurses should be based on best practices. Objectives: The aim of this project was to implement best practices in post-operative pain management in an intensive care unit. Methods: This evidence implementation project was conducted in a hospital for the surgical treatment of orthopedic diseases and trauma. The project followed the JBI Evidence Implementation Framework. The project used JBI PACES software as well as JBI's Getting Research into Practice (GRiP) audit and feedback tools to develop eight audit criteria for the baseline and follow-up audits. Results: The baseline audit showed that Criteria 3 and 6 had low compliance, with few patients having documented plans and goals, and receiving multimodal analgesia in the ICU, respectively. Criteria 7 and 8, which assessed the use of opioids and follow-up by a pain specialist, revealed compliance of 60% and 50%, respectively. Criterion 3 improved from 0% to 20%. Criteria 6, 7, and 8 also improved, rising to 30%, 22.8%, and 50%, respectively. Conclusion: The project improved compliance with best practices in post-operative pain management. Further studies are needed to ensure the project's long-term sustainability. [ABSTRACT FROM AUTHOR]

Life-threatening hemoptysis (formerly called massive hemoptysis), though relatively uncommon, imposes significant mortality risks. This article discusses the etiology, clinical presentation, assessment, treatment, and nursing interventions to promote effective clinical management of patients with this condition. [ABSTRACT FROM AUTHOR]

Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January–March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = −0.275 (0.100); LLCI = −0.487, ULCI = −0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = −0.053 (0.215), t = 0.248, p = 0.804, LLCI = −0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy. [ABSTRACT FROM AUTHOR]

Cardiac arrest is often a sudden and traumatic event. Family-witnessed resuscitation was first recommended by the American Heart Association over two decades ago. Since then several global professional bodies have identified a range of potential benefits for relatives; however, it remains contentious. For nurses working in emergency departments (EDs) in low-income countries, the evidence for, and experience of, family-witnessed resuscitation is limited. This article critically appraises the literature relating to the perceptions of medical professionals and critically ill patients and their families about communication, family presence and their involvement during resuscitation in the ED. Three themes relating to family-witnessed resuscitation in the ED were identified by a focused literature search. These were: leadership and communication, limitation of policies and guidelines and relatives' views. The recommendations from this review will be used to develop emergency and trauma nursing practice guidelines in Zambia, a low-income country in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. Aims: We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. Study design: The first part of this before/after study consisted in assessing the proportion of patients receiving an anti‐diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. Results: Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti‐diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p =.40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p =.35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1–7] vs. 0 day [0–2]; p <.001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p <.001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. Conclusions: The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. Relevance to clinical practice: The use of specific anti‐diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU. [ABSTRACT FROM AUTHOR]

Background: Early physical activity and physical rehabilitation are advocated in the critical care unit for patients recovering from critical illness. Despite this, there are still many factors associated with implementation of early physical rehabilitation into routine critical care and practice. One such factor that has been consistently identified is unit culture, yet there is little understanding of how or why the culture of a critical care unit impacts on implementation of early rehabilitation. Aim: To develop a detailed understanding of the cultural barriers and enablers to the promotion and implementation of physical activity and early mobilization in National Health Service (NHS) critical care units in the United Kingdom (UK). Study Design: A mixed‐methods, two‐phase study incorporating online group concept mapping (GCM) and ethnography. GCM will be conducted to provide a multistakeholder co‐authored conceptual framework of rehabilitation culture. Ethnographic observations and interviews will be conducted of culture and behaviours in relation to the implementation and promotion of early physical activity and rehabilitation in two NHS critical care units in the North East of England. Results: The results of the Group Concept Mapping and ethnographic observations and interviews will be triangulated to develop a contextual framework of rehabilitation culture in critical care. Relevance to Clinical Practice: This study will provide a detailed understanding of barriers and facilitators in relation to providing a positive rehabilitation culture in the critical care unit. [ABSTRACT FROM AUTHOR]

Background: Humanistic care involves caring, concern, paying attention to people's individuality, meeting their needs and respecting their rights, which is the core concept and central task of nursing. Effective care can enhance patients' ability to deal with stress and promote patient recovery. Implementing humanistic care in the intensive care unit (ICU) is particularly important for health care providers. Aim: This study aims to develop a framework of the humanistic care in the ICU. Study Design: The qualitative research followed Strauss' procedural grounded theory approach. Purposive sampling and theoretical sampling were used to select 12 nurses in the Department of Critical Medicine, 16 patients, and eight family members for semi‐structured interviews from October 2020 to April 2021. Results were summarized and analysed through three‐level coding based on grounded principles. Results: Sixteen subcategories and six main categories were extracted after three‐level coding, and the final ICU humanistic care framework was formed with home, activity, visit, environment, nursing and safety ("HAVENS") as the core. Conclusions: This study provides an explanatory theory of humanistic care in the ICU that can guide nurses' practice in ICU clinical work. Relevance to clinical practice: This theory provides guidance for nurses to implement humanistic care in critical care practice to improve the ICU stay experience of critically ill patients. [ABSTRACT FROM AUTHOR]

Background: Immediate life support (ILS) ambulances allow nurses to intervene in pre-hospital settings, supported by their technical-scientific knowledge and complex protocols of action and regulation through telemedicine. Objective: To analyze the contributions of nursing interventions in the evolution of the clinical state of critical patients. Methodology: Quantitative, descriptive-correlational, retrospective, and observational study conducted in ILS settings in northern Portugal. A total of 574 electronic clinical records were analyzed between 1 November and 31 December 2019, corresponding to the same number of people evaluated. The National Early Warning Score (NEWS) was used to assess the clinical evolution of critical patients. Results: There was a positive evolution of the NEWS score of critical patients after the intervention of ILS nurses (M = 4.43 ± 3.901 vs. 3.34 ± 3.329; sig < 0.001). Similarly, the clinical risk of critical patients decreased after the nurse's intervention. Conclusion: This study demonstrated the importance of nurses in prehospital care, as a guarantee of safety, quality, and continuous improvement of care for critical patients. [ABSTRACT FROM AUTHOR]

Background: Immediate life support (ILS) ambulances allow nurses to intervene in pre-hospital settings, supported by their technical-scientific knowledge and complex protocols of action and regulation through telemedicine. Objective: To analyze the contributions of nursing interventions in the evolution of the clinical state of critical patients. Methodology: Quantitative, descriptive-correlational, retrospective, and observational study conducted in ILS settings in northern Portugal. A total of 574 electronic clinical records were analyzed between 1 November and 31 December 2019, corresponding to the same number of people evaluated. The National Early Warning Score (NEWS) was used to assess the clinical evolution of critical patients. Results: There was a positive evolution of the NEWS score of critical patients after the intervention of ILS nurses (M = 4.43 ± 3.901 vs. 3.34 ± 3.329; sig < 0.001). Similarly, the clinical risk of critical patients decreased after the nurse's intervention. Conclusion: This study demonstrated the importance of nurses in prehospital care, as a guarantee of safety, quality, and continuous improvement of care for critical patients. [ABSTRACT FROM AUTHOR]