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Astrid Wevling,1 Brita Fosser Olsen,2 Anne Mette Nygaard,1 Turid Heiberg3 1Faculty of Health, Welfare and Organization, University College of Østfold, Halden, Norway; 2Faculty of Health, Welfare Organization, University College of Østfold, Halden, and Østfold Hospital Trust, Intensive and Post Operative Unit, Sarpsborg, Norway; 3Department of Clinical Research Support, Oslo University Hospital, Oslo and Faculty of Health, Welfare and Organization, University College of Østfold, Halden, NorwayCorrespondence: Astrid Wevling, Postboks 700 NO-1757, Faculty of Health, Welfare and Organization, University College of Østfold, Halden, Norway, Email astridw@hiof.noBackground: Non-technical skills (NTS) play an important role in preventing adverse events during hospitalization. Knowledge, awareness and mastery of NTS becomes important key factors in preventing errors. Current status of students and supervisor’s knowledge and awareness of NTS are needed in order to construct an educational plan for improvement.Purpose: To examine knowledge and awareness of NTS over the course of continuing education of nurse anaesthetists, emergency care nurses, critical care nurses, and operating room nurses.Methods: A descriptive, repetitive cross-sectional design with a questionnaire was used to evaluate knowledge and awareness in students and their supervisors about NTS at two different time points during the educational program. Cross tabulations were used in comparisons across specialties and between students and supervisors, frequencies to identify the levels of self-reported knowledge/importance/focus in clinical practice/ impact on adverse events.Results: The results showed that there was a numeric difference between the reported knowledge/focus in clinical practice on the one hand and importance/ impact on adverse events on the other, and that this gap was reduced after 12 months of education with special focus on NTS. There was no difference across specialties. Supervisors had higher focus on NTS in clinical practice and on the impact on adverse events, than students at both measurements.Conclusion: These data suggest that NTS may have important potential for improvement if included into learning programs both in education and clinical practice. Integration of NTS in various learning activities seems to strengthen students’ competence about NTS.Keywords: patient safety, nursing education, non-technical skills, NTS

Background: Hope is essential for mental health in general and for recovery following severe illness. However, the associations between posttraumatic stress symptoms (PTSS) and hope among intensive care unit (ICU) survivors has not been investigated., Objectives: To assess hope at 3, 6 and 12 months after ICU admission and examine possible associations between hope and selected demographic data, clinical characteristics, and 3-month PTSS-levels among ICU patients., Methods: ICU-patients from Norway self-reported on hope using Herth Hope Index. Data on demographics and clinical characteristics were collected from patient reports and medical records. PTSS were analysed 3 months after admission, using descriptive statistics and linear mixed model regression analyses., Results: A total of 73 adult ICU survivors were included (male n = 45 (61.6%); median age 66 years [IQR: 51.0;74.0]). Median hope scores were 41, 40, and 42 at 3, 6 and 12 months, respectively. A clinically minor but statistically significant reduction in hope was registered at 6 months (B = -1.24; 95% confidence interval [CI]: -2.25, -0.23; p = 0.016). Lower levels of PTSS 3 months after admission (B = -0.13; 95% CI [-0.23, -0.03]; p = 0.015) and being employed before admission (B = 5.87; 95% CI [1.85, 9.88]; p = 0.004) were significantly associated with higher hope during the first year after admission. A small but statistically significant association was also found between higher hope and a more extended hospital stay (B = 0.08; 95% CI [0.00, 0.15]; p = 0.042)., Conclusions: Hope scores remained stable during the first year after ICU admission. Lower levels of PTSS at 3 months after admission, being employed prior to admission, and having longer hospital stay were associated with higher hope during the first year after admission. Given the small sample, more research in larger samples is needed to enhance the clinical relevance of these findings., Competing Interests: Declaration of competing interest We, the authors, do not have any ethical conflicts or financial interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival., Objectives: To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission., Methods: Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures., Results: High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times., Conclusions: The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these., Competing Interests: Declaration of competing interest We, the authors, do not have any ethical conflicts or financial interests to disclose., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Post-traumatic stress symptoms (PTSS) following intensive care unit (ICU) treatment may increase morbidity and mortality. Therefore, it is important to identify patients at risk of suffering from such symptoms., Objectives: The objective of this study was to describe the prevalence and identify possible predictive factors associated with high levels of PTSS 3 months after ICU admission., Methods: A multicentre, observational study was carried out in six ICUs in Norway. Patients aged ≥18 years were included. The Impact of Event Scale-Revised measured PTSS 3 months after ICU admission. The impacts of pre-ICU measures; demographic and clinical measures; and daily measures of pain, agitation, and delirium were analysed using univariate and multivariate logistic regression models., Results: In total, of the 273 patients included, the prevalence rate of high levels of PTSS was 19.8% (n = 54) 3 months after ICU admission (95% confidence interval [CI]: [15.2, 25.0]). Female gender, age, pre-ICU unemployment, a minimum of one episode of agitation or delirium, and pre-ICU level of functioning in daily living were all significantly associated with high levels of PTSS in univariate logistic analyses. In the multivariate logistic regression, two models were analysed. In model 1, episodes of agitation during ICU stay (odds ratio [OR] = 4.73; 95% CI: [1.17, 19.0]), pre-ICU unemployment (OR = 3.33; 95% CI: [1.26, 8.81]), and pre-ICU level of functioning in daily living (OR = 0.78; 95% CI: [0.63, 0.96]) (implying lower level) increased the odds of reporting high levels of PTSS. In model 2, pre-ICU unemployment (OR = 2.70; 95% CI: [1.05, 6.93]) and pre-ICU level of functioning in daily living (OR = 0.77; 95% CI: [0.62, 0.95]) (implying lower level) increased the odds of reporting high levels of PTSS., Conclusions: Healthcare personnel are suggested to be aware of ICU patients' pre-ICU employment status, pre-ICU functioning in daily living, and agitation during ICU stay to identify those at risk of PTSS after discharge., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Aim: Patient transfer from intensive care units (ICUs) to general wards is a routine part of hospital care. However, if the transfer is not optimal, it can result in increased readmissions to the ICU, increased stress and discomfort for the patient and, thus, a threat to patient safety. The aim of this study was to explore how general ward nurses experience patient safety during patient transfers from ICUs to general wards., Design: A qualitative design based on a phenomenological approach was used., Methods: Two focus group interviews were conducted with a total of eight nurses from a medical ward and a surgical ward at one hospital in Norway. The data were analysed using systematic text condensation., Results: The nurses' experiences of patient safety during patient transfer had four themes: (1) the importance of preparedness; (2) the importance of the handover of information; (3) stress and a lack of resources and (4) a feeling of two different worlds., Conclusion: In order to promote patient safety, the informants highlighted the importance of being well prepared for transfer, and to have optimal handover of information. Stress, lack of resources and a feeling of two different worlds may pose threats to patient safety., Implications for the Profession And/or Patient Care: We suggest several intervention studies testing the effect of intervention improving patient safety during the transfer process are designed, and that increased knowledge in this area is used to develop local practice recommendations., Patient or Public Contribution: The participants of this study were nurses and this contribution has been explained in the Data collection section. There was no patient contribution in this study., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Norwegian hospitals have operated within capacity during the COVID-19 pandemic. We present patient and management characteristics, and outcomes for the entire cohort of adult (>18 years) COVID-19 patients admitted to Norwegian intensive care units (ICU) from 10 March to 19 June 2020., Methods: Data were collected from The Norwegian intensive care and pandemic registry (NIPaR). Demographics, co-morbidities, management characteristics and outcomes are described. ICU length of stay (LOS) was analysed with linear regression, and associations between risk factors and mortality were quantified using Cox regression., Results: In total, 217 patients were included. The male to female ratio was 3:1 and the median age was 63 years. A majority (70%) had one or more co-morbidities, most frequently cardiovascular disease (39%), chronic lung disease (22%), diabetes mellitus (20%), and obesity (17%). Most patients were admitted for acute hypoxaemic respiratory failure (AHRF) (91%) and invasive mechanical ventilation (MV) was used in 86%, prone ventilation in 38% and 25% of patients received a tracheostomy. Vasoactive drugs were used in 79% and renal replacement therapy in 15%. Median ICU LOS and time of MV was 14.0 and 12.0 days. At end of follow-up 45 patients (21%) were dead. Age, co-morbidities and severity of illness at admission were predictive of death. Severity of AHRF and male gender were associated with LOS., Conclusions: In this national cohort of COVID-19 patients, mortality was low and attributable to known risk factors. Importantly, prolonged length-of-stay must be taken into account when planning for resource allocation for any next surge., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Objectives: To compare nurses' self-assessed competence and perceived need for more training in intensive care units treating patients with respiratory insufficiency before and after completion of a seven-hour educational programme, and to assess whether factors such as age, educational level, years of experience and percentage of employment are associated with these outcomes., Research Methodology: The study had a quantitative, cross-sectional, descriptive design, with two measurement times. The ProffNurse SAS questionnaire was used to assess nurses' self-assessed competence and perceived need for more training., Setting: Nurses in one medical/surgical intensive care unit and one medical intensive care unit in a hospital in Norway., Main Outcome Measures: Nurses' self-assessed competence and perceived need for more training., Results: The pre- and post-education studies comprised responses from 85 (52%) and 52 (32%) nurses, respectively. The educational programme contributed to increased self-assessed competence in seven items. Self-assessed competence was significantly associated with nurses' educational level, and critical care nurses reported higher self-assessed competence than registered nurses on 50% of the items., Conclusion: The findings fill a gap in knowledge about nurses' competence in treating patients with respiratory insufficiency in intensive care units. Both education days and further education have beneficial effects on self-assessed competence., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Many patients have memories of pain during intensive care unit stay. To improve pain management, practice guidelines recommend that pain management should be guided by routine pain assessment and suggest an assessment-driven, protocol-based, stepwise approach. This recommendation prompted the development of a pain-management algorithm., Aim: Evaluate the feasibility and clinical utility of this algorithm., Design: A descriptive survey., Settings: One medical/surgical intensive care unit, one surgical intensive care unit, and one postanesthesia care unit at two hospitals in Norway., Participants/subjects: Nurses working at the three units., Methods: A pain-management algorithm, including three pain assessment tools and a guide to pain assessment and pain management, was developed and implemented in three intensive care units. Nurses working at the three units (n = 129) responded to a questionnaire regarding the feasibility and clinical utility of the algorithm used., Results: Our results suggested that nurses considered the new pain-management algorithm to have relatively high feasibility, but somewhat lower clinical utility. Less than half of respondents thought that pain treatment in clinical practice had become more targeted using the tree pain-assessment tools (45%) and the algorithm for pain assessment and pain management (24%)., Conclusions: Pain-management algorithms may be appropriate and useful in clinical practice. However, to increase clinical utility and to achieve more targeted pain treatment, more focus on pain-treatment actions and reassessment of patients' pain is needed. Further focus in clinical practice on how to implement an algorithm and more focus on pain-treatment action and reassessment of patients' pain is needed., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Aim: To assess occurrence of pain during the first 6 days of intensive care unit (ICU) stay and evaluate associations between occurrence of pain and selected patient-related variables., Design: A longitudinal study., Methods: Adult ICU patients from three units were included. Patients' pain was assessed with valid pain assessment tools every 8 hr during their first 6 days in ICU. Possible associations between occurrence of pain and selected patient-related variables were modelled using multiple logistic regression., Results: When pain was assessed regularly with pain assessment tools, 10% of patients were in pain at rest and 27% were in pain during turning. The proportions of patients who were in pain were significantly higher for patients able to self-report pain, compared with patients not able to self-report ( p  < .001). Several predictors were associated with being in pain. It is important to be aware of these predictors in order to improve pain management., Competing Interests: The authors do not have any ethical conflicts or financial interests to disclose., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Aims and Objectives: To describe what is known from the existing literature on nonpharmacological interventions targeting pain in patients admitted to the ICU., Background: Patients receiving intensive care nursing are exposed to a wide range of pain provoking tissue damage, diseases, surgery and other medical procedures in addition to the pain caused by nursing care procedures. The present shift to light sedation to improve patient outcomes and comfort underscores the need for effective pain management. Opioids are the mainstay for treating pain in the ICUs, whereas nonpharmacological treatments are understudied and possibly under-used., Method: A scoping review was undertaken using five of the six steps in the Arksey and O´Malley framework: (a) identification of the research question, (b) identification of relevant studies, (c) study selection, (d) charting the data and (e) collating, summarising and reporting the results. CINAHL, MEDLINE, PubMed, BMJ Best Practice, British Nursing Index and AMED databases were searched using relevant keywords to capture extensive evidence. Data were analysed using the six-step criteria for scoping reviews suggested by Arksey and O´Malley for data extraction. To ensure quality and transparency, we enclosed the relevant Equator checklist PRISMA., Results: Our search yielded 10,985 articles of which 12 studies were included. Tools for pain assessments were VAS, NRS, ESAS and BPS. Interventions explored were hypnosis, simple massage, distraction, relaxation, spiritual care, harp music, music therapy, listening to natural sounds, passive exercise, acupuncture, ice packs and emotional support. Reduction in pain intensity was conferred for hypnosis, acupuncture and natural sounds., Conclusion: The findings support further investigations of acupuncture, hypnosis and listening to natural sounds., Relevance to Clinical Practice: The main finding suggests the use of comprehensive multimodal interventions to investigate the effects of nonpharmacological treatment protocols on pain intensity, pain proportion and the impact on opioid consumption and sedation requirements., (© 2020 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Aims and Objectives: The aim of this study was to investigate if quality of life improved in chronic heart failure patients with Cheyne-Stokes respiration treated with adaptive servo-ventilation in nurse-led heart failure clinic., Background: Cheyne-Stokes respiration is associated with decreased quality of life in patients with chronic heart failure. Adaptive servo-ventilation is introduced to treat this sleep-disordered breathing., Design: Randomised, controlled design., Methods: Fifty-one patients (ranging from 53-84 years), New York Heart Association III-IV and/or left ventricular ejection fraction ≤40% and Cheyne-Stokes respiration were randomised to an intervention group who received adaptive servo-ventilation or a control group. Minnesota Living with Heart Failure Questionnaire was used to assess quality of life at randomisation and after three months. Both groups were followed in the nurse-led heart failure clinic., Result: Adaptive servo ventilation improved quality of life-scores both in a per protocol analysis and in an intention to treat analysis. Twenty-one patients dropped out of the study, nine in the control and 12 in the intervention group., Conclusion: Use of adaptive servo-ventilation improved quality of life in chronic heart failure patients with Cheyne-Stokes respiration. However, the drop-out rate was high., Relevance to Clinical Practice: Chronic heart failure patients come regularly to the nurse-led heart failure clinic. The heart failure nurses' competency has to include knowledge of equipment to provide support and continuity of care to the patients., (© 2016 John Wiley & Sons Ltd.)

Purpose: This study aimed to measure the impact of implementing a pain management algorithm in adult intensive care unit (ICU) patients able to express pain. No controlled study has previously evaluated the impact of a pain management algorithm both at rest and during procedures, including both patients able to self-report and express pain behavior, intubated and nonintubated patients, throughout their ICU stay., Materials and Methods: The algorithm instructed nurses to assess pain, guided them in pain treatment, and was implemented in 3 units. A time period after implementing the algorithm (intervention group) was compared with a time period the previous year (control group) on the outcome variables: pain assessments, duration of ventilation, length of ICU stay, length of hospital stay, use of analgesic and sedative medications, and the incidence of agitation events., Results: Totally, 650 patients were included. The number of pain assessments was higher in the intervention group compared with the control group. In addition, duration of ventilation and length of ICU stay decreased significantly in the intervention group compared with the control group. This difference remained significant after adjusting for patient characteristics., Conclusion: Several outcome variables were significantly improved after implementation of the algorithm compared with the control group., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To develop a pain management algorithm for intensive care unit (ICU) patients and to evaluate the psychometric properties of the translated tools used in the algorithm., Background: Many ICU patients experience pain. However, an evidence-based algorithm for pain management does not exist., Methods: Literature review, expert panel, and pilot testing were used to develop the algorithm. The tools were evaluated for inter-rater reliability between two nurses. Discriminant validity was evaluated by comparing pain during turning and rest., Results: An algorithm was developed. The Behavioral Pain Scale (BPS) and the Behavioral Pain Scale-Non Intubated (BPS-NI) discriminated between pain scores during turning and rest. Inter-rater reliability for the BPS varied from moderate (0.46) to very good (1.00). Inter-rater reliability for the BPS-NI varied from fair (0.21) to good (0.63)., Conclusions: The content of the pain management algorithm is consistent with the latest clinical practice guideline recommendations. It may be a useful tool to improve pain assessment and management in adult ICU patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: To implement a pain management algorithm in intensive care units (ICU) and to evaluate nurses' level of adherence with the algorithm., Background: Many ICU patients experience pain. Therefore, an evidence-based algorithm for pain management was developed., Methods: A pain management algorithm was implemented in three units over three weeks. Nurses' level of adherence with the algorithm and associations between level of adherence and patient and unit characteristics over 22 weeks were evaluated using multivariate regression analysis., Results: Nurses' level of adherence was 74.6%. Adherence rates were lower on the evening and night shifts compared to the day shift. Males were assessed significantly less frequently than females. Patients with "injury, poisoning, or certain other consequences of external causes" were assessed significantly less frequently than patients with "diseases of the respiratory system.", Conclusions: ICU nurses can use a pain management algorithm consistently. Findings from this study suggest that a pain management algorithm is a useful tool to increase ICU nurses' adherence with pain assessment., (Copyright © 2015 Elsevier Inc. All rights reserved.)