Consensos de professores especialistas de subáreas de conhecimento de Enfermagem: objetivos, conteúdos e métodos / Consenso de profesores especialistas en subáreas de conocimiento de Enfermería sobre objetivos, contenidos y métodos / Consensus of expert professors of subfields of Nursing knowledge: objectives, contents and methods

Resumo Objetivo descrever as relações entre objetivos, conteúdos e métodos de ensino em subáreas de conhecimento de Enfermagem a partir do consenso de professores especialistas. Método estudo Delphi em quatro rodadas. Participaram 112 professores de cursos de graduação de Instituições de Ensino Superior públicas do Brasil divididos em sete painéis por subárea. Os dados foram analisados pela técnica de Análise de Conteúdo à luz dos conceitos de conhecimento dos objetivos e conhecimento pedagógico de conteúdo de Shulman, transformados nas variáveis qualitativas de interesse, objetivos, conteúdos e métodos de ensino em torno das quais foi buscado consenso. Resultados somente as subáreas Enfermagem em Saúde Coletiva e Enfermagem na Gestão e Gerenciamento acordaram objetivos. Conteúdos acertados foram relacionados às políticas públicas e aos programas do Sistema Único de Saúde. Métodos sugerem a coexistência de tradição e inovação. Conclusões e implicações para a prática a tomada de consciência das relações entre os objetivos, conteúdos e métodos utilizados pelos professores impacta a promoção do diálogo e a integração entre as subáreas, implicando, na prática, uma formação profissional potencializada ou frágil em qualidade resolutiva de problemas de saúde.

Resumen Objetivo describir las relaciones entre objetivos, contenidos y métodos de enseñanza en subáreas del conocimiento de Enfermería a partir del consenso de profesores especialistas. Método estudio Delphi en cuatro rondas. Participaron 112 profesores de cursos de pregrado de instituciones públicas de educación superior de Brasil, divididos en siete paneles por subárea. Los datos fueron analizados mediante la técnica de Análisis de Contenido a la luz de los conceptos de conocimiento de los objetivos y conocimiento pedagógico del contenido de Shulman, transformados en variables cualitativas de interés, objetivos, contenidos y métodos de enseñanza en torno a los cuales se buscó el consenso. Resultados solo las subáreas Enfermería en salud colectiva y Enfermería en gestión y Gerenciamiento acordaron objetivos. Los contenidos del consenso se relacionaron con las políticas públicas y los programas del Sistema Único de Salud. Los métodos sugieren la coexistencia de la tradición e innovación. Conclusiones e implicaciones para la práctica la conciencia de la relación entre los objetivos, contenidos y métodos empleados por los docentes incide en la promoción del diálogo y la integración entre las subáreas, implicando en la práctica una formación profesional potencializada o frágil en términos de resolución de problemas de salud.

Abstract Aim to describe the relationships among objectives, content, and teaching methods in subfields of Nursing knowledge from the consensus of expert professors. Methods a Delphi study in four rounds. Participants were 112 professors from undergraduate courses at public Higher Education Institutions in Brazil divided into seven panels by subarea. The data were analyzed using the Content Analysis technique in light of Shulman's concepts of knowledge of objectives and pedagogical knowledge of content, transformed into the qualitative variables of interest, objectives, content and teaching methods, around which consensus was sought. Results only the subareas of Collective Health Nursing and Nursing in Management and Administration agreed on objectives. Agreed contents were related to public policies and programs of the Unified Health System. Methods suggest the coexistence of tradition and innovation. Conclusions and implications for practice the awareness of the relationships among the objectives, contents, and methods used by the professors impacts the promotion of dialogue and the integration among the subareas, implying, in practice, a potentiated or fragile professional formation in resolute quality of health problems.

A study of the role and educational needs of ophthalmic specialist nurses.

AIMS: To explore the current roles, responsibilities and educational needs of ophthalmic specialist nurses (OSNs) in the UK. METHOD: A survey of 73 OSNs ranging from band 4 to band 8 was undertaken in May 2018. FINDINGS: 73% of OSNs undertake more than one active role, with 59% involved in nurse-led clinics; 63% felt formal learning resources were limited, with 63% reporting training opportunities and 21% reporting time as major barriers to further training. More than 38% emphasised hands-on clinic-based teaching had a greater impact on their educational needs. Some 64% were assessed on their skills annually and 59% felt confident with their skill set. CONCLUSION: The Ophthalmic Common Clinical Competency Framework provides a curriculum and assessment tools for OSNs to use as a structure to maintain clinical skills and knowledge. Eye departments should use this as guidance to target learning needs and improve standards of care to meet the changing needs of society.

Bienestar subjetivo y motivos para elegir una especialidad en enfermeras peruanas de programas de especialización / Subjective Well-Being and Motivation for Choosing any Specialties in Peruvian Nurses of Specialization Programs

Introducción: La elección de especialidades en enfermería surge a partir de motivaciones, las que se evidencian en el bienestar subjetivo o felicidad que sienten las enfermeras desde el momento que se encuentra estudiando su especialidad. Objetivo: Determinar la relación entre los motivos de elección de especialidades y el bienestar subjetivo en enfermeras de los programas de segunda especialización. Métodos: Estudio descriptivo, correlacional y transversal, desarrollado en la Universidad Nacional Mayor de San Marcos, Perú, en 2017. La población de estudio fue de 177 enfermeras ingresantes al Programa de Segunda Especialidad y la muestra se constituyó por 121 enfermeras, se calculó estadísticamente, con un muestreo estratificado. La técnica de recolección de datos fue la encuesta y el instrumento de medición un cuestionario de motivos de elección de especialidad y una escala para medir el bienestar subjetivo. Para la correlación de variables se empleó el coeficiente correlación de Spearman (p < 0.05, significancia estadística). Resultados: Los principales motivos que llevaron a las enfermeras elegir sus especialidades fueron: "Valor social de la especialidad elegida" (87,26 por ciento) y "Vocación e interés por la carrera" (66,53 por ciento). Respecto al bienestar subjetivo, 65,29 por ciento se consideraban felices, resaltando la dimensión realización personal (65,37 por ciento); además, hubo relación entre los motivos de elección de especialidad y el bienestar subjetivo en enfermeras (rho = 0,394; p < 0,05). Conclusiones: Las enfermeras del programa de segunda especialización tenían un bienestar subjetivo aceptable, incluidas en la categoría de felices, tal bienestar se relaciona con los motivos que los llevo elegir su especialidad, en este caso fueron más los motivos de orientación intrínseca(AU)

Introduction: Choosing any nursing specialties arises from motivations, which are evidenced according to the subjective well-being or happiness that nurses feel from the moment that they are studying their specialties. Objective: To identify the relationship between the reasons for choosing specialties and subjective well-being in nurses from second specialization programs. Methods: Descriptive, correlational and cross-sectional study carried out in 2017 at Universidad Nacional Mayor de San Marcos, Peru. The study population was 177 nurses starting the second specialty program and the sample consisted of 121 nurses. The sample size was calculated statistically by stratified sampling. The data collection technique was the survey, while the measurement instrument was a questionnaire of reasons for choosing any specialties and a scale to measure subjective well-being. For the correlation of variables, the Spearman correlation coefficient (p < 0.05, statistical significance) was used. Results: The main reasons that led the nurses to choose their specialties were the social value of the chosen specialty (87.26 percent) and the vocation and interest in the major (66.53 percent). Regarding subjective well-being, 65.29 percent considered themselves happy, highlighting the dimension personal fulfillment (65.37 percent). Furthermore, there was a relationship between the reasons for choosing any specialties and subjective well-being in nurses (rho= 0.394; p < 0.05). Conclusions: The nurses of the second specialization program had an acceptable subjective well-being, included in the category happy. Such well-being is related to the reasons that led them to choose their specialties, in which case there were more intrinsic orientation reasons(AU)

Peripheral Intravenous Education in North American Nursing Schools: A Call to Action.

BACKGROUND: Peripheral intravenous (PIV) management requires knowledge, skill, and clinical judgment to ensure positive patient outcomes; yet, many nurses lack confidence in their PIV knowledge and skills. It is important that graduate nurses acquire PIV knowledge and skills in nursing school. This study aimed to explore PIV content coverage and clinical opportunities provided in U.S. and Canadian nursing curricula. METHOD: Using a descriptive, exploratory design, representatives of nursing schools completed a 12-item, web-based PIV curriculum survey. RESULTS: Most schools covered PIV content in classroom, laboratory, and clinical settings; however, some indicated students were not allowed to initiate PIVs in clinical settings. Participants noted that PIV education was a shared responsibility with health systems. CONCLUSION: It is important that nursing students develop PIV competence; however, competing pressures for time in nursing curricula may limit PIV coverage. Nurse educators can benefit from PIV and infusion therapy specialty organization resources. [J Nurs Educ. 2020;59(9):493-500.].

Liderança da enfermagem no enfrentamento da pandemia

O Debate Virtual do Conass de sexta-feira (14/8), às 17 horas irá tratar da liderança da enfermagem no enfrentamento da pandemia do novo coronavírus, destacando o papel destes profissionais nas atenções Primária, Especializada e Hospitalar, frente ao enorme desafio da Covid-19 no ano de 2020 – celebrado pela Organização Mundial da Saúde (OMS) como o ano internacional de profissionais de enfermagem e obstetrícia – marco comemorativo que reconhece o trabalho feito por enfermeiras, enfermeiros e parteiras em todo o mundo. O encontro virtual contará com a participação da enfermeira e embaixadora da Federação Mundial de Enfermeiros em Cuidados Críticos (WFCCN), membro Fundadora da Associação Brasileira de Enfermagem em Terapia Intensiva (Abenti) e doutora em Ciências da Saúde; Renata Pietro; da enfermeira e facilitadora do projeto Planificação da Atenção à Saúde (PAS), do Conass, Érika Sousa; e da enfermeira e também facilitadora da PAS, Sandra Sperotto. A mediação do debate será feita pela assessora técnica do Conass, enfermeira Carla Ulhoa André. Perguntas poderão ser enviadas pelo www.conass.org.br/participe O debate será transmitido pelo Portal do Conass: www.conass.org.br e pelos canais do Conselho no YouTube: www.youtube.com/conassoficial; e no FaceBook: www.facebook.com/conassoficial. Participe!

Evaluation of the Impact of the Wound Treatment Associate (WTA) Education Program on Practice and Quality Patient Outcomes.

PURPOSE: The Wound Treatment Associate (WTA) program is an education offering of the WOCN Society. This evidence-based continuing education program prepares nurses to serve as a unit-based resource for nursing staff. The WTA program is approved by the American Nurses Credentialing Association (ANCC) for 32.25 contact hours and aimed at licensed health care personnel. This article focuses on the impact of this education program, in particular a reduction in hospital-acquired pressure injury (HAPI) in acute care and decrease in visits per episode (VPE) and supply costs in home health. METHODS: Surveys were sent to all course participants to date to fulfill the summative evaluation requirement for ANCC approval to determine the perception of improvement in knowledge, skills, and practice. An additional survey was developed and reviewed by members to send to WTA program course coordinators. RESULTS: Participants (n = 153) reported an increase in confidence in knowledge and skills about wound care and use in nursing practice. The number of respondents to the course coordinator survey was lower (n = 48). Coordinators did report a reduction in pressure injuries in acute care. Home health respondents noted a decrease in VPE and reduction in the cost of supplies. Data reported on abstracts and posters suggested positive impacts of pressure injury prevention programs in acute and home health care. CONCLUSIONS: Although there are limitations to the aforementioned reporting, incorporating the WTA program into pressure injury prevention programs and wound treatment programs showed a reduction in HAPIs in acute care and decreased VPE and supply costs in home health.

[A specialist nurse consultation for post-transplant follow-up of patients undergoing allogeneic hematopoietic cell transplantation: Recommendations of the Francophone Society of Marrow Transplantation and Cellular Therapy (SFGM-TC)]. / Mise en place d'une consultation infirmière de suivi post-allogreffe de cellules souches hématopoïétiques : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

The number of hematopoietic stem cell transplantation is in constant rise. This increase has put in spotlight the lack of physician availability. Some healthcare centers have already organised a nurse's consultation under the supervision of an expert physician. We conducted a survey among nurses and physicians from the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) centers who confirmed the need to create a special transplantation-skilled population of nurses. During this ninth annual workshop of the SFGM-TC, we have defined the required conditions for a transplant nurse consultation until day 100 post-transplant with the responsibility of the transplant expert physician. To help the centers in this dynamic, we provided practical tools to support this consultation. The current heath policy is in favor of an increased autonomy of the expert nurse. The implementation of the status of nurse in advanced practice is the first step in this professional development.

Burn Nurse Competency Utilization: Report From the 2019 Annual American Burn Association Meeting.

Competence in healthcare is a recognized expectation by consumers. In 2018 following an extensive review and consensus-building process, burn nursing practice competencies were published. Clinical nurse leaders were called upon to use these published competencies in practice as a basis for the requisite knowledge and skills needed in the care of the burn-injured individual. In 2019 at the 51st Annual Meeting of the American Burn Association, nurses from four U.S. burn centers reported on their center's incorporation of the competencies within their educational nursing curriculums. This paper provides a forum for each of the lead authors from Rhode Island Hospital Burn Center, the University of Utah Health Burn Trauma Intensive Care Unit, Parkland Regional Burn Center, and the University of Chicago Medicine Burn Center to outline their current utilization of the new burn nurse competencies and plans for future use.

Competences of specialist nurses and advanced practice nurses. / Competencias en enfermeras Especialistas y en Enfermeras de Práctica Avanzada.

OBJECTIVE: To analyse the distribution of advanced competences in specialist nurses and advanced practice nurses and to evaluate their association with some characteristics of their professional profile. METHOD: Multicentre analytical cross-sectional study. Nurses who worked as advanced practice nurses and specialist nurses were included. Their level of perceived advanced competences was measured, as well as sociodemographic and professional characterization variables. RESULTS: A total of 277 nurses participated (149 practised as advanced practice nurses and 128 as specialists), with an average of 13.88 (11.05) years as a specialist and 10.48 (5.32) years as an advanced practice nurse. In the sample, 28.8% had a master's or doctorate level qualification, 50.2% worked in Primary Care, 24.9% in hospitals and 22.7% in Mental Health. The self-perceived global level was high in the different competences, the lowest dimensions being research, evidence-based practice, quality and safety management and leadership and consulting. The advanced practice nurses obtained a higher level of competence globally and in the dimensions of leadership and consulting, interprofessional relations, care management, and health promotion. There were no differences based on experience or possession of a master's degree or doctorate. In the advanced practice nurses, the practice context did not influence competence levels, although in the specialist nurses it did, in favour of those practicing in Mental Health. CONCLUSIONS: Specialist and advanced practice nurses have different competences that should be adequately managed for the development of advanced and specialist nursing services.

Advancing the practice of nursing through specialty fellowship development for pediatric nurse practitioners.

Fellowship training for physicians has historically been a training model for physicians to specialize their practice and develop research skills following medical school and residency. Advanced practice registered nurses, specifically nurse practitioners (NPs) practice in primary care, acute care, and specialty settings across the lifespan. Fellowship programs have emerged as a way for NPs to specialize their practice and meet the needs of an expanding health care system. This article describes the design, implementation, and outcomes of two similar yet distinct specialty NP fellowship programs: one in Developmental-Behavioral Pediatrics and one in Pediatric Physical Medicine and Rehabilitation.

Variation in the barriers to compassion across healthcare training and disciplines: A cross-sectional study of doctors, nurses, and medical students.

BACKGROUND: Despite the established importance of compassion in health, studies examining the specific barriers to compassionate care in healthcare are few. Recent work suggests that examining differences as a function of professional development and identifying variation in barriers to compassionate care across professions may highlight the origins of barriers and inform the development of compassion-enhancing interventions suited to the unique challenges of different professions and stages of training. OBJECTIVES: To explore whether the barriers to compassion vary (a) between physicians and nurses and (b) across samples of physicians and medical students (i.e., as a function of development and clinical experience). It was expected that medical students would report greater barriers than physicians and that nurses would generally report lower barriers to compassion, other than for external barriers. METHODS: Registered nurses, physicians, and medical students were recruited using convenience sampling in New Zealand. Following consent, 1700 participants (801 nurses, 516 physicians, and 383 medical students) completed a survey including the Copenhagen Burnout Inventory and the Barriers to Physician Compassion questionnaire. RESULTS: As expected, medical students reported greater barriers to compassion than physicians and nurses, with both professions generally reporting lower barriers. However, and also consistent with hypotheses, nurses reported greater work-environment-related barriers relative to physicians. DISCUSSION: Students reported greater barriers than physicians. While nurses generally reported lower barriers than physicians, they specifically reported greater work environment-related barriers. For nurses, results highlight the importance of implementing interventions that reduce external barriers to compassion, specifically the need to alleviate the structural barriers and restrictions that nurses face. For medical students and younger healthcare professionals, the results highlight the importance of mentorship, support, and ongoing professional and emotional development.

The effects of education and clinical specialization on nurses' status affirmation by physicians: A quantitative analysis.

Research has demonstrated a status gap between members of healthcare delivery teams. However, it is unclear which factors mitigate or exacerbate the status gap between healthcare providers. This paper examines the concept of status affirmation, the belief that others affirm the individual's social standing, as one factor that can affect the status gap between healthcare professionals. The aim of this exploratory study was to investigate two factors that affect nurses' status affirmation: nurses' educational backgrounds and clinical specializations. A close-ended survey was administered to registered nurses in Indiana, a midwestern American state 1 (N = 1262) to identify which nurses are likely to have their status affirmed by physicians, in general. Results of multinomial logistic regression analyses suggest that highly educated nurses are unlikely to receive status affirmation, and there are differences in status affirmation across clinical specialties. In addition, nurses with advanced degrees often do not work in specialties that receive status affirmation. These results suggest that conflict among nurses and doctors is as likely to exist across divisions in nurses' educational attainment as across work specializations. Status affirmation is posited as a theoretical antecedent to interprofessional collaboration.

An exploration of the experiences of rheumatology nurses counselling patients on methotrexate therapy.

OBJECTIVES: Methotrexate is commonly used to treat patients with inflammatory arthritis. A key role of a rheumatology nurse is to educate patients on how to take this drug safely prior to the commencement of treatment. The objective of the present study was to explore the experiences of rheumatology nurses conducting this role, focusing on the content of the consultation and training received to perform the role. METHODS: A qualitative phenomenological approach was used. Six semi-structured interviews were performed with nurses from two hospitals who regularly counsel patients prior to starting methotrexate. The interviews were thematically analysed by two researchers and themes extracted. RESULTS: Four main themes were identified: (a) using written information to structure the content of the consultation; (b) patients have different information needs; (c) time pressures; and (d) training and evolution of practice. All participants described a lack of confidence when they first started counselling patients commencing methotrexate, with a wide variation in training. Participants reported that patients required different information depending on whether they were commencing this agent on its own or in combination with other drugs. All participants experienced some time pressure. CONCLUSIONS: Participants reported that the majority of the consultation focused on conveying information, with little opportunity for patient interaction and questions. We suggest that there is a clear need for further exploration of these consultations, to identify possible training needs. Participants also used standard written information to guide both the structure and content of the consultation limiting patients'; opportunities to ask questions.

Training nurses in a competency framework to support adults with epilepsy and intellectual disability: the EpAID cluster RCT.

BACKGROUND: People with an intellectual (learning) disability (ID) and epilepsy have an increased seizure frequency, higher frequencies of multiple antiepileptic drug (AED) use and side effects, higher treatment costs, higher mortality rates and more behavioural problems than the rest of the population with epilepsy. The introduction of nurse-led care may lead to improvements in outcome for those with an ID and epilepsy; however, this has not been tested in a definitive clinical trial. OBJECTIVE: To determine whether or not ID nurses, using a competency framework developed to optimise nurse management of epilepsy in people with an ID, can cost-effectively improve clinical and quality-of-life outcomes in the management of epilepsy compared with treatment as usual. DESIGN: Cluster-randomised two-arm trial. SETTING: Community-based secondary care delivered by members of community ID teams. PARTICIPANTS: Participants were adults aged 18-65 years with an ID and epilepsy under the care of a community ID team and had had at least one seizure in the 6 months before the trial. INTERVENTIONS: The experimental intervention was the Learning Disability Epilepsy Specialist Nurse Competency Framework. This provides guidelines describing a structure and goals to support the delivery of epilepsy care and management by ID-trained nurses. MAIN OUTCOME MEASURES: The primary outcome was the seizure severity scale from the Epilepsy and Learning Disabilities Quality of Life questionnaire. Measures of mood, behaviour, AED side effects and carer strain were also collected. A cost-utility analysis was undertaken along with a qualitative examination of carers' views of participants' epilepsy management. RESULTS: In total, 312 individuals were recruited into the study from 17 research clusters. Using an intention-to-treat analysis controlling for baseline individual-level and cluster-level variables there was no significant difference in seizure severity score between the two arms. Altogether, 238 complete cases were included in the non-imputed primary analysis. Analyses of the secondary outcomes revealed no significant differences between arms. A planned subgroup analysis identified a significant interaction between treatment arm and level of ID. There was a suggestion in those with mild to moderate ID that the competency framework may be associated with a small reduction in concerns over seizure severity (standard error 2.005, 95% confidence interval -0.554 to 7.307; p = 0.092). However, neither subgroup showed a significant intervention effect individually. Family members' perceptions of nurses' management depended on the professional status of the nurses, regardless of trial arm. Economic analysis suggested that the competency framework intervention was likely to be cost-effective, primarily because of a reduction in the costs of supporting participants compared with treatment as usual. LIMITATIONS: The intervention could not be delivered blinded. Treatment as usual varied widely between the research sites. CONCLUSIONS: Overall, for adults with an ID and epilepsy, the framework conferred no clinical benefit compared with usual treatment. The economic analysis suggested that there may be a role for the framework in enhancing the cost-effectiveness of support for people with epilepsy and an ID. Future research could explore the specific value of the competency framework for those with a mild to moderate ID and the potential for greater long-term benefits arising from the continuing professional development element of the framework. TRIAL REGISTRATION: Current Controlled Trials ISRCTN96895428. FUNDING: This trial was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 10. See the NIHR Journals Library website for further project information.

Impact of an educational intervention for district nurses about preparedness to encounter women exposed to intimate partner violence.

AIM: To evaluate the impact of an educational intervention on the preparedness of district nurses at primary healthcare centres to encounter women exposed to intimate partner violence. METHODOLOGICAL DESIGN: An observational quasi-experimental study. Participants were divided into an intervention group (n = 117) and a control group (n = 204), both from the eastern part of Sweden. A group of nurses from across Sweden (the 'national group,' n = 217) was also recruited. The Violence Against Women Health Care Provider Survey was used pre- and 1 year postintervention to measure the intervention's impact. This survey, which measured preparedness, included eight factors: practitioner preparedness, self-confidence, lack of control, comfort following disclosure, professional support, practice pressures, abuse inquiry and consequences of asking. anova, the paired Wilcoxon test, the Mann-Whitney U test and the Kruskal-Wallis test were used to analyse the data. FINDINGS: Pre-intervention preparedness was equal in all three groups. In the intervention group, preparedness related to the factor practitioner lack of control increased (p = 0.003), but a comparison of change between the intervention and control groups showed no significant intervention effect (p = 0.069). CONCLUSIONS: The results indicate that the intervention had a low impact on district nurses' preparedness. The educational intervention must be adjusted; a main focus of changes should be the addition of continuing postintervention supervision and support.

An exploration of participants' experience of an intensive care nursing transition to specialty practice program.

BACKGROUND: Transition to specialty practice programs were developed to support, educate and facilitate recruitment and retention of nurses in specialised areas of practice. The intensive care nursing transition to specialty practice program in this study was implemented in 2000. To date, in Australia there are no published studies which focus on intensive care nursing transition to specialty practice programs. OBJECTIVES: The study aimed to explore the effects of an intensive care nursing transition to specialty practice program offered in two intensive care units in a single Australian health service. METHODS: A cross-sectional survey design was used. Quantitative data were collected from nurses who participated in the transition to specialty practice program from 2005 to 2015 using an anonymous online survey. Summary statistics and Chi-square tests were used to analyse the data. RESULTS: The response rate was 51.8% (n=86). Most of the transition to specialty practice program participants had medical nursing experience (n=35, 40.7%) or surgical nursing experience (n=35, 40.7%) prior to enrolling into the program. More than half (n=46, 53.5%) of the participants had worked in the intensive care units for more than two years post program. The majority of the participants (n=60, 69.8%) undertook post graduate education after the transition to specialty practice program. CONCLUSION: Significant numbers of experienced nurses undertook transition to specialty practice program into intensive care and majority of the participants reported positive results of the program.