RESUMO
OBJECTIVE: To establish an evidence-based recommendation on the use of validated scoring systems that measure nursing workload in relation to the complexity of care in adult Intensive Care Units. METHODS: A systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was conducted (PROSPERO registration: CRD42021251272). We searched for validation studies until July 2023 using the bibliographic databases CINAHL, Scopus, Pubmed, WOS, Cochrane Database, SCIELO, Cuiden and Cuidatge. Reference selection and data extraction was performed by two independent reviewers. The assessment of risk of bias was performed using QUADAS-2 and the overall quality according to COSMIN and GRADE approach. RESULTS: We included 22 articles identifying 10 different scoring systems. Reliability, criterion validity and hypothesis testing were the most frequently measurement properties reported. The NAS was the only tool to demonstrate a Class A recommendation (the best performing instrument). CONCLUSIONS: NAS is the best currently available scoring system to assess complexity of care from nursing workload in ICU. However, it barely met the criteria for a class A recommendation. Future efforts should be made to develop, evaluate, and implement new systems based on innovative approaches such as intensity or complexity of care. IMPLICATIONS FOR CLINICAL PRACTICE: The results facilitate decision making as it establishes a ranking of which instruments are recommended, promising or not recommended to measure the nursing workload in the intensive care units.
Assuntos
Unidades de Terapia Intensiva , Carga de Trabalho , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Reprodutibilidade dos Testes , Carga de Trabalho/estatística & dados numéricos , Carga de Trabalho/normas , Enfermagem de Cuidados Críticos/organização & administração , Enfermagem de Cuidados Críticos/normas , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Recursos Humanos de Enfermagem Hospitalar/normas , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricosRESUMO
Objective: To analyze the concept of autonomy of nurses in Intensive Care Units (ICU). Methods: The hybrid model approach proposed by Schwartz-Barcott and Kim, which includes theoretical, fieldwork and analytical phases, was used for this study. For the theoretical and fieldwork phases, the Graneheim and Lundman stages and the CORE-Q checklist were used, and the results were combined in the final analysis phase. For the theoretical phase, 46 related articles, two instruments and four books were identified after using a search strategy in 7 bibliographic databases in English and one in Persian with the terms MESH: 'nursing', 'autonomy' and 'intensive care'. The information extracted in the theoretical phase served as the basis for the design of the questions used in the semi-structured interviews in the fieldwork phase. Eight nurses with ICU experience working in hospitals affiliated to Isfahan University of Medical Sciences (Iran) participated in the fieldwork phase. Results: The antecedents of the concept of nurse autonomy in ICUs were: empowerment of the workforce, organizational platform, and social and individual views of the profession. Its attributes were professionalism and high personal capabilities. Finally, increased personal competencies, promotion of quality of care, improved attitudes towards the profession and professional outcomes were noted as consequences. Conclusion: The autonomy of nurses in the ICU can facilitate their empowerment, which translates into the promotion of their caring behaviours, followed by the improvement of patient outcomes and quality of care.
Assuntos
Unidades de Terapia Intensiva , Recursos Humanos de Enfermagem Hospitalar , Autonomia Profissional , Humanos , Unidades de Terapia Intensiva/organização & administração , Irã (Geográfico) , Recursos Humanos de Enfermagem Hospitalar/psicologia , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Atitude do Pessoal de Saúde , Enfermagem de Cuidados Críticos/organização & administração , Feminino , Adulto , Qualidade da Assistência à Saúde , Entrevistas como Assunto , Profissionalismo , Masculino , Empoderamento , Modelos de EnfermagemRESUMO
In order to improve the nursing effect of respiratory critical illness, this paper combines the refined nursing method to explore the nursing plan of respiratory critical illness. Moreover, this paper uses the variable control method to explore the effects of nursing management, combines the hospital patient samples to conduct a controlled trial analysis, and conducts sample grouping according to the random grouping method. The patients in the control group are managed by traditional nursing management methods, the patients in the test group are managed by refined nursing management methods, and other conditions are basically the same. In addition, the experiment process variable control is carried out according to the mathematical statistics method, and the reasonable statistics and data processing are carried out. Through the comparison method, we can see that the refined management method proposed in this paper has a good effect in the nursing of respiratory critical illness.
Assuntos
Enfermagem de Cuidados Críticos/organização & administração , Estado Terminal/enfermagem , Doenças Respiratórias/enfermagem , China/epidemiologia , Biologia Computacional , Enfermagem de Cuidados Críticos/estatística & dados numéricos , Estado Terminal/mortalidade , Humanos , Incidência , Modelos de Enfermagem , Cuidados de Enfermagem/estatística & dados numéricos , Pneumonia Associada à Ventilação Mecânica/mortalidade , Pneumonia Associada à Ventilação Mecânica/enfermagem , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Síndrome do Desconforto Respiratório/enfermagem , Doenças Respiratórias/mortalidadeRESUMO
PURPOSE: This quality improvement project created a guide for critical care providers transitioning patients to comfort measures only encouraging communication, collaboration, and shared decision making; ensuring management of patients' end-of-life symptoms and needs; and enhancing provider satisfaction by improving structure and consistency when transitioning patients. DESCRIPTION OF THE PROJECT: Interviews conducted with staff in intensive care units revealed opportunities to improve structure and processes of transitioning patients at the end of life. A subcommittee of experts designed a checklist to facilitate interdisciplinary conversations. Impact on provider satisfaction and symptom management was assessed. Presurveys circulated used a Research Electronic Data Capture tool. A checklist was implemented for 3 months, and then postsurveys were sent. Charts were audited to identify improvement in symptom management and compared with retrospective samples. OUTCOMES: Clinical improvements were seen in communication (12%), collaboration (25%), shared decision making (22%), and order entry time (17%). In addition, 72% agreed the checklist improved structure and consistency; 69% reported improved communication, collaboration, and shared decision making; 61% felt it improved knowledge/understanding of patient needs; and 69% agreed it improved management of patient symptoms. CONCLUSION: After checklist implementation, staff felt more involved and more comfortable, and reported more clarity in transitioning patients; no improvement in patient outcomes was realized.
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Lista de Checagem , Enfermagem de Cuidados Críticos/organização & administração , Recursos Humanos de Enfermagem Hospitalar/psicologia , Conforto do Paciente/organização & administração , Satisfação Pessoal , Comunicação , Tomada de Decisão Compartilhada , Humanos , Unidades de Terapia Intensiva , Relações Interprofissionais , Pesquisa em Avaliação de Enfermagem , Melhoria de QualidadeAssuntos
COVID-19/enfermagem , Enfermagem de Cuidados Críticos/organização & administração , Capacitação em Serviço , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/organização & administração , COVID-19/epidemiologia , Competência Clínica , Humanos , Pesquisa em Avaliação de Enfermagem , Estados Unidos/epidemiologiaRESUMO
ABSTRACT: The pandemic caused by the novel coronavirus has challenged healthcare systems around the world. Learn how one medical facility incorporated key guiding principles to quickly adapt normal policies and protocols in order to safely care for patients with COVID-19.
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COVID-19/enfermagem , Enfermagem de Cuidados Críticos/organização & administração , COVID-19/epidemiologia , HumanosRESUMO
Lessons learned from one hospital's COVID-19 experience.
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COVID-19/enfermagem , Modelos de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Boston/epidemiologia , COVID-19/epidemiologia , Enfermagem de Cuidados Críticos/organização & administração , Hospitais de Ensino/organização & administração , Humanos , Relações Interprofissionais , Papel do Profissional de Enfermagem , Enfermagem Perioperatória/organização & administraçãoAssuntos
COVID-19/epidemiologia , COVID-19/terapia , Enfermagem de Cuidados Críticos/organização & administração , Cuidados Críticos/organização & administração , Número de Leitos em Hospital , Capacidade de Resposta ante Emergências/organização & administração , COVID-19/complicações , Humanos , ItáliaRESUMO
STUDY HYPOTHESIS: We hypothesized that establishing a program of specialized emergency critical care (ECC) nurses in the ED would improve mortality of ICU patients boarding in the ED. METHODS: This was a retrospective before-after cohort study using electronic health record data at an academic medical center. We compared in-hospital mortality between the pre- and post-intervention periods and between non-prolonged (≤6 h) boarding time and prolonged (>6 h) boarding time. In-hospital mortality was stratified by illness severity (eccSOFA category) and adjusted using logistic regression. RESULTS: Severity-adjusted in-hospital mortality decreased from 12.8% pre-intervention to 12.3% post-intervention (-0.5% (95% CI, -3.1% to 2.1%), which was not statistically significant. This was despite a concurrent increase in ED and hospital crowding. The proportion of ECC patients downgraded to a lower level of care while still in the ED increased from 6.4% in the pre-intervention period to 17.0% in the post-intervention period. (+10.6%, 8.2% to 13.0%, p < 0.001). Severity-adjusted mortality was 12.8% in the non-prolonged group vs. 11.3% in the prolonged group (p = 0.331). CONCLUSIONS: During the post-intervention period, there was a significant increase in illness severity, hospital congestion, ED boarding time, and downgrades in the ED, but no significant change in mortality. These findings suggest that ECC nurses may improve the safety of boarding ICU patients in the ED. Longer ED boarding times were not associated with higher mortality in either the pre- or post-intervention periods.
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Enfermagem de Cuidados Críticos/organização & administração , Estado Terminal/mortalidade , Enfermagem em Emergência/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Mortalidade Hospitalar , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVES: To determine the relationship between ethical climate and burnout in nurses working in Intensive Care Units (ICUs). METHODS: This cross-sectional and multi-center study was conducted among 212 nurses working in adult ICUs of six hospitals affiliated to Shiraz University of Medical Sciences, Iran in 2019. The participants were selected using systematic random sampling technique. Data was collected using valid instruments of Olson's Hospital Ethical Climate Survey (HECS) and Maslach Burnout Inventory (MBI). RESULTS: Ethical climate was favorable (3.5±0.6). The intensity (32.2±12.4) and frequency (25.5±12.4) of burnout were high. Ethical climate had significant and inverse relationships with frequency of burnout (r =-0.23, p=0.001) and with intensity of burnout (r=-0.186, p=0.007). Ethical climate explained 5.9% of burnout. Statistically significant relationships were also found between these factors: age with ethical climate (p=0.001), work shifts with burnout (p=0.02), and gender and with intensity frequency of burnout in ICU nurses (p=0.038). The results of Spearman correlation coefficient showed significant and inverse relationships between ethical climate and job burnout (r=-0.243, p < 0.001). CONCLUSIONS: Nurses in ICUs perceived that ethical climate was favorable however, burnout was high. Therefore, burnout can be affected by many factors and it is necessary to support ICU nurses since they undertake difficult and complicated task. It is recommended to assess factors that increase burnout and adopt specific measures and approaches to relieve nursing burnout.
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Esgotamento Profissional/etiologia , Esgotamento Profissional/psicologia , Enfermagem de Cuidados Críticos/ética , Unidades de Terapia Intensiva/ética , Enfermeiras e Enfermeiros/psicologia , Cultura Organizacional , Percepção Social , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/epidemiologia , Enfermagem de Cuidados Críticos/organização & administração , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Unidades de Terapia Intensiva/organização & administração , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/organização & administração , Testes Psicológicos , Análise de Regressão , Fatores de RiscoRESUMO
Adults admitted to hospital with critical illness are vulnerable and at high risk of morbidity and mortality, especially in sub-Saharan African settings where resources are severely limited. As life expectancy increases, patient demographics and healthcare needs are increasingly complex and require integrated approaches. Patient outcomes could be improved by increased critical care provision that standardises healthcare delivery, provides specialist staff and enhanced patient monitoring and facilitates some treatment modalities for organ support. In Malawi, we established a new high-dependency unit within Queen Elizabeth Central Hospital, a tertiary referral centre serving the country's Southern region. This unit was designed in partnership with managers, clinicians, nurses and patients to address their needs. In this practice piece, we describe a participatory approach to design and implement a sustainable high-dependency unit for a low-income sub-Saharan African setting. This included: prospective agreement on remit, alignment with existing services, refurbishment of a dedicated physical space, recruitment and training of specialist nurses, development of context-sensitive clinical standard operating procedures, purchase of appropriate and durable equipment and creation of digital clinical information systems. As the global COVID-19 pandemic unfolded, we accelerated unit opening in anticipation of increased clinical requirement and describe how the high-dependency unit responded to this demand.
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COVID-19 , Unidades Hospitalares , Centros de Atenção Terciária , COVID-19/enfermagem , COVID-19/prevenção & controle , COVID-19/terapia , Enfermagem de Cuidados Críticos/educação , Enfermagem de Cuidados Críticos/organização & administração , Estado Terminal/terapia , Arquitetura Hospitalar , Humanos , Malaui , Qualidade da Assistência à Saúde , Encaminhamento e ConsultaRESUMO
BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a "tsunami" warning requiring instantaneous implementation and escalation of disaster plans. EVIDENCE REVIEW: An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. IMPLEMENTATION: The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S's became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. EVALUATION: Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. SUSTAINABILITY: The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.
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COVID-19/enfermagem , Enfermagem de Cuidados Críticos/métodos , Enfermagem de Cuidados Críticos/organização & administração , Estado Terminal/enfermagem , Unidades de Terapia Intensiva/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2RESUMO
In this presentation, I will share my unconventional journey, starting from my first job as a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, where I hold a joint position with the Institute for Applied Life Sciences and the College of Nursing. Throughout this journey, I have had many opportunities to participate in interdisciplinary clinical outcomes research and medical product development as a staff nurse, clinical nurse specialist, and project lead from the clinical, industry, and academic perspectives. While passionate about my central clinical research interests in technology innovation and its responsible use in critical and acute care, the foundation of my approach is dedicated to the values and lessons of my earliest experiences in critical care bedside nursing: supporting and preserving the dignity and humanity of person-centered patient care. Early in my career as a critical care nurse, I realized how vitally important a critical care nursing perspective could be in the design of technology for meeting the critical care needs of patients, nurses, and other professionals who provide this care. As the nation's largest group of health care professionals, nurses use more products than any other health care professional, and thus nurses have a uniquely practical and care-sensitive perspective on the development and design of medical products. Nurses, especially critical care nurses, are in a unique position to identify and address everyday health care issues, challenge assumptions and the status quo, address unrecognized and unarticulated needs, and ensure that clinical outcomes research serves as the foundation for validating the effectiveness of medical product innovation. My goal is to share lessons learned and to help participants to see the many different ways that critical care nursing knowledge can be used to improve patient care.
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Pesquisa Biomédica/organização & administração , Enfermagem de Cuidados Críticos/organização & administração , Invenções , Humanismo , Humanos , Unidades de Terapia Intensiva/organização & administração , Assistência Centrada no Paciente/organização & administraçãoRESUMO
BACKGROUND: Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. OBJECTIVE: To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. METHODS: In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. RESULTS: Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient's end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. CONCLUSIONS: The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.
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Enfermagem de Cuidados Críticos/organização & administração , Família/psicologia , Assistência Terminal/organização & administração , Assistência Terminal/psicologia , Adulto , Estudos Transversais , Escolaridade , Feminino , Arquitetura Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-FamíliaRESUMO
BACKGROUND: The coronavirus disease 2019 pandemic has led to escalating infection rates and associated deaths worldwide. Amid this public health emergency, the urgent need for palliative care integration throughout critical care settings has never been more crucial. OBJECTIVE: To promote palliative care engagement in critical care; share palliative care resources to support critical care nurses in alleviating suffering during the coronavirus disease 2019 pandemic; and make recommendations to strengthen nursing capacity to deliver high-quality, person-centered critical care. METHODS: Palliative and critical care literature and practice guidelines were reviewed, synthesized, and translated into recommendations for critical care nursing practice. RESULTS: Nurses are ideally positioned to drive full integration of palliative care into the critical care delivery for all patients, including those with coronavirus disease 2019, given their relationship-based approach to care, as well as their leadership and advocacy roles. Recommendations include the promotion of healthy work environments and prioritizing nurse self-care in alignment with critical care nursing standards. CONCLUSIONS: Nurses should focus on a strategic integration of palliative care, critical care, and ethically based care during times of normalcy and of crisis. Primary palliative care should be provided for each patient and family, and specialist services sought, as appropriate. Nurse educators are encouraged to use these recommendations and resources in their curricula and training. Palliative care is critical care. Critical care nurses are the frontline responders capable of translating this holistic, person-centered approach into pragmatic services and relationships throughout the critical care continuum.