Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence.

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.

The effect of resilience training with mHealth application based on micro-learning method on the stress and anxiety of nurses working in intensive care units: a randomized controlled trial.

INTRODUCTION: Nurses in intensive care units (ICUs) face high stress and anxiety, impacting their well-being and productivity. Addressing this, this study evaluated the impact of resilience training via a mHealth application based on micro-learning on ICU nurses' stress and anxiety levels. MATERIALS AND METHODS: This study, a single-blind randomized controlled trial conducted in 2022-23, involved sixty ICU nurses from two Tehran hospitals. Nurses were chosen through purposive sampling and divided into intervention and control groups by simple randomization. The intervention group was taught resilience via an educational mHealth application based on micro-learning, with data collected using the anxiety and stress subscales of DASS-21. RESULTS: Before the intervention, there were no significant differences in stress and anxiety scores between the intervention and control groups (P > 0.05). Upon utilizing the mHealth application, the intervention group exhibited significant reductions in stress, from 10.77 ± 3.33 to 9.00 ± 1.66 (P = 0.001), and in anxiety, from 9.43 ± 3.35 to 7.93 ± 0.98 (P < 0.001). In contrast, the control group experienced a slight increase in stress levels, from 10.10 ± 2.19 to 10.73 ± 2.15 (P = 0.002), and in anxiety levels, from 9.10 ± 1.63 to 10.23 ± 1.65 (P < 0.0001). CONCLUSIONS: The micro-learning-based mHealth application for resilience training significantly reduced ICU nurses' stress and anxiety, recommending its adoption as an innovative educational method. TRIAL REGISTRATION: The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023).

Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide, 7th Edition.

This guide has been prepared by the AWHONN Task Force to revise the AWHONN Education Guide, Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide. Education guides are reviewed periodically. This guide is not intended to be exhaustive; other sources of information and guidance are available and should be consulted. This guide is intended to encourage systematic education and ongoing skill development in basic, high-risk, and critical care obstetrics during the intrapartum period, immediate postpartum period, and newborn transition. It is not designed to define standards of practice for employment, licensure, discipline, legal, or other purposes. Variations and innovations that demonstrably improve the quality of patient care are encouraged.

Nurse Upskilling During Crisis: Collaborating for Continuing Education.

BACKGROUND: As rates of coronavirus disease 2019 (COVID-19) reached pandemic levels in early 2020, the need for intensive care unit (ICU) nurses with mechanical ventilator knowledge increased. In response to the pandemic, hospital systems with limited resources reported moving ICU nurse educators to direct patient care roles and reassigning non-ICU nurses to work in the ICU. With fewer resources to educate non-ICU nurses and many newly assigned nurses reporting feeling unprepared for work in the ICU, the need for an accessible and scalable introduction to ICU nursing became clear. METHOD: Our team responded by creating a free, online, self-paced, asynchronous course introducing the ICU nursing setting. RESULTS: More than 4,000 learners worldwide have enrolled in the course, with 94% of survey respondents expecting the course to positively impact their institution. CONCLUSION: Our project shows an approach to effective collaboration among clinical partners, instructional designers, and nursing experts to address critical needs in continuing education in nursing. [J Contin Educ Nurs. 2024;55(5):257-260.].

Time Is Survival: Continuing Education on Sepsis for Neurosurgical Critical Care Nurses.

BACKGROUND: Early identification of sepsis among neurosurgical critical care patients is a significant challenge because of the many possible confounding variables that lead to altered mental status in this specific patient population. Nurses' knowledge, attitudes, confidence, and practices related to the early identification and management of sepsis are crucial to patients' survival. METHOD: This evidence-based intervention project implemented continuing education for neurosurgical critical care nurses on the early signs and symptoms of sepsis and the management of sepsis according to the Surviving Sepsis Campaign (SSC) Guidelines. RESULTS: Continuing education on sepsis increased neurosurgical critical care nurses' knowledge of the SSC 1-hour sepsis bundle, reported confidence in the management of sepsis, and likelihood of assessing for sepsis. CONCLUSION: Continuing education for neurosurgical critical care nurses on the signs and symptoms of sepsis and the SSC Guidelines is necessary and may improve patient outcomes. [J Contin Educ Nurs. 2024;55(5):224-230.].

Learning in intensive care during the COVID-19 pandemic postgraduate critical care nursing students' experiences.

Objectives: This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. Methods: An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. Results: The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor.  2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.

Just-in-Time Orientation of Non-Critical Care Nurses to the Critical Care Environment.

During the COVID-19 pandemic, non-critical care nurses assisted in the provision of care to critically ill patients. Just-in-time education was needed for these nurses to effectively assist in the care of these patients. A 12-hour educational program was offered to non-critical care nurses. During this multi-modal program, instructors delivered information to participants through unique didactic classroom learning, simulation engagement, and hands-on experience in a critical care unit. After completing this innovative program, participants demonstrated a significant improvement in knowledge, confidence, and perception of competence in caring for critically ill patients. Participants were highly satisfied with the program. Implementation of a just-in-time, multi-modal critical care nursing program is an effective method of providing non-critical care nurses with basic levels of skills, knowledge, and competency during a crisis to enable them to assist with providing care to critically ill patients. [J Contin Educ Nurs. 2022;53(10):465-472.].

Critical Care Nursing in India.

Critical care nursing and medicine have evolved significantly over the past few decades. Critical care in India began the major urban hospitals and has not yet become established in rural health care facilities. The formation of Indian critical care nursing and medical societies led to emerging regular conferences, updates, continuing nursing and medical education, workshops, and training programs for the further training of nurses and doctors. Future challenges include development of guidelines and consolidation of research activities on the outcome of patients with critical illness. This article describes the organization and practice of critical care nursing in India.

Case Management on the Front Lines of COVID-19: The Importance of the Individualized Care Plan Across Care Settings.

PURPOSE: Since the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease known as COVID-19, case management has emerged as a critical intervention in the treatment of cases, particularly for patients with severe symptoms and medical complications. In addition, case managers have been on the front lines of the response across the health care spectrum to reduce risks of contagion, including among health care workers. The purpose of this article is to discuss the case management response, highlighting the importance of individual care plans to provide access to the right care and treatment at the right time to address both the consequences of the disease and patient comorbidities. PRIMARY PRACTICE SETTINGS: The COVID-19 response spans the full continuum of health and human services, including acute care, subacute care, workers' compensation (especially catastrophic case management), home health, primary care, and community-based care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: From the earliest days of the pandemic, case managers have assumed an important role on the front lines of the medical response to COVID-19, ensuring that procedures are in place for managing a range of patients: those who were symptomatic but able to self-isolate and care for themselves at home; those who had serious symptoms and needed to be hospitalized; and those who were asymptomatic and needed to be educated about the importance of self-isolating. Across the care spectrum, individualized responses to the clinical and psychosocial needs of patients with COVID-19 in acute care, subacute care, home health, and other outpatient settings have been guided by the well-established case management process of screening, assessing, planning, implementing, following up, transitioning, and evaluating. In addition, professional case managers are guided by values such as advocacy, ensuring access to the right care and treatment at the right time; autonomy, respecting the right to self-determination; and justice, promoting fairness and equity in access to resources and treatment. The value of justice also addresses the sobering reality that people from racial and ethnic minority groups are at an increased risk of getting sick and dying from COVID-19. Going forward, case management will continue to play a major role in supporting patients with COVID-19, in both inpatient and outpatient settings, with telephonic follow-up and greater use of telehealth.

Treinamento de higiene oral em paciente crítico / Oral hygiene training course in critically ill patients

Objetivo: descrever a experiência de enfermeiros acerca de um treinamento em saúde realizado em um hospital de alta complexidade, na perspectiva da prática de higiene oral em pacientes críticos, utilizando, como ferramenta, o ciclo Plan, Do, Check, Act. Método: trata-se de estudo qualitativo, descritivo, tipo relato de experiência, cuja ação tornou possível capacitar os profissionais de Enfermagem visando à melhoria da qualidade da execução da higiene oral realizada, identificando os dificultadores da prática da higienização oral dos pacientes em ventilação mecânica. Resultados: realizou-se a capacitação dos profissionais de Enfermagem visando à melhoria da qualidade da execução da higiene oral realizada, ressaltando os aspectos inerentes à produção do conhecimento e identificando os dificultadores da prática da higienização oral dos pacientes em ventilação mecânica. Conclusão: observou-se a importância em se utilizar modernas metodologias administrativas para se alcançar novos padrões de qualidade, uma vez que, constantemente, são necessárias atualizações acerca das ações em serviços de saúde.(AU)

Objective: to describe the experience of nurses in a health training course in a high complexity hospital from the perspective of oral hygiene practice in critically ill patients by using the Plan, Do, Check, Act cycle as a tool. Method: it is a qualitative, descriptive, experience report type study, whose action made it possible to train Nursing professionals with the aim to improve the quality of oral hygiene practice performance and identify the difficulties in the practice of oral hygiene of patients under mechanical ventilation. Results: the training of Nursing professionals was carried out with a view to improving the quality of the oral hygiene performance, highlighting the aspects inherent to the production of knowledge and identifying the difficulties in the practice of oral hygiene of patients under mechanical ventilation. Conclusion: the importance of using modern administrative methodologies to achieve new quality standards was observed, since updates on health service actions are constantly needed.(AU)

Objetivo: describir la experiencia de los enfermeros sobre la formación en salud realizada en un hospital de alta complejidad, desde la perspectiva de la práctica de la higiene bucal en pacientes críticos, utilizando como herramienta el ciclo Planificar, Hacer, Controlar, Actuar. Método: se trata de un estudio cualitativo, descriptivo, tipo de relato de experiencia, cuya acción permitió formar profesionales de enfermería con el objetivo de mejorar la calidad de la higiene bucal realizada, identificando las dificultades en la práctica de la higiene bucal de los pacientes en ventilación mecánica. Resultados: se capacitó a profesionales de enfermería para mejorar la calidad de la higiene bucal realizada, enfatizando los aspectos inherentes a la producción de conocimiento e identificando las dificultades en la práctica de la higiene bucal de los pacientes en ventilación mecánica. Conclusión: se observó la importancia de utilizar metodologías administrativas modernas para lograr nuevos estándares de calidad, ya que constantemente se requieren actualizaciones sobre las acciones de los servicios de salud.(AU)

Establishment of a high-dependency unit in Malawi.

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.

Critical Care Considerations in Adult Patients With Influenza-Induced ARDS.

TOPIC: Acute respiratory distress syndrome is a complex respiratory disease that can be induced by influenza virus infection. Critical care providers are uniquely positioned to manage this pathological progression in adult patients through evidence-based practice. CLINICAL RELEVANCE: Influenza and subsequent acute respiratory distress syndrome are associated with extremely high morbidity and mortality in adult patients in the United States. Although evidence-based medical management strategies can alter the clinical trajectory of acute respiratory distress syndrome and improve outcomes, critical care providers do not always implement these measures. PURPOSE: To provide critical care providers with an overview of the pathological progression of influenza-induced acute respiratory distress syndrome and the current evidence-based strategies for management. CONTENT COVERED: This article reviews the epidemiology and pathophysiology associated with influenza-induced acute respiratory distress syndrome, the criteria for diagnosis, and the evidence-based medical management.

Ultrasound-Guided Peripheral Intravenous Catheter Insertion: The Nurse's Manual.

Peripheral intravenous catheter placement is a skill that is used daily in the hospital. However, many nurses face the challenge of cannulating increasingly complex and difficult-to-access vasculature. Although emergency department clinicians have been using ultrasound to facilitate this procedure for the last 18 years, ultrasound-guided peripheral intravenous catheter placement has not been as rapidly adopted in the critical and acute care nursing realms. Given the benefits of this procedure, including increased patient satisfaction and reduced use of central catheters, its use should be encouraged among all acute care clinicians. The aim of this article is to provide the bedside nurse with a basic understanding of the techniques involved in placing ultrasound-guided peripheral intravenous catheters in patients with difficult venous access.

Evaluation of nurses' experiences of a post education program promoting recognition and response to patient deterioration: Phase 2, clinical coach support in practice.

Front-line nurses providing around the clock care are pivotal to the identification, recognition, and response to patient deterioration. However, there is growing evidence that patient deterioration indicators are poorly managed and not escalated to rapid response teams (RRTs), contributing to adverse outcomes. Access to effective educational programs has been cited as vital in optimising nurses' recognition and response to deteriorating patients. Several studies evaluated educational programs, but have not explored nurses' experiences of engaging in patient deterioration events post attendance. Participants in a multimodal education program (DeTER) were invited to attend a series of focus groups three months post workshop as phase two of an overall study. A convenience sample of 22 acute care nurses was recruited. A qualitative descriptive design incorporating focus groups and thematic analysis was used to evaluate participants' experiences of engaging with the RRT during patient deterioration events and whether clinical coach support in practice influenced their recognition and response. Four themes were identified within the data, categorised as enhanced confidence, effective communication, supportive culture, and early response. The importance of an educational model using multimodal strategies, underpinned by coach support and guidance post workshop, was clearly demonstrated to optimise nurses' management of patient deterioration events.

Systems Thinking for Managing COVID-19 in Health Care Systems: Seven Key Messages.

This article provides the most current guidelines for nurse educators and nurses to use systems thinking to manage COVID-19 in health systems. A working definition of systems thinking is offered, with a review of basic knowledge and care in the context of the system awareness model (SAM). Seven key messages assist nurse educators and nurses in the management of COVID-19 patients culminating in leadership of complex health care systems using systems thinking. [J Contin Educ Nurs. 2020;51(9):402-411.].