Environmental sustainability in intensive care: the path forward. An ESICM Green Paper.

PURPOSE: The European Society of Intensive Care Medicine (ESICM) Green Paper aims to address the challenge of environmental sustainability in intensive care and proposes actionable strategies for integrating sustainability into intensive care unit (ICU) stakeholder actions. METHODS: The ESICM Executive Committee appointed a task force of topic experts and ESICM committee representatives to develop the ESICM Green Paper. The task force convened biweekly from January to June 2024, identifying key domains for environmental sustainability and prioritizing actions. Drafts were iteratively refined and approved by the ESICM Executive Committee. RESULTS: Climate change will impact activities in intensive care in many ways, but also the impact of ICU activities on the environment is considerable; drivers for this include extensive resource use and waste generation in ICUs from energy consumption, use of disposable items, and advanced therapies for critically ill patients. The ESICM Green Paper outlines a structured approach for ICUs to reduce their environmental impact, emphasizing energy efficiency, waste reduction, and sustainable procurement. Furthermore, it endorses the need for awareness and education among healthcare professionals, integration of sustainability into research, and sustainable policies within scientific societies. CONCLUSIONS: The ESICM Green Paper reviewed the relevance of climate change to intensive care and provided suggestions for clinical practice, research, education, and ESICM organizational domains. It underscores that reducing intensive care's ecological footprint can coexist with high-quality patient care. Promoting a resilient, responsible healthcare system is a joint responsibility of all ICU stakeholders.

A mountain of waste created daily: a thematic analysis of environmental sustainability experiences of postgraduate intensive care nursing students.

BACKGROUND: The healthcare sector has a negative ecological impact, and intensive care is one of the most resource-consuming areas. Nurses have a duty to contribute to climate change reduction, design climate-resilient healthcare systems, and support individuals and communities in adapting to the effects of the planetary health crisis. It is essential to incorporate environmental sustainability into nursing education so that nurses can advocate for conscientious and ethically sustainable healthcare that benefits both patients and the planet. This study aimed to explore postgraduate intensive care nursing student experiences of environmental sustainability in clinical practice at intensive care units. METHODS: Data were collected using a qualitative questionnaire, and the data were analysed using inductive thematic analysis. The participants were 24 registered nurses studying postgraduate, specialist intensive care nursing courses at four universities in the south and west regions of Sweden. RESULTS: The results describe critical care students' environmental sustainability experiences in one overarching theme with five subthemes. Intensive care is a challenging context in terms of sustainability, where saving lives is the number one priority. There were good and bad sustainability habits among the staff, and awareness was key to improving. Clinical supplies come in unsustainable packages, and the participants wished for better alternatives and they wanted more knowledge and education on sustainable practices. The findings also emphasized the importance of a holistic perspective throughout each patient's pathway. CONCLUSIONS: Sustainability in intensive care units is somewhat unrecognised today, although intensive care nurses want that to change. The context where saving lives is prioritized makes implementing ecologically responsible practices a challenge. However, environmental sustainability in intensive care is feasible, with education needed for nurses to take on the responsibility of making improvements. Hospital management prioritizing sustainability is also important to support clinicians in implementing sustainable practices in intensive care units.

Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study.

BACKGROUND: Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. OBJECTIVES: This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. DESIGN: A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. SETTINGS: Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). PARTICIPANTS: A convenience sample of first-year undergraduate nursing students. METHODS: The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. RESULTS: Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1-6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the 'inclusion of climate change and sustainability in the nursing curricula'. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). CONCLUSIONS: Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.

Human factors and ergonomics to improve performance in intensive care units during the COVID-19 pandemic.

The COVID-19 pandemic has tested the very elements of human factors and ergonomics (HFE) to their maximum. HFE is an established scientific discipline that studies the interrelationship between humans, equipment, and the work environment. HFE includes situation awareness, decision making, communication, team working, leadership, managing stress, and coping with fatigue, empathy, and resilience. The main objective of HF is to optimise the interaction of humans with their work environment and technical equipment in order to maximise patient safety and efficiency of care. This paper reviews the importance of HFE in helping intensivists and all the multidisciplinary ICU teams to deliver high-quality care to patients in crisis situations.

Sustainability in critical care practice: A grounded theory study.

BACKGROUND: Sustaining high-quality, critical care practice is challenging because of current limits to financial, environmental, and social resources. The National Health Service in England intends to be more sustainable, although there is minimal research into what sustainability means to people working in critical care, and a theoretical framework is lacking that explains the social processes influencing sustainability in critical care. AIMS AND OBJECTIVES: This study aimed to explain the concept of sustainability from the perspective of practitioners caring for critically ill patients. DESIGN: The qualitative research followed a Charmazian constructivist grounded theory approach, including concurrent data collection and interpretation through constant comparison analysis. METHODS: In-depth interviews were conducted online or by telephone with 11 health care professionals working in critical care in the South of England (8 nurses, 2 physiotherapists, and 1 technician). Schatzman's dimensional analysis and Straussian grounded theory techniques supplemented the data analysis. RESULTS: Sustainability was defined as maintaining financial, environmental, and social resources throughout the micro, meso, and macro systems of critical care practice. The most pertinent social process enabling sustainability of critical care was satisficing (satisfaction of achieving a goal of quality care while sufficing within the limits of available resources). Increased satisficing enabled practitioners to fulfil their sense of normative, responsible, sustainable, and flourishing practice. Satisficing was bounded by the cognitive and environmental influences on decisions and an ethical imperative to ensure resources were used wisely through stewarding. CONCLUSIONS: An explanation of the concept of sustainability and significant social processes, in relation to critical care, are presented in a theoretical framework, with implications for how financial, environmental, and social resources for critical care practice can be maintained. RELEVANCE TO CLINICAL PRACTICE: This theory offers clinicians, managers, educators, and researchers a definition of sustainability in critical care practice and provides a structured approach to addressing critical care sustainability issues.

Patient Safety: Identifying and Managing Complications of Mechanical Ventilation.

Mechanical ventilation is a fundamental aspect of critical care practice to help meet the respiratory needs of critically ill patients. Complications can occur though, as a direct result of being mechanically ventilated, or indirectly because of a secondary process. Preventing, identifying, and managing these complications significantly contribute to the role and responsibilities of critical care nurses in promoting patient safety. This article reviews common ventilator-associated events, including both infectious (eg, ventilator-associated pneumonia) and noninfectious causes (eg, acute respiratory distress syndrome, pulmonary edema, pleural effusion, and atelectasis).

Quality and safety: reflection on the implications for critical care nursing education.

BACKGROUND: Safe and high quality health care is underpinned by health care professionals possessing the knowledge, skills and professional attributes which are necessary for their specific clinical speciality and area of practice. Education is crucial as it enables clinicians to learn and put into practice their specialist knowledge, skills and attributes. These elements will be based on clinical standards, which set the agenda for quality and safety in health care. AIM: The purpose of this paper is to reflect upon how a post-registration, degree-level critical care nursing course provided by an English university facilitates nurses to deliver high quality, safe nursing care for critically ill patients and their families. METHODS: As a reflective analysis, the process of reflection will be guided and structured according to Rolfe's framework for reflective practice. The reflection is based upon the personal observations and teaching experiences of two university lecturers involved in the delivery of the critical care course. CONCLUSIONS: Critical care nursing education can incorporate informed practice, simulation and non-technical skills into post-registration critical-care nursing courses as a way of promoting high-quality, safe clinical practice in the critical care setting. This article provides examples from one course's experience with doing this and ends with specific recommendations for how critical care nursing courses can enhance further the promotion of quality and safety. RELEVANCE TO CLINICAL PRACTICE: Educators, mentors and students of post-registration critical care nursing courses are encouraged to explore the relevance of nursing education in promoting safe and high-quality clinical practice.

The objective structured clinical examination within intensive care nursing education.

BACKGROUND: The objective structured clinical examination is commonly referred to as an 'OSCE' and is a way of assessing a student's competency with clinical skills. The OSCE involves the student demonstrating a skill during a simulated clinical situation in a controlled environment instead of using real patients in the practice setting. Post-registered nursing courses are now beginning to use the OSCE as a form of summative assessment either as replacement for or in addition to skills assessed by a mentor in practice. AIM: This paper aims to reflect back on a recent experience of introducing an OSCE into a post-registered, degree level intensive care nursing programme. METHODS: The process of reflection will be used throughout the analysis following the Six Thinking Hats tool. CONCLUSIONS: Organizing and implementing an OSCE for an intensive care nursing programme required a great deal of preparation and time of the teacher but also offered various benefits and advantages compared with other forms of assessment. Disadvantages and limitations of the OSCE are also identified in this article along with recommendations and practical advice for other teachers, examiners and students participating in OSCEs.

Enjoyable learning: the role of humour, games, and fun activities in nursing and midwifery education.

Education that captures the attention of students is an essential aspect of promoting meaningful, active learning. Rather than standing at the front of a group of learners simply speaking about a topic, teachers have the opportunity of livening up their teaching with humour, games, and other fun activities. This article critically evaluates the benefits and limitations of humour within nursing education as well as the use of games and fun activities as teaching strategies. Examples of various games and interactive activities are also provided.

A critical review of auscultating bowel sounds.

Auscultation (listening for bowel sounds) is part of an abdominal physical assessment and is performed to determine whether normal bowel sounds are present. This article evaluates the technique involved in listening for bowel sounds and the significance of both normal and abnormal auscultation findings. Review of the relevant literature reveals conflicting information and a lack of available research on the topic of auscultating bowel sounds. The clinical significance of auscultation findings when there is no evidence base to support the practice of listening for bowel sounds is explored by further analysis of the literature and reflection by the author on the teaching she received and her own personal practice.

Advanced physical assessment: the role of the district nurse.

This article describes an initiative by an NHS trust to support its district nurses in developing and using physical examination skills as part of patient assessment. The article outlines the process and suggests that the initiative is important to help meet the needs of older patients with long-term conditions.

Differential diagnosis in advanced nursing practice.

Differential diagnosis has become a key element of advanced nursing roles that are incorporating history taking and physical assessment into their remit of professional responsibilities. The aim of this article is to review the relevant definitions of different types of diagnoses, to describe the process of formulating a differential diagnosis including using clinical reasoning skills, and to use a case study as an example of differential diagnosis in advanced clinical practice.

The process of conducting a physical assessment: a nursing perspective.

Physical assessment is a new responsibility for many nurses in the UK who are expanding their parameters of advanced clinical practice. A physical assessment framework can be used by both community and acute care nurses as a guide to the process of conducting a physical assessment. The framework presented here consists of the following sequence of steps: identifying the purpose of the assessment; taking a health history; choosing a comprehensive or focused approach; and examining the patient using the sequence of inspection, palpation, percussion and auscultation. The next step, interpretation of the clinical findings, which results in either the recognition of abnormality or identification of a differential diagnosis, then becomes the basis for clinical decision making. This paper describes a comprehensive, head-to-toe assessment as one example of the application of this physical assessment framework in clinical practice.