Nursing Interventions in Neurocritical Care.

Highly educated and skilled nursing care is critical to improving patient outcomes in general and in specialties like neurocritical care. Nursing interventions reflect nursing knowledge, critical thinking, and decision-making and is generally rooted in the nursing process. Nursing interventions are also a key focus of research to better understand how nursing care influences patient outcomes. This review describes the literature regarding nursing interventions in key neurocritical diagnoses and contextualizes it within the broader discussion about the nursing process and nursing interventions research. Publications about nursing interventions in neurocritical care emphasize key themes, including managing neurophysiologic parameters, providing psychosocial support, managing the environmental milieu, and interventions to prevent complications. Further study of how to best support nurses in collecting and interpreting data to form nursing interventions is needed, as is understanding the benefits and limitations of the nursing process in low- and middle-income countries.

Triggers of intensive care patients with palliative care needs from nurses' perspective: a mixed methods study.

PURPOSE: Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses. METHODS: For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the "content-structuring content analysis" according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey. RESULTS: In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%. CONCLUSION: Intensive care nurses see various triggers, with interprofessional collaboration and the patient's prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

Determination of Pain-Related Knowledge and Behaviors of Adult Intensive Care Nurses.

AIM: To determine the knowledge and attitudes of adult intensive care nurses regarding pain. METHOD: This descriptive and cross-sectional study was conducted with 196 nurses working in the intensive care units of a tertiary university hospital between June 2022 and September 2022. Data were collected by face-to-face interview method, and the "Personal Information Form" and "Nurses' Knowledge and Attitude Scale Regarding Pain" were used as data collection tools. RESULTS: About 71.8% of the nurses were between the ages of 18 and 30, 58.5% were women, 54.9% had a bachelor's degree, and 55.1% had been working in intensive care for 0-5 years. The nurses' total knowledge and attitude score levels were 11.8% inadequate, 64.1% moderate, and 24.1% good. A statistically significant relationship was found between age, gender, receiving training on pain in the institution, satisfaction level with the unit in which one works, frequency of pain assessment and indicators taken into consideration when evaluating pain severity, and the total scale score average (p < 0.05). CONCLUSIONS: The average pain knowledge and attitude scores of intensive care nurses are at a good level. Results can be further improved with planned training on pain.

Design and content validation of a checklist about infection-prevention performance of intensive care nurses in simulation-based scenarios.

OBJECTIVE: To design, develop and validate a new tool, called NEUMOBACT, to evaluate critical care nurses' knowledge and skills in ventilator-associated pneumonia (VAP) and catheter-related bacteraemia (CRB) prevention through simulation scenarios involving central venous catheter (CVC), endotracheal suctioning (ETS) and mechanically ventilated patient care (PC) stations. BACKGROUND: Simulation-based training is an excellent way for nurses to learn prevention measures in VAP and CRB. DESIGN: Descriptive metric study to develop NEUMOBACT and analyse its content and face validity that followed the COSMIN Study Design checklist for patient-reported outcome measurement instruments. METHODS: The first version was developed with the content of training modules in use at the time (NEUMOBACT-1). Delphi rounds were used to assess item relevance with experts in VAP and CRB prevention measures, resulting in NEUMOBACT-2. Experts in simulation methods then assessed feasibility, resulting in NEUMOBACT-3. Finally, a pilot test was conducted among 30 intensive care unit (ICU) nurses to assess the applicability of the evaluation tool in clinical practice. RESULTS: Seven national experts in VAP and CRB prevention and seven national simulation experts participated in the analysis to assess the relevance and feasibility of each item, respectively. After two Delphi rounds with infection experts, four Delphi rounds with simulation experts, and pilot testing with 30 ICU nurses, the NEUMOBACT-FINAL tool consisted of 17, 26 and 21 items, respectively, for CVC, ETS and PC. CONCLUSION: NEUMOBACT-FINAL is useful and valid for assessing ICU nurses' knowledge and skills in VAP and CRB prevention, acquired through simulation. RELEVANCE FOR CLINICAL PRACTICE: Our validated and clinically tested tool could facilitate the transfer of ICU nurses' knowledge and skills learning in VAP and CRB prevention to critically ill patients, decreasing infection rates and, therefore, improving patient safety. PATIENT OR PUBLIC CONTRIBUTION: Experts participated in the Delphi rounds and nurses in the pilot test.

Critical Care Nursing: A Key Constraint to COVID-19 Response and Healthcare Now and in the Future.

This article discusses the crucial role and dearth of critical care nurses in the United States highlighted during the COVID-19 pandemic. This challenge of sufficient critical care nursing resources existed before the pandemic, but now concern is heightened by the need for such crucial healthcare providers now and in the future. We present strategies to address the gap, as well as challenges inherent in the suggested approaches. The discussion is relevant as nurse leaders adapt to COVID-19 and other novel challenges in the future.

Acute Care Reimagined: Home Hospital Care Can Support the Triple Aim and Reduce Health Disparities.

EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.

Bowen Family Systems Theory: Mapping a framework to support critical care nurses' well-being and care quality.

Intensive care nursing is prone to episodic anxiety linked to patients' immediate needs for treatment. Balancing biomedical interventions with compassionate patient-centred nursing can be particularly anxiety provoking. These patterns of anxiety may impact compassion and patient-centred nursing. The aim of this paper is to discuss the application of Bowen Family Systems Theory to intensive care nursing, mapping a framework to support critical care nurses' well-being and, consequently, the quality of care they provide. This article is founded on research, theoretical papers and texts focused on Bowen Family Systems Theory (BFST), and findings from a constructivist study on patient-centred nursing and compassion in the intensive care unit. The goal of Bowen Family Systems Theory is to empower individuals, decreasing blame and reactivity. Bowen Family Systems Theory can be applied to the sometimes intimate relationships that develop in this environment, aiding understanding of nurses' experience of compassion satisfaction and fatigue. Where organizational factors and management styles fall short in supporting critical care nurses to meet expectations, BFST can offer a perspective on the processes that occur within the intensive care unit, impacting nurse well-being and quality of care. This paper makes plain the importance of understanding the anxiety that occurs within the intensive care unit as a system, so that individuals, such as critical care nurses, can be supported appropriately to ensure nurse well-being and quality care.

Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X-ray Confirmation.

BACKGROUND: Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. AIMS: To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. METHODS: The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). RESULTS: Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. LINKING ACTION TO EVIDENCE: Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.

Understanding patients' experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary.

AIMS AND OBJECTIVES: To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). BACKGROUND: Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. DESIGN: A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. METHODS: Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. RESULTS: A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. CONCLUSION: Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. RELEVANCE TO CLINICAL PRACTICE: Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.

Newly graduated nurses' clinical competencies and need for further training in acute care hospitals.

AIM: To assess self-reported clinical competence and the need for further training among newly graduated registered nurses (NGRNs) working in Swedish acute care hospital settings. BACKGROUND: NGRNs are expected to take full responsibility for patients' nursing care in an increasingly complex clinical context, and professional nurses' clinical competence is critical in providing high-quality and safe nursing care. DESIGN: A cross-sectional design. METHODS: Data were collected using the 50-item ProffNurse SAS II. A total of 85 NGRNs who had recently commenced working with direct patient care at three hospitals in central Sweden participated in the study. The response rate was 69%. The STROBE cross-sectional reporting guidelines were used. RESULTS: The NGRNs assessed their clinical competence as being highest in areas relating to team collaboration and ethics and lowest in areas relating to professional development and direct clinical practice. The need for further training was greatest in areas such as direct clinical practice and patient safety and lowest in areas such as team collaborating and ethics. CONCLUSION: The use of instruments to identify NGRNs' self-assessed clinical competence is of value when designing and evaluating introductory programmes for NGRNs taking on positions in acute care hospital settings. The availability of experienced nurses from whom NGRNs can gain clinical competence and learn from is of importance, both from the perspective of the NGRNs themselves and patient safety. RELEVANCE TO CLINICAL PRACTICE: An understanding of NGRNs' clinical competence and their need for further training may assist in both planning and organising nursing programmes and in making clinical policy decisions when designing introduction programmes in acute care settings.

Methods used to examine technology in relation to the quality of nursing work in acute care: A systematic integrative review.

AIMS AND OBJECTIVES: To systematically locate, assess and synthesise research to describe methods used to examine technology in relation to the quality of nursing work in acute care. Specific objectives were to (a) describe the types of nursing work examined; (b) describe methods used to examine technology in nursing work; (c) identify outcomes used to evaluate technology in relation to the quality of nursing work; and (d) make recommendations for future research. BACKGROUND: New technologies can offer numerous benefits to nurses; however, it is challenging to evaluate health information technologies in relation to the quality of nurses' complex day-to-day work. DESIGN: A systematic integrative review using a five-step process. METHODS: Five databases were searched using search terms "nurs*," "workload," "task," "time." Data screening, extraction and interpretation were conducted independently by at least two authors and agreement verified by discussion. Data extraction followed PRISMA guidelines. RESULTS: Of the 41 studies included, most (87.8%, n = 36) examined physical dimensions of nursing work; 31.7% (n = 13) organisational dimensions; 17.1% (n = 8) cognitive dimensions; and only 12.2% (n = 5) emotional dimensions. More than half (58.5%, n = 24) examined only one dimension; one captured all four dimensions. Most frequently examined technologies were electronic medical/health records (36.5%) and electronic medication management (19.5%). Direct observation (58.8%, n = 28) and multiple methods (19.5%, n = 8) were the most common methods; nurse tasks, frequency, duration and time distribution were variables most often measured. CONCLUSIONS: Examinations of technology in nursing work often failed to capture the multiple dimensions of this work nor did they recognise the complexity of day-to-day nursing work in acute care. There is a paucity of literature to inform how and what technology should be measured in relation to the quality of nursing care. RELEVANCE TO CLINICAL PRACTICE: The outcomes inform useful research methods to comprehensively examine technology to enhance the quality of complex nursing work.

"Please mind the gap": A secondary analysis of discomfort and comfort in intensive care.

AIMS AND OBJECTIVES: To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. BACKGROUND: Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. DESIGN: Secondary qualitative analysis of data from two previous exploratory studies. METHODS: Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. RESULTS: Three themes, "Being deprived of a functioning body", "Being deprived of a functioning mind" and "Being deprived of integrity" characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients' needs and the nurses' achievements in fulfilling these needs. CONCLUSIONS: A gap exists between ICU patients' comfort needs and nurses' achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. RELEVANCE FOR CLINICAL PRACTICE: An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.

Practice priorities for acute care nursing: A Delphi study.

AIMS AND OBJECTIVES: To describe the risk and frequency of challenges in acute care nursing, and the practice priorities in Australian hospital wards based upon expert consensus. BACKGROUND: Health care is facing increasing demands that are negatively impacting upon the safety and quality of nursing care. DESIGN: Delphi Method. METHOD: A three-round electronic Delphi method was used to collect and synthesise expert consensus opinion of 30 participants in Rounds One and Two of the survey, and 12 participants in Round Three. The study was carried out from July to December 2016. This study complied with the STROBE checklist. RESULTS: High patient acuity or complexity, as well as inadequate bed space on wards, are "very high" risks that occur "often" and "very often," respectively. The pressure to admit patients, delayed medical review and patient boarding are all "high" risks that occur "often." Though only occurring "sometimes," inadequate numbers and skill mix of staff, suboptimal communication and early or inappropriate discharge all pose a "very high" risk to patient care. CONCLUSION: The key practice priorities for nurse managers should include the design, implementation and evaluation of sustainable system-wide frameworks, processes and models of care that address patient boarding, communication and discharge processes, job satisfaction, staffing numbers and expertise. RELEVANCE TO CLINICAL PRACTICE: This study provides a description of the challenges that face acute care nursing in the provision of safe and high-quality care.

Nurse management of vasoactive medications in intensive care: A systematic review.

AIM AND OBJECTIVE: To investigate how intensive care nurses prepare, initiate, administer, titrate, and wean vasoactive medications. BACKGROUND: The management of vasoactive medications is core business for intensive care nurses, but little is known on how nurses manage these ubiquitous and potentially harmful medications. DESIGN: A systematic review of the literature with narrative synthesis of data. METHODS: The databases CINAHL Complete, Medline Complete and EMBASE were searched from 1965 to January 2019 with keywords under five concept headings and in a variety of configurations. This systematic review was conducted according to the PRISMA guidelines. Studies were assessed for quality and bias, and a modified narrative synthesis was used to analyse data, investigate findings and explore relationships within and between studies. RESULTS: The review identified 13 studies: two observational studies, two pre and post intervention studies, four survey studies, two quasi-experimental studies, one longitudinal time series, one prospective controlled trial, and one interview incorporating content analysis. Four studies on preparing and initiating vasoactive medications described a lack of standardisation in infusion preparation and inconsistencies in dosing units and patient weights. Five of six studies on vasoactive medication administration examined nurses' use of syringe changeovers to reduce patient haemodynamic compromise and there were three studies on titration and weaning. CONCLUSION: Further research on nurse management of vasoactive medications is needed to develop an evidence base for specialist education and standardised practices aimed at reducing risk for patient harm. RELEVANCE TO CLINICAL PRACTICE: Nurses working in intensive care units in many parts of the world are responsible for the management of vasoactive medications. There is great variation in practices that include preparation, initiation, administration, titration and weaning of vasoactive medications, which increases the risk for medication errors and adverse events in a vulnerable population of critically ill patients.

Fifteen-minute consultation: Assessing the child with a Blalock-Taussig shunt who is unwell in a district general hospital.

Univentricular heart disease accounts for ~1.25% of all congenital heart disease. Such cases remain among the most challenging to manage, typically requiring a three-staged palliation. The first stage involves placement of a systemic to pulmonary shunt. While a variety of shunt types, including ductal stenting, can be used to manage univentricular conditions, the archetype remains the Blalock-Taussig (BT) shunt. While waiting future palliative intervention at home, intercurrent illness may necessitate presentation to a district general hospital where subspecialist advice and assessment is remote. This review aims to present the general paediatrician with a straightforward BT shunt physiology overview highlighting unique complications which may complicate intercurrent illness.

Exploring the meaning of critical incident stress experienced by intensive care unit nurses.

The complexity of registered nurses' work in the intensive care unit places them at risk of experiencing critical incident stress. Gadamer's philosophical hermeneutics (1960/2013) was used to expand the meanings of work-related critical incident stress for registered nurses working with adults in the intensive care unit. Nine intensive care unit registered nurses participated in unstructured interviews. The interpretations emphasized that morally distressing experiences may lead to critical incident stress. Critical incident stress was influenced by the perception of judgment from co-workers and the organizational culture. Nurses in this study attempted to cope with critical incident stress by functioning in 'autopilot', temporarily altering their ability to critically think and to conceal emotions. Participants emphasized the importance of timely crisis interventions tailored to support their needs. This study highlighted that critical incident stress was transformative in how intensive care unit nurses practiced, potentially altering their professional self-identity. Work-related critical incident stress has implications for nurses, the discipline, and the health care system.

Quality improvement at an acute medical unit in an Asian Academic Center: A mixed methods study of nursing work dynamics.

BACKGROUND: The acute medical unit (AMU) provides early specialist care to emergency department patients before inpatient admission. The workflows and skills for successful AMU nursing comprise a hybrid of internal and emergency medicine. PURPOSE: To understand nursing work dynamics in the AMU. METHODS: AMU at a 1,250-bed tertiary academic center in Singapore with 14,000 ED presentations monthly. Retrospective mixed methods study using focus group discussions and surveys. Fifteen nurses across three focus group discussions. Thirty-two physicians and 54 nurses responded to a validated questionnaire. FINDINGS: Focus group discussions transcripts content analyzed by two researchers. Survey items factor analyzed and attitudinal differences between AMU physicians and nurses, and among nurses compared using Student's t- and one-way ANOVA tests. DISCUSSION: AMU nursing staff faced obstacles of inadequate patient information, emergency department onboarding, unbalanced workload, and coworker conflicts, which led to them to develop processes and checklists to manage patient information, patient expectations, and teamwork. CONCLUSION: AMU nursing requires a combination of specialist internal medicine and emergency medicine skills. Training should familiarize nurse workforce with managing patient expectations and multidisciplinary teamwork.

Factors behind ethical dilemmas regarding physical restraint for critical care nurses.

BACKGROUND: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. AIM: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. DESIGN: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze the data. METHODS: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. ETHICAL CONSIDERATION: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. RESULTS: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses' negative feelings about restraint use and uncertainty over the decision on physical restraint use. CONCLUSION: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use.

A Theoretical Lens Through Which to View the Facilitators and Disruptors of Nurse-Promoted Engagement With Families in the ICU.

The theory of nurse-promoted engagement with families in the intensive care unit (ICU) was developed to describe the dynamic and complex interplay between factors that support or impair nurses' efforts to promote family engagement. Theory construction involved theory derivation and theory synthesis. Concepts and relationships from ecological theory, the Resiliency Model of Family Stress, Adjustment and Adaptation, moral distress theory, and the healthy work environment framework informed the initial formation of the emerging theory. The synthesis of findings from the literature further expanded the scope of the relationships and propositions proposed in the theory. This middle-range theory can set direction for theory-informed focused nursing research that can advance the science of family nursing and guide ICU clinicians in overcoming challenges in family nursing practice. Recommendations are provided for applying this new theoretical lens to guide family nursing curriculum development, practice improvements, and policy changes to support nurses in promoting family engagement.

An Educational Intervention Incorporating Digital Storytelling to Implement Family Nursing Practice in Acute Care Settings.

This project describes implementation of an educational intervention designed to initiate practice changes that support families and nurses during acute illness. An academic-practice partnership and digital storytelling methodology provided a foundation. A quasi-experimental research design included quantitative and qualitative measurement before and after the educational intervention. Themes identified in digital stories of nurse experiences caring for families provided direction for the educational intervention including the digital stories, empirical evidence, and proposed changes in nursing practice focused on families. Nurse participants (n = 160) in the educational intervention reported positive responses on a qualitative questionnaire. Comparing pretest and posttest results of the Family Nurse Practice Scale reflected positive, though not significant change. Family members (n = 49) reported significantly improved perceptions of support on 7 of the 14 items on the Iceland Perceived Family Support Questionnaire. This project highlighted digital storytelling's power to promote family interventions and move family nursing knowledge into practice.