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.

A strengths-based qualitative exploration of critical care nurses' reasons for remaining in critical care.

AIMS: Globally, the nursing shortage is a growing concern. Much of the research on retention of nurses focuses on the experience of those who left positions. In this study, we set out to listen to critical care nurses (CCRNs) who have chosen to remain in their positions to understand the factors retaining them in critical care. DESIGN: This interpretive descriptive study was guided by the following research question: 'what factors influence CCRN's decision to continue to work in critical care?' METHODS: Digitally recorded interviews and a focus group were conducted between July 2022 and January 2023 using a semi-structured, strengths-based interview guide with CCRNs from three critical care units at a tertiary hospital in a city in a central Canadian province. Transcribed interviews were analysed using open, axial and selective coding and constant comparative analysis. RESULTS: Twenty-two CCRNs participated in interviews and three in a focus group. The theme of Respect, demonstrated through the interconnected concepts of Working to Full Scope, Team, Rotations and Compensation was identified. Working to Full Scope was described as providing nursing care aligned with how each nurse envisions what nursing is. Being part of a Team led by strong nurse leaders that provides opportunities and supports the sharing of their perspectives was also found. Respect was also found to be demonstrated through Rotations that recognize that work is one part of these nurses' lives. Compensation that reflects the increased education, knowledge and skills required in critical care was the final concept of Respect. CONCLUSION: Organizations should focus their efforts across the identified concepts to demonstrate Respect for CCRNs and retain them. IMPLICATIONS FOR PRACTICE: The findings of this study provide ways to support the retention of CCRNs. IMPACT: This research will have an impact on nursing leaders by providing tangible ways to retain CCRNs. REPORTING METHOD: Reporting of this work was guided by the Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Challenges experienced by cardiac intensive care nurses during first out-of-bed patient mobilization after open-heart surgery: A descriptive phenomenological qualitative study.

AIM: To investigate the potential challenges experienced by cardiac intensive care unit (ICU) nurses in the first out-of-bed patient mobilization after open-heart surgery and propose solutions. DESIGN: A qualitative study design using the descriptive phenomenological approach. METHODS: Individual face-to-face interviews were conducted via a widely used videoconferencing program between 28 July and 22 October 2022, in the tertiary cardiac ICU of a university hospital. Nurses who had at least 1 year of cardiac ICU experience and actively participating in patient care were included. The COREQ criteria and checklist were followed in this investigation and the data were analysed by using the ATLAS.ti 8.0. FINDINGS: Nurses reported that they experience challenges when mobilizing patients, such as patients' fear, reluctance or resistance; nurses having insufficient experience, strength or lack of team members. Despite these challenges, they highlighted some positive outcomes of mobilization, such as feeling happy, reinforced team communication and nurse-patient relationship. The nurses also suggested some facilitators, such as patient motivation and an explanation of the process. CONCLUSION: Nurses experience various patient-related and nurse-related challenges during the first out-of-bed mobilization of the patient after open-heart surgery. It is recommended that healthcare institutions should implement effective strategies to address the staffing shortages and to support nurse motivation to ensure adequate nursing care. IMPACT: This study provides valuable insights into the existing literature by examining the potential challenges and strategies of the first out-of-bed patient mobilization in the cardiac ICU. It shows that patient education and organizational adaptations are effective ways to overcome the challenges. It also suggests that motivating and informing patients before the mobilization can make the process easier. Moreover, it reveals that successful patient mobilization makes nurses happy, improves team communication and strengthens nurse-patient relationship. PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT: No patient or public contribution.

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.

Moral distress among critical care nurses before and during the COVID-19 pandemic: A systematic review.

Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.

The impact of preceptorship on the newly qualified nurse and preceptors working in a critical care environment: An integrative literature review.

BACKGROUND: Preceptorship has been found to be effective in supporting Newly Qualified Nurses (NQNs) during their transition into challenging environments, particularly in addressing issues related to confidence and anxiety. Effective preceptorship is an element of best practice and essential to support NQNs' transition into the critical care setting. However, the impact of preceptorship on NQNs and their preceptors in critical care units is yet to be completely understood. AIM: To review the impact of preceptorship on NQNs and preceptors working in a critical care environment. STUDY DESIGN: An integrative literature review of the literature. The review employed Whittemore and Knafl's (2005) five-stage integrative review approach. METHODS: Three databases (MEDLINE, CINAHL and PsycINFO) were searched for papers published between January 2010 and May 2022. The PRISMA framework was used to guide the search and screening. Thematic analysis was used to extract, organize and analyse the data. RESULTS: Nine studies were included in this review. Reflective thematic analysis revealed three themes, with four related subthemes. Preceptorship has an impact on the development of the NQNs and preceptors' 'nurturing' relationship. NQNs develop their knowledge, competence and confidence when experiencing supportive preceptorship. Meanwhile, preceptors experience a combination of increased workload and opportunities for learning and professional development as a result of preceptorship. CONCLUSION: There is evidence of the impact of preceptorship on learning and professional development for both NQNs and preceptors, but this is a complex phenomenon and further research is required to understand this area more fully. RELEVANCE TO CLINICAL PRACTICE: In nursing practice, it is well-established that Newly Qualified Nurses (NQNs) often face heightened levels of anxiety and a lack of confidence when embarking on their careers, particularly in the demanding and stressful environment of critical care units. This review holds particular significance in the realm of clinical practice as it delves into the pivotal role of preceptorship in nurturing the professional growth and development of NQNs within the challenging domain of critical care. Effective preceptorship, as an essential component of best practice, plays a pivotal role in aiding NQNs' transition into critical care settings.

Lived experience of critical care nurses serving in a war zone: A phenomenological study.

BACKGROUND: War has always been a part of human life, and nurses are among the first people to attend to the battlefield alongside the soldiers. Nurses' experiences of being in war zones have long been of interest to researchers. In the conflicts in Syria, Iranian nurses have played a crucial role in saving the lives of many people. AIM: This qualitative study aims to explore the lived experience of Iranian critical care nurses deployed to battlefields in Syria between 2014 and 2020. STUDY DESIGN: This qualitative study adopted a hermeneutic phenomenology approach using Van Manen's methodology. The data was obtained through semi-structured in-depth interviews with 15 nurses who experienced war zones. Purposive sampling was used and interviews with the participants were conducted at the agreed place. Interviews were recorded, wrote verbatim and analysed with MAXQDA10 software. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation. RESULTS: The four main themes that emerged include 'blossoming of talents on the battlefield', 'capable nurses at war', 'nursing jihad' and 'mental preoccupations'. These themes include 12 subthemes and 32 primary subthemes that explain the meaning of Iranian nurses being in war zones in Syria. CONCLUSIONS: Nurses in the war zones of Syria gained valuable experiences of the blossoming of talents in themselves and others. The lived experiences of the nurses revealed that working in the war zones of Syria is a concept of nurses' capabilities. They considered being in the war zones of Syria as a form of nursing jihad. In spite of the many positive aspects of their experience, the nurses expressed their mental preoccupations during their deployment. RELEVANCE TO CLINICAL PRACTICE: Nursing care in a war zone for the critically wounded is a unique experience. The experience and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders who are planning future deployments.

Oesophageal pressure monitoring in intubated patients by intensive care units' nurses: An educational study.

Trained ICU nurses may perform oesophageal pressure measurements which may help facilitate its implementation in the usual patient care to better assess lung and chest wall mechanics and easily detect patient-ventilator asynchronies. We thus conducted a prospective educational study aiming to assess the ability of ICU nurses to perform reliable oesophageal pressure measurements after a short dedicated training program. All the 11 nurses who completed the program succeeded their practical evaluation (nine (82%) at the first evaluation and two (18%) at their second attempt). These results show that this training program is feasible and that trained ICU nurses can perform accurate oesophageal pressure measurements in mechanically ventilated patients.

Nurses' experiences of caring for nursing care-dependent ICU patients: A qualitative study.

BACKGROUND: Nursing care dependency is a key, yet under-studied, nursing phenomenon. Patients in intensive care units are highly dependent on nursing care. Patients find dependency challenging, experiencing feelings of powerlessness and shame. The nurse-patient care relationship can influence patients' perception of dependency. Understanding how nurses experience their care for dependent patients is crucial, as nurses might not always grasp the impact of their actions on patients' dependency experiences. AIM: To explore and interpret ICU nurses' perceptions of patients' nursing care dependency and their experiences in caring for nursing care-dependent patients. STUDY DESIGN: A qualitative interpretative phenomenological study inspired by Merleau-Ponty's philosophical stance was conducted using focus groups with nurses who had been caring for adult patients for at least 6 months in ICUs of two hospitals. Data analysis followed Smith et al.'s guidance. Researchers immersed themselves in the transcripts, noted individual's experiences before transitioning to shared insights, coded significant phrases and generated themes and superordinate themes. RESULTS: Four focus groups were conducted with 18 nurses with widely ranging ages and work experience. Four superordinate themes emerged: 'Time and context define dependency', 'Empathetic relationships help nurses understand patients' experience of dependency', 'Trusting nurse-patient relationships change the dependency experience' and 'Nurses' skills help patients to recover independence'. CONCLUSION: This study increases critical care nurses' awareness of the overlooked phenomenon of caring for nursing care dependent patients and offers them an opportunity to reflect on their care for dependent patients and adapt it to patients' experiences. Further studies are needed with nurses and patients in different ICUs, cultures and countries, to gain a broader picture of experiences of nursing care dependency. RELEVANCE TO CLINICAL PRACTICE: ICU nurses need strong relational skills to offer high-quality care for dependent patients, facilitating meaningful nurse-patient relationships based on empathy and trust. These relationships can significantly impact the patient's experience of dependence.

Between hope and disillusionment: ECMO seen through the lens of nurses working in a neonatal and paediatric intensive care unit.

BACKGROUND: Using extracorporeal membrane oxygenation (ECMO) in paediatric and neonatal intensive care units (PICU/NICU) creates ethical challenges and carries a high risk for moral distress, burn out and team conflicts. AIM: The study aimed to gain a more comprehensive understanding of the underlying factors affecting moral distress when using ECMO for infants and children by examining the attitudes of ECMO nurses. METHODS: Four focus groups discussions were conducted with 21 critical care nurses working in a Swiss University Children's Hospital. Purposive sampling was adopted to identify research participants. The data were analysed using reflexive thematic analysis. RESULTS: Unlike "miracle machine" stories in online media reports, specialized nurses working in PICU/NICU expressed both their hopes and fears towards this technology. Their accounts also contained references to events and factors that triggered experiences of moral distress: the unspeakable nature of the death of a child or infant; the seemingly lack of honest and transparent communication with parents; the apparent loss of situational awareness among doctors; the perceived lack of recognition for the role of nurses and the variability in end-of-life decision-making; the length of time it takes doctors to take important treatment decisions; and the resource intensity of an ECMO treatment. CONCLUSION: The creation of a multidisciplinary moral community with transparent information among all involved health care professionals and the definition of clear treatment goals as well as the implementation of paediatric palliative care for all paediatric ECMO patients should become a priority if we want to alleviate situations of moral distress. RELEVANCE FOR CLINICAL PRACTICE: The creation of a multidisciplinary moral community, clear treatment goals and the implementation of palliative care for all paediatric ECMO patients are crucial to alleviate situations of moral distress for nurses, and thus to improve provider well-being and the quality of patient care in PICU/NICU.

Perceptions of nurses on the scope of culturally competent care in critical care: A qualitative study.

BACKGROUND: The cultural competence of nurses is crucial in providing nursing care for patients from different cultures. The absence of cultural competence can negatively impact the entire course of care; however, implementing cultural competence in critical care unit can be complicated. AIM: This study aimed to determine nurses' perceptions regarding cultural competence in critical care units. STUDY DESIGN: This study used a qualitative design with semi-structured interviews with nurses (n = 10) working in critical unites. Data were collected from February to June 2022 and then categorized and evaluated. Atlas.ti was used for the inductive thematic content analysis. RESULTS: Three key areas identified were as follows: (1) nurses and culturally competent care in critical care, (2) cultural challenges in practice and (3) suggestions for improving culturally competent care. The participants expressed that culturally competent care in critical care units has specific limitations because of the nature of the intensive care units (ICUs). Additional learning included opportunities to improve culturally competent care, such as raising cultural awareness, developing language skills and promoting culturally competent care. CONCLUSIONS: Providing culturally competent care in critical care units is an understudied area. Identifying barriers and cultural challenges is one strategy nurses can use to improve culturally competent ICU care. RELEVANCE TO CLINICAL PRACTICE: Creating cultural awareness by training nurses in their own culture, in cultural diversity, and in overcoming prejudices and stereotypes is an essential step towards increasing cultural competence. Understanding nurses' perceptions on this topic can provide valuable insights into the challenges and opportunities for providing culturally sensitive care in a critical care setting.

Registered nurses' knowledge and interpretation of ECG rhythms: A cross-sectional study.

BACKGROUND: Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non-invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience. AIM: The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms. STUDY DESIGN: This was a cross-sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2-year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20-item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) RESULTS: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p < .001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p = .748). Length of time as a registered nurse (r = -0.304, p = .002) and length of time in current work environment were weakly correlated (r = -0.328, p = .001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p < .001). CONCLUSION: The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology. RELEVANCE TO CLINICAL PRACTICE: Monitoring and assessing ECG morphology provide important details about cardio-electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia.

Impact of knowledge, attitudes and self-reported practices of nurses on early mobilization of mechanically ventilated patients in the ICU.

BACKGROUND: Many ICUs worldwide are striving to integrate early mobilization as part of critical care rehabilitation. However, ICU nurses, who are essential contributors to the early mobilization of critically ill patients, still lack comprehensive surveys assessing their knowledge, beliefs, and practices regarding the early mobilization of mechanically ventilated patients. AIM: To analyse the knowledge, attitudes, and practices of intensive care unit (ICU) nurses regarding the early mobilization of mechanically ventilated patients and to explore the effects of these practices. STUDY DESIGN: A multicentre cross-sectional study. ICU nurses in five tertiary hospitals in Zhejiang Province, China, were selected by convenience sampling and invited to complete an online questionnaire between 1 June 2021 and 15 June 2021. Sociodemographic data and the knowledge, attitudes, and practices of ICU nurses regarding early mobilization. RESULTS: A total of 296 valid questionnaires were collected, for a response rate of approximately 77.5%. The average scores for knowledge, attitudes, and practices of ICU nurses regarding the early mobilization of mechanically ventilated patients were 42.7 ± 7.4, 34.3 ± 6.5, and 47.1 ± 6.5, respectively, which were good scores. Quantile regressions showed that at the 25% and 50% quartiles, increases in knowledge and attitude scores resulted in increases in practice scores (p < .001); however, at the 75% quartile, increases in knowledge scores did not result in practice score increases (t = 0.000, p = .999); moreover, there was still a 0.5-point increase in practice scores per 1-point increase in attitude scores (t = 0.500, p < .001). CONCLUSIONS: The knowledge, attitudes, and self-reported practices of ICU nurses were good, although there is room for improvement. Considering that the influence of attitudes on practice improvement is more important than knowledge, ICU managers should promote knowledge transformation, strengthen attitudes, and adopt comprehensive measures to promote the early mobilization of mechanically ventilated patients in the ICU. RELEVANCE TO CLINICAL PRACTICE: To optimize the early mobilization of mechanically ventilated patients in the ICU, introducing multipronged support strategies based on the knowledge and attitudes of ICU nurses is recommended to promote the implementation of such practices.

Nurses' attitudes towards factors determining the safety of patients treated in intensive care units: A cross-sectional study.

BACKGROUND: The goal of health care systems is to ensure high quality of medical services provided, including patient safety. The intensive care unit (ICU) is an environment conducive to the occurrence of adverse events and medical errors because of the complexity of the care provided, the severity of the conditions of patients treated in these units and work often performed under stressful conditions. AIM: Assessment of attitudes of nurses working in ICUs towards patient safety. STUDY DESIGN: A cross-sectional, descriptive study was conducted in a group of 214 nurses employed in ICUs in hospitals located in the southern part of Poland. The study used the Polish version of the Attitudes towards safety: (SAQ-SF PL) questionnaire and an original questionnaire consisting of questions on socio-demographic and professional data. RESULTS: The overall SAQ score for the whole group was 61.89, 57.29 for adult ICU nurses and 68.20 for children's ICU. The surveyed nurses in general obtained the highest average results in terms of teamwork climate (TC)-66.92, while the lowest scores were given to the management-hospital management (PM)-45.08 and working conditions (WC)-57.56. job satisfaction (JS) positively correlated with the assessment of the TC, the assessment of the safety climate (SC), the assessment of the management staff (Head of Department) (PM), the assessment of the management staff (hospital management) (PM) and the assessment of work conditions (WC). A statistically significant, negative correlation was found between the assessment of JS and the assessment of stress recognition (SR) (r = -.20; p < .01). CONCLUSIONS: In the surveyed ICU branches, there is a low SC, and it is related, among others, to the perception of WC and the role of the management staff. The level of JS among nursing staff mainly depends on the SC, the TC, WC and the support of the management staff. RELEVANCE TO CLINICAL PRACTICE: The results of the research presented here provide valuable assistance in identifying areas related to patient safety in ICUs. Managers' awareness of the importance of coping with occupational stress, WC or effective teamwork can help to improve staff attitudes and attitudes towards patient safety. When shaping a safe culture in a health care organization, it is important to remember that ensuring safe patient care is not only about programmes, standards or procedures, but safety is primarily about human resources-the staff involved in the treatment process-doctors, nurses, paramedics and physiotherapists. High awareness of safety at work, cooperation in an interdisciplinary team, assessment of safety culture at work and analysis and drawing conclusions may result in a real increase in quality and safety, and the patient will feel safer in 'XX' hospitals.

Nurses' decision-making around gastric residual volume measurement in UK adult intensive care: A four-centre survey.

BACKGROUND: Despite increasing evidence of the potential inaccuracy and unwarranted practice of regular GRV measurement in critically in adults, this practice persists within the United Kingdom. AIM: To explore adult intensive care nurses' decision-making around the practice of GRV measurement to guide enteral feeding. STUDY DESIGN: A cross-sectional 16 item electronic survey in four adult intensive care units (ICUs) in England and Wales. RESULTS: Two hundred and seventy-three responses were obtained across four ICUs with acceptable response rates for most [Unit 1 74 /127 = 58.2%; Unit 2 87/129 = 67.4%; Unit 3 77/120 = 64.1%; Unit 4 35/168 = 20.8%]. Most (243/273 (89%) reported measuring GRV 4-6 hourly, with most (223/273 82%) reporting that the main reason was to assess feed tolerance or intolerance and 37/273 (13.5%) saying their unit protocol required it. In terms of factors affecting decision-making, volume obtained was the most important factor, followed by the condition of the patient, with aspirate colour and appearance less important. When asked how they would feel about not measuring GRV routinely, the majority (78.2%) of nurses felt worried (140/273 = 51.2%) or very worried (74/273 = 27%). CONCLUSIONS: Factors affecting the nurses' decision-making around GRV were based largely on fear of risk (around vomiting and pulmonary aspiration) and compliance with unit protocols. RELEVANCE TO CLINICAL PRACTICE: Despite increasing evidence suggesting it is unnecessary, nurses' beliefs around the value of this practice persist and it continues to be embedded into unit protocols around feeding.

Intrahospital transport of critically ill patients: Nurse anaesthetists' and specialist ICU nurses' experiences.

BACKGROUND: Intrahospital transport (IHT) is often performed by nurse anaesthetists and specialist intensive care nurses. Studies have shown that IHT increases the risk of mortality and morbidity, with up to 71% negative incidents. Using checklists when preparing for an IHT is important. Several international guidelines exist to ensure IHT safety and reduce the risk of complications. However, existing guidelines are often problematic in clinical practice. AIM: This study aimed to describe the experiences of nurse anaesthetists and specialized intensive care nurses during the IHT of adult patients with critical illnesses. STUDY DESIGN: This study adopted a mixed-methods approach. METHODS: Data were collected through a questionnaire completed by 66 nurses with specialist education in anaesthesia or intensive care. The data were analysed with qualitative content analysis, and the quantitative data were analysed with descriptive statistics. RESULTS: Two categories with two subcategories each emerged from the analysis of the responses of nurse anaesthetists and specialist intensive care nurses regarding their IHT experiences: creating good circumstances (subcategories: being risk-conscious and the importance of meticulous preparations) and the importance of routines and education (subcategories: following guidelines and having adequate training). CONCLUSION: IHT was described as a high risk for patient safety and complications. Routines with good compliance and education can positively impact patient safety during IHT. Checklists and scenario training can better prepare nurse anaesthetists and specialist intensive care nurses to manage complications that may arise during IHT, resulting in safer patient care. RELEVANCE FOR CLINICAL PRACTICE: The findings underscore the importance of written guidelines for IHT, emphasizing awareness and adherence by the entire team. Careful pre-IHT preparations, coupled with an understanding of potential risks, are vital for ensuring patient safety. Clinical training and discussions following incidents during IHT play a crucial role in raising the collective awareness of patient safety within the entire team. Written guidelines about IHT are of utmost importance, and everyone in the team should be aware of and follow the guidelines. It is important to make careful preparations before IHT and to be aware of the possible risks to patient safety. Clinical training and discussions about IHT where patient safety has been impaired are important to increase the whole team's awareness of patient safety during IHT.

Occupational fatigue, compassion competence and caring behaviours of intensive care nurses: A structural equation modelling approach.

BACKGROUND: No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses. AIM: We studied the direct effect of participating nurses' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables. STUDY DESIGN: This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model. RESULTS: Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, ß = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, ß = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, ß = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R2 = 0.350). CONCLUSIONS: This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care.

Exploring the barriers and facilitators of palliative care in the adult intensive care unit from nurses' perspectives in China: A qualitative study.

BACKGROUND: Intensive care units (ICUs) in China primarily focus on active rescue efforts, and it is not common to provide palliative care services within the ICU. As nurses play a primary role as caregivers for end-of-life patients in the ICU, it is necessary to explore the factors that impede or facilitate palliative care from their perspective. AIM: To explore the barriers and facilitators associated with implementing palliative care in Chinese adult ICUs from nurses' perspectives. STUDY DESIGN: This study utilized a descriptive phenomenological research approach and purposive sampling to conduct face-to-face semi-structured interviews with nurses working in adult ICUs from three comprehensive hospitals in China during the period between February and May 2023. A total of 17 nurses were interviewed, and the collected data were transcribed, coded, and synthesized thematically. RESULTS: Two themes of barriers and facilitators of palliative care in the Chinese adult ICU were extracted. The three sub-themes of hindering factors are as follows: (1) The influence of Chinese traditional culture. (2) The specificity of the ICU context. (3) Lacking sufficient attention in the ICU. The three sub-themes of the promoting factors are as follows: (1) Government and society value palliative care. (2) Patients and their families have palliative care needs. (3) Nurses view palliative care positively. CONCLUSION: Currently, integrating palliative care into the ICU may face challenges such as cultural factors, the specificity of the ICU context, and insufficient attention. However, it is worth noting that as the government and society place more emphasis on palliative care, more and more people are gradually paying attention to the palliative care needs of critically ill patients and their families. RELEVANCE TO CLINICAL PRACTICE: This study serves as a reference for exploring an ICU palliative care service model that is suitable for China's national conditions, such as education and training, resource allocation, service processes, and the palliative care environment, among others.

Critical care nurse leaders addressing moral distress: A qualitative study.

BACKGROUND: Moral distress (MD) occurs when clinicians are constrained from taking what they believe to be ethically appropriate actions. When unattended, MD may result in moral injury and/or suffering. Literature surrounding how unit-based critical care nurse leaders address MD in practice is limited. AIM: The aim of this study was to explore how ICU nurse leaders recognize and address MD among their staff. STUDY DESIGN: Qualitative descriptive with inductive thematic analysis. RESULTS: Five ICU nurse leaders participated in a one-time individual interview. Interview results suggest that (1) ICU nurse leaders can recognize and address MD among their staff and (2) nurse leaders experience MD themselves, which may be exacerbated by their leadership role and responsibilities. CONCLUSIONS: Further research is needed to develop interventions aimed at addressing MD among nurse leaders and equipping nurse leaders with the skills to identify and address MD within their staff and themselves. RELEVANCE TO CLINICAL PRACTICE: MD is an unavoidable phenomenon ICU nurse leaders are challenged with addressing in their day-to-day practice. As leaders, recognizing and addressing MD is a necessary task relating to mitigating burnout and turnover and addressing well-being among staff within the ICU.

Proactive debriefing to promote wellbeing in intensive care nurses: A protocol.

BACKGROUND: The dynamic, rewarding, yet challenging environment of the intensive care unit is experienced in extremes by intensive care nurses. To ensure intensive care nurses can continue to fulfil their professional roles and responsibilities, careful consideration and promotion of collective and individual wellbeing is required. Regular proactive debriefing provides an opportunity to commune, connect, and reflect on the challenging nature of clinical work and is a potential intervention to aid in the promotion of wellbeing. AIM/OBJECTIVE: This study aims to collaboratively develop, implement, and evaluate a proactive debriefing intervention, which will target the promotion of nurses' wellbeing. STUDY PLAN: This hybrid effectiveness-implementation study will use a pretest/post-test design to test a codesigned proactive debriefing intervention on the wellbeing of nurses working in a large quaternary intensive care unit. This research will be conducted in two phases. Phase one will consist of focus groups and a codesign workshop. Phase two surrounds the implementation and analysis of the codesigned intervention.