Factors contributing to health care worker turnover in intensive care units during the COVID-19 pandemic in Alberta, Canada: a qualitative descriptive interview study.

PURPOSE: The COVID-19 pandemic has resulted in increased job vacancies in Canadian intensive care units (ICUs). We aimed to identify, explore, and describe factors contributing to the decisions of health care workers to leave, or strongly consider leaving their ICU positions during the peri-COVID-19 pandemic era. METHODS: We undertook a qualitative descriptive study between June and August 2022. We conducted semistructured interviews with 19 registered nurses and one respiratory therapist from a single ICU in Alberta, Canada who had left, or had strongly considered leaving their ICU position since the beginning of the pandemic. We used Braun and Clarke's thematic analysis to generate themes from these interviews. RESULTS: We identified five themes to describe the factors that contributed to participants' decisions to leave, or strongly consider leaving, their ICU positions. These were: 1) toxic workplace, 2) inadequate staffing, 3) distress from providing nonbeneficial care, 4) caring for patients with COVID-19 and their families, and 5) paradoxical responses to COVID-19 outside of the ICU. Some of these factors existed before the pandemic and were exacerbated by it, while others were novel to COVID-19. CONCLUSIONS: Participants described as key factors in their decision or desire to leave their ICU positions the impacts of the COVID-19 pandemic on workplace culture, staffing, and patient interactions, as well as the discourse surrounding COVID-19 outside of work. Strategies that target workplace culture and ensure adequate staffing should be prioritized to promote staff retention following the pandemic.

RéSUMé: OBJECTIF: La pandémie de COVID-19 a entraîné une augmentation du nombre de postes vacants dans les unités de soins intensifs (USI) canadiennes. Notre objectif était d'identifier, d'explorer et de décrire les facteurs qui ont contribué à la décision des travailleuses et travailleurs de la santé de quitter ou d'envisager fortement de quitter leur poste aux soins intensifs pendant la période péri-pandémie de COVID-19. MéTHODE: Nous avons réalisé une étude descriptive qualitative entre juin et août 2022. Nous avons mené des entrevues semi-structurées auprès de 19 membres du personnel infirmier autorisé et d'un·e inhalothérapeute d'une seule unité de soins intensifs en Alberta, au Canada, qui avaient quitté ou fortement envisagé de quitter leur poste aux soins intensifs depuis le début de la pandémie. Nous avons utilisé l'analyse thématique de Braun et Clarke pour générer des thèmes à partir de ces entretiens. RéSULTATS: Nous avons cerné cinq thèmes pour décrire les facteurs qui ont contribué à la décision des participant·es de quitter ou d'envisager fortement de quitter leur poste aux soins intensifs : 1) un lieu de travail toxique, 2) un personnel inadéquat, 3) la détresse liée à la fourniture de soins non bénéfiques, 4) la prise en charge des personnes atteintes de COVID-19 et de leurs familles, et 5) les réponses paradoxales à la COVID-19 en dehors de l'unité de soins intensifs. Certains de ces facteurs existaient avant la pandémie et ont été exacerbés par celle-ci, tandis que d'autres étaient nouveaux et liés à la COVID-19. CONCLUSION: Les participant·es ont décrit comme des facteurs clés dans leur décision ou leur désir de quitter leur poste aux soins intensifs les répercussions de la pandémie de COVID-19 sur la culture du lieu de travail, la dotation et les interactions avec la patientèle, ainsi que le discours entourant la COVID-19 en dehors du travail. Les stratégies qui ciblent la culture du milieu de travail et assurent une dotation adéquate devraient être priorisées afin de favoriser le maintien en poste du personnel après la pandémie.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.

What Are the Care Needs of Families Experiencing Sudden Cardiac Arrest? A Survivor- and Family-Performed Systematic Review, Qualitative Meta-Synthesis, and Clinical Practice Recommendations.

INTRODUCTION: Cardiac arrest care systems are being designed and implemented to address patients', family members', and survivors' care needs. We conducted a systematic review and a meta-synthesis to understand family experiences and care needs during cardiac arrest care to create treatment recommendations. METHODS: We searched eight electronic databases to identify articles. Study findings were extracted, coded and synthesized. Confidence in the quality, coherence, relevance, and adequacy of data underpinning the resulting findings was assessed using GRADE-CERQual methods. RESULTS: In total 4181 studies were screened, and 39 met our inclusion criteria; these studies enrolled 215 survivors and 418 family participants-which includes both co-survivors and bereaved family members. From these studies findings and participant data we identified 5 major analytical themes: (1) When the crisis begins we must respond; (2) Anguish from uncertainty, we need to understand; (3) Partnering in care, we have much to offer; (4) The crisis surrounding the victim, ignore us, the family, no longer; (5) Our family's emergency is not over, now is when we need help the most. Confidence in the evidence statements are provided along with our review findings. DISCUSSION: The family experience of cardiac arrest care is often chaotic, distressing, complex and the aftereffects are long-lasting. Patient and family experiences could be improved for many people. High certainty family care needs identified in this review include rapid recognition and response, improved information sharing, more effective communication, supported presence and participation, or supported absence, and psychological aftercare.

The experience of online cardiac arrest video use for education and research: A qualitative interview study completed in partnership with survivors and co-survivors.

Background: Swift recognition of cardiac arrest is required for survival, however failure to recognize (and delayed response) is common. Studying online cardiac arrest videos may aid recognition, however the ethical implications of this are unknown. We examined their use from the perspective of persons with lived experience of cardiac arrest, seeking to understand the experience of having one's cardiac arrest recorded and available online. Methods: We gathered qualitative data using focused interviews of persons affected by cardiac arrest. Inductive thematic analysis was performed, as well as a deductive ethical analysis. Co-researcher survivors and co-survivors were involved in all stages of this project. Findings: We identified themes of 'shock, hurt and helplessness' and 'surreality and reality' to describe the experience of having one's (or a family member's) cardiac arrest captured and distributed online. Participants provided guidance on the use of online videos for education and research, emphasising beneficence, autonomy, non-maleficence, and justice. Conclusions: Finding one's own, or a family member's cardiac arrest video online is shocking and potentially harmful for families. If ethical principles are followed however, there may be acceptable procedures for the use of online videos of cardiac arrest for education or research purposes. The careful use of online videos of cardiac arrest for education and research may help improve recognition and response, though additional research is required to confirm or refute this claim.

Caring for the invisible and forgotten: a qualitative document analysis and experience-based co-design project to improve the care of families experiencing out-of-hospital cardiac arrest.

OBJECTIVES: The objectives of this project were to collect and analyze clinical governance documents related to family-centred care and cardiac arrest care in Canadian EMS organizations; and to improve the family-centredness of out-of-hospital cardiac arrest care through experience-based co-design. METHODS: We conducted qualitative document analysis of Canadian EMS clinical governance documents related to family-centred and cardiac arrest care, combining elements of content and thematic analysis methods. We then used experience-based co-design to develop a family-centred out-of-hospital cardiac arrest care policy and procedure template. RESULTS: Thirty-five Canadian EMS organizations responded to our requests, representing service area coverage for 80% of the Canadian population. Twenty documents were obtained for review and six overarching themes were identified: addressing family in event of in-home death, importance of family, family member escort, provider discretion and family presence discouraged. Informed by our qualitative analysis we then co-designed a policy and procedure template was created that prioritizes patient care while promotes family-centredness. CONCLUSIONS: There were few directives to support family-centred care by Canadian EMS organizations. A family-centred out-of-hospital cardiac arrest care policy and procedure template was developed using experience-based co-design to assist EMS organizations improve the family-centredness of out-of-hospital cardiac arrest care.

RéSUMé: OBJECTIFS: Les objectifs de ce projet étaient de recueillir et d'analyser des documents de gouvernance clinique liés aux soins centrés sur la famille et aux soins de l'arrêt cardiaque dans les organisations canadiennes de SMU; et d'améliorer le caractère centré sur la famille des soins en cas d'arrêt cardiaque à l'extérieur de l'hôpital grâce à une co-conception fondée sur l'expérience. MéTHODES: Nous avons effectué une analyse qualitative des documents de gouvernance clinique des SMU canadiens liés aux soins axés sur la famille et aux arrêts cardiaques, en combinant des éléments de contenu et des méthodes d'analyse thématique. Nous avons ensuite utilisé la co-conception fondée sur l'expérience pour élaborer un modèle de politique et de procédure de soins en cas d'arrêt cardiaque centrés sur la famille en dehors de l'hôpital. RéSULTATS: Trente-cinq organisations Canadiennes de SMU ont répondu à nos demandes, ce qui représente une couverture de zone de service pour 80 % de la population canadienne. Vingt documents ont été obtenus aux fins d'examen et six thèmes principaux ont été cernés: s'adresser à la famille en cas de décès à domicile, l'importance de la famille, accompagnement d'un membre de la famille, la discrétion du fournisseur et la présence de la famille découragée. Éclairés par notre analyse qualitative, nous avons ensuite co-conçu un modèle de politique et de procédure qui priorise les soins aux patients tout en favorisant l'orientation familial. CONCLUSIONS: Il y avait peu de directives pour soutenir les soins axés sur la famille par les organisations canadiennes de SMU. Un modèle de politique de soins d'arrêt cardiaque centré sur la famille a été élaboré à l'aide d'une co-conception basée sur l'expérience pour aider les organisations de SMU à améliorer l'orientation familiale des soins en cas d'arrêt cardiaque hors hôpital.