Parent Perceptions of Transitioning From a 6-Bed Pod to a Single Family Room in a Mixed-Room Design NICU.

BACKGROUND: As some neonatal intensive care units (NICUs) shift toward mixed-room designs, with different room types available throughout family's stays, there is a need to better understand parent perceptions of this transition. METHODS: This study used a qualitative descriptive design to describe parent perceptions of transitioning from a 6-bed pod to a single family room in a mixed-room design NICU. Purposive sampling was used to recruit 10 mothers and 7 fathers who were regularly present on the unit before and after the transition. Semistructured telephone interviews were conducted a minimum of 2 days after the transition occurred. Interviews were transcribed and then analyzed using reflexive thematic analysis. FINDINGS: Four themes were identified: going into the unknown; approaching the finish line; becoming comfortable in the new reality and seeing the benefits; and gaining autonomy and confidence in parenting. CONCLUSION: These results further our understanding of the transition process from a 6-bed pod to a single-family room for parents in the NICU. Staff should be sensitized to this experience to provide tailored information and support for parents throughout the transition.

Factors Influencing Parents' Perception of Their Infants' Transition From a 6-Bed Pod to Single Family Room in a Mixed-Room Neonatal Intensive Care Unit.

BACKGROUND: While hospitalized in the neonatal intensive care unit (NICU), infants and their families undergo multiple transitions, and these have been found to be a source of stress for families. Although mixed-room NICU designs allow for infants to benefit from different room types as their needs evolve during their stay, these can necessitate a transfer from one room type to another, which represents a transition for families. As some NICUs change to mixed-room designs, there is a need to better understand the factors impacting these particular transitions from the perception of parents. PURPOSE: Examine parent perceptions of factors affecting the transition from a 6-bed pod to single family room in a mixed-room design NICU. METHODS: Using a qualitative descriptive design, semistructured interviews were conducted with 17 parents whose infant had transitioned from a 6-bed pod to single family room. Interviews were transcribed verbatim and then analyzed using content analysis. RESULTS: Four categories of factors were identified: (1) framing, timing, and comprehensiveness of information provided by staff regarding the transition; (2) parents' perception of advantages and disadvantages of the new space; (3) parent's own well-being and quality of support from staff; and (4) parent's previous NICU and parenting experience. IMPLICATIONS FOR PRACTICE: Staff should frame the information they provide about this transition in a positive way to help parents adjust. A family-centered approach should also be used to provide tailored information and support to individual families. IMPLICATIONS FOR RESEARCH: Future studies are needed into intraunit transfers including sources of support for parents, as well as staff perceptions of these transitions.

Factors influencing the implementation of a ventilation weaning protocol in an adult intensive care unit: a qualitative multidisciplinary evaluation.

PURPOSE: Development of protocolized care in the intensive care unit (ICU) improves patient outcomes, but presents multiple challenges. A mechanical ventilation weaning protocol (WP) was adopted in our institution but was underused. This study aimed to determine the factors that influenced the implementation of this protocol locally. METHODS: We performed a qualitative descriptive study using semidirected interviews in small profession-specific focus groups. The interviews were based on a standardized guide covering the major domains found in the Consolidated Framework for Implementation Research. A total of 32 participants across four key professions were recruited. The interviews were transcribed and codified sequentially, followed by categorization and analysis. RESULTS: Three broad factors emerged that negatively impacted the implementation of the WP. First, the goals of the WP differed between professional groups. This difference led to significant frustration and breaches in collaboration. Second, there was a lack of a continuous quality improvement process. Third, the WP was incompatible with the routine and procedures already in place at the time of implementation. Time-of-day of WP application and patient safety concerns were specifically identified issues. CONCLUSIONS: Implementation of a continuous improvement process with regular and specific follow-up may help identify potential challenges and thus help ensure a more consistent use of the WP.

RéSUMé: OBJECTIF : La mise au point de soins protocolisés à l'unité de soins intensifs (USI) améliore les issues pour les patients, mais présente de nombreux défis. Un protocole de sevrage de la ventilation mécanique a été adopté dans notre établissement mais a été sous-utilisé. Cette étude visait à déterminer les facteurs qui ont influencé la mise en œuvre de ce protocole au niveau local. MéTHODE: Nous avons réalisé une étude descriptive qualitative en nous fondant sur des entrevues semi-dirigées dans de petits groupes de discussion alloués par profession. Les entrevues étaient fondées sur un guide normalisé couvrant les principaux domaines du cadre CFIR (Consolidated Framework for Implementation Research). Au total, 32 participants de quatre professions clés ont été recrutés. Les entrevues ont été transcrites et codifiées séquentiellement, suivies d'une catégorisation et d'une analyse. RéSULTATS: Trois grands facteurs ayant un impact négatif sur la mise en œuvre du protocole de sevrage sont apparus. Premièrement, les objectifs du protocole de sevrage différaient d'un groupe professionnel à l'autre. Cette différence a entraîné une frustration importante et des bris de collaboration. Deuxièmement, il n'y avait pas de processus d'amélioration continue de la qualité. Troisièmement, le protocole de sevrage était incompatible avec la routine et les procédures déjà en place au moment de sa mise en œuvre. Le moment de la journée de l'application du protocole de sevrage et les préoccupations en matière de sécurité des patients ont été spécifiquement identifiés. CONCLUSION: La mise en œuvre d'un processus d'amélioration continue avec un suivi régulier et spécifique pourrait aider à identifier les défis potentiels, et ainsi assurer une utilisation plus cohérente du protocole de sevrage de la ventilation mécanique.

Handling missing data through prevention strategies in self-administered questionnaires: a discussion paper.

BACKGROUND: Self-administered questionnaires are efficient and low-cost ways of collecting data with wide cohorts. Nonetheless, their use in studies can result in a high occurrence of missing data, which can affect the statistical power, representativeness and generalisability of the findings. Imputation methods have been considered efficient statistical techniques for managing missing data. However, they have also been associated with limits, such as the risk of under-estimation of the effect, lower statistical power and decrease of correlation among variables. Recent studies have highlighted the importance of using prevention strategies to avoid missing data before the data are analysed. AIM: To identify strategies for preventing the occurrence of missing data and to discuss their effects, as well as their methodological and statistical considerations. DISCUSSION: The article discusses prevention strategies related to the administration format and follow-up and reminders. Strategies such as the use of electronic tablets, email and telephone reminders are associated with lower rates of missing data in self-administered questionnaires. However, methodological and statistical limits, including the absence of a comparison group and statistical validation of the reported results, limits the capacity to establish robust consensus. CONCLUSION: Prevention strategies represent relevant and feasible avenues for handling missing data in a wide range of clinical, nursing and epidemiological research. More projects based on robust design are needed to ensure accurate and reliable data are collected from patients, families, communities and clinicians. IMPLICATIONS FOR PRACTICE: It is important for clinicians and nurses to understand the phenomenon of missing data and the strategies available to prevent missing data, to collect data representing the patients' and families' perspectives and experiences.

Exploration of the occupational and personal dimensions impacted by the COVID-19 pandemic for nurses: A qualitative analysis of survey responses.

AIM: To explore the occupational and personal life dimensions that have been impacted by the COVID-19 pandemic for registered nurses (RN) and licensed practical nurses (LPN). DESIGN: Qualitative interpretive description approach. METHODS: Between July and September 2020, a web-based cross-sectional study was conducted among RNs and LPNs in Quebec, Canada. Included in this survey was an open-ended question allowing nurses to describe the occupational and personal life dimensions that were impacted by the COVID-19 pandemic. Thematic analysis was used to interpret the qualitative data from this open-ended question. Reporting followed the Standards For Reporting Qualitative Research (SRQR). RESULTS: Of the 1860 survey respondents, 774 RNs and 43 LPNs responded to the open-ended question (total n = 819). For the occupational dimension, six themes were identified: impacts of infection control on work, change in daily work tasks, offloading and reorganization of care, deterioration of working conditions, increased stress at work and issues related to the profession. For the personal dimension, four themes were found: impacts on the family, dealing with changes about leisure and personal life, impacts on physical and psychological health. CONCLUSION: Knowing the dimensions affected by the COVID-19 pandemic could help to identifying appropriate interventions to support RNs and LPNs. IMPACT: The COVID-19 pandemic has significantly impacted the occupational and personal lives RNs and LPNs working in the Quebec healthcare system. More specifically, Quebec's nurses experienced a major reorganization of care generated by important government decisions. Knowing how the pandemic affected different life dimensions will help in the development of support adapted to nurses' realities. Even in a pandemic context, improvements in the work environment or appropriate support could lead to an improved psychological health for nurses.

Emotional Closeness Among NICU Fathers: A Qualitative Descriptive Study.

BACKGROUND: The unique perspective of fathers with an infant in the neonatal unit on the development of emotional closeness toward their infant is not well understood. The purpose of this study is to explore experiences and instances of emotional closeness from the perspective of fathers as well as factors influencing emotional closeness during an infant's hospitalization in the neonatal unit. METHODS: This qualitative descriptive study employed one-on-one interviews with fathers recruited in a level 3 neonatal unit. The interview data were analyzed with thematic analysis, and emerging themes and subthemes were organized according to dimensional analysis. RESULTS: Eight fathers agreed to take part in this study. According to the participants, emotional closeness was a complex process composed of multiple dimensions. More specifically, emotional closeness was a difficult-to-describe, mixed, and growing feeling influenced by multiple factors such as the environment, co-parenting, and the father-infant relationship. It occurred in the contexts of presence and separation in the neonatal unit and was part of the development of the father-infant relationship. IMPLICATIONS FOR PRACTICE: The results presented in this article are important for neonatal intensive care unit nurses who support fathers in the development of their fathering role. By knowing more about the process and dimensions of emotional closeness, nurses can direct their interventions with fathers to enhance emotional closeness and better understand their experience. IMPLICATIONS FOR RESEARCH: No previous study has addressed emotional closeness as a complex process with multiple components like the current study. These findings contribute to our understanding of the process of emotional closeness for fathers.

Parents living with a child afflicted by a life-limiting medical condition: Typology of their narrative identity.

Parents of children suffering from a life-limiting medical condition struggle with difficult existential questions. Our objective was to understand why those parents' interactions with the medical world were so different, ranging from hostile to collaborative, with the themes of identity, spirituality and serenity. A grounded theory design based on the narrative identity framework was used to interview sixteen parents. Three categories emerged: i) Parents in the Almighty category delegate all their power to God or medicine and are the most suffering parents as they do not author their life; ii) Parents in the Me category make every decision on their own causing much anxiety, and they become rebarbative to the medical world; iii) Parents in the Guide category take advice from others, while remaining the authors of their stories and are the most serene parents. Understanding and recognizing these categories can have a major impact on communication with those families.

The Effect of Music on Pain in the Adult Intensive Care Unit: A Systematic Review of Randomized Controlled Trials.

CONTEXT: Multimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU. OBJECTIVES: Determine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction. METHODS: This review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms ["music*" and ("critical care" or "intensive care")]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random-effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I2 > 50% and explored via subgroup analyses and meta-regression. RESULTS: Eighteen randomized controlled trials with a total of 1173 participants (60% males; mean age 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n = 706). Music was efficacious in reducing pain (SMD -0.63 [95% CI -1.02, -0.24; n = 10]; I2 = 87%). Music interventions of 20-30 minutes were associated with a larger decrease in pain scores (SMD -0.66 [95% CI -0.94, -0.37; n = 5]; I2 = 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI -0.10, 0.29; n = 4]; I2 = 0%). On a 0-10 scale, 20-30 minutes of music resulted in an average decrease in pain scores of 1.06 points (95% CI -1.56, -0.56). CONCLUSION: Music interventions of 20-30 minutes are efficacious to reduce pain in adult ICU patients able to self-report.

Factors influencing oral care in intubated intensive care patients.

BACKGROUND: The practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator-associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption. AIMS AND OBJECTIVES: To study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs. DESIGN: A cross-sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada. METHODS: A questionnaire was completed by 375 nurses working in intensive care units (ICUs). RESULTS: Perceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors. CONCLUSIONS: This study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care. RELEVANCE TO CLINICAL PRACTICE: The results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.

Role of Family Members in Pain Management in Adult Critical Care.

This review describes family member involvement in intensive care unit pain assessment and management and generates implications for clinical practice, education, and future research. A literature review was performed in MEDLINE, PubMed, EMBASE, Cochrane, and CINAHL databases from their inception until April 30, 2019. Only 11 studies addressing the topic were identified, and the current quality of evidence is low. Family members can be involved in pain assessment by describing patients' pain behaviors and in pain management by selecting and delivering nonpharmacological interventions tailored to patients' needs, if the family members feel comfortable with this role. More-rigorous research is required to describe the role of family members in patients' pain assessment and management. Advancing knowledge in this field could improve patients' and family members' experiences with pain assessment and management in the intensive care unit.

The Impact of Pain Invisibility on Patient-Centered Care and Empathetic Attitude in Chronic Pain Management.

Objectives: The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context. Methods: A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer's assessment using a video of real patients with chronic pain. Results: The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler-Danlos syndrome and fibromyalgia) (p < 0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience. Discussion: The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.

Predictable prosthesis length on a high-resolution CT scan before a stapedotomy.

OBJECTIVE: (1) To assess the correlation between preoperative high-resolution CT (HRCT) imaging measurement from the long process of the incus to the footplate and the length of intraoperative selected prosthesis. (2) To determine if HRCT has a predictive value of prolapsed facial nerve during stapedotomy. MATERIALS AND METHODS: We evaluated in our tertiary care center, in a retrospective case series, 94 patients undergoing primary stapedotomy. Preoperative temporal bone HRCT scans were reformatted in the plane of the stapes to measure on the same section the distance between the long process of the incus and the footplate. Measurement was performed by otolaryngology resident and neurotologist. We analyze the interobserver correlation and the mean length measured on the HRCT to the selected prosthesis size intraoperatively. RESULTS: Mean HRCT measurement of the incus long process/footplate distance assessed by the otolaryngology resident and neurotologist was 4.34 and 4.38 mm, respectively. Interobserver correlation was statistically significant [intraclass correlation coefficient (ICC) of 0.679 (p < 0.001)]. Mean selected prosthesis length intraoperatively was 4.36 mm. Correlation between the mean selected length prosthesis and the mean HRCT measurement was also statistically significant [ICC of 0.791 (p < 0.001)]. Postoperatively, a statistical improvement was shown in air conduction (p < 0.001), bone conduction (p < 0.001) and air-bone gap reduction (p < 0.001). 2 cases of facial nerve covering one-half of the oval window were identified by HRCT and confirmed intraoperatively. CONCLUSION: HRCT is a valuable tool to predict preoperatively the length of the stapedotomy prosthesis. Moreover, it might be helpful to identify a potential prolapsed facial nerve, to confirm the diagnosis of otosclerosis and to rule out other abnormalities. Ultimately, it may optimize the stapedotomy procedure planning.

Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review.

AIM: To identify the theories used to explain learning in simulation and to examine how these theories guided the assessment of learning outcomes related to core competencies in undergraduate nursing students. BACKGROUND: Nurse educators face the challenge of making explicit the outcomes of competency-based education, especially when competencies are conceptualized as holistic and context dependent. DESIGN: Theoretical review. DATA SOURCES: Research papers (N = 182) published between 1999-2015 describing simulation in nursing education. REVIEW METHODS: Two members of the research team extracted data from the papers, including theories used to explain how simulation could engender learning and tools used to assess simulation outcomes. Contingency tables were created to examine the associations between theories, outcomes and tools. RESULTS: Some papers (N = 79) did not provide an explicit theory. The 103 remaining papers identified one or more learning or teaching theories; the most frequent were the National League for Nursing/Jeffries Simulation Framework, Kolb's theory of experiential learning and Bandura's social cognitive theory and concept of self-efficacy. Students' perceptions of simulation, knowledge and self-confidence were the most frequently assessed, mainly via scales designed for the study where they were used. Core competencies were mostly assessed with an observational approach. CONCLUSION: This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

Evaluation of Nurse Empathy Perceived by the Standardized Patient in Simulation: A French Validation of the Jefferson Scale of Patient Perceptions of Physician Empathy.

PURPOSE: The aim is to validate a French version of the Jefferson Scale of Patient Perceptions of Physician Empathy (F-JSPPPE). METHODS: Twenty-six intensive care nurses took part in a standardized clinical simulation (SCS). For each nurse, a standardized simulated patient completed the F-JSPPPE and three observers filled the French version of the Reynolds Empathy Scale (F-RES). RESULTS: The expert committee concluded that the F-JSPPPE has a good content validity. The internal consistency was good. A positive correlation was observed between the F-JSPPPE and the F-RES, suggesting good convergent validity. CONCLUSIONS: The F-JSPPPE validated with a standardized patient in SCS is the first reliable and valid instrument available in French to measure patient's perception of intensive care unit (ICU) nurse's empathy. Future study is needed to evaluate test-retest reliability.

Cost-effectiveness of introducing a nursing-based programme of ultrasound-guided peripheral venous access in a regional teaching hospital.

AIM: To analyse the cost-effectiveness of care provided to patients in need of peripheral venous access by comparing the traditional approach with a nurse-based ultrasound-guided programme. BACKGROUND: Letting nurses insert ultrasound-guided catheters is a promising cost-saving approach, but there are few data available to document the efficiency of this type of programme. METHOD: A cost-efficiency evaluative research design was used. Data were collected over a 6-year timeframe, before and after the implementation of the nurse-based programme. RESULTS: Results show that the evaluation conducted by nurses ensures the right choice of catheter for each patient based on the patient's needs, which decreases costs. The programme also shortens the waiting period between consultation and insertion of the catheter, which reduces costs related to prolonged hospitalisation. CONCLUSION: The nurse-based programme puts nurses' skills to good use as part of a new practice and helps enhance the efficiency of care and services provided to patients. IMPLICATIONS FOR NURSING MANAGEMENT: In addition to the significant cost savings this programme offers, the evaluation leads to an effective use of resources while ensuring optimal care.

Association between job strain, mental health and empathy among intensive care nurses.

BACKGROUND: Nursing shortage is a worldwide issue. It could influence factors such as job strain, nurses' mental health and nurse empathy towards patients. AIM: The aim of the study is to explore the associations between job strain, psychological distress, psychological well-being and empathy in intensive care units (ICUs). DESIGN: A cross-sectional descriptive correlational design. METHODS: Data were collected using questionnaires and an observation tool completed by three observers during a standardized clinical simulation (SCS). A total of 26 nurses practicing in three ICUs participated in the study, which took place over 3 days in December 2011. RESULTS: One dimension of job strain, psychological demand, was associated with two subscales of mental health (psychological distress positively and psychological well-being negatively). Positive correlations were demonstrated between psychological distress and nurse empathy as perceived by both the observers and the actor who played the role of patient. CONCLUSION: Some associations have been confirmed between job strain, psychological distress, psychological well-being and empathy in the ICU while others needs further investigation. RELEVANCE TO CLINICAL PRACTICE: It is important to reduce psychological demand among intensive care nurses in order to prevent psychological distress. The exploration of the connection between empathy and psychological distress should be advanced. This study suggests that SCSs provide an innovative approach that is useful for research.

Meta-analysis on the clinical outcomes in patients with intralabyrinthine schwannomas: conservative management vs. microsurgery.

The objective of this review is to compare the symptomatological evolution following conservative management (CM) or microsurgery (MS) in patients with intralabyrinthine schwannomas (ILS). A thorough systematic review of the English and French literature from 1948 to February 2014 was performed using Ovid Medline. An ancestor search was also completed. The major inclusion criterion consisted of a diagnosis of ILS with magnetic resonance imaging. Patients with a classic vestibular schwannoma, cases of incidentaloma during surgery or an autopsy were the main exclusion criteria. Thirty-one studies met our selective criteria. Descriptive data were collected from the articles. Clinical outcomes regarding the hearing loss, tinnitus, vertigo, dizziness and aural fullness were stated as improved, unchanged or worse at the last follow-up. All data were then separated into two different groups according to the management option: CM and MS. The data were analyzed using a Pearson χ (2) test and Fisher's exact test. This meta-analysis suggests that MS has a statistically significant favorable outcome regarding symptom relief compared to CM in patients with ILS suffering from tinnitus, vertigo and dizziness. Hearing level was not compared between treatment groups, as MS leads to anacusis. An indicative bias was the main limitation of this study, as patients suffering from intractable vertigo with moderate-to-severe hearing loss were referred to MS. Therefore, in the presence of a serviceable hearing, we suggest that CM should be the treatment of choice.

Validity of the French Version of the Reynolds Empathy Scale Among Intensive Care Nurses.

BACKGROUND AND PURPOSE: Empathy is an important part of the nurse-patient relationship. The aim was to validate the French version of the Reynolds Empathy Scale (F-RES) for assessing empathy in nurses during standardized clinical simulations (SCS). METHODS: A series of steps recommended for the translation and validation of an instrument was carried out. Then the F-RES was used to assess empathy during SCS sessions with 26 nurses. RESULTS: The results showed good internal consistency and inter-rater reliability of the F-RES. The expert panel was satisfied with the content and face validity of the instrument. Convergent validity was confirmed using the French version of the Jefferson Scale of Patient Perceptions of Physician Empathy. CONCLUSIONS: The F-RES has good psychometric qualities and potential for future research in French populations.

Assessing patient-centred care for chronic pain: Validation of a new research paradigm.

BACKGROUND: Chronic pain is a complex phenomenon resulting from biological, psychological and social factors, and the use of patient-centred care (PCC) appears to be a promising avenue for its treatment. Various methods have been used for measuring PCC in nurses and physicians (caregivers); however, methodological problems have been raised following the observation of real clinical encounters or standardized patient simulations. The development of new strategies is required. OBJECTIVE: To develop and validate an observation scale for the assessment of PCC in caregivers, using standardized videos of real patients with chronic pain. METHODS: An expert panel developed five videos and the Sherbrooke Observation Scale of Patient-Centered Care (SOS-PCC), which were tested in a sample of 21 nurses and 21 physicians working with chronic pain patients. The content validity, internal consistency and inter-rater reliability of the SOS-PCC were assessed. RESULTS: The expert panel was satisfied with the content validity of the SOS-PCC. Results revealed good internal consistency (Cronbach's alpha = 0.88) and inter-rater reliability (intraclass coefficient = 0.93) for this scale. CONCLUSIONS: To the authors' knowledge, the SOS-PCC is the first instrument available in French to assess PCC behaviour of caregivers using videos of real patients with chronic pain. The psychometric qualities of these instruments are good. Future studies will need to assess this instrument with other populations of caregivers.

Relationship Between Empathy and Well-Being Among Emergency Nurses.

INTRODUCTION: A large number of patients who are in pain upon arriving at the emergency department are still in pain when they are discharged. It is suggested that nurses' personal traits and their level of empathy can explain in part this issue in pain management. The purpose of this study was to better understand the shortfalls in pain management provided by emergency nurses by considering nurses' characteristics. METHODS: A cross-sectional descriptive correlational design was used for this pilot study. French validated self-administrated questionnaires (sociodemographic characteristics, empathy, psychological distress, and well-being) were presented to 40 emergency nurses. Thirty emergency nurses completed all questionnaires during work hours. Descriptive statistics, group comparisons, and correlation analyses were used for the data analysis. RESULTS: Emergency nurses appear to have low levels of empathy. High levels of psychological distress and low levels of well-being were also observed in our sample. Among these variables, only empathy and well-being appear to be related, because we found higher empathy scores in nurses with higher well-being. DISCUSSION: The poor mental health we found among emergency nurses is alarming. A clear need exists for supportive interventions for nurses. Finally, well-being was the only variable related to empathy. To our knowledge, this is the first study to report this relationship in nurses.