The Implementation of a Modified Fluid Assessment Tool to Improve the Clinical Assessment, Detection, and Management of Blood Pressure Control and Fluid Alterations Among Hemodialysis Patients.

Background: Fluid overload is a common complication of the care of End-stage Renal Disease patients that may lead to prolonged hospitalization and mortality. This warrants an effective and systemic approach to early recognition and management to improve patient outcomes. Aim: This study aims to evaluate the effect of a modified fluid assessment tool to improve accurate clinical assessments, detection, and management of blood pressure control and fluid alteration among hemodialysis patients. Methods: In this retrospective study, data were collected from forty-three dialysis patients who were seen and followed up from a dialysis unit of an acute care hospital during 8 weeks of standard care. A modified assessment tool was used to systematically highlight the appropriateness of the patient set dry weight using intradialytic weight gain (IWDG) and patient blood pressure. Paired sample t-test and repeated measure ANOVA within-group analysis were applied to compare the mean difference score for IDWG and the mean arterial pressure within the study group, respectively. Result: A total of 43 patients were enrolled (mean age, 59.07) (ranges 27-88 years) (SD - 14.30); 51.16% female; 79% Emirati Nationals, with Chronic Kidney Disease. A repeated measure ANOVA analysis showed a significant difference in the mean arterial pressure within the study group based on time, over six measurements (p = 0.001). However, the difference between the pre- and post-intra-dialytic weight gain mean scores yields insignificant results (p = 0.346). Conclusion: The implementation of a modified assessment tool improved blood pressure control, increased staff and physician involvement in assessing patient dry weight facilitated through fluid status evaluation, methodical assessment of dry weight, and precise fluid removal calculation, enhancing overall blood pressure and fluid management in HD patients.

The effect of multicomponent approach in enhancing the level of confidence with evidence-based practice activities and promoting evidence-based practice culture among nurses in a clinical setting in the United Arab Emirates.

AIM: The aim of this work is to examine the effect of multicomponent interventions on enhancing the level of confidence of staff nurses with evidence-based practice in an acute care hospital in the United Arab Emirates. BACKGROUND: Evidence-based practice is one of the strategic pillars of nursing practice and a key to organizational success. To effectively implement and sustain evidence-based practice programmes in clinical sites, well-designed implementations can promote staff attitude, knowledge, skills, and confidence in translating research evidence into optimal patient care. METHODS: Experienced and bachelor prepared nurse managers in collaboration with the clinical resource nurse undertook condensed staff training and interventions for the evidence-based practice programme, where 70 registered nurses participated. The intervention was conducted over a period of time extending from December 2019 until December 2020. The study design is quasi-experimental using the pre- and post-Self Efficacy Assessment tool to gauge the nurses' confidence in evidence-based practice. Also, SPSS software was used to explore the effect of the programme. RESULTS: Higher significant score on the evidence-based nursing practice self-efficacy scale postprogramme was noted (t = -7.667 and p value <.001). CONCLUSION: Participating in a well-structured evidence-based practice programme would positively enhance the nurse's confidence in the programme implementation and promote an evidence-based practice culture in clinical settings. IMPLICATIONS FOR NURSING MANAGERS: Nurse managers must recognize their critical role in promoting evidence-based practice among nurses. A focused and well-designed intervention may assist in establishing a culture of evidence-based practice to ensure the best patient outcome.

Investigation of the Experience of Immigrant Nurses in a Diverse Cultural Setting.

BACKGROUND: Work-related stress (WRS) is one of the most common stressors in healthcare workplace settings. PURPOSE: This research study was designed to examine and discuss perceived WRS, job performance, social support, and the desire of immigrant nurses to work in a multicultural workplace. METHODS: A case research mixed-methodology approach, a quantitative survey, and semistructured qualitative interviews were used in this research study. Three hundred twenty-one respondents were invited, of which 246 (76.6%) returned valid questionnaires. A purposeful sampling technique was used in the qualitative portion of the study. A semistructured interviewing system was used on 20 nurses. RESULTS: "Workload" was the most common traumatic occurrence, whereas "treatment" and "death and dying" were the least common traumatic occurrences. Similarly, the mean of the social support scale, as defined using the McCain and Marklin Social Integration Scale, was moderate to high, suggesting that most of the participants received strong social support from their colleagues. The qualitative research found that the participants faced high pressures related to work and have struggled to acquire cultural skills, while having difficulties meeting their patients' cultural and spiritual needs and sustaining high-quality nursing care. CONCLUSIONS: The findings of this study support that immigrant nurses working in the Kingdom of Saudi Arabia are stressed. A significant difference between the qualitative and quantitative results was found. The findings further contribute to our understanding of WRS, social support, job performance, and intention to stay among immigrant nurses in the Kingdom of Saudi Arabia.

Posttraumatic stress disorders and influencing factors during the COVID-19 pandemic: A cross-sectional study of frontline nurses.

AIMS: To assess the extent of posttraumatic stress disorder (PTSD) symptoms and severity, factors motivating work continuation, and factors influencing PTSD development among frontline nurses caring for patients with COVID-19. BACKGROUND: The COVID-19 pandemic has an emotional toll on nurses. Exposure to traumatic events associated with the pandemic places frontline nurses at risk for developing PTSD. DESIGN: Cross-sectional study. METHODS: Frontline nurses (n = 370) who cared for COVID-19 patients in three governmental hospitals in the United Arab Emirates were recruited from November 2020 to January 2021. The self-reported Posttraumatic Diagnostic Scale (PDS) was used to assess PTSD. The motivational factors for work continuation explored were: work-related factors (e.g., availability of personal protective equipment and management recognition), family support, and obligation to care. We used correlation and multiple regression analyses to investigate factors that influenced PDS score, including sociodemographic characteristics (e.g., gender, age, exercising status, and general health status), work factors (e.g., hospital type [COVID vs non-COVID], prior work experience, and encountering deaths), and factors motivating work continuation. The reporting of this study was consistent with STROBE guidelines. RESULTS: In total, 36.2% participants had a probable PTSD diagnosis (PDS score ≥28) with most reporting unwanted memories. Family support (95.9%) and management recognition (90.8%) were the most frequently reported motivating factors. Factors significantly associated with higher PDS score were smoking, lack of management recognition, not exercising, and encountering COVID-19 deaths; the correlation and regression coefficients (b) were significant (p < 0.05). CONCLUSIONS AND IMPLICATIONS FOR NURSING/HEALTH POLICY: Policy makers must expand healthcare policies to address frontline nurses' mental health as a priority during the pandemic. Nurse leaders must be involved in health policy development to protect nurses in anticipation of and during global health emergencies.

Self-Report Assessment of Nurses' Risk for Infection After Exposure to Patients With Coronavirus Disease (COVID-19) in the United Arab Emirates.

PURPOSE: Nurses have an increased risk for acquiring COVID-19 infection. This study assessed levels of risk for exposure to COVID-19 among nurses, and determined those at the greatest risk. DESIGN: A cross-sectional design was used to assess risk for exposure to COVID-19 in nurses from five randomly selected governmental hospitals in the United Arab Emirates. Participants completed an online survey (including the World Health Organization survey) to assess their risk for exposure to COVID-19. Descriptive statistics were used to describe classes of risk for exposure, and logistic regression was used to identify factors associated with greater risk. FINDINGS: Of the 552 participants, 284 nurses (51.4%) were classified at high risk for COVID-19 exposure as they did not report adherence to infection control and prevention (ICP) guidelines at all times during healthcare interactions and when performing aerosol procedures, or had accidental exposure to biological fluid and respiratory secretions. Compared with adherence to wearing medical masks, gloves, and hand hygiene practices, adherence to wearing face shields or goggles and disposable gowns and decontaminating high-touch surfaces was less frequent. Shifting to work in critical care units, not having adequate critical care experience, and reporting a need for training in ICP practices were factors that contributed to high-risk exposure (p values for Ex (Bs) = 2.60, 2.16, 1.75, ≤ 0.05, consecutively). CONCLUSIONS: A considerable number of nurses were classified at high risk for COVID-19 exposure. Critical care work experience and adequate evidence-based training in ICP practices related to COVID-19 must be considered to mitigate the risk for exposure to COVID-19 in nurses. CLINICAL RELEVANCE: This study provided a strong message regarding protecting nurses at high risk for exposure to COVID-19. Clinical leaders must stay vigilant to ensure nurses' adherence to ICP practices in the context of COVID-19, and to proactively address any related deficits.