Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

OBJECTIVE: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. DESIGN: A psychometric study. SETTING: Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. METHODS: The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. RESULTS: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. CONCLUSIONS: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. RELEVANCE FOR CLINICAL PRACTICE: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Protective factors of ethical conflict during a pandemic-Quali-Ethics-COVID-19 research part 2: An international qualitative study.

AIMS AND OBJECTIVES: To determine which factors can be considered protective of ethical conflicts in intensive care unit healthcare professionals during a pandemic. BACKGROUND: The COVID-19 pandemic gave rise to new ethical concerns in relation to the management of public health and the limitations on personal freedom. Continued exposure to ethical conflict can have a range of psychological consequences. DESIGN: A qualitative design based on phenomenological approach. METHODS: A total of 38 nurses and physicians who were regular staff members of Barcelona and Milan's public tertiary university hospitals and working in intensive care units during the first wave of the COVID-19 pandemic. Semi-structured online in-depth interviews were conducted. A thematic analysis was performed by two independent researchers following the seven steps of Colaizzi's methods. We adhere COREQ guidelines. RESULTS: One theme 'Protective factors of ethical conflict in sanitary crisis' and four subthemes emerged from the data: (1) knowledge of the infectious disease, (2) good communication environment, (3) psychological support and (4) keeping the same work team together. CONCLUSIONS: Four elements can be considered protective factors of ethical conflict for healthcare professionals during a sanitary crisis. While some of these factors have already been described, the joint identification of this set of four factors as a single element is, in itself, novel. This should help in ensuring the right mechanisms are in place to face future pandemics and should serve to improve institutional organisation and guarantee safe and high-quality patient care in times of healthcare crisis. RELEVANCE TO CLINICAL PRACTICE: Future strategies for the prevention of ethical conflict during sanitary crises, pandemics or other catastrophes need to consider a set of four factors as a single element. These factors are the knowledge of the infectious disease, a good communication environment, psychological support and keeping the same work team together into joint consideration.

COVID-19 pandemic experiences, ethical conflict and decision-making process in critical care professionals (Quali-Ethics-COVID-19 research part 1): An international qualitative study.

AIM AND OBJECTIVES: The aim of this study was to explore the sources of ethical conflict and the decision-making processes of ICU nurses and physicians during the first and subsequent waves of the COVID-19 pandemic. BACKGROUND: Depside several studies exploring ethical conflicts during COVID-19 pandemic, few studies have explored in depth the perceptions and experiences of critical care professionals regarding these conflicts, the decision-making process or which have analysed the complexity of actually implementing the recommendations of scientific societies and professional/healthcare institutions in interdisciplinary samples. DESIGN: A descriptive phenomenological study. METHODS: Thirty-eight in-depth interviews were conducted with critical care nurses and physicians from five hospitals in Spain and Italy between December 2020 and May 2021. A thematic content analysis of the interview transcripts was conducted by two researchers. Consolidated criteria for reporting qualitative research (COREQ) were employed to ensure the quality and transparency of this study. RESULTS: Two main themes emerged as sources of ethical conflict: the approach to end of life in exceptional circumstances and the lack of humanisation and care resources. The former comprised two subthemes: end-of-life care and withholding and withdrawal of life-sustaining treatment; the latter comprised three subthemes: the impossibility of guaranteeing the same opportunities to all, fear of contagion as a barrier to taking decisions and the need to humanise care. CONCLUSIONS: Professionals sought to take their decisions in line with professional ethics and bioethical principles, but, nevertheless, they experienced moral dilemmas and moral distress when not being able to care for, or to treat, their patients as they believed fit. RELEVANCE TO CLINICAL PRACTICE: Further education and training are recommended on the provision of end-of-life and post-mortem care, effective communication techniques via video calls, disclosure of bad news and bioethical models for decision-making in highly demanding situations of uncertainty, such as those experienced during the COVID-19 pandemic.

Psychological crisis and emergency intervention for frontline critical care workers during the COVID-19 pandemic.

AIM: To explore the main feelings and coping strategies among frontline critical care workers during the first phase of the COVID-19 pandemic and to evaluate the level of satisfaction after a psychological crisis and emergency intervention. BACKGROUND: The health crisis brought about by the COVID-19 pandemic has exposed critical care workers to an intense physical and emotional burden. Scientific research recommends psychological crisis and emergency interventions during the acute phase to help cope with the situation and prevent emotional side effects. DESIGN: A multicentre descriptive study with mixed qualitative and quantitative data was developed. METHODS: Healthcare and non-healthcare critical care workers from 16 hospitals were included. Psychological crisis assistance was given (for individuals and groups), both face-to-face and online, with 18 psychologists for two months. Content analysis from the psychologists' session reports after each intervention was performed (COREQ). Satisfaction with the intervention was assessed with an 'ad hoc' 21-item online survey. RESULTS: A total of 553 interventions were carried out (361 individually and 192 in groups). Four themes were identified: 1-Imbalance between occupational demands and resources; 2-Acute stress responses; 3-Personal and professional consequences; and 4-Protection factors. The main protection factor identified was group cohesion and perceived social support. The mean general satisfaction with the intervention was high and 96.2% (n=252) of the participants would recommend it in future. CONCLUSIONS: A psychological crisis and emergency intervention helped critical care workers during the COVID-19 pandemic to verbalise and integrate the situation, providing strategies to cope with the experience with a high level of satisfaction from the participants assisted. RELEVANCE TO CLINICAL PRACTICE: During the COVID-19 pandemic, support groups guided by psychologists fostered reflection on aspects related to work, interaction with patients and relatives and social support from workmates that help them for coping with stress, share emotions and experiences and feel understood.

Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study.

AIM: To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. BACKGROUND: Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. DESIGN: A qualitative study design with a hermeneutical approach was developed. METHODS: A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. RESULTS: Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. CONCLUSIONS: Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. RELEVANCE FOR CLINICAL PRACTICE: Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.

Futuras líneas de investigación en cuidados sobre dolor, sedación, contenciones y delirium en el paciente crítico / Future lines of research on pain care, sedation, restraints and delirium in the critically ill patient

La valoración y manejo del dolor-analgesia, agitación-sedación, contenciones mecánicas (CM) y delirium en el paciente critico ha ido evolucionando en los últimos años, tal y como recogen las recomendaciones de las Guías de Práctica Clínica (GPC) 1. Sin embargo, todavía quedan cuestiones pendientes, en las que las enfermeras pueden investigar destacando el efecto que los cuidados pueden tener en los resultados de salud sensibles a la práctica enfermera. A continuación, se proponen doce líneas de investigación en cuidados para la orientación de futuros proyectos sobre dolor, sedación, CM y delirium. (AU)

Ethical conflict during COVID-19 pandemic: the case of Spanish and Italian intensive care units.

AIM: To identify factors underlying ethical conflict occurring during the current COVID-19 pandemic in the critical care setting. BACKGROUND: During the first wave of the COVID-19 outbreak, Spanish and Italian intensive care units were overwhelmed by the demand for admissions. This fact revealed a crucial problem of shortage of health resources and rendered that decision-making was highly complex. SOURCES OF EVIDENCE: Applying a nominal group technique this manuscript identifies a series of factors that may have played a role in the emergence of the ethical conflicts in critical care units during the COVID-19 pandemic, considering ethical principles and responsibilities included in the International Council of Nurses Code of Ethics. The five factors identified were the availability of resources; the protection of healthcare workers; the circumstances surrounding decision-making, end-of-life care, and communication. DISCUSSION: The impact of COVID-19 on health care will be long-lasting and nurses are playing a central role in overcoming this crisis. Identifying these five factors and the conflicts that have arisen during the COVID-19 pandemic can help to guide future policies and research. CONCLUSIONS: Understanding these five factors and recognizing the conflicts, they may create can help to focus our efforts on minimizing the impact of the ethical consequences of a crisis of this magnitude and on developing new plans and guidelines for future pandemics. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Learning more about these factors can help nurses, other health professionals, and policymakers to focus their efforts on minimizing the impact of the ethical consequences of a crisis of this scale. This will enable changes in organizational policies, improvement in clinical competencies, and development of the scope of practice.

A Cross-International Study to Evaluate Knowledge and Attitudes Related to Basic Life Support among Undergraduate Nursing Students-A Questionnaire Study.

Practicing the algorithms of basic life support (BLS) is essential in order to take adequate measures to save lives, and future nursing staff should be advanced when it comes to performing lifesaving activities. The purpose of the study was to analyse the theoretical and practical knowledge of nursing students (within the undergraduate course) with regards to the basic life support (BLS). The study has a prospective, comparative and descriptive nature. Three countries that educate nursing students within the undergraduate course participated in the project. Data was collected with the use of a questionnaire based on the guidelines of the European Resuscitation Council (ERC 2015). The study was carried out among a total of 748 respondents from three countries: Poland (n = 189, 25.3%), Lithuania (n = 500, 66.8%) and Spain (n = 59; 7.9%). The average age of respondents was 23.41 (SD ± 5.90). The average score obtained by the respondents who answered the questions was 11.13 with a standard deviation of SD ± 2.29. The conducted study revealed that a substantial number of the respondents who participated in the study obtained an average result concerning theoretical and practical knowledge of BLS. It was also confirmed that the additional education in the form of first aid training courses has a major impact on improving the levels of knowledge among the students in each of the analysed country.

Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study.

BACKGROUND: Studies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses' intentions to use them. OBJECTIVE: The objective of this study was to determine critical care nurses' attitudes, subjective norms, perceived behavioural control, and intentions to use physical restraints in intubated patients and the relationship between them and sociodemographic, professional, and contextual factors using a survey approach. METHODS: A cross-sectional, multicentre study was conducted in a convenience sample of 12 intensive care units from eight hospitals in Spain (n = 354). The Physical Restraint-Theory of Planned Behaviour questionnaire and a researcher-developed survey were used to collect structural and clinical data from each unit. Multilevel model analysis was used. RESULTS: Critical care nurses showed a moderate level of intention to use physical restraints 12.52 (standard deviation = 3.81) [3-21]. More than a half (52%) agreed restraints were safe. The highest perceived barrier against physical restraint use was patient cooperation. Although nurses did not feel that others expected them to use restraints, they did not perceive high levels of disapproval of such practice. Nurses who had received previous training on restraints and who worked in units with a flexible family visitation policy, an informed consent form for restraint use, analgosedation and restraint protocols, and nurse-driven analgosedation management reported lower levels of intention to use restraints. Working in smaller units (beta -1.81; 95% confidence interval [CI]: -0.18, -3.44) and working in units with a consent form for restraint use (beta -4.82; 95% CI: -2.80, -6.85) were the variables with the highest impact on nurses' intentions to use restraints. CONCLUSIONS: Critical care nurses' intentions to use physical restraints are moderate and are influenced by intrapersonal, patient, and contextual factors. Nurses who work in units with organisational policies and alternatives to restraints demonstrated lower levels of intention to use them.

Development and initial validation of a Theory of Planned Behaviour questionnaire to assess critical care nurses' intention to use physical restraints.

AIMS: To develop and psychometrically test a Theory of Planned Behaviour (TPB) questionnaire to assess nurses' intention to use physical restraints (PRs) in intubated patients. DESIGN: A psychometric instrument validation study conducted in three phases. METHODS: A theory-driven questionnaire was developed. Eight experts validated the content of the preliminary 58-item questionnaire. A pilot study was conducted including 101 critical care nurses to test the reliability of the items. Construct validity and reliability were tested in a cross-sectional study of 12 units from eight hospitals in Spain (N = 354) from October - December 2017. Participants completed the questions based on the TPB, and socio-demographic and professional variables. RESULTS: The instrument comprised 48 items. All the direct and indirect constructs exhibited acceptable reliability. Confirmatory factor analysis indicated satisfactory fit indices for factorial structure according to the TPB. Nurses showed favourable attitudes, low perception of social pressure and modest perception of behaviour control. Perceived behavioural control and attitude were moderately positively correlated with the intention to use restraints, whereas subjective norm revealed the lowest correlation. Overall, the model explained 33% of the variance in intention. CONCLUSIONS: The Physical Restraint TPB questionnaire is a 48-item self-reporting theoretically based instrument with acceptable reliability and construct validity to identify nurses' intentions to use PRs in intubated patients. IMPACT: Unravelling the key determinants of nurses' intentions to use PRs should be examined to tailor quality improvement projects aimed at de-implementing restraints use in practice and to promote safer care.

Guía de práctica clínica del American College of Critical Care Medicine sobre prevención y manejo del dolor, agitación/sedación, contenciones mecánicas, delirio, inmovilidad y alteraciones del sueño del paciente adulto / Clinical Practice Guidelines of the American College of Critical Care Medicine for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients

Objetivo: Actualizar y ampliar la Guía de Práctica Clínica de 2013 para el manejo del dolor, agitación y delirio en pacientes adultos de la UCI. Diseño: Treinta y dos expertos internacionales, cuatro expertos en metodología, y cuatro supervivientes de enfermedades críticas se reunieron virtualmente, al menos una vez al mes. Todos los grupos de sección se reunieron personalmente en los congresos anuales de la Sociedad de Medicina de Cuidados Críticos; las conexiones virtuales incluyeron a aquellas personas que no pudieron asistir. A priori, se desarrolló una política formal de conflicto de intereses, que se hizo cumplir a lo largo del proceso. Las teleconferencias y debates electrónicos entre los subgrupos, así como el panel al completo, formaron parte del desarrollo de la guía. Todos los miembros del panel realizaron personalmente una revisión general del contenido en enero de 2017. Métodos: Los expertos contenidos, los expertos en metodología, y los supervivientes de la UCI estuvieron representados en cada una de las cinco secciones de la guía: Dolor, Agitación/sedación, Delirio, Inmovilidad (movilización/rehabilitación), y Sueño (interrupción). Cada sección creó preguntas descriptivas y no procesables sobre Población, Intervención, Comparación, y Resultados, basadas en la relevancia clínica percibida. A continuación, el grupo responsable de la guía votó su clasificación, y los pacientes priorizaron su importancia. Para cada pregunta sobre Población, Intervención, Comparación, y Resultados, las distintas secciones buscaron la evidencia mejor disponible, determinaron su calidad, y formularon recomendaciones del tipo declaraciones sobre prácticas "sólidas," "condicionales," o "buenas" basándose en los principios de calificación de valoración, desarrollo y evaluación de recomendaciones. Además, se identificaron explícitamente las brechas de la evidencia y las salvedades clínicas. Resultados: El panel sobre dolor, agitación/sedación, delirio, inmovilidad (movilización/rehabilitación), y sueño (interrupción) emitió 37 recomendaciones (3 sólidas y 34 condicionales), dos declaraciones de prácticas buenas, y 32 declaraciones no calificables y no procesables. Tres preguntas procedentes de la lista de preguntas priorizadas centradas en el paciente carecieron de recomendación. Conclusiones: Concluimos un acuerdo sustancial entre una gran cohorte interdisciplinaria de expertos internacionales en cuanto a la evidencia que respalda las recomendaciones y las brechas en la literatura pendientes en cuanto a evaluación, prevención y tratamiento del dolor, agitación/sedación, delirio, inmovilidad (movilización/rehabilitación), y sueño (interrupción) en adultos críticos. Subrayar dicha evidencia y las necesidades de investigación mejorarán el manejo del dolor, agitación/sedación, delirio, inmovilidad (movilización/rehabilitación), y sueño (interrupción), y aportarán las bases para mejorar los resultados y la ciencia en esta población vulnerable

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Eliciting critical care nurses' beliefs regarding physical restraint use.

BACKGROUND: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice. AIM: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. RESEARCH DESIGN: A belief elicitation study was conducted. PARTICIPANTS AND RESEARCH CONTEXT: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. ETHICAL CONSIDERATIONS: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. FINDINGS: Nurses framed the use of restraints as a way of prioritising patients' physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients' relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients' medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. DISCUSSION: Safety arguments based on the surrounding work environment were discussed. CONCLUSION: Nurses' behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives' involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research.

BACKGROUND: There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process. METHODS: Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively. DISCUSSION: The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.

Levels of exposure to ethical conflict in the ICU: Correlation between sociodemographic variables and the clinical environment.

OBJECTIVES: To analyse the level of exposure of nurses to ethical conflict and determine the relationship between this exposure, sociodemographic variables and perceptions of the clinical environment. DESIGN AND SETTING: Prospective and descriptive correlational study conducted at 10 intensive care units in two tertiary hospitals affiliated to the University of Barcelona. Sociodemographic and professional data were recorded from a questionnaire and then the previously validated Ethical Conflict in Nursing Questionnaire-Critical Care Version was administered to obtain data regarding experiences of ethical conflict. RESULTS: Two hundred and three nurses (68.6%) participated in the study, of whom only 11.8% had training in bioethics. Exposure to ethical conflict was moderate with a x¯=182.35 (SD=71.304; [0-389]). The realisation that analgesia is ineffective and the administration of treatment without having participated in the decision-making process were the most frequently reported ethical conflicts. Professionals who perceived their environment as supportive for dealing with ethical conflicts reported lower levels of these events (p=0.001). CONCLUSIONS: Ethical conflict is an internal problem but it is strongly influenced by certain variables and environmental conditions. The involvement of nurses in the decision-making processes regarding the care of critically ill patients emerges as a factor that protects against ethical conflicts.

Seguridad de los pacientes en una uci. Percepción enfermera / Cost-effectiveness of a tlc-nosf polyurethane foam dressing

La seguridad de los pacientes y la prevención de los errores que pueden alterarla emergen como una nueva dimensión de los cuidados de enfermería a lo largo de la última década. Nuestro trabajo, utilizando una metodología cualitativa, nos ha permitido identificar veinticinco situaciones y actividades enfermeras en las que existen riesgo de errores; en todas ellas, las enfermeras que han participado en el estudio creen que se puede mejorar la seguridad del paciente; así mismo, se considera que las que conllevan mayor riesgo de error son: la documentación escrita a mano, el manejo de fármacos, los cambios de turno, la falta de entrenamiento en determinadas situaciones, y la ausencia de reuniones de trabajo multidisciplinar. Nuestro estudio ha permitido obtener una percepción global de la seguridad de los pacientes desde la perspectiva enfermera en una Unidad de Cuidados Intensivos (UCI)(AU)

Chronic wounds represent a drain on the Spanish health system, nowdays is necessary an optimization of the resources used and that is for this that is necessary justify the use of the products over others through cost-effective studies for to show the economic benefit to professionals and the life quality of patient. This article compares the use of a new technology for format polyurethane foam, TLC-NOSF, with the most commonly used products for treating wounds. This comparison is made using a cost-effectiveness model (Markov Model). The results demonstrate that treatment with polyurethane foam dressing with TLC-NOSF are cost-effective versus treatments with polyurethane foams most commonly used in Spain(AU)

[Nurse perceptions of patient safety in ICU]. / Seguridad de los pacientes en una UCI.

Patient safety and error prevention have developed as a new dimension in nursing over the last decade. Using qualitative research methods we have been able to identify twenty-five scenarios and activities prone to errors. Participant nurses believed safety could be improved in each one of the scenarios. The riskier activities are related to hand written documentation, drug handling, sign outs, lack off appropriate training, and lack off multidisciplinary meetings. Our paper describes Intensive Care Unit (ICU) safety from the nursing point of view.