Factors influencing critical care nurses' family engagement practices: An international perspective.

BACKGROUND: Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. AIM: To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. STUDY DESIGN: Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. RESULTS: Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. CONCLUSIONS: Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. RELEVANCE TO CLINICAL PRACTICE: Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world.

Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration.

BACKGROUND: Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES: To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN: A qualitative-descriptive multi-site design using content analysis. SETTINGS: The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS: A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS: Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS: We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS: This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.

Comparing undergraduate student nurses' understanding of sustainability in two countries: A mixed method study.

AIM: To explore sustainability education in nursing students in two countries. DESIGN: Mixed methods including a sustainability survey and focus groups. METHODS: First-year undergraduate nursing students from two countries were invited to participate. 69 students from China and 32 students from England agreed to take part. Data were collected between December 2015 and February 2016. Students completed the Sustainability Attitudes in Nursing Survey (SANS_2) and a purposive sample were invited to participate in focus groups in each country. RESULTS: All students had a positive attitude towards sustainability. However, for these four items, the results indicated that Chinese nursing students rate them significantly higher in importance than English students: Climate change is an important issue for nursing Issues about climate change should be included in the nursing curriculum Sustainability is an important issue for nursing Sustainability should be included in the nursing curriculum. The qualitative data identified four themes: Student nurses' conceptual understanding of sustainability focused mostly on environmental aspects and clinical waste management; Promoting sustainability within nursing education: teaching and learning methods. Promoting sustainability within nursing education: evaluating and certifying learning. Factors to consider when introducing sustainability to nursing education. The paper outlines the similarities and differences between Chinese and English nursing students' perceptions. CONCLUSION: Sustainability in nurse education has similar concerns across countries. IMPACT: Sustainability is an important issue for student nurses but strategies promoting incorporation of sustainability issues within nursing curricula are needed.

Mouse Fat-Specific Protein 27 (FSP27) expressed in plant cells localizes to lipid droplets and promotes lipid droplet accumulation and fusion.

Fat-Specific Protein 27 (FSP27) belongs to a small group of vertebrate proteins containing a Cell-death Inducing DNA fragmentation factor-α-like Effector (CIDE)-C domain and is involved in lipid droplet (LD) accumulation and energy homeostasis. FSP27 is predominantly expressed in white and brown adipose tissues, as well as liver, and plays a key role in mediating LD-LD fusion. No orthologs have been identified in invertebrates or plants. In this study, we tested the function of mouse FSP27 in stably-transformed Arabidopsis thaliana leaves and seeds, as well as through transient expression in Nicotiana tabacum suspension-cultured cells and N. benthamiana leaves. Confocal microscopic analysis of plant cells revealed that, similar to ectopic expression in mammalian cells, FSP27 produced in plants 1) correctly localized to LDs, 2) accumulated at LD-LD contact sites, and 3) induced an increase in the number and size of LDs and also promoted LD clustering and fusion. Furthermore, FSP27 increased oil content in transgenic A. thaliana seeds. Given that plant oils have uses in human and animal nutrition as well as industrial uses such as biofuels and bioplastics, our results suggest that ectopic expression of FSP27 in plants represents a potential strategy for increasing oil content and energy density in bioenergy or oilseed crops.

First year nursing students use of social media within education: Results of a survey.

INTRODUCTION: Social media rapidly disseminates information but is a controversial learning platform in nurse education. This study aimed to explore how students viewed the use of Twitter, and other social media, in their first year of a nursing degree. AIM: The aim of this study was to evaluate first year student nurses' use of social media, before and after commencing a pre-registration programme, where Twitter was used in a module. METHODOLOGY: A cross-sectional approach using a descriptive survey was completed. METHODS: An online survey, that included Likert scale and open questions, was open for one month in 2016. SAMPLE: All students on Nursing Undergraduate Degrees, in Adult, Child and Mental Health, who were in the first year of their programme were eligible to participate. 121 students took part with a response rate of 32%. RESULTS: Most students were positive about using social media as they found it an engaging way to promote discussion and share information. Students use of Twitter changed in the first year with 19.8% using it once or more per week on commencement of the programme which increased to 45.5%; other social media platforms remained static. Most students (57.8%) understood the purpose of using Twitter although 14% reported that it was not used within their module; thus, not all students gained experience of using the social media. 81% of students said that using Twitter had been beneficial to increase awareness of nursing issues within their course. However, there were areas that students found difficult such as time, and not knowing what to say. CONCLUSION: The study suggests that teaching about social media, and incorporating it into learning activities, may be beneficial for students. However, more research into the subject using an experimental design to assess changes over time would be useful.

The National Competency Framework for Registered Nurses in Adult Critical Care: An overview.

In the years following the abolition of the English National Board for Nursing, Midwifery and Health Visiting in 2002, concerns were raised within the Critical Care nursing community about a lack of consistency in post-registration education programmes. In response to this, the Critical Care Network National Nurse Leads (CC3N) formed a sub-group, the Critical Care Nurse Education Review Forum (CCNERF) to address these concerns. A review of UK course provision confirmed marked inconsistency in the length, content and associated academic award. The CCNERF commenced a two-phase project, first developing national standards for critical care nurse education such as length of course and academic credit level, followed by the development of a national competency framework. Following significant review and revision, version two of the National Competency Framework for Registered Nurses in Adult Critical Care was published by CC3N in 2015. This paper introduces the National Competency Framework and provides an overview of its background, development and implementation. It then considers the future direction of UK post-registration Critical Care nurse education.

The significance of personal learning environments (PLEs) in nursing education: Extending current conceptualizations.

BACKGROUND: Personal learning environments (PLEs) have been shown to be a critical part of how students negotiate and manage their own learning. Understandings of PLEs appear to be constrained by narrow definitions that focus primarily on technological engagement with a range of web tools and associated applications. This paper addresses a gap in the literature around PLEs for students currently enrolled in undergraduate nursing degrees. PURPOSE: To provide in-depth insights into how undergraduate students of nursing manage and experience their learning. METHODS: This was an international multi-site qualitative study, utilizing focus groups. A schedule of 10 questions and nominal group techniques were used. FINDINGS: Whilst the focus groups took place in very different geographical locations, there were strong similarities in student understandings of effective PLEs. These went well beyond current technological definitions. Findings were organized into three major themes; technologies, learning modalities and influencing factors. DISCUSSION: We propose a broader understanding of PLEs that acknowledges individual personal and cultural contexts which we call the personally significant learning environment (PSLE). There is a need for greater investigation of how students understand and systematize their PSLE. CONCLUSIONS: This paper and our findings will be of interest to educators, researchers and institutions for developing appropriate frameworks that may maximize learning outcomes, encourage cultural sensitivities and facilitate greater understandings of how to support students to create appropriate PSLEs.

Caring and technology in an intensive care unit: an ethnographic study.

BACKGROUND: Critical care practice is a mixture of caring and technological activities. There is debate about whether the balance between these two elements is correct and a concern that critical care units can dehumanize the patient. This research sought to examine aspects that might affect this balance between the caring and technology within the critical care setting. AIM: What aspects affect registered health care professionals' ability to care for patients within the technological environment of a critical care unit? METHODOLOGY: A qualitative approach using ethnography was utilized as this methodology focuses on the cultural elements within a situation. Data collection involved participant observation, document review and semi-structured interviews to triangulate methods as this aids rigour for this approach. A purposeful sample to examine registered health care professionals currently working within the study area was used. A total of 19 participants took part in the study; 8 nurses were observed and 16 health care professionals were interviewed, including nurses, a doctor and 2 physiotherapists. The study took place on a District General Hospital intensive care unit and ethical approval was gained. FINDINGS: An overarching theme of the 'Crafting process' was developed with sub themes of 'vigilance', 'focus of attention, 'being present' and 'expectations' with the ultimate goal of achieving the best interests for the individual patient. CONCLUSION: The areas reflected in this study coincide with the care, compassion, competency, commitment, communication and courage ideas detailed by the Department of Health (2012). Thus, further research to detail more specifically how these areas are measured within critical care may be useful. RELEVANCE TO PRACTICE: Caring is a complex concept that is difficult to outline but this article can inform practitioners about the aspects that help and hinder caring in the technical setting to inform training.

Using a high-flow respiratory system (Vapotherm) within a high dependency setting.

BACKGROUND: Vapotherm 2000i is a non-invasive high-flow respiratory support system used mainly in the treatment of type 1 respiratory failure. It uses a mixture of oxygen and air to deliver a set concentration via nasal cannula (or tracheostomy mask). The advantage of this system is the high humidity achieved using the integral heated water system. The system has been used in neonatal practice as a replacement for conventional continuous positive airway pressure (CPAP) but there is little published research within the adult setting about its use. AIM: This study discusses the indications for the use of this non-invasive high-flow respiratory support system, the system set up, the benefits and complications of the system. AUDIT DESIGN: An audit of 72 patients was undertaken within the Surgical High Dependency Unit that collected data on the types of patient receiving the therapy, its effectiveness and patient experience. AUDIT FINDINGS: The audit demonstrated reduced respiratory rate and improvement in oxygenation for treated patients. CONCLUSION: A non-invasive high-flow respiratory support system can be effective at improving oxygenation in hypoxic patients. Patients were generally satisfied with the system and the system seems suitable for use in an adult surgical high dependency setting.

Pre-registration education: making a difference to critical care?

This paper aims to discuss the development of a pre-registration high-dependency nursing programme and evaluate its effects on student's perceived learning and confidence in managing critically ill patients. The programme consists of two modules that compliment one another, 'Care of the Acutely III Adult' focuses on a variety of disease processes and subsequent nursing care. Whilst the second module titled 'Caring for the Highly Dependant/Critically III Adult' focuses on assessment skills related to critically ill patients. The paper explores the content and delivery of the modules including the advantages and disadvantages of implementing them. Student evaluation from 59 nursing students found that student's knowledge, assessment skills and management of the critically ill patient had improved since completing the modules. Nurse Consultants, intensive therapy unit matrons and Critical Care Outreach nurses have acknowledged an increase in the number of nursing students identifying and referring critically ill patients to outreach teams. They also stated improvements in nurse recruitment in critical care since commencement of the modules.

Intensive care nurses' experiences of assessing and dealing with patients' psychological needs.

Several authors have highlighted the short- and long-term psychological effects of an intensive care unit (ICU) stay. Few authors have discussed the nurses' perceptions of psychological care. In this research, 12 nurses, who currently work in ICU, were interviewed using a semi-structured technique. Six categories were developed about issues in psychological care. Implications for practice included the important role of the family, need for improved communication and improved staff awareness of issues.

Nursing care of the acute head injury: a review of the evidence.

This article aims to review the current evidence in relation to acute head injury care. Head injuries are a frequent cause of death and disability in western society with the first 72 h being an important period for prevention of further brain damage. The underlying physiology behind head injury and intracranial pressure will be discussed. The monitoring of intracranial pressure and implications for practice will be addressed. The specialized nursing care and drug therapy management that is necessary for acute head injury patients will be highlighted. Recommendations for practice will be given.