The Current State of Nursing.

Workforce issues, challenges, and opportunities.

COVID-19: Perspectives From Frontline Critical Care Nurses in New York.

New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.

The impact of the first COVID-19 surge on the mental well-being of ICU nurses: A nationwide survey study.

OBJECTIVES: To determine the impact of the first COVID-19 surge (March through June 2020) on mental well-being and associated risk factors among intensive care unit nurses. RESEARCH METHODOLOGY: In September 2020, a nationwide cross-sectional survey study among Dutch intensive care nurses was carried out to measure prevalence rates of symptoms of anxiety, depression, posttraumatic stress disorder, and need for recovery (NFR), objectified by the HADS-A, HADS-D, IES-6 and NFR questionnaires, respectively. Associated risk factors were determined using multivariate logistic regression analyses. RESULTS: Symptoms of anxiety, depression, and post traumatic stress disorder were reported by 27.0%, 18.6% and 22.2% of the 726 respondents, respectively. The NFR was positive, meaning not being recovered from work, in 41.7%. Working in an academic hospital, being afraid of infecting relatives and experiencing insufficient numbers of colleagues were associated with more mental symptoms, while having been on holiday was associated with reduced depression symptoms and need for recovery. CONCLUSION: The first COVID-19 surge had a high impact on the mental well-being of intensive care nurses, increasing the risk for drop out and jeopardising the continuity of care. Effort should be made to optimize working conditions and decrease workload to guarantee care in the next months of the COVID-19 pandemic.

Critical Care Nursing: A Key Constraint to COVID-19 Response and Healthcare Now and in the Future.

This article discusses the crucial role and dearth of critical care nurses in the United States highlighted during the COVID-19 pandemic. This challenge of sufficient critical care nursing resources existed before the pandemic, but now concern is heightened by the need for such crucial healthcare providers now and in the future. We present strategies to address the gap, as well as challenges inherent in the suggested approaches. The discussion is relevant as nurse leaders adapt to COVID-19 and other novel challenges in the future.

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing.

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person-centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.

Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey data.

BACKGROUND: Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care. OBJECTIVES: To identify current trends and future recommendations for critical care nursing research in the Nordic countries. METHODS: We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016-2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research. RESULTS: A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles. CONCLUSION: Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing.

Examination of nursing drug administration practices via central venous catheter: An observational study.

AIM: To determine the compliance with nursing drug administration procedure steps associated with access to the central venous catheter for bolus infusion in intensive care units. METHODS: This observational study was conducted with 30 nurses working in an intensive care unit of a university hospital. The drug administrations practiced by nurses via central venous catheter were monitored simultaneously at 12:00 a.m., 02:00 p.m., and 06:00 p.m. by two observers. The data were collected using a data collection form and central venous catheter drug administration procedure steps. RESULTS: A total of 90 different drug administrations were observed in three different treatment hours from 30 nurses. The interobserver conformity was found to be moderate in two steps (kappa = 0.520-0.627, P = 0.01) and perfect in all other steps (kappa = 0.821-1.000, P = 0.000). According to the drug administration procedure steps via a central venous catheter, all nurses applied the following steps correctly during all treatment hours: drug card control, preparation of treatment materials, checking the patient's identity, and steps of drug treatment administration. The following tasks were frequently performed incorrectly or not at all: hand hygiene (before treatment 87.8%; after treatment 82.2%), scrubbing the three-way stopcock entrance with an alcohol swab (55.6%), waiting for the alcohol to dry (81.1%), and flushing the lumen with a compatible fluid (before treatment 84.4%: after treatment 75.6%). CONCLUSION: Observation of drug administration procedure steps via central venous catheter according to the treatment hours showed that the nurses performed many incomplete or inaccurate drug administration procedure steps and the mistakes increased toward the evening hours.

Ethical conflicts and their characteristics among critical care nurses.

INTRODUCTION: Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. AIM: The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire-Critical Care Version and, second, to analyse Portuguese critical care nurses' level of exposure to ethical conflict and its characteristics. METHODS: A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. ETHICAL CONSIDERATIONS: The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. FINDINGS: The Portuguese version of the Ethical Conflict Nursing Questionnaire-Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources.

Transplante renal: enfermeiro da terapia intensiva no pós-operatório imediato / Renal transplantation: intensive therapeutic nurse in the immediate post-operative period / Transplante renal: enfermero terapéutico intensivo en el post-operatorio inmediato

Objetivo: Avaliar os saberes de enfermeiros no cuidado ao paciente no período pós-operatório imediato de transplante renal. Métodos: Estudo qualitativo, realizado no ano de 2015 em um hospital público de Santa Catarina. Participaram enfermeiros que atuavam na Unidade de Terapia Intensiva com experiência em cuidado no pós-operatório de transplante renal. Para a coleta de dados foi utilizado entrevista semiestruturada e a análise foi através do Discurso do Sujeito Coletivo. Resultados: O estudo deu origem a 5 discursos do sujeito coletivo: As primeiras horas requerem cuidados intensivos, checklist como potencialidade no cuidado de pacientes no pós operatório de transplante renal, qualificação profissional como ponto forte no cuidado, momento de expectativa e ansiedade para os pacientes e o acompanhante familiar no pósoperatório. Conclusão: O estudo evidenciou o fortalecimento de saberes dos enfermeiros, destacou o uso de checklist, a importância da educação continuada e de familiares como fonte de apoio aos pacientes

Objective: The study's main purpose has been to assess the nurses' understanding vis-à-vis patient care in the immediate postoperative period of renal transplantation. Methods: It is a descriptive-exploratory study with a qualitative approach, which was performed in a public hospital from the Santa Catarina State, in 2015. The participants were nurses who worked in the Intensive Care Unit with experience in postoperative renal transplant care. Data collection took place through semi-structured interviews, and the Collective Subject Discourse was used for data analysis. Results: This study resulted into five Collective Subject Discourses, as follows: the first hours require intensive care; checklist as potentiality in the care of patients undergoing postoperative period of renal transplantation; professional qualification as a strong support in caring; moment of expectation and anxiety for patients; and, the family companion during the postoperative period. Conclusion: This research evidenced the strengthening of nurses' knowledge concerning patient care and underlined the use of checklists, as well as the importance of continuing education and relatives as a source of support for patients

Objetivo: Evaluar y reflexionar sobre el conocimiento del enfermero en el cuidado de enfermería al paciente en el período post-operatorio inmediato de trasplante renal. Métodos: Estudio cualitativo descriptivo exploratorio, se utilizó la entrevista semiestructurada como forma de recolección de los datos con enfermeros actuantes de la unidad de terapia intensiva del local investigado. Resultados: se evidenció un respaldo teórico y práctico por parte de los enfermeros sobre el contexto del trasplante renal y la utilización del check-list como herramienta de trabajo. Se destacó la realización de capacitaciones en la institución hospitalaria. La familia fue identificada como relevante en la recuperación del paciente y la necesidad de un enfoque más amplio sobre la temática en la graduación. Conclusión: Los enfermeros identifican conocimientos y habilidades esenciales para el cuidado del paciente trasplantado, así como la institución hospitalaria, ya que ofrece oportunidad de perfeccionamiento técnico-científico a los profesionales

Emotional Intelligence in Neonatal Intensive Care Unit Nurses: Decreasing Moral Distress in End-of-Life Care and Laying a Foundation for Improved Outcomes: An Integrative Review.

End-of-life care in the neonatal intensive care unit (NICU) is one of the most challenging practices for nurses. Negative emotions associated with moral distress often cause care to be incomplete or nurse disengagement. Emotional intelligence in nurses holds potential to address this issue, while improving patient outcomes. The purpose of this study was to critically appraise the evidence about emotional intelligence in nursing and to explore the relationship between emotional intelligence, moral distress in NICU nurses, end-of-life care, and other priority nurse and patient outcomes. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-structured integrative review was conducted, and CINAHL, Ovid, PubMed, and other databases were searched. Twelve studies were identified as relevant to this review after exclusion criteria were applied. Evidence supports the efficacy of emotional intelligence in bedside nurses as a method of improving key nurse and patient outcomes. Additionally, research suggests that emotional intelligence can be improved by training interventions. Clinical educators should integrate emotional intelligence concepts and strategies into staff training. Further research is recommended to validate previous findings in the NICU setting. Exploration of the relationship between emotional intelligence and moral distress in NICU nurses would provide a foundation for experimental designs to evaluate the effectiveness of emotional intelligence training interventions.

Room Design-A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment.

Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.

Effects of an ethical empowerment program on critical care nurses' ethical decision-making.

BACKGROUND: Nurses require empowerment if they are to make ethical decisions. Ethical empowerment has always been one of the main concerns in nurse training programs. RESEARCH AIM: The present study was conducted to determine the effect of an ethical empowerment program on critical care nurses' ethical decision-making. RESEARCH DESIGN: This is a clinical trial study with two groups and pre and post design. PARTICIPANTS AND RESEARCH CONTEXT: In this study, 60 nurses working in Intensive Care Unit were selected through random sampling and then divided into a control and an experimental group after filling out the Moral Sensitivity Questionnaire. Both groups completed the questionnaire again immediately and 2 months after the ethical empowerment workshop had been held for the experimental group. The collected data were analyzed in SPSS-16 using descriptive and inferential statistics. ETHICAL CONSIDERATIONS: The goals of the study were explained to the participants and then a written informed consent was received from them. FINDINGS: The results showed no significant differences between the two groups in terms of their ethical sensitivity scores at the beginning of the study; however, immediately and 2 months after the intervention, the mean score increased significantly in the experimental group. Moreover, the scores obtained 2 months after the workshop increased compared to the pre-intervention scores but showed a drop compared to the scores reported immediately after the workshop. DISCUSSION: The ethical empowerment program, given to the critical care nurses in this study, improved their ethical sensitivity in making decisions significantly over time. Despite the extensive methods, available for teaching nursing ethics, the ethical empowerment program, adopted in this study, had long-lasting effects in terms of ameliorating the process of ethical decision-making in clinical situations. CONCLUSION: The ethical empowerment of nurses requires the adoption and application of proper methods and patterns of complying with nursing ethics.