Psychological recovery after intensive care

Outcomes of a long-term quasi-experimental study of structured nurse-led follow-up | Intensive and Critical Care Nursing

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Image source: Jasmine Parker – Wellcome Images // CC BY-NC 4.0

Objectives: To compare psychological recovery of patients receiving structured nurse-led follow-up and patients receiving usual care after intensive care discharge.

Results: The experimental group had significantly more symptoms of post-traumatic stress and anxiety than the control group over the 12 months. Patients from both groups had severe symptoms of post-traumatic stress. Patients with post-traumatic stress at three months had disturbing memories and psychological reactions.

Conclusion: The structured nurse-led follow-up did not improve patients’ measured outcomes of psychological recovery after intensive care. Patients with severe symptoms of post-traumatic stress are of concern. Emphasis needs to be placed on disturbing memories of the intensive care stay and psychological reactions when constructing intensive care nurse-led follow-up.

Full reference: Jónasdóttir, R.J. et al. (2017) Psychological recovery after intensive care: Outcomes of a long-term quasi-experimental study of structured nurse-led follow-up. Intensive and Critical Care Nursing. Published online: 21 July 2017

Does good critical thinking equal effective decision-making among critical care nurses?

The aim of this study was to understand whether critical care nurses’ critical thinking disposition affects their clinical decision-making skills | Intensive and Critical Care Nursing

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Background: A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses’ decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses’ critical thinking and decision-making has not been examined closely in Malaysia.

Conclusion: While this small-scale study has shown a relationship exists between critical care nurses’ critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses’ perceived high level of critical thinking and decision-making also needs further investigation.

Full reference: Ludin, S.L. (2017) Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey. Intensive and Critical Care Nursing. Published online: 26 June 2017

Latest issue of “Intensive and Critical Care Nursing” Volume 40 June 2017

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Titles of articles published in this issue include “Working together: a critical care nurses experiences of temporary staffing within Swedish health care: a qualitative study”, “burnout and job satisfaction of intensive care personnel and the relationship with personality and religious traits: an observational multi centre cross sectional study” and “Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: an interrupted time series analysis”

The content page of this issue can be accessed via this link.

To see the full text of any of these articles direct from the journal’s homepage requires a personal subscription.  Individual articles can be ordered via the Rotherham NHS Foundation Trust Library and Knowledge Service.  Registered members of the library can make article requests online via this link.

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Research Use of Nurses Working in the Critical Care Units

There is a distinct gap between theory and practice with respect to research use in clinical practice, particularly in critical care units, that could be related to the presence of a number of barriers that hinder the use of research findings | Dimensions of Critical Care Nursing

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Aims: The aims of the study were to identify barriers and facilitators to research use as perceived by Jordanian nurses in critical care units and to examine the predictors of research use among those nurses.

 

Conclusions: Research use has not been widely implemented yet in Jordan because of various barriers. The organization-related barriers were the most influential. Factors hindering research use are multidimensional, and optimizing them should be a shared responsibility of nurse managers, researchers, clinicians, and academicians. Further initiatives are required to raise awareness of the importance of using evidence-based practice.

Full reference: Hweidi, I. et al. (2017) Research Use of Nurses Working in the Critical Care Units: Barriers and FacilitatorsDimensions of Critical Care Nursing. 36(4) pp. 226–233

“What happens behind the curtains?”: ICU nurses’ experiences of post mortem care

The aim of this study was to explore the experiences of intensive care nurses performing post mortem care on patients who had died in an intensive care unit at a private hospital in Cape Town. The study further sets out to identify educational needs and to offer recommendations that may address these needs for this sample of nurses | Intensive and Critical Care Nursing

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Findings: Safeguarding the integrity and physical appearance of the dead body was the major finding and of the utmost priority for the participants in this study. Regardless of how the nurses felt about death, providing professional and quality care to the dead body and the family was seen as significantly important.

The nurses, whilst performing post mortem care, experienced detachment from various relationships. This comprised of the nurse detaching him/herself professionally and emotionally from the dead patient, the family and him/herself from the death experience.

This ‘unspoken’ experience of thanatophobia became apparent when the nurses were confronted by the reality of their own deaths.

Conclusion and recommendations: In a technological society, where answers to many questions can be pursued through science, understanding the experience of death, as opposed to dying, may be logically incomprehensible. Death remains one of the most traumatic events experienced by the patient and their family, and in some instances nurses themselves.

The study has drawn attention to the nurses’ experiences and in doing so; the emotional and educational needs have been identified, and in part, pedagogical offerings are recommended.

Full reference: de Swardt, C. & Fouché, N. (2017) “What happens behind the curtains?” An exploration of ICU nurses’ experiences of post mortem care on patients who have died in intensive care. Intensive and Critical Care Nursing. Published online: June 05, 2017

Promoting Evidence-Based Practice at a Primary Stroke Center

Promoting a culture of evidence-based practice within a health care facility is a priority for health care leaders and nursing professionals; however, tangible methods to promote translation of evidence to bedside practice are lacking | Dimensions of Critical Care Nursing

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Objectives: The purpose of this quality improvement project was to design and implement a nursing education intervention demonstrating to the bedside nurse how current evidence-based guidelines are used when creating standardized stroke order sets at a primary stroke center, thereby increasing confidence in the use of standardized order sets at the point of care and supporting evidence-based culture within the health care facility.

 

Discussion: This nurse education strategy increased RNs’ confidence in ability to explain the path from evidence to bedside nursing care by demonstrating how evidence-based clinical practice guidelines provide current evidence used to create standardized order sets. Although further evaluation of the intervention’s effectiveness is needed, this educational intervention has the potential for generalization to different types of standardized order sets to increase nurse confidence in utilization of evidence-based practice.

Full reference: Case, C.A. (2017) Promoting Evidence-Based Practice at a Primary Stroke Center: A Nurse Education Strategy. Dimensions of Critical Care Nursing. 36(4) pp. 244–252

Critical Care Nurses Suggestions to Improve End-of-Life Care Obstacles

Critical-care nurses (CCNs) provide end-of-life (EOL) care on a daily basis as 1 in 5 patients dies while in intensive care units. Critical-care nurses overcome many obstacles to perform quality EOL care for dying patients | Dimensions of Critical Care Nursing

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Objectives: The purposes of this study were to collect CCNs’ current suggestions for improving EOL care and determine if EOL care obstacles have changed by comparing results to data gathered in 1998.

Methods: A 72-item questionnaire regarding EOL care perceptions was mailed to a national, geographically dispersed, random sample of 2000 members of the American Association of Critical-Care Nurses. One of 3 qualitative questions asked CCNs for suggestions to improve EOL care. Comparative obstacle size (quantitative) data were previously published.

Results: Of the 509 returned questionnaires, 322 (63.3%) had 385 written suggestions for improving EOL care. Major themes identified were ensuring characteristics of a good death, improving physician communication with patients and families, adjusting nurse-to-patient ratios to 1:1, recognizing and avoiding futile care, increasing EOL education, physicians who are present and “on the same page,” not allowing families to override patients’ wishes, and the need for more support staff. When compared with data gathered 17 years previously, major themes remained the same but in a few cases changed in order and possible causation.

Conclusion: Critical-care nurses’ suggestions were similar to those recommendations from 17 years ago. Although the order of importance changed minimally, the number of similar themes indicated that obstacles to providing EOL care to dying intensive care unit patients continue to exist over time.

Full reference: Beckstrand, R.L. et al. (2017) Critical Care Nurses Suggestions to Improve End-of-Life Care Obstacles: Minimal Change Over 17 Years. Dimensions of Critical Care Nursing. 36(4) pp. 264–270