The creation of meaning – Intensive care nurses’ experiences of conducting nurse-led follow-up on intensive care units

This article by Flinterud was published on line in “Intensive and Critical Care Nursing” during May 2019.
Objective:  To explore and describe the experiences of Norwegian intensive care unit nurses providing nurse-led follow-up to patients and their families.
Design and methods:  The study had a qualitative design with a phenomenological approach. Three focus-group interviews were conducted with nurses on three intensive care units. Giorgi’s phenomenological method guided the analysis.
Findings:  The creation of meaning emerged as a general structure describing intensive care nurses’ experiences of nurse-led follow-up. When caring for critically ill patients, nurses described becoming emotionally moved, which motivated them to perform nurse-led follow-up procedures, such as writing in patient diaries. A general wish to give context to the patients’ time spent in intensive care emerged. When conducting nurse-led follow-up, the nurses made personal contributions, which could be emotionally challenging for them. Overall, nurse-led follow-up was found to increase nurses’ insight into and motivation for their own practice.
Conclusion:  The performance of nurse-led follow-up appears to be grounded in care for and engagement in individual patients and families. The nurses studied wanted to help patients and families to be able to handle their experiences during an intensive care stay. In addition, nurse-led follow-up gave meaning to the intensive care nurses’ own practice.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

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Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning

This research by Tobiano and colleagues was published in Intensive and Critical Care Nursing in March 2019.
Objectives:  To evaluate the implementation of a regular Nursing Round as an educational strategy for workplace learning in an intensive care unit with a single room environment.
Research design:  A multiple methods design was used. Fifty-four Nursing Rounds were observed and nurses (n = 40) completed bespoke evaluative surveys. Structured observational data and open-ended survey responses were submitted to content analysis and descriptive statistics were used to analyse survey findings.
Results:  Nursing Rounds involved a diverse range of participants, most frequently nurses. The content most frequently discussed included empirical clinical issues where nurses decided on nursing care actions to address these issues. The most frequently observed outcome of Nursing Rounds was knowledge translation. Nursing Rounds were perceived to positively influence application of evidence in practise, identification of areas for practise improvement and ability to communicate clinical information. Two categories emerged from analysis of open-ended survey questions; (1) ‘Positive learning environment’, where nurses described Nursing Rounds as a social learning experience; and (2) ‘Impediments to Nursing Rounds’, including difficulty attending Nursing Rounds due to competing priorities.
Conclusion:  Nursing Rounds enabled evidence-based learning that enhanced inter-disciplinary collaboration. Further investigation may be required to understand how to enable nurses to attend more frequently, and generate a more holistic, evidence-based discussion.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

ICU nurses feel unprepared to care for patients with mental illness: A survey of nurses’ attitudes, knowledge, and skills

This article by Weare and colleagues was published online in “Intensive and Critical Care Nursing” during March 2019.
Objectives:  To examine the knowledge, skills, and attitudes of a cohort of Australian nurses towards caring for patients with mental illness in the intensive care unit.
Research design:  A questionnaire was developed and distributed via internal email to all nurses working in the study intensive care unit. Responses were anonymous.
Setting: A metropolitan intensive care unit located in Melbourne, Australia.
Main outcome measures: Intensive care nurses completed a 76-question self-administered questionnaire.
Results:  Forty intensive care nurses completed the survey, a response rate of 35.7% (n = 40/112). Respondents were predominantly female (82.5%) and held a post-graduate qualification (62.5%).
ICU nurses felt that they needed further training and education to care for patients with mental illness in the intensive care unit. While respondents were empathetic to this patient group, negative stereotypes and stigma were reported by some participants. The pressures of the environment were perceived barriers to delivering optimal person-centred care for patients with mental illness.
Conclusion:  This sample of nurses felt they require education and support in order to care for patients with mental illness in the intensive care unit. Further education may also help to reduce negative perceptions of this patient group.
Subscribers to Intensive and Critical Care Nursing can access the full text of the article via this link.  The full text of articles from issues older than sixty days is available via this link to an archive of issues of Intensive and Critical Care Nursing.  A Rotherham NHS Athens password is required.  Eligible staff can register for an Athens password via this link.  Please speak to the library staff for more details.

Effects of a Multimodal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial

This article by El Khamali and others was published inJAMA during November 2018.
Importance:  Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.
Objective:  To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.
Design, Setting, and Participants:  Multi-center randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29,2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.
Interventions:  The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization),which were followed by debriefing sessions on attitude and discussion of practices.
Main Outcomes and Measures:  The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21(score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.
Results:  Among 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]),182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively;between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%];P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group(between-group difference, 8% [95% CI, 0%-17%]; P = .04).
Conclusions and Relevance:  Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program.Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.
The print copy of this issue JAMA is available in the Healthcare Library on D Level of Rotherham General Hospital.

Bright environmental light improves the sleepiness of night shift ICU nurses

This article by Griepentrog and others was published in Critical Care in November 2018.
Background:  Shift work can disturb circadian homeostasis and result in fatigue, excessive sleepiness, and reduced quality of life. Lighttherapy has been shown to impart positive effects in night shift workers. Wesought to determine whether or not prolonged exposure to bright light during anight shift reduces sleepiness and enhances psychomotor performance among ICUnurses.
Methods:  This is a single-center randomized, cross over clinical trial at a surgical trauma ICU. ICU nurses working a night shift were exposed to a 10-h period of high illuminance (1500-2000 lx) white light compared to standard ambient fluorescent lighting of the hospital. They then completed the Stanford Sleepiness Scale and the Psychomotor Vigilance Test. The primary and secondary endpoints were analyzed using the paired t test. Ap value <0.05 was considered significant.
Results:  A total of 43 matched pairs completed both lighting exposures and were analyzed. When exposed to high illuminance lighting subjects experienced reduced sleepiness scores on the Stanford Sleepiness Scalethan when exposed to standard hospital lighting: mean (sem) 2.6 (0.2) vs. 3.0(0.2), p = 0.03. However, they committed more psychomotor errors: 2.3 (0.2) vs.1.7 (0.2), p = 0.03.
Conclusions:  A bright lighting environment for ICU nurses working the night shift reduces sleepiness but increases the number of psychomotor errors.

The full text of this article is freely available via this link.

Intensive care nurse conceptions of well-being: a prototype analysis

This research by Jarden et al was published in Nursing in Critical Care in November 2018.
Background:  Accurately conceptualizing intensive care nurse work well-being is fundamental for successful engagement with workplace well-being interventions. Little is currently known about intensive care nurse work well-being.
Aims:  The study aimed to identify intensive care nurses’ conceptions of work well-being and ascertain whether the term ‘work well-being’ is prototypically organized.
Methods:  Three linked studies conceptualize intensive care nurse well-being. For study one, participants listed key features of work well-being as free-text responses. Study two measured whether there was prototypical organization of these responses. Study three sought to confirm the prototypical organization of the term ‘work well-being’ through narrative ratings.
Results:  A total of 82 New Zealand intensive care nurses were randomly allocated to the three studies; 65 participated. In study one (n= 23), the most frequently endorsed elements included: workload (n= 14), job satisfaction (n= 13) and support (n= 13). In study two (n= 25), the highest rated elements included: feeling valued, respect, support, work-life balance and workplace culture. Elements of support, work-life balance and workload were in the top five most frequently endorsed elements and were also rated in the top 12 most central. Overall, the ratings of centrality and number of endorsements were positively correlated (r=0.35, P < 0.05). In study three (n= 17), nine participants selected the same rating across both narratives with no differentiation on the 11-point scale and were excluded from analysis. The mean score for the central narrative was 7.88 and for the peripheral narrative was 7.38. Confirmatory analyses did not reach statistical significance.
Conclusions:  Unique conceptions of work well-being were identified. Workload and work-life balance were central characteristics. Feeling valued and experiencing respect and support were considered most important.
Relevance to Clinical Practice:  Intensive care nurse conceptions of work well-being are fundamental for future measures of work well-being and future interventional studies and initiatives.
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Effects of a Multi modal Program Including Simulation on Job Strain Among Nurses Working in Intensive Care Units: A Randomized Clinical Trial

This article by El Kharnali and colleagues as part of the SISTRESSREA Study Group was published in JAMA during October 2018.
Importance:  Nurses working in an intensive care unit (ICU) are exposed to occupational stressors that can increase the risk of stress reactions, long-term absenteeism, and turnover.
Objective:  To evaluate the effects of a program including simulation in reducing work-related stress and work-related outcomes among ICU nurses.
Design, Setting, and Participants:  Multicenter randomized clinical trial performed at 8 adult ICUs in France from February 8, 2016, through April 29, 2017. A total of 198 ICU nurses were included and followed up for 1 year until April 30, 2018.
Interventions:  The ICU nurses who had at least 6 months of ICU experience were randomized to the intervention group (n = 101) or to the control group (n = 97). The nurses randomized to the intervention group received a 5-day course involving a nursing theory recap and situational role-play using simulated scenarios (based on technical dexterity, clinical approach, decision making, aptitude to teamwork, and task prioritization), which were followed by debriefing sessions on attitude and discussion of practices.
Main Outcomes and Measures:  The primary outcome was the prevalence of job strain assessed by combining a psychological demand score greater than 21 (score range, 9 [best] to 36 [worst]) with a decision latitude score less than 72 (score range, 24 [worst] to 96 [best]) using the Job Content Questionnaire and evaluated at 6 months. There were 7 secondary outcomes including absenteeism and turnover.
Results:  Among 198 ICU nurses who were randomized (95 aged ≤30 years [48%] and 115 women [58%]), 182 (92%) completed the trial for the primary outcome. The trial was stopped for efficacy at the scheduled interim analysis after enrollment of 198 participants. The prevalence of job strain at 6 months was lower in the intervention group than in the control group (13% vs 67%, respectively; between-group difference, 54% [95% CI, 40%-64%]; P < .001). Absenteeism during the 6-month follow-up period was 1% in the intervention group compared with 8% in the control group (between-group difference, 7% [95% CI, 1%-15%]; P = .03). Four nurses (4%) from the intervention group left the ICU during the 6-month follow-up period compared with 12 nurses (12%) from the control group (between-group difference, 8% [95% CI, 0%-17%]; P = .04).Conclusions and Relevance:  Among ICU nurses, an intervention that included education, role-play, and debriefing resulted in a lower prevalence of job strain at 6 months compared with nurses who did not undergo this program. Further research is needed to understand which components of the program may have contributed to this result and to evaluate whether this program is cost-effective.
The print copy of this issue JAMA is available in the Healthcare Library on D Level of Rotherham General Hospital.