Lived experiences of intensive care nurses in caring for critically ill patients

This research by Limbu and colleagues was published in Nursing in Critical Care in July 2018.
Background:  Caring for critically ill patients requires competent nurses to help save and secure the lives of patients, using technological developments while maintaining humanistic care. Nepal is a developing country with limited advanced technologies and resources. It is important to understand nursing care for critically ill patients under these shortages.
Aim:  To describe the lived experiences of intensive care nurses in caring for critically ill patients in intensive care units.
Methods:  A hermeneutic phenomenological study was conducted. Purposive sampling was used to recruit 13 nurses from three intensive care units, who met the inclusion criteria. Face-to-face, in-depth individual interviews with an audio recorder were used to collect the data. The interview transcriptions were analysed and interpreted using van Manen’s approach. Trustworthiness was established following the criteria of Lincoln and Guba.
Findings:  Seven thematic categories emerged from the experiences of nurses and were reflected within the four life worlds of space, body, relation and time. The categories were: low technology of care and insufficient resources (lived space); physical and psychological distress and requiring competency in caring (lived body); connecting relationship as a family, trusting technology of care, and realizing team working (lived relation); and less time to be with the patient as a whole person (lived time).
Conclusions:  This study provides an understanding of the lived experience of nurses caring for critically ill patients, with inadequate support that can affect holistic care of patients and nurses’ health.
Relevance to Clinical Practice:  Intensive care nurses need to enhance their knowledge and skills related to the use of technologies and patient care by attending training programs and gaining further education. This study recommends that hospital administrators should support sufficient facilities and technologies of care and, in particular, increase the competency of nurses in caring for critically ill patients as the whole person.
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Current issue of “Intensive and Critical Care Nursing” Volume 46 June 2018

The current issue content page can be accessed via this link.
iccn

Articles published in this issue include; “The communication experience of tracheostomy patients with nurses in the intensive care unit: A phenomenological study”, “The effect of provision of information on serum cortisol in patients transferred from the coronary care unit to the general ward: A randomised controlled trial” and “Standardised simulation-based emergency and intensive care nursing curriculum to improve nursing students’ performance during simulated resuscitation: A quasi-experimental study”.
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Implementation of an Evidence-Based Practice Nursing Handover Tool in Intensive Care Using the Knowledge-to-Action Framework

This article in the March 2018 issue of “Worldviews on Evidence Based Nursing” is by Spooner and colleagues.
Background:  Miscommunication during handover has been linked to adverse patient events and is an international patient safety priority. Despite the development of handover resources, standardized handover tools for nursing team leaders (TLs) in intensive care are limited.
Aims:  The study aim was to implement and evaluate an evidence-based electronic minimum data set for nursing TL shift-to-shift handover in the intensive care unit using the knowledge-to-action (KTA) framework.
Methods:  This study was conducted in a 21-bed medical-surgical intensive care unit in Queensland, Australia. Senior registered nurses involved in TL handover were recruited. Three phases of the KTA framework (select, tailor, and implement interventions; monitor knowledge use; and evaluate outcomes) guided the implementation and evaluation process. A post-implementation practice audit and survey were carried out to determine nursing TL use and perceptions of the electronic minimum data set 3 months after implementation. Results are presented using descriptive statistics (median, IQR, frequency, and percentage).
Results:  Overall (86%, n = 49), TLs’ use of the electronic minimum data set for handover and communication regarding patient plan increased. Key content items, however, were absent from handovers and additional documentation was required alongside the minimum data set to conduct handover. Of the TLs surveyed (n = 35), those receiving handover perceived the electronic minimum data set more positively than TLs giving handover (n = 35). Benefits to using the electronic minimum data set included the patient content (48%), suitability for short-stay patients (16%), decreased time updating (12%), and printing the tool (12%). Almost half of the participants, however, found the minimum data set contained irrelevant information, reported difficulties navigating and locating relevant information, and pertinent information was missing. Suggestions for improvement focused on modifications to the electronic handover interface.
Linking Evidence to Action:  Prior to developing and implementing electronic handover tools, adequate infrastructure is required to support knowledge translation and to ensure clinician and organizational needs are met.
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Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

This article by Han et al was published in the Japan Journal of Nursing Science in December 2017.
Aim:  To examine theoxygen-502887_960_720 effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units.Methods:  A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared.

Results:  After education, there was a significant improvement in the nurses’ self-efficacy and clinical performance in emergency airway management situations.
Conclusion:  Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education.
Rotherham Foundation Trust Library members can order the full text of journal articles via our website using the article requests online via this link.

Effects of a simulated emergency airway management education program on the self-efficacy and clinical performance of intensive care unit nurses.

This article by Han et al was published in the Japan Journal of Nursing Science in December 2017.hospital-834152_960_720
Aim:  To examine the effects of a simulated emergency airway management education program on the self-efficacy and clinical performance among nurses in intensive care units.
Methods:  A one-group, pre- and post-test design was used. Thirty-five nurses who were working in adult intensive care units participated in this study. The simulation education program included lectures, skill demonstration, skill training, team-based practice, and debriefing. Self-efficacy and clinical performance questionnaires were completed before the program and 1 week after its completion. The data were analyzed by using descriptive statistics and the paired t-test to compare the mean differences between the pre-test and post-test. The scores before and after education were compared.
Results:  After education, there was a significant improvement in the nurses’ self-efficacy and clinical performance in emergency airway management situations.
Conclusion:  Simulation education effectively improved the self-efficacy and clinical performance of the nurses who were working in intensive care units. Based on the program for clinical nurses within a hospital, it will provide information that might advance clinical nursing education.
Library members can order the full text of journal articles via our website using the article requests online via this link.

Nursing Care Disparities in Neonatal Intensive Care Units.

This article was published in the September 2017 issue of Health Services Research by Lake et al.

Objectives:  To describe the variation across neonatal intensive care units (NICUs) in missed nursing care in disproportionately black and non-black-serving hospitals. To analyze the nursing factors associated with missing nursing care.

Data sources:  Survey of random samples of licensed nurses in four large U.S. states.

Study design:  This was a retrospective, secondary analysis of 1,037 staff nurses in 134 NICUs classified into three groups based on their percent of infants of black race. Measures included the average patient load, individual nurses’ patient loads, professional nursing characteristics, nurse work environment, and nursing care missed on the last shift.

Data collection:  Survey data from a Multi-State Nursing Care and Patient Safety Study were analyzed (39 percent response rate).

Principal Findings:  The patient-to-nurse ratio was significantly higher in high-black hospitals. Nurses in high-black NICUs missed nearly 50 percent more nursing care than in low-black NICUs. Lower nurse staffing (an additional patient per nurse) significantly increased the odds of missed care, while better practice environments decreased the odds.

Conclusions:  Nurses in high-black NICUs face inadequate staffing. They are more likely to miss required nursing care. Improving staffing and workloads may improve the quality of care for the infants born in high-black hospitals.

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The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review.

This article was published in the September issue of Human Resources for Health and written by Woo and colleagues.

Background:  The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes.

Objectives:  The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings.

Methods:  A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools.

Results:  Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings.

Conclusions:  Capitalizing on nurses in advanced practice to increase patients’ access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and critical care settings improves patient outcomes. The transformation of healthcare delivery through effective utilization of the workforce may alleviate the impending rise in demand for health services. Nevertheless, it is necessary to first prepare a receptive context to effect sustainable change.

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