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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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”

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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