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.

Strengthening workplace well-being: perceptions of intensive care nurses

This article by Jarden et al was published in the September 2018 issue of Nursing in Critical Care.
Background:  Intensive care nursing is a professionally challenging role, elucidated in the body of research focusing on nurses’ ill-being, including burnout, stress, moral distress and compassion fatigue. Although scant, research is growing in relation to the elements contributing to critical care nurses’ workplace well-being. Little is currently known about how intensive care nurse well-being is strengthened in the workplace, particularly from the intensive care nurse perspective.
Aims and Objectives:  Identify intensive care nurses’ perspectives of strategies that strengthen their workplace well-being.
Design:  An inductive descriptive qualitative approach was used to explore intensive care nurses’ perspectives of strengthening work well-being.
Method:  New Zealand intensive care nurses were asked to report strategies strengthening their workplace well-being in two free-text response items within a larger online survey of well-being.
Findings:  Sixty-five intensive care nurses identified 69 unique strengtheners of workplace well-being. Strengtheners included nurses drawing from personal resources, such as mindfulness and yoga. Both relational and organizational systems’ strengtheners were also evident, including peer supervision, formal debriefing and working as a team to support each other.
Conclusions:  Strengtheners of intensive care nurses’ workplace well-being extended across individual, relational and organizational resources. Actions such as simplifying their lives, giving and receiving team support and accessing employee assistance programmes were just a few of the intensive care nurses’ identified strengtheners. These findings inform future strategic workplace well-being programmes, creating opportunities for positive change.
Relevance to clinical practice:  Intensive care nurses have a highly developed understanding of workplace well-being strengtheners. These strengtheners extend from the personal to inter-professional to organizational. The extensive range of strengtheners the nurses have identified provides a rich source for the development of future workplace well-being programmes for critical care.
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Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses’ and ward nurses’.

This article was published in “Intensive and Critical Care Nursing” September 2018 issue by Haggstrom and colleagues.
Objective:  The aim of this study was to describe critical care nurses’ and ward nurses’ perceptions of the benefits and challenges with a nurse-led follow-up service for intensive care-survivors at general wards.
Background:  Patients recently transferred from intensive care to the general ward are still vulnerable and require complex care. There are different models of intensive care follow-up services and some include ward visits after transfer from intensive care. Research methodology/design: This study had a qualitative design. Data from 13 semi-structured interviews with Swedish critical care nurses and ward nurses were analysed using qualitative content analysis.
Findings:  The findings consisted of one theme, namely, “Being a part of an intra-organisational collaboration for improved quality of care”, and four subthemes: “Provides additional care for the vulnerable patients, “Strengthens ward-based critical care”, “Requires coordination and information”, and “Creates an exchange of knowledge”. The nurse-led follow-up service detected signs of deterioration and led to better quality of care. However, shortage of time, lack of interaction, feedback and information about the function of the follow-up service led to problems.
Conclusion:  The findings indicate that ward visits should be included in the intensive care follow-up service. Furthermore, intra-organisational collaboration seems to be essential for intensive care survivors’ quality of care.
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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.
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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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