Do health care professionals worry about delirium? Relatives’ experience of delirium in the intensive care unit: A qualitative interview study

This research by Bohart and colleagues was published online in “Intensive and Critical Care Nursing” during May 2019.
Objectives:  In intensive care units, there is a high incidence of delirium, which relates to the risk of complications. Engagement of relatives is an acknowledged part of handling delirium, but knowledge of relatives’ perspectives is lacking.
Aim:  To explore relatives’ experiences of delirium in the critically ill patient admitted to an intensive care unit.Research design:  A qualitative design with a phenomenological approach. Semi-structured interviews with eleven relatives of critically ill patients who had delirium during admission to the intensive care unit.Setting:  An intensive care unit in Denmark.
Findings:  Three categories emerged: ‘Delirium is not the main concern’, ‘Communication with health-care professionals is crucial’, and ‘Delirium impacts on relatives’. Relatives had a lack of knowledge of delirium. Symptoms of delirium were thought of as a natural consequence of critical illness and seemed to be a secondary problem. Health-care professionals did not talk about delirium and information was requested. Delirium and the manifestation of it was experienced in different ways and brought different ways of coping.
Conclusion:  Findings give a new insight into relatives’ experience of delirium in the intensive care unit. Relatives need more information to better understand delirium. Future research must investigate the potential in helping relatives to cope with delirium, to the benefit of both patient and relatives.
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Meaningful experiences and end-of-life care in the intensive care unit: A qualitative study

This article by Stokes and colleagues was online during April 2019 in “Intensive and Critical Care Nursing”.
Objectives:  The purpose of this study was to provide a comprehensive exploration of nurses’ meaningful experiences of providing end-of-life care to patients and families in the intensive care unit (ICU). The objectives of this research were: (1) To explore what is meaningful practice for nurses regarding end-of-life care; (2) To describe how nurses create a good death in the intensive care unit and (3) To identify the challenges that nurses face that affect their meaningful experiences and ultimately the creation of a good death.
Research design:  This study utilised an interpretive phenomenological approach using Van Manen’s (1997) method.
Setting:  In-depth, face-to-face interviews were conducted with six intensive care nurses employed in a 32-bed medical/surgical intensive care unit of an academic tertiary care centre in Canada.
Findings:  The overarching theme from the analysis of this experience was “being able to make a difference” which was intricately woven around contributing to a good death. Three main themes were identified and included: creating a good death, navigating the challenges and making it work.
Conclusion:  The findings reveal how intensive care nurses provide good end-of-life care and create good deaths for patients and families.
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.

Caring for non-sedated mechanically ventilated patients in ICU: A qualitative study comparing perspectives of expert and competent nurses

This article by Mortensen and colleagues was published on line in February 2019 in the Journal of Intensive and Critical Care Nursing.
Background:  Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction.
Objective:  We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients.
Method:  The study had a qualitative comparative design applying semi-structured dyadic interviews. We interviewed five pairs of expert and competent ICU nurses with respectively >8 and 2–3 years of ICU experience and performed qualitative content analysis to explore the two perspectives.
Findings:  We identified four main categories illustrating complexities of nurse-patient interaction: Managing frustration, Attempting dialogue, Negotiating reality and Alleviating discomfort. Expert nurses expressed more frustration and ambivalence towards light sedation than competent nurses, who took awake patients for granted. All nurses experienced communication issues, demanding patients, and inability to provide adequate patient comfort.
Conclusion:  Our study added to the knowledge of nurse-patient interaction by describing issues of frustration, ambivalence and insecurity in a contemporary context of minimal sedation. Expert nurses were mere concerned by awake patients than competent nurses. Lighter sedation in ICU requires better staffing and improved communication tools.
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.

A mixed methods exploration of intensive care unit nurses’ perception of handling oxygen therapy to critically ill patients

This article was published on line in “Intensive and Critical Nursing” in January 2019 by Bunkenborg and Bundgaard.
Objectives:  Nurses handle supplementary oxygen to intensive care unit patients as part of their daily practise. To secure patients of optimal and safe care, knowledge of nurses’ perception of this practise, including influencing factors for adjusting oxygenation levels is essential. This study aimed to explore intensive care nurses’ perception of handling oxygenation and of factors that govern and influence this practise.
Research methodology/design:  A mixed methods approach was applied comprising six focus group interviews, conducted in February/March 2017, leading to construction of a questionnaire distributed to 535 ICU nurses in September 2017. Following a process of content analysis, the findings were discussed against Gittell’s framework for relational coordination.
Setting:  Intensive care units in rural, urban and university hospital settings.
Main outcome:  A deeper understanding of nurses’ perception of handling oxygenation to patients in the intensive care unit.
Findings and results:  Findings are presented through the categories Treatment Guidance, Nursing Practise, Knowledge and Competences and Inter-professional Collaboration.
Conclusion:  Nurses’ practise of handling supplementary oxygen therapy to the intensive care patient is influenced by day-by-day physician prescribed upper and lower limits for pO2 and pCO2, by nurses’ understanding of the individual clinical patient situation and by knowledge of pros and cons in relation to oxygen therapy including observational and clinical assessment expertise. Establishing working environments in the intensive care unit setting based on mutual inter- and intra-professional respect may contribute to enhance safe and high quality patient care.
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.

Barriers in achieving patient participation in the critical care unit

This article by Falk, Schandl and Frank was published online in “Intensive and Critical Care Nursing” during December 2018.
Objectives:  Patient participation in healthcare is important for optimizing treatment outcomes and for ensuring satisfaction with care. Therefore, this study aims to identify barriers to patient participation in the critical care unit, as identified by critical care nurses.
Design and settings:  Qualitative data were collected in four focus group interviews with 17 nurses from two separate hospitals. The interviews were analyzed using qualitative content analysis.
Findings:  The results show three main categories: nurse’s attitude toward caring, the organization of the critical care unit and the patient’s health condition.
Conclusion:  Barriers for patient participation in the ICU were found and this lead to a power imbalance between patient and nurse. In contrast to other care settings, this imbalance could be a consequence of the critical care organization and its degree of highly specialized care. The clinical application of our results is that these barriers should be considered when implementing patient participation in such a highly technological care situation as a critical care unit.
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.

The Impact of Social Support Networks on Family Resilience in an Australian Intensive Care Unit: A Constructivist Grounded Theory.

This article by Wong and colleagues was published in the Journal of Nursing Scholarship during November 2018.
Purpose:  This article discusses the findings of a grounded theory of family resilience in an Australian intensive care unit (ICU) with a specific focus on families’experiences of their interactions with other members within their own family,and the families of other patients in the ICU.
Design:  A constructivist grounded theory methodology was adopted. Data were collected using in-depth interviews with 25 family members of 21 critically ill patients admitted to a tertiary-level ICU in Australia.
Findings:  The core category regaining control represents the families’ journey toward resilience when in ICU. The major categories represent facilitators for, and barriers to,regaining control. One of the main facilitators is drawing strength, and it explains the manner with which families receive social support from their own and other family members to help them cope.
Conclusions:  This study offers a framework to improve patient- and family-centered care in the ICU by facilitating families’ ability to manage their situation more effectively.Social support offered by family members facilitates the families’ ability to regain control. An ICU family resilience theoretical framework, situated within the context of the Australian healthcare system, adds to what is currently known about the families’ experiences in the ICU.
Clinical Relevance: The relationships that develop between families in the ICU may provide a source of social support; however, not all families welcome interactions with other ICU families, and it may cause further emotional distress. Further research is warranted to determine whether families suffer a secondary stress reaction from incidental interactions with other patients’ families in the ICU.Furthermore, when family members pull together and offer social support to each other, they are better able to regain control. This process contributes to an ICU family resilience framework.
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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.
To access the full text of this article via the journal’s homepage you require a personal subscription to the journal.  Some articles may be available freely without a password.  Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.