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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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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Peer Support in Critical Care: A Systematic Review

This review by Haines et al was published in Critical Care Medicine in September 2018.
Objectives:  Identifying solutions to improve recovery after critical illness is a pressing problem. We systematically evaluated studies of peer support as a potential intervention to improve recovery in critical care populations and synthesized elements important to peer support model design.
Data sources:  A systematic search of Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Excertpa Medica Database was undertaken May 2017.
Study selection:  Two independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were included where 1) patients and families had experienced critical illness and 2) patients and families had participated in a peer support intervention. Discrepancies were resolved by consensus and a third independent reviewer adjudicated as necessary.
Data extraction:  Two independent reviewers assessed study quality with the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool, and data were synthesized according to the Preferred Reporting Items for Systematic Reviews guidelines and interventions summarized using the Template for Intervention Description and Replication Checklist.
Data synthesis:  Two-thousand nine-hundred thirty-two studies were screened. Eight were included, comprising 192 family members and 92 patients including adults (with cardiac surgery, acute myocardial infarction, trauma), paediatrics, and neonates. The most common peer support model of the eight studies was an in-person, facilitated group for families that occurred during the patients’ ICU admission. Peer support reduced psychologic morbidity and improved social support and self-efficacy in two studies; in both cases, peer support was via an individual peer-to-peer model. In the remaining studies, it was difficult to determine the outcomes of peer support as the reporting and quality of studies was low.
Conclusions:  Peer support appeared to reduce psychologic morbidity and increase social support. The evidence for peer support in critically ill populations is limited. There is a need for well-designed and rigorously reported research into this complex intervention.
To access the full text of these articles via the journal’s homepage you require a personal subscription to the journal. Library members can order individual articles via the Rotherham NHS Foundation Trust Library and Knowledge Service using the article requests online via this link.

Burnout and health among critical care professionals

To analyse the mediational role of resilience in relationships between burnout and health in critical care professionals; to determine relationships among resilience level, three burnout dimensions, and physical/mental health | Intensive & Critical Care Nursing


Participants/setting: A total of 52 critical care professionals, mainly nurses, were recruited from an intensive care unit of Madrid (Spain).

Conclusions: Resilience minimises and buffers the impact of negative outcomes of workplace stress on mental health of critical care professionals. As a result, resilience prevents the occurrence of burnout syndrome. Resilience improves not only their mental health, but also their ability to practice effectively. It is therefore imperative to develop resilience programs for critical care nurses in nursing schools, universities and health centres.

Full reference: Arrogante, O & Aparicio-Zaldivar, E. (2017) Burnout and health among critical care professionals: The mediational role of resilience. Intensive & Critical Care Nursing. DOI:

Measuring Moral Distress Among Critical Care Clinicians

Lamiani, G. et al. Critical Care Medicine. Published online: December 7 2016

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Objectives: Moral distress is a common experience among critical care professionals, leading to frustration, withdrawal from patient care, and job abandonment. Most of the studies on moral distress have used the Moral Distress Scale or its revised version (Moral Distress Scale-Revised). However, these scales have never been validated through factor analysis. This article aims to explore the factorial structure of the Moral Distress Scale-Revised and develop a valid and reliable scale through factor analysis.

Conclusions: The Italian Moral Distress Scale-Revised is a valid and reliable instrument to assess moral distress among critical care clinicians and develop tailored interventions addressing its different components. Further research could test the generalizability of its factorial structure in other cultures.

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Perceived Nonbeneficial Treatment of Patients, Burnout, and Intention to Leave the Job Among ICU Nurses and Junior and Senior Physicians.

Schwarzkopf, D. et al. Critical Care Medicine. Published online: October 21 2016

businessman-150451_960_720Objectives: Perceiving nonbeneficial treatment is stressful for ICU staff and may be associated with burnout. We aimed to investigate predictors and consequences of perceived nonbeneficial treatment and to compare nurses and junior and senior physicians.

Design: Cross-sectional, multicenter paper-pencil survey on personal and work-related characteristics, perceived nonbeneficial treatment, burnout, and intention to leave the job.

Setting: Convenience sample of 23 German ICUs.

Subjects: ICU nurses and physicians.

Interventions: None.

Measurements and Main Results: A total of 847 questionnaires were returned (51% response); 778 had complete data for final multivariate analyses. Nonbeneficial treatment was in median perceived “sometimes.” Adjusted for covariates, it was perceived more often by nurses and junior physicians (both p <= 0.001 in comparison to senior physicians), while emotional exhaustion was highest in junior physicians (p <= 0.015 in comparison to senior physicians and nurses), who also had a higher intention to leave than nurses (p = 0.024). Nonbeneficial treatment was predicted by high workload and low quality collaboration with other departments (both p <= 0.001). Poor nurse-physician collaboration predicted perception of nonbeneficial treatment among junior physicians and nurses (both p <= 0.001) but not among senior physicians (p = 0.753). Nonbeneficial treatment was independently associated with the core burnout dimension emotional exhaustion (p <= 0.001), which significantly mediated the effect between nonbeneficial treatment and intention to leave (indirect effect: 0.11 [95% CI, 0.06-0.18]).

Conclusions: Perceiving nonbeneficial treatment is related to burnout and may increase intention to leave. Efforts to reduce perception of nonbeneficial treatment should improve the work environment and should be tailored to the different experiences of nurses and junior and senior physicians.

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Causes of Moral Distress in the ICU: A Qualitative Study

Henrich, N.J. et al. Journal of Critical Care. Published online: 12 May 2016

Purpose: To examine the causes of moral distress in diverse members of the ICU team in both community and tertiary ICUs.

Materials and Methods: We used focus groups and coding of transcripts into themes and sub-themes in 2 tertiary care intensive care units and 1 community intensive care unit.

Results: Based on input from 19 staff nurses (3 focus groups), 4 clinical nurse leaders (1 focus group), 13 physicians (3 focus groups), and 20 other health professionals (3 focus groups), the most commonly reported causes of moral distress were concerns about the care provided by other health care workers, the amount of care provided (especially too much care at end of life), poor communication, inconsistent care plans, and issues around end of life decision-making.

Conclusions: Causes of moral distress vary among ICU professional groups but all are amenable to improvement.

Read the abstract here