Ward visits- one essential step in intensive care follow-up. An interview study with critical care nurses’ and ward nurses’

Background Critical care nurses routinely care for dying patients. Research on obstacles in providing end-of-life care has been conducted for more than 20 years, but change in such obstacles over time has not been examined. Objective To determine whether the magnitude scores of obstacles and helpful behaviors regarding end-of-life care have changed over time. Methods In this cross-sectional survey study, questionnaires were sent to 2000 randomly selected members of the American Association of Critical-Care Nurses. Obstacle and helpful behavior items were analyzed using mean magnitude scores. Current data were compared with data gathered in 1999. Results Of the 2000 questionnaires mailed, 509 usable responses were received. Six obstacle magnitude scores increased significantly over time, of which 4 were related to family issues (not accepting the poor prognosis, intrafamily fighting, overriding the patient’s end-of-life wishes, and not understanding the meaning of the term lifesaving measures). Two were related to nurse issues. Seven obstacles decreased in magnitude, including poor design of units, overly restrictive visiting hours, and physicians avoiding conversations with families. Four helpful behavior magnitude scores increased significantly over time, including physician agreement on patient care and family access to the patient. Three helpful behavior items decreased in magnitude, including intensive care unit design. Conclusions The same end-of-life care obstacles that were reported in 1999 are still present. Obstacles related to family behaviors increased significantly, whereas obstacles related to intensive care unit environment or physician behaviors decreased significantly. These results indicate a need for better end-of-life education for families and health care providers.

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Practice of Expert Critical Care Nurses in Situations of Prognostic Conflict at the End of Life

American Journal of Critical Care ◽

10.4037/ajcc2006.15.5.480 ◽

2006 ◽

Vol 15 (5) ◽

pp. 480-491 ◽

Cited By ~ 48

Author(s):

Catherine McBride Robichaux ◽

Angela P. Clark

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

End Of Life ◽

Narrative Analysis ◽

Critical Care Nurses ◽

Realistic Picture ◽

Inappropriate Treatment ◽

Expert Nurses ◽

End Of Life Decision

• Background Prolonging the living-dying process with inappropriate treatment is a profoundly disturbing ethical issue for nurses in many practice areas, including the intensive care unit. Despite the frequent occurrence of such distressing events, research suggests that critical care nurses assume a limited role in end-of-life decision making and care planning. • Objectives To explore the practice of expert critical care nurses in end-of-life conflicts and to describe actions taken when the nurses thought continued aggressive medical interventions were not warranted. • Methods A qualitative design was used with narrative analysis of interview data that had a temporal ordering of events. Interviews were conducted with 21 critical care nurses from 7 facilities in the southwestern United States who were nominated as experts by their colleagues. • Results Three recurrent narrative plots were derived: protecting or speaking for the patient, presenting a realistic picture, and experiencing frustration and resignation. Narratives of protecting or speaking for the patient concerned preventing further technological intrusion and thus permitting a dignified death. Presenting a realistic picture involved helping patients’ family members reframe the members’ sense of the potential for recovery. Inability to affect a patient’s situation was expressed in narratives of frustration and resignation. • Conclusions The transition from curative to end-of-life care in the intensive care unit is often fraught with ambiguity and anguish. The expert nurses demonstrated the ability and willingness to actively protect and advocate for their vulnerable patients even in situations in which the nurses’ actions did not influence the outcomes.

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Eliciting critical care nurses’ beliefs regarding physical restraint use

Nursing Ethics ◽

10.1177/0969733017752547 ◽

2018 ◽

Vol 26 (5) ◽

pp. 1458-1472 ◽

Cited By ~ 11

Author(s):

Gemma Via-Clavero ◽

Marta Sanjuán-Naváis ◽

Marta Romero-García ◽

Laura de la Cueva-Ariza ◽

Gemma Martínez-Estalella ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Theory Of Planned Behaviour ◽

Physical Restraint ◽

Critical Care Nurses ◽

Control Beliefs ◽

Physical Restraints ◽

Planned Behaviour ◽

Restraint Use ◽

And Control

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

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Pain in Intensive Care Unit: Italian critical care nurses' best practice

Minerva Anestesiologica ◽

10.23736/s0375-9393.21.15565-8 ◽

2021 ◽

Vol 87 (7) ◽

Author(s):

Alessandro GALAZZI ◽

Gian D. GIUSTI ◽

Nicola PAGNUCCI ◽

Stefano BAMBI ◽

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Best Practice ◽

Critical Care Nurses

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Decisions Made By Critical Care Nurses During Mechanical Ventilation and Weaning in an Australian Intensive Care Unit

American Journal of Critical Care ◽

10.4037/ajcc2007.16.5.434 ◽

2007 ◽

Vol 16 (5) ◽

pp. 434-443 ◽

Cited By ~ 21

Author(s):

Louise Rose ◽

Sioban Nelson ◽

Linda Johnston ◽

Jeffrey J. Presneill

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Critical Care ◽

Intensive Care ◽

Interdisciplinary Collaboration ◽

Multiple Organ ◽

Critical Care Nurses ◽

Royal Melbourne Hospital ◽

Adult Intensive Care Unit ◽

Fraction Of Inspired Oxygen

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

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Moral distress of critical care nurses

American Journal of Critical Care ◽

10.4037/ajcc1995.4.4.280 ◽

1995 ◽

Vol 4 (4) ◽

pp. 280-285 ◽

Cited By ~ 129

Author(s):

MC Corley

Keyword(s):

Factor Analysis ◽

Critical Care ◽

Intensive Care ◽

Private Hospital ◽

Moral Distress ◽

Medical Center ◽

Critical Care Nurses ◽

Moral Integrity ◽

Healthcare Organizations ◽

Aggressive Care

BACKGROUND: Constraint of nurses by healthcare organizations, from actions the nurses believe are appropriate, may lead to moral distress. OBJECTIVE: To present findings on moral distress of critical care nurses, using an investigator-developed instrument. METHODS: An instrument development design using consensus by three expert judges, test-retest reliability, and factor analysis was used. Study participants (N = 111) were members of a chapter of the American Association of Critical-Care Nurses, critical care nurses employed in a large medical center, and critical care nurses from a private hospital. A 32-item instrument included items on prolonging life, performing unnecessary tests and treatments, lying to patients, and incompetent or inadequate treatment by physicians. RESULTS: Three factors were identified using factor analysis after expert consensus on the items: aggressive care, honesty, and action response. Nurses in the private hospital reported significantly greater moral distress on the aggressive care factor than did nurses in the medical center. Nurses not working in intensive care experienced higher levels of moral distress on the aggressive care factor than did nurses working in intensive care. Of the 111 nurses, 12% had left a nursing position primarily because of moral distress. CONCLUSIONS: Although the mean scores showed somewhat low levels of moral distress, the range of responses revealed that some nurses experienced high levels of moral distress with the issues. Research is needed on conditions organizations must provide to support the moral integrity of critical care nurses.

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ICU nurses' coping measures: response to work-related stressors

Critical Care Nurse ◽

10.4037/ccn1992.12.2.18 ◽

1992 ◽

Vol 12 (2) ◽

pp. 18-23 ◽

Cited By ~ 21

Author(s):

DJ Lewis ◽

JA Robinson

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critical Care Nurses ◽

Work Related Stress ◽

Work Related ◽

Related Stress ◽

Work Related Stressors

Stress is an integral part of every workplace. The environment of an intensive care unit exposes critical care nurses to a proportionately greater amount of work-related stress than most occupations. Several components contributing to stress as well as coping measures are discussed in this article.

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Marfan's syndrome

Critical Care Nurse ◽

10.4037/ccn1991.11.4.69 ◽

1991 ◽

Vol 11 (4) ◽

pp. 69-72 ◽

Cited By ~ 2

Author(s):

JK Anderson

Keyword(s):

Critical Care ◽

Intensive Care ◽

Patient Education ◽

Clinical Presentation ◽

Critical Care Nurses ◽

Frequent Occurrence ◽

Marfan’S Syndrome ◽

Marfan's Syndrome

Although Marfan's syndrome is not a frequent occurrence in critical care, serious cardiovascular problems can exist, requiring intensive care. This article has identified the manifestations in those coping with Marfan's syndrome. Critical care nurses need to be aware of the clinical presentation and pathophysiology of the problem to understand the treatment and assist in patient education.

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