Monitoring Delirium in the Intensive Care Unit Practices, perceptions and attitudes of critical care nurses and physicians. A French National Survey

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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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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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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Factors Affecting Resilience and Development of Posttraumatic Stress Disorder in Critical Care Nurses

American Journal of Critical Care ◽

10.4037/ajcc2017798 ◽

2017 ◽

Vol 26 (3) ◽

pp. 184-192 ◽

Cited By ~ 30

Author(s):

Meredith Mealer ◽

Jacqueline Jones ◽

Paula Meek

Keyword(s):

Intensive Care Unit ◽

Posttraumatic Stress Disorder ◽

Critical Care ◽

Intensive Care ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Critical Care Nurses ◽

Burnout Syndrome ◽

Cumulative Exposure ◽

Graduate Degree

Background Job stress and cumulative exposure to traumatic events experienced by critical care nurses can lead to psychological distress and the development of burnout syndrome and posttraumatic stress disorder. Resilience can mitigate symptoms associated with these conditions. Objective To identify factors that affect resilience and to determine if the factors have direct or indirect effects on resilience in development of posttraumatic stress disorder. Methods Data from 744 respondents to a survey mailed to 3500 critical care nurses who were members of the American Association of Critical-Care Nurses were analyzed. Mplus was used to analyze a mediation model. Results Nurses who worked in any type of intensive care unit other than the medical unit and had high scores for resilience were 18% to 50% less likely to experience post-traumatic stress disorder than were nurses with low scores. Nurses with a graduate degree in nursing were 18% more likely to experience posttraumatic stress disorder than were nurses with a bachelor’s degree. Conclusion Because of their effects on resilience, working in a medical intensive care unit and having a graduate degree may influence the development of posttraumatic stress disorder. Future research is needed to better understand the impact of resilience on health care organizations, development of preventive therapies and treatment of posttraumatic stress disorder for critical care nurses, and the most appropriate mechanism to disseminate and implement strategies to address posttraumatic stress disorder.

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Critical Care Nurses’ Experiences During the COVID-19 Pandemic: A US National Survey

American Journal of Critical Care ◽

10.4037/ajcc2022312 ◽

2021 ◽

pp. e1-e7

Author(s):

Jill L. Guttormson ◽

Kelly Calkins ◽

Natalie McAndrew ◽

Jacklynn Fitzgerald ◽

Holly Losurdo ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Moral Distress ◽

Community Support ◽

Well Being ◽

The United States ◽

Critical Care Nurses ◽

Emotional Symptoms

Background Given critical care nurses’ high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the ICU workforce. Objective To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States. Methods Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic. Results Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses’ feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent. Conclusions Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses’ experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

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Nurse Project Consultant: Critical Care Nurses Move Beyond the Bedside to Affect Quality and Safety

Critical Care Nurse ◽

10.4037/ccn2018838 ◽

2018 ◽

Vol 38 (3) ◽

pp. 54-66 ◽

Cited By ~ 2

Author(s):

Lynn G. Mackinson ◽

Juliann Corey ◽

Veronica Kelly ◽

Kristin P. O’Reilly ◽

Jennifer P. Stevens ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Care Delivery ◽

Critical Care Nurses ◽

Lessons Learned ◽

Scope Of Practice ◽

Clinical Expertise ◽

Health Care Delivery Systems

A nurse project consultant role empowered 3 critical care nurses to expand their scope of practice beyond the bedside and engage within complex health care delivery systems to reduce harms in the intensive care unit. As members of an interdisciplinary team, the nurse project consultants contributed their clinical expertise and systems knowledge to develop innovations that optimize care provided in the intensive care unit. This article discusses the formal development of and institutional support for the nurse project consultant role. The nurse project consultants’ responsibilities within a group of quality improvement initiatives are described and their challenges and lessons learned discussed. The nurse project consultant role is a new model of engaging critical care nurses as leaders in health care redesign.

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Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

Journal of Intensive Care Medicine ◽

10.1177/0885066617696853 ◽

2017 ◽

Vol 34 (4) ◽

pp. 311-322 ◽

Cited By ~ 11

Author(s):

Amir Vahedian-Azimi ◽

Mohammadreza Hajiesmaeili ◽

Mari Kangasniemi ◽

Joana Fornés-Vives ◽

Rita L. Hunsucker ◽

...

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Critical Care Nurses ◽

Peer Collaboration ◽

Burnout Syndrome ◽

Survey Method ◽

Post Traumatic Stress ◽

Cross Sectional ◽

Stress Levels

Background: Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future. Methods: We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey. Results: We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse–patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels. Conclusion: As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

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