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

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.

Giving nurses a voice during ethical conflict in the Intensive Care Unit

2020 ◽  
Vol 27 (8) ◽  
pp. 1631-1644
Author(s):  
Natalie S McAndrew ◽  
Joshua B Hardin
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Ethics Education ◽  
Moral Distress ◽  
Academic Medical Center ◽  
The United States ◽  
Critical Care Nurses ◽  
Organizational Resources ◽  
Ethical Conflict

Background: Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit. Research question/objectives/methods: The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice. Participants and research context: Responses to two open-ended questions were collected from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States. Ethical considerations: This study was approved by the Institutional Review Board at the organization where the study took place. Findings: Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict. Discussion: Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict. Conclusion: These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care.

scholarly journals Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects

2011 ◽  
Vol 115 (6) ◽  
pp. 1349-1362 ◽  
Author(s):  
Lee P. Skrupky ◽  
Paul W. Kerby ◽  
Richard S. Hotchkiss
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
The United States ◽  
Difficult Problem ◽  
Treatment Algorithms ◽  
New Treatment ◽  
Overall Mortality

Anesthesiologists are increasingly confronting the difficult problem of caring for patients with sepsis in the operating room and in the intensive care unit. Sepsis occurs in more than 750,000 patients in the United States annually and is responsible for more than 210,000 deaths. Approximately 40% of all intensive care unit patients have sepsis on admission to the intensive care unit or experience sepsis during their stay in the intensive care unit. There have been significant advances in the understanding of the pathophysiology of the disorder and its treatment. Although deaths attributable to sepsis remain stubbornly high, new treatment algorithms have led to a reduction in overall mortality. Thus, it is important for anesthesiologists and critical care practitioners to be aware of these new therapeutic regimens. The goal of this review is to include practical points on important advances in the treatment of sepsis and provide a vision of future immunotherapeutic approaches.

Moral Distress of Staff Nurses in a Medical Intensive Care Unit

2005 ◽  
Vol 14 (6) ◽  
pp. 523-530 ◽  
Author(s):  
Ellen H. Elpern ◽  
Barbara Covert ◽  
Ruth Kleinpell
Keyword(s):  
Job Satisfaction ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Moral Distress ◽  
Medical Intensive Care Unit ◽  
Well Being ◽  
Individual Characteristics ◽  
Medical Intensive Care ◽  
Distress Scale

• Background Moral distress is caused by situations in which the ethically appropriate course of action is known but cannot be taken. Moral distress is thought to be a serious problem among nurses, particularly those who practice in critical care. It has been associated with job dissatisfaction and loss of nurses from the workplace and the profession.• Objectives To assess the level of moral distress of nurses in a medical intensive care unit, identify situations that result in high levels of moral distress, explore implications of moral distress, and evaluate associations among moral distress and individual characteristics of nurses.• Methods A descriptive, questionnaire study was used. A total of 28 nurses working in a medical intensive care unit anonymously completed a 38-item moral distress scale and described implications of experiences of moral distress.• Results Nurses reported a moderate level of moral distress overall. Highest levels of distress were associated with the provision of aggressive care to patients not expected to benefit from that care. Moral distress was significantly correlated with years of nursing experience. Nurses reported that moral distress adversely affected job satisfaction, retention, psychological and physical well-being, self-image, and spirituality. Experience of moral distress also influenced attitudes toward advance directives and participation in blood donation and organ donation.• Conclusions Critical care nurses commonly encounter situations that are associated with high levels of moral distress. Experiences of moral distress have implications that extend well beyond job satisfaction and retention. Strategies to mitigate moral distress should be developed and tested.

scholarly journals Critical Care Recovery Center: a model of agile implementation in intensive care unit (ICU) survivors

2019 ◽  
Vol 32 (12) ◽  
pp. 1409-1418 ◽  
Author(s):  
Sophia Wang ◽  
Philip Hanneman ◽  
Chenjia Xu ◽  
Sujuan Gao ◽  
Duane Allen ◽  
...  
Keyword(s):  
Mental Health ◽  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Focus Group ◽  
The United States ◽  
Mental Health Symptoms ◽  
Health Symptoms

ABSTRACTBackground:As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI).Methods:The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS.Results:Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences.Conclusions:Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.

scholarly journals Report on the Third International Intensive Care Unit Diary Conference

2020 ◽  
Vol 40 (5) ◽  
pp. e18-e25 ◽  
Author(s):  
Peter Nydahl ◽  
Ingrid Egerod ◽  
Megan M. Hosey ◽  
Dale M. Needham ◽  
Christina Jones ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Psychiatric Morbidity ◽  
Implementation Strategies ◽  
The United States ◽  
Staff Members ◽  
The Third ◽  
Post Intensive Care Syndrome

Topic Many patients in intensive care units have frightening experiences and memories and subsequent post–intensive care syndrome, with psychiatric morbidity including depression, anxiety, and posttraumatic stress disorder. Intensive care unit diaries, written by staff members and families, support patients’ understanding of what occurred and may alleviate their psychological suffering. Clinical Relevance An increasing number of critical care nurses in the United States and elsewhere are implementing intensive care unit diaries, but implementation remains challenging. Purpose To address emerging questions and support implementation in the United States, we held the Third International Intensive Care Unit Diary Conference as a 1-day preconference during the Seventh Annual Johns Hopkins Critical Care Rehabilitation Conference on November 1, 2018, in Baltimore, Maryland. This article summarizes the conference. Content Covered Conference presentations included intensive care unit–related experiences of patients and families, psychosocial aspects of post–intensive care syndrome, the evolution of diaries, implementation strategies for intensive care unit diaries, special topics (eg, legal issues, electronic vs handwritten diaries, pediatric diaries, and time of handover), and psychosocial recovery.

scholarly journals Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 381-383
Author(s):  
Steven Liu ◽  
Cara Sweeney ◽  
Nalinee Srisarajivakul-Klein ◽  
Amanda Klinger ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
New York ◽  
New York City ◽  
Intensive Care ◽  
Initial Phase ◽  
The United States ◽  
Lessons Learned ◽  
Hypoxemic Respiratory Failure ◽  
Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

scholarly journals Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

2014 ◽  
Vol 35 (10) ◽  
pp. 1304-1306 ◽  
Author(s):  
David J. Weber ◽  
David van Duin ◽  
Lauren M. DiBiase ◽  
Charles Scott Hultman ◽  
Samuel W. Jones ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
The United States ◽  
Burn Injuries ◽  
Morbidity And Mortality ◽  
Common Source ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

scholarly journals Family Behaviors as Unchanging Obstacles in End-of-Life Care: 16-Year Comparative Data

2020 ◽  
Vol 29 (4) ◽  
pp. e81-e91
Author(s):  
Renea L. Beckstrand ◽  
Jasmine B. Jenkins ◽  
Karlen E. Luthy ◽  
Janelle L. B. Macintosh
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Critical Care Nurses ◽  
Life Care ◽  
Care Providers ◽  
Over Time

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.

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

2006 ◽  
Vol 15 (5) ◽  
pp. 480-491 ◽  
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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