The influence of simulation in predicting intent to stay, among critical care nurses

Aim: This paper will present a study, which tested a theoretical Critical Care Nurse Retention model and mechanisms that may influence intent to stay in the organization, unit and nursing profession. Background: The current international nursing shortage is worsening and is particularly acute in critical care settings. There is a rapidly aging nursing workforce and at the same time a significant shortfall in the number of new graduates to replace the large numbers of retiring nurses. Intensive care units have been shown to have the highest turnover rates and there is limited scientific evidence on how to retain critical care nurses. One of the most commonly listed incentives for nurses is organizational support in the form of access to educational opportunities and career development. Design: A quasi-experimental longitudinal design was used in a random sample of 363 critical care nurses from multiple hospital sites in Ontario. Method: The 374-hour intervention included an online component, high-fidelity simulation, and a preceptored clinical component. Data Analysis: ANCOVA and hierarchical regression were used to analyze the hypothesized model. Results: Findings showed the professional development intervention had a direct effect on intent to stay in the unit and intent to stay in the profession. Final analysis revealed that the model explained 23% of the variance in intent to stay in the profession. Conclusion: This research provides new evidence supporting the relevance and importance of investing in professional development opportunities and its subsequent impact on intent to stay.

A call for standardized national guidelines on QT/QTc monitoring in Canada

Background: With QT-prolonging drugs being trialed for the treatment of COVID-19, national health associations allude to the importance of proficient QT interval assessment. However, in Canada there is no policy in place that clearly identifies a single method for routine QT monitoring. Aim: To demonstrate the need for a clear Canadian guideline for the measurement of the QT/QTc interval and to advocate for a standardized approach to education. Methods: This paper uses a medical anthropological approach to scale this practice gap from the individual provider to the institutions that govern practice and education. Nurses and emergency medical personnel from hospitals across Canada were polled with questionnaires on their confidence and knowledge of assessing the QT/QTc interval. We seek to identify causes for the widespread lack of confidence that goes beyond the context of nursing and is interdisciplinary in nature. Findings: Of the 292 participants who were polled, roughly 75% report measuring the QT interval. However, more than 50% of participants are not confident in their measurement. Although critical care nurses report the highest levels of confidence, the rate of correct answers amongst the whole of participants on knowledge-based questions is shockingly low (only nine percent attempted to provide a value for the QTc; 34% of those who were unsure of the normal QTc say they were not taught). Ninety percent of participants report they do not analyze the QTc, with critical care nurses accounting for 34% of participants. Conclusion: The lack of consensus on a QTc formula and the absence of clear guidelines on this well-documented issue exacerbate the continued gap in practice observed in our findings. We urge leading organizations to create a national guideline that supports a standardized approach to QT/QTc measurement that can be taught to and used by not only critical care nurses, but everyone in healthcare who provides cardiac monitoring.

Rôle de l’infirmière lors de la prise en charge d’une personne ventilée aux soins intensifs : une revue narrative

En pratique clinique, l’infirmière joue un rôle essentiel dans la prise en charge de la personne ventilée aux soins intensifs. Afin de mieux comprendre ce rôle, une revue narrative de la littérature a été effectuée en sciences infirmières et plus précisément, la littérature qui porte sur la prise en charge des personnes ventilées aux soins intensifs. Une recherche des bases de données MEDLINE, Nursing & Allied Health Database, CINAHL et PsycINFO a généré 1107 écrits. Après avoir appliqué nos critères de sélection, un total de 45 écrits ont été sélectionnés et analysés. Nos résultats suggèrent que la gestion de l’anxiété, l’agitation, la douleur, la dyspnée, l’hygiène, le sommeil et l’environnement font partie intégrante du rôle de l’infirmière vis-à-vis de la prise en charge d’une personne ventilée aux soins intensifs. L’infirmière est également le lien de communication entre la personne ventilée, les membres de sa famille et l’équipe de soins. Toutefois, l’infirmière rencontre plusieurs obstacles lorsqu’elle prend en charge une personne ventilée, notamment le manque de connaissances, de ressources, de temps, de collaboration et d’autonomie. D’autres recherches sont nécessaires afin de relever les nombreux obstacles auxquels les infirmières sont confrontées et d’identifier des pistes de solutions au plan clinique.

Diagnosis of chronic post-hypoxic myoclonus in near hanging survivor: Case report

A 39-year-old male, who attempted suicide by hanging, developed chronic myoclonus with intact cognitive function. Chronic post-hypoxic myoclonus is a rare syndrome that may develop after a respiratory arrest and it presents as late onset and persistent purposeful myoclonus with preserved or slightly impaired cognitive function. Increasing critical care nurses’ awareness of chronic post-hypoxic myoclonus will lead to earlier diagnosis of this rare syndrome.

Explicit recall related to mechanical ventilation: An evolutionary concept analysis

Mechanical ventilation combined with sedation is widely used in the intensive care unit (ICU). However, this intervention is not without consequence on the patient. ICU patients can, in fact, remember perceptions that occurred during their mechanical ventilation—a phenomenon known as explicit recall. This phenomenon is not well defined, and no common terminology exists in the medical and nursing literature, where a variety of concepts are used interchangeably to describe the same experience. The goal of this concept analysis was to address the conceptual vagueness that surrounds explicit recall. Using Rodgers’ evolutionary approach, a total of 68 articles were analyzed to identify the concept’s antecedents, attributes, and consequences. The findings revealed that the explicit recall concept is perceptive, interpretative, subjective, dynamic, and temporal. It occurs following treatment that requires general anesthesia or sedation. It is also shaped by the modalities of anesthesia and sedation, as well as individual characteristics. Consequences of explicit recall can include anxiety, flashbacks, and post-traumatic stress disorder.

Supporting ethical ICU nursing practice in organ donation: An analysis of personhood

Organ donation is critical to the survival of thousands of people waiting for an organ transplant. While nurses take responsibility for patient and family comfort and quality of dying whenever patients die in the intensive care unit (ICU), organ donation presents unique challenges to these ideals. Critical care settings are essential for organ donation, where candidates for donation are identified, referred, stabilized, and maintained until organs can be retrieved. Nurses may feel challenged in completing organ donation-related tasks without forsaking values and practices that are typically associated with a palliative nursing approach and the achievement of a ‘good death’ in the ICU. Further, the moral uncertainty in this context could be increasing, given the advent of a new pathway for organ donation in ICU: medical assistance in dying (MAiD). In this paper, we reflect on the ethical meanings, challenges and possibilities of a good death in the context of organ donation in ICU nursing. We argue that personhood—as a conceptual frame to guide nursing practice—offers one way of reconciling seemingly disparate values and practices. To illustrate the importance of integrating this concept, we draw on real-life case studies from clinical ICU nursing. These examples showcase the emotional engagement and moral tension that nurses could experience when caring for people who occupy a liminal space between life and death. Ultimately, we hope this paper will inspire and support ethical reflection and action among ICU nurses caring for organ donors.