Dimensions of Critical Care Nursing最新文献

Background: Perceived organizational support (POS) is necessary for the health care team, specifically for nursing staff, to improve job performance (JP) and the quality of care provided.

Objectives: This study aimed to identify POS and its relationship with JP among critical care nurses. We used a descriptive, cross-sectional, correlational survey as our method. A convenience sample of 133 Jordanian registered nurses working in intensive care units from 2 educational hospitals in Irbid participated. The Six-Dimensional Scale of Nursing Performance was used to measure the JP, and the Survey of Perceived Organizational Support was used to calculate the POS.

Results: Findings demonstrated a moderate level of both POS and JP. Furthermore, the study found a significant moderate positive relationship (r = 0.321, P = .01) between POS and JP.

Conclusion: Administrators and policymakers may be advised to pay more attention to improving POS and, consequently, JP among Jordanian nurses working in critical care areas to enhance the quality of care.

Background: Cardiac catheterization is one of the most widely performed cardiac procedures. After this procedure, being confined to the bed for at least 6 hours is usually recommended. Although prolonged bed rest diminishes the procedure's vascular complications, it typically impacts the patient's body functioning, particularly the hemodynamic parameters. The aim of this study was to evaluate the effect of supine versus semi-Fowler position on the patient's hemodynamic status after femoral sheath removal after cardiac catheterization.

Methods: A quasi-experimental research design was used. A purposive sample of 80 patients was chosen and divided into the intervention (n = 40) and the control groups (n = 40). The intervention included semi-Fowler positioning of study participants, whereas the control group used supine positioning. Physiological parameters were assessed immediately, after 3 hours, and 6 hours of sheath removal.

Results: There were statistically significant differences in the mean blood pressure, heart rate, and respiration rate between the study groups (P < .05). However, oxygen saturation measures did not show significant variations.

Conclusion: Compared with the supine position, the semi-Fowler position can improve physiological scores for post-cardiac catheterization patients following femoral sheath removal. Critical care nurses might consider incorporating semi-Fowler positioning into the routine care of cardiac catheterization patients.

Background: Bedside bronchoscopy is a pivotal diagnostic and therapeutic tool often used with critically ill patients in the critical care setting. Bronchoscopy allows for direct visualization of the airways and lung parenchyma and can be useful in evaluating different bronchopulmonary diseases including foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage.

Objective: This article explores bedside bronchoscopy in critically ill patients. Covering key areas from preprocedure preparation care, it emphasizes the nurse's role, procedural techniques, and adaptations. The focus extends to nurses' roles with emerging bedside bronchoscopy technologies and provides insight on implications for clinical practice.

Conclusion: Bedside bronchoscopy serves as a vital tool in critical care, enabling both diagnosis and treatment of various pulmonary conditions. Nurses play a pivotal role in ensuring procedural success and patient safety, from preprocedure preparation to postprocedure monitoring. As technology evolves, nurses must adapt, embracing opportunities for ongoing learning and interdisciplinary collaboration, while also advocating for patient-centered care and ethical considerations in the integration of advanced technologies.

Background: It is crucial for nurses to identify deficiencies and areas for improvement within the health care system while performing care practices. In order for nurses to identify solutions to these issues through an innovative approach, it is essential that they develop their individual innovativeness characteristics. The willingness of nurses to innovate can be fostered by embracing innovation and adopting a positive perspective toward it. Individual innovativeness characteristics play a pivotal role in influencing the emergence of innovative behaviors among nurses.

Aim: This study was conducted to ascertain the individual innovativeness characteristics of nurses working in intensive care units.

Method: The research was carried out using a descriptive design with 108 intensive care nurses who worked at the university hospital in the city center of Antalya. The research data were collected using the Nurse Promotion Form and Individual Innovation Scale. The data were evaluated using descriptive statistics such as average, SD, percentage, analysis of variance, t test in independent groups, Mann-Whitney U test, and Kruskal-Wallis test.

Findings: Although the nurses' overall score average on the Individual Innovation Scale is 60.14 ± 5.62, it is seen that the individual innovation classification includes interrogators (15.7%), skeptics (55.6%), and traditionalists (28.7%). The group of pioneers and innovators did not include nurses, and most nurses (55.6%) were in the skeptics group. The point averages of the nurses received from the scale subdimensions were, respectively, the opinion leadership, 26.12 ± 4.26; resistance to change, 24.39 ± 3.53; and risk taking, 16.41 ± 2.00, and the scale totaled 60.14 ± 5.62. According to the scores of the nurses from the lower dimensions of the scale, the level of risk taking, opinion leadership, and resistance to change were above average.

Results: Nurses are among the skeptical group regarding individual innovation, want to take risks, and respond positively to opinion leadership but resist change. According to the findings obtained from the study, nurses working in specialized units such as intensive care are open to developing innovative thinking and need to be supported in this regard.

Background: It has become more common for patients with long-term diseases or receiving aggressive cancer treatments to need intensive care. Research about palliative care in the intensive care unit (ICU) largely focuses on decision-making in relation to end-of-life care and organ donation. Few studies examine the current evidence about how palliative care in its wider conceptualization is understood by intensive care health care professionals.

Objectives: To synthesize the literature on ICU health care professionals' experiences and views of providing palliative care in the ICU.

Methods: This was an integrative review where data were assessed and analyzed using Whittemore and Knafl's approach.

Results: Four themes were identified in the synthesis: the meaning of palliative care, relationships with families, multidisciplinary working, and preparation for providing palliative care.

Discussion: Our findings suggest there is variation in how palliative care in the ICU is conceptualized and interpreted. Intensive care unit professionals need enhanced competencies and training to develop their confidence in providing palliative care and improve role clarity. Such training should focus on serious illness conversations with patients/families and interdisciplinary teamwork. Integration of palliative consultants into the ICU could be further developed.

Background: Compassion fatigue is the accumulation of negative feelings from long-term exposure to human suffering, which leads to emotional, physical, and spiritual exhaustion. Intensive care unit nurses are especially prone to this due to the unique stressors of their work environment, such as high patient mortality and caring for medically unstable patients. There is currently a gap in literature appraising the effectiveness of interventions that help manage compassion fatigue in intensive care unit nurses.

Objectives: This systematic review evaluates the efficacy of compassion fatigue interventions for intensive care unit nurses.

Methods: This systematic review was conducted following guidelines from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Literature published between 2005 and 2024 was obtained from Cochrane Library, CINAHL, and PsycINFO databases. Studies were included if they met the following inclusion criteria: quantitative study design, involved an intervention to prevent or manage compassion fatigue, evaluation of compassion fatigue or one of its components (burnout and secondary traumatic stress), an intervention involving intensive care unit nurses, and articles published in the English language.These data were appraised by 2 independent reviewers using the Joanna Briggs Institute Critical Appraisal tool.

Results: A total of 17 studies were included. This review found moderate and high strength of evidence for interventions to reduce compassion fatigue in intensive care unit nurses. The most effective interventions were mind-body interventions that were accessible, portable, brief, and adaptable to nurses' work settings.

Discussion: This review has several limitations. Many studies included in this review had small sample sizes, were conducted at 1 hospital setting or unit, and used weak study designs. Several studies also used different interventions and measurement approaches, making it difficult to compare and synthesize findings and outcomes. Thus, the heterogeneity of studies limited our ability to draw strong conclusions about different types of interventions. Additional and more rigorous studies examining interventions to decrease and manage compassion fatigue in intensive care unit nurses are needed. There is also a need to foster better generalizability of research findings.

Background: During COVID-19, organizations accommodated an increase in critically ill and isolated patients. Rapid changes to workload and the environment consumed daily operations, causing an unrelenting strain on nurses.

Objective: This study explored the lived experience of nurses during a pandemic event. Additional objectives were to determine the levels of individual resilience and burnout.

Methods: This cross-sectional survey used a convergent mixed-methods design. Descriptive and inferential statistics were used to summarize and test differences in resiliency and burnout scores. Constant comparative analysis was used to analyze qualitative responses.

Results: The Brief Resilient Coping Scale indicated medium resilient copers (mean, 15.7 [SD, 2.52]). There was no correlation between burnout and Brief Resilient Coping Scale (r = 0.186). Four themes were identified: (1) mental, physical, and emotional toll; (2) constant change; (3) perceptions of leadership; and (4) burnout.

Discussion: No correlation was found between coping ability and burnout. Nursing burnout was associated with the ongoing tolls, constant change, and leadership challenges.

Background: There have been 2 primary methods of intravenous fluid administration for diabetic ketoacidosis (DKA) treatment described in the literature: the serial bag method and the 2-bag method.

Objectives: This study will assess the clinical outcomes and workflow efficiency after a transition in practice from the serial fluid method to the 2-bag method for pediatric DKA.

Methods: This was a retrospective chart review of pediatric DKA patients 18 years or younger, 1 year before and after the transition was conducted. After exclusion criteria, 94 patients in the serial bag method group and 100 patients in the 2-bag method group remained. Variables included patient demographics, laboratory values, and duration of therapy.

Results: Patients achieving physiologic resolution of DKA had a median duration of 8.7 hours using the serial bag method and 7.5 hours using the 2-bag method (P = .193). Duration of DKA pharmacologic therapy had median values of 11.6 and 12.7 hours, between the serial bag and 2-bag method, respectively (P = .203). The 2-bag method resulted in faster workflow efficiency per bag for intravenous fluids, with a median duration of 35.5 minutes compared with 44.5 minutes using the serial bag (P = .025). Episodes of hypokalemia (P = .010) and hyperchloremia (P = .002) with the 2-bag method were significantly more frequent.

Discussion: Duration of DKA pharmacologic therapy and that of physiologic DKA were not statistically different between methods. Workflow efficiency improved with the 2-bag method. Further studies are needed to address potential electrolyte disturbances with the 2-bag method.

Background: The supply of future registered nurses successfully matriculating from undergraduate nursing programs is critical to address the national nursing shortage. Mentoring in higher education increases recruitment and retention within nursing programs. E-mentoring is an innovative approach to mentorship within nursing education that can optimize undergraduate nursing graduation rates. Establishing E-Mentor Competencies (EMCs) for nurses may ultimately address the nursing shortage gap.

Objectives: The purpose of this study is to develop EMCs for mentors of undergraduate nursing students through expert group consensus via e-Delphi methodology.

Methodology: The EMC survey was developed by a subject matter expert group and electronically distributed to an expert participant group. Items were ranked using a 5-point Likert scale for importance and relevance during iterative survey rounds to reach consensus.

Results: Sixteen EMCs were identified and categorized as knowledge, skill, or attitude. This research study identified 16 competencies required of an e-mentor for undergraduate nursing students. The 3 most important competencies identified were relationship building (4.71), cultural competence (4.88), and empathy and support (4.55).

Discussion: The EMCs identified by expert participant group consensus will provide a standard level of knowledge, skills, and attitudes for e-mentorship of undergraduate nursing students. Results may lead to an enhanced e-mentorship experience for both mentee and mentor and support existing and future e-mentor programs.

Background: Moral distress is highly prevalent among health care workers in intensive care in which spirituality has been identified both as a risk factor for moral distress and as a resource to mitigate it.

Objectives: Considering these contradictory findings, this study examined why moral distress is perceived in different ways and to what extent spirituality influences the ability to cope with moral distress.

Methods: In a qualitative study in German-speaking countries, semistructured interviews were evaluated using thematic analysis and typology construction according to Stapley et al.

Results: Between May and September 2022, a sample of 13 health care professionals (nurses, physicians, physiotherapists, respiratory therapists) from Germany and Austria was interviewed. Three types of spirituality among critical care staff are identified: (1) the religious type, (2) the dignity type, and (3) the instrumental type. Depending on the type of spirituality, intensive care providers experience moral distress differently and therefore require different resources to cope with moral distress.

Discussion: Appropriate spiritual interventions are facilitated by respecting different spiritualities as potential resources for mitigating moral distress. This preliminary study permits the differentiation of types of spirituality in critical staff and of appropriate supporting interventions.