Intensive and Critical Care Nursing最新文献

Background

Little is known about non-medical prescribers in critical care in the United Kingdom. In 2007, a small survey identified few non-medical prescribers; however, in the intervening years, there have been many changes to the Medicine Act 1968. It is likely that prescribing within the non-medical workforce in critical care has changed significantly.

Aim/s

This survey aimed to explore the breadth and diversity of prescribing practices of non-medical prescribers working within the wider critical care environment in the United Kingdom.

Method

Data were collected via an online questionnaire adapted from the 2007 version and distributed by the BACCN to their members between 26th October 2021 and 19th November 2021. Freedom of Information requests were made to the Nursing and Midwifery Council, The Health and Care Professions Council and the General Pharmaceutical Council to understand the number of non-medical prescribers.

Results

The survey elicited 259 responses; 105 respondents identified themselves as non-medical prescribers, and 57 used Patient Group Directions only. In the ICU/HDU, 75 respondents identified as non-medical prescribers, with an additional 45 using Patient Group Directions.

Conclusion

Since the last survey, there has been a large increase in the number and representation across all professional groups identifying as a non-medical prescriber and/or utilising patient group directions across critical care. Many staff responded to this survey who were neither NMPs nor utilising PGDs; of these, a large proportion were interested in taking on this additional responsibility.

Implications for practice

Many people working within critical care are interested in becoming non-medical prescribers.

Assists with understanding characteristics of those working as non-medical prescribers within critical care.

Shows variations in practice in respect to PGDs, authorising of blood products and prescribing.

Objectives

To explore patients’ and nurses’ views of potential facilitators, barriers, and prospective acceptability of implementing a communication board in Sri Lankan intensive care units.

Design

A qualitative, descriptive study.

Research methodology

Eight patients who received mechanical ventilation and nine nurses who worked in adult medical and surgical intensive care units were purposively selected. Data were collected via audio-taped, semi-structured, face-to-face interviews in January/February 2023. Interview guide questions were informed by the knowledge-to-action framework and the theoretical framework of acceptability. Data were analysed using inductive and deductive content analysis. The 32-item checklist of the consolidated criteria for reporting qualitative research (COREQ) was used to ensure the quality of reporting.

Setting

A 3,000 bed Sri Lankan teaching hospital with 18 intensive care units.

Findings

Four categories reflecting patients’ and nurses’ anticipated use of the board were found. The first category described patients’ and nurses’ ‘readiness to use the communication board’ and their positive attitudes towards it. The second category focused on the ‘potential benefits of the communication board’, while the third category emphasised the ‘individual patient characteristics’ that should be taken into consideration when implementing communication boards. The final category described practical aspects related to ‘integrating communication boards into routine practice’.

Conclusion

This study demonstrates communication boards may improve communication between ventilated patients and nurses, and they are acceptable to end users. Adopting these tools may be a pivotal step to enhancing patient-centred care in demanding intensive care settings.

Implications for clinical practice

An inability to communicate effectively with ventilated intensive care patients creates negative experiences for both patients and nurses. Communication boards may act as a medium to better understand patients’ needs during mechanical ventilation. Understanding patients’ and nurses’ views is beneficial when designing patient-centred communication interventions in intensive care units.

Critically ill patients in rural areas at times require an interhospital transfer from their local hospital to an urban tertiary care centre for advanced critical care services not available locally. Family members have described this transfer window as a communication blackout and one of the most stressful times of their relative’s critical illness event.

Objective

To explore what communication process would be most acceptable between family members and transfer team members (consisting of critical care nurses, paramedics, and physicians) during interhospital transfers of critically ill patients.

Research methodology

Using a qualitative descriptive approach of critical thematic analysis, data were collected in September and November 2022, from focus groups of five family members and four transfer team members who experienced this phenomenon.

Setting

Rural Canada where speciality services such as interventional cardiology and neurosurgery are unavailable, and a tertiary care hospital is more than 160 km away.

Findings

Within themes of unequal power relations and status-based hierarchies, family members described how communication during interhospital transfers supports connection and coping, challenges experienced in accessing information, an overwhelming unknown, and practical challenges of the transfer. Transfer team members described a context of power relations and status-based hierarchies in which themes of transfer team burden, role confusion or connection, protection and management of family members, and complexities of information sharing during interhospital transfers were identified.

Conclusion

In critical illness, communication linkages are created between healthcare providers and family members but are broken during an interhospital transfer resulting in increased stress for family members. Acceptable communication elements described by transfer team members and family members may maintain these linkages during the transfer window.

Implications for clinical practice

These findings provide the foundation for critical care nurses and their professional colleagues to take family care to the next level with an explicit communication strategy during interhospital transfers.

Objectives

Siblings are an important yet often forgotten part of the paediatric intensive care unit (PICU) family experience. Commonly, siblings are supported through the experience by their parents; however, very little is known about parental experiences of providing this support. This study aims to explore parental experiences of supporting sibling inclusion in PICU.

Research methodology/design

This study utilised a qualitative descriptive approach to conduct semi-structured interviews with 6 parents of 5 children with congenital heart disease who had spent time in PICU. Data were analysed using reflexive thematic analysis.

Setting

Australian PICUs.

Findings

Parental considerations and experiences for sibling inclusion were identified across three key phases: Pre-inclusion, The PICU visit, and Post-inclusion. Prior to including siblings in PICU, parents considered various ways of sharing information with siblings, and weighed up the risks and benefits of bringing siblings into PICU. Parents also recounted a number of challenges and facilitators to a positive sibling experience in PICU, including supportive staff and fun activities. Finally, parents, identified that siblings require ongoing support after their inclusion in PICU and made suggestions for ongoing availability of information and supportive resources.

Conclusions

This study has illuminated key parental experiences when supporting sibling inclusion in PICU before, during and after their visit. By understanding these parental experiences, PICU staff can work with and support parents where needed, helping to achieve a positive sibling inclusion experience.

Implications for clinical practice

Parents need ongoing support to explain the PICU to siblings of critically ill children and may benefit from specific visual resources to aid communication. In addition, PICUs should aim to ensure the physical layout is supportive of sibling needs, with dedicated spaces for siblings to play and take time out during their experience.