Dynamics (Pembroke, Ont.)最新文献

Unlabelled: Pediatric clinical research is dependent on obtaining consentfrom the parents or legal guardian of eligible patients. Little is known about parents' perspectives and the process by which they make the decision to enroll their child in a pediatric critical care trial.

Objective: To describe the experience of parents/legal guardians who consented or declined consent for their child to be enrolled in a pediatric critical care research study. Factors that influenced parents' decisions and suggestions for improving and modifying the consent process were explored.

Method: This study used a qualitative descriptive research design. Seven semi-structured qualitative interviews were conducted with parents who had given or declined consent for their child to participate in a clinical research study while their child was in a pediatric critical care unit in one of two Canadian pediatric teaching hospitals. Parents were interviewed within 48 hours of their child's transfer from the PICU to a hospital ward unit. The interviews were audio recorded, transcribed, and analyzed using a content analysis method.

Results: Parental decision-making related to research consent in the context of pediatric critical care is influenced by specific characteristics of the consent encounter (timing, location, and information), parent (emotional state, decision-making style, familiarity with environment, past experience, and personal motivation), child (condition and response to pain/needles) and study (risk, method, burden, and benefit). Parents identified that the timing and ways in which they received information during the consent encounter could be improved.

Conclusion: Pediatric critical care researchers can improve the parental consent encounter experience by considering how parents perceive the approach to consent for a research trial for their child to balance the need to support parents with the need for participants in pediatric critical care research trials.

Burnout and its development in critical care nurses is a concept that has received extensive study, yet remains a problem in Canada and around the world. Critical care nurses are particularly vulnerable to developing burnout due to the chronic occupational stressors they are exposed to, including high patient acuity, high levels of responsibility, working with advanced technology, caring for families in crisis, and involved in morally distressing situations, particularly prolonging life unnecessarily. The purpose of this article is to explore how the chronic stressors that critical care nurses are exposed to contribute to the development of burnout, and strategies for burnout prevention. A review of the literature between the years 2007 and 2012 was conducted and included the search terms burnout, moral distress, compassion fatigue, intensive care, critical care, and nursing. The search was limited to the adult population, English language, and Western cultures. The results revealed that nurse managers play a crucial role in preventing burnout by creating a supportive work environment for critical care nurses. Strategies for nurse managers to accomplish this include being accessible to critical care nurses, fostering collegial relationships among the different disciplines, and making a counsellor or grief team available to facilitate debriefing after stressful situations, such as a death. In addition, critical care nurses can help prevent burnout by being a support system for each other and implementing self-care strategies.

Objectives: Delirium in critically ill patients is common and is associated with increased morbidity and mortality. Routine delirium screening is recommended by the Society of Critical Care Medicine. The Intensive Care Delirium Screening Checklist (ICDSC) is one validated and commonly-used tool, but little is known about nurses'perceptions of using the ICDSC, and of barriers to delirium assessment and treatment.

Design: A survey was administered to 189 critical care-trained nurses working on four oncology inpatient units, where the ICDSC has been used for greater than five years.

Results: Eighty-four nurses (44%) responded to the survey. Respondents indicated that they had knowledge of delirium, confidence in the ICDSC, and that the ICDSC was useful. Respondents perceived that physicians did not value the ICDSC results. Similar to prior nurse surveys for other delirium screening tools, physicians were the most frequently identified barrier to both delirium assessment and treatment, with other frequent barriers being lack of time, feedback on performance, and knowledge of delirium.

Conclusions: The ICDSC is viewed favourably by nurses with experience using the tool. Future delirium screening programs should encourage physician engagement early in the planning process to help address perceived barriers to delirium assessment and treatment.

In this paper, the authors outline the rationale, planning, delivery, results, evaluation and knowledge transfer strategies employed in offering an eight-hour education day offered 12 times in 2010, to a total of 200 staff in three Toronto General Hospital (TGH) intensive care units (ICU) at the University Health Network (UHN). The integration of members from the point-of-care staff teams into the planning, development, presentation and attendance was a critical success factor for this initiative. Organizers and participants had the opportunity to build bridges with each other and across teams and programs by engaging in interprofessional learning, sharing narratives and consolidating increasing awareness of resources with facilitation from staff from nursing, medicine, palliative care, bioethics, social work, physiotherapy, respiratory therapy, wellness and spiritual care. The format, which will be outlined with examples and stories of engagement, included an opportunity to explore common elements of ICU work including moral distress, demonstrated wellness and team communication strategies, as well as the introduction of an interprofessional patient/family meeting checklist reviewed and evaluated by participants. An assessment of quality of life in an ICU was explored using a panel, case study and discussion. The results of the evaluation, which included a qualitative reflection on collaborative themes, a program evaluation and an individual learning assessment, will be discussed, as well as sustainability and transferability possibilities specific to interprofessional programming and team development.