The characteristics and factors associated with omitted nursing care in the intensive care unit: A cross-sectional study

IntroductionPrior research showed that work environment features in acute care settings influence nurses’ capacity to provide care and impacts patient outcomes (e.g., falls). However, little is known about this phenomenon in the intensive care unit. The objectives of this study were to describe the characteristics of omitted nursing care, and to examine the associations between work environment features, omitted nursing care and nurse-reported outcomes in the intensive care unit.MethodsAn electronic cross-sectional correlational study was conducted in the province of Quebec, Canada. Over September 2021, nurses were asked to complete the Healthy Work Environment Assessment Tool (HWEAT), the Intensive Care Unit Omitted Nursing Care instrument (ICU-ONC) and to report their perceptions of nurse-reported outcomes (e.g., quality of care). The associations between these variables were estimated using multivariable cluster-robust regression models, adjusted for nurse and hospital characteristics.ResultsA total of 493 nurses from 42 distinct hospitals participated to this study. On average, nurses felt that their work environment was acceptable, and that the quality and safety of patient care was good. Basic care activities (e.g., mobilisation) were most frequently reported as omitted as opposed to those related to surveillance and medical interventions. In multivariable analyses, higher work environment scores were associated with reduced omitted nursing care scores (p < 0.001) and better ratings for nurse-reported outcomes (p < 0.001). Also, higher omitted nursing care scores were associated with more negative perceptions about the quality and safety of care (p < 0.001).ConclusionOur study portrays the characteristics and some factors associated with omitted nursing care in the intensive care unit. Further research should determine whether intensive care nurses’ reports of organisational features and omitted nursing care are associated with objectively captured patient outcomes.     

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

BackgroundTrauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.ObjectivesThe purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.MethodsThe project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.ResultsThere were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.ConclusionsInter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.     

Factors associated with bereaved family surrogates’ satisfaction with end-of-life care in intensive care units

ObjectivesFamily satisfaction with end-of-life care in the intensive care unit constitutes an important outcome for evaluating end-of-life care quality. Research on this topic focuses on linking end-of-life care processes to family-surrogate satisfaction with the patient’s end-of-life care but has seldom examined patient- and family-surrogate-based factors. We aimed to comprehensively and simultaneously examine factors facilitating or deterring family satisfaction with end-of-life care in the intensive care unit from patient- and family-surrogate perspectives.MethodsFor this secondary-analysis study, 278 Taiwanese family surrogates were surveyed one-month post-patient death using the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU), which measures care and decision-making. Associations between family satisfaction with end-of-life care and patient and family characteristics, patient disease severity, and length of intensive care stay were examined by multivariate, multilevel linear regression models.ResultsFemale family surrogates were more satisfied with patients’ end-of-life care than male family surrogates when patients had a higher APACHE II but a lower SOFA score. Adult-child surrogates had lower FS-ICU Care scores than other family surrogates. Higher satisfaction with ICU decision-making was associated with patients’ higher APACHE II but lower SOFA scores, longer stay and family socio-demographics, including being unmarried, educational attainment above junior high school and reported financial sufficiency to make ends meet.ConclusionPatient disease severity and family-surrogate characteristics are significantly associated with surrogates’ satisfaction with patients’ end-of-life care in the intensive care unit. Specific interventions should be tailored to the needs of high-risk family surrogates to increase their satisfaction with this care.     

The impact of family-centered care interventions on neonatal and parental outcomes in a Turkish hospital

AimThis study aimed to improve nurses’ attitudes towards parental engagement and to examine the impact of implementing nursing interventions related to family-centred care on neonatal and parental outcomes in a university hospital in Turkey.MethodsA quasi-experimental, nonequivalent, and post-test research design was used. Using convenience sampling, the study was completed with 128 preterm infants and their parents, including 64 in the experimental group and 64 in the control group at a neonatal intensive care unit of a university hospital. The control group data were collected from medical records and parents before practising family-centred nursing interventions developed for the experimental group. In addition, nurses were given a four hour training session aimed to improve their attitudes towards parental participation in care, with the nurses’ attitudes measured before, immediately after, and one month after the training. The experimental group data were collected from medical records and parents after 10 nursing interventions based on family-centred care supported by managers began to be implemented by trained nurses in the neonatal intensive care unit. The Parent-Preterm Infant Characteristics Form, Maternal Attachment Inventory, Empowerment of Parents in the Intensive Care-Neonatology (EMPATHIC-N), and Parental Engagement Attitude Scale were used for the data collection.FindingsWhile nurses’ scores of attitudes toward parental participation obtained immediately after and one month after the training were higher than those before the training, the scores one month after were lower compared to those immediately after. The results indicated that discharge weight gain of infants in the experimental group were significantly higher than those in the control group and that there was no significant difference between the groups in length of stay at neonatal intensive care unit. The maternal attachment and satisfaction scores of the parents in the experimental group were significantly higher than those in the control group.ConclusionImplementing family-centred nursing care interventions, developed based on unit needs and supported by managers, with trained neonatal intensive care nurses positively impacted parent-infant attachment, parent satisfaction, and infant weight gain.     

Nurse decision-making when managing noradrenaline in the intensive care unit: A naturalistic observational study

ObjectiveIntensive care nurses care for critically ill patients in a complex, fast paced environment. Management of noradrenaline (norepinephrine) is core business for intensive care nurses and nurse decision-making on noradrenaline is poorly understood. The study objective was to investigate decision-making processes nurses use when caring for intensive care unit patients receiving noradrenaline.Research MethodologyA qualitative exploratory design used the Cognitive Continuum Theory as a framework for naturalistic observations and interviews in two medical/surgical intensive care units in Melbourne, Australia.Main Outcome MeasuresObservational and interview data from field notes and audiovisual recordings were transcribed and coded to develop themes using reflexive thematic analysis.FindingsFourteen nurse and patient dyads were recruited to observational sessions from December 2019 to June 2021. Three major themes developed were Learning through doing; Individualised patient care; and Clinical expertise, with six supporting sub-themes. Nurses learned to manage noradrenaline experientially and developed titration and weaning strategies to support decision-making. Blood pressure targets and monitor alarms were used consistently to aid decision-making processes. Nurses were observed practicing across the cognitive continuum depending on knowledge structure, complexity of interventions, response time, and patient acuity.ConclusionExperiential learning of complex and high-risk interventions in the absence of guidelines or algorithms meant nurses developed their own titration and weaning strategies based on constant evaluation and re-evaluation of patient cues. Patient heterogeneity, cue ambiguity and a dynamic practice environment contributed to decision-making complexity that would benefit from development of evidence-based practice resources.Implications for Clinical PracticeNurses learn to manage noradrenaline through experiential learning, using blood pressure targets and monitor alarms to support decision-making when titrating and weaning noradrenaline. Nurses develop noradrenaline titration and weaning strategies to support decision-making in the absence of guidelines or algorithms. Supporting nurse decision-making and streamlining practice would reduce practice variation and cognitive workload.     

The training needs of Korean intensive care unit nurses regarding delirium

ObjectivesThe aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses’ delirium care competency.DesignA cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses.SettingIntensive care units in the Republic of Korea.Main outcome measuresIntensive care unit nurses’ delirium care competency.ResultsExploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses’ delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses.ConclusionTraining programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

Designing devices to communicate effectively with intensive care nurses to prevent pressure injuries: A qualitative study

ObjectivesThe aim of this research was to identify “what” key design elements of a device for detecting hospital acquired pressure injuries should do and “how” these elements should function. The goal of the resulting design was to prompt intensive care unit nurses to intervene appropriately to reduce the incidence/severity of pressure injuries, while minimizing workflow disruptions.MethodsA mixed method study was performed in an intensive care unit, which included shadowing, interviewing, surveying and conducting focus groups with individuals knowledgeable about pressure injuries and related patient care. This study focused on identifying and prioritizing the needs/wants of nurses regarding devices aimed at detecting hospital acquired pressure injuries. These needs were then used as the foundation for designing key elements of such a device.FindingsIntensive care nurses indicated that a device for the early detection of pressure injuries should communicate information as real-time summaries about the severity of a skin issue in an easy-to-understand manner and provide reminders for them to take action when needed without unnecessarily interrupting their workflow.ConclusionThe findings regarding nurses’ needs will be useful for the future development of technologies/devices that help reduce the incidence/severity of hospital acquired pressure injuries. In turn, nurses may be more likely to use such a device to enhance patient care.     

The core of patient-participation in the Intensive Care Unit: The patient’s views

ObjectivesPatient participation is an established concept in public welfare. However, reports of the phenomenon of patient participation during intensive care from the patient’s point of view are scarce. Therefore, the aim of this study was to explore the meaning of patient participation in the intensive care unit from the patient’s perspective.Research designA qualitative design was used for the purpose of the study with a purposive convenient sample of nine adult patients with memories from their intensive care stay.MethodData was collected through individual interviews and analysed using a phenomenological hermeneutical method.FindingsThe results of our study show a variety of meanings and degrees of participation that continuously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patient participation varied due to individual cognitive abilities and individual preferences, and the caregiver’s attention altered between the body and the person through the continuum of care.ConclusionPatient participation during ICU care is more than participation in decision-making processes or direct patient care decisions. An understanding of the concept participation from the individual patient is necessary to support person centred care and the patient’s relatives play an important role in during the entire care process.     

Practice and clinical decision-making autonomy among Hellenic critical care nurses

BACKGROUND: Nursing autonomy has been associated with better patient-outcomes; therefore, it is a priority for critical care nursing management. Low authority has been a persistent complaint of Hellenic intensive care unit nurses; however, issues of nursing autonomy have not been previously addressed empirically in Hellas. PURPOSE: To investigate: (1) the perceived contribution to clinical decision-making, (2) the degree of autonomy in technical tasks, and (3) factors related to practice autonomy in critical care nurses in Hellas. Additionally, because of the lack of sufficient tools, this study also aimed to construct and to validate a new tool for assessing practice and clinical decision-making autonomy among Hellenic intensive care unit nurses. MATERIALS AND METHODS: A Hellenic intensive care nursing autonomy scale, focused on technical aspects of care, was developed through literature review, a panel of experts and a pilot study in a random sample of 120 respondents. Items were refined by factor analysis, which revealed three major conceptual categories of autonomy: (1) basic technical, (2) advanced technical, and (3) clinical decision. Hellenic intensive care nursing autonomy (Likert 4, range: 38-152), was distributed to all nurses employed in intensive care units in Hellas (n = 807; attrition: 27%). Comparisons, correlation and multivariate regression were employed. RESULTS: The Hellenic intensive care nursing autonomy scale exhibited appropriate reliability (Cronbach's alpha = 0.86) and validity properties. Autonomy scores were moderate (mean: 105.24 +/- 9.58). Highest autonomy was attributed to basic technical tasks, followed by advanced technical tasks and decision-making. Male gender and higher education were predictors of higher overall, advanced technical and decision-making autonomy (P = 0.01). Bachelor degree graduates scored higher in decisional autonomy (P = 0.03). Intensive care unit experience and type of intensive care unit were also important determinants of decisional autonomy (P = 0.02). CONCLUSIONS: The results revealed moderate autonomy in technical tasks and low decisional autonomy among Hellenic intensive care unit nurses. Factors related to the educational preparation of nurses, gender issues and institutional characteristics might hinder intensive care unit nurses' autonomy in Hellas.     

The effects of spiritual care intervention on spiritual well-being,loneliness, hope and life satisfaction of intensive care unit patients

BackgroundThe intensive care unit is a place where patients try to cope with pain and question the meaning and purpose of life and spiritual needs emerge.ObjectiveThe present study was conducted to examine the effects of spiritual care interventions on the spiritual well-being, loneliness, hope, and life satisfaction of patients treated in intensive care.Research methodologyThe study was conducted in an intensive care unit as an interventional study with a randomized pre-test, post-test, and control group between September and December 2021. A total of 64 patients, 32 in the intervention group and 32 in the control group, were included in the sample. The patients in the intervention group received eight sessions (twice a week) of spiritual nursing interventions according to the Traditions-Reconciliation-Understandings-Searching-Teachers model in the intensive care unit, while the control group received routine nursing care.ResultsThe mean age of the participants was 63.53 ± 4.10 years in the intervention group and 63.37 ± 3.18 years in the control group. Most of the participants in both the intervention (59.4 %) and control (68.7 %) groups were female. Following the intervention, the findings showed that the intervention had positive effects on patients’ spiritual well-being (t = -10.382), loneliness (t = 13.635), hope (t = -10.440), and life satisfaction (t = -10.480) levels (p < 0.001).ConclusionsIt was found that the spiritual care provided in the intensive care unit positively affected patients’ spiritual well-being, hope, loneliness, and life satisfaction levels. It can be recommended that nurses working in intensive care develop a spiritually supportive environment by addressing the spiritual issues of patients and their relatives and using existing spiritual care services.Implications for clinical practiceIntensive care nurses should provide an environment and nursing care that meet their patients’ spiritual needs. Spiritual care can be given to improve spiritual well-being, hope, and life satisfaction levels and to alleviate loneliness in intensive care patients.     

Fulfilling the psychological and information need of the family members of critically ill patients using interactive mobile technology: A randomised controlled trial

BackgroundIntensive care nurses may have an important role in empowering families by providing psychological support and fulfilling the family's pivotal need for information.AimTo determine whether ‘education of families by tab’ about the patient’s condition was more associated with improved anxiety, stress, and depression levels than the ‘education of families by routine’.Research designA randomized control trial of 74 main family caregivers (intervention: 39; control: 35).SettingAn adult intensive care unit.Main outcome measuresDepression Anxiety Stress Scale, and Communication and Physical Comfort Scale.ResultsAlthough information need satisfaction was not significantly different between intervention and control groups, the former reported significantly better depression score on Depression Anxiety Stress Scale comparing to the control group (p < 0.01; η² = 0.09) with a medium effect size. Reduction of anxiety in the intervention group were clinically significant.ConclusionThe results suggest that use of ‘education of family by tab’ is promising for intensive care nurses to provide psychological support for family members. More studies are needed to investigate this aspect of family care for better psychological support and information need satisfaction that contributes to the evidence-based practice of intensive care nursing.     

The role of the intensive care nurse in the medical emergency team: A constructivist grounded theory study

BackgroundIntensive care nurses are essential members of rapid response systems (RRSs) with little qualitative data available to capture what intensive care nurses do as they navigate their way around the complexity of a medical emergency call.ObjectiveThe study aims to describe and explain the role of the intensive care nurse within the medical emergency team (MET) of a tertiary-level hospital to develop an understanding of the intensive care nurse role, the way it is enacted, and their responsibilities within the team.MethodA constructivist grounded theory research approach collected qualitative data from intensive care nurses who had experience attending MET calls. Data were collected through participant observation (16 MET calls), followed by 12 semistructured interviews.FindingsA substantive theory was developed that ‘keeping patient's safe’ is a fundamental role of the intensive care nurse within the MET. This is derived from four key concepts: Systematic framework for decision making, Figuring it out, Directing care, and Patient safety. Each of these concepts was developed from categories that describe the role of the intensive care unit nurse on the MET. They include performing assessments and interventions, figuring it out, critical thinking, prioritising care, directing care, being supportive, and ensuring patient safety.ConclusionThis study provides new insights into and an understanding of the ways intensive care nurses work within the MET, making a significant contribution to our existing understanding of the role.     

Quality of life as a mediating factor in the relationship between fatigue and perception of safety among critical care nurses in the United Arab Emirates

BackgroundA scientific understanding of the relationships between intensive care unit nurses’ well-being and patient safety will allow nurse managers, administrators, and policymakers to simultaneously manage crucial organisational goals of nurses’ health and patient safety. Understanding predictors of fatigue among intensive care unit nurses may help to balance personal and organisational impacts (e.g., turnover intention, sick leave) and provide a way to positively influence their safety perception.ObjectiveThe aim of this study was to explore the association between work fatigue and perception of patient safety among nurses working in critical care units and determine whether their quality of life levels mediated this relationship.MethodsThis study used a cross-sectional correlational comparative design. Participants were a sample of 250 intensive care unit nurses recruited conveniently from three large hospitals in the United Arab Emirates. The self-reported questionnaire included the Nursing Quality of Life Scale, the Fatigue Severity Scale, and the Safety Attitudes Questionnaire (SAQ)-ICU version, as well as sociodemographic characteristics and work-related information.ResultsOf the 250 participating nurses, 76.8 % reported low QoL. There was a statistically significant correlation between nurses’ Quality of Life and fatigue levels (r = 0.234, P = 0.000). Overall, 52.8 % of the sample had high fatigue and 49.6 % had poor safety perception. Multiple regression analysis using the Baron and Kenny approach showed that QoL, marital status, gender, and work environment were predictors of nurses’ perception of safety.ConclusionIntensive care unit nurses had high levels of fatigue and poor Quality of Life. High Quality of Life and a favourable work environment were independent predictors of good patient safety perception. Efforts should be directed to maximize staffing resources that positively impact patient safety. These findings are comparable with international studies, suggesting that these issues may be ubiquitous.Implications for clinical practiceIntensive care practitioners, managers and policymakers should adopt measures to modify intensive care nurses’ exhausting working conditions and provide a supportive environment. these interventions might improve nurses’ perception of patient safety and consequently prevent safety incidents.     

Us and them: Experiences of agency nurses in intensive care units

ObjectiveThis qualitative case study describes the work experiences of agency nurses from their perspective. It explores their interactions with intensive care unit managers to whom they report in their designated intensive care units and their relationships with fellow permanent nurses.MethodsA qualitative study was undertaken in three intensive care units at a public hospital in South Africa. Face-to-face interviews were used to collect data from eleven agency nurses. Thematic analysis of the data was undertaken.FindingsThe challenges of agency nursing work were haphazard clinical allocation, a lack of self-efficacy and competence, and feelings of exclusion. Positive aspects of the agency nurse experience included feedback and support from permanent nurses and intensive care unit managers and occurrences of belonging and acceptance.ConclusionThe findings of this study point to the importance of agency nurse relationships with managers and fellow permanent nurses. To ensure patient care is not compromised, managers and nurse managers have a responsibility to ensure a welcoming, inclusive and nurturing environment for all staff tasked with intensive care unit responsibilities.