Trust between nursing management and staff in critical care: a literature review

Aim: This paper aims to provide a comprehensive review of the topic of trust between nurses and nurse managers in the context of critical care units. Method: A comprehensive literature review exploring the concept of trust between nurse and nurse managers was undertaken. Search terms were used both singularly and in combination and 71 relevant citations were found. Abstracts were read and in total 20 peer reviewed articles were retained as a result of consistency with project aims. Results: Trust emerged as an essential component in the nurse‐patient relationship. However, trust among staff and management received little attention. Conclusions: Trust emerges as an important attribute of effective nurse managers. Nurse managers need to appreciate the importance of fostering a trustworthy relationship with subordinates. Engendering trust between management and staff empowers staff and has positive organizational outcomes.     

The family and critical care nursing: a brief review of the literature

While there is generalised agreement in the literature on the importance of involving family members in critical care practice, there is little in regard to the roles and responsibilities of both nurses and families. There are many factors that can influence the nurse-family relationship, in both positive and negative dimensions, and this relationship can impact significantly on the family member's experience of critical illness. It can also impact on his or her perception of need and need satisfaction. However, the complex nature of critical care practice may be too demanding, both physically and emotionally, for nurses to respond to many of the family's needs and concerns.     

Supportive nursing: a critical review of the literature.

Nurses have long thought that providing support was a part, if not a central part, of their nursing practice. In the literature, nurses have described their ability to provide support and have discussed their inability as well as their reasons why they have been unable to give support. Support for nurses has at least three parameters: physical, social, and emotional. The emotional parameter has received the most attention by nurses. The meaning of support in nursing needs to be clearer and more precise. Although several nurses, either through theoretical discussions or exploratory research studies, have begun to further define support, this construct warrants more thought and investigation by nurses. Once an operational definition is determined and supportive behaviors identified, nurses can further investigate the influence of support to the promotion of health.     

Readmission to intensive care: a review of the literature.

Acutely ill patients are commonly found on general hospital wards; some of these are patients who have been recently discharged from an intensive care unit (ICU). These patients may require a higher level of care than other ward patients and, due to the acuity of their illness, are at risk of readmission to ICU. Research has indicated that patients readmitted to ICU have mortality rates up to six times higher than those not readmitted and are eleven times more likely to die in hospital. Numerous studies have retrospectively examined these readmissions but, despite this, there is still no clear indication of why ICU readmissions occur or what the common characteristics of readmitted patients are. This literature review examines the published studies on patients who have been readmitted to ICU. Further research is needed to explore why readmissions to ICU occur and the type of patient who is at greatest risk for readmission.     

Ventilator-associated pneumonia in paediatric intensive care: a literature review

Background: Ventilator‐associated pneumonia (VAP) has been identified as the most common nosocomial infection in intensive care units (ICUs) with associated health and financial costs. To date, more research has been carried out in adult ICUs than in paediatric units, thus prompting a review and investigation of the implications for paediatric practice. Aims: To identify relevant paediatric literature surrounding VAP and use this in association with research carried out in the adult environment to establish the implications of VAP and possible management strategies. Search strategies: A literature search was undertaken using databases within DialogDatastar to identify the extent to which VAP has been researched in both paediatric and adult centres. This information was used to try and gain a clearer concept of the impact and management of VAP in the paediatric setting. Key words and combinations included VAP, intensive care, paediatric, antibiotics, positioning, suction, economics, management, nosocomial and morbidity and mortality. Results of analysis: Despite the documented significance of VAP in terms of its financial and health implications, discrepancies and inconsistencies exist surrounding the identification and treatment of VAP. This is reflected in paediatric centres by a dearth of literature on the subject and the lack of a national standard as to the management and prevention of VAP. Inappropriate management of VAP plays an important role in the development and spread of multiresistant bacteria within hospitals. Conclusions: While inadequate paediatric research exists, extrapolating from adult research suggests that the financial and health costs of VAP are substantial and can be reduced by introducing simple low‐cost measures. Such measures include improving education surrounding VAP and its implications and making small changes in practice to improve and maintain oral hygiene standards. Implications: With a growing cohort of paediatric patients requiring short‐ and long‐term ventilation, progress must be made in identifying the extent and impact of VAP in paediatric ICUs and among the community ventilated patients. This will require changes in practice and attitudes towards VAP for which an appropriate knowledge base would need to be established using audit and research. These issues are particularly relevant in the current environment given the links with multiresistant strains of bacteria within hospitals and the community.     

End-of-life care pathways and nursing: a literature review

Aim To identify and discuss the current state of knowledge about end-of-life care (EOLC) pathways in relation to nursing. Background Enhancing EOLC has become a central concern in governments’ health policies worldwide. End-of-life care pathways have been championed as complex interventions to enhance the quality of end-of-life care. However, concerns have been expressed regarding their purpose, initiation and use. Evaluation A range of published literature was used to examine EOLC pathways in relation to nursing. Key issues Three main themes emerged: nursing’s contribution to the evolution of EOLC pathways, implementing EOLC pathways and the influence of EOLC pathways on nursing practice. Conclusions End-of-life care pathways are to be welcomed as a means by which the quality of EOLC might be enhanced. However, the state of knowledge about EOLC pathways, their development, implementation and influence on families and professional practice is in its infancy. Implications for nursing management End-of-life care pathways are championed as a means by which the quality of EOLC, for dying people and their families might be enhanced. However, as concerns regarding the quality of EOLC persist, nursing management has a crucial role in driving forward and supporting EOLC pathway development, implementation and evaluation.     

Competence in nursing practice: a controversial concept--a focused review of literature

The competency-based approach to education, training and assessment has surfaced as a key policy in industrialised nations. Following the transition of nurse preparation to the higher education sector the need to attenuate the tension of interests between employer and educator arose. While the competency-based approach has the potential to fulfil this, the application of competence to nursing is controversial and little consensus exists on definition. This paper synthesises a significant volume of literature relating to the acceptability and definition of the concept of competence with regard to nursing practice. Subsequent to a focused review of literature, problems inherent to the definition and utilisation of the concept of nursing competence are discussed. Because nursing requires complex combinations of knowledge, performance, skills and attitudes, a holistic definition of competence needs to be agreed upon and operationalised. This could facilitate greater acceptance of the concept and also underpin the development of competency standards and the tools required for the assessment of such.     

Propensity scores in intensive care and anaesthesiology literature: a systematic review

Introduction  

Propensity score methods have been increasingly used in the last 10 years. However, the practical use of the propensity score (PS) has been reported as heterogeneous in several papers reviewing the use of propensity scores and giving some advice. No precedent work has focused on the specific application of PS in intensive care and anaesthesiology literature.     

Diagnostic practise in nursing: a critical review of the literature

The purpose of this article is to critically review and synthesize the literature related to the general concepts and the process of diagnosing the client's condition, and the possible variables which influence diagnostic practise in nursing. It is suggested that statistical theories are capable of capturing the diagnostic process and offer an effective means to predict diagnostic decisions. Studies underpinned by information-processing theory argue that diagnosing a patient's condition follows a hypothetico-deductive model that consists of specific stages. Those who hold a phenomenological perspective remark that there is yet another form of diagnostic practise: intuitive reasoning, which plays an important role in diagnosing the patient's clinical condition. Other related studies suggest that diagnostic practise is contingent on some personal, psychosocial, and structural variables. Regrettably, these studies offer no conclusive explanation to delineate diagnostic practise in nursing. Based on the literature reviewed, a conceptual framework is suggested to help articulate the underlying structures and processes of diagnostic practise in nursing.     

Noise in hospital intensive care units-a critical review of a critical topic

Purpose

The aims of the study were to examine the studies related to hospital noise in intensive care units (ICUs) to understand the sources and effects of noise and to describe best practices and common problems in the varying methods commonly applied to reduce the noise level.

Materials and Methods

The ISI Web of Knowledge and PubMed were used to search original research articles to obtain articles related to hospital ICU noise analysis.

Result

This review article analyzes the 29 extant studies related to noise in ICUs.

Conclusion

Significant opportunities exist to improve methodologies to study noise levels to reduce noise in hospital ICUs. Many previous studies have used inconsistent methodologies with poorly defined parameters that make it difficult to compare results. Our work points out common pitfalls in the recording and sharing of hospital acoustic parameters and also points to the paucity of important economic considerations in extant studies. These results can be helpful for future research in this area. Many past salutary interventions—including educational noise reduction programs, behavioral modification using sound detection equipment, and low- as well as high-cost environmental alterations—do not generally appear to be adequate to minimize noise to levels for hospital rooms specified by international agencies. But a potentially important clue for future work involves the finding that as the number of patients and staff of the ICU increases, noise levels appear to also increase.     

Emotional outcome after intensive care: literature review

Title. Emotional outcome after intensive care: literature review. Aim. This paper is a report of a literature review to identify (a) the prevalence of emotional and psychological problems after intensive care, (b) associated factors and (c) interventions that might improve this aspect of recovery. Background. Being a patient in intensive care has been linked to both short‐ and long‐term emotional and psychological consequences. Data sources. The literature search was conducted during 2006. Relevant journals and databases were searched, i.e. Medline and CINAHL, between the years 1995 and 2006. Review methods. The search terms were ‘anxiety’, ‘depression’, posttraumatic stress’, ‘posttraumatic stress disorder’ and ‘intensive care’. Results. Fifteen papers were reviewed representing research studies of anxiety, depression and posttraumatic stress, and seven that represented intensive care follow‐up clinics and patient diaries. Being in intensive care can result in significant emotional and psychological problems for a number of patients. For the majority of patients, symptoms of distress will decrease over time but for a number these will endure for some years. Current evidence indicates that emotional problems after intensive care are related to both subjective and objective indicators of a patient’s intensive care experience. Evidence suggests some benefit in an early rehabilitation programme, daily sedation withdrawal and the use of patient diaries. However, additional research is required to support such findings. Conclusion. Our understanding of the consequences of intensive care is improving. Psychological care for intensive care patients has lagged behind care for physical problems. We now need to focus on developing and evaluating appropriate interventions to improve psychological outcome in this patient group.     

Assessment of clinical practice in intensive care: a review of the literature.

Nursing is a practice-based discipline, with clinical practice forming the heart of any programme of study. The major goal of all programmes should be on facilitating students to develop the skills necessary for competent and compassionate practice. Assessment of clinical competence is a fundamental aspect of programme development and as such deserves attention during the curriculum design process. The literature on assessment of students in clinical practice suggests that the tools used have evolved through various stages, ranging from the use of simple check list and rating scale to the development of competence assessment tools. Each stage has been fraught with difficulties and has taxed nurse educators, clinical assessors and students alike. The literature also indicates that there is a limited range of research available on clinical assessment tools, especially with an intensive care context. In part one of this two-part paper, the literature on assessment of clinical practice is explored, with specific emphasis on the assessment of competence with the Intensive Care environment. Part two of the paper reports on the findings of a study on students perceptions on a clinical competence assessment tool, used in an Intensive Care environment.     

Palliative care in stroke: a critical review of the literature

The aim of this literature review was to identify the palliative care needs of stroke patients. Stroke results in high levels of mortality and morbidity, yet very little is known about the nature and extent of palliative care services that are available to this patient group, and the ways in which such services could be delivered. A critical review of the international literature found only seven papers that attempted to identify the palliative care needs of patients diagnosed with stroke. The results of the review showed that the preferences of stroke patients and their families in relation to palliative care services are largely unknown. The review also indicated the paucity of data in regard to the distinction between provision of palliative care services for patients who die in the acute phase of stroke and for those patients who die later. Establishing reliable assessments of need are central to designing and implementing effective interventions and further research is required in this area. Further data on how the input of palliative care experts and expertise could be of benefit to patients, and the most effective ways these inputs could be targeted and delivered is required.     

Relocation stress in critical care: a review of the literature

1. Transfer to the ward following a period in intensive care may cause stress for patients. 2. A review of the literature reveals that this phenomenon has been described in a number of different ways, such as transfer stress, transfer anxiety, translocation syndrome and, more recently, relocation stress. 3. This paper reviews the various concepts before arriving at a more operational definition of the phenomenon. 4. It attempts to reveal what causes this phenomenon and to what extent it exists. 5. Patients' responses to transfer are identified and the physical and psychological problems that have been associated with discharge from intensive care are discussed. 6. Lists of interventions that the literature suggests may reduce or prevent this phenomenon from occurring are reviewed. 7. Recommendations for practice development and further research are made.     

Parental participation in care: a critical review of the literature

The literature reviewed demonstrates that parental participation is a complex issue which has been viewed mainly in a fragmented manner which does not recognize the integrated holistic nature of parent-nurse partnership There is a dearth of research which focuses upon parents' perspectives and expectations of participation Furthermore, there is an assumption that parental participation is unproblematic which precludes the identification of social and environmental constraints The current level of knowledge about nurses' attitudes regarding parental participation is limited There is an absence of clear indicators of how parental participation may be facilitated and supported in the institutional setting It is proposed that further research is required which determines the extent of parental participation and which considers the lived experiences of both the parents and nurses of parental participation Improved care for children and families could result fromefforts directed to those endeavours     

Pressure ulcer prevalence and incidence in intensive care patients: a literature review

Background: Pressure ulcers remain a common health problem worldwide within the different health‐care settings, especially in intensive care settings. Aims: The aims of this were to systematically assess the recent prevalence and incidence of pressure ulcers in intensive care patients (2000–2005), the factors related to pressure ulcer prevalence and incidence and the methodological rigour of studies about pressure ulcer prevalence and incidence in intensive care patients. Methods: The research design involved a review of literature for the period of 2000 to 2005, focused on the prevalence and incidence of pressure ulcers in intensive care patients. Results: The analysis of published papers revealed variations in pressure ulcer prevalence in intensive care settings ranging from 4% in Denmark to 49% in Germany, while incidence ranged from 38% to 124%. There was a wide variation in the prevalence and incidence of pressure ulcers in intensive care patients as evidenced in the studies examined. There is also a gap between theory and practice in the prevention and treatment of pressure ulcers which needs to be addressed. Conclusion: Further research is needed regarding the effectiveness of nursing care on pressure ulcer development and into treatments that may successfully prevent their occurrence in intensive care patients.     

From ward-based critical care to educational curriculum 1: a literature review.

There has been recent recognition in the literature, and a longer standing awareness amongst clinicians, that critically ill patients are to be found outside of intensive care units. These patients are not always well managed and some have concluded that their care is 'suboptimal' [Br. Med. J. 316 (1998) 1853] and that they die of preventable clinical problems [Extremes of Age: the 1999 Report of the National Confidential Enquiry into Perioperative Deaths (1999) NCEPOD]. Whilst the cause of this situation in the NHS probably involves a complex interplay of factors including failures in management, policy and the evidence/information base for practice, education failures have also been blamed. In response the government has mandated formal critical care education for ward nurses [Comprehensive Critical Care: a Review of Adult Critical Care Services (2000) Department of Health]. In this two-part paper, the literature around education for ward-based critical care is examined (Part 1) prior to a report of the findings (Part 2) of a case study exploring the everyday practices, context and culture of an acute surgical ward where seriously ill patients were cared for prior to the introduction of a critical care outreach service (Part 2). Implications for practice, education and future research are discussed.     

Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit.

BACKGROUND: The role of oral hygiene in maintaining the health and well being of patients in the intensive care unit (ICU) is indisputable. This importance is not reflected in the body of research related to ICU practice. While a number of studies have examined oral hygiene practices in oncological patients there is significantly less attention devoted to these practices in the critically ill. AIM: This paper has two discrete yet interrelated aims. Firstly, in relation to current available evidence and based on a sound knowledge of oral physiology, identify barriers to effective oral hygiene and subsequent effectiveness of the most commonly used and recommended methods of providing oral hygiene in the critically ill population. Secondly, informed by the critical review, identify recommendations for practice and future intervention studies. FINDINGS: To date, there is no definitive evidence to determine the most appropriate method of oral hygiene including the use of beneficial mouth rinses. Barriers identified in this review to providing optimal hygiene include: (1) mechanical barriers and equipment issues, (2) perceptions of the importance of mouth care and empathy with patient discomfort by nurses, (3) altered patient sensory perception and discomfort and (4) difficulties in patient communication. In spite of these challenges opportunities for collaborative research and increasing expertise in nurse researchers creates a climate to derive solutions to these factors. CONCLUSIONS: It is clearly evident from this review of oral hygiene practices in intensive care that the need for ongoing research is of paramount importance. ICU nurses undeniably require rigorous research studies in order to inform their practice in the provision of oral hygiene for critically ill patients.