A comparison of nurses' work satisfaction between single-room and multioccupancy adult intensive care units: A mixed-methods integrative review

ObjectivesTo systematically review and compare the evidence for the transition from multi- occupancy adult intensive care units to single room intensive care units.Review method usedA mixed methods systematic review informed by Joanna Briggs Institute guidelines for Systematic Reviews.Data sourcesThe databases CINAHL, Medline and Embase were searched for primary research articles relating from 2008–2019.Review MethodsThe methodological quality of all studies that met the inclusion criteria were assessed using Mixed Methods Appraisal Tool (MMAT). The findings were synthesised into themes.Results6349 records were identified, and four of those met the inclusion criteria and included in the review. Eight inter-related themes were revealed, which were teamwork, isolation, patient safety, proximity, staff education, satisfaction, staff morale and ambience.ConclusionsWhen planning transitions from multi-occupancy to single room ICU’s, although patient safety, and patient and family privacy are paramount, consideration should be also given to the nurse work environment and work satisfaction.     

Organizational and safety culture in Canadian intensive care units: relationship to size of intensive care unit and physician management model

Purpose

The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture.

Materials and Methods

In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture.

Results

Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P < .01), relative technical quality of care (r = 0.66; P < .01), and medical director budgeting authority (r = 0.46; P = .03), and moderately strong negative correlations with frequency of events reported (r = −0.46; P = .03), and teamwork across hospital units (r = −0.51; P = .01). There were similar patterns for relationships with intensivist management. For most pairs of domains, there were weak correlations between organizational and safety culture.

Conclusion

Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs.     

Delirium incidents in three Danish intensive care units

Background: Delirium as a result of hospitalization in an intensive care unit (ICU) is defined by a mental state different from the patients' normal state and an acute fluctuating course. Both morbidity and mortality are increased in relation to delirium. The incidence of delirium has been reported from 16% to 87% in international studies primarily in elderly patients. Aims: The purpose of this study was to evaluate the incidence of delirium in adult intensive care patients in Denmark and to identify correlations between delirium, sedatives, opiod analgesics and age. Methods: In a prospective follow‐up study, 139 adult patients were screened for delirium using the confusion assessment method for the ICU (CAM‐ICU) from 48 h after admission to ICU, twice a day until discharged. Results: A total of 41 patients had at least one positive score for delirium, 61 had only negative scores and 37 were too heavily sedated to be scored during the study period. Thus, the incidence of delirium was 40% among patients who were able to be CAM‐ICU scored. Patients who were lightly sedated had a 10‐fold increased risk of delirium. There was no difference in incidence by age. Patients who received Fentanyl were more at risk of developing delirium compared with patients who received other or no analgesics. Sedative drugs did not influence the incidence. Conclusion: In this study delirium occurred in 40% of adult ICU patients of all ages.     

The impact of the addition of nurse practitioners to surgical intensive care units: A retrospective cohort study

BackgroundDemand for surgical critical care is increasing, but work-hour restrictions on residents have affected many hospitals. Recently, the use of nurse practitioners (NPs) as providers in the intensive care unit (ICU) has expanded rapidly, although the impacts on quality of care have not been evaluated.ObjectivesTo compare the outcomes of critically ill surgical patients before and after the addition of NPs to the ICU team.MethodsWe conducted a retrospective cohort study in a Taiwanese surgical ICU. We compared the outcomes of patients admitted to ICU during the 2-year period before and after the addition of NPs to the ICU team. Patients admitted in the 1-year transition phase were excluded from comparisons. The primary endpoint was ICU mortality. Secondary endpoints included ICU length of stay and incidence of unplanned extubation.ResultsA total of 8747 patients were included in the study. For all eligible admissions, primary and secondary outcomes did not differ significantly between the two groups. For scheduled ICU admissions, ICU mortality was significantly lower after the addition of NPs (2.2% before vs. 1.1% after addition of NPs, p = 0.014). For unscheduled ICU admissions, ICU mortality did not differ significantly between the two groups. In the multivariate analysis, admission after the addition of NPs was associated with significantly reduced ICU mortality (odds ratio = 0.481; 95% confidence interval = 0.263–0.865; p = 0.015) among scheduled admissions.ConclusionIncorporating NPs in the ICU team was associated with improved outcomes in scheduled admissions to surgical ICU when compared with a traditional, resident-based team.     

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.     

The quality and duration of sleep in the intensive care setting: An integrative review

Background

Sleep is essential for well-being and recovery from illness. The critically ill are in significant need of sleep but at increased risk of sleep loss and disruption.

Objectives

To determine the quality and duration of sleep experienced by adults who are patients in intensive care units and factors affecting their sleep.

Design

An integrative approach was used for this literature review in order to explore the available evidence on this topic, which has yet to be fully investigated.

Data sources

PubMed, CINAHL, Psychinfo, the Australian Digital Theses Program and ProQuest Dissertations and Theses (Interdisciplinary) databases were searched for studies conducted about sleep in adult intensive care units. Manual searches of papers identified from this search were performed to find additional studies.

Review methods

Data related to the quality and duration of sleep along with study design, sample size and intensive care context were extracted, evaluated and summarised.

Results

Total sleep time is normal or reduced with significant fragmentation. Light sleep is prolonged and deep and rapid eye movement sleep are reduced. The most likely factors affecting sleep quality are high sound levels, frequent interventions and medications. Data obtained from polysomnography are supported by patient self reports. Considerable variation in data exists between patients and studies affecting generalizability. Existing criteria for staging sleep may be inadequate for quantifying sleep in intensive care patients.

Conclusions

There is evidence that intensive care patients’ sleep is significantly disrupted. Alternative methods of quantifying sleep for intensive care patients may be required. Few large observational or interventional studies have used polysomnography and simultaneous recordings of intrinsic and extrinsic disruptive factors. These studies are required in order to improve sleep for intensive care patients.     

Factors affecting adult intensive care units costs by using the bottom-up and top-down costing methodology in OECD countries: A systematic review

ObjectivesTo review the studies, which calculated the total intensive care unit costs and indicated the main cost drivers in the intensive care by using either top-down, bottom-up approach or the combination of them.Research methodology/designsA systematic review of papers published until October 2020 was conducted. Search was performed on PubMed, Medline, Scopus and Science Direct databases.SettingThis review i examined costs in adult intensive care units, in countries belonging to the Organisation for Economic Co-operation and Development (OECD) (medical, surgical or general adult , paediatric and neonatal were not included).Main outcome measuresEighteen articles were included in the review.ResultsEight of the studies used the top-down costing methodology, six of them used the bottom-up approach and four of them used both of them. The mean total patient cost per day ranged from €200.75 to €4321.91 (all costs are presented in 2020 values for euro). Human resources were identified as the largest proportion of total costs. Length of stay, mechanical ventilation, continuous haemodialysis and severe illness are the main cost drivers of intensive care unit total costs.ConclusionThere are a variety of methods and study designs used to calculate costs of an intensive care unit stay.t It is necessary to evolve standardised costing methods in order to make comparisons and succeed in cost-effective management.     

A cross-sectional study of predictors of pain control during the transition from the surgical intensive care unit to surgical ward

Background

The transition of patients from the intensive care unit (ICU) to the ward is a complicated process and patients may be at risk of increased levels of pain.

Access to intensive care units: A survey in North-East Italy

The factors associated with policies for allowing visitors into intensive care units (ICUs) are a debated issue in the nursing literature.The aim of this survey was to describe visiting policies in the ICUs of North-East Italy and to verify the hypothesis of an association between attitudes regarding accessibility to visitors and environmental, organisational or logistic variables. Data were collected by means of questionnaires sent by mail to head nurses of ICUs.The questionnaires were completed for 104 of the 110 ICUs contacted (94.5%). Visiting hours were generally less than 4 h a day (86%) and only 14% of the ICUs reported imposing no restrictions. Children under 12 years old were rarely admitted (22%). Twenty-one percent of the ICUs reported always allowing exceptions, while 77% did so only under ‘particular’ circumstances. Visiting times were not associated with logistic and organisational factors, but rather with the type of ICU (p = 0.000), city setting (p = 0.009), exceptions to rules (p = 0.029), allowing more than one person (p = 0.016) and opening to children (p = 0.001).Restrictive visiting policies emerged; paediatric units were generally more flexible. The association between the variables regarding visiting policy, such as visiting times and exceptions to rules, or allowing more than one person or children, seem to confirm how the rules are influenced mainly by the staff's attitude, which could be changed by continuing professional education.     

Patient,family-centred care interventions within the adult ICU setting: An integrative review

ObjectivesPatient, Family-Centred Care (PFCC) is internationally advocated as a way to improve patient care. The aim of this integrative review was to extend the knowledge and understanding by synthesising empirical evidence of PFCC interventions within the adult intensive care unit (ICU) setting.Review method usedAn integrative review methodological framework was employed, permitting the inclusion of all research designs. A comprehensive and systematic search, selection, quality appraisal, and data extraction of research were conducted to synthesise knowledge and identify research gaps.Data sourcesA systematic search of the following databases was conducted: MEDLINE; CINHAL; PsycINFO; Cochrane Library; Web of Science—Current Contents Connect; Web of Science—Core Collection; The Joanna Briggs Institute EBP Database; ProQuest Sociological Abstracts; and ProQuest Dissertation and Theses Global. Primary research in adult ICUs was included.Review methodsData extracted from the studies included authors, year, country of origin, design, setting, sample, intervention, data collection strategies, main findings and limitations. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsForty-two articles met the inclusion criteria and were included in the review. Only a third of the papers stated the theory underpinning their study. Three themes emerged with interventions predominantly around Interacting with the target sample; Culture and Connection and Service Delivery interventions were also identified. Few studies integrated more than one dimension of PFCC.ConclusionsResearch into PFCC interventions is diverse; however, few researchers present a multi-dimensional approach incorporating a culture shift to enact PFCC throughout the ICU trajectory. There is an opportunity for future research to describe, develop, and test instruments that measure PFCC based on its multiple dimensions and not on one component in isolation. Importantly, for PFCC to successfully individualise quality patient care, a commitment and enactment of partnerships between health care professionals, patients, and family members is imperative.     

Nurses’ experiences of ICU diaries following implementation of national recommendations for diaries in intensive care units: A quality improvement project

ObjectivesTo evaluate critical care nurses’ experiences of ICU diaries following the implementation of national recommendations for the use of diaries for critically ill patients.DesignA quality improvement project describing the development and implementation of national recommendations (2011), as well as the assessment of the use of diaries in intensive care nursing practice (2014).SettingNorwegian intensive care units (ICUs).ParticipantsThirty-nine Norwegian ICUs took part in the study.InterventionA multi-component process for developing national recommendations for the use of diaries in Norwegian ICUs, including recommendations for the target group, when to start, health professionals as authors, diary content, structure, language, use of photographs, handover, access and storage within patient medical records.Main outcome measureA questionnaire asking about experiences of implementing national recommendations on diaries in Norwegian ICUs, as well as their impact and how they are used.ResultsThree years after the implementation of the national recommendations, diaries were provided in 24 (61.5%) of the responding ICUs. Fifty-six per cent of the ICUs had revised their routines, of which 62% had updated and 38% had developed new protocols. Most ICUs kept the diary along with other medical information describing patient care, but only 50% of the ICUs scanned handwritten diaries into the electronic medical records before handing them over to patients or the bereaved. ICU nurses reported that implementing national recommendations had increased their awareness and knowledge on patient and family needs, as well as the long-term effects of critical illness.ConclusionThe results of this quality improvement project indicate that access to national recommendations on the use of diaries for critically ill patients have a potential of changing routines and increase standardisation.     

Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review

ObjectivesTo synthesize and evaluate current non-pharmacological sleep interventions for critically ill adult patients in intensive care units and provide recommendations for future studies of non-pharmacological means of improving this population’s sleep quality.Research Methodology/DesignThe literature search was conducted following PRISMA guidelines. Seven databases CINAHL, PsycINFO, Embase, Medline, Cochrane Library, Web of Science, and Scopus and three keywords, sleep, intervention and intensive care unit were employed. All possible combinations of the keywords and similar words were considered. Included studies were primary studies, involved adult intensive care unit patients, focused on non-pharmacological sleep interventions, measured subjective and/or objective sleep quality and were published in English between January 2010 and September 2020.ResultsThe 20 included studies examined different types of non-pharmacological sleep interventions involving use of earplugs, an eye mask, white noise, music, aromatherapy, massage, acupressure, light intensity, a sleep hygiene protocol, quiet time and minimization of nursing care. Of 18 studies employing an experimental design, most reported that non-pharmacological interventions improved sleep quality. All these interventions involved environmental factors or complementary relaxation strategies.ConclusionsNon-pharmacological sleep interventions can have a positive influence on sleep quality in critically ill patients, but more research is needed to determine their effectiveness.