Interruptions experienced by cardiovascular intensive care unit nurses: An observational study

Purpose

Intensive care unit (ICU) nurses get interrupted frequently. Although interruptions take cognitive resources from a primary task and may hinder performance, they may also convey critical information. Effective management of interruptions in ICUs requires the understanding of interruption characteristics, the context in which interruption happens, and interruption content.

Methods

An observational study was conducted in a cardiovascular ICU at a Canadian teaching hospital. Four observers (1 PhD and 3 undergraduate students) trained in human factors research observed 40 nurses, approximately 1 hour each, over a 3-week period. Data were recorded by the observers in real time, using touchscreen tablet PCs and special software designed for this purpose.

Results

Although approximately half of the interruptions (~ 51%) happened during high-severity tasks, more than half of these interruptions, which happened during high-severity tasks, conveyed either work- or patient-related information. Furthermore, the rate of interruptions with personal content was significantly higher during low-severity tasks compared with medium- and high-severity tasks.

Conclusions

Mitigation strategies other than blocking should also be explored. In addition, interrupters might have evaluated primary task severity before interrupting. Therefore, making task severity more transparent may help others modulate when and how they interrupt a nurse.     

A qualitative analysis of ethical problems experienced by physicians and nurses in intensive care units in Turkey

In this qualitative study, we aimed to identify and compare the ethical problems perceived by physicians and nurses in intensive care units at Baskent University hospitals in Turkey. A total of 21 physicians and 22 nurses were asked to describe ethical problems that they frequently encounter in their practice. The data were analyzed using an interactive model. The core problem for both physicians and nurses was end-of-life decisions (first level). In this category, physicians were most frequently concerned with euthanasia while nurses were more concerned with do-not-resuscitate orders (second level). At the third level, we saw that almost all of the participants' responses related to negative perceptions about euthanasia. Communication and hierarchical problems were the second most reported main category. Nurses were more likely to cite problems with hierarchy than physicians. At the third level, a large percentage of nurses described communication problems with authority and hierarchical problems with physicians. In the same category, physicians were most often concerned with communication problems with patients' relatives. The ethical problems were reported at different frequencies by physicians and nurses. We asked the participants about ethical decision-making styles. The results show that nurses and physicians do not follow a systematic pattern of ethical decision making.     

Experience of neonatal intensive care unit nurses in providing developmentally‐supportive care: A qualitative study

Many challenges have been noted in the implementation of developmentally‐supportive care principles in neonatal intensive care units, despite evidence that adhering to such care principles achieves positive results for the neonate. The aim of this study was to explore and describe compliance in adhering to developmentally‐supportive care principles implemented in one neonatal intensive care unit in South Africa. An exploratory design was used in this qualitative study with purposive sampling to select eligible neonatal intensive care registered nurses (n = 14) as participants. Participants all worked in a 10 bed neonatal intensive care unit at a large tertiary care public hospital. Six audio‐recorded interviews were conducted, with recordings subsequently transcribed and analyzed. Three main themes were identified: value of developmentally‐supportive care, nature of developmentally‐supportive care, and barriers to developmentally‐supportive care. One of the main themes had subthemes, which substantiated the findings, and included parent involvement, nurse engagement, and holistic care. Study outcomes offer insight into the development or revision of policies and practices, which are crucial when implementing developmentally‐supportive care, particularly in resource‐poor settings where challenges are magnified.     

Experience of patients in the intensive care unit. A qualitative study

How patients experience their stay in the Intensive Care Unit is often not discernible externally. The patients are frequently sedated and in such a life-threatening condition that they cannot express their experiences in this situation. Observation of the patients during their stay in ICU lends little to understanding their experiences. What one perceives from the outside can differ greatly from that which the patients experience themselves. Therefore, in this study, the patients were interviewed about their experiences several weeks to months after their release from the hospital. In this way, the patients could describe their perceptions from their own perspectives and thus be better understood. For this purpose the methodology of narrative interview was chosen so that the former patients could talk freely about what they experienced during their stay in ICU. Two of the interviews were completely analysed sequentially. The remaining interviews were used for purposes of comparison. The results of this study are the dimensions, which describe the experiences of patients in Intensive Care Units. The first dimension describes the experience of losses of memory, orientation impairment, and dreams. These experiences are closely related to outside influences, which could help to reconstruct the lost time and regain orientation, for example the reports of relatives. The second dimension represents how ill or healthy the patients considered themselves, and how much understanding they showed for their being treated in the ICU. The third dimension, which can be considered of overriding importance, outlines the patients' trust in relatives, the nursing staff and doctors.     

Oral care practices of intensive care nurses: A descriptive study

The aim of this study was to investigate intensive care unit (ICU) nurses’ views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using ‘Oral Care Practices Survey’ which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x² = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x² = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications.     

Person-centred care among intensive care unit nurses: A cross-sectional study

ObjectivePractising person-centred care is crucial for nurses in the intensive care unit, as patients have high physical and psychological care needs. We aimed to identify the predictors of person-centred care among nurses working in intensive care settings.MethodsIn this cross-sectional study, 188 intensive care unit nurses at four tertiary hospitals in two cities of South Korea were included. They completed self-reported questionnaires on emotional intelligence, compassion satisfaction, secondary traumatic stress, burnout, and person-centred care. Emotional intelligence was measured using the Korean version of the Wong and Law’s emotional intelligence scale. Compassion satisfaction, secondary traumatic stress, and burnout were measured by the Professional Quality of Life questionnaire (version 5). Person-centred care was measured using the person-centred critical care nursing scale.ResultsMultiple regression identified compassion satisfaction (β = 0.49, p <.001) as the most powerful predictor of person-centred care, followed by emotional intelligence (β = 0.21, p =.004) and intensive care unit career length (β = 0.17, p =.021). These three variables accounted for 31.0 % of the variance in person-centred care.ConclusionsThis study highlights the importance of career length, emotional intelligence, and compassion satisfaction in the promotion of person-centred care among intensive care unit nurses. Nursing management should contemplate specific measures to reduce turnover among experienced intensive care unit nurses and to enhance the factors that promote person-centred care, such as compassion satisfaction and emotional intelligence.     

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.     

New graduate nurses and dementia care in acute care: A qualitative study

With the increasing older adult population, new graduate nurses will be providing care for patients with dementia more frequently. The purpose of this qualitative study was to explore the experiences of new graduate nurses when providing care for patients with dementia in acute care environments. We conducted semi-structured interviews with eleven new graduate nurses in Ontario, Canada. Three themes emerged from the thematic analysis: (1) building of vision and values; (2) clashing of vision and values; and (3) making do with what you have. Barriers to providing dementia care in acute care were similar to barriers experienced by non- new graduate nurses reported in the literature, such as challenges with responsive behaviours, maintaining safety and providing psychosocial care. Facilitators identified were supportive colleagues and early exposure to dementia care.     

Suicidal patients as experienced by psychiatric nurses in inpatient care

Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.     

A qualitative study of the experiences of patients following transfer from intensive care.

In nursing literature much attention has been paid to patients' experiences while in intensive care. Extensive literature exists examining the longer-term effects of critical care [Jones C, Humphris GM, Griffiths RD. Psychological morbidity following critical illness - the rationale for care after intensive care. Clinical Intensive Care 1998;9:199-205; Griffiths RD, Jones C. ABC of intensive care. Recovery from intensive care. Br Med J 1999;319:417-429]. There is an apparent scarcity of data examining patients' experiences immediately following discharge to wards. A Husserlian phenomenological approach was utilised to gain some understanding of the experience of patients following transfer from intensive care. Ten patients selected purposively comprised the sample. Interviews were performed on the wards 3-5 days following transfer from intensive care. Data was analysed utilising () [Colaizzi PF. Psychological Research as the phenomenologist views it. In: Valle R, King M, editors. Alternatives for psychology. New York: Oxford University Press; 1978. p. 48-71] procedural approach to phenomenological interpretation and analysis. Three major themes emerged: physical response, psychological response and provision of care. These provide a possible framework for patient assessment. Implications for future practice and study are discussed.     

Suffering and pleasure experienced by nurses working at an intensive care unit of a university hospital

The purpose of this study is to grasp and to understand the nurses' social representations concerning their work in intensive care unit and the ways of expressing feelings of suffering and pleasure. Six nurses of the intensive care unit of medical, surgical and pediatric clinics were interviewed. The analysis of the social representations made possible the apprehension of the symbolic dimension of the work in the psycho-social (individual), social-dynamic (group) and institutional perspective. We verified that the work in intensive care unit brings pleasure to nurses despite of intense emotional constraint. This qualitative study allowed na in-depth reflection on the issue and made evident the need to deepen research. However, other investigations have to be carried out to deepen the subject on the subjective and symbolic dimension to subsidize the administration of human resources in nursing.