Nurses’ perception of troubled conscience in intensive care units: a qualitative study
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SUBMITTER: Cheraghi M
PROVIDER: S-EPMC11340055 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:OBJECTIVES:The aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management. SETTING:This study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain). PARTICIPANTS:Purposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years. DESIGN:A qualitative study using focus groups. METHODS:7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6-10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data. RESULTS:3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care. CONCLUSIONS:Patients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process of care in patients with delirium.
| S-EPMC4735179 | biostudies-literature
Project description:AimPatient transfer from intensive care units (ICUs) to general wards is a routine part of hospital care. However, if the transfer is not optimal, it can result in increased readmissions to the ICU, increased stress and discomfort for the patient and, thus, a threat to patient safety. The aim of this study was to explore how general ward nurses experience patient safety during patient transfers from ICUs to general wards.DesignA qualitative design based on a phenomenological approach was used.MethodsTwo focus group interviews were conducted with a total of eight nurses from a medical ward and a surgical ward at one hospital in Norway. The data were analysed using systematic text condensation.ResultsThe nurses' experiences of patient safety during patient transfer had four themes: (1) the importance of preparedness; (2) the importance of the handover of information; (3) stress and a lack of resources and (4) a feeling of two different worlds.ConclusionIn order to promote patient safety, the informants highlighted the importance of being well prepared for transfer, and to have optimal handover of information. Stress, lack of resources and a feeling of two different worlds may pose threats to patient safety.Implications for the profession and/or patient careWe suggest several intervention studies testing the effect of intervention improving patient safety during the transfer process are designed, and that increased knowledge in this area is used to develop local practice recommendations.Patient or public contributionThe participants of this study were nurses and this contribution has been explained in the Data collection section. There was no patient contribution in this study.
| S-EPMC10495723 | biostudies-literature
Project description:ObjectivesVarious authors have explored the combination of competencies necessary for ensuring safe and quality care carried out by nurses in Intensive Care Units (ICUs). Nurses' perception of training is an element that must be studied in order to adopt appropriate educational measures. This study aimed to evaluate nurses' perception of the importance of intensive care training in Spain.MethodsA descriptive, cross-sectional, multicentre study was conducted on a national level in Spain. Totally 85 ICUs took part in the study. The questionnaire used was developed using the Delphi method and had 66 items to investigate nurses' perception on competency requirements and training needs. The evaluation was conducted by a 10-point Likert scale.ResultsThe sample was 568 Spanish nurses. Significant differences were found on an academic level, in terms of gender and hospital type, and in the professional experience of the nurse when it comes to evaluating the different training items; the differences in overall questionnaire scores among these groups were statistically significant (P < 0.05). The nurses analyzed believe that previous training and professional experience in other care services are necessary before starting work in an ICU.ConclusionImplementation of training programs tailored to the needs of critical nurses had benefits for nurses and the health system. Nurses benefited from training focused on the skills and knowledge of each moment of their working life. Nurses have a different evaluation of their training needs throughout their professional cycle. Therefore, their training must be adapted to the professional stage of each nurse.
| S-EPMC9305005 | biostudies-literature
Project description:ObjectiveThis article aims to provide an in-depth analysis of the concept of self-care in the intensive care unit and outline its defining attributes, antecedents, consequences and empirical referents.MethodsThe literature was searched electronically using databases such as CINAHL, Medline, Psych INFO, ERIC, ScienceDirect, Amed, EBSCO (Health Source: Nursing and Academic Edition), Sage, Ujoogle and Google Scholar. Articles from 2013 to 2020 were searched to target recent and up-to-date information about the definitions, attributes, antecedents and consequences of the concept of self-care. Walker and Avant's framework was utilised to analyse the concept of self-care.ResultsThe results of the concept analysis identified seven attributes, namely process, activity, capability, autonomous choice, education, self-control and interaction. The seven identified antecedents are self-motivation, participation, commitment, resources, religious and cultural beliefs, social, spiritual and professional support, and the availability of time. The consequences are the maintenance of health and wellbeing, autonomy, increased self-esteem, disease prevention, empowerment, increased social support and the ability to cope with stress.ConclusionsThe result of the concept analysis was used to describe a model to facilitate professional nurses' self-care in the intensive care unit.
| S-EPMC7434369 | biostudies-literature
Project description:ObjectivesVarious strategies to promote light sedation are highly recommended in recent guidelines, as deep sedation is associated with suboptimum patient outcomes. Yet, the challenges met by clinicians in delivering high-quality analgosedation is rarely addressed. As part of the evaluation of a cluster-randomised quality improvement trial in eight Scottish intensive care units (ICUs), we aimed to understand the challenges to optimising sedation in the Scottish ICU settings prior to the trial. This article reports on the findings.DesignA qualitative exploratory design: We conducted focus groups (FG) with clinicians during the preintervention period. Setting and participants: Eight Scottish ICUs. Nurses, physiotherapists and doctors working in each ICU volunteered to participate. FG were recorded and verbatim transcribed and inserted in NVivo V.10 for analysis. Qualitative thematic analysis was undertaken to develop emergent themes from the patterns identified in relation to sedation practice. Ethical approval was secured by Scotland A Research ethics committee.ResultsThree themes emerged from the inductive analysis: (a) a recent shift in sedation practice, (b) uncertainty in decision-making and (c) system-level factors including the ICU environment, organisational factors and educational gaps. Clinicians were challenged daily to manage agitated or difficult-to-sedate patients in the era of a progressive mantra of 'just sedate less' imposed by the pain-agitation-delirium guidelines.ConclusionsThe current implementation of guidelines does not support behaviour change strategies to allow a patient-focused approach to sedation management, which obstructs optimum sedation-analgesia management. Recognition of the various challenges when mandating less sedation needs to be considered and novel sedation-analgesia strategies should allow a system-level approach to improve sedation-analgesia quality.Desist registration numberNCT01634451.
| S-EPMC6538047 | biostudies-literature
Project description:AimTo determine the professional profile and the work conditions of nurses working in intensive care units (ICU) in Colombia, Argentina, Peru and Brazil.BackgroundICUs require a differentiated professional profile to provide quality care, and appropriate working conditions, leading to a transformation of care and management practices.DesignDescriptive multicentre cross-sectional observational study.MethodsAn online survey was applied to identify both the characteristics of the professional profile and the working conditions. 1,427 ICU nursing professionals were included. RStudio statistical software was used for the analysis of the information. Descriptive statistics were used for the presentation of the results. The STROBE checklist for cross-sectional studies was used in this study.ResultsOnly 33.6% of the professionals had a specialisation degree in intensive care. The skills that were most frequently put into practice were communication (68.5%) and care management (78.5%). The most predominant nurse-to-patient ratios were 1:2, and greater than 1:6. 59.1% of the nurses had an indefinite term contract, 38.8% worked 48 hours per week and 49.8% had rotating shifts. Only 50.4% of them received incentives. The average salary ranged between 348 and 1,500 USD. 64.5% of the participants were satisfied with their job.ConclusionIt is necessary to strengthen nurses' professional profile by promoting both postgraduate education and the development of troubleshooting and teamwork skills. It is necessary to standardise the nurse-to-patient ratio, improve wages and increase incentives to achieve greater job satisfaction.Relevance to practiceThe knowledge and the improvement of both the professional profile and the work conditions of nurses working in intensive care units will improve the quality of the care given to critical patients and, therefore, the quality of health outcomes.
| S-EPMC9291988 | biostudies-literature
Project description:IntroductionWith the development of medical technology, clinical alarms from various medical devices, which are rapidly increasing, are becoming a new problem in intensive care units. The aim of this study was to evaluate alarm fatigue in Polish nurses employed in Intensive Care Units and identify the factors associated with alarm fatigue.MethodsA cross-sectional study. The study used the nurses' alarm fatigue questionnaire by Torabizadeh. The study covered 400 Intensive Care Unit nurses. The data were collected from February to June 2021.ResultsThe overall mean score of alarm fatigue was 25.8 ± 5.8. Participation in training programs related to the use of monitoring devices available in the ward, both regularly (ß = -0.21) and once (ß = -0.17), negatively correlated with nurses' alarm fatigue. On the other hand, alarm fatigue was positively associated with 12 h shifts [vs. 8 h shifts and 24 h shifts] (ß = 0.11) and employment in Intensive Cardiac Surveillance Units-including Cardiac Surgery [vs. other Intensive Care Units] (ß = 0.10).ConclusionMonitoring device alarms constitute a significant burden on Polish Intensive Care Unit nurses, in particular those who do not take part in training on the operation of monitoring devices available in their ward. It is necessary to improve Intensive Care Unit personnel's awareness of the consequences of overburdening and alarm fatigue, as well as to identify fatigue-related factors.
| S-EPMC10179395 | biostudies-literature
Project description:BackgroundThe critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear.AimsThis study aims to explore the experience of intensive care nurses coping with ethical conflict in China.MethodsFrom December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study.ResultsTwo distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features.ConclusionThis study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.
| S-EPMC10687825 | biostudies-literature
Project description:ObjectivesTo describe critical care nurses' perception of moral distress during the second year of the COVID-19 pandemic.Design/methodsA cross-sectional study involving a questionnaire was conducted. Participants responded to the Italian version of the Moral Distress Scale-Revised, which consists of 14 items divided in dimensions Futile care (three items), Ethical misconduct (five items), Deceptive communication (three items) and Poor teamwork (three items). For each item, participants were also invited to write about their experiences and participants' intention to leave a position now was measured by a dichotomous question. The data were analysed with descriptive statistics and qualitative content analysis. The study followed the checklist (CHERRIES) for reporting results of internet surveys.SettingCritical care nurses (n = 71) working in Swedish adult intensive care units.ResultsCritical care nurses experienced the intensity of moral distress as the highest when no one decided to withdraw ventilator support to a hopelessly ill person (Futile care), and when they had to assist another physician or nurse who provided incompetent care (Poor teamwork). Thirty-nine percent of critical care nurses were considering leaving their current position because of moral distress.ConclusionsDuring the COVID-19 pandemic, critical care nurses, due to their education and experience of intensive care nursing, assume tremendous responsibility for critically ill patients. Throughout, communication within the intensive care team seems to have a bearing on the degree of moral distress. Improvements in communication and teamwork are needed to reduce moral distress among critical care nurses.
| S-EPMC9167948 | biostudies-literature
Project description:This study evaluated the communication experiences of critical care nurses while caring for patients in an intensive care unit setting. We have collected qualitative data from 16 critical care nurses working in the intensive care unit of a tertiary hospital in Seoul, Korea, through two focus-group discussions and four in-depth individual interviews. All interviews were recorded and transcribed verbatim, and data were analyzed using the Colaizzi's method. Three themes of nurses' communication experiences were identified: facing unexpected communication difficulties, learning through trial and error, and recognizing communication experiences as being essential for care. Nurses recognized that communication is essential for quality care. Our findings indicate that critical care nurses should continuously aim to improve their existing skills regarding communication with patients and their care givers and acquire new communication skills to aid patient care.
| S-EPMC7347110 | biostudies-literature