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:IntroductionWorkplace bullying (WB) is a significant occupational hazard for nurses, especially in high-stress environments such as pediatric intensive care units (PICUs). WB adversely affects nurses' physical and mental health, patient safety, and overall quality of care. This study aimed to explore the causes of WB among nurses working in PICUs.MethodsThis qualitative study used a conventional content analysis approach. Eleven nurses from the PICUs of the Children's Medical Center Hospital, affiliated with Tehran University of Medical Sciences, participated in the study. Participants were selected through purposive sampling. Data were collected through semi-structured face-to-face interviews, continuing until data saturation was achieved. The data were analyzed using Graneheim and Lundman's five-step approach. Lincoln and Guba's four criteria-credibility, confirmability, dependability, and transferability-were used to ensure the study's rigor.ResultsThe analysis of the data revealed two main categories: [1] the "Imposing and Stereotypical Atmosphere," which encompasses sub- categories such as power imbalances, work-related challenges, immature behaviors among staff, and passive reactions of nursing managers; and [2] the "Victim's Achilles' Heel," which emphasizes weaknesses in clinical and communication skills as contributing factors to WB.ConclusionThe study identifies organizational and personal factors as causes of WB in PICUs. Nursing leaders can implement targeted interventions aimed at improving workplace culture, monitoring interpersonal relationships, enhancing communication skills, and promoting the clinical skills of staff. These strategies can reduce WB and create a healthier work environment for nurses.
| S-EPMC11908083 | biostudies-literature
Project description:ObjectivesThe 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.SettingThis study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain).ParticipantsPurposeful 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.DesignA qualitative study using focus groups.Methods7 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.Results3 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.ConclusionsPatients 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:BackgroundAnticipated nursing care is provided significantly earlier than expected by nurses, caregivers, and other healthcare staff for patients. This type of care is influenced by many factors and is followed by various positive and negative consequences. Accordingly, the present study sought to explore nurses' perceptions of anticipated nursing care.MethodsThis qualitative study was conducted using content analysis on twelve nurses from different internal and surgical wards of Shahid Sadoughi Hospital, Yazd, Iran from November 2022 to September 2023The participants were selected using purposive sampling. The data were collected through semi-structured interviews with the nurses and analyzed using Graneheim and Lundman's qualitative content analysis method.ResultsData analysis revealed four main categories and eleven subcategories. The main categories included early and priority care with two subcategories, scope of anticipated care with four subcategories, predictors of anticipated care with three subcategories, and outcomes of anticipated care with two subcategories.ConclusionsBased on the findings, it is suggested that nursing managers must focus on the antecedents of anticipated care and address strategies to improve the working conditions of nurses, changing routine procedures for providing care and the doctor-nurse interaction, developing and organizing training programs on clinical reasoning, decision-making and time management for nurses.
| S-EPMC11819522 | biostudies-literature
Project description:BackgroundThere is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care.MethodsA qualitative descriptive design was used to describe clinician's perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis.ResultsFrom 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork.ConclusionsClinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU.
| S-EPMC10877773 | biostudies-literature