Nursing perspectives and strategies in patients with respiratory insufficiency

Background Approximately 30% of patients admitted to an intensive care unit experience respiratory distress. The COVID‐19 pandemic has led to an enormous increase in patients with respiratory symptoms. Nurse competence is essential for ensuring quality treatment and care for these patients; however, research on nursing strategies for patients with respiratory insufficiency is limited. Aim This study explored nurses' perspectives on and nursing strategies in patients with respiratory insufficiency when admitted to three different intensive care units. Design The study had an exploratory, descriptive, qualitative design. Methods Four focus group interviews with a total of 20 nurses, critical care nurses, and critical care nursing students were conducted. Data were analysed using content analysis. Results Participants' perspectives fell into two main themes: “nurse competence” and “the art of balancing.” “Nurse competence” incorporated the sub‐themes “observations and assessments,” “to make decisions,” and “collaboration.” The theme ‘the art of balancing’ incorporated the sub‐themes “nursing interventions,” “patients feeling safe,” and “patient participation.” Conclusion This study contributes new knowledge about nurses' perspectives on patients with respiratory insufficiency. Nurse competence was assumed essential to observe, assess, and treat patients with respiratory insufficiency. Nursing strategies included balancing nursing interventions, conducting medical treatment, and taking a whole‐person approach to patients' needs. Relevance to clinical practice The COVID‐19 pandemic has shown the need for nurse competence in caring for patients with respiratory insufficiency. This study adds to existing literature emphasizing the need for competence in health care services. Caring for patients with respiratory insufficiency requires nurses with experience; competence in observation, assessment, and medical treatment; and a whole‐person approach to patients' needs.publishedVersio

I Survived the ICU: Post-Intensive Care Syndrome from Patient and Nursing Perspectives

Excerpt from Introduction After a head-on collision with a drunk driver, Kathy Torpie had a long road to recovery ahead of her. After three weeks in the intensive care unit (ICU), sedation, and mechanical ventilation, she was left with a set of symptoms coined Post-Intensive Care Syndrome (PICS) (Torpie, 2005). PICS is defined as “a condition that encompasses new or worsening impairments in the patient’s physical, cognitive, or mental status arising after critical illness and persisting beyond the acute hospitalization” (Makic, 2016, p. 172). With technological advancements, ICU survival rates are on the rise. Now that survival has increased, it is time that the focus of intensive care expands to not only the survival of the patient but to encompass the patient as a whole; cognitively, psychologically, and physically in order to prevent PICS (Makic, 2016). Patient perspectives of PICS are a valuable asset in finding the most appropriate treatments for these patients. Furthermore, patient perspectives aid in applying possible preventative measures and treatment options to best nursing practice

Defining patient deterioration through acute care and intensive care nurses' perspectives

Aim: To explore variations between acute care and intensive care nurses’ understanding of patient deterioration according to their use of this term in published literature. Background: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses’ help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Design: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing focused database. Method: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses’ perspectives on patient deterioration was conducted. Findings: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses’ accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. Conclusions: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology toward critical illness. Contextual factors relating to acute care units appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modeling the concept of patient deterioration, which could be specific to acute care units. Relevance to Clinical Practice: The findings suggest it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issu

Applying Feminist Poststructuralism as a Framework for Exploring Infant Feeding Interactions in the Neonatal Intensive Care Unit

Childbearing/rearing families in Canada face a variety of conflicting discourses related to infant feeding, entrenched in a complex web of gendered, social, institutional and political discourses. For parents of preterm and/or critically ill infants, this area remains largely under-explored through a feminist lens. We offer a critical examination of the applicability of feminist poststructuralism (FPS) as a theory to explore infant feeding interactions in the neonatal intensive care unit (NICU). Scholarly literature from diverse perspectives, including nursing, healthcare, gender studies, and social sciences is critiqued and the use of FPS as a guiding framework for nursing research and praxis is discussed. We discuss FPS and the relevance of various discourses to explore the phenomenon of infant feeding interactions in the NICU. Ultimately, we propose that FPS does offer a relevant lens through which to critically examine infant feeding interactions and bring voice to the complex processes embedded in the NICU

What is the potential of distance education for learning and practice development in critical care nursing in the South Island of New Zealand? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education in Adult Education at Massey University

This thesis explores the potential of distance approaches to teaching and learning in post registration nursing education within the context of critical care nursing practice. The thesis specifically considers the appropriateness of distance education within the population of critical care nurses in the South Island of New Zealand. The geographical distribution of critical care services and subsequent population distribution of practising critical care nurses within the South Island has resulted in a demand for post registration education from relatively small yet distinct groups of nurses spanning a substantial land area (150,461 Km2). National shortages of experienced and qualified critical care nurses, and consensus regarding the necessity for post registration education for specialist practice have been recognised throughout the Western World (Ball 1992, Charlton, Machin and Clough 2000, Cutler 2000, Johnston 2002). Yet nurses in the South Island of New Zealand have limited provision or access to critical care education programmes (Hardcastle 2003). The thesis therefore presents a pertinent and timely exploration into the potential of distance approaches to educational provision for an area of specialist practice that is currently unable to consistently meet health care demands. The thesis uses descriptive and interpretive research (previously conducted by the author), and relevant literature in order to provide a comprehensive exploration of the study context and consider the research question. The thesis aims to enhance understanding of the specific population in terms of educational provision and demand, and the meaning of 'effective' education for critical care nursing practice. Subsequent examination of the potential of distance education within this context will more clearly indicate whether distance approaches could be compatible with concepts of effective education. The outcome of which will be useful in order to determine educational strategies that may positively influence the future of education for critical care nursing practice within the South Island of New Zealand

Moral Distress in Critical Care Nursing: The State of the Science

Background: Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions. Objectives: An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions. Review Methods: This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies. Results: Synthesis of the scientific literature revealed inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions. Conclusion: Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended

An Electronic Delphi Study to Establish Pediatric Intensive Care Nursing Research Priorities in Twenty European Countries*

OBJECTIVES:: To identify and to establish research priorities for pediatric intensive care nursing science across Europe. DESIGN:: A modified three-round electronic Delphi technique was applied. Questionnaires were translated into seven different languages. SETTING:: European PICUs. PARTICIPANTS:: The participants included pediatric intensive care clinical nurses, managers, educators, and researchers. In round 1, the qualitative responses were analyzed by content analysis and a list of research statements and domains was generated. In rounds 2 and 3, the statements were ranked on a scale of one to six (not important to most important). Mean scores and SDs were calculated for rounds 2 and 3. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Round 1 started with 90 participants, with round 3 completed by 64 (71%). The seven highest ranking statements ( 5.0 mean score) were related to end-of-life care, decision making around forgoing and sustaining treatment, prevention of pain, education and competencies for pediatric intensive care nurses, reducing healthcare-associated infections, identifying appropriate nurse staffing levels, and implementing evidence into nursing practice. Nine research domains were prioritized, and these were as follows: 1) clinical nursing care practices, 2) pain and sedation, 3) quality and safety, 4) respiratory and mechanical ventilation, 5) child- and family-centered care, 6) ethics, 7) professional issues in nursing, 8) hemodynamcis and resuscitation, and 9) trauma and neurocritical care. CONCLUSIONS:: The results of this study inform the European Society of Pediatric and Neonatal Intensive Care's nursing research agenda in the future. The results allow nurse researchers within Europe to encourage collaborative initiatives for nursing research

The use of simulation to address the acute care skills deficit in pre-registration nursing students: A clinical skills perspective

The increase in patient acuity in primary and secondary settings is continuing, with a corresponding increase in the need for technological competence in these areas. Evidence, however, both nationally and internationally, suggests that these expectations are not being met. This paper offers a review of the literature on acute care, with a specific focus on pre-registration nursing students and the development of acute care skills. Three themes are discussed: factors contributing to the acute care skills deficit, the knowledge and skills required to work in acute care and strategies used to support the acquisition of acute care skills. In response to the review, and based upon the evidence-based solutions identified, the clinical skills team at Bournemouth University designed and developed two teaching sessions, using simulation and role play to support the acquisition of acute care skills in pre-registration students. Student evaluations identify that their knowledge, competence and confidence in this area have increased following the teaching sessions, although caution remains regarding transferability of these skills into the practice environment

Does Culture Influence the Needs of Critical Care Families?

Purpose: This study explores ICU patient\u27s family member needs, particularly Vietnamese and Latino families. Design: Convenience sampling at 24 bed ICU in acute care community hospital serving ethnically diverse population. Methods: Non-experimental survey with pretest-posttest design using Demographic sheet, Critical Family Needs Inventory (CCFNI), and Needs Met Inventory (NMI). Information pamphlets were distributed. Data analysis was by ethnic groups using measures of central tendency and descriptive statistics. Findings: CCFNI results indicate family members of all ethnicities experience the same priority of needs; support and information are top two needs. English, Spanish and Vietnamese pamphlets met information needs of the majority of the recipients

Fostering confidence in critical thinking and research appraisal skills through Journal Club participation: an action research study

Evidence based nursing is an essential element of modern nursing practice. Nurses require an understanding of research appraisal and critical thinking skills. However, evidence suggests that many nurses lack confidence in these skills. Lecturer observation of post-registration nurses undertaking a ‘top-up’ degree corroborated this and identified weaknesses in research utilisation skills. As a result a single round of an action research model was undertaken. This research aimed to explore the views of these nurses on the impact of the journal club on perceived confidence in appraising and utilising research within the academic environment. Seven undergraduate post-registration intensive care nurses participated in the study during 2014. Focus groups were used to collect data pre and post the journal club programme. Data were analysed using thematic and descriptive data analysis. As a result of the programme, participants reported an increase in confidence following completion of the journal club programme. This study identifies that in this context, participation in a journal club programme improves the confidence of undergraduate post-registration nurses’ skills in engaging with clinical research