Selection of an instrument to evaluate the organizational environment of nurses working in intensive care: an integrative review

Objective: To determine an appropriate survey instrument to evaluate the impact of organizational structures on the work environment of intensive care nurses. Background: Internationally the demand for intensive care is increasing. Solely increasing bed capacity is not sustainable. Large capacity multi-specialty Intensive Care Units are emerging as the preferred organizational model with benefits resulting from optimizing operational synergies and economies of scale. The impact of this organizational transition on intensive care nurses is not well understood. An appropriate survey instrument for intensive care nurses is required. Design: Integrative literature review. Data Sources: CINAHL, PubMed, EMBASE and OVID Nursing databases searched for studies published between 2005 and 2013. Review methods: An integrative review and quality assessment of the studies was undertaken to select nurse outcome measures associated with organizational structures across a range of acute and critical care settings. Congruence between nurse outcome measures and nurse survey instruments tested in the literature was assessed to select instruments for further psychometric evaluation. Results: Thirty-one cross sectional quantitative studies, from fourteen countries, were reviewed. Twenty one nurse outcome measures associated with organizational factors were identified and a total of twenty five survey instruments used in the studies reviewed. Assessment of congruence and psychometric properties determined that a combination of two instruments is required to comprehensively assess the organizational environment of nurses working in intensive care units. Conclusion: The environment of nurses working in intensive care is effectively evaluated with an instrument that combines subscales from the Practice Environment Scale-Nurse Work Index and Maslach’s Burnout Inventory

Critical care health professionals' self-reported needs for wellbeing during the COVID-19 pandemic: A thematic analysis of survey responses.

BACKGROUND: Critical care healthcare professionals are a key part of any pandemic response and are at an increased risk for physical and psychological harm, yet their self-reported suggestions to ameliorate the negative effects of pandemics on their wellbeing have rarely been sought. OBJECTIVES: The objective of this study was to explore and interpret themes of critical care healthcare professionals' responses to the question 'What do you think could assist your wellbeing during the COVID-19 crisis?' METHODS: A descriptive study using an online survey, performed in April 2020, investigating pandemic preparedness and psychological burden during the early stages of the COVID-19 pandemic among critical care professionals was carried out. Informal snowball sampling was used. Thematic analysis of qualitative data from an open-ended survey item was informed by Braun and Clark. FINDINGS: Eighty percent (2387/3770) of respondents completed the open-ended survey. Three themes were generated from the synthesis: adequate resourcing for the role; consistent, clear information, and prioritised communications; and the need for genuine kindness and provision of support for healthcare professional wellbeing. CONCLUSIONS: There is merit for considering the perceptions, concerns, and suggestions of critical care clinicians during a pandemic. Suggestions included simple measures to maintain physical and mental health, clear messaging, consistent information, trust in health and political leaders, supportive working environments, specific training, and allowances for personal circumstances. This information is important for health and political leaders and policy makers to implement strategies to reduce the burden associated with delivering care in the context of a pandemic

Impact of the coronavirus disease 2019 pandemic on critical care healthcare workers' depression, anxiety, and stress levels.

AIM: The aim of the study was to determine levels of depression, anxiety, and stress symptoms and factors associated with psychological burden amongst critical care healthcare workers in the early stages of the coronavirus disease 2019 pandemic. METHODS: An anonymous Web-based survey distributed in April 2020. All healthcare workers employed in a critical care setting were eligible to participate. Invitations to the survey were distributed through Australian and New Zealand critical care societies and social media platforms. The primary outcome was the proportion of healthcare workers who reported moderate to extremely severe scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21). RESULTS: Of the 3770 complete responses, 3039 (80.6%) were from Australia. A total of 2871 respondents (76.2%) were women; the median age was 41 years. Nurses made up 2269 (60.2%) of respondents, with most (2029 [53.8%]) working in intensive care units. Overall, 813 (21.6%) respondents reported moderate to extremely severe depression, 1078 (28.6%) reported moderate to extremely severe anxiety, and 1057 (28.0%) reported moderate to extremely severe stress scores. Mean ± standard deviation values of DASS-21 depression, anxiety, and stress scores amongst woman vs men was as follows: 8.0 ± 8.2 vs 7.1 ± 8.2 (p = 0.003), 7.2 ± 7.5 vs 5.0 ± 6.7 (p < 0.001), and 14.4 ± 9.6 vs 12.5 ± 9.4 (p < 0.001), respectively. After adjusting for significant confounders, clinical concerns associated with higher DASS-21 scores included not being clinically prepared (β = 4.2, p < 0.001), an inadequate workforce (β = 2.4, p = 0.001), having to triage patients owing to lack of beds and/or equipment (β = 2.6, p = 0.001), virus transmission to friends and family (β = 2.1, p = 0.009), contracting coronavirus disease 2019 (β = 2.8, p = 0.011), being responsible for other staff members (β = 3.1, p < 0.001), and being asked to work in an area that was not in the respondents' expertise (β = 5.7, p < 0.001). CONCLUSION: In this survey of critical care healthcare workers, between 22 and 29% of respondents reported moderate to extremely severe depression, anxiety, and stress symptoms, with women reporting higher scores than men. Although female gender appears to play a role, modifiable factors also contribute to psychological burden and should be studied further