Does simulation enhance nurses' ability to assess deteriorating patients?

Recognising and responding to patient deterioration has been identified as a key skill in nursing care to ensure that care is escalated for prompt, efficient management of the potentially critically ill patient. Simulation is one teaching strategy that has been established in nurse education as a method for enhancing skills. The objective was to explore the experiences of registered nurses to ascertain whether they perceived that simulation enhanced their skills in recognising the deteriorating patient. An exploratory qualitative design was used. Data were collected from registered nurses using semi-structured interviews following a professional development course where scenario-based simulation had been used to assess the patient. Eight registered nurses were interviewed for this study. Semi-structured interviews were conducted face to face. Verbatim transcripts were analysed using thematic analysis to identify major themes. Four themes were identified: knowledge, improved assessment skills in caring for the acutely ill patient, the learning environment and decision making. The use of simulation as a strategy was perceived by nurses to improve their own ability in identifying deteriorating patients. The participants described how their knowledge was transferred to clinical practice, with the overall perception that this led to improved patient care

Study protocol: Intensive care anxiety and emotional recovery (Icare) - A prospective study

Background Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown. Purpose The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a statistical model to determine the relationship between state anxiety during ICU stay and symptoms of anxiety, depression and PTSD at three occasions; after ICU discharge but prior to hospital discharge and at the third and sixth months post ICU discharge. Methods Prospective study including adult patients admitted to the ICU of a tertiary metropolitan Australian hospital for ≥24 h who are able to: (1) communicate verbally or nonverbally; (2) understand English and (3) open their eyes spontaneously or in response to voice to respond to the Faces Anxiety Scale (state anxiety assessment). One hundred and seventy patients will be assessed for their levels of state anxiety during their ICU stay to achieve a sample size of about 104 patients six months after discharge. The outcomes of the ICARe study will include symptoms of anxiety, depression and PTSD assessed by standardised questionnaires widely used in intensive care research. Demographic, clinical, and social support information will also be collected. Results The projected sample size will provide sufficient power to evaluate the association between state anxiety and adverse emotional outcomes, as well as a variety of variables that will be entered into a multivariate regression analysis. Conclusion This study will provide new evidence to improve care during critical illness and reduce adverse outcomes during recovery with the potential to decrease unnecessary suffering, promote comfort and improve long-term recovery

Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: a systematic review

Background nurse shortages have been identified as central to workforce issues in healthcare systems globally and although interventions to increase the nursing workforce have been implemented, nurses leaving their roles, particularly in the first year after qualification, present a significant barrier to building the nurse workforce. Objective to evaluate the characteristics of successful interventions to promote retention and reduce turnover of early career nurses. Design this is a systematic review Data sources Online databases including Academic Search Complete, Medline, Health Policy reference Centre, EMBASE, Psychinfo, CINAHL and the Cochran Library were searched to identify relevant publications in English published between 2001 and April 2018. Studies included evaluated an intervention to increase retention or reduce turnover and used turnover or retention figures as a measure. Review methods The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies were quality-assessed using the Joanna Briggs Institute Critical Appraisal tools for Quasi Experimental and Randomised Controlled Trials. Retention/turnover data were used to guide the comparison between studies and appropriate measures of central tendency and dispersion were calculated and presented, based on the normality of the data. Results A total of 11, 656 papers were identified, of which 53 were eligible studies. A wide variety of interventions and components within those interventions were identified to improve nurse retention. Promising interventions appear to be either internship/residency programmes or orientation/transition to practice programmes, lasting between 27-52 weeks, with a teaching and preceptor and mentor component. Conclusions Methodological issues impacted on the extent to which conclusions could be drawn, even though a large number of studies were identified. Future research should focus on standardising the reporting of interventions and outcome measures used to evaluate these interventions and carrying out further research with rigorous methodology. Clinical practice areas are recommended to assess their current interventions against the identified criteria to guide development of their effectiveness. Evaluations of cost-effectiveness are considered an important next step to maximise return on investment

Sample size: How many is enough?

Sample size is an element of research design that significantly affects the validity and clinical relevance of the findings identified in research studies. Factors that influence sample size include the effect size, or difference expected between groups or time points, the homogeneity of the study participants, the risk of error that investigators consider acceptable and the rate of participant attrition expected during the study. Appropriate planning in regard to each of these elements optimises the likelihood of finding an important result that is both clinically and statistically meaningful

Strategies to Improve Information Transfer for Multitrauma Patients.

The aim of this multiphase mixed-method study was to improve access, flow, and consistency of information transfer for multitrauma patients leaving the Emergency Department. Methods included literature review, focus group interviews, chart audits, staff surveys, and a review of international trauma forms to inform an intervention developed with a researcher-led, clinician stakeholder group. Analysis included descriptive and inferential statistics. Baseline data revealed variability existed in patient-care documentation, showing little standardization. Improvement strategies implemented included a gold standard for information embedded in handover tools, raising staff awareness of complexities for information transfer. Improvement was seen in communication between wards coordinating transfer, improved documentation, decreased information duplication, improved legibility, and increased ease and efficiency in navigating to key information. Improvement in communication at patient transition is essential to continuity of safe, effective care, and is impacted by complex interactions between multiple factors. Difficulty increases for patients with high acuity

Inconsistent VAP definitions raise questions of usefulness

Ventilator Associated Pneumonia (VAP) is recognised as one of the most frequent nosocomial infections in Intensive Care Unit (ICU), with infection rates varying from 10 to 30% of mechanically ventilated patients. VAP is undoubtedly a burden on the health care system and has been associated with adverse patient outcomes; increases in ICU Length of stay (LOS), hospital LOS and crudely associated with increased mortality. Furthermore, it has been widely reported to impact on health care resources resulting in significant inflation of health care costs

Evaluation of an Australian nursing partnership to improve disaster response capacity

Purpose– The purpose of this paper is to evaluate a partnership with specialized nurses from geographically disparate hospitals to provide critical support in national disaster

Trait anxiety but not state anxiety during critical Illness was associated with anxiety and depression over 6 months after ICU

Objective: To determine the association between anxiety during critical illness and symptoms of anxiety and depression over 6 months after ICU discharge in survivors of intensive care treatment. Design: Longitudinal study. Setting: One closed mixed ICU in an adult tertiary hospital in Brisbane, Australia. Patients: Participants (n = 141) were adults (≥ 8 yr), admitted to ICU for at least 24 hours, able to communicate either verbally or nonverbally, understand English, and open their eyes spontaneously or in response to voice. Interventions: None. Measurements and Main Results: The outcomes of symptoms of anxiety and depression over 6 months after ICU discharge were assessed using the Hospital Anxiety Depression Scale. The primary variable of interest was anxiety during critical illness. Two components of anxiety (state and trait) were assessed during critical illness using the Faces Anxiety Scale and the trait component of the State-Trait Anxiety Inventory. Perceived social support, cognitive functioning, and posttraumatic stress symptoms were also assessed using standardized instruments. Clinical and demographic data were obtained from patients and medical records. Participants were followed up in hospital wards and at 3 and 6 months after ICU discharge. During ICU treatment, 81 of the 141 participants (57%) reported moderate to severe levels of state anxiety. Of the 92 participants who completed the surveys at the 6-month follow-up, 26 participants (28%) reported symptoms of anxiety and 21 (23%) symptoms of depression. Symptoms of anxiety and depression were strongly correlated in this cohort of survivors. Trait anxiety was significantly associated with both anxiety and depression symptoms over time; however, state anxiety was not associated with either outcome. Participants who reported post-ICU memories of intra-ICU anxiety were significantly more anxious during recovery over 6 months. Cognitive functioning and posttraumatic stress symptoms were both significantly associated with anxiety and depression symptoms over time. Conclusion: Symptoms of anxiety and depression are a significant issue for general ICU survivors. Trait anxiety was significantly associated with adverse emotional outcomes over 6 months after ICU discharge. There was also a significant relationship between post-ICU memories of intra-ICU anxiety and anxiety during recovery. Interventions to reduce anxiety during critical illness need to be considered and evaluated for their longer term benefits for survivors of critical illness