Relationships Among Climate of Care, Nursing Family Care and Family Well-being in Intensive Care Units

Family inclusion in health care delivery is vital for family well-being. However, intensive care (ICU) nurses experiencing frequent ethical conflict, low levels of organizational support and high levels of burnout may not be able to adequately care for families. The purpose of this study was to explore the relationships among variables related to the climate of care, nursing family care and family well-being in the ICU setting. A conceptual model derived from nursing, family, and organizational theories guided the study. A cross-sectional, correlational design was used with a convenience sample of nurses (n= 115) and family members (n = 44) from 5 ICUs at a Midwest hospital. The Ethical Conflict Questionnaire-Critical Care Version, Maslach Burnout Inventory-Human Services Survey and Hospital Ethical Climate Scale were used to measure the climate of care. The Family-Centered Care-Adult Version and Nurse Provided Family Social Support Scale were family measures of nursing family care, and the Family Well-being Index was used to measure family well-being. There was an indirect effect of organizational resources on family-centered care through nurse depersonalization, indicating a possible mediation effect of nurse burnout. Nursing years in the current ICU had a direct effect on family well-being and family-centered care. Nurse years in the ICU had a negative relationship with family-centered care, suggesting family-centered care decreases as nurse years in the ICU increase. In contrast, there was a positive relationship between family well-being and nursing years in the current ICU, indicating experienced ICU nurses may enhance family well-being. Organizational resources and depersonalization were significant predictors of family-centered care. There were weak, nonsignificant relationships between nurse provided family support and family well-being and family-centered care and family well-being. This study highlights the importance of organizational resources, as well as the negative influence burnout may have on the delivery of family-centered care. Nursing experience was related to family-centered care and family well-being, supporting the need for educational and practice-based interventions to enhance nursing family care. Further research is needed to examine the relationships among the ICU climate of care, nursing family care and family outcomes

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

COVID-19 Pandemic: Impact on Nurses Working in Critical Care in the United States

Rationale: It is likely the COVID-19 pandemic has and will continue to have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the critical care work force. The purpose of this study is to describe the impact of COVID-19 on nurse moral distress, burnout, anxiety, and depression. Methods: This descriptive study recruited a national sample of nurses that have worked in the ICU during the COVID-19 pandemic through American Association of Critical Care Nurses newsletters and social media (Twitter; Facebook). Reliable and Valid measures included: Measure of Moral Distress in Healthcare Professionals, Professional Quality of Life Scale, and the Patient Health Questionnaire Anxiety and Depression Scale. Results: The survey was launched in November 2020 and data collection is ongoing. To date, 498 nurses have completed the survey. Staff nurses comprise 90% of respondents with the majority working in a University Medical Center or a community hospital. Of the respondents, 28% were reassigned to a COVID unit other than their usual ICU. The majority (71%) experienced a shortage of personal protective equipment (PPE). Analysis of respondent anxiety, depression, burnout, and moral distress will be completed after the survey closes at the end of December 2020. Conclusion: To fully support nurses working on the frontline, we must understand the impact of the pandemic on ICU nurses. Results from this study will be used to develop recommendations for supporting nurses as the pandemic continues, as well as after the crisis. Improving the well-being of ICU nurses and decreasing nurse turnover are urgent critical care research and practice priorities. This study offers important insights about the mental health of nurses during a global pandemic that can guide the development of tailored interventions for ICU nurses

COVID-19 Pandemic: Experiences of Nurses Working in Critical Care in the United States

Introduction/Rationale: The coronavirus disease 2019 (COVID-19) global pandemic has put immense strain on healthcare workers (HCWs) at the frontlines. This is particularly true for health care workers caring for COVID19 patients in intensive care units (ICU). News reports highlight the extreme stress on healthcare workers in critical care. In this context national leaders have acknowledged a significant risk of posttraumatic stress disorder (PTSD), moral distress and burnout for critical care nurses related to the COVID-19 pandemic. It is likely the COVID-19 pandemic has and will continue to have a tremendous influence on ICU nurses’ mental health and continuation in the critical care work force. Although some early surveys have documented clinician’s perceptions of challenges and personal concerns, we are unaware of a qualitative study that is evaluating the broad experience and mental health impact of the pandemic on nurses practicing in ICUs across the nation. The purpose of the study is to describe the experiences of critical care nurses during the COVID-19 pandemic, specifically focusing on their personal and professional wellbeing, how they have changed as a result of their experience and how they feel ICU care will be affected in the future. Methods: This is a cross sectional, descriptive qualitative study that will recruit a national sample of nurses that worked in ICU during the COVID-19 pandemic in the United States in 2020. Nurses will be recruited through social media (Twitter and Facebook) and the American Association of Critical-Care Nurses (AACN) Newsletters. We plan to interview up to 40 respondents. Two researchers will be conducting the interviews using a semi-structured interview guide. Interviews will be conducted via Zoom, TEAMS or phone. They will be audio recorded and transcribed verbatim. Interviews will be analyzed with inductive content analysis by the research team. Results: Nine nurses have been interviewed to date. Additional recruitment and data collection are in progress and will be completed by January 2021. Conclusions: COVID-19 may have lasting effects on the health and well-being of nurses which could have a negative impact on the critical care workforce. In order to develop meaningful interventions and to fully support nurses working on the frontline through the next year and in similar situations it is imperative that we understand the experiences of nurses working on the frontlines during the pandemic