Search Results (187)

Burnout and moral distress are increasingly recognized as critical challenges within healthcare systems, particularly in high-stress environments such as intensive care units (ICUs). This cross-sectional study investigates the prevalence and interrelationships of moral distress, burnout, and turnover intentions among ICU nurses in Latvia, a country facing significant nursing shortages and structural workforce challenges. A total of 155 ICU nurses completed validated instruments assessing moral distress, the three subscales of burnout (personal, work-related, and client-related), and intentions to leave the profession. The results indicate that 68.2% of respondents experienced moderate to high levels of moral distress, especially related to providing aggressive treatment contrary to clinical judgment. Burnout scores were highest in the personal and work-related dimensions, with emotional exhaustion strongly correlated with moral distress. Approximately 30% of participants reported active intentions to leave their positions. Regression and mediation analyses confirmed that moral distress significantly predicted both burnout and turnover intentions, with burnout partially mediating this relationship. These findings highlight urgent risks not only to nurse well-being but also to healthcare quality and sustainability. This study underscores the importance of systemic interventions, including structured workload assessment tools, psychological support, and ethical consultation services. The results contribute to the international literature and offer context-specific insights for workforce resilience in Eastern European health systems. Full article

Background: Pain is a problem faced by critically ill surgical patients and has a major impact on their outcomes. Pain assessment is therefore essential for effective pain management, with a combination of pharmacological and non-pharmacological treatment. Clinical supervision, supported by models such as SafeCare, can improve professional development, safety and the quality of care in intensive care units. Objectives: This study aimed to: (1) assess current pain assessment practices in a polyvalent Intensive Care Unit (ICU) in the Porto district; (2) identify nurses’ training needs regarding the Clinical Supervision-Sensitive Indicator—Pain; and (3) evaluate the impact of clinical supervision sessions on pain assessment practices. Methods: A quantitative, quasi-experimental, cross-sectional study with a pre- and post-intervention design was conducted. Based on the SafeCare model, it included a situational diagnosis, 6 clinical supervision sessions (February 2023), and outcome evaluation via nursing record audits (November 2022 and May 2023) in 31 total critical ill patients. Pain was assessed using standardised tools, in line with institutional protocols. Data was analysed using Software Statistical Package for the Social Sciences v25.0. Results: Pain was highly prevalent in the first 24 h, decreasing during hospitalisation. Generalised acute abdominal pain predominated, with mild to moderate intensity, and was exacerbated by wound care and mobilisation/positioning. Pain management combined pharmacological and non-pharmacological treatment. There was an improvement in all the parameters of the pain indicator post-intervention. Conclusions: Despite routine assessments, gaps remained in reassessing pain post-analgesia and during invasive procedures. Targeted clinical supervision and ongoing training proved effective in improving compliance with protocols and supporting safer, more consistent pain management. Full article

Background/Objectives: Evidence-based nursing practice (EBNP) is essential in high-acuity settings such as intensive care units (ICUs) and emergency departments (EDs), where nurses are frequently required to make time-critical, high-stakes clinical decisions that directly influence patient safety and outcomes. Despite its recognized importance, the implementation of EBNP remains inconsistent, with frontline nurses often facing barriers to accessing and applying current evidence. Methods: This descriptive, cross-sectional study systematically mapped and prioritized clinical questions generated by ICU and ED nurses at a tertiary hospital in South Korea. Using open-ended questionnaires, 204 clinical questions were collected from 112 nurses. Each question was coded and classified according to the Nursing Interventions Classification (NIC) taxonomy (8th edition) through a structured cross-mapping methodology. Inter-rater reliability was assessed using Cohen’s kappa coefficient. Results: The majority of clinical questions (56.9%) were mapped to the Physiological: Complex domain, with infection control, ventilator management, and tissue perfusion management identified as the most frequent areas of inquiry. Patient safety was the second most common domain (21.6%). Notably, no clinical questions were mapped to the Family or Community domains, highlighting a gap in holistic and transitional care considerations. The mapping process demonstrated high inter-rater reliability (κ = 0.85, 95% CI: 0.80–0.89). Conclusions: Frontline nurses in high-acuity environments predominantly seek evidence related to complex physiological interventions and patient safety, while holistic and community-oriented care remain underrepresented in clinical inquiry. Utilizing the NIC taxonomy for systematic mapping establishes a reliable framework to identify evidence gaps and support targeted interventions in nursing practice. Regular protocol evaluation, alignment of continuing education with empirically identified priorities, and the integration of concise evidence summaries into clinical workflows are recommended to enhance EBNP implementation. Future research should expand to multicenter and interdisciplinary settings, incorporate advanced technologies such as artificial intelligence for automated mapping, and assess the long-term impact of evidence-based interventions on patient outcomes. Full article

Background/Objectives: The Jackson/Cubbin scale is a recommended tool to assess the risk of pressure injury in intensive care unit (ICU) patients. This scale is deemed to have superior predictive validity compared to the Braden scale. Many Italian nurses struggle with reading and applying the tool in English. This language barrier results in a lack of use of the Jackson/Cubbin scale clinically, meaning that patients potentially experience worse outcomes. This study aims to translate the original English version of the Jackson/Cubbin scale into the Italian language, conduct a cultural adaptation, and verify its content validity. Methods: An observational study was conducted using Beaton’s five-step methodology: (1) forward translation, (2) synthesis, (3) back-translation, (4) expert committee approval using Fleiss’ Kappa (κ) index, and (5) pre-testing, where participants assessed item clarity on a dichotomous scale (clear/unclear). Items deemed unclear by 20% or more of the sample were revised. Content validity was assessed using the Content Validity Index (CVI). Results: Fleiss’ κ index was 0.74. Item 3 “PMH-affecting condition” was unclear to 36% of the sample and required revision. The item-level CVI (I-CVI) was >0.78 for each item. The scale-level CVI (S-CVI) and the scale-level CVI using the average method (S-CVI-Ave) were 0.92 and 0.94, respectively. Conclusions: The translation process resulted in a linguistically accurate scale requiring content modifications to reflect current evidence and reduce inter-rater variability. This may improve implementation of the Jackson/Cubbin scale in clinical practice for Italian nurses and reduce the incidence of pressure injury for ICU patients. Full article

Objectives: This study aims to explore the experiences of bereaved family members during and after the loss of a relative in an intensive care unit (ICU) during the COVID-19 pandemic-related visitation restrictions, as well as to assess their perceptions of a nurse-led bereavement support programme. Methods: Ten participants with a relative who had died in an ICU were recruited in September 2020 during a follow-up bereavement meeting at a tertiary cardiac centre in Switzerland. Descriptive qualitative research was conducted. Face-to-face nurse-led follow-up bereavement meetings, adapted to the pandemic circumstances and conducted as semi-structured interviews, were analysed by a thematic analysis. Findings: Fifteen sub-themes and three main categories were identified. The motivation behind the family members’ participation in the meetings was to ask and learn about their experiences regarding the death of their relative during this abnormal time. The reactions to the meetings varied among the families. Many expressed that the experience of bereavement was particularly challenging and painful, and that the absence of a final farewell to their loved one, as well as the impossibility of having a formally held funeral, made the deaths harder to accept. The families appreciated the interview as it gave them clarification, information, and an awareness of the facts and the care provided, and for several of them it was also a chance to share their emotions and express any difficulties they might have encountered both during and after the patient’s death. Conclusion: The COVID-19 pandemic’s restrictions had a profound impact on families who lost a loved one in an ICU. The nurse-led bereavement support service responded to the needs of grieving families, providing valuable emotional and practical support and re-establishing a healthy relationship between the families and the caregivers that was hindered by pandemic restrictions. The study also shows that a nurse-led bereavement support service can be a valuable component of family-centred care. Full article

Background: Pressure ulcers (PUs) remain a prevalent complication in intensive care unit (ICU) settings, especially among immobilized patients. The impact of structured, nursing-led mobilization protocols on PU prevention and recovery remains underexplored. Objective: To evaluate the impact of nursing-led mobilization protocols on the incidence and progression of PUs in critically ill patients. Methods: In this retrospective observational cohort study, 188 ICU patients were admitted during one of two consecutive periods of care: conventional care (6-hourly repositioning) and an advanced nursing-led protocol (3-hourly repositioning with support surfaces and specialized nurse training), which replaced conventional care as standard in our institution. The primary outcome included new PU development for patients with no pre-existing ulcers or worsening/non-progression of pre-existing ulcers at discharge; ICU mortality was evaluated as a secondary outcome. Results: Among patients without pre-existing ulcers (n = 155), new PU incidence did not significantly differ between groups, even after adjusting for SOFA score (OR 0.40, 95% CI: 0.05 TO 3.17; p = 0.374). However, in patients with pre-existing ulcers (n = 33), the advanced care group showed improvement (53.3% versus 0% in the conventional group, OR 0.07, 95% CI: 0.01–0.64; p = 0.012); this effect was independent of initial SOFA score. Mortality was associated with the SOFA score, but not with the type of care. Conclusions: While advanced nursing-led mobilization did not reduce PU incidence, it significantly improved existing ulcer outcomes. Findings support the integration of structured protocols for high-risk ICU patients, especially those with existing ulcers. Full article

Background/Objectives: Mechanical ventilation management is a critical competency for intensive care unit (ICU) nurses; however, traditional training methods are often insufficient to prepare nurses for the complexities of alarm management and clinical decision-making. This study aimed to evaluate the effectiveness of a 360-degree virtual reality (VR)-based mechanical ventilation nursing education program for ICU nurses in Korea. Methods: A quasi-experimental pre-test–post-test design was employed with 65 ICU nurses (32 in the experimental group and 33 in the control group). Data were collected from May to October 2023. The VR-based program, developed using the ADDIE instructional design model, incorporated simulation-based scenarios focusing on ventilator alarm management and clinical reasoning. Outcome measures included knowledge of ventilation nursing, self-efficacy, clinical reasoning, learning immersion, turnover intention, and educational satisfaction. Data were analyzed using normality tests, descriptive statistics, independent t-tests, and paired t-tests. Results: The experimental group demonstrated significantly greater improvements in knowledge (Δ = 5.54), self-efficacy (Δ = 0.94), clinical reasoning (Δ = 0.76), and learning immersion (Δ = 0.88) compared to the control group (all p < 0.001), where Δ denotes the change score (post-test minus pre-test). Post-test assessments were conducted immediately after the intervention. Educational satisfaction was also significantly higher in the experimental group (p < 0.001). No significant difference was observed in turnover intention between the groups, suggesting a limited short-term impact on this outcome. Conclusions: A 360-degree VR-based education program effectively enhanced key competencies among ICU nurses. While these findings reflect short-term outcomes, future research is warranted to assess the long-term effects and sustainability of VR-based learning in ICU continuing education. Full article

Background/Objectives: The COVID-19 pandemic has placed intensive care unit (ICU) nurses under intense psychological pressure, increasing emotional and psychological stress. Two constructs—difficulties in emotion regulation and psychological inflexibility (i.e., low contact with the present moment and a lack of committed action based on personal values)—have been associated with increased perceived stress levels but remain underexplored in this population. Aims: This study investigated whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress in ICU nurses. It also examined whether years of ICU work experience moderate the direct relationship between emotion regulation difficulties and perceived stress. Methods: A cross-sectional study was conducted with 210 ICU nurses (65.2% women; 34.8% men; mean age = 40.25 years ± 11.36) from Italian public hospitals. The participants completed the Difficulties in Emotion Regulation Scale, the Acceptance and Action Questionnaire-II, and the Perceived Stress Scale. A moderated mediation model was tested to examine whether psychological inflexibility mediates the relationship between emotion regulation difficulties and perceived stress and whether years of ICU work experience moderate the path between these variables. Results: Higher difficulties in emotion regulation predicted greater psychological inflexibility, which, in turn, predicted higher perceived stress. Psychological inflexibility fully mediated the relationship between emotion regulation difficulties and perceived stress. Additionally, years of ICU work experience significantly moderated the direct link between emotion regulation difficulties and perceived stress. This relationship was strongest for nurses with 1–15 years of ICU experience. The model explained 33% of the variance in perceived stress. Conclusions: This study highlights the importance of the novel construct of psychological inflexibility in the context of healthcare professionals and its role in shaping perceived stress. Addressing psychological inflexibility through targeted interventions may help mitigate stress and promote well-being among ICU nurses. Full article

Objectives: Currently, there are a lack of data on the use of systemic lidocaine infusion in critically ill surgical patients, particularly regarding optimal dosing and monitoring. This study aimed to assess the feasibility of conducting a subsequent full-scale, randomized controlled trial (RCT) on the use of systemic lidocaine infusion in surgical intensive care units (ICUs). Methods: A single-center, prospective, single-arm pilot trial was conducted at the surgical intensive care unit (ICU) at Houston Methodist Hospital. The study population included 12 subjects over 18 years old who were admitted to the surgical ICU after open abdominal surgery. A low-dose lidocaine infusion of 10–30 mcg/kg/min within 1 h of ICU admission. Results: The feasibility outcomes encompassed recruitment, retention, and withdrawal rates. The study initially screened 18 participants, all of whom were successfully enrolled, resulting in a recruitment rate of 100%. However, 6 participants (33.3%) from the enrolled group were subsequently withdrawn for various reasons, resulting in a retention rate of 12 participants (66.7%). All 12 remaining participants were included in the analysis at the baseline stage. The safety outcomes included adverse events and serum lidocaine levels, with no serious adverse events reported. Dizziness and hypertension were the most frequently reported adverse events in their respective categories, affecting 16.7% of patients each. Four patients (33%) exhibited elevated lidocaine levels exceeding 5 mcg/mL; however, no clinical features of lidocaine toxicity were observed. This study adhered to the CONSORT 2010 extension for pilot and feasibility trials. In accordance with these guidelines, no formal hypothesis testing for efficacy was performed. The exploratory outcomes included a reduction in opioid requirements, as measured by morphine milligram equivalents (MMEs), and pain scores. The median MMEs decreased from 22.6 on postoperative day 0 to 2.5 on day 3. The pain scores decreased by 1.09 units per day (β = −1.09; 95% CI: −1.82 to −0.36; p = 0.003); however, the absence of a control group limits the robustness of this observation. Conclusions: A large-scale, randomized controlled trial to evaluate the safety and efficacy of systemic lidocaine infusion in the surgical intensive care unit (ICU) seems feasible, with minor adjustments to the eligibility criteria and improved collaboration among nurses, anesthesiologists, and surgeons. Full article

Background: Patients who undergo cardiac surgery and procedures often experience functional impairments. However, few studies have compared changes in physical function, cognitive function, mental health, and sleep quality before and after the interventions. Methods: Intensive care unit (ICU) nurses visited the ward and conducted the assessments. The Japanese version of the Cardiovascular Health Study (J-CHS) and the Barthel index for physical function, mini-mental state examination (MMSE) for cognitive function, hospital anxiety and depression scale for anxiety (HADS-A) and depression (HADS-D) for mental health, and a 5-point Likert scale for sleep quality were used. Results: Of the 210 cases, 156 were included. Cardiac surgeries and procedures included valve replacement or valvuloplasty (43%), coronary artery bypass graft (9%), and transcatheter aortic valve implantation (39%). At a median of 7 (4–9) days after ICU discharge, the J-CHS score worsened from 2 (1–3) to 3 (2–3) (p < 0.01), and the Barthel index worsened from 95 (85–100) to 75 (55–85) (p < 0.01). The HADS-A score improved from 3 (1–6) to 1 (0–4) (p < 0.01), and the HADS-D score improved from 4 (1–7) to 2 (1–6) (p < 0.01). The MMSE score remained unchanged at 26 (24–29; p = 0.91). Sleep quality worsened from 4 (3–5) to 3 (2–4) (p < 0.01). In the multivariate analysis, sleep quality deterioration was associated with open thoracotomy. Conclusions: After cardiac surgeries and procedures, physical function and sleep quality worsened, whereas anxiety and depression improved, and cognitive function remained unchanged. Full article

Introduction: Sleep disturbances are a common and often underestimated complication during intensive care unit (ICU) stays. These disturbances can significantly impact patients’ recovery and overall well-being. This study aimed to assess the sleep quality of ICU patients and investigate the environmental and clinical factors that affect sleep quality during their ICU stay. Methods: We conducted a six-month cross-sectional study involving patients who had stayed in the ICU for at least three nights and were oriented to time and place upon discharge. Sleep quality was assessed using the Arabic version of the Freedman Sleep Questionnaire. Both environmental factors (e.g., noise, light, and nursing interventions) and clinical variables (illness severity and pain) were examined. The differences across three time periods were analyzed using the Wilcoxon test and Spearman’s correlation. Multiple regression analysis identified the factors influencing sleep quality. Statistical analyses were performed using JAMOVI software (version 2.3.28). Results: The study enrolled 328 patients, with an average age of 49.74 ± 17.89 years. Of the participants, 75.3% were adults. The primary reasons for admission were circulatory distress (45.73%) and metabolic disorders (24.09%). Sleep quality was significantly lower in the ICU compared to patients’ sleep at home (Z = −14.870, p < 0.001). The EVA and APACHE II scores had a statistically significant effect on sleep quality (p < 0.001 and p = 0.015, respectively). In contrast, the Charlson and Quick SOFA scores did not show significant effects (p = 0.128 and p = 0.894). Environmental factors, including noise (p = 0.008), light (p = 0.009), and nursing interventions (p = 0.009), significantly impacted sleep quality. Conclusions: Patients in the ICU generally reported poor sleep quality. Our findings suggest that improving pain management, minimizing environmental noise, and reducing staff-related disturbances could significantly enhance sleep quality for patients in the intensive care unit (ICU). Full article

Background and Objective: Delirium, a prevalent neurocognitive disorder, frequently affects critically ill patients hospitalized in intensive care units (ICUs), leading to increased mortality, prolonged hospital stays, and higher healthcare costs. This quasi-experimental study assessed the effect of an educational program relating to ICU nurses’ knowledge of delirium in a university hospital in Nablus, Palestinian Authority. Methods: A pre-test–post-test design was employed, utilizing a 25-item questionnaire for 114 ICU nurses. The educational intervention included a presentation on delirium, the distribution of educational materials, and follow-up video sessions. Our study aim was to evaluate nurses’ understanding of ICU delirium and the impact of the educational program on their ability to identify and evaluate the delirium. Results: Pre-intervention assessments indicated limited awareness among nurses regarding delirium diagnosis and management tools, i.e., the Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening Checklist. Post-intervention results showed a significant improvement in knowledge; median scores increased from 6 (range: 3–13) to 15 (range: 12–20) (p < 0.001). Nurses also reported greater confidence in identifying and managing delirium, and 50% found CAM-ICU easy to use. However, knowledge gaps remained concerning mixed delirium types and modifiable risk factors. Conclusions: Continuous educational programs are essential for ensuring long-term knowledge retention. We recommend integrating routine delirium education with hospital policies and emphasizing the use of delirium assessment tools during each shift. Findings show that targeted education can enhance ICU nurses’ competencies and thereby improve patient outcomes through more effective delirium management. Full article

Background/Objectives: In hospital settings, the wide variability of acute and complex chronic conditions—among both adult and pediatric patients—requires advanced approaches to detect early signs of clinical deterioration and the risk of transfer to the intensive care unit (ICU). Nursing diagnoses (NDs), standardized representations of patient responses to actual or potential health problems, reflect nursing complexity. However, most studies have focused on the total number of NDs rather than the individual role each diagnosis may play in relation to outcomes such as ICU transfer. This study aimed to identify and rank the specific NDs most strongly associated with ICU transfers in hospitalized adult and pediatric patients. Methods: A retrospective, monocentric observational study was conducted using electronic health records from an Italian tertiary hospital. The dataset included 42,735 patients (40,649 adults and 2086 pediatric), and sociodemographic, clinical, and nursing data were collected. A random forest model was applied to assess the predictive relevance (i.e., variable importance) of individual NDs in relation to ICU transfers. Results: Among adult patients, the NDs most strongly associated with ICU transfer were Physical mobility impairment, Injury risk, Skin integrity impairment risk, Acute pain, and Fall risk. In the pediatric population, Acute pain, Injury risk, Sleep pattern disturbance, Skin integrity impairment risk, and Airway clearance impairment emerged as the NDs most frequently linked to ICU transfer. The models showed good performance and generalizability, with stable out-of-bag and validation errors across iterations. Conclusions: A prioritized ranking of NDs appears to be associated with ICU transfers, suggesting their potential utility as early warning indicators of clinical deterioration. Patients presenting with high-risk diagnostic profiles should be prioritized for enhanced clinical surveillance and proactive intervention, as they may represent vulnerable populations. Full article

Pediatric Intensive Care Units (PICUs) provide specialized care for critically ill children. Developing and managing these units in South Asia remains challenging. Resource limitations and infrastructural disparities are leading to challenging conditions. Above all, nurses play a pivotal role in delivering quality critical care. Effective nursing practices can curb hospital-acquired infections (HAIs), ensure medication safety, and enable protocols such as the ICU Liberation Bundle. In South Asia, another challenge is the proper management of the nursing workforce. Nurse-to-patient ratios are highly disproportionate, contributing to nurse burnout. This review highlights the country-specific challenges and circumstances. There is no one-size-fits-all solution; effective strategies vary based on each country’s context. With context-specific solutions, nurses can bridge the gap between healthcare teams and families, ultimately improving patient outcomes. Full article

The COVID-19 pandemic has led to a general increase in the workload in Intensive Care Units (ICUs). The objective here was to analyze the nursing workload in a Cardiology ICU of a tertiary and teaching inner hospital in Brazil before and during the COVID-19 pandemic. A retrospective and ecological study was conducted. Nursing Activities Score mean by month (NAS-mm) data were collected from the unit’s opening in October 2014 until May 2023. The data were divided into pre-pandemic and pandemic periods, with the pandemic further divided into three phases/years. A workload decrease was observed during the pandemic and varied across different pandemic years. In the pre-pandemic period, the mean was 53.80 points (95%CI: 52.99; 54.60; n = 65), whereas during the pandemic, it was 52.02 points (95%CI: 50.88; 53.17; n = 39). The first year had the lowest mean workload at 50.94 points, followed by the second year with 48.37 points, while the third year had the highest with 55.82 points, exceeding the pre-pandemic period’s workload. Amid the COVID-19 pandemic scenario, a decrease in nursing workload was observed in the unit, only returning to reference values in the third pandemic year, possibly associated with patient and administrative profile changes. Full article