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Tang MT, Chui PL, Chong MC, Zhang HY, Li XM, Wang T. Translation, cross-cultural adaptation, reliability, and validity of the Chinese version of the intensive care unit environment stress scale for pediatric patients. J Pediatr Nurs 2024; 77:e511-e519. [PMID: 38782669 DOI: 10.1016/j.pedn.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE There is currently a lack of understanding of children's experience in the pediatric intensive care unit (PICU) environment. Additionally, pediatric patients may experience post-PICU syndrome following discharge. Thus, we aimed to adapt and evaluate the psychometric properties of a tool specifically for use with children in the PICU. DESIGN AND METHODS According to Brislin's Model, the Intensive Care Unit Environment Stress Scale (ICUESS) was translated both forward and backward and adapted cross-culturally. A total of 210 PICU patients were selected from four hospitals in XXX to analyze the final translated version of the questionnaire, the Pediatric Intensive Care Unit Environmental Stress Scale (PICUESS). Content validity, exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) were used to assess the validity, while reliability was assessed using Cronbach's alpha and split-half reliability analysis. RESULTS For PICUESS, seven of 42 items were modified. Content validity was high (overall = 0.96, item validity = 0.8 to 1.0). Exploratory factor analysis revealed eight common factors (Kaiser-Meyer-Olkin = 0.857, significant Bartlett's test). The results of the CFA indicate that the scale model fits well across the 8 factors. The entire scale demonstrated excellent internal consistency (Cronbach's alpha = 0.934). The overall split-half reliability was 0.935. CONCLUSIONS The Chinese version of PICUESS demonstrates good reliability and validity, making it suitable for assessing pediatric patients' perceptions of the PICU environment. PRACTICE IMPLICATIONS The PICUESS can assist healthcare professionals in providing personalized environment care for PICU patients. It has the potential to serve as a tool for further testing and international comparisons of pediatric patients' perceptions of the PICU environment.
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Affiliation(s)
- Mao Ting Tang
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Ping Lei Chui
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Hai Yang Zhang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
| | - Xiao Min Li
- Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ting Wang
- Department of Pediatric Intensive Care Unit Nursing, West China Second University Hospital, Sichuan University, West China School of Nursing, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu, Sichuan, China
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Gonzalez-Baz MD, Pacheco Del Cerro E, Ferrer-Ferrándiz E, Araque-Criado I, Merchán-Arjona R, de la Rubia Gonzalez T, Moro Tejedor MN. Psychometric validation of the Kolcaba General Comfort Questionnaire in critically ill patients. Aust Crit Care 2023; 36:1025-1034. [PMID: 36906429 DOI: 10.1016/j.aucc.2022.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND There is a lack of validated tools to measure comfort in critically ill patients. OBJECTIVE The objective of this study was to evaluate the psychometric properties of the General Comfort Questionnaire (GCQ) in patients admitted to intensive care units (ICUs). METHODOLOGY A total of 580 patients were recruited, randomising the sample into two homogeneous subgroups of 290 patients for exploratory factor analysis and confirmatory factor analysis, respectively. The GCQ was used to assess patient comfort. Reliability, structural validity, and criterion validity were analysed. RESULTS The final version included 28 of the 48 items from the original version of the GCQ. This tool was named the Comfort Questionnaire (CQ)-ICU, maintaining all types and contexts of the Kolcaba theory. The resulting factorial structure included seven factors: psychological context, need for information, physical context, sociocultural context, emotional support, spirituality, and environmental context. A Kaiser-Meyer-Olkin value of 0.785 was obtained, with Bartlett's sphericity test (0.000) being significant, and the total variance explained was 49.750%. The Cronbach's alpha was 0.807, with subscale values ranging from 0.788 to 0.418. Regarding convergent validity, high positive correlations were obtained between the factors and the GCQ score, the CQ-ICU score, and the criterion item GCQ31: "I am content". In terms of divergent validity, correlations were low with the APACHE II scale and with the NRS-O except for physical context (-0.267). CONCLUSION The Spanish version of the CQ-ICU is a valid and reliable tool to assess comfort in an ICU population 24 h after admission. Although the resulting multidimensional structure does not replicate the Kolcaba Comfort Model, all types and contexts of the Kolcaba theory are included. Therefore, this tool enables an individualised and holistic evaluation of comfort needs.
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Affiliation(s)
- Ma Dolores Gonzalez-Baz
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
| | - Enrique Pacheco Del Cerro
- Department of Nursing, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Spain; Nursing Management, San Carlos Clinical Hospital, Madrid, Spain.
| | - Esperanza Ferrer-Ferrándiz
- Escuela Universitaria de Enfermería La Fe, Valencia, Spain; Grupo Investigación Arte y Ciencia del Cuidado (GREIAC) of Instituto de Investigación Sanitaria La Fe, Spain.
| | - Irene Araque-Criado
- Department of Evidence Based Practice, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Raúl Merchán-Arjona
- Escuela de Enfermería de Cruz Roja Española, Universidad Autónoma de, Madrid, Spain.
| | | | - Ma Nieves Moro Tejedor
- Nursing Research Support Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain; Red Cross University College of Nursing, Spanish Red Cross, Autonomous University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Spain.
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Toqan D, Ayed A, Khalaf IA. Effect of progressive muscle relaxation exercise on anxiety among nursing students prior to critical care clinical training. J Public Health Res 2023; 12:22799036231181668. [PMID: 37333031 PMCID: PMC10272653 DOI: 10.1177/22799036231181668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Intensive care units are considered stressful and emotionally risky situations by both professionals and patients and their families. The purpose was to assess the effect of progressive muscle relaxation exercise on anxiety among nursing students in intensive care units prior to clinical training. Method A randomized, controlled study design was used. The study composed of 80 nursing students from Arab American University. For 2 weeks, the experimental group's 40 participants were taught progressive muscle relaxation exercises to help with anxiety control, whereas the control group's 40 participants received no training. Results The results revealed that the experimental group was capable of reducing the anxiety (p < 0.05). Also, the experimental group had les anxiety (1.15 ± SD = 0.43) compared with the control group (2.83 ± SD = 0.40). Conclusion The current study's findings confirmed the effect of progressive muscle relaxation exercise (PMRE) on anxiety reduction in intensive care units during clinical training among nursing students.
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Affiliation(s)
- Dalia Toqan
- Faculty of Nursing, Arab American University, Jenin, Palestine
| | - Ahmad Ayed
- Faculty of Nursing, Arab American University, Jenin, Palestine
| | - Inaam A Khalaf
- School of Nursing, The University of Jordan, Amman, Jordan
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Tan JXJ, Cai JS, Ignacio J. Effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted into intensive care units: A systematic review. Intensive Crit Care Nurs 2023; 76:103396. [PMID: 36738535 DOI: 10.1016/j.iccn.2023.103396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE This review aims to evaluate the effectiveness of aromatherapy on anxiety and sleep quality among adult patients admitted to an intensive care unit. MATERIALS AND METHODS A systematic search for published and unpublished studies across nine databases and sources were conducted. Randomised Controlled Trials and Controlled Clinical Trials, which assessed the effectiveness of aromatherapy on anxiety and sleep quality among intensive care unit patients, were included in this review. Only studies that used aromatherapy as a single intervention were included. Narrative synthesis was conducted across all outcomes due to high heterogeneity across studies. RESULTS A total of 26 studies involving 2176 participants across six countries were included in this review. Most studies had an overall high risk of bias. Publication bias was detected in the studies. Findings have shown that aromatherapy may be effective in reducing anxiety based on the low GRADE certainty of evidence, and improving sleep quality based on the very low GRADE certainty of evidence. Inconsistencies in findings were also observed. CONCLUSION Aromatherapy might be beneficial on anxiety and sleep quality among intensive care unit patients, however, the level of evidence is very low, based on the low quality of studies. Considerations can be made to incorporate aromatherapy into existing interventions that improve anxiety and sleep quality in the intensive care unit. Due to inconsistencies in findings, further research can be done to investigate and strengthen these evidence. IMPLICATION FOR CLINICAL PRACTICE This review has demonstrated that aromatherapy may have benefits on anxiety and sleep quality. Despite uncertain evidence, aromatherapy may still be considered as a complementary or alternative option to improve anxiety and sleep quality among intensive care patients as it is relatively safe, cost-effective and easy to implement (Buckle, 2014). However, proper training by a professional clinical aromatherapist is needed to ensure there is screening of patients for suitability, proper technique for administering aromatherapy, safe handling of essential oils and monitoring for adverse events (Farrar & Farrar, 2020).
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Affiliation(s)
- Jie Xi Jassie Tan
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, 90 Yishun Central, Singapore 768828, Singapore.
| | - Junyao Stefanie Cai
- Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, 90 Yishun Central, Singapore 768828, Singapore.
| | - Jeanette Ignacio
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.
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Shih CY, Pai HC. Factors Affecting the Relationship Between Stress and Anxiety in Critically Ill Patients: A Partial Least Squares Structural Equation Modeling Approach. Clin Nurs Res 2023; 32:366-374. [PMID: 34866443 DOI: 10.1177/10547738211062346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aimed to examine the factors affecting the relationship between stress and anxiety in critically ill patients. A cross-sectional research paradigm was employed to enroll patients admitted to the medical intensive care unit (ICU) of a medical university hospital. Partial least squares structural equation modeling (PLS-SEM) was used to examine the data. A total of 90 ICU patients were included in this study; 56 were men and 34 were women. The patients' mean age was 65.3 years. Only the emotional responses dimension of illness was significantly positively correlated with stress. However, the emotional responses dimension of illness representation, acute physiology and chronic health evaluation system (APACHE) score, age, and education level were significantly positively correlated with anxiety. Nevertheless, treatment control was significantly negatively correlated with anxiety. Overall, illness representations (emotional responses and treatment control), APACHE score, age, and education were important predictors of anxiety, with an explanatory power of 37.9%. We recommend that for clinically relevant practice, besides focusing on ICU patients' illness representation, attention should also be paid to their individual characteristics, such as differences in age and education levels.
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Affiliation(s)
| | - Hsiang-Chu Pai
- Chung-Shan Medical University.,Chung-Shan Medical University Hospital
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Kawano T, Ono H, Abe M, Umeshita K. Changes in Physiological Indices Before and After Nursing Care of Postoperative Patients With Esophageal Cancer in the ICU. SAGE Open Nurs 2023; 9:23779608231190144. [PMID: 37528908 PMCID: PMC10387705 DOI: 10.1177/23779608231190144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/17/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Various stressors have been identified in patients in the intensive care unit (ICU), including postoperative pain, ventilatory management, and nursing care. However, sedated patients are less responsive, and nurses have difficulty capturing their stressors. Objective To investigate patient stress caused by nursing care performed in the ICU on sedated patients based on changes in physiological indices. Methods We observed nursing care performed on patients with postoperative esophageal cancer under sedation in the ICU. This included endotracheal suctioning and turning, the time required for the care, and the patients' behavioral responses. Information on arousal levels, autonomic nervous system indices, and vital signs were also obtained. The changes in indicators before and after care were then compared and analyzed. Results There were 14 patients in the study. The mean age of the patients was 68 years. Ninety-nine scenes of nursing care were observed, and in six of these, additional bolus sedation was administered because of the patient's significant body movements. In endotracheal suctioning, no significant changes were observed in all indicators. In turning, vital signs changed significantly, and when both were continued, all indicators changed significantly. Conclusion Our study found that different types and combinations of nursing care may cause different stresses to the patients. Moreover, the autonomic nervous system indices may be more likely to react to stresses in a variety of nursing care, while arousal levels may be more likely to react to burdensome stresses. If the characteristics of these physiological indicators can be understood and effectively utilized during care, it may be possible to better identify and reduce patient stress during sedation management.
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Affiliation(s)
| | - Hiroshi Ono
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Masaki Abe
- Faculty of Nursing Science, Osaka Seikei University, Osaka, Japan
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Darawad MW, Abu Feddeh S, Saleh AM. Factors affecting the caring performance of newly graduated Nurses' working in critical care units. Int J Nurs Pract 2022; 28:e13047. [PMID: 35263813 DOI: 10.1111/ijn.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/19/2021] [Accepted: 02/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although many studies have discussed nurses' caring performance, few have focussed on critical care nurses. Also, none have studied this among newly graduated nurses despite their very different circumstances. AIM The purpose of this study was to examine factors affecting the caring performance of newly graduated nurses in critical care units. METHOD A descriptive cross-sectional design, using self-reported questionnaires, was used among a sample of 209 nurses interviewed in Jordanian hospitals. The Mental Health Professionals Stress Scale was used for measuring work-related stress and the Caring Behaviours Assessment tool to assess caring performance. Data collection was conducted from March to May 2018. RESULTS The participants had moderate levels of caring performance (M = 182.6/315, SD = 15.46). The highest score was reported for 'Supportive/Protective/Corrective Environment' subscale, while the lowest for 'Teaching/Learning' subscale. Many significant differences were noticed in caring performance based on participants' demographics. Only working in private hospitals was a significant predictor for caring performance (P < .05) predicting 14% of variance. CONCLUSION Caring performance of newly graduated nurses in critical care units was affected by many factors including workload, self-doubt, income and area of working. The significance was flagged of developing nursing policies concerned with stress relief and improvement of caring performance.
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Affiliation(s)
| | | | - Ali M Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
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Delaney LJ, Litton E, Huang HCC, Lopez V, van Haren FMP. The accuracy of simple, feasible alternatives to polysomnography for assessing sleep in intensive care: An observational study. Aust Crit Care 2022; 36:361-369. [PMID: 35361553 DOI: 10.1016/j.aucc.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Sleep disturbance is common in intensive care patients. Understanding the accuracy of simple, feasible sleep measurement techniques is essential to informing their possible role in usual clinical care. OBJECTIVE The aim of the study was to investigate whether sleep monitoring techniques such as actigraphy (ACTG), behavioural assessments, and patient surveys are comparable with polysomnography (PSG) in accurately reporting sleep quantity and quality among conscious, intensive care patients. METHODS An observational study was conducted in 20 patients admitted to the intensive care unit (ICU) for a minimum duration of 24 h, who underwent concurrent sleep monitoring via PSG, ACTG, nursing-based observations, and self-reported assessment using the Richards-Campbell Sleep Questionnaire. RESULTS The reported total sleep time (TST) for the 20 participants measured by PSG was 328.2 min (±106 min) compared with ACTG (362.4 min [±62.1 min]; mean difference = 34.22 min [±129 min]). Bland-Altman analysis indicated that PSG and ACTG demonstrated clinical agreement and did not perform differently across a number of sleep variables including TST, awakening, sleep-onset latency, and sleep efficiency. Nursing observations overestimated sleep duration compared to PSG TST (mean difference = 9.95 ± 136.3 min, p > 0.05), and patient-reported TST was underestimated compared to PSG TST (mean difference = -51.81 ± 144.1 7, p > 0.05). CONCLUSIONS Amongst conscious patients treated in the ICU, sleep characteristics measured by ACTG were similar to those measured by PSG. ACTG may provide a clinically feasible and acceptable proxy approach to sleep monitoring in conscious ICU patients.
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Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, Wunderlich MM, Lütz A, Balzer F, Weiss B, Spies CD. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10:jcm10173928. [PMID: 34501376 PMCID: PMC8432195 DOI: 10.3390/jcm10173928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Jakob Gülden
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Vivian-Marie Mauersberger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Lukas Ehlen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | | | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Alawi Lütz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Correspondence: ; Tel.: +49-30-450-551-102
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Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units: Patients' perceptions. Nurs Crit Care 2021; 27:195-203. [PMID: 33949036 DOI: 10.1111/nicc.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels. AIMS AND OBJECTIVES To assess the stressors affecting patients admitted to ICCUs. DESIGN This is a cross-sectional study performed in a public hospital in São Paulo, Brazil. METHODS A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests. RESULTS Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control." CONCLUSIONS Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions. RELEVANCE TO CLINICAL PRACTICE Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.
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Affiliation(s)
- Aluê Constantino Coelho
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Vinicius Batista Santos
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
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Deffner T, Rosendahl J, Niecke A. [Psychotraumatological aspects in intensive care medicine]. DER NERVENARZT 2021; 92:81-89. [PMID: 33410960 DOI: 10.1007/s00115-020-01060-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.
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Affiliation(s)
- Teresa Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland.
- Kinderklinik, Sektion Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland.
| | - Jenny Rosendahl
- Institut für Psychosoziale Medizin und Psychotherapie, Universitätsklinikum Jena, Jena, Deutschland
| | - Alexander Niecke
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Uniklinik & Medizinische Fakultät, Universität zu Köln, Köln, Deutschland
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Gezginci E, Goktas S, Orhan BN. The effects of environmental stressors in intensive care unit on anxiety and depression. Nurs Crit Care 2020; 27:113-119. [PMID: 32954635 DOI: 10.1111/nicc.12553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical and emotional conditions of patients treated in an intensive care unit (ICU) may be adversely affected by environmental stressors. AIMS AND OBJECTIVES The aim of this study was to investigate the relationship between patients' anxiety and depression levels and environmental stressors in the ICU. DESIGN This was a descriptive cross-sectional study. METHODS The study was conducted between June 2018 and April 2019 with 150 patients treated in the ICUs of a training and research hospital. Patient information form and ICU environmental stressors and hospital anxiety and depression scales were used for data collection. Descriptive statistics, t-test, one-way analysis of variance, and Pearson's correlation coefficient were used to evaluate the data. RESULTS The mean hospital anxiety score of the patients in ICUs was 11.1 ± 2.7, and 77.3% of patients were at risk for anxiety (10-point cut-off). The mean hospital depression score was 10.6 ± 3.3, and 94% of patients were at risk for depression (7-point cut-off). The mean score of environmental stressors was 123.9 ± 13.1. A moderate positive correlation between hospital anxiety and hospital depression (r = .63, P < .001) and a weak negative correlation between environmental stressors and hospital anxiety (r = -.24, P = .003) were found. However, no significant correlation between environmental stressors and hospital depression was found (r = -.13, P = .12). CONCLUSION According to this study, the environmental stressors in the ICU were high, and the patients were at risk of anxiety and depression. The depression levels of the patients increased along with their anxiety levels. As environmental stressors increased, hospital anxiety levels of the patients decreased. However, there was no significant relationship between environmental stressors and patients' hospital depression levels. RELEVANCE TO CLINICAL PRACTICE Environmental stressors in ICUs are high, and the patients in the ICUs are at risk of anxiety and depression.
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Affiliation(s)
- Elif Gezginci
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Sonay Goktas
- Hamidiye Faculty of Nursing, University of Health Sciences Turkey, Istanbul, Turkey
| | - Busra Nur Orhan
- Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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[Psychotraumatological aspects in intensive care medicine]. Med Klin Intensivmed Notfmed 2020; 115:511-518. [PMID: 32749505 DOI: 10.1007/s00063-020-00706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022]
Abstract
In the context of intensive care medicine, patients, their relatives, and more infrequently members of the ICU team can be affected by potential trauma. Acute stress disorder often results. Psychological symptoms of critically ill patients should therefore be regularly screened in a standardized manner in order to be able to identify and treat patients with a high symptom burden. Some traumatic stressors in intensive care medicine can be reduced using trauma-sensitive communication. Psychological and psychotherapeutic interventions can complement this basic care. High quality communication with relatives contributes to a risk reduction with regard to their subsequent psychological stress. On the part of the ICU team, stress should be differentiated from potentially traumatizing events and both problem areas should be dealt with preventively. After experiencing a traumatic event during work, a procedure analogous to physical work accidents is recommended.
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Yeh J, Ostini R. The impact of health literacy environment on patient stress: a systematic review. BMC Public Health 2020; 20:749. [PMID: 32448284 PMCID: PMC7245697 DOI: 10.1186/s12889-020-08649-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background There exists little literature on situational health literacy - that is, how an individual’s health literacy varies across different health literacy environments. However, one can consider the role of stress when examining the relationship between health situations and decision-making ability, and by proxy health literacy. The aim of this study was to assess the strength of the evidence on the relationship between health situations and patient stress, considered in the context of health professional perception, and determine what health situations act to influence patient stress. Methods A systematic review of English articles using PubMed, PsycINFO, CINAHL and Embase databases was conducted. Search terms focused on ‘patient’, ‘stress’, and ‘health care situations’. Only peer-reviewed original research with data on patient stress in the context of a health facility environment was included. Studies were screened and critically appraised by both authors. Study elements for extraction were defined by RO and extracted by JY. Results Twenty-four studies were included for narrative synthesis. Patients in Intensive Care Units were more stressed about factors relating to their physical discomfort, with some agreement from health care professionals. Parents of children in Intensive Care Units were more concerned with stressors relating to their child’s appearance and behaviour, and alteration in their parental role. Few studies examined health settings other than Intensive Care Units, and those that did varied greatly in terms of study design and population characteristics, lacking generalisability. Conclusions Overall, the findings of what patients find most stressful in Intensive Care Units can guide health care professionals practicing best practice care. However, the evidence on how patient stress is influenced by non-Intensive Care Unit health care settings is weak. Further research is needed to enhance current understanding of the interaction between patient stress and health care environments in both hospital and primary care settings.
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Affiliation(s)
- John Yeh
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
| | - Remo Ostini
- Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
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Webster KEF, Carlson E. Building therapeutic connections with the acutely ill through standardised patient simulation in nurse education an evaluation study. NURSE EDUCATION TODAY 2020; 84:104261. [PMID: 31722281 DOI: 10.1016/j.nedt.2019.104261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/30/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Phenomenological empathy and sense of coherence are two researched communication approaches used to improve therapeutic connections with patients in a variety of nurse related settings. The aim of this study is to evaluate students' feedback concerning how this event has enabled that understanding, development and refinement of skill-sets in PE and SoC when managing the acutely ill during simulation. METHODS 114 third year bachelor degree-nursing students were given the opportunity to complete an evaluation, developed for the specific purpose of this study. The evaluation contained six closed questions on a four point Likert-scale and three open questions, handed out upon completion of the standardised patient simulation of the acutely ill. Comments written in response to the open questions were analysed using manifest content analysis and closed questions using SPSS to produce descriptive frequencies. RESULTS 100 students completed the evaluation. Student nurses', regardless of previous experience or age, indicated the need for more education and practice in phenomenological empathy and sense of coherence to enhance their ability to build therapeutic connections with the acutely ill. CONCLUSIONS Teaching phenomenological empathy and sense of coherence, as an integral part of standardised patient simulation is necessary to motivate student nurses ability to build therapeutic relationships with the acutely ill to enhance person centred care.
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Sedaghat S, Rostami S, Ebadi A, Fereidooni-Moghadam M. Stressors in open-heart surgery patients: A qualitative study. ARYA ATHEROSCLEROSIS 2019; 15:192-200. [PMID: 31819753 PMCID: PMC6884732 DOI: 10.22122/arya.v15i4.1840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Open-heart surgery is a stressful experience for the patients and their families. From the moment that patients are told they must undergo surgery until discharge, they experience different degrees of worry and nervousness. This study was conducted with the aim of identifying stress factors in heart surgery patients. METHODS This study was performed using a qualitative method on 21 participants (14 patients and 7 caregivers). The research environment was open-heart surgery wards of two educational hospitals in Ahwaz (south of Iran) in 2017. The participants were selected through purposive sampling. The data were collected through semi-structured interviews, and then, analyzed using the qualitative approach of content analysis proposed by Graneheim and Lundmnan (2004). RESULTS The 5 themes of “physical stressors”, “self-care stressors”, “psychological stressors”, “religious stressors”, and “hospital stressors” were obtained. These themes were the result of the patients’ experiences and dimensions of patients’ perceptions regarding stressors in open-heart surgery. CONCLUSION Stress in patients undergoing open-heart surgery is a contextual and relative concept and a subjective experience, which is experienced as a sense of worry. Identifying and clarifying stressors in open-heart surgery patients for nurses is vital, like a key for improving care quality. Nursing managers in clinical practice can also benefit from these findings regarding heart surgery in improving the care quality and professional performance of nurses.
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Affiliation(s)
- Soheila Sedaghat
- Nursing Care Research Center in Chronic Disease Care, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahnaz Rostami
- Nursing Care Research Center in Chronic Disease Care, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Zengin N, Ören B, Üstündag H. The relationship between stressors and intensive care unit experiences. Nurs Crit Care 2019; 25:109-116. [PMID: 31407452 DOI: 10.1111/nicc.12465] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients in intensive care units (ICUs) face many physical and psychological stressors because of the environment of these units and their own critical conditions and experience stress in various degrees. Each stressor may affect patients' experiences in ICUs differently. AIM AND OBJECTIVES This study aimed to examine the relationship between stressors and patients' experiences in an ICU. METHODS This descriptive, cross-sectional study was conducted between September 2014 and June 2015 in a university hospital and included 116 patients who were admitted to the general ICU for at least 24 hours. Data were collected using the Intensive Care Experience Scale and a questionnaire that included questions about socio-demographic and disease-related characteristics of patients and their stressors. RESULTS The mean age of the patients was 57.81 ± 13.81 years, and the mean duration of ICU stay was 2.28 ± 3.88 days. There was a moderate positive relation between the stressors noise (r = .534; P < .01), thirst (r = .438; P < .01), loneliness (r = .410; P < .01), and pain (r = .404; P < .01) and the subscale frightening experiences. However, there was a moderate, negative relation between the stressors inability to speak (r = -.444; P < .01), surrounding speeches (r = -.458; P < .01), equipment noise (r = -.490; P < .01), and physical exercise (r = -.546; P < .01) and the subscale satisfaction with care. CONCLUSIONS The patients associated stressors with satisfaction and frightening experiences in the early period of their discharge from the ICU. As stressors increases, so do frightening experiences, and satisfaction with care is affected negatively. RELEVANCE TO CLINICAL PRACTICE Currently, stressors to which patients discharged from ICU are exposed during their admission to wards are not evaluated in practice. This study is important in that it can help health professionals be aware of effects of stressors on patients in the early period of their discharge.
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Affiliation(s)
- Neriman Zengin
- Faculty of Health Sciences, Department of Midwifery, University of Health Science, Istanbul, Turkey
| | - Besey Ören
- Faculty of Health Sciences, Department of Midwifery, University of Health Science, Istanbul, Turkey
| | - Hülya Üstündag
- Faculty of Health Sciences, Department of Nursing, İstanbul Bilgi University, Istanbul, Turkey
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Deffner T, Schönle J, Neyer FJ, Schulze J. [Assessment of mental symptoms in intensive care unit patients : Suggestion for a German version of the Intensive Care Psychological Assessment Tool]. Med Klin Intensivmed Notfmed 2019; 115:140-147. [PMID: 30721334 DOI: 10.1007/s00063-019-0537-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 12/07/2018] [Accepted: 12/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive care unit (ICU) treatment may be associated with mental symptoms such as anxiety, depressed mood, hopelessness and nightmares in critically ill patients. While many physical symptoms can be detected via standardized measures, an instrument to assess mental symptoms is actually missing. OBJECTIVES An existing validated screening tool to detect mental symptoms in critically ill patients, the Intensive Care Psychological Assessment Tool (IPAT), has been translated into German and tested in two surgical ICUs and an intermediate care unit. MATERIALS AND METHODS In addition to the German translation of the IPAT, Stait-Trait-Anxiety-Inventory (STAI-SKD) and Hospital Anxiety and Depression Scale (HADS-D) were used to determine convergent validity. Within a survey period of 3 months, a total of 90 awake and fully oriented patients were included in the study. RESULTS Internal consistency of the German translation was lower than that of the original study. The initial factor structure was partially replicated. Convergent validity was demonstrated for depressive and anxiety symptoms, but not for the presence of delirium. Patients who completed the screening were frequently suffering from sleep disturbances, tension, anxiety and depressed mood. A total of 37% of the patients exceeded the cut-off and are considered at-risk patients for psychological sequelae. DISCUSSION With regard to test quality, the results of the German version are currently not satisfactory. This may be due to the small sample size and sample selectivity, which is also the largest limitation of the study. The instrument proved to be practicable if patients can complete it as an interview. The adaptation for external assessment seems to be useful to capture psychological stress in patients with impaired communication and perception.
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Affiliation(s)
- T Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - J Schönle
- Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - F J Neyer
- Institut für Psychologie, Arbeitsbereich Differentielle Psychologie, Friedrich-Schiller-Universität Jena, Jena, Deutschland
| | - J Schulze
- Institut für Psychologie, Arbeitsbereich Differentielle Psychologie, Friedrich-Schiller-Universität Jena, Jena, Deutschland
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Adams AMN, Chamberlain D, Giles TM. The perceived and experienced role of the nurse unit manager in supporting the wellbeing of intensive care unit nurses: An integrative literature review. Aust Crit Care 2018; 32:319-329. [PMID: 30174110 DOI: 10.1016/j.aucc.2018.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The number of patients requiring admission into intensive care units (ICUs) is increasing worldwide. Concurrently, recruitment and retention of the ICU nursing workforce is becoming a major challenge due to the high intensity environment, heavy workloads, and decreasing nurse wellbeing. Nurse unit managers play a vital role in promoting and supporting ICU nurse wellbeing, yet little is known about perceptions and experiences of this role. OBJECTIVES To examine the perceived and experienced role of the nurse unit manager in supporting the wellbeing of ICU nurses. REVIEW METHODS A comprehensive review of the literature was undertaken using Whittemore and Knafl's five stage approach: (i) problem identification, (ii) literature search, (iii) quality appraisal, (iv) data analysis, and (v) presentation of findings. DATA SOURCES The following databases were searched for literature published between January 2007 and December 2017: Cumulative Index to Nursing and Allied Health Literature, Cochrane, Informit, Joanna Briggs Institute Library of Systematic Review, ProQuest, PubMed, Scopus, and Wiley online library digital databases. Variations and synonyms of key words included: nurse unit manager, ICU, compassion fatigue, burnout, stress, job satisfaction, bullying, wellbeing, and work environment. RESULTS Rigour and trustworthiness of the included studies were assessed using the Critical Appraisal Skills Program qualitative research checklist,71 a modified Critical Appraisal Skills Program Cohort study checklist for quantitative research,72 and the Mixed Methods Appraisal Tool for mixed-method studies.73 The critical review guidelines by Shenton74 and Polit and Beck75 were also used to make judgements about the worth of the evidence. All of the 11 qualitative studies provided moderate to strong evidence. The overall quality of the quantitative studies was lower, with three of seven studies providing only adequate evidence. The majority of the 19 included studies represented the voices of ICU nurses. Three major themes emerged from the analysis; '1) building professional relationships', '2) leading the way' and '3) satisfying the needs of ICU nurses'. CONCLUSION Nurse unit manager behaviours clearly affect the wellbeing of ICU nurses. However, the role of supporting ICU nurses is complex and challenging. More research is needed to investigate the needs of ICU nurses and the facilitators and barriers nurse unit managers face when supporting the wellbeing of nurses in their unit.
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Affiliation(s)
- Anne Mette N Adams
- Flinders University College of Nursing and Health Sciences, SA, Australia.
| | - Diane Chamberlain
- Flinders University College of Nursing and Health Sciences, SA, Australia
| | - Tracey M Giles
- Flinders University College of Nursing and Health Sciences, SA, Australia
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Lima EC, Bernardes A, Baldo PL, Maziero VG, Camelo SHH, Balsanelli AP. Critical incidents connected to nurses' leadership in Intensive Care Units. Rev Bras Enferm 2018; 70:1018-1025. [PMID: 28977229 DOI: 10.1590/0034-7167-2016-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 03/10/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: The goal of this study is to analyze nurses' leadership in intensive care units at hospitals in the state of São Paulo, Brazil, in the face of positive and negative critical incidents. Method: Exploratory, descriptive study, conducted with 24 nurses by using the Critical Incident Technique as a methodological benchmark. Results: Results were grouped into 61 critical incidents distributed into categories. Researchers came to the conclusion that leadership-related situations interfere with IC nurses' behaviors. Among these situations they found: difficulty in the communication process; conflicts in the daily exercise of nurses' activities; people management; and the setting of high quality care targets. Final considerations: Researchers identified a mixed leadership model, leading them to the conclusion that nurses' knowledge and practice of contemporary leadership theories/styles are crucial because they facilitate the communication process, focusing on behavioral aspects and beliefs, in addition to valuing flexibility. This positively impacts the organization's results. Objetivo: Analisar a liderança do enfermeiro em Centros de Terapia Intensiva de hospitais localizados no interior do estado de São Paulo, diante de incidentes críticos positivos e negativos. Método: Estudo exploratório, descritivo, realizado com 24 enfermeiros, que utilizou a Técnica do Incidente Crítico como referencial metodológico. Resultados: Os resultados foram agrupados em 61 incidentes críticos distribuídos em categorias. Identificou-se que situações relacionadas à liderança interferem no comportamento do enfermeiro de Terapia Intensiva, dentre elas: dificuldade no processo de comunicação, conflitos existentes no dia a dia do exercício profissional, gerenciamento de pessoas e estabelecimento de metas para o alcance da assistência qualificada. Considerações finais: Encontrou-se um modelo misto de liderança, o que permite concluir que o conhecimento e a prática dos enfermeiros acerca de teorias/estilos contemporâneos de liderança tornam-se fundamentais, pois facilitam o processo de comunicação, focando nos aspectos comportamentais e crenças, e valorizam a flexibilidade, impactando positivamente os resultados da organização.
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Affiliation(s)
- Elaine Cantarella Lima
- Universidade de São Paulo, Ribeirão Preto College of Nursing, Postgraduate Program Basic Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Andrea Bernardes
- Universidade de São Paulo, Ribeirão Preto College of Nursing, Postgraduate Program Basic Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Priscila Lapaz Baldo
- Universidade de São Paulo, Ribeirão Preto College of Nursing, Postgraduate Program Basic Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Vanessa Gomes Maziero
- Universidade de São Paulo, Ribeirão Preto College of Nursing, Postgraduate Program Basic Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Silvia Helena Henriques Camelo
- Universidade de São Paulo, Ribeirão Preto College of Nursing, Postgraduate Program Basic Nursing. Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Pazetto Balsanelli
- Universidade Federal de São Paulo, São Paulo School of Nursing, Department of Administration in Health Care and Nursing Services. São Paulo, Brazil
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Locihová H, Axmann K, Padyšáková H, Pončíková V. PERCEPTION OF INTENSIVE CARE STRESSORS BY PATIENTS, NURSES AND FAMILY. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2018. [DOI: 10.15452/cejnm.2018.09.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Traumatic Stressors in the Intensive Care Unit: Iranian Patients’ and Nurses’ Viewpoints. Trauma Mon 2016. [DOI: 10.5812/traumamon.37631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Castillo MI, Cooke M, Macfarlane B, Aitken LM. Factors associated with anxiety in critically ill patients: A prospective observational cohort study. Int J Nurs Stud 2016; 60:225-33. [PMID: 27297383 DOI: 10.1016/j.ijnurstu.2016.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 05/11/2016] [Accepted: 05/11/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anxiety is an unpleasant emotion that most intensive care patients experience. This emotion is an important issue in intensive care settings because of its prevalence, adverse effects and severity. Little is known about the factors associated with state and trait anxiety during critical illness. OBJECTIVES To describe the patterns of state anxiety reported by intensive care patients, and identify factors associated with state and trait anxiety. DESIGN Prospective observational cohort study. SETTINGS One mixed intensive care unit in Brisbane, Australia. PARTICIPANTS Adults (n=141, ≥18 years) admitted to the intensive care unit for ≥24h; able to communicate verbally or non-verbally; understand English; and, open their eyes spontaneously or in response to voice. METHODS Outcomes were state anxiety as measured by the Faces Anxiety Scale and trait anxiety as measured by the State-Trait Anxiety Inventory. Pre-intensive care factors tested for possible associations with both state and trait anxiety were: age, gender, marital status, employment status, level of education, smoking status, personality trait of optimism and evidence of mental health care/treatment. Intra-intensive care factors tested were: reason for admission to the intensive care unit, delirium, pain, airway status, hours of mechanical ventilation, severity of illness, days of stay in intensive care, exposure to corticosteroids, opioids, benzodiazepines, anxiolytics, antidepressants, beta-blockers, anaesthetic agents and analgesics; length of sedation and analgesia and total doses of sedatives and analgesics. RESULTS Of 141 participants, 98 (70%) were male with an average age of 54 (standard deviation: ±15) years and stayed in intensive care for about 4 (Interquartile Range: 3-7) days. The majority (n=115; 82%) of participants experienced state anxiety at least once during their stay in intensive care, with 57% reporting moderate to severe levels. Factors related to state anxiety in intensive care were pain and trait anxiety. Factors associated with trait anxiety were trait optimism, state anxiety, evidence of mental health care/treatment and age. CONCLUSIONS This study provides a better understanding of contributing factors for anxiety in the critically ill. Trait anxiety and state anxiety were significantly associated with each other, namely, patients who were anxious by nature experienced higher levels of state anxiety, which persisted throughout their stay in the intensive care unit. Recognising the importance of state and trait anxiety assessments using validated tools and determining ways to manage anxiety in the critically ill are critical aspects of the intensive care nurses role.
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Affiliation(s)
- Maria I Castillo
- School of Nursing and Midwifery, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; Intensive Care Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia.
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia.
| | - Bonnie Macfarlane
- School of Nursing and Midwifery, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia.
| | - Leanne M Aitken
- School of Nursing and Midwifery, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; NHMRC Centre of Research Excellence in Nursing (NCREN), Menzies Health Institute Queensland, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; Intensive Care Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia; School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, United Kingdom.
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Bagheri Nesami M, Shorofi SA, Jafari A, Khalilian AR, Ziabakhsh Tabari S. The Relationship Between Stressors and Anxiety Levels After CABG in Sari, Iran. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e25407. [PMID: 27437127 PMCID: PMC4939229 DOI: 10.5812/ircmj.25407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/23/2014] [Accepted: 01/04/2015] [Indexed: 11/16/2022]
Abstract
Background Hospitalization and surgery are crucial adverse life events that lead to considerable anxiety in patients. Objectives The present study aimed to investigate stressors after coronary artery bypass graft surgery and identify stressors that predict anxiety. Patients and Methods This is a descriptive-analytical study that uses a non-random convenience sampling method on patients undergoing coronary artery bypass graft surgery at the cardiac surgery intensive care unit of Fatemeh Zahra Cardiac center in Sari, Iran. A total of 186 patients completed the post-surgical stressors questionnaire and the Spielberger State-Trait Anxiety Inventory on postoperative days 2 or 3 in the cardiac surgery intensive care unit. Data were analyzed using descriptive statistics including frequencies, means, and standard deviations. The Mann–Whitney U test was used to determine the relationship between the observed variables, and the logistic regression model was used to identify the relationship between stressors and anxiety after-surgery. Results Post-surgical anxiety predictors included insufficient sleep during hospitalization (Odds ratio [OR]: 5.42; 95% confidence interval [CI]: 1.46 - 20.00; P = 0.010), treatment not explained to the patient by the nurse (OR: 4.83; 95% CI: 1.82 - 12.84; P = 0.002), being away from family members (OR: 3.88; 95% CI: 1.46 - 10.26; P = 0.006), presence of a chest tube (OR: 3.27; 95% CI: 1.83 - 5.84; P = 0.000), and pain in any part of the body (OR: 1.95; 95% CI: 1.06 - 3.58; P = 0.031). Conclusions Physical or physiological and psychological stressors impose greater stress and are predictors of anxiety. When preparing their nursing care plan, nurses should consider these stressors that affect anxiety levels in patients undergoing CABG surgery and those hospitalized in intensive care units.
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Affiliation(s)
- Masoumeh Bagheri Nesami
- Mazandaran Pediateric Infectious Disease Research Center (MPIDRC), Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, IR Iran
- Adjunct Research Fellow, Flinders University, Adelaide, Australia
| | - Azam Jafari
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding Author: Azam Jafari, Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, IR Iran. Tel: +98-9101001520, Fax: +98-1133368915, E-mail:
| | - Ali Reza Khalilian
- Department of Biostatistics and Epidemiology, Mazandaran University of Medical Sciences, Sari, IR Iran
- Psychiatry and Behavioral Sciences Research Centre, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Shervin Ziabakhsh Tabari
- Department of Cardiac Surgery, Fatemeh Zahra Hospital, Mazandaran University of Medical Sciences, Sari, IR Iran
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Moscoso Loaiza LF, Bernal Cardenas CY. Cuidado y manejo del dolor en el paciente en posoperatorio de revascularización miocárdica. AVANCES EN ENFERMERÍA 2016. [DOI: 10.15446/av.enferm.v33n2.52477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>En la actualidad, se ha puesto de manifiesto la relación existente entre el dolor agudo posoperatorio y la aparición de múltiples complicaciones, que hacen necesario el manejo efectivo del dolor posquirúrgico por parte del profesional de enfermería. Objetivo: Generar una propuesta de cuidado de enfermería para el manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, tras la extubación, con base en la Teoría de los Síntomas Desagradables. Metodología: A partir de la metodología del marco lógico, se socializó la importancia del manejo del dolor en el paciente en posoperatorio de revascularización miocárdica, así como la Teoría de los Síntomas Desagradables, al personal de enfermería que labora en una Unidad de Cuidado Intensivo de una Institución Prestadora de Servicios de Salud de IV Nivel en la ciudad de Bogotá. Se elaboró un formato de valoración para establecer los factores que determinaban el dolor, las características del síntoma dolor y las consecuencias del síntoma, para luego establecer la propuesta de cuidado de enfermería. Resultados: Se valoró la experiencia del dolor en nueve pacientes en posoperatorio de revascularización miocárdica, obteniendo como hallazgo que la presencia del dolor, principalmente, impedía la actividad física, la tos efectiva y el sueño, ocasionando un alto nivel de ansiedad, preocupación y cansancio. Con base en los hallazgos, se proponen ocho diagnósticos de enfermería, con sus respectivas actividades. Conclusión: La adecuada valoración y manejo del dolor postquirúrgico por parte del profesional de enfermería permite una recuperación adecuada, así como un aumento del bienestar y la comodidad en el paciente revascularizado.</p>
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Literature review: patients' and health care providers' perceptions of stressors in critical care units. Dimens Crit Care Nurs 2013; 32:22-7. [PMID: 23222224 DOI: 10.1097/dcc.0b013e31826199a0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this article was to provide a historical review and analysis of the research literature focusing on patients', nurses', and health care providers' perceptions of stressors in the critical care setting. A narrative historical literature review method was used. The inclusion criteria include English-language studies of stressors as perceived by patients and health care providers from 1984 to 2011. Several studies investigated perceptions of stressors using the Environmental Stressors Questionnaire and the findings did not show any significant changes of stress perception over time since 1989 until the present. There is a need to further investigate stress perceptions in the health care setting using a mixed qualitative and quantitative approach to provide a more precise description of stressors and stress perceptions in the critical care setting.
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Parvan K, Zamanzadeh V, Lak Dizaji S, Mousavi Shabestari M, Safaie N. Patient's Perception of Stressors Associated with Coronary Artery Bypass Surgery. J Cardiovasc Thorac Res 2013; 5:113-7. [PMID: 24252987 DOI: 10.5681/jcvtr.2013.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 08/21/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiac surgery, due to being associated with stressors, has many physiological, psychological, emotional, growths, and spiritual potential consequences. However, few studies have been conducted about identifying the stressors. Therefore, the objective of the study was to determine patients' perceptions of stressors associated with coronary artery bypass surgery. METHODS In this descriptive study during the two-month investigation, qualified patients for participation in the study (68 persons) undergoing coronary artery bypass graft surgery on the third to fifth postoperative day were selected and with using of Revised Cardiac Surgery Stressors Scale (RCSSS), interpersonal, intrapersonal, and extra personal stressors were determined. RESULTS The findings showed that intrapersonal stressors are perceived more than interpersonal and extra personal stressors by patients. In the analysis of data, the highest stressors were "pain and discomfort", "the need to have heart surgery", "death due to illness or surgery", "being away from home and work", "having chest tube". CONCLUSION In this study the intrapersonal stressors were perceived more than interpersonal and extra personal stressors by patients, which nurses should put emphasis on identification and elimination of intrapersonal stressors based on the needs of patients.
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Affiliation(s)
- Kobra Parvan
- Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Parvan K, Zamanzadeh V, Lakdizaji S, Mousavi Shabestari M. Nurse's Perception of Stressors Associated with Coronary Artery Bypass Surgery. J Caring Sci 2012; 1:237-43. [PMID: 25276701 DOI: 10.5681/jcs.2012.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 05/12/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Cardiac surgery has many physiological, psychological, emotional, growth and spiritual potential consequences due to stress. Identifying and understanding the nature of stress can help nurses in controlling and reducing it. However, few studies have been conducted to identify the stressors. Therefore, the objective of this study was to determine nurses' perceptions of patients' stressors associated with coronary artery bypass surgery. METHODS During a two month investigation, qualified nurses (n = 68) of patients undergoing coronary artery bypass were selected on the third to fifth day after surgery. With the use of Revised Cardiac Surgery Stressors Scale (RCSSS), interpersonal, intrapersonal and extrapersonal stressors were determined. RESULTS The findings showed that the most interpersonal, intrapersonal and extrapersonal stressors were; "the need to have cardiac surgery", "death due to illness or surgery", "needing assistance with various activities", "doctors and nurses discussing about other patients", "having chest tube" and "Payment of hospital and medical bills". CONCLUSION Identification of stressors in patients with coronary artery bypass graft helps nurses in taking better care of them. It would make a better ground for the officials and practitioners towards managing the stressors, especially interpersonal and extrapersonal stressors. Thereby patients are helped to cope with stressors.
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Affiliation(s)
- Kobra Parvan
- Department of Nursing, Faculty of Nursing and Midwifery, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zamanzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sima Lakdizaji
- Department of Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mitra Mousavi Shabestari
- Department of Nursing, Tabriz University of Medical Sciences, International University of Aras, Tabriz, Iran
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