Critical care nurses' perceptions about their involvement in significant decisions regarding patient care

Decision Making in Acute Care: A practical framework supporting the ‘best interests’ Principle

The best interests principle is commonly utilized in acute care settings to assist with decision making about life-saving and life-sustaining treatment. This ethical principle demands that the decision maker refers to some conception of quality of life that is relevant to the individual patient. The aim of this article is to describe the factors that are required to be incorporated into an account of quality of life that will provide a morally justifiable basis for making a judgement about the future quality of life, and therefore the best interests, of critically ill patients who are mentally incompetent. This account consists of three major components - pain and suffering, body functioning, and autonomy - and is applicable in situations where very limited information is available to guide decision making. This framework helps to make decisions about the provision of life-saving treatment that are as consistent as possible in all patient situations.

Competence of nurses in the intensive cardiac care unit

INTRODUCTION

Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses' competences. This study aimed to explain nurses' competence in the ICCU.

METHODS

This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012-2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method.

RESULTS

The main categories were "clinical competence," comprising subcategories of 'routine care,' 'emergency care,' 'care according to patients' needs,' 'care of non-coronary patients', as well as "professional competence," comprising 'personal development,' 'teamwork,' 'professional ethics,' and 'efficacy of nursing education.'

CONCLUSION

The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing.

Impact of Nurse Integrated Rounds on Self-Reported Comprehension, Attitudes, and Practices of Nurses and Resident Physicians in a Pediatric Intensive Care Unit

Objectives:

To evaluate the impact of nurse integrated rounds (NIRs) on self-reported comprehension, attitudes, and practices of nurses and resident physicians (RPs) in a pediatric intensive care unit (PICU).

Materials and methods:

A self-reported comprehension, attitude, and practice survey of RPs and nurses was done prior to (T0), 3 months (T3), and 15 months (T15) after initiation of NIRs in our PICU. Responses were graded on Likert-type scale from 1 to 5. The RPs, attending physicians, and nurses also ranked their overall perception of NIRs during these 3 survey time periods.

Results:

All 3 components of the surveys showed statistically significant improvement ( P < .05) from the T0 to T3 and T15 in RPs and nurses. A complete or almost complete reversal of attitude was noted for most questions in the attitude section in both RPs and nurses when T15 was compared to T0. The overall perception that NIRs was good for patient care also showed significant improvement in the survey of nurses and physicians.

Conclusions:

The NIRs are well accepted by nurses and physicians and are accompanied by self-reported improvements in comprehension, attitudes, and practices of nurses and RPs in the PICU.

Haemodynamic instability after cardiac surgery: nurses' perceptions of clinical decision-making

BACKGROUND

Cardiac surgical patients are distinguished by their potential for instability in the early postoperative period, highly invasive haemodynamic monitoring technologies and unique clinical presentations as a result of undergoing cardiopulmonary bypass. Little is known about nurses' perceptions of assuming responsibility for such patients. An understanding of nurses' perceptions may identify areas of practice that can be improved and assist in determining the adequacy of current decision supports.

AIM

The aim of this study was to describe critical care nurses' perceptions of assuming responsibility for the nursing management of cardiac patients in the initial two-hour postoperative period.

DESIGN

An exploratory descriptive study based on naturalistic decision-making.

METHODS

Thirty-eight nurses were interviewed immediately following a two-hour observation of their clinical practice. Content analysis and a systematic thematic analysis process called 'Framework' were used to analyse the interview transcripts.

RESULTS

Nurses described their perceptions of managing patients in terms of how they felt about making decisions for complex cardiac surgical patients and in terms of how clinical processes unique to the admission phase impacted their decision-making. Nurses felt either daunted or stimulated and challenged when making decisions. Nurses identified handover from anaesthetists, settling in procedures and forms of collegial assistance as important processes that impacted their decision-making.

CONCLUSION

Nurses' previous experiences with similar patients influenced how they felt about making decisions during the initial two-hour postoperative period, but did not alter their views about processes important for patient safety during this time.

RELEVANCE TO CLINICAL PRACTICE

Feelings expressed by nurses in this study highlight the need for clinical supervision and appropriate allocation of resources during the immediate recovery period after cardiac surgery. Nurses identified ways to improve clinical processes that impacted their decision-making during the immediate recovery of cardiac surgical patients.