A measure of critical care nurses' post-code stress

Enhancing ACLS training effects through video-assisted boosting methods: A comparative analysis of self-simulation and model simulation videos

AIMS

To assess the impact of learner-participation and instructor-led simulation videos on nurses' CPR skills, focusing on iterative learning to boost proficiency in ACLS.

BACKGROUND

Advanced cardiac life support (ACLS) training is crucial for nurses, especially to improve cardiopulmonary resuscitation (CPR) proficiency, for which an effective training strategy is needed.

DESIGN

A quasi-experimental, pretest-posttest design was implemented to assess the impact of self-simulation and model simulation videos on sustaining CPR education.

METHODS

The research was carried out at a university hospital in Korea from August 2021 to July 2022. A total of 110 nurses were allocated into three groups based on the building of their workplace in the hospital. Each group watched training videos at 4-month intervals after the simulation training. The self-video group viewed simulations featuring their participation, while the model video group watched instructor-led simulations. A comparison group participated in the simulations without subsequent video boosting.

RESULTS

Both the self-video and model video groups exhibited significantly superior ACLS performance compatred with the comparison group at both four months (H = 70.33, p <.001) and eight months (H = 81.52, p <.001) following the intervention, with large effect sizes (self-video vs. comparison: d = 4.73 at four months, d = 12.54 at eight months; model video vs. comparison: d = 4.53 at four months, d = 11.01 at eight months). ACLS knowledge scores also significantly increased over time in both intervention groups (self-video: χ² = 22.09, p <.001; model video: χ² = 24.13, p <.001), but not in the comparison group (χ² = 3.75, p =.153). There were no significant differences among the groups in terms of CPR self-efficacy or stress at either time point.

CONCLUSION

Supplementary training using simulation videos is an effective method for maintaining and enhancing nurses' ACLS competency, offering a sustainable approach to repetitive CPR training. This study underscores the value of incorporating recorded simulation videos in clinical training, offering insights into efficient methods for continuous learning and CPR proficiency among nursing professionals.

Perceived stress and coping strategies after unsuccessful cardiopulmonary resuscitation among pre-hospital emergency technicians: A multicenter cross-sectional study

Background

Effective stress management after unsuccessful cardiopulmonary resuscitation (CPR) requires the determination of perceived stress and identification and reinforcement of effective coping strategies. Therefore, the present study was conducted to determine perceived stress and coping strategies after unsuccessful CPR for the first time among Iranian pre-hospital emergency technicians.

Methods

A cross-sectional, descriptive, correlational, multicenter study was conducted in 2022. The research population included all pre-hospital emergency technicians working in 44 urban, road, and aerial pre-hospital emergency stations in 22 counties of Ilam Province, west of Iran. A total of 374 technicians worked in these stations, which were included in the study by census method according to the inclusion criteria. The data collection tools were the Questionnaire of perceived stress after unsuccessful CPR and Brief Coping Orientation to Problems Experienced (COPE) Inventory. The collected data were analyzed with SPSS software version 27 using descriptive and analytical statistics (Pearson correlation test, multiple linear regression analysis, independent sample T-test, and ANOVA) at a significance level of p ≤ 0.05.

Results

The perceived stress was at a moderate level with a mean score of 65.56 ± 14.21. Among six coping strategies, problem-focused coping had the highest (3.01 ± 0.59) and denial had the lowest mean value (1.94 ± 0.79). Perceived stress had a significant direct relationship with 5 coping strategies, including problem-focused coping, support-focused coping, emotion-focused coping, self-distraction, and religion (p < 0.05). The strongest relationship was found between perceived stress and self-distraction followed by emotion-focused coping. According to the results of multiple regression analysis, emotion-focused coping and self-distraction had predictive roles.

Conclusion

The participants used different coping strategies to cope with the stress of unsuccessful CPR. The most common coping mechanisms used by the participants were problem-focused, emotion-focused, and support-focused coping. Pre-hospital emergency officials can assist pre-hospital emergency technicians in coping with occupational stress, including the stress of unsuccessful CPR, through organizing educational courses, teaching effective coping strategies, and offering support programs.

Perception of Personal Participation of the Nurses in Resuscitation Procedures: A Qualitative Study

Background and Objectives: Resuscitation is one of the most stressful tasks in emergency medicine. The participation of nurses in this procedure can have specific effects on them. In this research, we wanted to find out what these effects are. Materials and Methods: A qualitative approach by conducting semi-structured interviews was used, and a thematic data analysis of the recorded interviews was carried out. The collected data were transcribed verbatim, with no corrections to the audio recordings. The computer program ATLAS.ti 22 was used for the qualitative data analysis. Results: Eleven male registered nurses were interviewed, with an average of 18.5 years of experience working in a prehospital environment (max. 32/min. 9). A total of 404 min of recordings were analyzed, and 789 codes were found, which were combined into 36 patterns and 11 themes. As the most stressful situations, the interviewees pointed out the resuscitation of a child, familiar persons, conflicts with the environment, conflicts within the resuscitation team, nonfunctioning or insufficient equipment, complications during resuscitation, and resuscitating a person only for training. As positive effects, the interviewees cited successful resuscitations or their awareness that, despite an unsuccessful resuscitation, they did everything they could. Conclusions: Participation in these interventions has a specific positive or negative impact on the performers. The interviewees shared the opinion that they can cope effectively with the adverse or stressful effects of resuscitation. Yet, despite everything, they allow the possibility of subconscious influences of this intervention on themselves.

Compassion fatigue and stress related to cardiopulmonary resuscitation: a study of critical care nurses' experiences

BACKGROUND

Cardiopulmonary resuscitation (CPR) is considered one of the most stressful experiences in critical care nursing; it directly and indirectly leads to compassion fatigue and burnout.

AIM

Determine the levels of and relationship between postcode stress and compassion fatigue.

DESIGN AND METHODS

A descriptive-correlational study using 300 critical care nurses from five intensive care units in two hospitals was conducted.

TOOLS

Demographic and work-related data, the Postcode Stress Scale, and the Professional Quality of Life Scale: Compassion Fatigue subscale.

RESULTS

Nurses had moderate to high postcode stress and compassion fatigue (67.98 ± 16.39 and 65.40±14.34, respectively). Moreover, there was a significant positive correlation between postcode stress, burnout (r=0.350, p=<0.001), secondary traumatic stress (r=0.518, p=<0.001), and subsequently, compassion fatigue (r=0.449, p=<0.001). In addition, higher levels of postcode stress were associated with higher levels of compassion fatigue with its subscales: burnout and secondary traumatic stress, with a coefficient of determination for compassion fatigue (0.199), burnout subscale (0.121), and secondary traumatic stress (0.266).

CONCLUSION

Critical care nurses involved in resuscitation experiences are susceptible to postcode stress, burnout, secondary traumatic stress, and compassion fatigue. There is a significant relationship between these factors, with higher levels of postcode stress contributing to higher levels of compassion fatigue and its subscales: burnout and secondary traumatic stress. These results highlight the importance of addressing and managing the psychological well-being of nurses in resuscitation settings to mitigate the adverse effects of stress and promote their overall resilience and well-being.

Effect of a hybrid team-based advanced cardiopulmonary life support simulation program for clinical nurses

BACKGROUND

During in-hospital cardiac arrest events, clinical nurses are often the first responders; therefore, nurses require sufficient advanced cardiac life support (ACLS) competency. This study aimed to verify the effects of a hybrid team-based ACLS simulation (HTAS) program (developed in this study) on nurses' ACLS performance, specifically ACLS knowledge, cardiopulmonary resuscitation (CPR) self-efficacy, and CPR-related stress.

METHODS

The developed HTAS comprised four lecture videos, one team-based skills training video, and a team-based ACLS simulation. A quasi-experimental pretest-posttest design with a comparison group (CG) was used to evaluate the effectiveness of the HTAS. Of the 226 general ward nurses with more than 6 months of clinical experience, 117 were allocated to the intervention group (IG), which attended the HTAS, and 109 to the CG, which attended only basic ACLS training.

RESULTS

The IG's ACLS performance significantly improved (t = 50.8, p < 0.001) after the training. Relative to the respective pretest conditions, posttest ACLS knowledge (t = 6.92, p < 0.001) and CPR self-efficacy (t = 6.97, p < 0.001) of the IG also significantly increased. However, when the mean difference values were compared, there was no significant difference between the two groups with respect to ACLS knowledge (t = 1.52, p = 0.130), CPR self-efficacy (t = -0.42, p = 0.673), and CPR stress (t = -0.88, p = 0.378).

CONCLUSION

The HTAS for ward nurses was effective at enhancing the nurses' ACLS performance. It is necessary to develop effective training methods for team-based ACLS and verify the sustained effects of such training.

Exploring the Feelings of Nurses during Resuscitation—A Cross-Sectional Study

Cardiopulmonary resuscitation (CPR) is one of the most stressful situations in emergency medicine. Nurses involved in performing basic and advanced resuscitation procedures are therefore exposed to a certain amount of stress. The purpose of this study was to determine the stressors and the level of stress experienced by nurses during resuscitation. A cross-sectional quantitative study was done. The sample consisted of 457 nurses who worked in emergency units. First demographic data were collected, followed by a questionnaire regarding the effect of different situations that occur during and after resuscitation on nurses including Post-Code Stress Scale questionnaire. The most disturbing situations for respondents were resuscitation of young person (MV = 3.7, SD = 1.4), when they fail to establish an intravenous pathway (MV = 3.5, SD = 1.4), chaotic situation during resuscitation (MV = 3.4, SD = 1.4) and making decision about termination of resuscitation (MV = 3.1, SD = 1.5). Research has shown that nurses are exposed to a certain amount of stress during resuscitation, but most of them manage to compensate for stress effectively.

Effects of a Simulation-Based CPR Training Program on Knowledge, Performance, and Stress in Clinical Nurses

BACKGROUND

Rapid and accurate cardiopulmonary resuscitation (CPR) performed by clinical nurses plays an important role in increasing the survival rate of cardiac arrest patients in the hospital.

PURPOSE

This study examined the effects of a simulation-based CPR training program on knowledge, performance, and stress of CPR in clinical nurses.

METHOD

A quasi-experimental pretest-posttest control group design was used. Study participants included 60 clinical nurses (experimental group, n = 30, and control group, n = 30) in a general hospital in Seoul, South Korea. A 4-hour simulation-based CPR training program was conducted. Measures included the knowledge scale and performance scale from the Korean Association of Cardiopulmonary Resuscitation and the Post Code Stress Scale in Korean.

RESULTS

The simulation-based CPR training program significantly improved CPR knowledge (t = 4.664, p < .001) and performance (t = 4.940, p < .001), and decreased stress (t = -5.832, p < .001) in clinical nurses.

CONCLUSION

These findings indicate a simulation-based CPR training program was effective in improving knowledge and performing CPR, as well as in decreasing stress of CPR in clinical nurses. [J Contin Educ Nurs. 2020;51(5):225-232.].

'Why didn't you write a not-for-cardiopulmonary resuscitation order?' Unexpected death or failure of process?

Objective The aim of the present study was to understand the reasons for the delivery of non-beneficial cardiopulmonary resuscitation (CPR) attempts in a tertiary private hospital over 12 months. We determined doctors' expectations of survival after CPR for their patient, whether they had considered a not-for-resuscitation (NFR) order and the barriers to completion of NFR orders. Methods Anonymous questionnaires were sent to the doctors primarily responsible for a given patient's care in the hospital within 2 weeks of the unsuccessful CPR attempt. The data were analysed quantitatively where appropriate and qualitatively for themes for open-text responses Results Most doctors surveyed in the present study understood the poor outcome after CPR in the older person. Most doctors had an expectation that their own patient had a poor prognosis and a poor likely predicted outcome after CPR. This implied that the patient's death was neither unexpected nor likely to be reversible. Some doctors considered NFR orders, but multiple barriers to completion were cited, including the family's wishes, being time poor and diffusion or deferral of responsibility. Conclusions It is likely that futile CPR is provided contrary to policy and legal documents relating to end-of-life care, with the potential for harms relating to both patient and family, and members of resuscitation teams. The failure appears to relate to process rather than recognition of poor patient outcome. What is known about the topic? Mandatory CPR has been established in Australian hospitals on the premise that it will save lives. The outcome from in-hospital cardiac arrest has not improved despite significant training and resources. The outcome for those acutely hospitalised patients aged over 80 years has been repeatedly demonstrated to be poor with significant morbidity in the survivors. There is emerging literature on the extent of the delivery of non-beneficial treatments at the end of life, including futile CPR, the recognition of harms incurred by patients, families and members of the resuscitation teams and on the opportunity cost of the inappropriate use of resources. What does this paper add? This is the first study, to our knowledge, that has demonstrated that doctors understood the outcomes for CPR, particularly in those aged 80 years and older, and that failure to recognise poor outcome and prognosis in their own patients is not a barrier to writing NFR orders. What are the implications for practitioners? Recognition of the poor outcomes from CPR for the elderly patient for whom the doctor has a duty of care should result in a discussion with the patients, allowing an exploration of values and expectations of treatment. This would promote shared decision making, which includes the use of CPR. Facilitation of these discussions should be the focus of health service review.

"Sacred Pause" in the ICU: Evaluation of a Ritual and Intervention to Lower Distress and Burnout

BACKGROUND

Increased exposure to deaths in the intensive care unit (ICU) generate grief among ICU staff, which remains unresolved most of the time. Unresolved grief becomes cumulative and presents a risk factor for burnout. "sacred pause" is a ritual performed at patient's death to honor the lost life and recognize the efforts of the health-care team.

OBJECTIVE

To study the impact of the ritual of sacred pause on the attitudes and behaviors of the ICU physicians and nurses.

METHODS

Ten-question online anonymous survey was sent to ICU physicians and nurses in the medical ICU of a tertiary care hospital in July 2017.

RESULTS

Thirty-four ICU team members completed the survey including 12 physicians and 22 nurses. Seventy sacred pause rituals were performed from July 2016 to June 2017. Seventy-nine percent respondents believed that the ritual brought closure and helped them overcome the feelings of disappointment, grief, distress, and failure after the death of their patient in ICU. Seventy-three percent agreed that the ritual has instilled and encouraged a sense of team effort. Eighty-two percent responded that the ritual makes their efforts feel appreciated. Many felt that the ritual should be a universal phenomenon in all ICUs. Only 55% respondents felt that the practice has a potential to decrease ICU burnout, many of them (42%) were undecided.

CONCLUSION

Sacred pause brings closure, prevents cumulative grief and distress, builds resilience, promotes team effort, and improves professional satisfaction of ICU team. It may lower burnout syndrome in ICU, but further studies are warranted.

Emergency department nurses' experience of performing CPR in South Korea

BACKGROUND

Emergency Department (ED) nurses often confront unexpected cardiopulmonary resuscitation (CPR) with little information about the patients.

METHODS

This qualitative study explored the experience of performing CPR among ED nurses. Data collection took place between May and June 2016 using an online advertisement to recruit 17 ED nurses. Each participant was interviewed for 40-90min. Interviews were recorded and transcribed verbatim. Data analysis was conducted using a conventional content-analysis method.

RESULTS

Four themes emerged: Pressure from the urgency of the CPR, becoming sharp tempered in addressing personnel during CPR, keeping psychological conflicts of CPR patient care to oneself, and growing as an ED nurse through CPR.

CONCLUSION

ED nurses had anxiety about CPR, regardless of their ability to perform CPR. They also suffered psychologically afterward. ED nurses could benefit from education that promotes their competencies for CPR and support systems to alleviate their psychological distress.

Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation

BACKGROUND

Participation by a critical care nurse in an unsuccessful resuscitation can create a unique heightened level of psychological stress referred to as postcode stress, activation of coping behaviors, and symptoms of posttraumatic stress disorder (PTSD).

OBJECTIVES

To explore the relationships among postcode stress, coping behaviors, and PTSD symptom severity in critical care nurses after experiencing unsuccessful cardiopulmonary resuscitations and to see whether institutional support attenuates these repeated psychological traumas.

METHODS

A national sample of 490 critical care nurses was recruited from the American Association of Critical-Care Nurses' eNewsline and social media. Participants completed the Post-Code Stress Scale, the Brief COPE (abbreviated), and the Impact of Event Scale-Revised, which were administered through an online survey.

RESULTS

Postcode stress and PTSD symptom severity were weakly associated (r = 0.20, P = .01). No significant associations between coping behaviors and postcode stress were found. Four coping behaviors (denial, self-distraction, self-blame, and behavioral disengagement) were significant predictors of PTSD symptom severity. Severity of postcode stress and PTSD symptoms varied with the availability of institutional support.

CONCLUSIONS

Critical care nurses show moderate levels of postcode stress and PTSD symptoms when asked to recall an unsuccessful resuscitation and the coping behaviors used. Identifying the critical care nurses most at risk for PTSD will inform the development of interventional research to promote critical care nurses' psychological well-being and reduce their attrition from the profession.

Stress measurement among charge nurses: developing a cross-cultural tool

AIM

The aim of this study was to develop a cross-cultural tool for the measurement of stress among charge nurses in general hospitals.

BACKGROUND

Studies of the specific stressors unique to different nursing roles are few, particularly those related to hospital charge nurses. The Charge Nurse Stress Questionnaire is a well-validated Israeli-developed scale. However, it has not been tested cross-culturally.

DESIGN

A descriptive methodological study was conducted in Israel, Ohio and Thailand.

METHOD

A total of 2616 nurses from 23 hospitals (small to large size) completed the questionnaire between 2011-2013. The questionnaire was translated into English and Thai. To establish tool validity and reliability, content validity, internal consistency reliability, exploratory and confirmatory factor analysis were performed.

RESULTS

Analyses resulted in a final abbreviated version of the questionnaire with 25 items and four stress subscales. Internal consistency for the subscales indicated very good internal consistency.

CONCLUSIONS

We developed a self-reported, cross-cultural, valid and reliable tool for evaluating the specific stressors of the role of charge nurses. A rigorous assessment of charge nurse stress provides a good basis for planning tailored stress reduction interventions. It is recommended to further use the tool in different settings across different countries.

The Effect of Computer-Based Resuscitation Simulation on Nursing Students’ Performance, Self-Efficacy, Post-Code Stress, and Satisfaction

Computer-based simulation has intuitive appeal to both educators and learners with the flexibility of time, place, immediate feedback, and self-paced and consistent curriculum. The purpose of this study was to assess the effects of computer-based simulation on nursing students’ performance, self-efficacy, post-code stress, and satisfaction between computer-based simulation plus instructor-led cardiopulmonary resuscitation training group and instructor-led resuscitation training-only group. This study was a nonequivalent control group posttest-only design. There were 213 second year nursing students randomly assigned to one of two groups: 109 nursing students with computer-based simulation or 104 with control group. Overall nursing students’ performance score was higher in the computer-based simulation group than in the control group but reached no statistical significance (t = 1.086, p = .283). There were no significant differences in resuscitation-specific self-efficacy, post-code stress, and satisfaction between the two groups. Computer-based simulation combined with hands-on practice did not affect in nursing students’ performance, self-efficacy, post-code stress, and satisfaction in nursing students. Further study must be conducted to inform instructional design and help integrate computer-based simulation and rigorous scoring rubrics.

Stress, depression, and intention to leave among nurses in different medical units: implications for healthcare management/nursing practice

AIMS

The aim of the present study was to compare the levels of stress, depression, and intention to leave among clinical nurses employed in different medical units in relation to their demographic characteristics under the National Health Insurance (NHI) System in Taiwan.

METHODS

Cross-sectional Spearman's correlation, one-way ANOVA with Scheffe post hoc analysis tests, and multiple regression analyses were conducted. Several self-report questionnaires, such as the Center for Epidemiological Studies Depression Scale, the Perceived Stress Scale and Intention to Leave Scale, were administered. A total of 314 research participants were surveyed, all of whom came from regional hospitals in Northern Taiwan.

RESULTS

Marital status and working tenure were significant predictors to the levels of stress, depression, and intention to leave among nurses before taking the medical units into consideration. However, with adding medical units as predictors, the effect of marital status and working tenure were insignificant except for the stress model, indicating medical units were showing dominant effect over other variables. In particular, internal medical ward (IMW) nurses experienced a higher prevalence of depression than emergency room (ER) nurses and professional nursing practitioners. External medical ward (EMW) nurses also experienced greater depression than emergency room (ER) nurses. Both IMW and EMW nurses perceived significantly greater stress than ER and dialysis center. Moreover, IMW nurses also perceived greater stress than operating room (OR) nurses and showed stronger intention to leave than their counterparts in the outpatient service departments.

CONCLUSIONS

The results indicated that significant differences existed among various medical units with regards to nurses' stress, depression, and intention to leave. Nurses working in internal and external medical wards, especially the inexperienced and married ones, experienced greater depression and stress, thereby developing stronger intention to leave their job.

Factors that influence pediatric intensive care unit nurses to leave their jobs

The purpose of this qualitative study was to discover why 10 nurses voluntarily left the pediatric intensive care unit (PICU) at 1 large pediatric hospital in the southwest. Critical theory provided the philosophical framework, whereas action research and Heideggerian hermeneutic phenomenology provided the methodological framework. Data analysis was conducted using the circular hermeneutic process described by Heidegger and explicated by Diekelmann. From the findings of this study, it was concluded that there is an inescapable and inevitable tension between the human factors and the PICU work environment. Nurses identified the constitutive pattern of unrelieved job stress as the major reason they left the PICU. The multidimensional and interactive environmental characteristics of nature of the job, insufficient resources, and negative perceptions of managers/team leaders contributed to the development of job stress. The results of this study revealed the evidence needed to begin to focus on interventions in the areas of nursing practice, education, and research required, reducing the likelihood of losing more PICU nurses.

Identification and analysis of stress factors at nursing workplace: A comparative study of four clinical departments

Introduction. Several studies show that nursing is, by its very nature, an occupation exposed to a high degree of stress. The main aims of the present research were to analyze the presence and to identify occupational stress factors and assess stress levels among nurses in clinical/hospital settings. Material and Methods. The research was conducted as a cross-sectional study. The sample included nurses (n=205) employed in different settings, who were also control groups to each other. Expanded Nursing Stress Scale and an additional questionnaire created for the purpose of this investigation were used as research instruments. Results. The results show that stressful situations, in the psychological occupational environment are the greatest stress factors regardless of the workplace; in regard to sociodemographic determinants, married nurses have significantly higher average values as compared to unmarried ones (p<0.05), and the values statistically significantly lower in nurses under 30 years of age, with less than 10 years of work experience (p<0.01). Workload is a potential stress factor from the physical environment, whereas average values of this stress factor highly statistically differ in regard to the workplace (p<0.01). Nurses working in settings without support from their superiors and engaged in inter-professional conflicts, especially between nurses and physicians, face a great problem. Conclusion. It is important to promote conditions of work (work space, providing new equipment), organization of work, as well as social relationships, which is in accordance with the recommendations of ICN.

Critical Care Nurse Intern program: addressing psychological reactions related to critical care nursing

Rhode Island Hospital Critical Care Nurse Internship program prepares recent graduates to work in critical care specialty units. Despite best efforts to prepare nurse interns for immersion into the critical care arena, significant clinical challenges await, and it is unknown how individual nurse interns will react under stressful clinical encounters. With this concern in mind, it was decided to add a new lecture to the critical care curriculum to address psychological reactions related to critical care nursing. This article presents an overview of 4 major psychological reactions critical care nurse interns will likely experience including acute bereavement reactions, moral distress, secondary traumatization, and performance guilt. Specific strategies to navigate these difficult encounters are explored.

Graduate nurses' lived experience of in-hospital resuscitation: a hermeneutic phenomenological approach

AIM

The purpose of this research was to explore, describe and interpret the lived experience of graduate [junior] Registered Nurses who have participated in an in-hospital resuscitation event within the non-critical care environment.

METHOD

Using a hermeneutic phenomenological design, a convenience sample was recruited from a population of graduate Registered Nurses with less than 12 months experience. Focus groups were employed as a means of data collection. Thematic analysis of the focus group narrative was undertaken using a well-established human science approach.

FINDINGS

Responses from participants were analysed and grouped into four main themes: needing to decide, having to act, feeling connected and being supported. The findings illustrate a decision-making process resulting in participants seeking assistance from a medical emergency team based on previous experience, education and the perceived needs of the patient. Following this decision, participants are indecisive, questioning their decision. Participants view themselves as learners of the resuscitation process being educationally prepared to undertake basic life support, but not prepared for roles in a resuscitation event expected of the Registered Nurse, such as scribe. With minimal direction participants identified, implemented and evaluated their own coping strategies. Participants desire an environment that promotes a team approach, fostering involvement in the ongoing management of the patient within a 'safe zone'.

CONCLUSION

Similarities are identifiable between the graduate nurses' experience and the experience of bystanders and other healthcare professional cohorts, such as the chaotic resuscitation environment, having too many or not enough participants involved in a resuscitation event, being publicly tested, having a decreased physical and emotional reaction with increased resuscitation exposure and having a lack of an opportunity to participate in debriefing sessions. Strategies should be implemented to provide non-critical care nurses with the confidence and competence to remain involved in the resuscitation process, firstly to provide support for less experienced staff and secondly to participate in the ongoing management of the patient. Additionally, the need for education to be contextualized and mimic the realities of a resuscitation event was emphasised.

Use of factor analysis in Journal of Advanced Nursing: literature review

AIM

This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing.

BACKGROUND

Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable.

METHOD

Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study.

RESULTS

One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used.

CONCLUSIONS

Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.

Critical care nurses - perceptions of 12-h shifts

BACKGROUND

Twelve-hour shifts have been illustrated in the literature as being a highly contentious shift pattern. However, it has also been highlighted that there is a distinct paucity of literature solely related to such a shift pattern in critical care areas, where there is high activity and a requirement for multiple and highly significant decision-making situations. It was therefore identified that such an area deserved further exploration.

AIM

This study aimed to elicit critical care nurses' perceptions of working 12-h shifts.

METHODS

Fifty-four nurses from three critical care areas within a large local NHS teaching hospital currently working 12-h shifts completed a self-administered questionnaire on their perceptions of 12-h shifts. Following on, a focus group interview was conducted to complement this questionnaire in an attempt to further explore these perceptions.

RESULTS

From the results of the questionnaire, patient care, job satisfaction, off duty and family life achieved the most positive responses, whereas communication, fatigue and education achieved the most negative. The focus group explored these issues with added comments on work-shy staff, suggestions on shift patterns, breaks and staffing levels.

CONCLUSIONS

Twelve-hour shifts in critical care areas are suitable shift patterns for nurses, patients and management, provided that they are fundamentally well-managed.

Development of work stress scale for correctional officers

INTRODUCTION

This study aimed at examining the psychometric properties of Work Stress Scale for Correctional Officers (WSSCO).

METHODS

One hundred nineteen correctional officers (109 males and 10 females) employed in Turkey participated in this study. In addition to WSSCO, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered to the participants.

RESULTS

The internal consistencies and the item-total correlations were acceptable both for the whole scale and for its subscales; namely, "work overload," "role conflict and role ambiguity," "inadequacies in physical conditions of prison," "threat perception," and "general problems." Test-retest reliability coefficient was 0.77 for total scale, and test-retest reliability coefficients ranged between 0.68 and 0.78 for the subscales. The total scale and most of the subscales were positively correlated with depression, anxiety, and hopelessness, and negatively correlated with perceived social support. Furthermore, all subscales significantly differentiated high depressive symptomatology group from the low depressive symptomatology group.

CONCLUSIONS

The present results revealed that the psychometric properties of WSSCO were quite adequate. The scale can provide a potentially useful tool for research on job stress in correctional officers.

Personal use of complementary and alternative therapies by critical care nurses

Critical care settings are stressful to nurses, and exposure over time may contribute to stress-related symptoms and illnesses. Nurses' personal use of complementary and alternative therapies (CAT) may lessen the effects of stress and contribute to their overall well-being and health maintenance. A national survey of critical care nurses who are members of the American Association of Critical-Care Nurses revealed that a majority (96.4%) of critical care nurse respondents were using one or more CAT for personal use or had consulted a provider for CAT therapy. The most common therapies used were exercise, diet, massage, and prayer (or spiritual direction). Nurses' personal use of CAT was related to having knowledge of more types of CAT, use of more CAT in practice, a perception of benefits of greater numbers of CAT, more openness to use, more types of CAT recommended to patients, and a perception of more barriers to use in their institutional setting. Data support our model that links nurses' personal use to use in practice. Educational programs to promote nurses' knowledge and personal use of CAT could lead to an increase in appropriate use of CAT in professional practice and potential benefits to critical care patients and their families.

Clinical group supervision in an intensive care unit: a space for relief, and for sharing emotions and experiences of care

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.