Critical care nursing organizations and activities: a third worldwide review

The National Competency Framework for Registered Nurses in Adult Critical Care: An overview

In the years following the abolition of the English National Board for Nursing, Midwifery and Health Visiting in 2002, concerns were raised within the Critical Care nursing community about a lack of consistency in post-registration education programmes. In response to this, the Critical Care Network National Nurse Leads (CC3N) formed a sub-group, the Critical Care Nurse Education Review Forum (CCNERF) to address these concerns. A review of UK course provision confirmed marked inconsistency in the length, content and associated academic award. The CCNERF commenced a two-phase project, first developing national standards for critical care nurse education such as length of course and academic credit level, followed by the development of a national competency framework. Following significant review and revision, version two of the National Competency Framework for Registered Nurses in Adult Critical Care was published by CC3N in 2015. This paper introduces the National Competency Framework and provides an overview of its background, development and implementation. It then considers the future direction of UK post-registration Critical Care nurse education.

Critical care nursing organizations and activities: a fourth worldwide review

AIM

To examine the activities and concerns of critical care nurses and professional critical care nursing organizations around the world and to identify expectations held of nursing leaders and policy makers to help address their concerns.

BACKGROUND

This study is the fourth worldwide review of its type. Previous surveys were undertaken in 2001, 2005 and 2009.

METHODS

An online descriptive survey was emailed to 88 potential participants from countries with critical care nursing organizations or known critical care nursing leaders. Responses were downloaded into Survey Monkey™ (Version 22) and analysed by geographical region and income level.

RESULTS

Fifty-nine respondents from 58 countries completed the questionnaire, of whom 43 had critical care nursing organizations established in their countries and 29 were members of the World Federation of Critical Care Nurses. The services provided by the organizations to be of most value were national conferences, website, professional representation, and practice standards and guidelines. Professional policies had been developed by some organizations on workforce, education and practice, while almost half provided their members with either a newsletter or journal. Collectively, the most important issues for critical care nurses were working conditions, provision of formal practice guidelines and competencies, staffing levels and access to quality education programmes.

CONCLUSIONS

Important issues continue to challenge the specialty of critical care nursing as new developments, priorities, clinical issues and other global events and influences impact critical care nursing worldwide.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

This study will help guide nursing leaders and policy makers to address the needs of critical care nurses and their patients. Collaborative approaches between the specialty, nursing leaders and health policy advisors will assist to inform appropriate change in areas recommended for further action.

Emergency nurses' experience of crisis: A qualitative study

AIM

A crisis is an environment created in a rapidly changing and chaotic work setting which is found in a busy emergency department of a hospital with higher intensity. The objective of this study was to define and explore emergency room nurses' description of crisis in critical situations and to identify barriers and mitigating factors that affect how nurses handle crises.

METHODS

This study is a qualitative research with a content analysis approach. Eighteen emergency nurses were purposefully selected to take part in this study. Data collection was through face-to-face semistructured interviews until data saturation was finalized. Data analysis was conducted using content analysis.

RESULTS

The data analysis consisted of four main categories: (i) loss of balance; (ii) crisis control (anticipation-preparation, resource control, control skills, and supporting nurses); (iii) human factors related to staff (sufficient staff, competent staff, individual characteristics, ability to communicate); and (iv) teamwork (cooperation and reciprocal trust).

CONCLUSION

Findings showed the meaning of the crisis and challenges and issues faced by emergency nurses throughout the crisis. Health services authorities can use these results to make comprehensive plans in order to reduce emergency crises.

The impact of hospital and ICU organizational factors on outcome in critically ill patients: results from the Extended Prevalence of Infection in Intensive Care study

OBJECTIVE

To investigate the impact of various facets of ICU organization on outcome in a large cohort of ICU patients from different geographic regions.

DESIGN

International, multicenter, observational study.

SETTING

All 1,265 ICUs in 75 countries that contributed to the 1-day point prevalence Extended Prevalence of Infection in Intensive Care study.

PATIENTS

All adult patients present on a participating ICU on the study day.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The Extended Prevalence of Infection in Intensive Care study included data on 13,796 adult patients. Organizational characteristics of the participating hospitals and units varied across geographic areas. Participating North American hospitals had greater availability of microbiologic examination and more 24-hour emergency departments than did the participating European and Latin American units. Of the participating ICUs, 82.9% were closed format, with the lowest prevalence among North American units (62.7%) and the highest in ICUs in Oceania (92.6%). The proportion of participating ICUs with 24-hour intensivist coverage was lower in North America than in Latin America (86.8% vs 98.1%, p = 0.002). ICU volume was significantly lower in participating ICUs from Western Europe, Latin America, and Asia compared with North America. In multivariable logistic regression analysis, medical and mixed ICUs were independently associated with a greater risk of in-hospital death. A nurse:patient ratio of more than 1:1.5 on the study day was independently associated with a lower risk of in-hospital death.

CONCLUSIONS

In this international large cohort of ICU patients, hospital and ICU characteristics varied worldwide. A high nurse:patient ratio was independently associated with a lower risk of in-hospital death. These exploratory data need to be confirmed in large prospective studies that consider additional country-specific ICU practice variations.