Nursing challenges with a severely injured patient in critical care

Developing effective In-Service Education for intensive care nurses: Exploring the views of clinical stakeholders in the Kingdom of Saudi Arabia

BACKGROUND

Evidence-based in-service education (ISE) in the intensive care unit (ICU) is essential to maintaining nurse skill and competence in this complex clinical area. However, there has been limited research that has focused on developing and optimising the specialised training required by ICU nurses working in trauma care.

OBJECTIVES

To explore the perspectives of ICU clinical stakeholders regarding their needs and preferences for ISE to inform the future development and implementation of effective educational interventions.

DESIGN

A qualitative, multiple-case study supported by the "Empowering Education" theoretical framework, which emphasises the importance of stakeholder involvement in education development.

SETTINGS

Adult ICUs in three major hospitals located in two geographical areas in Saudi Arabia.

PARTICIPANTS

Forty clinical nurses, twelve nurse managers, nine nurse leaders and seven clinical educators participated.

METHODS

Data were collected through semi-structured interviews followed by focus groups. Framework analysis was used for data analysis.

FINDINGS

Stakeholders wanted ISE and training by subject experts characterised by: (i): relevant educational content; (ii): a range of educational techniques and (iii) flexible delivery and format. Nurses also identified factors that encouraged them to participate in ISE including adequate resources and a supportive work environment, whilst heavy workloads, cost and scheduling issues hindered engagement.

CONCLUSION

This paper highlights the importance of considering staff needs and local context when developing in-service ICU education to support nurses' competence. Further recommendations and a proposed framework to develop future ISE in the ICU are provided.

TWEETABLE ABSTRACT

The key to effective in-service education for ICU nurses is understanding stakeholders' needs and motivational drivers, whilst addressing barriers to successful implementation.

In-service education in trauma care for intensive care unit nurses: An exploratory multiple case study

AIM

This study explores the perceptions of intensive care units (ICUs) nurses with different educational backgrounds regarding their abilities in trauma care and the in-service education they receive to support it.

BACKGROUND

The advanced care of patients with traumatic injuries in ICU environments requires skilled and knowledgeable nurses, who need continuing and in-service education to provide the best care. Therefore, it is essential to understand the competencies and educational support these nurses may need in the ICUs to ensure safe and effective care delivery.

DESIGN

An exploratory multiple case study design was used, comprising three hospitals located in two different regions of Saudi Arabia.

METHODS

The study was conducted between October 2021 and March 2022. A total of forty ICU clinical staff, twelve managers, nine leaders and seven clinical educators participated in semi-structured interviews, which were complemented by a review of available documents on the trauma care in-service education syllabi, competencies and protocols. Interview data were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis.

FINDINGS

The data analysis revealed two interrelated categories relevant to trauma care: (i) care practice and (ii) education practice. The trauma care practice category highlighted the limited competencies and education in trauma care, as well as the perceived challenges and educational needs of nurses. The education practice category described the staff learning behaviours, supervision practices and in-service education systems in the participants' settings.

CONCLUSIONS

The study concludes that there is a lack of trauma care education at the examined sites. It suggests the need for further research to develop a theoretical foundation for trauma care education that can meet ICU nurses' educational needs while this being feasible to implement in the specific ICU context and practice.

The effectiveness of educational interventions on trauma intensive care unit nurses' competence: A systematic review and meta-analysis

OBJECTIVES

To examine the current evidence on the effect of education on intensive care unit nurses' knowledge and skills competence in caring for adult major trauma patients.

METHODOLOGY

A systematic review and meta-analysis was conducted to identify relevant studies through a comprehensive search, following strict eligibility criteria. Five databases were searched: MEDLINE, PubMed, CINAHL, Cochrane and Web of Science. A subsequent hand search was performed. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument tool was used to assess methodological quality.

RESULTS

Five eligible quantitative studies were identified and appraised. The overall results demonstrated that educational interventions have positive effects in improving intensive care nurses' knowledge and practice in managing major trauma patients. Meta-analysis was applied to three homogenous studies relating to knowledge outcome. Results demonstrated significant improvements immediately post-intervention and at one-to three-month follow-up [MD (mean difference) = 29.12, 95%CI (confidence interval) 10.29-47.95; P < 0.00001], and [MD = 23.70, 95%CI 8.84-38.56; P < 0.00001], respectively. A slight decrease in the knowledge and practice scores was noted from one- to three-month follow-up.

CONCLUSION

This review demonstrated the significant effects of trauma education on improving intensive care nurses' knowledge and practices. Further research should develop valid competencies and policies to drive nurses' practice and potentially improve the safety and quality of care.

Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project

BACKGROUND

Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge.

OBJECTIVES

The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.

METHODS

The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement.

RESULTS

There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.

CONCLUSIONS

Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.

Developing a trauma care syllabus for intensive care nurses in the United Kingdom: A Delphi study

BACKGROUND

Increased rates of mortality in the intensive care unit (ICU) following injury have been associated with a lack of trauma specific training. Despite this, training relevant to nurses is limited. Currently, little consideration has been given to understanding the potential training needs of ICU nurses in caring for critically injured patients.

OBJECTIVES

The aim of this study was to construct a consensus syllabus of trauma care for registered nurses working in an intensive care setting.

DESIGN

A two round modified Delphi was conducted.

METHODS

Twenty-eight intensive care professionals participated in the study in 2014 in the United Kingdom. Data were analysed using content and descriptive statistics.

RESULTS

Round-1 generated 343 subjects. Following analysis these were categorised into 75 subjects and returned to the panel for rating. An 82% (23/28) response rate to round-2 identified high consensus (equal to or greater than 80%) in 55 subjects, which reflected the most severely injured patients needs.

CONCLUSIONS

There is a requirement for specific training to prepare the ICU nurse for caring for the critically injured patient. This survey presents a potential core syllabus in trauma care and should be considered by educators to develop a meaningful programme of trauma education for ICU nurses.

Pressure ulcers in trauma patients with suspected spine injury: a prospective cohort study with emphasis on device-related pressure ulcers

Of all patients in a hospital environment, trauma patients may be particularly at risk for developing (device-related) pressure ulcers (PUs), because of their traumatic injuries, immobility, and exposure to immobilizing and medical devices. Studies on device-related PUs are scarce. With this study, the incidence and characteristics of PUs and the proportion of PUs that are related to devices in adult trauma patients with suspected spinal injury were described. From January-December 2013, 254 trauma patients were visited every 2 days for skin assessment. The overall incidence of PUs was 28·3% (n = 72/254 patients). The incidence of device-related PUs was 20·1% (n = 51), and 13% (n = 33) developed solely device-related PUs. We observed 145 PUs in total of which 60·7% were related to devices (88/145). Device-related PUs were detected 16 different locations on the front and back of the body. These results show that the incidence of PUs and the proportion of device-related PUs is very high in trauma patients.

The role of shock index as a predictor of multiple-trauma patients' pathways

OBJECTIVES

This research was conducted with the aim of investigating the accuracy of the shock index (SI) in distinguishing which multiple-trauma patients should be admitted to an intensive care unit (ICU) after treatment in an emergency room (ER).

BACKGROUND

The SI is an easily obtained indicator, as it corresponds to an arithmetic ratio between the two parameters that are always measured during the first-aid treatment of multiple-trauma patients: heart rate (HR) and systolic blood pressure (SBP). There are many studies examining the SI in the multiple-trauma patients as a possible predictor of the destination unit. The SI is evaluated both at the trauma scene (pre-hospital SI-pH) and in the emergency room (SI-ER).

DESIGN AND METHODS

An observational study with a retrospective approach was conducted on 158 adult patients with multiple trauma.

RESULTS

The mean SI-pH and SI-ER values were higher in ICU patients than in-patients discharged or admitted to a normal ward, but the difference between these two patient groups was significant only for the SI-ER. Analysis of the receiver operating characteristic (ROC) curves confirmed that only the SI-ER is significant as a reliable indicator for ICU admission with a best cut-off of 1·05. However, a threshold value of 0·75 was still able to establish the correct type of destination for multiple-trauma patients, with a sensitivity of 57·3% and a specificity of 62·5%.

CONCLUSIONS

This research showed that the SI-pH and SI-ER values are correlated, but only the SI-ER has shown statistical significance in terms of distinguishing the type of destination of multiple-trauma patient (ICU, ordinary ward or discharge) after initial treatment in the ER.

RELEVANCE TO CLINICAL PRACTICE

The results of this study suggest the possibility of using SI in multiple-trauma patients as a triage indicator to assess the patients' care complexity and to guide the choice of proper clinical paths.