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Sandnes L, Uhrenfeldt L. Caring touch as communication in intensive care nursing: a qualitative study. Int J Qual Stud Health Well-being 2024; 19:2348891. [PMID: 38723246 PMCID: PMC11086036 DOI: 10.1080/17482631.2024.2348891] [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: 01/11/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE This article describes intensive care nurses` experiences of using communicative caring touch as stroking the patient`s cheek or holding his hand. Our research question: "What do intensive care nurses communicate through caring touch?" METHODS In this qualitative hermeneutically based study data from two intensive care units at Norwegian hospitals are analysed. Eight specialist nurses shared experiences through individual, semi-structured interviews. RESULTS The main theme, Communicating safety and presence has four sub-themes: Amplified presence, Communicating security, trust and care, Creating and confirming relationships and Communicating openness to a deeper conversation. Communicative caring touch is offered from the nurse due to the patient`s needs. Caring touch communicates person-centred care, invites to relationship while respecting the patient's dignity as a fellow human being. Caring touch conveys a human initiative in the highly technology environment. CONCLUSION Caring touch is the silent way to communicate care, hope, strength and humanity to critical sick patients. This article provides evidence for a common, but poorly described phenomenon in intensive care nursing.
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Affiliation(s)
- Lise Sandnes
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Lisbeth Uhrenfeldt
- Department of orthopedic surgery, Lillebaelt University hospital, Kolding, Denmark
- Institute of Regional Research, Southern Danish University, Odense, Denmark
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Källestedt MLS, Asp M, Letterstål A, Widarsson M. When caring becomes an art - how clinical gaze are perceived to be developed. Int J Qual Stud Health Well-being 2023; 18:2156659. [PMID: 36482509 PMCID: PMC9744224 DOI: 10.1080/17482631.2022.2156659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This qualitative study describes nurses' experiences and perceptions of how they develop the clinical gaze. METHODS This qualitative study used an inductive approach and content analysis to assess the experiences of newly graduated nurses, nurse managers, and nursing teachers. Nineteen interviews were conducted. To achieve credibility, the study followed the guidelines of the Consolidated Criteria for Reporting Qualitative research (COREQ). RESULTS Two themes emerged: nurses' personal abilities and the learning culture. Learning culture was considered the foundation of the development of the clinical gaze. The clinical gaze was found to be developed in relationships with patients and when learning together with colleagues, in which the opportunities for reflection are central. To develop the clinical gaze, structures for learning activities, such as reflection, communication exercises, and simulation, are needed so that they become a natural part of daily work. This can also be achieved through supervision and skills training both at university and in a care context. CONCLUSIONS Prerequisites for the development of the clinical gaze include physical presence with the patient combined with learning activities such as conscious reflection with others in a safe learning culture.
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Affiliation(s)
- Marie-Louise Södersved Källestedt
- Källestedt Clinical Skills Center, Region Västmanland, Västerås, Sweden,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden,CONTACT Marie-Louise Södersved Källestedt School of Health, Care and Social Welfare, Mälardalen University, VästeråsSE-721 23, Sweden
| | - Margareta Asp
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Anna Letterstål
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Widarsson
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Nielsen AH, Larsen LK, Collet MO, Lehmkuhl L, Bekker C, Jensen JF, Laerkner E, Nielsen TA, Rossen BS, Thorn L, Laursen E, Fischer S, Villumsen M, Shiv LH, Høgh M, Rahr MN, Svenningsen H. Intensive care unit nurses' perception of three different methods for delirium screening: A survey (DELIS-3). Aust Crit Care 2023; 36:1035-1042. [PMID: 36774292 DOI: 10.1016/j.aucc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/06/2022] [Accepted: 12/09/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Delirium is common in critically ill patients with detrimental effects in terms of increased morbidity, mortality, costs, and human suffering. Delirium detection and management depends on systematic screening for delirium, which can be challenging to implement in clinical practice. OBJECTIVES The aim of this study was to explore how nurses in the intensive care unit perceived the use of Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Confusion Assessment Method for the Intensive Care Unit-7 (CAM-ICU-7), and Intensive Care Delirium Screening Checklist (ICDSC) for delirium screening of patients in the intensive care unit. METHODS This was a cross-sectional, electronic-based survey of nurses' perceptions of delirium screening with the three different instruments for delirium screening. Nurses were asked to grade their perception of the usability of the three instruments and how well they were perceived to detect delirium and delirium symptom changes on a 1- to 6-point Likert scale. Open questions about perceived advantages and disadvantages of each instrument were analysed using the framework method. RESULTS One hundred twenty-seven of 167 invited nurses completed the survey and rated the CAM-ICU-7 as faster and easier than the ICDSC, which was more nuanced and reflected changes in the patient's delirium better. Despite being rated as the fastest, easiest, and most used, the CAM-ICU provided less information and was considered inferior to the CAM-ICU-7 and ICDSC. Using familiar instruments made delirium screening easier, but being able to grade and nuance the delirium assessment was experienced as important for clinical practice. CONCLUSIONS Both the ICDSC and the CAM-ICU-7 were perceived well suited for detection of delirium and reflected changes in delirium intensity. The CAM-ICU was rated as fast and easy but inferior in its ability to grade and nuance the assessment of delirium. Emphasis on clinical meaningfulness and continued education in delirium screening are necessary for adherence to delirium management guidelines.
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Affiliation(s)
- Anne Højager Nielsen
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark; Institute for Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.
| | - Laura Krone Larsen
- Department of Anaesthesia and Intensive Care 6021, The Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Marie Oxenbøll Collet
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - Lene Lehmkuhl
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Baagøes Alle 15, 5700 Svendborg, Denmark.
| | - Camilla Bekker
- Department of Anaesthesiology and Intensive Care Medicine, Zealand University Hospital, Lykkebækvej 1, 4600 Køge, Denmark.
| | - Janet Froulund Jensen
- Department of Neurology, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark; Department of Anesthesiology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark.
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Tina Allerslev Nielsen
- Department of Anaesthesiology and Intensive Care, Viborg Regional Hospital, Banevejen 7C, 8800 Viborg, Denmark.
| | - Birgitte Sonne Rossen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Glostrup Valdemar Hansensvej 13, 2600 Glostrup, Denmark.
| | - Linette Thorn
- Department of Intensive Care, Aarhus University Hospital, AUH, Palle Juul-Jensens Boulevard 165, 8200 Aarhus N, Denmark.
| | - Edel Laursen
- Department of Anaesthesiology and Intensive Care, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark.
| | - Susanne Fischer
- Department of Anaesthesiology and Intensive Care, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark.
| | - Marianne Villumsen
- Department of Anaesthesiology and Intensive Care, Randers Regional Hospital, Skovlyvej 15, 8930 Randers NØ, Denmark.
| | - Louise Hvid Shiv
- Department of Intensive Care, North Zealand Hospital, Dyrhavevej 29, 3400 Hillerød, Denmark.
| | - Marianne Høgh
- Department of Intensive Care, Vejle Hospital, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Mette Nygaard Rahr
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Hospitalsparken 15, 7400 Herning, Denmark.
| | - Helle Svenningsen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, Programme for Physical and Mental Health, VIA University College, Campus Aarhus N, Hedeager 2, 8200 Aarhus N, Denmark.
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Lai H, Wu G, Zhong Y, Chen G, Zhang W, Shi S, Xia Z. Red blood cell distribution width improves the prediction of 28-day mortality for patients with sepsis-induced acute kidney injury: A retrospective analysis from MIMIC-IV database using propensity score matching. JOURNAL OF INTENSIVE MEDICINE 2023; 3:275-282. [PMID: 37533812 PMCID: PMC10391576 DOI: 10.1016/j.jointm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/02/2022] [Accepted: 02/07/2023] [Indexed: 08/04/2023]
Abstract
Background The predictive value of red blood cell distribution width (RDW) for mortality in patients with sepsis-induced acute kidney injury (SI-AKI) remains unclear. The present study aimed to investigate the potential association between RDW at admission and outcomes in patients with SI-AKI. Methods The Medical Information Mart for Intensive Care (MIMIC)-IV (version 2.0) database, released in June of 2022, provides medical data of SI-AKI patients to conduct our related research. Based on propensity score matching (PSM) method, the main risk factors associated with mortality in SI-AKI were evaluated using Cox proportional hazards regression analysis to construct a predictive nomogram. The concordance index (C-index) and decision curve analysis were used to validate the predictive ability and clinical utility of this model. Patients with SI-AKI were classified into the high- and low-RDW groups according to the best cut-off value obtained by calculating the maximum value of the Youden index. Results A total of 7574 patients with SI-AKI were identified according to the filter criteria. Compared with the low-RDW group, the high-RDW group had higher 28-day (9.49% vs. 31.40%, respectively, P <0.001) and 7-day (3.96% vs. 13.93%, respectively, P <0.001) mortality rates. Patients in the high-RDW group were more prone to AKI progression than those in the low-RDW group (20.80% vs. 13.60%, respectively, P <0.001). Based on matched patients, we developed a nomogram model that included age, white blood cells, RDW, combined hypertension and presence of a malignant tumor, treatment with vasopressor, dialysis, and invasive ventilation, sequential organ failure assessment, and AKI stages. The C-index for predicting the probability of 28-day survival was 0.799. Decision curve analysis revealed that the model with RDW offered greater net benefit than that without RDW. Conclusion The present findings demonstrated the importance of RDW, which improved the predictive ability of the nomogram model for the probability of survival in patients with SI-AKI.
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Affiliation(s)
- Honghao Lai
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
- Research Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510060, China
| | - Guosheng Wu
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Yu Zhong
- Department of Burns, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Guangping Chen
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Wei Zhang
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Shengjun Shi
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
| | - Zhaofan Xia
- Department of Burns, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, Guangdong, China
- Department of Burns, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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Turjamaa R, Simon-Bellamy J, Salminen L, Löyttyniemi E, Kajander-Unkuri S. Graduating nursing students' competence in nursing patients with acute coronary syndrome. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2022. [DOI: 10.15452/cejnm.2022.13.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Nygaard AM, Haugdahl HS, Laholt H, Brinchmann BS, Lind R. Professionals' narratives of interactions with patients' families in intensive care. Nurs Ethics 2022; 29:885-898. [PMID: 35196935 PMCID: PMC9289990 DOI: 10.1177/09697330211050995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: ICU patients’ family members are in a new, uncertain,
and vulnerable situation due to the patient’s critical illness and complete
dependence on the ICU nurses and physicians. Family members’ feeling of being
cared for is closely linked to clinicians’ attitudes and behavior. Aim: To explore ICU nurses’ and physicians’ bedside interaction with
critically ill ICU patients´ families and discuss this in light of the ethics of
care. Research design: A qualitative study using participant observation,
focus groups, and thematic narrative analysis. Participants and research context: Data were gathered from July 2017
to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven
focus groups with ICU nurses and physicians. Ethical considerations: The Regional Committee for Medical and
Health Research Ethics and the Norwegian Centre for Research Data approved the
study. Findings: Quality of ICU family care depends on nurses’ and
physicians’ attitudes, behavior, and personality traits. Three main themes were
identified: being attentive, an active
approach, and degree of tolerance. Discussion: The findings are discussed in light of the ethics of
care and empirical research from the intensive care environment. Conclusions: This study shows that attentive, active, and tolerant
clinicians represent a culture of ethical care that gives families greater
freedom of action and active participation in patient care. Clinicians must not
bear sole responsibility for this culture; it must have a firm basis in the
hospital and ICU and be established through training, interprofessional
reflection, and support of clinicians.
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Affiliation(s)
- Anne M Nygaard
- Department of Health and Care Sciences, 60482UiT, The Arctic University of Norway, Tromso, Norway
| | - Hege S Haugdahl
- Department of Public Health and Nursing, Levanger Hospital, 60500Nord-Trøndelag Hospital Trust and NTNU Norwegian University of Science and Technology, Levanger, Norway
| | - Hilde Laholt
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Troms, Norway
| | | | - Ranveig Lind
- Department of Health and Care Sciences, UiT The Arctic University of Norway and Research Nurse at Intensive Care Unit, University Hospital of North Norway, Harstad, Norway
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Dikmen BT, Bayraktar N, Yılmaz ÜD. A qualitative study of medical-surgical intensive care unit nurses’ experiences in caring for critical patients. Rev Esc Enferm USP 2022; 56:e20220220. [PMID: 36382933 PMCID: PMC10081655 DOI: 10.1590/1980-220x-reeusp-2022-0220en] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
ABSTRACT Objective: To describe the meaning attributed to nurses’ clinical experience in a medical-surgical intensive care unit in Northern Cyprus. Method: The qualitative study was conducted in two medical-surgical intensive care units at a university hospital. Data were collected through in-depth interviews with 17 nurses. Giorgi’s descriptive phenomenological approach was used to analyze nurses’ experiences. The consolidated criteria for reporting a qualitative research checklist were followed in this study. Results: The data analysis led to the extraction of the 5 themes and 19 subthemes. The themes identified for the study were competence, the emotional universe, stress resources, the meaning of nursing care, and profoundly affecting events. The study results show that the nurses expressed that having gained much experience in intensive care units and working there has contributed significantly to their professional development. Conclusion: It was indicated that the nurses had meaningful, caring experiences in intensive care units, which were perceived, however, as stressful experiences as well. The study has important implications for nurses, faculty members, and administrators to gain positive care experiences in terms of intensive care units.
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Abstract
Significant scientific and technological advances in intensive care have been made. However, patients in the intensive care unit may experience discomfort, loss of control, and surreal experiences. This has generated relevant debates about how to humanize the intensive care units and whether humanization is necessary at all. This paper aimed to explore how humanizing intensive care is described in the literature. A scoping review was performed. Studies published between 01.01.1999 and 02.03.2020 were identified in the CINAHL, Embase, PubMed, and Scopus databases. After removing 185 duplicates, 363 papers were screened by title and abstract. Full-text screening of 116 papers led to the inclusion of 68 papers in the review based on the inclusion criteria; these papers mentioned humanizing or dehumanizing intensive care in the title or abstract. Humanizing care was defined as holistic care, as a general attitude of professionals toward patients and relatives and an organizational ideal encompassing all subjects of the healthcare system. Technology was considered an integral component of intensive care that must be balanced with caring for the patient as a whole and autonomous person. This holistic view of patients and relatives could ameliorate the negative effects of technology. There were geographical differences and the large number of studies from Spain and Brazil reflect the growing interest in humanizing intensive care in these particular countries. In conclusion, a more holistic approach with a greater emphasis on the individual patient, relatives, and social context is the foundation for humanizing intensive care, as reflected in the attitudes of nurses and other healthcare professionals. Demands for mastering technology may dominate nurses’ attention toward patients and relatives; therefore, humanized intensive care requires a holistic attitude from health professionals and organizations toward patients and relatives. Healthcare organizations, society, and regulatory frameworks demanding humanized intensive care may enforce humanized intensive care.
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Affiliation(s)
- Monica Evelyn Kvande
- 155319Lovisenberg Diaconal University College, University Hospital of North Norway, Norway
| | - Sanne Angel
- 1006Aarhus University, Denmark; 5562Molde University College, Norway
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Henriksen KF, Hansen BS, Wøien H, Tønnessen S. The core qualities and competencies of the intensive and critical care nurse, a meta-ethnography. J Adv Nurs 2021; 77:4693-4710. [PMID: 34532876 DOI: 10.1111/jan.15044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 08/18/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
AIM To develop a conceptual framework of the core qualities and competencies of the intensive and critical care nurse based on the experiences of intensive care patients, their relatives and the intensive and critical care nurses. DESIGN Meta-ethnography. DATA SOURCES A comprehensive, systematic search in seven databases supplemented with hand, citation and reference search. Sources published from 2007 to 2019 were included. REVIEW METHODS Noblit and Hare's understanding of meta-ethnography and the work of the eMERGE project have directed the synthesis. RESULTS Nineteen studies were included and synthesized into a conceptual framework. Overarching theme: 'feeling safe and being safe', subtheme: 'creating confidence and motivation' and conceptual categories (CCs): 'technical skills and biophysical knowledge'; 'inter/intra professional teamwork skills'; 'communication skills (with patients and their relatives)'; 'constant and attentive bedside presence'; 'creating participative care'; 'creating confidence through daily care'; 'creating a good atmosphere and having a supportive and encouraging attitude'; and 'building relationship to maintain self-esteem'. CONCLUSION By including the perspectives of intensive care patients, their relatives and intensive and critical care nurses, the core qualities and competencies comprise elements of both patient safety and the feeling of safety. The framework outlines concepts necessary to ensure person-centred and safe intensive care. Further research should involve each perspective to validate and strengthen the findings. IMPACT The development of standards and competence guidelines expressing the learning outcomes and qualification of intensive and critical care nurses should be based on input from intensive care patients, their relatives and intensive and critical care nurses. A variety of core qualities and competencies are necessary to create confidence and motivation, and to make the patient feel safe and be safe. This conceptual framework might form a basis for development of a program or assessment tool to facilitate excellence in education and practice in intensive care.
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Affiliation(s)
- Kjersti Forbech Henriksen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Britt Saetre Hansen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hilde Wøien
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | - Siri Tønnessen
- Faculty of Health and Social Sciences, Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
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Kvande ME, Delmar C, Lauritzen J, Damsgaard JB. Ethical dilemmas embedded in performing fieldwork with nurses in the ICU. Nurs Ethics 2021; 28:1329-1336. [PMID: 33827342 PMCID: PMC8640261 DOI: 10.1177/0969733021996025] [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] [Indexed: 11/29/2022]
Abstract
Background: Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher’s may need to be prepared to spend longer periods in the field to pursue data collection opportunities that were not foreseen. Furthermore, nurse researchers performing qualitative research among patients and their relatives often experience unforeseen ethical dilemmas. Aim: This paper aimed to explore aspects of ethical dilemmas related to qualitative nursing research among patients and their relatives in the intensive care unit (ICU). Research design: This paper is based on a qualitative researcher’s personal experience during a hermeneutic phenomenological study involving close observation and in-depth interviews with 11 intensive care nurses. Data were collected at two ICUs in two Norwegian university hospitals. Ethical considerations: The study was approved by the Norwegian Social Science Data Services (NSD). The Regional Committee for Medical and Health Research Ethics (REK) granted dispensation to the project regarding health personnels confidentiality of the patients who were present during the observation (2012/622-4). Findings: Close observation with nurses in the ICU requires the researcher to balance being a qualitative researcher, an ICU nurse and a sensitive fellow human being open to the suffering of the other—that is, being embodied, engaged and affected by sensitive situations and simultaneously constantly stepping back and reflecting on the meaning of those situations. Conclusions: The qualitative researcher’s ethical awareness also entails knowing and acknowledging his or her own vulnerability, which becomes apparent in the researcher-participant relationship and settings in which being a fellow human always overrules the researcher’s role in ethical dilemmas.
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Affiliation(s)
| | | | - Jette Lauritzen
- 317905VIA University College, Denmark; Aarhus University, Denmark
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Alastalo M, Salminen L, Vahlberg T, Leino-Kilpi H. Knowledge of patient observation among critical care nurses. Nurs Crit Care 2020; 26:341-351. [PMID: 33150722 DOI: 10.1111/nicc.12573] [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: 06/07/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive. AIM The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it. STUDY DESIGN A cross-sectional knowledge test survey with critical care nurses in Finland was used. METHODS Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics. RESULTS Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum-variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit. CONCLUSION The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care. RELEVANCE TO CLINICAL PRACTICE Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career.
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Affiliation(s)
- Mika Alastalo
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- The Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- The Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- The Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
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Magro-Morillo A, Boulayoune-Zaagougui S, Cantón-Habas V, Molina-Luque R, Hernández-Ascanio J, Ventura-Puertos PE. Emotional universe of intensive care unit nurses from Spain and the United Kingdom: A hermeneutic approach. Intensive Crit Care Nurs 2020; 59:102850. [PMID: 32229184 DOI: 10.1016/j.iccn.2020.102850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 02/20/2020] [Accepted: 03/07/2020] [Indexed: 11/30/2022]
Abstract
AIM To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom. METHODOLOGY The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it. FINDINGS Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be. CONCLUSION The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.
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Affiliation(s)
- Ana Magro-Morillo
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain
| | - Salma Boulayoune-Zaagougui
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - Vanesa Cantón-Habas
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - Rafael Molina-Luque
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
| | - José Hernández-Ascanio
- Department of Sociology, Department of Social Sciences and Humanities, Calle San Alberto Magno, s/n, P.C. 14071, Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Department of Nursing, Pharmacology and Physiotherapy, Avda. Menéndez Pidal, s/n, P.C. 14071, Córdoba, Spain.
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13
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Alastalo M, Salminen L, Jeon Y, Vahlberg T, Leino-Kilpi H. Critical care nurses' self-assessed patient observation skills: a cross-sectional survey study. Nurs Crit Care 2019; 24:268-275. [PMID: 30637884 DOI: 10.1111/nicc.12412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/05/2018] [Accepted: 12/07/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Observing a patient's clinical condition is an important responsibility of critical care nurses and an essential component of their competence. Critical care nurses' patient observation skills contribute to patient safety and quality of care. These observation skills have not been assessed or measured previously. AIM The aim of this study was to measure the self-assessed level of critical care nurses' patient observation skills and to explore the factors associated with these skills. STUDY DESIGN This was a multicentre cross-sectional survey conducted in Finland. METHODS The sample consisted of critical care nurses working at Finnish university hospitals. The data were collected between September 2017 and January 2018 using an instrument developed for the study - Patient Observation Skills in Critical Care Nursing (visual analogue scale 0-100). Descriptive and inferential statistics were used to analyse the data. RESULTS A total of 372 critical care nurses (49%) responded. Finnish critical care nurses assessed their patient observation skills overall as excellent. The bio-physiological foundation was assessed as good, whereas skills in using observation methods and skills in recognizing changing clinical condition were assessed as excellent. Education for special tasks in intensive care units, information searching in scientific journals, working experience in critical care nursing and critical care nurses' perception of critical care as a preferred field of nursing were factors promoting patient observation skills. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE The study provided a novel instrument for measuring critical care nurses' patient observation skills. The instrument may be used as an assessment tool in clinical practice and education. Developing orientation and on-the-job training in intensive care units are essential in assuring critical care nurses' adequate patient observation skills. Patient observation skills could be developed during nursing education by providing students with opportunities for clinical training and applying patient cases in virtual learning environments.
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Affiliation(s)
- Mika Alastalo
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Leena Salminen
- Professor, Department of Nursing Science, University of Turku, Turku, Finland
| | - Yunsuk Jeon
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Biostatistician, Department of Biostatistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland
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14
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Despins LA, Kim JH, Deroche C, Song X. Factors Influencing How Intensive Care Unit Nurses Allocate Their Time. West J Nurs Res 2019; 41:1551-1575. [DOI: 10.1177/0193945918824070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spending time with the patient is essential for intensive care unit (ICU) nurses to detect clinical change. This article reports on an examination of factors influencing nurses’ activity time allocation. Data were analyzed from a prospective time and motion study of medical ICU nurses. Nurse demographic data and observation, electronic locator technology, and electronic medical record log data were collected over 12 days from 11 registered nurses. Charlson Co-Morbidity Index and Sequential Organ Failure Assessment scores were calculated for patient assignments. Nurses averaged 78.04 ( SD = 47.85) min per patient on activities in the patient room. Years of ICU nursing experience and the patient’s Charlson Co-Morbidity Index was significantly associated with time spent in the patient’s room. Neither nursing education nor specialty certification was found to influence time spent in a patient’s room. Using technology can advance understanding of nurses’ time allocation leading to interventions optimizing time spent with the patient.
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15
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Scholes J, Albarran J. What's in this issue? Nurs Crit Care 2017; 22:65-66. [PMID: 28191747 DOI: 10.1111/nicc.12287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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