Intensive and Critical Care Nursing RSS feed: Current Issue. The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects. http://www.intensivecriticalcarenursing.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Intensive and Critical Care Nursing0964-3397281February 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.intensivecriticalcarenursing.com/article/PIIS0964339711001364/abstract?rss=yesEditorial Board10.1016/S0964-3397(11)00136-4Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1iihttp://www.intensivecriticalcarenursing.com/article/PIIS0964339711001078/abstract?rss=yesSummary: Objective: This paper assesses the frequency of prescribing and the types of medications prescribed by a New Zealand critical care nurse practitioner (NP) whilst performing a critical care outreach role.Method: A before and after audit was conducted from June 2006 to July 2008. Audit data were collected prospectively and analysed retrospectively. Data collected between July 2006 and June 2007 when standing orders were used were compared to data collected between July 2007 and June 2008 when the NP was authorised to prescribe. Data were analysed using count, chi-square, the Fisher's Exact Test and Phi.Findings: The NP completed 1061 patient visits. When compared to using standing orders, the NP prescribed a greater number and a wider range of medications when authorised to prescribe (χ2=9.280, p=.002, Φ=.094). Electrolytes and analgesics were the most common medications prescribed in both audit periods.Conclusion: The results provide insight into critical care NP prescribing practice to better inform future critical care workforce development.A critical care nurse practitioner's prescribing using standing orders and authorised prescribing when performing a critical care outreach role: A clinical auditAlison M. Pirret10.1016/j.iccn.2011.10.008Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles15http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001194/abstract?rss=yesSummary: Aim: The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU).Method: Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analysed using a phenomenological-hermeneutic method inspired by Ricoeur.Results: Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless, deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to ‘flow with’ the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship.Conclusion: A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival.The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic studyVeronika Karlsson, Ingegerd Bergbom, Anna Forsberg10.1016/j.iccn.2011.11.002Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles615http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001248/abstract?rss=yesSummary: Objective: To describe the experience and perceptions of nurse study participants regarding a communication intervention (training and communication tools) for use with nonspeaking, critically ill patients.Research methodology/design: Small focus groups and an individual interview were conducted with six critical care nurses. Transcripts were analysed using qualitative content analysis and constant comparison.Setting: Two ICUs within a large, metropolitan medical centre in western Pennsylvania, United States of America.Main outcome measures: Critical care nurses’ evaluations of (1) a basic communication skills training programme (BCST) and (2) augmentative and alternative communication strategies (AAC) introduced during their study participation.Results: Six main categories were identified in the data: (1) communication value/perceived competence; (2) communication intention; (3) benefits of training; (4) barriers to implementation; (5) preferences/utilisation of strategies; and 6) leading-following. Perceived value of and individual competence in communication with nonspeaking patients varied. Nurses prioritised communication about physical needs, but recognised complexity of other intended patient messages. Nurses evaluated the BCST as helpful in reinforcing basic communication strategies and found several new strategies effective. Advanced strategies received mixed reviews. Primary barriers to practise integration included patients’ mental status, time constraints, and the small proportion of nurses trained or knowledgeable about best patient communication practices in the ICU.Conclusions: The results suggest that the communication skills training programme could be valuable in reinforcing basic/intuitive communication strategies, assisting in the acquisition of new skills and ensuring communication supply availability. Practice integration will most likely require unit-wide interdisciplinary dissemination, expert modelling and reinforcement.Nurses’ perceptions of communication training in the ICUJill V. Radtke, Judith A. Tate, Mary Beth Happ10.1016/j.iccn.2011.11.005Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles1625http://www.intensivecriticalcarenursing.com/article/PIIS0964339711000966/abstract?rss=yesSummary: Background: Although strict adherence to infection control strategies is recognised as the simplest and most cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the direct impact that such adherence may have on the risk of developing such infections has always been a challenge.Purpose: The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak. Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of infection control strategies during the SARS outbreak may have had on the risk of HAIs.Methods: A retrospective chart review was conducted on the medical records of 400 intensive care patients who were admitted to the ICU three months before and during the 2003 SARS outbreak.Results: The rate of HAIs was higher in the pre-SARS period than the SARS period. Specifically, 61.7% of all reported infections were diagnosed in the pre-SARS period. The rate of HAIs in the pre-SARS period was 14.5% as opposed to 9% during the SARS period. Adjusted logistic regression analysis suggested that the odds of HAIs were 2.2 times higher in the pre-SARS period as compared to the SARS period (OR=2.2; 95%CI=1.08–4.49).Conclusion: Our findings suggest that strict enforcement of infection control strategies may have a positive impact on the efforts to minimise the risk of HAIs. These findings carry a clinical significance that shall not be ignored with regard to our overall efforts to minimise the risk of developing HAIs in the ICU.Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: A retrospective studyMaher M. El-Masri, Margaret (Peggy) Oldfield10.1016/j.iccn.2011.10.003Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles2631http://www.intensivecriticalcarenursing.com/article/PIIS096433971100125X/abstract?rss=yesSummary: Background: ICU nurses often report that timely informational and supportive resources would ease distress for clients and providers alike.Objectives: This pilot study was aimed to explore the role of a comprehensive information and support programme in enhancing the work environment, task performance and reducing emotional distress amongst ICU nurses.Research methodology/design: Through a mixed quantitative and qualitative design, nurses were invited to complete self-report questionnaires (n=25) and to participate in focus groups (n=7) prior to (T1) and 6 weeks after the implementation of the supportive programme (T2).Results: Measures of physical and mental effort were found to be significantly lower (t=2.45, p=0.02) at post test (T2). Statistical trends towards significance were observed for higher performance satisfaction (t=1.70, p=0.10) and lower emotional distress (t=2.00, p=0.06) at T2. Focus group data revealed that nurses felt more supported in their work, had more satisfaction with work tasks accomplished and felt more emotionally supported with the programme being in place.Conclusions: Preliminary data from this pilot study suggest that a comprehensive information and support programme designed to support nurses in the ICU can enhance well being and workplace related factors. Work is currently underway to document the program's impact on family members in the ICU. Future studies should document further how and when similar programme contribute to enhance the workplace for other ICU staff.A pre–post evaluation of the Adler/Sheiner Programme (ASP): A nursing informational programme to support families and nurses in an intensive care unit (ICU)Carmen G. Loiselle, Céline Gélinas, Jamie Cassoff, Johanne Boileau, Lynne McVey10.1016/j.iccn.2011.11.006Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles3240http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001066/abstract?rss=yesSummary: Background: Despite the fact that Italian nurses have only recently gained autonomy when making health-care decisions, there is little evidence available regarding the decisions actually taken in clinical practice.Objectives: Exploring the patterns that guide the nurses’ decision-making process in weaning and extubating the patient after cardiac surgery.Methods: We have adopted a qualitative ethnographic approach. The study was conducted in the Cardiosurgical Intensive Care Unit (CICU) in a Teaching and Research Hospital (Milan) and was first created using participant non-directive observation in which decisions about weaning and extubation were observed. Through aimed sampling until saturation, 18 nurses at both expert and novice professional stages, the nurse manager and the anaesthesiologist director were interviewed.Results: The pattern of a nurse's decision-making process in weaning and extubation is based on three themes: (a) collect data and suggest a decision, (b) standardise the competence and (c) maintain adherence to unwritten rules. The nurses would never take the initiative to start weaning and extubating the patient by themselves: they collect data, consult with other nurses and then propose decisions which are ultimately authorised by the physicians.Conclusions: The near-decision-making process of nurses expressed a pattern determined by personal factors, clinicians, organisations, structures and cultural reported unwritten rules. To ensure that the nurses become responsible and independent decision makers, it is necessary to pay particular attention to structural and cultural conditions in order to help them reach their full potential in the future.Nurses’ near-decision-making process of postoperative patients’ cardiosurgical weaning and extubation in an Italian environmentGiulia Villa, Duilio Manara, Alvisa Palese10.1016/j.iccn.2011.10.007Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Original Articles4149http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001169/abstract?rss=yes‘Ward-Based Critical Care: a guide for health professions’ is a work centred on the care of those adult in-patients whose condition may be deteriorating and who are still being cared for at ward level. The title would indicate that it is targeted at ward based staff caring for these patients. Therefore, this book appears to sit between works aimed at critical care and those focusing on the care of medical and surgical patients. Despite this I would suggest it would also be of considerable benefit for Critical Care staff.Gerard McMenamin10.1016/j.iccn.2011.11.001Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Book Review5050http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001261/abstract?rss=yesResearch Reviews – February 201210.1016/j.iccn.2011.11.007Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Research Reviews5152http://www.intensivecriticalcarenursing.com/article/PIIS0964339711001200/abstract?rss=yesChest X-ray quiz10.1016/j.iccn.2011.11.003Intensive and Critical Care Nursing 28, 1 (2012)2012-02-01Intensive and Critical Care Nursing2012-02-01281S0964-3397(11)X0007-1Research Reviews5354