NANDA-I® nursing diagnoses in adult critical patients with COVID-19 / Diagnósticos de enfermagem da NANDA-I® em pacientes críticos adultos portadores de COVID-19 / Diagnósticos en enfermería de NANDA-I® en pacientes críticos adultos con COVID-19

Resumo Objetivo Identificar possíveis diagnósticos de enfermagem conforme a classificação da NANDA-International presentes em pacientes críticos adultos portadores de COVID-19 a partir de pistas diagnósticas descritas pela literatura científica. Métodos Estudo descritivo, desenvolvido em três etapas: revisão de literatura e agrupamento das pistas diagnósticas identificadas de acordo com as Necessidades Humanas Básicas; levantamento dos diagnósticos de enfermagem da NANDA-International a partir da correspondência entre as pistas diagnósticas descritas pela literatura com o título e indicadores diagnósticos; validação da correspondência diagnóstica por enfermeiros peritos. Foi utilizado o índice de concordância ≥ 0,80. Resultados A partir da leitura de 20 estudos, elegeram-se 51 pistas diagnósticas que foram agrupadas em 11 Necessidades Humanas Básicas Psicobiológicas. Após três rodadas de análise pelos peritos, identificou-se correspondência das 51 pistas diagnósticas com 26 títulos diagnósticos de enfermagem da NANDA-International. Os domínios dessa classificação com maior número de diagnósticos foram: atividade/repouso (n=9); segurança/proteção (n=7) e nutrição (n=4). Ressalta-se que 45,1% das pistas diagnósticas apresentaram correspondência com mais de um título diagnóstico. Além disso, a maioria dos diagnósticos de enfermagem (60,0%) refere-se a problemas reais e 40,0% a problemas potenciais. Conclusão Os resultados obtidos permitiram a identificação de pistas diagnósticas presentes em pacientes críticos adultos portadores de COVID-19 e verificar sua equivalência com 26 títulos diagnósticos da NANDA-International.

Resumen Objetivo Identificar posibles diagnósticos en enfermería según la clasificación de NANDA-International presentes en pacientes críticos adultos con COVID-19 a partir de pistas diagnósticas que se describen en la literatura científica. Métodos Estudio descriptivo, desarrollado en tres etapas: revisión de literatura y agrupación de las pistas diagnósticas identificadas de acuerdo con las Necesidades Humanas Básicas; recopilación de los diagnósticos de enfermería de NANDA-International a partir de la correspondencia entre las pistas diagnósticas que se describen en la literatura con el título e indicadores diagnósticos; validación de la correspondencia diagnóstica por enfermeros expertos. Se utilizó el índice de coincidencia ≥ 0,80. Resultados A partir de la lectura de 20 estudios, se eligieron 51 pistas diagnósticas que se agruparon en 11 Necesidades Humanas Básicas Psicobiológicas. Después de tres rondas de análisis de los expertos se identificó la correspondencia de las 51 pistas diagnósticas con 26 títulos diagnósticos de enfermería de NANDA-International. Los dominios de esa clasificación con un mayor número de diagnósticos fueron: actividad/reposo (n=9); seguridad/protección (n=7) y nutrición (n=4). Se destaca que 45,1 % de las pistas diagnósticas presentaron correspondencia con más de un título diagnóstico. Además, la mayoría de los diagnósticos de enfermería (60,0 %) se refiere a problemas reales y el 40,0 % a problemas potenciales. Conclusión Los resultados alcanzados permitieron la identificación de pistas diagnósticas presentes en pacientes críticos adultos con COVID-19 y verificar su equivalencia con 26 títulos diagnósticos de NANDA-International.

Abstract Objective To identify possible nursing diagnoses according to the NANDA-International classification present in critically ill adult patients with COVID-19 based on diagnostic clues described in the scientific literature. Method This is a descriptive study, developed in three stages: literature review and grouping of diagnostic clues identified according to Basic Human Needs; survey of NANDA-International nursing diagnoses based on the correspondence between diagnostic clues described in the literature with title and diagnostic indicators; validation of diagnostic correspondence by expert nurses. An agreement index ≥ 0.80 was used. Results From the reading of 20 studies, 51 diagnostic clues were selected and grouped into 11 Psychobiological Basic Human Needs. After three rounds of analysis by the experts, a correspondence of 51 diagnostic clues with 26 NANDA-International nursing diagnosis titles was identified. The domains of this classification with the highest number of diagnoses were: activity/rest (n=9); safety/protection (n=7) and nutrition (n=4). It is noteworthy that 45.1% of the diagnostic clues corresponded to more than one diagnostic title. Moreover, most nursing diagnoses (60.0%) refer to real problems and 40.0% to potential problems. Conclusion The results obtained allowed the identification of diagnostic clues present in critically ill adult patients with COVID-19 and to verify their equivalence with 26 diagnostic titles from NANDA-International.

Evolution of patients with COVID-19 in pronation in an ICU reconverted during the first wave

Objective: to describe the profile and evolution of patients with COVID-19 after postural change to pronation as part of their treatment for acute respiratory distress symptom (ARDS) at the Cardiovascular ICU of the Hospital Clínic in Barcelona which was reconverted to COVID ICU during the first wave of the pandemic. Methodology: a cross sectional case series study, conducted between March and May 2020. The study included adults who had been positioned in pronation as part of their ARDS treatment. The following variables were collected through clinical record review: gender, age, medical history, ventilation and sedation, SAPS-II score, time of hospitalization, PAFI evolution (the ratio of arterial oxygen pressure to fractional inspired oxygen), complications and mortality. Descriptive statistics were used. Results: in total, 44 patients were admitted, and 30% of them required pronation;21 position changes were made in 13 patients, with 24 hours as median time. Of these patients, 69% were male, with 67.8 years as mean age, and 69% had a previous cardiopathy. The mean time with mechanical ventilation was 23.9 days, and the mean hospital stay was 45.1 days. There was an improvement in PAFI after pronation in all patients (initial = 132.5;during pronation = 232.6;final = 168.6). There was a 30.8% patient mortality during hospitalization at ICU. The most frequent complications were hemodynamic (n= 8). Conclusion: the patient profile was a >65-year-old male with previous cardiopathy. There was a positive evolution in oxygenation. Mortality was not differentiated from other settings and it was lower than that estimated through the SAPSS-II score. There was a low proportion of complications. © 2022 DAE Editorial, Grupo Paradigma. All rights reserved.

The impact of a three-tiered model of nursing redeployment during the COVID-19 pandemic: A cross-sectional study.

OBJECTIVE: The COVID-19 pandemic resulted in extreme system pressures, requiring redeployment of nurses to intensive care units. We aimed to assess the impacts of a 3-tiered pandemic surge model on nurses working in intensive care units during the COVID-19 pandemic. METHODOLOGY: In this cross-sectional study, 931 nurses (464 intensive care and 467 redeployed nurses) who worked within four adult units in Western Canada during pandemic surge(s) were invited via email to participate in a survey. The survey explored the impact of redeployment, rapid unit orientations, just-in-time training, and the 3-tiered model of nursing during pandemic surge. Burnout was measured utilizing the Copenhagen Burnout Inventory questionnaire. RESULTS: A total of 191 survey responses were retained (59 intensive care nurses and 132 redeployed). Survey results are reported by tier, with outcomes varying based on team leadership, intensive care unit, and redeployment nursing roles. Burnout in personal and workplace domains was present amongst all nursing tiers, while only team leadership roles experienced burnout in the patient domain. Overall, team leadership roles and permanent intensive care nurses experienced the highest rates of burnout. Redeployed nurses reported numerous aids to success including support from colleagues, prior experience, and educational supports. Skill-based orientation, ongoing education, optimized scheduling, role clarity, and mitigators of psychological impacts were identified by respondents as potential facilitators of redeployment and surge models. CONCLUSION: Nurses working within this tiered model experienced high degrees of burnout, with highest prevalence amongst team leads and intensive care nurses. Optimization of support for and interventions aimed at improving well-being are important considerations going forward. IMPLICATIONS FOR CLINICAL PRACTICE: Targeted strategies are required to support education, role transition, and optimize competency and role clarity during nursing redeployment for overcapacity surge. Essential strategies to support redeployed nurses include individualized competency assessments pre-redeployment and prior to role transitions, pairing redeployed nurses with the same intensive care nurse consistently, and availability of a nurse educator or resource for additional just-in-time training supports. Contingency disaster strategies should also include interventions targeting staff wellness and prevention of burnout, as well as identify scenarios in which redeployment may increase risks of psychological harm. Debriefing and peer-to-peer support models may increase the efficiency of psychological support for nurses, though additional research is required. Lastly, given enaction of tiered models of nursing care is largely a novel occurrence in the intensive care unit, leadership training is required to support frontline nurses taking on supervisory roles within these team models.

The relationship between practice environment, job satisfaction and intention to leave in critical care nurses.

BACKGROUND: Recent studies in the Kingdom of Saudi Arabia (KSA) have shown that the increasing nursing turnover in the health care industry has become a great source of concern. The overdependence on the supply of expatriate nurses (74%) and coronavirus disease 2019 (COVID-19) travel restrictions have exacerbated this staffing issue. AIMS: To examine the relationship between perception of nursing practice environment (NPE), job satisfaction and intention to leave (ITL) among critical care nurses working in the state of Ha'il in KSA. DESIGN: Cross-sectional correlational (observational) design. METHODS: Data were collected via electronic online survey distributed to registered critical care nurses working in King Khalid Hospital (KKH), Ha'il, KSA, between July and August 2020. Participant demographics and key variables data related to NPE, job satisfaction and ITL respectively were collected from the participants using existing and validated questionnaires. Descriptive statistics and correlational analysis and multivariable analyses were conducted. RESULTS: A response rate of 98% was achieved (152/160) for the study. Findings showed that the NPE was largely favourable (M = 2.89, SD = 0.44); however, nurse participation in hospital affairs (M = 2.83, SD = 0.47) and staffing and resource adequacy (M = 2.88, SD = 0.47) scored lowest. NPE was found to be significantly correlated with job satisfaction (rs = .287, P < .01). A significant negative relationship was found between NPE and ITL (rs = -0.277**, P < .01). However, job satisfaction was associated with ITL (rs = -.007, P = .930). CONCLUSIONS: Maintaining a healthy work environment and job satisfaction levels in critical care units is key to improving, recruitment and retention of nursing staff. RELEVANCE TO CLINICAL PRACTICE: Critical care and hospital leaders should implement programs that enhance the quality of the practice environment. This will improve nurse participation in unit and hospital affairs, job satisfaction and intention to stay.

Learning from critical care nurses' wartime experiences and their long-term impacts.

BACKGROUND: The history of critical care nursing is intertwined with that of battlefield nursing, where for almost 200 years, nurses worked to save injured soldiers' lives, risking their own physical and emotional injuries. Today, with nurses increasingly deployed to provide critical care during natural, man-made and public health crises that can resemble battlefield situations, there is much to learn from battlefield nurses. This qualitative study explores the lessons of the experiences of civilian nurses deployed to Israeli battlefields in three wars between 1967 and 1982. METHODS: Qualitative, semi-structured, in-depth interviews were conducted with twenty-two former military nurses who were deployed in three wars between 1967 and 1982. We analysed interview transcripts using a content analysis approach. COREQ, a 32-item checklist, guided method selection, data analysis and the findings' presentation. FINDINGS: Data analysis revealed three main themes, with ten related subthemes: Field Service Challenges, Coping with Challenges, and Nurses' Need for Recognition. CONCLUSION: The findings identify mental, emotional, and organizational issues resulting from nurses' wartime experiences, revealing numerous opportunities for better preparing and supporting critical care nurses before, during, and after crises. RELEVANCE TO CLINICAL PRACTICE: Critical care nursing during crises, such as wartime, is unique but increasingly common. The memories and ongoing impact of those experiences offer invaluable information for nursing and health policy stakeholders planning for future deployments during wartime or other disasters such as the COVID-19 pandemic and the Russo-Ukrainian war.

Moving Forward From a New Place in 2023

The author discusses the need to stay alert to public health needs, the complexities of disparities, and the value of attentive leadership in 2023. Topics covered include lessons learned from the COVID-19 pandemic, the culture shift after the pandemic, and a framework for organizational introspection.

Mental well-being of intensive care unit nurses after the second surge of the COVID-19 pandemic: A cross-sectional and longitudinal study.

OBJECTIVES: To determine the impact of the second surge of the COVID-19 pandemic (October 2020 to June 2021) on mental well-being of intensive care unit nurses and factors associated with mental health outcomes. METHODS: An online survey was available for Dutch intensive care unit nurses in October 2021, measuring mental health symptoms; anxiety, depression (Hospital Anxiety and Depression Scale), and post-traumatic stress disorder (Impact of Event Scale-6). Additionally, work-related fatigue was measured using the Need For Recovery-11 questionnaire. Previous data from the first surge (March until June 2020) were used to study mental well-being longitudinally in a subgroup of intensive care unit nurses. Logistic regression analyses were performed to determine factors associated with mental health symptoms. RESULTS: In total, 589 nurses (mean age 44.8 [SD, 11.9], 430 [73.8 %] females) participated, of whom 164 also completed the questionnaire in 2020. After the second surge, 225/589 (38.2 %) nurses experienced one or more mental health symptoms and 294/589 (49.9 %) experienced work-related fatigue. Compared to the first measurement, the occurrence of mental health symptoms remained high (55/164 [33.5 %] vs 63/164 [38.4 %], p = 0.36) and work-related fatigue was significantly higher (66/164 [40.2 %] vs 83/164 [50.6 %], p = 0.02). Granted holidays as requested (aOR, 0.54; 95 % CI, 0.37-0.79), being more confident about the future (aOR, 0.59; 95 % CI, 0.37-0.93) and a better perceived work-life balance (aOR, 0.42; 95 % CI, 0.27-0.65) were significantly associated with less symptoms. CONCLUSION: The second surge of the COVID-19 pandemic further drained the mental reserves of intensive care unit nurses, resulting in more work-related fatigue.

Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature

Background Aims Study Design Results Conclusions Relevance to clinical practice Within the context of the increasing prevalence of prolonged critical illness, a situation intensified by the COVID‐19 global pandemic, advancing understanding of the experiences of families of survivors that are discharged home is important in understanding the complexity of life for these people.To examine research related to the experiences of families of survivors of prolonged critical illness that are discharged home.This review was conducted using the Whittemore and Knafl framework for integrated literature reviews. A literature search was conducted using the electronic databases of Web of Science, CINHAL, Scopus, and PubMed for English language studies published between January 2002 and October 2021. Article titles and s were screened in view of finding a selection of articles that focussed on the experiences of families of people who have survived a prolonged intensive care stay that are discharged home. Study quality was assessed using the CASP (Critical Appraisal Skills Programme) tool. Data analysis of nine peer‐reviewed articles was informed by the Braun and Clarke approach to thematic analysis. The PRISMA guidelines were used to report the review process.Nine articles were included in the review. Three major themes were identified, namely, (i) the negative impact on family caregiver health and well‐being, (ii) caregiver burden, and (iii) unmet support needs.Families of prolonged critical illness survivors that are discharged home face complex challenges that make their experience difficult and demanding. Family support needs once patients are discharged home are largely unrecognized in this population.This review evidences the need to investigate further the experiences of families of survivors of prolonged critical illness. Further qualitative research has the potential to help inform service provision and support for these people. [ FROM AUTHOR]

Nursing workforce deployment and intensive care unit strain during the COVID-19 pandemic in Victoria, Australia.

BACKGROUND: The COVID-19 pandemic demanded intensive care units (ICUs) globally to expand to meet increasing patient numbers requiring critical care. Critical care nurses were a finite resource in this challenge to meet growing patient numbers, necessitating redeployment of nursing staff to work in ICUs. OBJECTIVE: Our aim was to describe the extent and manner by which the increased demand for ICU care during the COVID-19 pandemic was met by ICU nursing workforce expansion in the late 2021 and early 2022 in Victoria, Australia. METHODS: This is a retrospective cohort study of Victorian ICUs who contributed nursing data to the Critical Health Information System from 1 December 2021 to 11 April 2022. Bedside nursing workforce data, in categories as defined by Safer Care Victoria's pandemic response guidelines, were analysed. The primary outcome was 'insufficient ICU skill mix'-whenever a site had more patients needing 1:1 critical care nursing care than the mean daily number of experienced critical care nursing staff. RESULTS: Overall, data from 24 of the 47 Victorian ICUs were eligible for analysis. Insufficient ICU skill mix occurred on 10.3% (280/2725) days at 66.7% (16/24) of ICUs, most commonly during the peak phase from December to mid-February. The insufficient ICU skill mix was more likely to occur when there were more additional ICU beds open over the 'business-as-usual' number. Counterfactual analysis suggested that had there been no redeployment of staff to the ICU, reduced nursing ratios, with inability to provide 1:1 care, would have occurred on 15.2% (415/2725) days at 91.7% (22/24) ICUs. CONCLUSION: The redeployment of nurses into the ICU was necessary. However, despite this, at times, some ICUs had insufficient staff to cope with the number and acuity of patients. Further research is needed to examine the impact of ICU nursing models of care on patient outcomes and on nurse outcomes.

Evaluation of an international health partnership to capacity build emergency, trauma and critical care nurse education and practice in Zambia: An experience from the field.

AIM: To evaluate an international health partnership project to capacity build emergency, trauma and critical care nurse education and practice in Zambia. BACKGROUND: Zambia continues to face a significant workforce challenge and rising burden of communicable and non-communicable diseases, compounded by the COVID-19 pandemic. In response to these, the Zambian Ministry of Health is investing in specialised nurses. Emergency, trauma and critical care nursing education and training were seen as one of the solutions. North-south partnerships have been identified as a force for good to capacity build and develop emerging specialities. SOURCES OF EVIDENCE: We use an evaluative approach, which includes desk research, a rapid literature review and documentary data analysis from published papers, government reports and project documentation. Ethics committee approval was sought and gained in both Zambia and the UK. DISCUSSION: A critical review of the evidence identified three key themes: challenges with changing education and practice, developing Zambian faculty for sustainability and the effect of an international health partnership project on both Zambia and UK. The outcomes from this project are multifaceted; however, the main achievement has been the implementation of emergency, trauma and critical care graduate programmes by the Zambian faculty. CONCLUSION: This experience from the field outlines the benefits and limitations of a north-south partnership and the importance of transparency, shared ownership and collegiate decisions. It has facilitated knowledge exchange and sharing to capacity build emergency, trauma and critical care nursing. IMPLICATIONS FOR NURSING PRACTICE: Lessons learned may be applicable to other international nursing partnerships, these include the need for deep understanding of the context and constraints. Also, the importance of focusing on developing long-term sustainable strategies, based on research, education and practice was noted. IMPLICATIONS FOR NURSING POLICY: This paper outlines the importance of developing nursing education and practice to address the changing burden of disease in line with Zambian national policy, regional and international standards. Also, the value of international nursing partnerships for national and international nursing agendas was described.

Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study.

AIM: To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. DESIGN: A qualitative study was performed following the consolidated criteria for reporting qualitative research. METHODS: Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. RESULTS: A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. RELEVANCE TO CLINICAL PRACTICE: This framework can be a reference for the assessment and training of ECMO nurses.

Learning in intensive care during the COVID-19 pandemic postgraduate critical care nursing students' experiences.

Objectives: This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. Methods: An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. Results: The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor.  2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.

COVID-19 pandemic: the impact on Canada's intensive care units

The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided. © 2022 Gibney et al.

Antecedents of burnout and turnover intentions during the COVID-19 pandemic in critical care nurses: A mediation study

Background: Nurses working in critical care environments have experienced a great deal of psychological stress during the successive waves of the COVID-19 pandemic. Identifying factors that contribute to burnout and turnover intentions are important to retain intensive care unit (ICU) nurses. Purpose: The purpose of this study is to identify factors that are directly and indirectly associated with burnout and turnover intentions in ICU nurses. Methods: A cross-sectional design was used with survey data during the peak of the second wave of the COVID-19 pandemic. Data were collected through an online survey and analyzed using mediation analysis. A total of 236 ICU nurses across Canada participated in the study. Results: The results indicate that burnout mediates the relationship between moral distress, organizational support, resilience, and turnover intentions. Moreover, 49% of the participants were considering leaving. The reasons were related to lack of administrative support, poor work environment and safety concerns. Discussion: Organizational support and individual resilience can both play a role in turnover intentions through the prevention of burnout symptoms. Managers at all levels play an important role in mitigating the harmful effects of the pandemic. Conclusion: The pandemic has had a serious psychological impact on ICU nurses. Targeted interventions are needed to support this group.

Nurses' experiences of the phenomenon 'isolation communication'.

BACKGROUND: Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. AIM: To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. STUDY DESIGN: A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. FINDINGS: Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. CONCLUSION: The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. RELEVANCE TO CLINICAL PRACTICE: As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.

'Doing the best we can': Registered Nurses' experiences and perceptions of patient safety in intensive care during COVID-19.

AIMS: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. DESIGN: A qualitative interview study informed by constructivism. METHOD: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. RESULTS: Two key themes were identified. 'On a war footing'-an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. 'Doing the best we can'-Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. CONCLUSION: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. IMPACT: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.

Impact of COVID-19 on Intensive Care Unit Nurse Duty of Care and Professional Roles: A Qualitative Content Analysis.

Background: Nurse duty of care, the balance between nursing occupational obligations to provide care, the personal costs for providing such care, and the reward for providing care, has been significantly altered by the COVID-19 pandemic. ICU nurses are increasingly burdened with higher personal costs to fulfill their jobs, but little additional reward for continuing to provide care. Objectives: The purpose of this study was to examine the impact of the COVID-19 pandemic on the duty of care balance among ICU nurses who manage COVID-19 patients. Design: This was a descriptive qualitative study using semi-structured interviews. Methods: Nurses were recruited for a parent study on ICU nursing during COVID-19; this is a secondary analysis of the interviews that took place during the parent study. Content analysis was utilized to identify themes from interview transcripts. Results: Thirteen nurses participated in interviews. Nurses reported betrayal at perceived breeches in their duty of care agreement by their employers, the general public, and national health authorities. They described alterations to previous standards of care such as significantly increased workloads, worsening understaffing, and changes to patient care expectations that were implemented for reasons other than betterment of patient care. Nurses reported they felt a moral obligation to provide care, however they experienced disempowerment and burnout that affected them both in and out of the workplace. Conclusion: The COVID-19 pandemic has affected several aspects of the duty of care balance, resulting in a duty of care balance that is inequitable to nurses. Imbalance in the effort, risks, and rewards for nursing professionals may contribute to nurse burnout. Relevance to Clinical Practice: This research highlights the need for healthcare administrators to consider resource allocation, nurse appreciation, and commensurate compensation for professional nurses.

Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic...Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) Convention, 25-29 June, 2022, Aurora, Colorado

The article offers information about the missed critical nursing care processes on labor and delivery units during the Covid-19 pandemic. It mentions that study examined the rates of three critical nursing care processes on labor and delivery units and assessed the relationship with reports of reduced nursing time at the bedside and frequency of unit staffing adequacy during the Covid-19 pandemic in the U.S.