Knowledge, attitudes, and practice related to the prone positioning of patients among intensive care unit nurses working in COVID-19 units: A cross-sectional study in China.

BACKGROUND: An increasing number of studies persistently demonstrate that prone position ventilation can significantly improve the oxygenation index and blood oxygen saturation for most patients (70-80%) with acute respiratory distress syndrome (ARDS). Studies have also shown that the awake prone position was both safe and effective in helping patients with coronavirus disease 2019 (COVID-19) breathe spontaneously. However, the prone position is not widely adopted when treating patients with COVID-19 or ARDS from other causes. Basic knowledge, positive attitudes, and correct practices among the nursing staff are necessary to increase the use of prone positions, reduce the incidence of complications associated with prone positions, and improve the quality and safety of health care. AIM: This study aimed to investigate the knowledge, attitudes, and practice of prone positioning of patients among intensive care unit (ICU) nurses working in COVID-19 units and provide suggestions for improvement. STUDY DESIGN: ICU nurses were recruited from two designated tertiary hospitals for COVID-19 treatment in Shanghai, China, in April 2022, using convenience sampling. A questionnaire survey focusing on the dimensions of knowledge, attitudes, and practice of the prone position with 42 items, was conducted. RESULTS: A total of 132 ICU nurses participated. The scores on the overall questionnaire and the dimensions of knowledge, attitudes, and practice of prone position were 167.28 (95% CI, 161.70-172.86), 78.35 (95% CI, 76.04-80.66), 32.08 (95% CI, 31.51-32.65), and 56.85 (95% CI, 52.42-61.28) respectively. The overall average score was 79.66% (95% CI, 0.77-0.82). The results of multiple linear regression analysis showed that prior experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. CONCLUSIONS: The ICU nurses strongly believed in the effectiveness of prone positioning, but their knowledge and practice levels need improvement. The experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Nursing managers should ensure that ICU nurses are well trained in prone positioning and help enhance the knowledge and attitudes toward prone positioning to promote its widespread use. RELEVANCE TO CLINICAL PRACTICE: Clinical guidelines and in-service training modules need to be developed to promote the use of prone positioning and reduce prone position-related complications.

The early impact of COVID-19 on intensive care nurses' personal and professional well-being: A qualitative study.

OBJECTIVE: To describe the impact of the COVID-19 pandemic on intensive care nurses personal and professional well-being. RESEARCH METHODOLOGY/DESIGN: A descriptive, qualitative design was used. Two nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a semi-structured interview guide. SETTING: Thirteen nurses who were working in an intensive care unit in the United States participated in the study. A convenience sample of nurses who completed a survey in the larger parent study provided an email and were contacted by the research team to participate in interviews to discuss their experiences. MAIN OUTCOME MEASURES: An inductive approach to content analysis was used to develop categories. FINDINGS: Five major categories emerged from the interviews: (1) We are not heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses the second victim. CONCLUSION: The COVID-19 pandemic has taken a physical and mental health toll on intensive care nurses. The impact of the pandemic on personal and professional well-being has serious implications for retaining and expanding the nursing workforce. IMPLICATIONS FOR CLINICAL PRACTICE: This work highlights the importance for bedside nurses to advocate for systemic change to improve the work environment. It is imperative for nurses to have effective training including evidence-based practice and clinical skills. There needs to be systems in place to monitor and support nurses' mental health and encourage bedside nurses to use self-care methods and practices to prevent anxiety, depression, post-traumatic stress disorder and burnout.

Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid-19: A mixed-methods study.

BACKGROUND: The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses. AIM: To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic. DESIGN: This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021. METHODS: The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire. RESULTS: Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. CONCLUSIONS: The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses' professional functioning and their work life well-being.

Assessing readiness and effectiveness to learning with a smartphone application

Purpose: The purpose of this project is to improve and explore the modalities of how intensive care nurses at Northwest Medical Center access knowledge and information about infrequently used equipment through an educational smartphone application.Background: Annual in-person training on infrequently used equipment was limited for nursing staff because of COVID 19 pandemic. This limitation emphasized that online learning, with its schedule flexibility, is becoming a standard for education. Smartphone use has shown improvement with knowledge-based testing, allowing high level of flexibility with mobile and on-demand accessibility. Thus, development of an educational smartphone application for easier access to training materials for practicing nurses is recommended to expand and refresh knowledge.Methods: This project used descriptive quantitative design with surveys and pretesting/post testing to assess readiness and effectiveness of learning how to set-up, implement, manage, and maintain HotLine© blood warmer from smartphone application for intensive-care nurses. Pretest/posttest was evaluated with a paired t-test.Results: There were 40 intensive-care nurse participants, of which 38 completed data collection surveys. Of the participants, 36.11% responded asking co-workers for assistance and referring to policies/procedures is current process to set up and operate infrequently used devices. Half of participants showed indifference with current support or process to operate infrequently used equipment. Study participants also indicated there are barriers to learning. Most comfortable method of learning was 1:1 for 42.5% of participants. An overwhelming majority of participants, 91%, agreed they are likely or highly likely to use smartphone application as bedside resource on 10 readiness assessment. Pretest/posttest showed increased knowledge with smartphone intervention as the initial scores were 36.5% +/-2.34, and the post scores increased to 84.5% +/-2.87. The smartphone application showed a significant improvement of post scores after intervention (p < 0.0001).Conclusions: There was significant improvement in the knowledge of the intensive care nurse participants to operate the level 1 hotline blood warmer following the use of the educational smartphone application. Readiness assessment showed that an overwhelming majority of study participants would use the smartphone application as a bedside resource. These results confirmed that the smartphone application is a viable, accessible, and accepted educational training resource that increases knowledge. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Smart secretion management to protect nurses from COVID19 and other infectious diseases.

BACKGROUND: COVID-19 has been linked to over 40 million infections and 1.1 million deaths in 210 countries as of October 19, 2020. This highly contagious communicable disease has put not only infected individuals but other patients and frontline workers like nurses at risk in hospitals, especially in Intensive Care units (ICUs). There is a need for minimizing patient contact, improving hand hygiene practices, and optimizing healthcare provider time, especially nurses. Globally it is estimated that nearly a million health care providers have been infected with COVID-19 as of the end of October 2020. METHODS: This retrospective service evaluation documents the experience of health care providers in a COVID-19 ICU in India that was used to implement new protocols for secretion management and oral hygiene. Patient chart information and staff feedback were utilized. INTERVENTION: This pilot study captures the practical benefits of using VAPCare, an automated, closed-loop system for oral secretion removal. RESULTS: Six patients were included in this small-scale study; three patients following the current standard of care for suctioning and oral hygiene and three receiving the new VAPCare and Lumen device protocol. With the new device protocol, the number of infected secretion interactions by a nurse was 50% lower, and nursing time spent on oral hygiene and secretion management 70% less than seen with the current standard of care. The number of disposable gloves used with VAPCare and Lumen was reduced by over 50%. All 10 nurses and six doctors gave positive feedback on device usage. The department recommended updating protocols to prioritize the use of the new secretion management system for patients with COVID19 and other highly contagious conditions. CONCLUSION: The findings are an early indication that using VAPCare for patients could help protect infected patients, other ICU patients, and health care workers.