Critical care nursing role in low and lower middle-income settings: a scoping review.

OBJECTIVES: A scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)? DESIGN: Scoping review guided by the JBI Manual for Evidence Synthesis. DATA SOURCES: Six electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021. REVIEW METHODS: The search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country. RESULTS: Literature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives. CONCLUSIONS: Despite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

ICU nurse preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role: A mixed-methods study.

This paper explores Intensive Care nurses' perceptions of benefits, rewards, supports and their commitment to the role of preceptor. A questionnaire, consisting of Likert-scales and open-ended questions was used to collect data during October 2018. Preceptors were committed to their role. Correlations were found between preceptors' perceptions of benefits or rewards and commitment to the role (p = 0.003, r2 = 0.39) and perceptions of support and commitment to the role (p = .001, r2 = 0.46). Altruistic benefits were perceived to be of the greatest importance. Participants who recognised the importance of preceptorship for the organisation were more likely to be committed to the role. Eighty-three percent of respondents reported a lack of consistency in allocation to work with their preceptee. Qualitative results elucidated themes of helping, personal professional development, the opportunity to teach, and organisational improvement. Supports as barriers and enablers to successful preceptorship were discussed in terms of peer and leadership support, role preparation, the logistics of the environment, role conflict, and consistency of allocation to work in a preceptorship dyad. Commitment to the preceptor role may be increased by highlighting organisational benefits of preceptorship, increasing consistency of contact between preceptorship dyads, and increasing access to supports and preparation.