Alarm fatigue and moral distress in ICU nurses in COVID-19 pandemic.

INTRODUCTION: Most ICU nurses feel overwhelmed by the variety of alarms at the same time. Therefore, nurses experience very stressful situations in relation to many responsibilities and care demands. This stressful condition has recently been exacerbated by COVID-19 and potentially endangers patient safety. The aim of this study was to investigate the alarm fatigue and moral distress of ICU nurses in COVID-19 crisis. METHOD: This is a descriptive-analytical cross-sectional study (April-May 2021). Sampling was done by convenience among ICU nurses affiliated to Isfahan University of Medical Sciences, Iran. Data were collected using Nurses' alarm fatigue and the moral distress scale (MDS). Data were analyzed using ANOVA, independent t-test and multivariate logistic regression. RESULT: The results showed that the mean score of alarm fatigue was moderate)19.08 ± 6.26 (and moral distress was low (33.80 ± 11.60). The results showed that there was a significant relationship between alarm fatigue and related training courses)P = .012(.So that, alarm fatigue in nurses who were trained in working with ventilators and alarm settings was significantly less than other nurses. Also, a significant relationship was found between moral distress and marital status(P = .001) and Shift type(P = .01). On the other hand, the risk of alarm fatigue was higher in participants who have a PhD. The results showed that no significant correlation was found between alarm fatigue and moral distress (r = 0.111, P = 0.195). CONCLUSION: It is suggested that practical training courses on alarm management be included in the curriculum and the ICU nurses should have practical training before starting work in the ICU and on an annual basis. In order to protect nurses and ensure quality care of patients, nurse managers should reduce the number of rotating shifts of ICU nurses.

Psychometric Properties of Nursing Manager Communication Competency Questionnaire (CCCQ): An Instrument Design Study.

Introduction: One of the most important factors that can enhance the efficiency and success of hospitals for achieving the objectives is the communication competency of nursing managers. Due to the lack of a local questionnaire to measure the communication competency of nursing managers, the present study has been conducted aimed to design and validate the Nursing Manager Communication Competency Questionnaire (NMCCQ). Method: First, after designing the questionnaire (production of primary items), based on the definition of the results of the study, the analysis of Schwartz, Barcott, and Kim's hybrid concept was performed and then it was evaluated. According to the definitions of the results of Schwartz, Barcott, and Kim's Hybrid concept analysis study, the questionnaire was designed and then it has been assessed psychometrically. Face validity with the opinion of 15 participants and content validity have been assessed using the opinion of 15 experts. Construct validity has been assessed by 300 nurses via completing the questionnaire using factor analysis. Results: First, a questionnaire with 83 items of qualitative data was made. After confirming content validity, the number of items reduced to 62 items. Exploratory factor analysis included five constructs of non-verbal communication skill, negotiation, reporting, communication ethics, and the application of communication knowledge, which consisted of 56 items that together accounted for 61.410% of the observed variance. Cronbach's alpha coefficient for constructs ranged from 0.862 to 0.987 and the intra-class correlation coefficient (ICC) ranged from 0.969 to 0.994. Conclusion: The results showed that nursing managers' communication competency questionnaire is a valid and reliable scale that can help managers select, assess, and appoint nursing managers. As a result, this tool can be used in future studies.

The effect of open and closed endotracheal tube suctioning system on respiratory parameters of infants undergoing mechanical ventilation.

AIMS: Mechanical ventilation is used for some infants in neonatal intensive care units (NICU) due to many physiological and clinical causes. Since these patients have endotracheal tubes, cleaning and keeping the airways open through suctioning should be done to increase oxygenation. This study aimed to evaluate effect of open and closed suctioning methods on respiratory parameters of infants undergoing mechanical ventilation. MATERIALS AND METHODS: In this crossover clinical trial, 44 infants were selected among those undergone mechanical ventilation in NICU of Isfahan's Al-Zahra Hospital using convenience sampling method. The subjects were randomly divided into two groups. In the first group, open suctioning was carried out and after three hours of cleaning, closed suctioning was done. In the second group, closed suctioning was firstly done and following three hours of cleaning, open suctioning was implemented. Respiratory rate (RR) and percentage of arterial blood oxygen saturation was measured before, during and after each type of suctioning. Data were analyzed using repeated measures ANOVA and independent student's t-test. FINDINGS: There was a significant difference between mean respiratory rate and arterial blood oxygen saturation in infants before, during and after the closed and open suctioning. The percentage of arterial blood oxygen saturation had a significant reduction in open method compared to closed method during suctioning and immediately after it. RR three minutes after suctioning showed a significant reduction in both steps in open method compared to closed method. CONCLUSIONS: Close method caused fewer changes in hemodynamic status of infants. Therefore, in order to prevent respiratory complications in infants, nurses are recommended to perform the endotracheal tube suctioning by closed method.