Bullying and Its Prevention Among Intensive Care Nurses.

PURPOSE: International studies report that nurse bullying is a common occurrence. The intensive care unit (ICU) is known for its high stress levels, one factor thought to increase bullying. No studies were found that investigated bullying in this population. The purpose of this study was to describe the prevalence of ICU nurse bullying and what measures were taken to prevent bullying. DESIGN: This was a descriptive study of a convenience sample of 156 ICU nurses from five medical centers in Israel. Data collection was conducted over a 10-month period in 2012 and 2013. METHODS: After ethical approval, three questionnaires (background characteristics, Negative Acts Questionnaire-Revised, and Prevention of Bullying Questionnaire) were administered according to unit preference. Descriptive statistics were calculated for all responses and a Pearson product moment correlation was calculated to determine the relationship between bullying and its prevention. FINDINGS: Most of the nurses in the study were married, female staff nurses with a baccalaureate in nursing. No participant responded that they had been bullied daily, but 29% reported that they were a victim of bullying. The mean bullying score was 1.6 ± 1.4 out of 5. The mean prevention score was 2.4 ± 0.3 out of 4. Significant differences were found between hospitals on bullying, F (4,155) = 2.7, p = .039, and between hospitals, F (4,155) = 2.9, p = .026, and units, F (5,143) = 3.4, p = .006, on prevention. The Prevention Scale significantly correlated with the bullying scale (r = .58, p < .001). No other variables were found to be associated with either bullying or prevention scores. CONCLUSIONS: An alarming percentage of nurses were victims of bullying. Levels of bullying were low to moderate. Level of prevention was weak or moderate. The higher the level of bullying, the lower the level of prevention. The work environment as opposed to individual characteristics seems to have an impact on bullying and its prevention. CLINICAL RELEVANCE: More measures must be taken to prevent bullying. Nurses must be educated to accept only a zero tolerance to bullying and to report bullying when confronted by bullying.

The quality of intensive care unit nurse handover related to end of life: a descriptive comparative international study.

BACKGROUND: Quality ICU end-of-life-care has been found to be related to good communication. Handover is one form of communication that can be problematic due to lost or omitted information. A first step in improving care is to measure and describe it. OBJECTIVE: The objective of this study was to describe the quality of ICU nurse handover related to end-of-life care and to compare the practices of different ICUs in three different countries. DESIGN: This was a descriptive comparative study. SETTINGS: The study was conducted in seven ICUs in three countries: Australia (1 unit), Israel (3 units) and the UK (3 units). PARTICIPANTS: A convenience sample of 157 handovers was studied. METHODS: Handover quality was rated based on the ICU End-of-Life Handover tool, developed by the authors. RESULTS: The highest levels of handover quality were in the areas of goals of care and pain management while lowest levels were for legal issues (proxy and advanced directives) related to end of life. Significant differences were found between countries and units in the total handover score (country: F(2,154)=25.97, p=<.001; unit: F(6,150)=58.24, p=<.001), for the end of life subscale (country: F(2, 154)=28.23, p<.001; unit: F(6,150)=25.25, p=<.001), the family communication subscale (country: F(2,154)=15.04, p=<.001; unit: F(6,150)=27.38, p=<.001), the family needs subscale (F(2,154)=22.33, p=<.001; unit: F(6,150)=42.45, p=<.001) but only for units on the process subscale (F(6,150)=8.98, p=<.001. The total handover score was higher if the oncoming RN did not know the patient (F(1,155)=6.51, p=<.05), if the patient was expected to die during the shift (F(1,155)=89.67, p=<.01) and if the family were present (F(1,155)=25.81, p=<.01). CONCLUSIONS: Practices of end-of-life-handover communication vary greatly between units. However, room for improvement exists in all areas in all of the units studied. The total score was higher when quality of care might be deemed at greater risk (if the nurses did not know the patient or the patient was expected to die), indicating that nurses were exercising some form of discretionary decision making around handover communication; thus validating the measurement tool.

ICU nurses' oral-care practices and the current best evidence.

PURPOSE: The purpose of this study was to describe the oral-care practices of ICU nurses, to compare those practices with current evidence-based practice, and to determine if the use of evidence-based practice was associated with personal demographic or professional characteristics. DESIGN: A national survey of oral-care practices of ICU nurses was conducted using a convenience sample of 218 practicing ICU nurses in 2004-05. The survey instrument included questions about demographic and professional characteristics and a checklist of oral-care practices. Nurses rated their perceived level of priority concerning oral care on a scale from 0 to 100. A score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the current best evidence. This score was then statistically analyzed using ANOVA to determine differences of EBP based on demographic and professional characteristics. FINDINGS: The most commonly used equipment was gauze pads (84%), followed by tongue depressors (55%), and toothbrushes (34%). Chlorhexidine was the most common solution used (75%). Less than half (44%) reported brushing their patients' teeth. The majority performed an oral assessment before beginning oral care (71%); however, none could describe what assessment tool was used. Only 57% of nurses reported documenting their oral care. Nurses rated oral care of intubated patients with a priority of 67+/-27.1. Wide variations were noted within and between units in terms of which techniques, equipment, and solutions were used. No significant relationships were found between the use of an evidence-based protocol and demographic and professional characteristics or with the priority given to oral care. CONCLUSIONS: While nurses ranked oral care a high priority, many did not implement the latest evidence into their current practice. The level of research utilization was not related to personal or professional characteristics. Therefore attempts should be made to encourage all ICU nurses to introduce and use evidence-based, oral-care protocols. CLINICAL RELEVANCE: Practicing ICU nurses in this survey were often not adhering to the latest evidence-based practice and therefore need to be educated and encouraged to do so in order to improve patient care.