Use of technological equipment in critical care units: nurses' perceptions in Greece.

AIMS AND OBJECTIVES: The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants. BACKGROUND: Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole. DESIGN: Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions. METHODS: The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview. RESULTS: A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel. CONCLUSIONS: The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care. RELEVANCE TO CLINICAL PRACTICE: Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.

Nursing activities and use of time in the postanesthesia care unit.

Specialty areas, such as the PACU, are currently characterized by a shortage of qualified nursing personnel along with the pressure for a most cost-conscious function of services. These, in combination with both the increasing acuity of patients and the advances of science and technology, have rendered necessary the investigation of how existing personnel can be better used. The work sampling approach has been widely used in different clinical settings to offer data about the amount of time nurses devote to specific activities. The aim of the current study was to categorize and quantify the activities of nurses employed in the PACU of the General University Hospital of Patras, Greece, and to identify differences with regard to shifts, varying nurse-patient ratios, and nurses' experiences. In the first phase, a classification form, which included all nursing activities, was constructed. This was based on literature review, researchers' experience, and semistructured personnel interviews. In the second phase, the researchers observed all PACU nurses, and activities were recorded on an hourly check sheet. A total of 4,320 observations were collected from 9/1/2004 to 9/30/2004. Nurses spent 35.2% of their time on direct clinical care, 11.6% on patient assessment, 7.0% on communication with patients, 7.2% on communication with other persons, 8.6% on clerical nursing duties, 9.3% on documentation, 2.3% on non-nursing duties, and 18.8% on personal activities. Variations in the use of time were found between shifts, different nurse-patient ratios, and PACU experience. Methods of decreasing time when the nurse-patient ratio is inappropriate and increasing time allocated to direct care activities are proposed.

Effects of hypothermia and shivering on standard PACU monitoring of patients.

Inadvertent postoperative hypothermia is common among patients in the postanesthesia care unit (PACU). Shivering traditionally is attributed to hypothermia, but it is not always thermoregulatory. The exact impact of hypothermia and shivering on standard PACU monitoring parameters of patients has not been sufficiently studied. The present study included 170 orthopedic surgical patients. On PACU arrival, we recorded the incidence of hypothermia and shivering, as well as heart rate, mean arterial blood pressure, and oxygen saturation of all subjects. Analysis of covariance was used to investigate the effects of hypothermia and shivering on these monitoring parameters. Among orthopedic patients, 73.5% of them had hypothermia and 24.7% experienced shivering, which was observed primarily in hypothermic patients. Mean arterial blood pressure was significantly higher in hypothermic patients, and heart rate was significantly higher in shivering patients, whereas oxygen saturation was not affected by hypothermia or shivering. Our data confirm that standard PACU monitoring parameters are affected partially by hypothermia and shivering. A low incidence of shivering in normothermic patients and a high incidence of shivering in younger patients are discussed. Limitations of this study are reported.