The presence of resilience is associated with a healthier psychological profile in intensive care unit (ICU) nurses: results of a national survey

ObjectiveICU nurses are repeatedly exposed to work related stresses resulting in the development of psychological disorders including posttraumatic stress disorder and burnout syndrome. Resilience is a learnable multidimensional characteristic enabling one to thrive in the face of adversity. In a national survey, we sought to determine whether resilience was associated with healthier psychological profiles in intensive care unit nurses.DesignSurveys were mailed to 3500 randomly selected ICU nurses across the United States and included: demographic questions, the Posttraumatic Diagnostic Scale, Hospital Anxiety and Depression Scale, Maslach Burnout Inventory and the Connor–Davidson Resilience Scale.Measurements and main resultsOverall, 1239 of the mailed surveys were returned for a response rate of 35%, and complete data was available on a total of 744 nurses. Twenty-two percent of the intensive care unit nurses were categorized as being highly resilient. The presence of high resilience in these nurses was significantly associated with a lower prevalence of posttraumatic stress disorder, symptoms of anxiety or depression, and burnout syndrome (<0.001 for all comparisons). In independent multivariable analyses adjusting for five potential confounding variables, the presence of resilience was independently associated with a lower prevalence of posttraumatic stress disorder (p < 0.001), and a lower prevalence of burnout syndrome (p < 0.001).ConclusionsThe presence of psychological resilience was independently associated with a lower prevalence of posttraumatic stress disorder and burnout syndrome in intensive care unit nurses. Future research is needed to better understand coping mechanisms employed by highly resilient nurses and how they maintain a healthier psychological profile.     

Association of Persistent Intense Thirst With Delirium Among Critically Ill Patients: A Cross-sectional Study

ContextThirst is a prevalent distressing symptom often reported by patients in the intensive care unit (ICU). Little is known about the association of thirst with delirium.ObjectiveWe aimed to investigate the relationship between thirst and delirium.MethodsThis retrospective cross-sectional study enrolled 401 patients who were evaluated for thirst intensity in the ICU between March 2017 and October 2017. We assessed thirst intensity on a scale of 0–10 (with 10 being the worst) and defined intense thirst as a score ≥8. If intense thirst persisted for more than 24 hours, we defined it as persistent intense thirst. Delirium was screened using the Intensive Care Delirium Screening Checklist. Propensity score matching and inverse probability of treatment weighting analyses were performed.ResultsOf 401 patients, 66 (16.5%) had intense thirst sensation for more than 24 hours. After matching, patients with persistent intense thirst showed an increased risk for delirium compared with those without persistent intense thirst (odds ratio, 4.95; 95% confidence interval, 2.58–9.48; P < 0.001). Propensity score weighted logistic regression analysis also indicated that persistent intense thirst was significantly associated with delirium (odds ratio, 5.74; 95% confidence interval, 2.53–12.99; P < 0.001).ConclusionIntense thirst persisting for more than 24 hours was associated with increased risk for delirium.     

The effect of nonpharmacological training on delirium identification and intervention strategies of intensive care nurses

ObjectiveThis study aims to investigate the effect of nonpharmacological intervention training on delirium recognition and the intervention strategies of intensive care (ICU) nurses.MethodThis is a quasi-experimental study conducted using a pretest–posttest design. The study sample included a total of 95 patients staying in the medical ICU of a university hospital and 19 nurses working in these units. The data were collected using the Patient and Nurse Introduction, Confusion Assessment Method for the ICU, and Delirium Risk Factors, and Non-pharmacological Interventions in Delirium Prevention Forms.ResultsDelirium was identified in 26.5% and 20.9% of the patients in the pre- and posttraining phase, respectively. Patients with delirium had a longer duration of stay in the ICU, lower mean Glasgow Coma Scale score and a higher number of medications in daily treatment (p < 0.05). The risk of delirium increased 8.5-fold by physical restriction and 3.4-fold by the presence of hypo/hypernatremia. The delirium recognition rate of nurses increased from 7.7% to 33.3% in the post-training phase.ConclusionOur study results show that training can increase the efficiency of ICU nurses in the management of delirium.     

A cross-sectional study of clinical emergency department nurses’ occupational stress,job involvement and team resilience

IntroductionThe occupational stress of clinical nurses has drawn increasing attention. It has been proven that occupational stress is related to job involvement, and job involvement affects team resilience. However, research on the relationship between emergency nurses’ occupational stress, job involvement and team resilience is lacking.AimTo explore relationships between occupational stress, job involvement, and team resilience among a sample of emergency nurses and determined significant influencing factors of occupational stress in emergency departments.MethodsIn four hospitals in Shandong, China, 187 emergency room nurses participated in a study. The Utrecht Work Engagement Scale, the Chinese version of the Stressors Scale for Emergency Nurses, and a scale for evaluating the team resilience of medical professionals were used to collect data.ResultsThe overall occupational stress score of nurses working in the emergency departments in Shandong province was 81.07 ± 25.80. The results of Single-factor analysis demonstrated that the scores indicating the occupational stress for emergency nurses differed significantly with respect to age, education level, marital status, children, professional title, work experience and work shift (P < 0.05). Additionally, there is a negative correlation between job involvement and team resilience and occupational stress. Multiple linear regression results showed that the job involvement, team resilience and work shift were statistically significant influencing factors of the level of occupational stress (change R² = 17.5 %, F = 5.386, P < 0.001).ConclusionsStronger team resilience and more active job involvement resulted in lower occupational stress levels experienced by emergency nurses.     

Factors associated with stress of conscience in caring for older people with delirium in a hospital setting: An exploratory cross-sectional study

BackgroundNurses caring for older people with delirium encounter moral challenges in hospitals which could trouble their conscience, if they perceive limitations that prevent them from fulfilling their duties. Little is known about the stress associated with troubled conscience, that is stress of conscience, beyond nursing homes.AimTo explore factors associated with stress of conscience among nurses caring for older people with delirium in a hospital setting.MethodAn exploratory cross-sectional study was conducted. A total of 223 nurses completed the questionnaire at a tertiary hospital in Australia.FindingsThe stress of conscience mean sample score, comparable to previous studies, was 63.6. Younger age, more years of nursing experience, lower levels of perceived person centeredness were associated with higher stress of conscience (p < 0.001). The regression model explained 24% of the total variation in Stress of Conscience (R² = 0.24: F = 13.874: p < 0.001).DiscussionThe levels of stress of conscience (mean score of 63.6) in this study were comparable to studies of nurses caring for older people with cognitive impairment in nursing homes. Younger age and longer working experience correlated with higher levels of stress of conscience, consistent with previous research. The novel contribution was that higher perceived levels of person centeredness could mitigate nurses stress of conscience.ConclusionHigher levels of person-centredness which positively correlated with less stress of conscience in the hospital setting, provide a foundation to explore barriers and facilitators to support quality care and staff health. Further studies would be valuable as the regression model accounted for 24% of the total variance in stress of conscience.     

Self-efficacy of caring for patients in the intensive care unit with delirium: Development and validation of a scale for intensive care unit nurses

BackgroundImproving the self-efficacy of intensive care unit nurses for delirium care could help them adapt to the changing situation of delirium patients. Validated measures of nurses' self-efficacy of delirium care are lackingObjectivesThe objective of this study was to develop a Delirium Care Self-Efficacy Scale for assessing nurses' confidence about caring for patients in the intensive care unit and to examine the scale's psychometric properties.MethodsDraft scale items were generated from a review of relevant literature and face-to-face interviews with intensive care unit nurses; content validity was conducted with a panel of five experts in delirium. A group of nurses were recruited by convenience sampling from intensive care units (N = 299) for item analysis of the questionnaire, assessment of validity, and reliability of the scale. Nurse participants were recruited from nine adult critical care units affiliated with a hospital in Taiwan. Data were collected from August 2020 to July 2021.ResultsContent validity index was 0.98 for the initial 26 items, indicating good validity. The critical ratio for item discrimination was 14.47–19.29, and item-to-total correlations ranged from 0.67 to 0.81. Principal component analysis reduced items to 13 and extracted two factors, confidence in delirium assessment and confidence in delirium management, which explained 66.82% of the total variance. Cronbach's alpha for internal consistency was 0.94 with good test–retest reliability (r = 0.92). High scale scores among participants were significantly associated with age (≥40 years), work experience in an intensive care unit (≥10 years), delirium education, and willingness to use delirium assessment tools.ConclusionsThe newly developed Delirium Care Self-Efficacy Scale demonstrated acceptable reliability and validity as a measure of confidence for intensive care nurses caring for and managing patients with delirium in the intensive care unit.     

Association between delirium prediction scores and days spent with delirium

PurposeTo determine the correlation and discriminative value of the E-PRE-DELIRIC and PRE-DELIRIC scores with delirium exposure to evaluate the prognostic value of both models.MethodsA secondary analysis of a randomized clinical trial enrolling 1506 delirium-free, critically ill adults with an anticipated ICU stay of ≥2 days. Days spent with delirium (≥1 positive CAM-ICU) or coma (≥1 RASS ≤−4) in the 28-days after ICU admission were calculated. Patients were categorized into four groups: no delirium, short-exposure (1 delirium day), moderate-exposure (2–5 delirium days), and long- exposure (≥6 delirium days) to determine the correlation and discriminative value of the E-PRE-DELIRIC and the PRE-DELIRIC with days spent with delirium.ResultsThe correlation between the overall E-PRE-DELIRIC and PRE-DELIRIC scores and days spent with delirium were: R = 0.08 (P = .005) and R = 0.26 (P < .001), respectively. The correlation between both prediction scores and days spent with coma or delirium were R = 0.21 (P < .0001) and R = 0.46 (P < .0001), respectively. The highest Area Under the Receiver Operating Characteristic for both E-PRE-DELIRIC [0.57 (95% CI:0.51–0.62)] and PRE-DELIRIC [0.58 (95% CI:0.53–0.62)] was found in the long delirium exposure group.ConclusionThe E-PRE-DELIRIC and PRE-DELIRIC model each poorly correlate and discriminate with days spent with delirium in the 28 days after ICU admission.     

Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals

AimTo examine the previously untested relationship between the level of compassion fatigue (CF) in critical care nurses and the rates of three nurse-sensitive indicators in four critical care units in hospitals in Saudi Arabia.BackgroundCF can manifest in nurses who provide direct, intimate care to patients with different levels of illness including nurses working in specialty areas such as critical care where they care for patients experiencing challenging illnesses. Pressure injuries, patient falls, and medication errors are key nurse-sensitive indicators that identify critical care nurses as the primary causal agent. These indicators also correlate with burnout and poor multidisciplinary team communication, both factors that govern CF.MethodsA multisite survey was conducted to collate and examine the number of reported pressure injuries, falls, and medication errors over 3 months at four hospitals in two Saudi Arabian cities during 2018 to determine the relationship between the occurrence of these nurse-sensitive indicators and the level of CF in critical care (intensive care unit [ICU]) nurses. A survey of 516 critical care nurses was undertaken; analysis was performed using the Professional Quality of Life Scale, version 5 (ProQol-5), and results were further analysed using Pearson's correlations and three-way analysis of variance.ResultsThe results of the regression analysis indicated resilience as a predictor explained 66% of the compassion satisfaction (CS) variance (B = 0.318, R² = 0.436, F_{(2, 12.495)} = 123.013, p < 0.001) and 26% of the burnout (BO) variance (B = 0.152, R² = 0.067, F_{(2, 11.500)} = 3.279, p < 0.001). In addition, the level of resilience as a predictor explained 15.4% of the secondary traumatic stress (STS) variance (B = 0.063, R² = 0.024, F_{(2, 7.758)} = 2.785, p = 0.006). Conversely, coping strategies did not predict CS, BO, or STS (p > 0.05) at a statistically significant level. The concurrent measure of CF, BO, and STS found that almost 20% of the critical care nurse participants reported having very low CS, indicating increased potential for the development of CF. In addition, male nurses reported experiencing higher levels of stress and BO than female nurses. This study also found that neither the number of patients being treated nor the number of beds in the care setting affected the rate of the nominated nurse-sensitive indicators. The results for rates of pressure injuries did vary among the hospitals, with the worst performing hospital reporting pressure injury rates of one in every 40 patients and the better performing hospital reporting no cases of pressure injuries after treating more than 100 patients. Patient falls and medication errors were rare occurrences and did not vary between hospitals.SignificanceThis study indicates that there is a possible issue contributing to the differential level of care between hospitals. The mode and length of time nurses spend on handover may also reflect communication issues that increase both the rate of nurse-sensitive indicators and the level of CF reported by nurses. Therefore, the implications of this study, in terms of improving nursing practice, occurs in handover to ensure that information on aspects of nonpatient critical care are fully covered, such as time of patient turning to avoid pressure injuries.     

The association of gratitude with perceived stress among nurses in Korea during COVID-19 outbreak

BackgroundDuring the COVID-19 pandemic, nurses might experience added emotional stress. This study examined the relationship between gratitude and psychological stress to explore effective psychological support among nurses.MethodsA cross-sectional survey assessed the level of psychological distress in 646 nurses in Gwangju, South Korea, using the Perceived Stress Scale-10 (PSS-10), Gratitude Questionnaire-6 (K-GQ-6), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Maslach Burnout Inventory-General Survey (MBI-GS). Sociodemographic factors and COVID-19-related experiences were also examined. A linear regression model was used to determine the factors influencing perceived stress.ResultsThe mean PSS-10 score was 19.0 ± 4.4. Linear regression analyses revealed that the MBI-GS-Exhaustion, PHQ-9, and GAD-7 scores were positively associated with perceived stress, while the MBI-GS-Professional efficacy score was inversely associated with perceived stress. Gratitude disposition using the K-GQ-6 score negatively predicted PSS-10 (β = 0.829, p < 0.001).ConclusionsPsychological interventions that help cultivate gratitude and professional efficacy among nurses can help promote stress resilience throughout the course of the COVID-19 pandemic.     

The relationship between secondary traumatic stress and burnout in critical care nurses: The mediating effect of resilience

PurposeTo examine the mediating factor on the association of secondary traumatic stress and burnout among critical care nurses.DesignA correlational study.MethodsData were collected from a convenience sampling of 147 nurses from two general hospitals who had six or more months of experience working in an intensive care unit. The collected data were analyzed through t-test, ANOVA, Scheffé test, Mann-Whitney test, Kruskal-Wallis test, Bonferroni correction, and Pearson’s correlation coefficient using SPSS 25.0. The mediating effect of resilience was analyzed through the three-stage mediation effect test procedure using hierarchical regression analysis and the Sobel test.ResultsSecondary traumatic stress had a statistically significant positive correlation with burnout (r = 0.45, p <.001), and a statistically significant negative correlation between burnout and resilience (r = −0.54, p <.001) was observed. Secondary traumatic stress was found to have a statistically significant effect on resilience, which was the mediating variable (β = −0.17, p =.042). Additionally, secondary traumatic stress had a statistically significant effect on burnout (β = 0.45, p <.001). The significance of the mediating effect of resilience on the relationship between secondary traumatic stress and burnout was investigated using the Sobel test, and the mediating effect of resilience was found to be statistically significant (Z = 1.98, p =.048).ConclusionResilience was found to have a partial mediating effect in the relationship between critical care nurses’ secondary traumatic stress and burnout. The study thus provides basic data on the importance of resilience in preventing burnout from secondary traumatic stress.     

Delirium prevalence and prevention in patients with acute brain injury: A prospective before-and-after intervention study

ObjectivesKnowledge regarding delirium prevention in patients with acute brain injury remains limited. We tested the hypothesis that an intervention bundle which targeted sedation, sleep, pain, and mobilisation would reduce delirium in patients with acute brain injury.DesignA prospective before-after intervention study: a five-month phase of standard care was followed by a six-month intervention phase.SettingThe neuro-intensive care unit, University Hospital of Copenhagen, Denmark.Main outcome measuresThe Intensive Care Delirium Screening Checklist was used to detect delirium. Primary outcome was delirium duration; secondary outcomes were delirium prevalence, ICU length of stay and one year mortality.ResultsForty-four patients were included during the standard care phase, and 50 during the intervention phase. Delirium was present in 90% of patients in the standard care group and 88% in the intervention group (p = 1.0), and time with delirium was 4 days vs 3.5 days (p = 0.26), respectively. Also, ICU length of stay (13 vs. 10.5 days (p = 0.4)) and the one year mortality (21% vs 12% (p = 0.38))) were similar between groups.ConclusionWe found a high prevalence of delirium in patients with acute brain injury. The intervention bundle did not significantly reduce prevalence or duration of delirium, ICU length of stay or one year mortality.     

Deep Natural Language Processing Identifies Variation in Care Preference Documentation

ContextDocumentation of care preferences within 48 hours of admission to an intensive care unit (ICU) is a National Quality Forum-endorsed quality metric for older adults. Care preferences are poorly captured by administrative data.ObjectivesUsing deep natural language processing, our aim was to determine the rate of care preference documentation in free-text notes and to assess associated patient factors.MethodsRetrospective review of notes by clinicians using a deep natural language processing to identify care preference documentation, including goals-of-care and treatment limitations, within 48 hours of ICU admission within five ICUs (medical, cardiac, surgery, trauma surgery, and cardiac surgery) for adults 75 years and older. Covariates included demographics, ICU type, sequential organ failure assessment score, and need for mechanical ventilation.ResultsDeep natural language processing reviewed 11,575 clinician notes for 1350 ICU admissions. Median patient age was 84.0 years (interquartile range 78.0–88.4). Overall, 64.7% had documentation of care preferences. Patients with documentation were older (85 vs. 83 years; P < 0.001) and more often female (53.8% vs. 43.4%; P < 0.001). In adjusted analysis, rates of care preference documentation were higher for older patients, females, nonelective admissions, and admissions to the medical vs. the cardiac or surgical ICUs (all P ≤ 0.01).ConclusionCare preference documentation within 48 hours was absent in more than one-third of ICU admissions among patients aged 75 years and older and was more likely to occur in medical vs. cardiac or surgical ICUs.     

Development of a scale measuring the difficulties faced by nurses who care for patients with delirium in intensive care units

BackgroundDelirium in patients in the intensive care unit is associated with adverse outcomes. Nurses experience many difficulties in caring for those with delirium, which can lead to nurse burnout, prevent effective care for patients, and negatively impact the patient. The identification of factors creating challenges for nurses is, therefore, important to enable intervention.ObjectivesThe aim of this study was to develop a new scale to assess the difficulties faced by nurses caring for patients with delirium in the intensive care unit and to examine its reliability and validity.MethodsWe based our draft scale items on literature reviews and interviews. Four experts evaluated the collected items. After a pilot study, 211 nurses working in intensive care units in Japan completed the questionnaire. Subsequent statistical analysis of results included factor validity, construct validity, known-group validity, internal consistency, and test–retest reliability.ResultsExploratory factor analysis extracted a scale of 33 items with eight factors and an additional scale of four items with one factor. The analysis of construct validity suggested a possible association with the Strain of Care for Delirium Index. In the known-group validity, a comparison with two groups based on experience in the intensive care unit found significant differences among the five factors. Internal consistency (Cronbach's α = 0.68–.87) and test–retest reliability (intraclass correlation coefficients = .46–.62) were confirmed.ConclusionWe developed a difficulty scale for nurses caring for patients with delirium in the intensive care unit and confirmed its reliability and validity. The difficulty factors were developed with the intention to identify educational interventions for nurses and the introduction of new organisational resources, such as manpower and providing emotional support and feedback to nurses.     

A research regarding the relationship among intensive care nurses' self-esteem,job satisfaction and subjective well-being

ObjectiveThe paper aims to explore the status of intensive care unit (ICU) nurses' self-esteem, job satisfaction, and subjective well-being and to investigate the relationship among the three elements.MethodsA cross-sectional survey of 224 nurses from five teaching hospitals in Tianjin, China, was conducted. Self-esteem scale, job satisfaction scale, and subjective well-being scale were used to explore the status of ICU nurses' self-esteem, job satisfaction, and subjective well-being. Correlation among the three elements was calculated by SPSS 17.0.ResultsThe scores of three scales (i.e., ICU nurses' self-esteem, job satisfaction, and subjective well-being) were 27.67 ± 3.41, 43.57 ± 9.04, and 69.73 ± 11.60, respectively. The subjective well-being was significantly positively correlated with self-esteem and job satisfaction (r = 0.454, P < 0.01; r = 0.584, P < 0.01, respectively).ConclusionThe study shows that the prevalence of subjective well-being and self-esteem with ICU nurses are at a low level, and job satisfaction is at the median level. Associations among self-esteem, job satisfaction, and subjective well-being in ICUs have been confirmed. Self-esteem and job satisfaction positively correlated with nurse subjective well-being. The higher the self-esteem and job satisfaction levels are, the stronger the subjective well-being is. The working pressure in ICUs cannot be alleviated temporarily; hence, to promote a high subjective well-being, managers and ICU nurses increase their self-esteem and job satisfaction through taking strategies that strengthen psychological construction.     

Nurses’ knowledge and perception of delirium screening and assessment in the intensive care unit: Long-term effectiveness of an education-based knowledge translation intervention

ObjectivesTo determine the impact of education on nurses’ knowledge of delirium, knowledge and perception of a validated screening tool, and delirium screening in the ICU.MethodsA quasi-experimental single group pretest-post-test design.SettingA 16 bed ICU in a Canadian urban tertiary care centre.Main outcome measuresNursing knowledge and perception were measured at baseline, 3-month and 18-month periods. Delirium screening was then assessed over 24-months.ResultsDuring the study period, 197 surveys were returned; 84 at baseline, 53 at 3-months post education, and 60 at the final assessment period 18-months post intervention. The significant improvements in mean knowledge scores at 3-months post intervention (7.2, SD 1.3) were not maintained at 18-months (5.3, SD 1.1). Screening tool perception scores remained unchanged. Improvements in the perception of utility were significant at both time periods (p = 0.03, 0.02 respectively). Physician value significantly improved at 18-months (p = 0.01). Delirium screening frequency improved after education (p < 0.001) demonstrating a positive correlation over time (p < 0.01).ConclusionMultifaceted education is effective in improving delirium knowledge and screening; however, without sustained effort, progress is transient. Education improved perceived tool utility and over time utility perception and physician value improved.