BACKGROUND AND OBJECTIVE

Replicating critical care practice settings in high-fidelity simulation (HFS) provides more learning opportunities to develop competencies, improve self-confidence, and learner satisfaction in a safe environment. Simulation is increasingly adopted globally as an alternative teaching strategy. Yet, data on the HFS experience of Filipino undergraduate nursing students is limited. This study describes the satisfaction, self- confidence, and perception of undergraduate nursing students on the use of HFS-based learning on critically-ill adult and pediatric patients requiring advanced life support (ALS).

A quantitative, descriptive, correlational study was conducted using purposive sampling on all fourth-year BS Nursing students enrolled in Critical Care Nursing course in a state university. Data were collected through an online survey on demographic data, and the students’ perceptions towards high-fidelity simulation-based learning (SBL) using three tools, namely: Simulation Design Scale, Educational Practices Questionnaire, and Student Satisfaction and Self-confidence in Learning. T-test and ANOVA were used to compare the means of the variables. Bivariate analysis (Pearson’s product-moment correlation) was performed to find the relationship between variables.

A total of 86 students participated in the survey. Overall, the students were highly satisfied with the simulation experience (4.46 out of 5.0, SD=0.47), and had high ratings of self-confidence in SBL (4.44 out of 5.0, SD=0.42). Overall satisfaction level was positively related to student’s perception on simulation design (r=0.61, p<0.01) and educational practices (r=0.59, p<0.01). Similarly, the students’ overall self-confidence with SBL was also positively correlated with their perceptions of the simulation design (r=0.32, p<0.01), and educational practices (r=0.34, p<0.01).

Effective use of technology through HFS-based learning is useful in increasing satisfaction and self-confidence of Filipino undergraduate nursing students in caring for critically-ill patients needing ALS. Educators must highly consider all parameters of simulation design and educational practices in planning and implementing HFS- based learning to achieve meaningful learner experience.

care units (ICUs). Although it is recommended that empirical treatment regimens should be based on the local distribution of pathogens in patients with suspected hospital-acquired pneumonia, few studies observe patients admitted to ICUs with nursing home–acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER).METHODS: We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015–May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression.RESULTS: Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics–treated group than in the appropriate antibiotics–treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER.CONCLUSION: NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.]]>
Anti-Bacterial Agents ; Bacteria ; Cohort Studies ; Critical Care ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Multivariate Analysis ; Nursing ; Pneumonia ; Retrospective Studies ; Risk Factors

PURPOSE: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. METHODS: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. RESULTS: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. CONCLUSION: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs.
Critical Care ; Education ; Humans ; Intensive Care Units ; Methods ; Needs Assessment ; Nursing ; Terminal Care

PURPOSE: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model.METHODS: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24.RESULTS: In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium.CONCLUSION: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.
Critical Care ; Delirium ; Drainage ; Early Ambulation ; Electronic Health Records ; Emergency Service, Hospital ; Enteral Nutrition ; Hospital Mortality ; Humans ; Intensive Care Units ; Length of Stay ; Mass Screening ; Nursing ; Pressure Ulcer ; Prognosis ; Risk Factors ; Unconsciousness ; Ventilators, Mechanical ; Vital Signs

PURPOSE: The purpose of this study was to identify status and characteristics of patients who have been readmitted to ICU, and to analyze risk factors associated with the readmission to ICU within 48hours.METHODS: Data were collected from patient's electronic medical reports from one hospital in B city. Participants were 2,937 patients aged 18 years old or older admitted to the ICU. Data were analyzed using odd ratios (ORs) from multivariate logistic regressions.RESULTS: 2.2% of the 2,937 patients were early readmitted to ICU. Risk factors for early readmission to ICU were existence of respiratory disease, use of mechanical ventilator, and duration of hospitalization (longer).CONCLUSION: The assessment on the respiratory system of the patient who will be discharged from the ICU was identified as an important nursing activity. Therefore, the respiratory system management and education should be actively conducted. In addition, early ICU readmission may be prevented and decreased if a link was built to share the information on patient condition between the ICU and general wards.
Critical Care ; Education ; Hospitalization ; Humans ; Intensive Care Units ; Logistic Models ; Nursing ; Patient Readmission ; Patients' Rooms ; Respiratory System ; Risk Factors ; Ventilators, Mechanical

PURPOSE: This study was to determine the levels of environmental stressor, posttraumatic stress disorder, and quality of life in intensive care units (ICU) survivors after intensive care, and to explore the factors affecting posttraumatic stress disorder and quality of life.METHODS: With a longitudinal survey design, data were collected from 116 patients who were discharged from the ICU of a university hospital. The environmental stressor, posttraumatic stress disorder, and quality of life were measured immediately following and 1 month after the ICU discharge.RESULTS: Of all the subjects, 16.4% experienced posttraumatic stress disorder after discharge. Multiple regression analysis revealed that ICU environmental stressors, experience of ICU readmission, using psychotropic drugs and narcotic analgesics, and ICU admission after surgery or cardiac intervention accounted for 22.2% of posttraumatic stress disorder. Posttraumatic stress disorder and sedation status when entering ICU accounted for 28.3% of the quality of life 1 month after ICU discharge.CONCLUSION: Nursing interventions focused on ICU environmental stressors would not only reduce environmental stress but also contribute to the reduction of posttraumatic stress disorder and later improvement of quality of life.
Critical Care ; Humans ; Intensive Care Units ; Longitudinal Studies ; Narcotics ; Nursing ; Psychotropic Drugs ; Quality of Life ; Stress Disorders, Post-Traumatic ; Survivors

PURPOSE: The purpose of this study was to investigate the effect of the perceived nursing work environment (NWE) on person-centered critical care nursing (PCCN) practices among nurses in intensive care units (ICUs).METHODS: A cross-sectional research design was adopted for this study; participants were 126 ICU nurses working in five hospitals in B city. From December 2018 to February 2019, a survey questionnaire on NWE and PCCN were conducted. The collected data were analyzed with a multiple hierarchical regression analysis.RESULTS: The mean score for NWE was 2.98±0.39. Among the factors, basic work system was the highest (3.39±0.41), followed by leadership of the head nurse (3.31±0.55), interpersonal relationships (2.77±0.62), and institutional support (2.58±0.52). The mean score for PCCN was 3.52±0.46. Among the factors, comfort was the highest (3.77±0.62), followed by respect (3.55±0.56), compassion (3.43±0.60), and individuality (3.38±0.56). The interpersonal relationship (β =.31, p=.001) and the number of patients per shift (β =−.23, p=.005) had a significant effect on PCCN, accounting for 25.9% of the total variance.CONCLUSION: These results suggest that it is necessary to enhance the relationship-oriented culture and reduce the workload of nurses in order to improve the quality of nursing care in ICUs.
Critical Care Nursing ; Critical Care ; Empathy ; Humans ; Individuality ; Intensive Care Units ; Leadership ; Nursing ; Nursing Care ; Nursing, Supervisory ; Patient-Centered Care ; Research Design

PURPOSE: The purpose of this study was to identify factors influencing the professional self-concept of nurses working in intensive care units (ICUs).METHODS: Data were collected from July 1 to August 15, 2014. The subjects were 206 ICU nurses working in four university hospitals in B and U cities, Korea. Their professional self-concept was measured using Arthur's Scale revised by Yoon (2012), and professional quality of life (QOL) was measured using Pro QOL Korean Ver. 5 developed by Stamm (2010). Data were analyzed with SPSS Ver. 18, using a t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis.RESULTS: Professional self-concept was significantly correlated with compassion satisfaction (r=.61, p<.001), and burn out (r=−.57, p<.001). The factors influencing professional self-concept were compassion satisfaction (β=.46, p<.001), burn out (β=−.27, p<.001), and education level (β=.14, p=.014). The explanatory power of this model was 46.5%.CONCLUSION: The results suggest that the influencing factors found in this study should be considered when planning nursing intervention programs for improving the professional self-concept of ICU nurses.
Burns ; Critical Care ; Education ; Empathy ; Hospitals, University ; Intensive Care Units ; Korea ; Nursing ; Quality of Life ; Tertiary Care Centers

PURPOSE: This study aims to identify the relationship between person-centered critical care nursing (PCCN) and family satisfaction for intensive care unit (ICU) nurses.METHODS: This research used a cross-sectional survey. The participants were 142 nurses and 121 family members from 8 ICUs in 4 hospitals in B city. The questionnaire survey was conducted between December 2018 and March 2019. The eight ICUs were divided into those that scored high and those that scored low for person-centered care relative to the average score for PCCN, and the difference in family satisfaction between the ICUs with high and low scores was compared using t-test.RESULTS: The mean score of PCCN was 3.68±0.40 out of 5. In the subcategories of PCCN, “comfort”was the highest at 3.95±0.49, followed by “respect” at 3.73±0.57, “compassion” at 3.59±0.57, and “individuality” at 3.47±0.54. The average score of family satisfaction with the ICUs was 3.45±0.67 out of 5. In its subcategories, “emotion” was the highest at 3.69±0.72, followed by “information” at 3.61±0.75, “participation” at 3.30±0.79, and ”resources‘ at 3.20±0.80. The family satisfaction (3.75±0.54) with the ICU of the highest-scoring PCCN was significantly higher than the family satisfaction (3.25±0.53) with the ICU with the lowest-scoring PCCN (t=4.97, p<.001).CONCLUSION: The results suggest that the PCCN scores of ICU nurses should be promoted to improve family satisfaction. It is necessary to pursue a variety of ways to secure the provision of person-centered nursing practice in ICUs.
Critical Care Nursing ; Cross-Sectional Studies ; Humans ; Intensive Care Units ; Nursing ; Patient-Centered Care

PURPOSE: The purpose of this study was to investigate the influence of perceptions of death, end-of-life (EOL) care stress, and emotional intelligence on attitudes toward EOL care among nurses in the neonatal intensive care unit (NICU). METHODS: The participants were 111 nurses working in a NICU who had experienced EOL care at least once. Data were analyzed using the t-test, Pearson correlation coefficient, and stepwise multiple regression analysis in SPSS for Windows. RESULTS: The mean score for perceptions of death was 3.16 out of 5, the mean score for EOL care stress was 3.61 out of 5, the mean emotional intelligence score was 4.66 out of 7, and the average score for EOL care attitudes was 2.77 out of 4. The factors affecting attitudes towards EOL care were academic degree, anxiety regarding death, negativity towards death, experiences of patient death, and emotional intelligence. The explanatory power of these variables for attitudes towards EOL care was 24.7%. CONCLUSION: The results of this study are expected to serve as a basic reference for the development of nursing education programs and EOL care protocols to improve attitudes toward EOL care among NICU nurses.
Anxiety ; Critical Care ; Education, Nursing ; Emotional Intelligence* ; Humans ; Infant, Newborn ; Intensive Care, Neonatal* ; Terminal Care