Triggers have been developed internationally to identify intensive care patients with palliative care needs. Due to their work, nurses are close to the patient and their perspective should therefore be included. In this study, potential triggers were first identified and then a questionnaire was developed to analyse their acceptance among German intensive care nurses.
For the qualitative part of this mixed methods study, focus groups were conducted with intensive care nurses from different disciplines (surgery, neurosurgery, internal medicine), which were selected by convenience. Data were analysed using the \"content-structuring content analysis\" according to Kuckartz. For the quantitative study part, the thus identified triggers formed the basis for questionnaire items. The questionnaire was tested for comprehensibility in cognitive pretests and for feasibility in a pilot survey.
In the qualitative part six focus groups were conducted at four university hospitals. From the data four main categories (prognosis, interprofessional cooperation, relatives, patients) with three to 15 subcategories each could be identified. The nurses described situations requiring palliative care consults that related to the severity of the disease, the therapeutic course, communication within the team and between team and patient/relatives, and typical characteristics of patients and relatives. In addition, a professional conflict between nurses and physicians emerged. The questionnaire, which was developed after six cognitive interviews, consists of 32 items plus one open question. The pilot had a response rate of 76.7% (23/30), whereby 30 triggers were accepted with an agreement of ≥ 50%.
Intensive care nurses see various triggers, with interprofessional collaboration and the patient\'s prognosis playing a major role. The questionnaire can be used for further surveys, e.g. interprofessional triggers could be developed.

OBJECTIVE: To explore intensive care nurses\' (ICN) perceptions of simulation-based learning (SBL).
METHODS: A systematic review and meta-synthesis.
METHODS: The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark\'s thematic analysis approach. Quality appraisal was assessed using the CASP tool.
RESULTS: Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration.
CONCLUSIONS: The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN\'s education.
CONCLUSIONS: These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting.
UNASSIGNED: This review involved analysis of existing literature and as such no unique patient or public involvement occurred.
UNASSIGNED: The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.

No previous study has examined the direct effect of occupational fatigue, inter-shift recovery and compassion competence on caring behaviours, including assurance, knowledge-skill, respect and commitment in intensive care nurses.
We studied the direct effect of participating nurses\' occupational fatigue, inter-shift recovery and compassion competence levels on their caring behaviours and the relationship among these variables.
This was a descriptive correlational study. All nurses who were registered members of the Turkish Intensive Care Nurses Association were invited to participate in this online survey. This study was conducted with 315 intensive care nurses using convenience sampling between April and July 2022. The data were collected using the Occupational Fatigue Exhaustion/Recovery Scale, which consists of three subscales: acute fatigue, chronic fatigue and inter-shift recovery; the Compassion Competence Scale, including communication, sensitivity and insight subscales; and the Caring Behaviours Inventory-24. In addition, a structural equation model was established using variables correlating with caring behaviours. Independent variables were occupational fatigue, inter-ship recovery and compassion competence; and the dependent variable was caring behaviours in this hypothesized model.
Three hundred and fifteen nurses completed the survey (315/1000) with a response rate of 31.5%. The increase in the inter-shift recovery levels of participants was statistically and positively associated with caring behaviours (95% confidence interval [CI]: 0.001-0.011, β = .154 [moderate effect size], p < .05). The sub-dimensions of the Compassion Competence Scale, that is, communication (95% CI: 0.110-0.443, β = .251 [moderate effect size]) and sensitivity (95% CI: 0.084-0.427, β = .241 [moderate effect size]), were statistically and positively associated with the caring behaviours of participants (p < .05). In addition, independent variables accounted for 35% (large effect size) of the total change in caring behaviours (R2 = 0.350).
This study suggests that the high inter-shift recovery and compassion competence levels of intensive care nurses are positively associated with their caring behaviours.
Nursing managers should consider the direct effect of occupational fatigue, inter-shift recovery and the compassion competence levels of intensive care nurses on their caring behaviours to provide high-quality care.

UNASSIGNED: Medical devices and equipment are necessary for accurate and continuous monitoring of the patients admitted to intensive care units, one of which is alarm systems. Frequent sounds of alarms can affect nurses\' concentration and accuracy when providing care. Complications such as headache, fatigue, and stress occur after repeated alarms, leading to poor quality of professional life among nurses. This study aimed to determine the relationship between quality of professional life and alarm fatigue syndrome among intensive care unit nurses.
UNASSIGNED: This cross-sectional study used convenience sampling to select nurses working in intensive care units from three hospitals in southern Iran in 2021 (n = 201). Data were collected using three questionnaires, including sociodemographic form, the professional quality of life questionnaire (ProQOL), and the alarm fatigue symptom (AFS) scale.
UNASSIGNED: The mean scores of compassion satisfaction (CS), burnout, secondary traumatic stress (STS) (subscales of the ProQOL), and AFS were 34.66 ± 7.54, 28.98 ± 7.59, 27.69 ± 5.87, and 13.48 ± 7.32, respectively. The majority of them had no or mild AFS, moderate CS, burnout, and STS. Among the study variables, only AFS were a significant predictor of CS and STS among ICU nurses. In addition, work experience in ICU, AFS, and a second job were significant predictors of burnout among ICU nurses.
UNASSIGNED: The study results showed a significant relationship between alarm fatigue syndrome, burnout, STS, and CS. Given that more than half of the nurses in the intensive care unit in the present study experienced some degree of alarm fatigue syndrome, it is necessary to plan and implement interventions to better manage the alarms in the intensive care unit.

Intensive care units (ICUs) have been overwhelmed by the increasing number of coronavirus disease 2019 (COVID-19) cases, causing psychological burdens, stress, and various types of conflict among nurses.
To examine the occurrence, type, and intensity of conflict and preferred management styles among ICU nurses during the COVID-19 pandemic.
This cross-sectional descriptive study was conducted in a government hospital in Saudi Arabia using a convenience sample of 95 nurses from three ICUs. Data were collected using an e-questionnaire comprising the Nursing Conflict Scale, Rahim Organizational Conflict Inventory-II, and sociodemographic variables.
Most participants reported exposure to moderately (64.2%) or highly (34.79%) intense conflict during the pandemic. The competitive (2.23 ± .472) and intragroup (2.23 ± .385) types of conflict were the most frequently reported. The preferred conflict management style was collaborating (21.85 ± 5.49), followed by accommodating (18.39 ± 4.03). Pearson\'s correlation analysis showed that age, years of experience, and education were significantly associated with conflict type and management style. Preparedness to care for suspected or confirmed COVID-19 cases was associated with interpersonal conflict (r = .20, p = .04).
The participants experienced moderate- to high-intensity conflict; however, they employed constructive rather than destructive management styles.
Nurse leaders, policymakers, and educators must initiate transformational intervention programmes to enhance and sustain nurses\' competencies in constructive conflict management strategies. Interpersonal communication and crisis management training programmes should be formulated to raise nurses\' awareness and enhance their competencies vis-à-vis taking a positive approach to overcoming various conflict types and levels, particularly during crises.

The aim of this study is to explore intensive care nurses\' perceptions and experiences about death and dying patient. This study included 15 nurses from a university hospital\'s intensive care units (paediatric and internal medicine). Data were collected through face-to-face, in-depth and individual interviews using the \"Nurse Information Form\" and \"Semi-Structured Interview Form\". Six major themes and sixteen sub-themes were identified on the nurses\' perceptions and experiences with death. After the nurses described their perceptions of death, their responses, approaches, coping mechanisms, and effects on the dead and dying patient in care and factors affecting perceptions of death were defined. Our findings suggest that nurses, particularly those working in intensive care, should be educated/trained on death, and dying patient care. Thus, orderly psychological support should be provided to nurses.

OBJECTIVE: This study aimed to determine the effect of spiritual well-being of intensive care nurses on compassion fatigue.
METHODS: It is a descriptive study. The sample of the study was composed of 167 nurses who were working in the intensive care units of the hospitals in Turkey. Data were collected by using \"Personal Information Form\", \"The Spiritual Well-Being Scale\" and \"The Compassion Fatigue-Short Scale\" between July and October 2022. Descriptive statistics, t-tests, correlation, and simple regression analysis were used to analyse data.
RESULTS: 35% (n = 59) of the participants were between 22 and 27 years old; 73% (n = 122) were females; 67% (n = 112) had an undergraduate degree; 57% (n = 96) had an experience of 1 to 5 years in the intensive care. It was determined that intensive care nurses had a moderate level of compassion fatigue and a high level of spiritual well-being. Although especially the educational levels of the nurses contributed to their level of spiritual well-being, a younger age and being single and less experienced in the nursing profession and intensive care were identified as significant factors in determining compassion fatigue. Nurses\' Spiritual Well-Being Scale mean score was 113.89 ± 15.50. The mean score of the Compassion Fatigue Scale was 60.15 ± 29.24. A positive correlation was found between the Spiritual Well-Being and the Compassion Fatigue Scales (ß = 0.358, p = 0.000).
CONCLUSIONS: Although intensive care nurses have a high level of spiritual well-being in general, they experience a moderate level of compassion fatigue. Younger and less experienced nurses should get more attention in intensive care units against compassion fatigue.
CONCLUSIONS: Management of feelings of compassion can be a protective factor for compassion fatigue and can be used as a prevention strategy in the context of improving mental well-being among intensive care nurses. Awareness and knowledge of nurses on spiritual needs should be enhanced.

An increasing number of studies persistently demonstrate that prone position ventilation can significantly improve the oxygenation index and blood oxygen saturation for most patients (70-80%) with acute respiratory distress syndrome (ARDS). Studies have also shown that the awake prone position was both safe and effective in helping patients with coronavirus disease 2019 (COVID-19) breathe spontaneously. However, the prone position is not widely adopted when treating patients with COVID-19 or ARDS from other causes. Basic knowledge, positive attitudes, and correct practices among the nursing staff are necessary to increase the use of prone positions, reduce the incidence of complications associated with prone positions, and improve the quality and safety of health care.
This study aimed to investigate the knowledge, attitudes, and practice of prone positioning of patients among intensive care unit (ICU) nurses working in COVID-19 units and provide suggestions for improvement.
ICU nurses were recruited from two designated tertiary hospitals for COVID-19 treatment in Shanghai, China, in April 2022, using convenience sampling. A questionnaire survey focusing on the dimensions of knowledge, attitudes, and practice of the prone position with 42 items, was conducted.
A total of 132 ICU nurses participated. The scores on the overall questionnaire and the dimensions of knowledge, attitudes, and practice of prone position were 167.28 (95% CI, 161.70-172.86), 78.35 (95% CI, 76.04-80.66), 32.08 (95% CI, 31.51-32.65), and 56.85 (95% CI, 52.42-61.28) respectively. The overall average score was 79.66% (95% CI, 0.77-0.82). The results of multiple linear regression analysis showed that prior experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position.
The ICU nurses strongly believed in the effectiveness of prone positioning, but their knowledge and practice levels need improvement. The experience in treating patients with COVID-19 and professional titles were related to the level of knowledge, attitudes, and practice of prone position. Nursing managers should ensure that ICU nurses are well trained in prone positioning and help enhance the knowledge and attitudes toward prone positioning to promote its widespread use.
Clinical guidelines and in-service training modules need to be developed to promote the use of prone positioning and reduce prone position-related complications.

OBJECTIVE: To describe the impact of the COVID-19 pandemic on intensive care nurses personal and professional well-being.
METHODS: A descriptive, qualitative design was used. Two nurse researchers conducted one-on-one interviews via Zoom or TEAMS using a semi-structured interview guide.
METHODS: Thirteen nurses who were working in an intensive care unit in the United States participated in the study. A convenience sample of nurses who completed a survey in the larger parent study provided an email and were contacted by the research team to participate in interviews to discuss their experiences.
METHODS: An inductive approach to content analysis was used to develop categories.
RESULTS: Five major categories emerged from the interviews: (1) We are not heroes, (2) inadequate support, (3) helplessness, (4) exhaustion, and (5) Nurses the second victim.
CONCLUSIONS: The COVID-19 pandemic has taken a physical and mental health toll on intensive care nurses. The impact of the pandemic on personal and professional well-being has serious implications for retaining and expanding the nursing workforce.
CONCLUSIONS: This work highlights the importance for bedside nurses to advocate for systemic change to improve the work environment. It is imperative for nurses to have effective training including evidence-based practice and clinical skills. There needs to be systems in place to monitor and support nurses\' mental health and encourage bedside nurses to use self-care methods and practices to prevent anxiety, depression, post-traumatic stress disorder and burnout.

The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses.
To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic.
This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021.
The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire.
Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning.
The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses\' professional functioning and their work life well-being.