The use of knowledge of respiratory physiology in critical care nurses' clinical decision-making : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University

The knowledge and experience of expert nurses has long been recognised as contributing to early identification of patient problems, early intervention and an improved patient outcome. The present study sought to answer the research question, following completion of a critical care specialty practice programme, do nurses use knowledge of respiratory physiology in their clinical decision-making? An evaluation methodology using a managerial perspective was used to compare the use of knowledge of respiratory physiology in critical care nurses' clinical decision-making with the respiratory physiology recommended in the New Zealand Standards for Critical Care Nursing Education (Critical Care Nurses' Section, 2000). Using intensity sampling, 27 nurses who had completed a critical care specialty practice programme and who were currently working in the critical care units of two tertiary hospitals in a large metropolitan city within New Zealand were selected. Quantitative and qualitative methods were used to collect data. Data analysis was completed using descriptive statistics, correlations and identification of common terms and themes. The results showed that following completion of a critical care programme, critical care nurses demonstrated a low to medium level of knowledge of respiratory physiology in their clinical decision-making. In the total group, no statistically significant associations were found between the use of knowledge of respiratory physiology in clinical decision-making and age, experience, academic level, use of guidelines and protocols, standards and integrated care pathways, conference attendance, reading of journals and accessing the World Wide Web for literature. Qualitative analysis identified factors contributing to the low to medium use of knowledge as being nurses' high reliance on intuitive knowledge, lack of in-depth discussion of respiratory concepts in critical care programmes, lack of opportunity in the clinical practice environment to discuss respiratory physiology and lack of collaborative practice. The study identified the need for more collaborative practice and for clinical nurse educators firstly, to have a closer relationship with the critical care programme providers to ensure adequate theoretical content and secondly, to work with nurses in the clinical setting

Respiratory support of adults in the emergency department: A protocol for a prospective, observational, multicenter point prevalence study

© 2022 The Authors.Background and Aims Providing respiratory support (RS) to patients may improve their oxygenation and ventilation, reducing the work of breathing. Emergency department (ED) patients often need RS; COVID-19 has heightened this need. Patients receiving RS may need escalation of their treatment; hence, studies considering the prevalence of escalation are warranted. Method This is a protocol for a prospective, observational, multicenter point prevalence study (PPS). Researchers will collect data over 2 days. All participants are adult ED patients needing RS. The setting is four EDs in New Zealand. The primary research question asks, “Which patients receiving RS require escalation of therapy in the ED?” For example, transitioning from conventional oxygen therapy (COT) to intubation is deemed an escalation of therapy. A sample size of 80 participants is required to resolve the primary research question. Secondary research questions: (1) Which patients receive nasal high flow (NHF) in the ED? (2) How is NHF therapy delivered in the ED? (3) What are the effects of NHF therapy on physiological and patient-centered outcomes? Research Electronic Data Capture (REDCap) will be used for data organization. Data will be imported for analysis from REDCap to IBM SPSS software (Statistics for Windows, Version 27.0). Data reporting on the primary outcome shall be considered by analysis of variance, regression modeling, and determination of two treatment effects: Odds Ratio and Number Needed to Treat. Statistical significance for inferential statistics shall use a two-sided α with p-values fixed at ≤0.05 level of significance and 95% confidence intervals. This protocol has ethical approval from Massey University, New Zealand. Conclusion This novel PPS may reduce the evidence and clinical practice gap on RS delivery and ED patient outcomes, as evidenced by the emergence of COVID-19

A practical approach to establishing a critical care outreach service: An expert panel research design

Background: For over two decades, nurse-led critical care outreach services have improved the recognition, response, and management of deteriorating patients in general hospital wards, yet variation in terms, design, implementation, and evaluation of such services continue. For those establishing a critical care outreach service, these factors make the literature difficult to interpret and translate to the real-world setting. Aim: The aim of this study was to provide a practical approach to establishing a critical care outreach service in the hospital setting. Method: An international expert panel of clinicians, managers, and academics with experience in implementing, developing, operationalising, educating, and evaluating critical care outreach services collaborated to synthesise evidence, experience, and clinical judgment to develop a practical approach for those establishing a critical care outreach service. A rapid review of the literature identified publications relevant to the study. A modified Delphi technique was used to achieve expert panel consensus particularly in areas where insufficient published literature or ambiguities existed. Findings: There were 502 publications sourced from the rapid review, of which 104 were relevant and reviewed. Using the modified Delphi technique, the expert panel identified five key components needed to establish a critical care outreach service: (i) approaches to service delivery, (ii) education and training, (iii) organisational engagement, (iv) clinical governance, and (v) monitoring and evaluation. Conclusion: An expert panel research design successfully synthesised evidence, experience, and clinical judgement to provide a practical approach for those establishing a critical care outreach service. This method of research will likely be valuable in other areas of practice where terms are used interchangeably, and the literature is diverse and lacking a single approach to practice

Models and activities of critical care outreach in New Zealand hospitals: results of a national census.

AIM: To review clinical models and activities of critical care outreach (CCO) in New Zealand public hospitals. METHODS: Data were collected using a two-stage process. Stage 1 consisted of a cross-sectional descriptive online survey distributed to nurse managers of all CCO in New Zealand. Stage 2 requested that all respondent sites supply outreach documentation for analysis. RESULTS: Twenty acute care public hospitals replied to the data request (100%). Nine hospitals (45%) had CCO and completed the survey. There was considerable diversity in the models of CCO used. All nine hospitals had CCO that were nurse-led; 66% of these had intensive care medical input. There was variation in the size and scope of each CCO with only 4 (44%) sites providing 24-h clinical cover. The majority of referral requests made to CCO were for ward-based reviews (mean: 57%) and intensive care discharge reviews (mean: 31%). The most frequently performed activity was provision of support to ward staff (89%). All CCO routinely collected data on activities across a range of clinical areas. CONCLUSION: Less than half of the public hospitals in New Zealand have a CCO service despite national recommendations that every hospital utilize one to support deteriorating ward patients. New Zealand hospitals that have critical care outreach have adopted recognized international models and adapted these to meet local demands. Whilst the evidence base demonstrating impact of critical care outreach continues to be established, international support for critical care outreach continues. Given this, critical care outreach should be more widely available 24/7 and activities standardized across New Zealand to align with national recommendations. RELEVANCE TO CLINICAL PRACTICE: Critical care outreach service models and activities in New Zealand hospitals continue to be diverse. Awareness of these variances will help influence critical care outreach service development and regional integration

Recommendations on basic requirements for intensive care units: structural and organizational aspects

OBJECTIVE: To provide guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine. METHODOLOGY: The Working Group on Quality Improvement (WGQI) of the European Society of Intensive Care Medicine (ESICM) identified the basic requirements for ICUs by a comprehensive literature search and an iterative process with several rounds of consensus finding with the participation of 47 intensive care physicians from 23 countries. The starting point of this process was an ESICM recommendation published in 1997 with the need for an updated version. RESULTS: The document consists of operational guidelines and design recommendations for ICUs. In the first part it covers the definition and objectives of an ICU, functional criteria, activity criteria, and the management of equipment. The second part deals with recommendations with respect to the planning process, floorplan and connections, accommodation, fire safety, central services, and the necessary communication systems. CONCLUSION: This document provides a detailed framework for the planning or renovation of ICUs based on a multinational consensus within the ESIC