Background: Critical care nurses (CCNs) provide end-of-life (EOL) care for critically ill patients. CCNs face many obstacles while trying to provide quality EOL care. Some research has been published focusing on obstacles CCNs face while trying to provide quality EOL care; however, research focusing on family behavior obstacles is limited.Objective: To determine if magnitude scores (obstacle item size x obstacle item frequency of occurrence) have changed since previous magnitude score data were first gathered in 1999.Methods: A random geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses (AACN) was surveyed. Responses from quantitative Likert- type items were statistically analyzed for mean and standard deviation for size of obstacle and how frequently each item occurred. Current data were then compared to similar data gathered in 1999.Results: Six items’ magnitude scores significantly increased over time. Four of the six items related to issues with families including families not accepting poor prognosis, interfamily fighting about continuing or stopping life-support, families requesting life-sustaining measures contrary to the patients’ wishes and, families not understanding the term “life-saving” measures. Two other items included nurses knowing patients’ poor prognosis before families knows and unit visiting hours that were too liberal.Seven items significantly decreased in magnitude score over time, including two items specifically related to physician behavior such as physicians who would not let patients die from the disease process or physicians who avoid talking to family members. Other items which significantly decreased were poor design of units, visiting hours that were too restrictive, no available support personnel, and when the nurse’s opinion regarding direction of care was not valued or considered.Conclusions: EOL care obstacles emphasized in 1999 are still valid and pertinent. Based on magnitude scores, some EOL obstacles related to families increased significantly, whereas, obstacles related to ICU environment and physicians have significantly decreased. Based on this information, recommendations for areas of improvement include improved EOL education for families and nurses.

Background: Nurses working in intensive care units are at high risk for experiencing moral distress, a response to an ethical event, in which a nurse recognizes or partakes in an action that does not align with their values. In response, nurses may experience negative health effects, which drives attrition. This can negatively impact patient care and the stability of healthcare organizations. There is a scarcity of high-quality and effective organizational interventions to mitigate moral distress, and even lesser work has been done to understand nurses’ practice-based needs to ameliorate moral distress. New conditions of moral distress in the context of COVID-19 have increased the relevance of these shortcomings. Aim: The purpose of this study was to learn about intensive care unit nurses’ responses to moral distress experienced in their professional practice during the COVID-19 pandemic. Methods: This interpretive descriptive study explored the experiences of 40 intensive care unit nurses, who self-reported experiencing moral distress in their professional practice during the COVID-19 pandemic (March 2020 – Sept 2021). Data generation included a demographic questionnaire, including the Measure of Moral Distress - Healthcare Professionals survey, and one-to-one semi-structured virtual interviews. The categorization and synthesis of the data was guided by methods of reflexive thematic analysis and rapid qualitative analysis. Results: Findings indicated that nurses regularly navigated pre-existing and novel ethical events in practice, which were exacerbated in the context of the COVID-19 pandemic. In response, they often experienced moral distress under the complex interplay of two overarching and broad conditions: (1) when nurses’ voices were not heard; and (2) when patients received substandard levels of care, that was not patient-centered, pain free, or that did not align standards of care. Moral distress experienced by nurses resulted in negative outcomes across serval health domains, that drove feelings of burnout and attrition. To cope, nurses engaged in patterns of action, avoidance, and acquiesce. Finally, they made recommendations for mitigative interventions rooted in their desire to be heard, in efforts to optimize patient care and nurse well-being. Conclusion: Intensive care unit nurses’ voices need to be amplified and valued, in the context of various healthcare organizations (e.g., practice, research, education and polity), to mitigate moral distress and the associated negative outcomes. / Thesis / Master of Health Sciences (MSc)

Background Each Emergency Room (ER) across the USA provides every patient with paperwork upon discharge, which commonly includes information about the patient’s diagnosis. This information will briefly describe the condition, provide information on treatment outside the ER, and possibly more, depending on the document and source. These documents are not made by hospital staff, but are generally purchased from outside providers who mass market such documents as resources for hospitals to use to educate patients. One issue with these documents lies in their mass usage, which is not necessarily designed to target the general population’s reading and educational levels. Purpose The purpose of this research was to investigate currently used discharge education materials and evaluate them for their readability and content. From this investigation, recommendations were made and adjustments to the documents were applied in order to increase understanding for the general population. Results The documents ranged in Flesch-Kincaid grade level rankings from 7.8 to 3.6, and with Flesch Reading Ease scores of 54.7 to 85.3. The entirety of the standard documents were ranked at a minimum of 7th grade equivalents, and are, at the hardest rank, ranked at a 54.7 by the Reading Ease score. In comparison, the ‘easy to read’ documents were ranked all below 5th grade level, and at the hardest rank, ranked at a 69.0 with the Flesch Reading Ease calculation. At a minimum, all documents included condition information and home care guidelines. The major obvious difference between the documents considered ‘easy to read’ and the standard documents are that those considered easy to read typically had sections found on the standard document removed, and have the same overall content as the standard version remaining, only in a simpler vocabulary. Conclusions In order to provide the best educational materials to the general public, it would be in the best interest of companies manufacturing these documents to produce only one version, which would be at a level around the 6th grade or below. A document slightly below the 6th grade level would be more ideal, as the simpler the document is, the more patients it will be accessible for overall, accounting for those who are below the national standards. It is not truly necessary to separate the documents into two forms, and it helps to prevent confusion or offense by doing so.

‎Nursing is a trusted profession aimed at delivering quality, patient-centered care perceived by patients as caring and satisfactory. While empiric care components are measurable as associated with clinical outcomes, patients’ perceptions of care are increasingly important in determining satisfaction with the patient care experience. Not clearly defined, nor empirically measurable, the “art” of nursing is taking on increasing importance as a component of satisfaction with the patient experience. The purpose of this integrative literature review was to review the literature in order to find common themes influencing determination of the art of nursing on patient satisfaction in acute care settings. Fourteen studies were selected and reviewed after a search of CINAHL Plus with Full Text, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, ERIC, MEDLINE, PsycARTICLES, and PsycINFOCINAHL databases. Four themes that emerged: building a relationship with the patient; conducting a thorough assessment of the patient; meaningful communication with the patient, and availability of nurses for their patients. The findings suggest that the art of nursing, as grounded in the demonstration of nursing care behaviors, is a component of patients’ satisfaction with the provision of care. This evidence-based knowledge is transferable to efforts in modifying nursing practices that exemplify patient-centered care.

This thesis examined the experience of compassion fatigue in nurses through analysis of research studies conducted within the past ten years. A literature review was completed using CINAHL Plus with Full Text, MEDLINE, and PsycINFO databases. Efficacy of current management strategies and interventions was evaluated. Findings indicate that educating nurses working in high-risk units improves self-recognition and lowers compassion fatigue levels. Institutional factors such as a lack of managerial support and organizational commitment contribute to the experience of compassion fatigue. An organization's involvement in maximizing compassion satisfaction through meaningful recognition of nurses' contributions to care and implementation of organizational prevention programs minimizes the risk of developing compassion fatigue. Once self-recognition by nurses and organizations participation level in mitigating compassion fatigue is addressed, interventions can be implemented to attenuate the experience of compassion fatigue. Resiliency programs and mindfulness-based interventions were efficacious in mitigating compassion fatigue.

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Bakgrund: Självdestruktiva handlingar betraktas som symptom på underliggande känslomässig ångest. Patienter som behöver vård för självdestruktiva handlingar ökar, såväl antalet patienter som behöver intensivvård. Tidigare forskning kring intensivvårdssjuksköterskans erfarenheter av att vårda patienter efter självdestruktiv handling är svåridentifierad, men den forskning som finns pekar på utmaningar för andra sjuksköterskor i vården av dessa patienter. Motiv: Antalet patienter som behöver intensivvård efter självdestruktiv handling ökar enligt statistik. Tidigare forskning har beskrivit vården som utmanande, men specifik forskning om intensivvårdssjuksköterskors erfarenheter saknas. Studien syftar till att bidra med ny kunskap för att förbättra vården av denna patientgrupp. Syfte: Att belysa intensivvårdssjuksköterskans erfarenheter av att vårda patienter efter självdestruktiv handling. Metod: Kvalitativ intervjustudie med induktiv ansats utfördes. Det var 8 stycken intensivvårdssjuksköterskor som arbetar på en intensivvårdsavdelning i norra Sverige som deltog i var sin semistrukturerad intervju som utfördes under två veckor under november år 2023. Kvalitativ innehållsanalys utfördes. Resultat: Resultatet presenterades genom tre huvudkategorier: emotionell påfrestning, utmanande möten med patienter och anhöriga samt behov av utbildning och vårdorganisatorisk samverkan. Under dessa presenteras sju subkategorier: känslor relaterat till att vilja hjälpa – men inte kunna, känslor relaterat till en självförvållad och återkommande skada, utmaningar med att agera professionellt och ha förståelse för patienten, upplevelsen av hopp och utmaningar i anhörigmötet, behov av utbildning samt önskan om samarbete med psykiatrin. Konklusion: Intensivvårdssjuksköterskor möter utmaningar och känslor vid vården av patienter efter självdestruktiva handlingar. Studien visar på kopplingen mellan fysiskt och psykiskt lidande hos dessa patienter. För patienten betonar studien behovet av mer personcentrerad och förebyggande vård. För vårdaren understryker den komplexa emotionella reaktioner och behovet av ökad kompetens och stöd. Resultaten kan förbättra vården genom holistisk syn och medvetenhet om det existentiella lidandet. För verksamheten betonas vikten av samarbete och utbildning för att förbättra vården av dessa patienter. / Background: Self-destructive acts are considered symptoms of underlying emotional distress. The number of patients requiring care for self-destructive acts is increasing, including those needing intensive care. Previous research on intensive care nurses' experiences in caring for patients after self-destructive acts is challenging to identify, but existing research highlights challenges for other nurses in caring for these patients. Motivation: The statistics indicate an increasing number of patients requiring intensive care after self-destructive acts. While previous research has described the care as challenging, specific research on intensive care nurses' experiences is lacking. The study aims to contribute new knowledge to enhance the care for this patient group. Aim: To illuminate the experiences of intensive care nurses in caring for patients after self-destructive acts. Method: A qualitative interview study with an inductive approach was conducted. Eight intensive care nurses working in a northern Swedish intensive care unit participated in individual semi-structured interviews conducted over two weeks in November 2023. Qualitative content analysis was performed. Results: The results were presented through three main categories: emotional strain, challenging encounters with patients and relatives, and the need for education and organizational collaboration. Within these, seven subcategories were presented: feelings related to wanting to help but being unable to, feelings related to self-inflicted and recurring injuries, challenges in acting professionally and understanding the patient, the experience of hope and challenges in encounters with relatives, the need for education, and the desire for collaboration with psychiatry. Conclusion: Intensive care nurses face challenges and emotions in caring for patients after self-destructive acts. The study highlights the connection between physical and psychological suffering in these patients. For the patient, the study emphasizes the need for more person-centered and preventive care. For the caregiver, it underscores complex emotional reactions and the need for increased competence and support. The results can improve care through a holistic approach and awareness of existential suffering. For the organization, the importance of collaboration and education to enhance the care for these patients is emphasized.