Investigation Of Critical Care Nursing Practice In Shanghai

ObjectiveTo describe the current situation of critical care nurses’ practice activities, professional competences and critical care models in shanghai.MethodsDescriptive-study design. A convenient sampling method was used to recruit5ICU departments and1313critical care nurses at23hospitals in shanghai. First hands observation was conducted from August to December2010to record critical care models among5ICU departments. A cross-sectional survey was carried out from September2011to January2012to describe the current situation of critical care nursing practice by self-completed questionnaires with1313critical care nurses. Six questionnaires entitled "critical care nurses’ background (to obtain professional and demographic information)","critical care nursing practice activities","critical care nursing advanced practice activities","professional competences for critical care nurses","patient care problems in critical care" and "critical care models" were used to investigate the critical care nurses’practice activities, professional competences and critical care models respectively.ResultsResults related to critical care nurses’background and patient care problems:1. Nurses’ background Over half of the respondents (66.8%) practiced in the three upper first-class comprehensive hospitals. The largest percentages of critical care nurses worked in a surgical ICU (17.9%) or a combined ICU (12.6%). The majority of the respondents were women (96.7%) and the mean age was28years old (28.12±5.20). The critical care nurses had an average of nearly7years of experience as an RN (7.04±5.89), and41/2years in an acute/critical care setting (4.51±4.33). Over one third of critical care nurses indicated that they worked in the role of clinical coordinator (31.6%) and clinical educater (49.0%). The largest percentages of critical care nurses held the nurse title (45.2%) and nurse practitioner title (46.8%). For the highest degree earned by respondents,58.9%of the critical care nurses had earned the associate’s degree,26.5%of the critical care nurses had earned the bechelor’s degree. Nearly half of the critical care nurses (49.7%) had not receive the hospital-level and above critical care nursing professional training. The average number of patients each critical care nurse cared for at present was3in day shift,4in middle shift and5in night shift. The ideal proportion that nurses recommended was one critical care nurse care for two patients in every shift. A total of13.7%of critical care nurses worked in ICU for voluntary admission. About two thirds of the critical care nurses liked the work in ICU (66.9%), and would stay in ICU (61.7%). Nearly three quarters of critical care nurses (75.9%) held the opinion that the head nurse should responsible for both ward management and nursing practice. About two thirds of critical care nurses (61.5%) would like to concentrate on professional nursing practice in the future.2. Patient care problems All the patient care problems in the survey were within the admission scope of the investigated ICU departments. For the97critical care patient problems,22were treated frequently by more than half ICU departments. The most frequently treated patient problems were primarily centered on cardiovascular system and pulmonary system. For the37cardiac medicine critical care patient problems,22were treated frequently by more than half cardiac medicine ICU departments. For the28cardiac surgery critical care patient problems,16were treated frequently by more than half cardiac surgical ICU departments.Results related to critical care nursing practice activities:1. Critical care nursing practice activities All the practice activities in the survey were performed within the critical care nurses’daily work. For the89critical care nursing practice activities,65were performed frequently by more than half critical care nurses. The most frequently performed practice activities were primarily centered on cardiovascular system and pulmonary system. For the17cardiac medicine critical care nursing practice activities,9were performed frequently by more than half cardiac medicine critical care nurses. For the15cardiac surgery critical care nursing practice activities,14were performed frequently by more than half cardiac surgical critical care nurses.2. Critical care nursing advanced practice activities All the advanced practice activities in the survey were performed within the critical care nurses’ daily work. For the65critical care nursing advanced practice activities,35were performed frequently by more than half critical care nurses. The most frequently performed practice activities were primarily centered on clinical judgement dimension and caring practices dimension.Results related to the professional competences of critical care nurses:1. The criticality of professional competences The competences that the critical care nurses rated highest were associated with the competences of clinical judgement (7.38) and caring practices (6.60), followed by collaboration (5.65), systems thinking (5.49), advocacy and moral agency (4.67), facilitation of learning (3.81) and response to diversity (3.79). The competence of clinical inquiry (3.45) was rated lowest by critical care nurses.2. Assessment of professional competences The weighted average score of the comprehensive professional competences was2.15±0.43, the overall level of critical care nurses’professional competences was assumed to be at level3. The competences that the critical care nurses scored highest were associated with the competences of clinical judgement (0.40) and caring practices (0.35), followed by systems thinking (0.30), collaboration (0.29), advocacy and moral agency (0.23), response to diversity (0.21) and facilitation of learning (0.20). The competence of clinical inquiry (0.16) was scored lowest by critical care nurses.Results related to critical care models:1. The results from cross-sectional investigation Among the49ICU departments surveyed,31were adopting Beds In Charge Model and16were adopting Group Collaboration Model. The majority of the doctors worked in ICU were physicians (61.22%) and surgeons (46.94%). The most common collaborations between doctors and nurses were joint participation in the bedside rounds (83.70%) and case discussions (61.20%). Most of the ICU departments (89.80%) implemented the first aid contingency plan to manage sudden or emergency admissions or sudden increases in patients’acuity.2. The results from direct observation Among the5ICU departments observed,3were adopting Beds In Charge Model and2were adopting Group Collaboration Model. Both critical care models had their own advantages and disadvantages.ConclusionsBoth critical care nursing practice activities and critical care nursing advanced practice activities were all performed within the daily work of critical care nurses and need to be further refined and standardized. The overall level of critical care nurses’professional competences was assumed to be at level3. The critical care nurses’professional competeces were subject to further cultivation and enhancement. Beds In Charge Model was the main critical care model at present. The Group Collaborative Model represented the major trend in the future. Standardizing critical care nursing practice activities, enhancing professional competences of critical care nurses and transforming critical care models as soon as possible were conductive to promoting the continuous improvement and development of critical care nursing practice and advanced nursing practice.