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Background Given critical care nurses’ high prepandemic levels of moral distress and burnout, the COVID-19 pandemic will most likely have a tremendous influence on intensive care unit (ICU) nurses’ mental health and continuation in the ICU workforce. Objective To describe the experiences of ICU nurses during the COVID-19 pandemic in the United States. Methods Nurses who worked in ICUs in the United States during the COVID-19 pandemic were recruited to complete a survey from October 2020 through early January 2021 through social media and the American Association of Critical-Care Nurses. Three open-ended questions focused on the experiences of ICU nurses during the pandemic. Results Of 498 nurses who completed the survey, 285 answered the open-ended questions. Nurses reported stress related to a lack of evidence-based treatment, poor patient prognosis, and lack of family presence in the ICU. Nurses perceived inadequate leadership support and inequity within the health care team. Lack of consistent community support to slow the spread of COVID-19 or recognition that COVID-19 was real increased nurses’ feelings of isolation. Nurses reported physical and emotional symptoms including exhaustion, anxiety, sleeplessness, and moral distress. Fear of contracting COVID-19 or of infecting family and friends was also prevalent. Conclusions Intensive care unit nurses in the United States experienced unprecedented and immense burden during the COVID-19 pandemic. Understanding these experiences provides insights into areas that must be addressed to build and sustain an ICU nurse workforce. Studies are needed to further describe nurses’ experiences during the COVID-19 pandemic and identify effective resources that support ICU nurse well-being.

Nurses' attitudes impact sedation administration practices. Modifying nurses' attitudes on sedation and the experience of mechanical ventilation may be necessary to change sedation practices with mechanically ventilated patients.

Objectives The purpose of this study was to describe the patient experience of communication during mechanical ventilation Research Methodology This descriptive study is a secondary analysis of data collected to study the relationship between sedation and the MV patients' recall of the ICU. Interviews, conducted after extubation, included the Intensive Care Experience Questionnaire. Data were analyzed with Spearman correlation coefficients (rs) and content analysis. Setting Participants were recruited from a medical-surgical intensive care unit in the Midwest United States. Results Participants (n=31) with a mean age of 65 ± 11.9 were on the ventilator a median of 5 days. Inability to communicate needs was associated with helplessness (rs = .43). While perceived lack of information received was associated with not feeling in control (rs =.41) and helplessness (rs =.41). Ineffective communication negatively impacted satisfaction with care. Participants expressed frustration with failed communication and a lack of information received. They believed receipt of information helped them cope and desired a better system of communication during mechanical ventilation. Conclusion Communication effectiveness impacts patients' sense of safety and well-being during mechanical ventilation. Greater emphasis needs to be placed on the development and integration of communication strategies into critical care nursing practice.

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Although enrolling a sufficient number of participants is a challenge for any multisite clinical trial, recruiting patients who are critically ill and receiving mechanical ventilatory support presents additional challenges because of the severity of the patients’ illness and the impediments to their communication. Recruitment challenges related to the research sites, nursing staff, and research participants faced in the first 2 years of a 4-year multisite clinical trial of a patient-directed music intervention for managing anxiety in the intensive care unit were determined. Strategies to overcome these challenges, and thereby increase enrollment, were devised. Individual strategies, such as timing of screening on a unit, were tailored to each participating site to enhance recruitment for this trial. Other strategies, such as obtaining a waiver for a participant’s signature, were instituted across all participating sites. Through implementation of these various strategies, the mean monthly enrollment of participants increased by 50%. Investigators are advised to plan well in advance of starting recruitment for a clinical trial based in an intensive care unit, anticipate peaks and valleys in recruitment, and be proactive in addressing issues creatively as the issues arise.

QT may influence sedation administration and promote patient rest. Future studies are required to further understand the influence of QT on mechanically ventilated patients in the intensive care unit.

Background Intensive Care Unit Acquired Weakness (ICUAW) is a frequent complication of critical illness due to immobility and prolonged mechanical ventilatory support. Objectives To describe daily peripheral muscle strength measurement in ventilated patients and explore relationships among factors that influence ICUAW. Methods Peripheral muscle strength of 120 ventilated ICU patients (mean age 59.8 ± 15.1; 51% female; APACHE III 61.3 ± 20.7; ICU stay 10.6 ± 8.6 days) was measured daily using a standardized hand grip dynamometry protocol. Three grip measurements for each hand were recorded in pounds-force; the mean of these three assessments was used in the analysis. Correlates of ICUAW were analyzed with mixed models to explore their relationship to grip strength (age, gender, illness severity, length of ventilatory support, medications). Results Median baseline grip strength was variable yet diminished (7.7; 0-102) with either a pattern of diminishing grip strength or maintenance of the baseline low grip strength over time. Controlling for days on protocol, female gender [β = −10.4(2.5); p = <.001], age [= −.24(.08); p = .004], and days receiving ventilatory support [= −.34(.12); p = .005] explained a significant amount of variance in grip strength over time. Conclusions Patients receiving prolonged periods of mechanical ventilatory support in this sample show marked decrements in grip strength measured by hand dynamometry, a marker for peripheral muscle strength. Hand dynamometry is a reliable method to measure muscle strength in cooperative ICU patients and can be used in future research to ultimately develop interventions to prevent ICUAW.