Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended.

Study purpose was to describe critical care nurses' levels of moral distress and the effects of that distress on their professional practice environment. A descriptive, correlational, prospective, survey design was used. The intensity of moral distress was inversely related to physician/nurse collegial relationships and the frequency of moral distress was inversely related to all aspects of the professional practice environment except foundations for quality of care. It is important to monitor the frequency of moral distress. Strategies to improve the nurse's sense of control over practice, teamwork, communication, and autonomy need to be developed and tested in future research.

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.

Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.

Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing workflow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.Keywords critical care; family caregivers; family-centered nursing; family engagement An increasing number of Americans require treatment in the intensive care unit (ICU), and a proportional increase in family caregivers will assume caregiving responsibilities that can have persistent negative effects on their health and overall quality of life. [1][2][3][4][5][6] The conventional ICU care paradigm has primarily targeted the informational needs of family Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH (bdh66@case.edu). HHS Public AccessAuthor manuscript AACN Adv Crit Care. Author manuscript; available in PMC 2017 September 07. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript caregivers of the critically ill, but has not addressed how to actively engage caregivers in other aspects of the ICU experience such as symptom assessment and the direct provision of care. [7][8][9][10] Although critical care research, policy, and practice guidelines 9,10 increasingly recognize family caregivers as part of a larger patient-provider interaction during critical illness, the literature on family caregiver engagement in this context mainly focuses on passive forms of involvement such as family presence, communication, and decisionmaking. Few studies address family caregivers' active contributions to patient care. 7,8,[11][12][13][14][15][16][17][18] Patient and family engagement are defined as active partnerships among health care providers, patients, and families. 7 Identifying effective ways to implement patient and family engagement is paramount to improving the patient and family experience as well as improving safety, quality, and delivery of care. [7][8][9] In the ICU, critical care nurses are the frontline providers of life-sustaining care and key staff members in promoting patient and family engagement. However, the literature provides evidence that critical care nurses express resistance to involving family caregivers because of misconception...

Several organizations have published national guidelines on providing the option of family presence during resuscitation (FPDR). Although FPDR is being offered in clinical practice, there is limited description of family experiences after FPDR. The aim of this study was to describe family experiences of the FPDR option after trauma from motor vehicle crashes and gunshot wounds. A descriptive, qualitative design based on content analysis was used to describe family experiences of the FPDR option. Family members (N = 28) were recruited from a major level 1 adult trauma center in the Midwest. Participants in this study were 1 family member per patient who were 18 years or older, visited the patient in the surgical intensive care unit, spoke and understood English, and had only one critically injured patient in the family. Family interview data on experiences during FPDR after trauma were used to identify themes. Two main categories were found. Families view the role of health care professionals (HCPs) to "fix" the patient, whereas they as family members have an important role to protect and support the patient. Subcategories related to the role of the HCP include the following: multiple people treating the patient, completion of many tasks with "assessment of the damages," and professionalism/teamwork. Important subcategories related to the family member role include the following: providing information to the HCP, ensuring that the medical team is doing its job, and remaining close to provide physical and emotional comfort to the patient. Health care professionals are viewed positively by the family, and the role of the family is viewed as important. Families wanted to be present and would recommend the choice to other family members. The findings of this study support that the FPDR option is an intervention that helps family members build trust in HCPs, fulfills informational needs, allows family members to gain close proximity to the patient, and support their family member emotionally.

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Purpose/Objectives: The purpose of the study was to describe the relationship between anger, spirituality, and subjective and objective indices of heart disease risk among a convenience sample of nontraditional college students at a small private university in South Texas. Nontraditional college students are defined as slightly older commuter students who balance family, work, and school schedules.Research Hypothesis/Question(s):(1) What are the risk factors, level of anger, and spirituality of nontraditional college students participating in a wellness course at a small private south Texas university? (2) What are the self-assessed risk factors among nontraditional college students participating in a wellness course at a small private south Texas university?Design: The study used a descriptive correlational design. Methods: The sample consisted of 19 mostly single female students with a mean age of 30 years (range, 21Y64 years). Instruments included Self-assessment of Health Risk Profile, State Trait Anger Expression Inventory (6 scales and 5 subscales), Anger Expression Index, and Spiritual Well-being Index.Findings: Over half were minority. Sixty-nine percent were overweight; 60% were prehypertensive; 26% had a total cholesterol greater than 200. Over two-thirds stated they weighed more than they should. Over half reported a family history of high blood pressure; 37% reported a family history of diabetes; 42% smoked. Fifteen percent of the sample had anger scores suggesting a need for referral. Over half had scores in the moderate range for spiritual well-being. Scores on the existential well-being subscale were negatively correlated with overall anger expression.Conclusions: These findings suggest the need for targeted lifestyle and anger management interventions among this population.Implications for Practice: Future studies with larger samples are needed to determine whether spirituality mediates anger, and how anger is related to cardiac risk among this group.