SUMMARYBackground: Quality indicators (QIs) play an important role in evaluating quality improvement initiatives. A generally accepted set of QIs specific to the nursing care in the intensive care unit (ICU) is not available.Aim: To identify QIs associated with nursing care for adult ICU in the literature. The methodological quality of QIs was assessed and associated variables of quality and quantity of nursing care were also identified.Methods: We employed an integrative literature review. A focused search of electronic databases was applied. Inclusion and exclusion criteria were used for the selection of relevant articles. Quality assessment of the included studies was based on the guidance document of domains and elements suggested by the Agency of Health Care Research and Quality. QIs’ methodological quality was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument.Results: The review identified 13 studies and 45 QIs associated with nursing care in the ICU. The set of QIs assessed in each study, the type of nurse staffing measure as well as morbidity and mortality rates varied considerably. Findings suggest that quality and quantity of nursing care are strongly associated with higher rates of adverse events, mortality, infections and complications in adult ICUs. Methodological quality of the QIs also differed considerably. Higher AIRE scores, indicating higher scientific evidence of methodological quality, can be used to select evidence-based and valid QIs.Conclusions: A number of QIs quantifying nursing care in the ICU have been identified. These QIs could be combined to form a tool which would allow to the quantification and assessment of the quality of ICU nursing care provided in a regular basis.

A limited number of studies have investigated the distress during the COVID-19 pandemic and the lockdown measures in the general population. We studied psychological distress during the COVID-19 pandemic and the lockdown measures in the general population in Greece and Cyprus. Also, we investigated several demographic, clinical and job characteristics of the participants as possible determinants of distress. Data collection was performed during lockdown measures in Greece and Cyprus (from April 21st to May 4th 2020). All participants provided informed consent to participate in the study. We used the Impact of Event Scale-Revised (IES-R) to measure the psychological distress in response to the COVID-19 pandemic and lockdown measures. Seventeen point four percent of the participants had overall IES-R score from 24 to 32 indicating that posttraumatic stress disorder (PTSD) is a clinical concern, while 33.5% had overall IES-R score >32 indicating that PTSD is a probable diagnosis. Females, Cyprus residents, participants that live with elderly people or patients with a chronic disease in home, participants with a mental health disease or/and chronic disease, participants under pharmaceutical treatment, participants that lost their work due to the pandemic and participants that work in hospital experienced greater distress. Also, increased age and decreased educational level was associated with increased distress. Findings suggest that our sample experienced great distress and this distress was affected by several demographic, clinical and job characteristics. Appropriate interventions should be established in order to support psychologically high risk groups and decrease their distress. Keywords: distress, COVID-19, posttraumatic stress disorder, cross-sectional study, on-line survey, public health

Background:The selection of quality indicators demonstrating the efficiency and relevance of nursing practice in patient outcomes in the intensive care unit remains a challenge. Aim:The aim of this study was to develop a set of potential quality indicators to quantify nursing care provided to critically ill patients through a consensus method.Design: This was a three-phase study including a European survey of intensive care unit (ICU) nurses (phase one) followed by a two-phase face-to-face consensus meeting of experts from Cyprus.Method: Two distinct panels of experts were asked to rate each quality indicator using a 4-point Likert scale in phases one and two. The level of consensus was set at 60%. In phase three, scores of the content validity index for items and scales were considered for the final selection of quality indicators.Results: The phase one survey included 139 ICU nurses from 13 European countries, and phases two and three included seven ICU experts from Cyprus. "Consensus in" was achieved for 12 items at the end of phase two. Three of the quality indicators were significantly different by country: (a) falls (P = .006), (b) accidental removal of nasogastric tube (P < .001), and (c) accidental removal of intravascular catheters (P < .001). Only falls was significantly correlated with higher academic qualifications of the participants (P = .002).Conclusions: Fifteen items have been identified as potential indicators for adult ICU nursing quality. These need to be prospectively studied to determine the extent to which they can accurately capture nursing care quality in this setting.This study was approved by a vising committee as part of a doctoral thesis.

COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation ( p -value <0.001). Examination of risk factors based on multivariate logistic regression analysis showed that alcohols and alcohols-based materials were associated with skin effects (OR, 1.98; 95%CI, 1.87–2.09), per-chlorine was associated with eye effects (OR, 1.83; 95%CI, 1.74–1.93), and highly likely with itching and throat irritation (OR, 2.00; 95%CI, 1.90–2.11). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). Furthermore, formaldehyde was associated with a higher prevalence of neurological effects (OR, 2.17; 95%CI, 1.92–2.44). The use of sodium hypochlorite and per-chlorine also had a high chance of having respiratory effects. The findings of the current study suggest that health authorities need to implement more awareness programs about the side effects of using sanitizers and disinfectants during viral epidemics especially when they are used or overused. Supplementary Information The online version contains supplementary material available at 10.1007/s11356-023-27197-6.

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