This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

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Context. Multimodal analgesic approaches are recommended for intensive care unit (ICU) pain management. Although music is known to reduce pain in acute and chronic care settings, less is known about its effectiveness in the adult ICU.Objectives. Determine the effects of music interventions on pain in the adult ICU, compared with standard care or noise reduction.Methods. This review was registered on PROSPERO (CRD42018106889). Databases were searched for randomized controlled trials of music interventions in the adult ICU, with the search terms ["music*" and ("critical care" or "intensive care")]. Pain scores (i.e., self-report rating scales or behavioral scores) were the main outcomes of this review. Data were analyzed using a DerSimonian-Laird random effects method with standardized mean difference (SMD) of pain scores. Statistical heterogeneity was determined as I 2 >50% and explored via subgroup analyses and meta-regression. Results. Eighteen randomized controlled trials with a total of 1173 participants (60% males; mean age of 60 years) were identified. Ten of these studies were included in the meta-analysis based on risk of bias assessment (n = 706). Music was efficacious in reducing pain (SMD of -0.63 [95% CI -1.02, -0.24; n = 10]; I 2 = 87%). Music interventions of 20-30 minutes were associated with a larger decrease in pain scores (SMD -0.66 [-0.94, -0.37; n = 5]; I 2 = 30%) compared with interventions of less than 20 minutes (SMD 0.10 [95% CI -0.10, 0.29; n = 4]; I 2 = 0%). On a 0-10 scale, 20-30 minutes of music resulted in an average decrease in pain scores of 1.06 points [95% CI -1.56, -0.56]. Conclusion.Music interventions of 20-30 minutes are efficacious to reduce pain in adult ICU patients able to self-report.

Objectives The use of interdisciplinary patient-centered care (PCC) and empathetic behaviour seems to be a promising avenue to address chronic pain management, but their use in this context seems to be suboptimal. Several patient factors can influence the use of PCC and empathy, but little is known about the impact of pain visibility on these behaviours. The objective of this study was to investigate the influence of visible physical signs on caregiver's patient-centered and empathetic behaviours in chronic pain context. Methods A convenience sample of 21 nurses and 21 physicians participated in a descriptive study. PCC and empathy were evaluated from self-assessment and observer's assessment using a video of real patients with chronic pain. Results The results show that caregivers have demonstrated an intraindividual variability: PCC and empathetic behaviours of the participants were significantly higher for patients who have visible signs of pain (rheumatoid arthritis and complex regional pain syndrome) than for those who have no visible signs (Ehler–Danlos syndrome and fibromyalgia) (p < 0.001). Participants who show a greater difference in their patient-centered behaviour according to pain visibility have less clinical experience. Discussion The pain visibility in chronic pain patients is an important factor contributing to an increased use of PCC and empathy by nurses and physicians, and clinical experience can influence their behaviours. Thus, pain invisibility can be a barrier to quality of care, and these findings reinforce the relevance to educating caregivers to these unconscious biases on their behaviour toward chronic pain patients.

BackgroundThe practice of oral care in intensive care settings remains inconsistent among intubated patients, yet these patients are at high risk of developing ventilator‐associated pneumonia. Therefore, it is important to adopt safe professional behaviour based on clinical practice guidelines. This study was based on Ajzen's (1985) theory of planned behavior, a conceptual framework that allows a better understanding of how internal and external factors influence behaviour adoption.Aims and objectivesTo study influential factors in how nurses practice oral care with intubated clients in intensive care settings, referring to the theory of planned behavior (TPB) constructs.DesignA cross‐sectional descriptive correlational design was conducted through a provincial postal survey in Quebec, Canada.MethodsA questionnaire was completed by 375 nurses working in intensive care units (ICUs).ResultsPerceived behavioural control and attitude were the most important determinants in the level of intention to engage in oral care. Knowledge, available human and material resources, and number of years of experience in critical care nursing also seemed to be significant influencing factors.ConclusionsThis study improved our understanding of the factors influencing the practice of oral care in intubated patients in the ICU, relying on TPB as an explanatory framework. It would be important to continue to study this professional behaviour and to work in collaboration with health care facilities to promote the importance of oral care as an imperative for the safety and quality of health care.Relevance to clinical practiceThe results of this study represent a solid foundation for advancing continuing education programmes and intensive care orientation programmes tailored to the needs of nurses.