Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low.Content analysis was used to identify themes of Role Conflict With Management/Rules, Death and Suffering, Dealing With Violence in the Intensive Care Unit, Dealing With Family, Powerlessness, Physical Distress, and Medical Versus Nursing Values. Additional themes identified were caring, helping families, long-time interdependent relationships of colleagues, and satisfaction in trauma nursing.As work engagement increased, compassion satisfaction significantly increased, and burnout significantly decreased. Results of this study support moral distress as a clinically meaningful issue for surgical intensive care unit nurses. Moral distress scales were elevated, whereas work engagement scales were low. This finding was congruent with Lawrence's study and may reflect ongoing need for greater supports for experienced intensive care unit nurses, from both education and management. Future recommendations for research include examining the interaction of these variables in larger samples to examine additional explanatory factors as well as strategies for self-care, mot...

Background In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families’ needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families’ satisfaction with care in this setting. Objective To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. Method A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. Results Forty family members completed the survey. Overall, the mean score for families’ satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families’ satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient’s condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families’ experience. Conclusion Although patients’ family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients’ families, and patients will be targeted for quality improvement initiatives.

Multidisciplinary clinical simulation can be an essential part of nursing education strategies to improve and enhance patient safety and experience. Clinical simulation can be utilized to change practice, reinforce practices, and direct patient and family education needs for a safe discharge. Anaphylaxis is potentially fatal and is increasing in occurrence. A simulation scenario was designed by a multidisciplinary team to review anaphylaxis recognition and to provide simulated practice for emergency response. Clinical scenarios were developed based on evidence-based practices and included a prebriefing and postdebriefing. Bandura's self-efficacy theory was used as a framework to develop the project, as it supports behavior change strategies well suited for clinical simulation. Clinical simulations provide a nonthreatening environment for staff to learn, practice, and receive feedback to improve patient care and serve as a vehicle to role-play expected practices, enhance communication between disciplines, demonstrate progress, and evaluate competency.