This issue of Critical Care Nursing Quarterly broaches some topics that are very important to the profession of nursing as well as to the specialty of critical care. As critical care nurses, we carry a very heavy responsibility of caring for the "sickest of the sick." We do so in a fast-paced environment that requires us to be intelligent critical (fast) thinkers, with skillful (quick) hands that do not hurry (because that is when mistakes are made) while maintaining a sense of genuine caring about what we are doing and patients for whom we are caring.
Professional development and empowerment not only explores ways for us to be more accountable to those we are caring for and improve patient care outcomes in a more cost-effective manner but also offers suggestions for innovatively training nurse leaders and mentoring young nurses.
In critical care, technology abounds, the healthcare delivery system is constantly changing, and healthcare reform is upon us. Skees explains why we have a professional and ethical responsibility to seek continuing education in her article "Continuing Education: A Bridge in Critical Care Nursing." She embraces lifelong learning as a way of increasing one's knowledge base and broadening one's critical thinking acumen. Continuing education units assist critical care nurses in maintaining necessary skills for their work environment and can enrich their contribution to healthcare. There is power in learning and that power can lead to less delay in bringing evidence-based practice (EBP) to the bedside and improving patient outcomes. Skees takes note of the challenging obstacles that nurses face in continuing their education and/or obtaining continuing education credits and offers suggestions to assist in achieving continuing education goals.
As critical care nurses, we all want to provide our patients with safe, high-quality patient care and positive clinical outcomes. Research has shown that this happens most effectively through the swift implementation and maintenance of EBP. Tuite and George emphasize this in their article "The Role of the CNS in Facilitating EBP Within a University Setting." They look at the importance of advanced practice nurses, specifically the clinical nurse specialist (CNS), in leading multidisciplinary team committees and facilitating the implementation and sustaining of EBP to improve patient outcomes. They emphasize how vital the role of the CNS can be in bridging the gap between medicine and nursing. As a CNS chair shares committee leadership with a physician cochair and is also accompanied by a nurse administrator meeting attendee to reinforce the value of the committee's work, the CNS is empowered to facilitate change in practice. This can be accomplished by the CNS facilitating and assisting in the transfer of some of the decision making of the hospital leaders to those individuals who perform the day-to-day care in the critical care units-the critical care staff nurses. Tuite and George give examples of how their facility has improved intensive care unit (ICU) ventilation-acquired pneumonia (VAP) prevention rates and compliance with the sedation interruption protocol through CNS initiative development, EBP implementation, and tracking of staff compliance with EBP guidelines.
In the article "Trauma VAP SWAT Team: A Rapid Response to Infection Prevention," Laux et al demonstrate a commitment to excellence and quality as well as an improvement in VAP prevention rates in their facility's 5 ICUs. Through the utilization of a rapid cycle quality improvement model using "plan, do, study, act" components, a group consisting of the unit's advanced practice nurse, clinical nurse educator, and the nurse director investigated their problem of rising VAP rates. They then performed a detailed analysis of best practice interventions and implemented an action that would prove to be highly effective in reducing VAP as well as easily track for compliance. Their process involved both bedside- and unit-based research. With the assistance of the facility's medical director of patient care and safety, their efforts empowered the critical care bedside nurses and respiratory therapists to make a difference in their work. As a result, the facility is now experiencing their lowest VAP rates in more than 4 years (in all 5 of their ICUs)!!
It is no secret that critical care nurse managers face many demands in their role. They are often responsible for the hiring of qualified staff nurses as well as key ancillary staff, such as unit secretaries, nurse assistants, and clinical technicians, who will be responsible for coordinating and delivering complex, high-quality, safe patient care. In addition, they must be responsible financial managers of highly technological units that require numerous supplies and advanced, specialty equipment specific to meet the care delivery needs of their specialty ICU. Lest we forget, they are mediators and coaches of a multigenerational workforce that is under constant stress and frequently full of very strong personalities. DeCampli et al know the importance of having skilled frontline managers in these multifaceted, extremely stressful roles that facilitate the interface between patients, nursing staff, medical staff, other clinical and ancillary staff, and hospital administration. In their work "Beyond the Classroom to Coaching: Preparing New Nurse Managers," they acknowledge that despite their numerous responsibilities, new nurse managers frequently receive little, if any, formal training. In addition, if they do have a preceptor, that preceptor also has multiple demands on his or her time and frequently little, if any, preceptor training. DeCampli et al describe the success in utilizing a formal "coach" to provide more personal, concentrated support to nurse managers in training. They enlighten us to how this formal "coaching" relationship focuses on the learning needs of the individual nurse manager and fosters the development of new leadership skills.
There is very little research available on the subject of self-transcendence. A characteristic of developmental maturity, self-transcendence facilitates the integration of the concepts of living, aging, and dying. The trait is frequently seen in the personalities of professional nurses. Palmer et al define self-transcendence as the ability of human beings to find meaning in their lives by being directed toward something, or someone, other than themselves. In this issue, they publish the results of their descriptive correlational study "Self-transcendence and Work Engagement in Acute Care Staff Registered Nurses." With the data collected at the National Teaching Institute of the American Association of Critical-Care Nurses and through utilization of Reed's Theory of Self-transcendence, they identify the positive correlation between self-transcendence and increased work engagement in acute care staff nurses as well as the negative correlation between self-transcendence and overwhelming, emotional workload and nurse burnout. Their findings give insight to the importance of fostering the development of and nurturing acute care nurses, an imperative for retention of nurses in a swiftly changing, ever-so-challenging healthcare environment.
McDonald et al explore the known fact that structures that empower nurses contribute to a healthy work environment and promote professional nurse autonomy, both of which can attribute to nurses having a greater sense of commitment to their organization and an improved sense of job satisfaction. In their work "Relationship Between Staff Nurse Involvement in Organizational Structures and Their Perceptions of Empowerment," McDonald et al publish the results of their research study in which they used a descriptive correlation survey to investigate nurses' perception of structural empowerment at their institution. They examine the relationship between nurses' perceived sense of empowerment and participation in an organizational structure council at the facility and suggest areas for future research on this topic.
Eisert et al rally the need for standardized care and proper forensic evidence collection and preservation for gunshot wound (GSW) victims. Eisert et al describe in detail how the formation of a multidisciplinary team was instrumental in the development and implementation of a set of evidence-based practice guidelines for forensic evidence collection. Their work entitled "CSI: New @ York Development of Forensic Evidence Collections Guidelines for the Emergency Department" describes education provided for persons who are integral in the collection of forensic evidence such as patient representatives, emergency nurses, and trauma nurses. They also detail how practice was modified to assure that evidence was appropriately recognized, handled, documented, packaged, and preserved. In addition, they emphasize the importance of assuring that the proper chain of evidence is always followed when collecting forensic evidence.
"Facilitated Sensemaking: A Feasibility Study for the Provision of a Family Support Program in the Intensive Care Unit," by Davidson et al, introduces a new midrange nursing theory, Facilitated Sensemaking, which proposes that nurses facilitate the sensemaking process with family members of ICU patients through a series of interventions. The goals are to help the family members make sense of the situation and of the new role as caregivers. The author's interventions included identifying and meeting the information needs of the family, coaching them on how to visit and meet their own needs, providing them with support, and providing meaningful activities to perform at the bedside. Through the use of several tools including a Critical Care Family Needs Inventory, Family Support Program evaluation and a piloted family needs survey (which the author hopes to use for future measurement of the effects of the intervention), the authors performed a qualitative analysis of data collected, which yielded descriptive statistics describing the perception of helpfulness of the implemented interventions by the family members. If effective, these research interventions may be crucial in assisting family members in achieving effective coping strategies and proper adaptation to the situation. Hence, if effective, these interventions may prevent the anxiety, depression, and the posttraumatic stress syndrome associated with ineffective coping and maladaptation when a family member has a loved one in the ICU.
Finally, I, with some assistance from Janet Skees, explore the impact of mentorship on recruitment, retention, and job satisfaction on all levels of nursing practice, from the undergraduate student nurses to more senior nurse leaders and faculty. We look at the challenges and benefits of mentorship in critical care units as well as those that affect healthcare organizations in general. There is emphasis on having the necessary organizational culture to support mentoring, and key elements necessary to the development of a successful mentorship program are discussed. Most importantly, we share the fact that an effective mentoring program can improve nursing care and patient care outcomes.
Tara Kay Race, MSN, RN, CNS, CCRN
Issue Editor