Intensive Care Unit Nurses' Perceptions of Work Environments: A Cross‐Sectional Study From Five European Counties

ABSTRACT

Aim

To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, national differences, and demographic associations.

Design

Cross-sectional study using a survey design.

Methods

Study conducted between January 2021 and April 2022, using a convenience sample of intensive care unit nurses across Cyprus, Spain, Croatia, and Poland, Romania. The Critical Elements of a Healthy Work Environment Scale (CEHWES) developed by the American Association of Critical Care Nurses and cross-culturally adapted by the authors was used, which included four sections, including sociodemographic data and a total of 50 questions. The core section of the tool comprised 16 questions using Likert-type response (1—strongly disagree—4 strongly agree). Perception of fulfilment of healthy work environment standards was calculated using the aforementioned Likert-type scale.

Results

A total of 1183 nurses participated reporting moderate perception of fulfilment of the standards, with mean scores ranging from 2.6 to 2.8. Skilled communication and effective decision making were the highest rated. 56% (n = 662) reported awareness of some standards and while 25.8% (n = 305) reported full or significant implementation in their unit. Significant differences related to the perception of all standards were observed across countries. Implementation of the standards was significantly associated with higher quality of care having better perception when standards were fully implemented.

Conclusions

This study shows moderate perception of healthy work environment standards among intensive care nurses. Country differences highlight the need for more awareness, training, and further implementation of the standards, which is linked to better care quality.

Implications for the Profession

Work environment still need to improve and needs to be prioritised by organisations, considering local and national particularities. Having a measuring tool available in multiple languages facilitates comparisons and getting a global picture.

Impact

The questionnaire used is validated in different languages, allowing results to be compared with other countries. Novel data from countries that were poorly investigated is now available. More evidence points out the need to prioritise work environment for maintaining quality in patient care.

Reporting Method

The study has been reported following the STROBE checklist.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Epidemiological investigation of perinatal depression among pregnant and postpartum women: findings from a cross-sectional survey in the Philippines

Objective

This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.

Design

Cross-sectional survey.

Setting

The Philippines.

Participants

Participants were recruited online and face-to-face from maternal care facilities.

Primary outcome measure

Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).

Results

A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.

Conclusions

At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.

Can a digital intervention 'Momentum improve social functioning and transdiagnostic symptoms for Australian youth at ultrahigh risk for psychosis? Protocol for a superiority randomised controlled trial comparing treatment as usual with and without Momentu

Introduction

Existing psychological and pharmacological interventions for young people at ultra-high risk (UHR) for psychosis have shown benefit in at least delaying the transition to psychosis, but they have limited benefit for comorbid disorders or social dysfunction, which are prominent for those at UHR. We developed a moderated online social therapy platform (named Momentum) including: (1) transdiagnostic therapeutic interventions targeting social functioning, depression, generalised anxiety and social anxiety; (2) a moderated, peer-led online community and (3) specialised human support from clinicians, career consultants and peer workers. The aim of this trial is to determine whether, in addition to treatment as usual (TAU), Momentum, a 12-month digital intervention, informed by the complex intervention framework, is superior to 12 months of TAU in improving social functioning in UHR young people.

Methods and analysis

The study design is a prospective, parallel group, rater-masked randomised controlled trial. We will recruit young people aged 14–27 years, meeting one or more UHR for psychosis criteria. Participants are randomly assigned to the condition using randomly permutated blocks with a 1:1 allocation ratio. Participants are stratified by age (

Ethics and dissemination

Melbourne Health Human Research Ethics Committee (HREC/42964/MH-2018) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. De-identified individual participant data will be available after publication for 3 years via the Health Data Australia catalogue (https://www.researchdata.edu.au/health). Requests must include a methodologically sound proposal. Specific conditions of use may apply and will be specified in a data sharing agreement (or similar) that the requester must agree to before access is granted. Supplementary material including study protocol, informed consent material and statistical analysis plan will also be available.

Trial registration number

Australian New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619001411134.

Age-dependent patterns of cardiac complexity unveiled by topological data analysis of pediatric heart rate variability

by Andy Domínguez-Monterroza, Alfonso Mateos Caballero, Antonio Jiménez-Martín

Heart rate variability (HRV) is a well-established marker of autonomic regulation and undergoes profound maturation during early human development. In this study, topological data analysis (TDA) is applied to investigate the evolving geometric complexity of HRV across pediatric developmental stages. Using persistent homology in homological dimension 1, we extracted topological descriptors from time-delay embedded RR interval series of 127 individuals aged 1 month to 17 years. We identified statistically significant, age-dependent transformations in the topological structure of HRV signals. Neonates and infants exhibited a greater number and strength of persistent features, reflecting highly heterogeneous cardiac control dynamics during early autonomic maturation. In contrast, adolescents displayed reduced topological complexity and increased entropy, suggesting a shift toward more uniform and structured physiological control. Topological measures correlated with conventional HRV indices, confirming their physiological relevance. Furthermore, pairwise distances between persistence landscapes revealed an inverse relationship between intra-group topological variability and classical HRV measures. Collectively, our findings demonstrate that persistent homology provides a powerful, multiscale-aware framework to capture developmental trajectories in cardiac autonomic regulation, with potential applications in pediatric monitoring, developmental physiology, and early detection of dysautonomia.

¿Qué importancia y justificación tiene para enfermería la competencia cultural en lactancia materna? Una revisión narrativa de estudios cualitativos

Introducción: en el mundo contemporáneo donde cada vez se dan más oleadas de migraciones de un país a otro, se hace más necesaria una enfermería competente culturalmente. La mujer en su embarazo, en su maternidad y en la lactancia materna necesita ser apoyada con sensibilidad cultural por parte del profesional sanitario. Objetivo: revisar y reflexionar sobre la importancia y justificación que tiene la competencia cultural para enfermería en lactancia materna a través de estudios de metodología cualitativa. Material y método: se plantea una revisión narrativa en castellano e inglés en los recursos bibliográficos Pubmed, Scopus, Dialnet y Scielo teniendo en cuenta el objetivo de la revisión y los objetivos de inclusión. Los trabajos han de ser de metodología cualitativa y tener como temática de estudio la maternidad y/o la lactancia materna teniendo en cuenta la competencia cultural. Resultados: finalmente son seleccionados 6 artículos por cumplir los criterios de inclusión. En síntesis, en todos los estudios seleccionados se muestra la justificación e importancia que tiene la competencia cultural en todo lo concerniente a la maternidad y a la lactancia materna a nivel internacional entre grupos de mujeres diversamente culturales. Conclusiones y reflexiones finales: continúan existiendo márgenes de mejora en cuanto a la formación enfermera en competencia cultural en el cuidado de la mujer en el embarazo, en el puerperio y en lo que respecta a la lactancia materna internacionalmente.

Continuidad de vínculos con el ser querido fallecido y los cuidados de Enfermería de Salud Mental según el Modelo Tidal

El objetivo principal es analizar de qué manera el Modelo Tidal favorece la reconstrucción de significados en el duelo como continuidad de vínculos. El duelo es un proceso complejo que tiene componentes naturales y construidos, en ocasiones, las personas dolientes validan la continuidad de vínculos con la persona fallecida por medio de la organización de las autonarrativas. El manejo de este fenómeno es interdisciplinario donde destaca la Enfermería de Salud Mental orientada por el Modelo Tidal el cual se apoya en la historia personal para la reconstrucción de los significados tras la muerte de un ser querido favoreciendo la adaptación a través del cuidado. Conclusión principal: El abordaje de la continuidad de vínculos desde el Modelo Tidal favorece la adaptación al duelo centrado en la persona y su historia al afianzar la reconstrucción de significados que mejoren la calidad de vida por medio del cuidado enfocado en las necesidades actuales.

Influencia de los cambios de posición y la aspiración de secreciones en la presión intracraneal de los pacientes neurocríticos

Introducción: El manejo del paciente neurocrítico precisa un estrecho control de la presión de perfusión cerebral y de la presión intracraneal. A lo largo de los años, se ha estudiado la relación entre las intervenciones y los cuidados de enfermería, con la alteración de las cifras de presión intracraneal, demostrándose que, algunas de ellas como los cambios posturales y la aspiración de secreciones, producen un importante impacto. Objetivo: Determinar la influencia de los cambios de posición y la aspiración de secreciones en la presión intracraneal y encontrar un consenso de actuación para mejorar la calidad de la práctica diaria. Método: Se realizó una búsqueda en varias bases de datos, entre abril y mayo de 2017, para recuperar el mayor número de evidencias recientes posibles. Se establecieron criterios de inclusión y exclusión. Tras los procesos de cribado de los artículos, diez de ellos se incluyeron en la revisión sistemática. Resultados y conclusiones: El personal de enfermería constituye una pieza clave en el cuidado de estos pacientes. Todos los estudios coincidieron en que tanto los cambios de posición como la aspiración de secreciones tienen influencia sobre la PIC.

La limitación terapéutica en la Unidad de Cuidados Intensivos.

Rev Enferm;39(5): 20-4, 2016 May. . [Artículo]

Uso del acido tranexámico en hemorragias en zona de combate

Rev Enferm;41(2): 122-125, feb. 2018. [Artículo]