Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit

Background: Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients. Objectives: The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU. Materials and Methods: This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient’s reports and documents were used. Information saturation was determined as an interview termination criterion. Results: Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications). Conclusions: Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

[1]  T. Burns,et al.  Dissonant imperatives in nursing: a conceptualization of stress in intensive care in Sweden. , 2001, Intensive & critical care nursing.

[2]  J. Landeweerd,et al.  The diversity of work: differences, similarities and relationships concerning characteristics of the organisation, the work and psychological work reactions in intensive care and non-intensive care nursing. , 2002, International journal of nursing studies.

[3]  Jenny A Darvas,et al.  What makes a good intensive care unit: a nursing perspective. , 2002, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[4]  J. E. Hardcastle.  The meaning of effective education for critical care nursing practice: a thematic analysis. , 2004, Australian critical care : official journal of the Confederation of Australian Critical Care Nurses.

[5]  B. Lundman,et al.  Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. , 2004, Nurse education today.

[6]  C. Durbin,et al.  Team model: Advocating for the optimal method of care delivery in the intensive care unit , 2006, Critical care medicine.

[7]  K. Walshe.  Understanding what works--and why--in quality improvement: the need for theory-driven evaluation. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[8]  P. Ashworth,et al.  Similarities and differences in critical care nursing. , 2007, Intensive & critical care nursing.

[9]  Solange Regina Giglioli Fusco,et al.  Nursing workload in intensive care units: a study using the Therapeutic Intervention Scoring System-28 (TISS-28). , 2007, Intensive & critical care nursing.

[10]  P. Sainsbury,et al.  Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[11]  K. G. Padilha,et al.  Nursing activities score (NAS): a proposal for practical application in intensive care units. , 2007, Intensive & critical care nursing.

[12]  H. Lundgrén-Laine,et al.  Nursing intensity and patient classification at an adult intensive care unit (ICU). , 2007, Intensive & critical care nursing.

[13]  L. Eisen,et al.  Eye care in the intensive care unit: Narrative review and meta-analysis , 2008, Critical care medicine.

[14]  R. M. D. de Sousa,et al.  Nursing Activities Score in the intensive care unit: analysis of the related factors. , 2008, Intensive & critical care nursing.

[15]  Pascale Carayon,et al.  Exploring performance obstacles of intensive care nurses. , 2009, Applied ergonomics.

[16]  C. J. Shields,et al.  Preparing the next generation of nurse leaders: an educational needs assessment. , 2010, Journal of continuing education in nursing.

[17]  Janet Skees.  Continuing Education: A Bridge to Excellence in Critical Care Nursing , 2010, Critical care nursing quarterly.

[18]  E. Idvall,et al.  Staff empowerment in intensive care: nurses' and physicians' lived experiences. , 2010, Intensive & critical care nursing.

[19]  V. McAlister,et al.  Utilization profile of the trauma intensive care unit at the Role 3 Multinational Medical Unit at Kandahar Airfield between May 1 and Oct. 15, 2009. , 2011, Canadian journal of surgery. Journal canadien de chirurgie.

[20]  E. Cook,et al.  Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score , 2011, Critical care.

[21]  J. Gilyoma,et al.  Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania , 2011, Scandinavian journal of trauma, resuscitation and emergency medicine.

[22]  C. Thanapaisal,et al.  A comparison of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Trauma-Injury Severity Score (TRISS) for outcome assessment in Srinagarind Intensive Care Unit trauma patients. , 2012, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[23]  M. Jegers,et al.  Monitoring costs in the ICU: a search for a pertinent methodology , 2012, Acta anaesthesiologica Scandinavica.

[24]  K. Inaba,et al.  Management of post-traumatic retained hemothorax: A prospective, observational, multicenter AAST study , 2012, The journal of trauma and acute care surgery.

[25]  H. Leino‐Kilpi,et al.  Competence requirements in intensive and critical care nursing--still in need of definition? A Delphi study. , 2012, Intensive & critical care nursing.

[26]  T. Scalea,et al.  Continuously recorded oxygen saturation and heart rate during prehospital transport outperform initial measurement in prediction of mortality after trauma , 2012, The journal of trauma and acute care surgery.

[27]  U. Schmidt,et al.  Effects of routine monitoring of delirium in a surgical/trauma intensive care unit , 2013, The journal of trauma and acute care surgery.

[28]  M. Bloom,et al.  The impact of implementing a 24/7 open trauma bed protocol in the surgical intensive care unit on throughput and outcomes , 2013, The journal of trauma and acute care surgery.

[29]  J. Moorman,et al.  Predicting the need for urgent intubation in a surgical/trauma intensive care unit. , 2013, Surgery.

[30]  Yen-Ko Lin,et al.  Association of head, thoracic and abdominal trauma with delayed diagnosis of co-existing injuries in critical trauma patients. , 2014, Injury.

[31]  T. Vahlberg,et al.  Basic competence in intensive and critical care nursing: development and psychometric testing of a competence scale. , 2014, Journal of clinical nursing.