La humidificación en oxigenoterapia convencional de bajo flujo se ha utilizado para prevenir sequedad de mucosas y mejorar la tolerancia, sin embargo, su beneficio sobre el confort y la seguridad del proceso continúan siendo debatidos. El objetivo de esta revisión de alcance fue mapear descriptivamente la evidencia sobre humidificación en oxigenoterapia convencional de bajo flujo en adultos, considerando confort, seguridad del paciente e implicancias potenciales para la práctica enfermera. Se realizaron búsquedas en PubMed/MEDLINE, Scopus, CINAHL y Web of Science, además de búsqueda manual, entre 2015 y 2025, en inglés, español o portugués. Se incluyeron estudios primarios y secundarios en adultos (≥18 años) con oxigenoterapia de bajo flujo mediante cánula nasal o mascarilla, y se efectuó extracción estandarizada orientada a la extracción de datos (charting) descriptivo de variables, desenlaces y medidas reportadas. Se incluyeron 12 estudios con diseños heterogéneos. Los estudios incluidos reportaron resultados no consistentes sobre beneficios de la humidificación rutinaria en confort global, los desenlaces se concentraron principalmente en síntomas nasales u orofaríngeos y tolerancia al dispositivo. En seguridad, se mapearon hallazgos de contaminación o colonización, especialmente en dispositivos reutilizables, con evidencia limitada sobre desenlaces clínicos atribuibles. La práctica enfermera apareció vinculada a valoración clínica, educación y estandarización del proceso cuando estos elementos fueron descritos por los estudios. En conjunto, esta revisión identifica una evidencia heterogénea que no permite sostener una recomendación general de humidificación rutinaria en bajo flujo, más bien, orienta a considerar decisiones contextualizadas y reevaluables, junto con estudios que incorporen medición estandarizada del confort y resultados clínicos y organizacionales.
Introduction Postoperative hemorrhagic shock is a time-critical complication associated with high morbidity and mortality, particularly in older surgical patients, requiring rapid, coordinated management in the intensive care unit (ICU). This case report describes specialized nursing management guided by the International Classification for Nursing Practice (ICNP®/CIPE®) and Benner's Clinical Wisdom Theory. Case presentation An 89-year-old woman underwent emergency gastrojejunostomy for intestinal obstruction and subsequently developed hemorrhagic shock with profound anemia (hemoglobin nadir 5.8g/dL), severe hyperlactatemia (12mmol/L), hypothermia (33.6̊C), peripheral hypoperfusion, and hypotension (mean arterial pressure<65mmHg). She required orotracheal intubation, invasive mechanical ventilation, and deep sedation. Diagnostic reassessment included serial hemoglobin and arterial blood gas analyses, lactate trending, invasive hemodynamic monitoring, and surgical re-exploration with intraoperative upper endoscopy, which suggested an upper gastrointestinal source (suspected Mallory–Weiss type lesion) treated endoscopically. Nursing priorities, structured using ICNP®, focused on perfusion restoration and correction of the lethal triad (hypothermia, acidosis, coagulopathy), multimodal analgesia, continuous monitoring, prevention bundles (infection and pressure injury prevention), and structured family communication. Discussion The patient progressively stabilized, with hemoglobin increasing to 9.6g/dL, lactate decreasing to <1mmol/L, normothermia recovery, discontinuation of vasopressors, and no documented ICU-acquired complications during the ICU stay. This case highlights how standardized nursing language (ICNP®/CIPE®), combined with advanced clinical reasoning and evidence-based ICU bundles, can improve the structure, traceability, and continuity of nursing care in postoperative hemorrhagic shock.
Introduction Vancomycin treats severe infections by resistant bacteria, but its acidity and local toxicity demand careful intravenous administration. Central venous catheters reduce these risks but pose complications. Midline catheters offer a less invasive alternative, though evidence remains limited. Objectives To map and describe the available clinical evidence on the safety and vascular complications associated with peripheral intravenous administration of vancomycin, compared with other vascular access devices, focusing on the type of complications reported, their diagnostic methods, and the methodological characteristics of the studies. Method A scoping review was conducted following the PRISMA-ScR guidelines. A comprehensive literature search was performed in Medline (via PubMed), Web of Science, Cochrane Library, CINAHL, and CUIDEN databases to identify studies reporting on intravenous vancomycin administration, catheter type and associated complications. Results Four studies met the inclusion criteria—two clinical trials and two cohort studies—with sample sizes ranging from 14 to 1087 participants. All studies reported complications attributed to vancomycin, regardless of catheter type. Two studies reported low rates of certain complications in patients receiving vancomycin through midline catheters, while other studies described complications associated with peripheral administration or recommended central access based on clinical considerations. Conclusion The available studies report heterogeneous findings regarding vascular complications associated with different vascular access devices for vancomycin administration. The evidence is limited and methodologically diverse, highlighting important gaps in the literature regarding outcome definitions, diagnostic approaches, and comparative evaluation across catheter types.
INTRODUCTION:Aerosol therapy during invasive mechanical ventilation is a common practice in intensive care units, however, its effectiveness is highly dependent on technical factors. Variability in device positioning and nursing technique produces substantial differences between the nominal dose and the fraction of drug that reaches the lungs, underscoring the need for standardized placement to enhance both safety and therapeutic efficiency. OBJECTIVE:To examine recent scientific evidence to determine the optimal positioning of aerosol delivery devices within the ventilator circuit, thereby guiding nursing practice toward standardized, evidence-informed procedures. METHODOLOGY:Systematized review (2018-2025) conducted in PubMed, BVSalud, and complementary academic search engines. MeSH, DeCS, and free-text terms related to aerosol therapy and mechanical ventilation were used. The PIO framework was applied following PRISMA guidelines and GRADE assessment. From 165 initial records, eight original studies were included. RESULTS:Vibrating mesh nebulizers demonstrated greater efficiency when positioned on the inspiratory limb, either near the Y-piece (10-15 cm) or at the humidifier inlet. Jet nebulizers showed optimal placement varying according to the device type (continuous, breath-actuated, or synchronized), although their overall performance was inferior to that of vibrating mesh nebulizers. Metered-dose inhalers were most effective when positioned on the inspiratory limb before the Y-piece, particularly when used with a spacer. CONCLUSIONS:The available evidence suggests that device positioning influences the efficiency of aerosol therapy during invasive mechanical ventilation. Vibrating mesh nebulizers and properly positioned inhalers may improve pulmonary drug delivery; however, the overall certainty of the evidence remains low.
Background Delirium is a common neuropsychiatric disorder but underdiagnosed in intensive care units due to the different presentations it can manifest. Nurses have an important role to play in preventing its onset and promoting sleep in their patients. Aim To describe the efficacy of the use of eye masks and earplugs in adult patients admitted to intensive care units on sleep quality and the development of delirium. Methods Systematic literature review of randomized clinical trials. During June and July 2024, the CINHAL, ScienceDirect, Medline, LILACS, ProQuest, Web of Science, and BioMed Central databases were consulted, applying filters based on time period, population, type of study, topic, and scientific journal. Studies were selected that analyzed the use of eye masks and earplugs as nursing care and whose methodological quality achieved a medium-high score using the CASPe tool. Results We found (N = 3742) studies. After applying filtering and selection criteria, a total of eight (n = 8) clinical trials were collected. With a total of 611 participants, it was observed that the use of eye masks and earplugs improved subjective sleep quality, while the data obtained on the incidence of delirium reflected an inconclusive result for its prevention due to the heterogeneity of the results. Conclusions Studies indicate that the use of sleep masks and earplugs in intensive care unit patients can improve sleep quality and reduce delirium. However, comfort and tolerance vary among patients, and it is crucial to consider duration of use and removals only for short periods of time. Although some studies show significant benefits, others find no relevant differences, suggesting the need for further research to optimize its use. The review has not received any funding.
Introducción La inteligencia emocional (IE) ayuda a las enfermeras a manejar emociones y a gestionar las situaciones estresantes prestando una atención de alta calidad. La sensibilidad moral (SM) es necesaria para reconocer los dilemas morales y evaluar las diferentes decisiones. Objetivos Conocer el nivel de inteligencia emocional y sensibilidad moral de las enfermeras de un área de críticos, así como estudiar la relación entre ambas y los datos sociodemográficos. Metodología Estudio descriptivo, prospectivo, correlacional en el área de críticos de un hospital universitario de nivel terciario. Se utilizó la escala de Wong and Law Emotional Intelligence Scale para evaluar el nivel de IE percibida en las enfermeras. Valora 4 dimensiones: percepción intrapersonal, percepción interpersonal, asimilación y regulación emocional. Para evaluar la SM se utilizó la escala de evaluación de la SM en los cuidados enfermeros (CuSMCE-23), que mide 2 factores: valores enfermeros y respuestas enfermeras. Además, se recogieron datos sociodemográficos. Se utilizó estadística descriptiva e inferencial considerándose estadísticamente significativos valores de p<0,05. Resultados Sesenta y dos enfermeras participaron en el estudio. La puntuación total de la IE fue de 5,51 (IC 95%: 5,37-5,64). El nivel de SM fue de 93,40 (IC 95%: 90,83-95,96).Con relación a la IE se hallaron diferencias significativas entre la puntuación total y tener personas a su cargo (p=0,010) y la jornada laboral (p=0,012). En cuanto a la SM también hubo correlación positiva entre la edad (p=0,046) y tener personas a su cargo (p=0,013).La correlación entre la IE y la SM también fue positiva (r=0,432, p<0,001). Conclusión Las enfermeras de cuidados críticos mostraron niveles medio-altos de IE y muy altos de SM. Factores como la edad y tener personas a cargo influyen en ambas. Es clave reconocer su relación para aplicarla en la práctica clínica. Se requieren programas formativos y más investigación para comprender mejor esta conexión emergente.
Introducción El delirium es un trastorno neuropsiquiátrico común pero infradiagnosticado en las unidades de cuidados intensivos debido a las diferentes presentaciones que puede manifestar. El personal de enfermería tiene una importante labor para prevenir su aparición y favorecer el sueño de sus pacientes. Objetivo Describir la eficacia del uso de antifaces y tapones para los oídos en el paciente adulto ingresado en unidades de cuidados intensivos sobre la calidad del sueño y el desarrollo de delirium. Metodología Revisión sistemática de la literatura de ensayos clínicos aleatorizados. Se consultaron durante los meses de junio y julio de 2024 las bases de datos CINHAL, ScienceDirect, Medline, LILACS, ProQuest, Web of Science y BioMed Central, aplicándose filtros de carácter temporal, poblacional, tipo de estudio, temático y relacionado con la revista científica. Se seleccionaron estudios que analizaran el empleo de antifaces y tapones como cuidados de enfermería y cuya calidad metodológica alcanzase una puntuación media-alta mediante la herramienta CASPe. Resultados Se hallaron (n=3.742) estudios. Tras aplicar filtrado y criterios de selección se recopilaron un total de (n=8) ensayos clínicos. Con un total de 611 participantes, se observó que el empleo de antifaces y tapones mejoraba la calidad subjetiva del sueño, mientras que los datos obtenidos en incidencia de delirium reflejaron un resultado no concluyente para su prevención debido a la heterogeneidad de los resultados. Conclusiones Los estudios indican que el uso de antifaces y tapones para los oídos en pacientes de la unidad de cuidados intensivos puede mejorar la calidad del sueño y reducir el delirium. Sin embargo, la comodidad y la tolerancia varían entre los pacientes, y es crucial considerar la duración de uso y las retiradas solamente durante breves periodos de tiempo. Aunque algunos estudios muestran beneficios significativos, otros no encuentran diferencias relevantes, lo que sugiere la necesidad de más investigación para optimizar su uso. La revisión no ha recibido fuentes de financiación.
INTRODUCTION:Pistoning is defined as the back-and-forth movement of the catheter at the insertion site. OBJECTIVE:To determine the frequency of pistoning in continuous renal replacement therapy catheters (CRRTC) and its relationship with intravascular thrombosis and catheter dysfunction. METHOD:A longitudinal descriptive study (March 2023-June 2024) was conducted in two intensive care units. Patients with CRRTC inserted in these units were included.Body mass index (BMI), insertion site, dwell time, and reason for removal were recorded. At each dressing change, pistoning, dysfunction, day of onset, suture fixation status (SFS), hematoma, and line traction were assessed. After catheter removal, ultrasound was performed to determine intravascular thrombosis. Descriptive statistics and bivariate analysis using chi-square or Fisher's exact test and t-Student test were applied, with significance set at p ≤ 0,05. RESULTS:A total of 63 catheters were analysed. Pistoning occurred in 42.9% (n = 27;) and dysfunction in 31.8% (n = 20), at median 3 [P25 = 2-P75 = 9] and 3.5 [P25 = 1.5-P75 = 6.5] days respectively. Intravascular thrombosis was identified in 26.1% (n = 12). Incorrect SFS was observed in 59.3% of catheter with pistoning (CWP) compared with 11.1% of catheter without pistoning(CWoP) (p < 0.001). CWP remained in place for 11 days (8.5) and CWoP for 7.3 days (3.9) (p = 0.02). Patients with dysfunction had a BMI of 34.5 kg/m2 (SD = 10.3) compared with 29.8 kg/m2 (SD = 4.6) in those without dysfunction (p = 0.03). No significant differences were found between pistoning and thrombosis (p = 0.30) or between pistoning and dysfunction (p = 0.06). DISCUSSION:Pistoning was frequent and was mainly associated with defective SFS and longer dwell time. Obesity was identified as a factor associated with catheter dysfunction. CONCLUSIONS:Nearly half of CRRT catheters present pistoning, associated with inadequate fixation and longer dwell time. Catheter dysfunction is more frequent in patients with obesity.
Introduction Spirituality, recognized as an essential aspect of nursing care, contributes to well-being and resilience in critical care settings. Its integration into practice strengthens the meaning and sense of meaning and purpose in the lives of nursing professionals. Objective To systematically review the evidence on spirituality among nursing professionals working in critical healthcare settings. Methodology A systematic review and meta-analysis were conducted following the PRISMA guidelines. The protocol was registered in PROSPERO (CRD42023371984). Searches were performed from inception to april 2024 in the following databases: Medline/PubMed, Embase, Lilacs, Cochrane CENTRAL, and Web of Science. The meta-analysis of individual means was performed using a random-effects model. Untransformed means (MRAW) were used to estimate the 95% confidence intervals of individual studies, while the I2 and tau2 statistics assessed heterogeneity. Results A total of 1175 studies were identified, 34 of which were included in the systematic review and 4 in the meta-analysis. A prevalence of 58,8% was observed in non-experimental quantitative studies, with “spirituality education and meeting spiritual needs” being the main theme. Meta-analyses were conducted on studies using scales to assess spirituality levels, particularly the Spiritual Care Competence Scale (SCCS), which showed the best performance with an MRAW of 98,56 (IC 95%: 97,86; 99,25; I2: 0,0%), indicating a moderate level of competence in spiritual care. Conclusions The findings highlight the importance of spirituality in professional performance in critical care settings, emerging as a key component for promoting well-being by strengthening resilience in the face of caregiving challenges.
INTRODUCTION:Higher nursing workload (NW) is associated with a negative impact on patient-focused clinical outcomes in critical care units. Adjusting the nursing staffing to the individualized care needs of critically ill patients' using a validated scale could constitute an efficient care management strategy in these settings. OBJECTIVE:Assessing NW within 24 h of admission and discharge using the Nursing Activities Score (NAS) in 4 adult critical care units. METHODOLOGY:Prospective, observational, single-center study. POPULATION:Patients admitted to the critical care units of a high-complexity hospital from October 2022 to February 2023. Descriptive analysis, Student's t-test, ANOVA, and multiple linear regression were performed using SPSS® v26. RESULTS:A total of 236 patients were included, of which 143 (60.9%) were male and the mean age was 61.30 (15.79). The reason for admission was medical in 151 (64.3%) cases, unplanned in 184 (78.3%) cases, APACHE II 17.09 (7.31), Charlson index of 5 [3-8], number of devices 4 [3-6], invasive ventilation 97 (41.1%), length of stay 5 [3-10] days, on admission ratio 1:2 in 203 (86.0%) and care level 3 in 236 (100.0%), on discharge with ratio 1:2 in 232 (98.3%) and care level 2 in 195 (82.6%). The mean NAS 24 h on admission was 59.46 (5.19) and on discharge was 51.13 (7.55). The variables that predicted the 24-h NAS on admission were the unit (P = .001), number of devices (P < .001), and APACHE IIs (P < .001); while those predicting 24-h NAS at discharge were unit (P < .001), mortality (P < .001), care level (P < .001), number of devices (P = .011), and length of ICU stay (P = .037). CONCLUSIONS:NW was high, both at admission and discharge, exceeding the 1:2 ratio. Higher rates were found in the afternoon shift. The variables that predict NW on admission are the unit, number of devices and severity of illness, and on discharge, also mortality, level of care, and length of ICU stay.
Introduction Point-of-care ultrasound is essential in the initial assessment of polytrauma patients. The E-FAST protocol enables rapid detection of intra-abdominal free fluid, pericardial effusion, and pneumothorax, with particular usefulness in prehospital settings. However, ultrasound training among emergency nursing staff remains limited, especially within Advanced Life Support (ALS) mobile units. Objective To evaluate the effect of a brief, structured training program on the acquisition of competencies for obtaining E-FAST windows in ALS mobile units nurses, assessing knowledge, technical skills, scanning sequence, and perceived confidence. Method A quasi-experimental pre-post intervention study was conducted with nurses with ≥6 months of experience in emergency or prehospital care. The intervention included baseline assessment, a 2-h theoretical module, high-fidelity simulation with Ultrasound Mentor®, and hands-on practice with human models. Final assessment combined a theoretical test, simulator-based practical evaluation, and scanning with a real ultrasound device. Knowledge, execution times, and confidence levels were recorded. Results Fourteen nurses participated, most without previous ultrasound training (85.7%). Initial confidence was low and improved significantly after the intervention. Theoretical performance increased in 5 of the 6 evaluated items, reaching up to 92.9% accuracy in key content areas. Practical assessment demonstrated an organized scanning sequence and appropriate times for prehospital care (medians of 118 s [IQR 24.5] in advanced simulation and 237 s [IQR 33.3] using a real ultrasound device). Discussion The program enabled the acquisition of essential skills even in professionals without prior ultrasound experience. The combination of theory, simulation, and hands-on practice facilitated rapid competency transfer and protocol standardization. Conclusions A brief training program improves ALS mobile units nurses’ competence and confidence in obtaining E-FAST windows, supporting the safe integration of point-of-care ultrasound into prehospital care.
Introducción Un reparto inadecuado de la carga de trabajo enfermero (CTE) en las unidades de cuidados críticos influye negativamente sobre los resultados clínicos de los pacientes. La identificación individualizada de las necesidades de cuidados de estos pacientes mediante una escala validada podría constituir una estrategia de gestión eficiente en este nivel asistencial. Objetivo Evaluar la CTE en las 24h del ingreso y del alta mediante la Nursing Activities Score (NAS) en 4 unidades de cuidados críticos de adultos. Método Estudio observacional prospectivo unicéntrico. Población Pacientes ingresados en unidades de cuidados críticos de un hospital de alta complejidad desde octubre de 2022 a febrero de 2023. Se realizó análisis descriptivo, test de la t de Student, ANOVA y regresión lineal múltiple utilizando SPSS® v26. Resultados Se incluyeron 236 pacientes, siendo hombres 143 (60,9%), edad media 61,30 (15,79), motivo de ingreso médico 151 (64,3%), urgente 184 (78,3%), APACHE II 17,09 (7,31), índice de Charlson de 5 [3-8], número de procedimientos 4 [3-6], ventilación invasiva 97 (41,1%), estancia 5 [3-10] días, al ingreso ratio 1:2 en 203 (86,0%) y nivel de cuidados 3 en 236 (100,0%), al alta con ratio 1:2 en 232 (98,3%) y nivel de cuidados 2 en 195 (82,6%). La media de NAS 24h al ingreso fue 59,46 (5,19) y al alta fue 51,13 (7,55). Las variables que predijeron la NAS 24h ingreso fueron la unidad (p=0,001), el número de procedimientos (p<0,001) y APACHE II (p<0,001); en cuanto a la NAS 24h alta, fueron la unidad (p<0,001), la mortalidad (p<0,001), el nivel de cuidados (p<0,001), el número de procedimientos (p=0,011) y los días de estancia (p=0,037). Conclusiones Las CTE tanto al ingreso como al alta son superiores a la ratio 1:2, siendo mayores en el turno de tarde. Las variables que predicen las CTE al ingreso son la unidad, el número de procedimientos y la gravedad; y al alta, además, la mortalidad, el nivel de cuidados y los días de estancia.
Introducción La espiritualidad identificada como un aspecto esencial en el cuidado de enfermería, contribuye al bienestar y resiliencia en los contextos críticos de atención. Su incorporación en la práctica refuerza el significado y sentido de propósito en la vida de los profesionales de enfermería. Objetivo Revisar sistemáticamente la evidencia sobre la espiritualidad en los profesionales de enfermería que laboran en contextos críticos de atención en salud. Metodología Revisión sistemática y metaanálisis que siguió las recomendaciones de la declaración PRISMA. El protocolo se registró en PROSPERO (CRD42023371984). La búsqueda fue realizada desde el inicio hasta abril de 2024 en las bases de datos: Medline / PubMed, Embase, Lilacs, Cochrane CENTRAL y Web of Science. El metaanálisis de medias individuales fue efectuado mediante un modelo de efectos aleatorios. Las medias no transformadas (MRAW) se utilizaron para estimar el intervalo de confianza del 95% (IC 95%) de los estudios individuales, mientras que los estadísticos I2 y tau2 examinaron la heterogeneidad. Resultados Se identificaron 1.175 estudios, 34 fueron incluidos en la revisión sistemática y 4 en el metaanálisis. Se evidenció una prevalencia del 58,8% en investigaciones cuantitativas no experimentales, siendo la «educación en espiritualidad y asistencia a los requerimientos espirituales» el tema principal. Se realizaron metaanálisis en los estudios que usaron las escalas que evaluaban el nivel de espiritualidad, destacando la escala de Spiritual Care Competence Scale (SCCS), que obtuvo una MRAW de 98,56 (IC 95%: 97,86-99,25; I2: 0,0%), con el mejor comportamiento, obteniendo un nivel medio de competencia en cuidado espiritual. Conclusión Se señala la importancia de la espiritualidad en el desempeño profesional en contextos críticos, visibilizándose como un componente fundamental para su bienestar al reforzar su resiliencia ante los desafíos en el cuidado.
INTRODUCTION:Microcirculatory integrity is essential for maintaining tissue homeostasis. In critically ill patients, microcirculatory dysfunction is strongly associated with tissue hypoperfusion, multiple organ failure, and increased mortality, yet remains frequently undetected by conventional macrocirculatory parameters. This discrepancy has driven growing interest in identifying reliable bedside tools for microcirculatory assessment in intensive care settings. OBJECTIVES:To evaluate the prognostic and clinical utility of key microcirculatory monitoring parameters-including lactate, central venous oxygen saturation (SvcO₂), veno-arterial carbon dioxide difference (ΔPCO2), and capillary refill time (CRT)-in adult critically ill patients. METHODS:A systematic review with narrative synthesis was conducted and reported in accordance with the PRISMA guidelines. The search encompassed publications from 2020-2024 in PubMed, Web of Science, ScienceDirect, and Cochrane Library. Studies involving adult ICU patients that assessed the relationship between microcirculatory parameters and clinical outcomes were selected. Out of 250 identified studies, 18 were included after screening, with their quality assessed using the Jadad and Newcastle-Ottawa scales. Methodological heterogeneity precluded meta-analysis. RESULTS:A ΔPCO₂ >6 mmHg and CRT > 3 s were associated with higher mortality and organ dysfunction, although CRT showed limitations due to subjectivity. Lactate ≥4.1 mmol/L at 6 h was the best predictor (AUC = .845), despite low specificity from non-hypoxic causes. SDF microscopy demonstrated microvascular dysfunction as an independent predictor, though requiring standardization. CRT-guided resuscitation reduced fluid overload; parameter combination improved prognostic accuracy compared to isolated use. The utility of ΔPCO₂, CRT, and lactate depends on clinical context, timing of measurement, and an integrative approach; however, their physiological and methodological limitations - lack of standardised protocols, need for training, and technical constraints - challenge isolated interpretation, reinforcing the need for multimodal strategies and dynamic monitoring. CONCLUSION:Integrating microcirculatory monitoring into standard hemodynamic assessment holds potential to improve individualized resuscitation strategies, minimize iatrogenic fluid burden, and enhance outcomes in critically ill patients.
BACKGROUND:Critical care nurses are in an important position of patient care, and time management can increase their ability to make faster decisions and improve patient outcomes. Time management is an important part of nurses' professional performance. PURPOSE:This study aimed to determine time management and its dimensions among nurses working in critical care units. METHODS:This descriptive cross-sectional study was conducted on 350 nurses working in adult critical care units (ICU and CCU) of teaching hospitals in Tehran, Iran in 2022. Multistage random sampling was used. The researcher provided the time management questionnaire to eligible nurses. Inferential statistics were used to investigate the correlation between demographic variables and time management. RESULTS:Most nurses reported favorable TM (mean score = 94.43 ± 22.82 on a 0-100 scale). A multiple linear regression model identified three significant predictors: nurses working 1-20 monthly overtime hours scored higher in TM (β = 0.17, P = 0.001); those earning 70-130 million Rials scored lower than higher-income peers (β = -0.157, P = 0.003); and nurses with 1-5 years of critical care experience outperformed those with >20 years (β = 0.119, P = 0.024). However, the model explained only 7% of the variance in TM scores (R2 = 0.07). CONCLUSIONS:Most nurses demonstrated favorable time management. Higher years of work experience/income and official employment were not associated with better time management in critical care nurses. However, good time management was reported in fewer monthly overtime hours. IMPLICATIONS FOR PRACTICE:In-service time management training, especially for nurses with more years of work experience and stable working conditions, can improve all aspects of time management.
INTRODUCTION:Critical care, emergency, and urgent care nursing is practiced within a highly specialised clinical setting that requires advanced competencies extending beyond generalist nursing education and that are not currently formally delineated through a state-recognized residency-based specialty within the nursing specialties of the Spanish National Health System. The national regulatory framework allows for the justification of new specialties based on healthcare needs, clinical complexity, and the existence of clearly differentiated professional competencies. OBJECTIVE:To identify the specific competencies of nurses in critical care, emergency, and urgent care, by analysing their differences in relation to existing nursing specialties, as a basis for justifying their establishment as a distinct specialty. METHOD:A sequential mixed-methods, descriptive and comparative study was conducted in three phases: 1) a competency questionnaire based on the Nursing Interventions Classification, the Therapeutic Intervention Scoring System-28, and the National Aeronautics and Space Administration-Task Load Index; 2) an eDelphi consensus process; and 3) an association analysis between nursing interventions and NANDA-I diagnoses. Data were analysed using descriptive statistics and concordance measures, yielding high levels of reliability. RESULTS:The first phase of the study was completed by 3476 nurses, and 302 experts participated in the second phase. In the third phase, 72.72% of the interventions reached a high frequency level (4-5), with a predominance of generalist activities such as nutrition, mobility, hygiene, safety, and comfort. In contrast, specific interventions; including oxygenation, advanced therapies, diagnostics, and critical communication; showed a high frequency exclusively in intensive care units, post-anesthesia care units, in-hospital and out-of-hospital emergency services, and advanced life support and nurse-led advanced life support teams (85.6%). Concordance in nursing interventions was 67.10%, and the intervention-nursing diagnosis association reached 53.65%, with only 31.46% shared with existing nursing specialties. DISCUSSION:The findings identify an advanced and homogeneous competency core in critical care, emergency, and urgent care nursing, clearly differentiated from generalist practice and aligned with international advanced practice frameworks. CONCLUSIONS:Establishing a dedicated specialty would standardise training and competencies, leading to improvements in patient safety, quality of care, and healthcare system efficiency.
