Background: The provision of end-of-life care (EOLC) is an ongoing component of practice in intensive care units (ICUs). Interdisciplinary, multicomponent interventions may enhance the quality of EOLC for patients and the experience of family members and ICU clinicians during this period. Objectives: This study aimed to assess the impact of a multicomponent intervention on EOLC practices in the ICU and family members' and clinicians' perceptions of EOLC. Methods: A before-and-after interventional study design was used. Interventions comprising of EOLC guidelines, environmental and memory-making resources, EOLC education day for nurses, web-based resources, and changes to EOLC documentation processes were implemented in a 30-bed adult tertiary ICU from September 2020 onwards. Data collection included electronic health record audits of care provided post initiation of EOLC and family and clinician surveys. Open-ended survey questions were analysed using content analysis. Data from before and after the intervention were compared using the Chi-squared test for categorical variables, unpaired two-sample t-tests for normally distributed continuous measurements, and Manne-Whitney U tests for non-normally distributed data. Findings: A reduction in documented observations and medications and an increased removal of invasive devices unrelated to EOLC were observed post the intervention. The mean overall satisfaction of family members improved from 4.5 to 5 (out of 5); however, this was not statistically significant. Statistically significant improvements in clinicians' perception of overall quality of EOLC (mean difference = 0.28, 95% confidence interval: 0.18, 0.37; t(282) = 5.8, P < 0.01) were found. Although statistically significant improvements were evident in all subscales measured, clinicians' work stress related to EOLC and support for staff, patients, and their families were identified as needing further improvement. Conclusions: The development and implementation of a multicomponent interdisciplinary intervention successfully improved EOLC quality, as measured by chart audit and family and clinician perceptions. Continuing interdisciplinary collaboration is needed to drive further change to continue to support high- quality EOLC for patients, families, and clinicians in the ICU. Crown Copyright (c) 2024 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

ABSTRACTAimsTo evaluate the implementation process of a novel program focused on improving interactive (dialogic) feedback between clinicians and students during placement.DesignQuantitative cross‐sectional hybrid type 3 effectiveness–implementation study driven by a federated model of social learning theory and implementation theory.MethodsFrom June to November 2018, feedback approaches supported by socio‐constructive learning theory and Normalisation Process Theory were enacted in four clinical units of a healthcare facility in southeast Queensland, Australia. The study involved 16 clinical instructors/supervisors, 94 bedside nurses, and 85 final‐year nursing students. Engagement was evaluated using the Normalisation Measure Development survey. Situated learning encounters were constructed based on the needs of each group.ResultsSurvey results of the four Normalisation Process Theory constructs identified variable adoption by participant groups. Engagement in situated learning encounters that facilitate dialogic feedback was greatest in clinical instructors/supervisors, followed by students. Bedside registered nurses, while indicating they understood purposeful feedback behaviours, did not demonstrate them in practice.ConclusionThe extent to which each group practiced dialogic feedback depended on their perceptions of their influence, whether they saw it as part of their role, and the effort and time required, regardless of the activity's importance, role statements, and codes of conduct.Implications for the ProfessionUnderstanding the norms that shape communication, engagement, and nurses' role priorities is crucial for guiding practice and ongoing engagement with feedback.ImpactThe research provides valuable insights for leaders aiming to enhance the integration of evidence into practice. It guides leaders to understand that participants prioritise the reach, relevance, and resources of evidence over formal role descriptions, responsibilities, policies, and codes of conduct. This research encourages leaders to scrutinise existing beliefs, norms, and routines when implementing evidence‐based practices.Reporting MethodStandards for Reporting Implementation Studies (StaRI) reporting guidelines were used.No Patient or Public ContributionNone.

Objectives: In responding to a Chemical, Biological, Radiological, and Nuclear explosive (CBRNe) disaster, clinical leaders have important decision-making responsibilities which include implementing hospital disaster protocols or incident command systems, managing staffing, and allocating resources. Despite emergency care clinical leaders' integral role, there is minimal literature regarding the strategies they may use during CBRNe disasters. The aim of this study was to explore emergency care clinical leaders' strategies related to managing patients following a CBRNe disaster. Methods: Focus groups across 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. Thirty-six hospital clinical leaders from the 6 study sites crucial to hospital disaster response participated in 6 focus groups undertaken between February and May 2021 that explored strategies and decision making to optimize patient care following a CBRNe disaster. Results: Analysis revealed the use of rehearsals, adopting new models of care, enacting current surge management processes, and applying organization lessons were facilitating strategies. Barriers to management were identified, including resource constraints and sites operating over capacity. Conclusions: Enhanced education and training of clinical leaders, flexible models of care, and existing established processes and tested frameworks could strengthen a hospital's response when managing patients following a CBRNe disaster.

Introduction Natural hazards resulting in disasters are increasing globally, impacting communities and disrupting industries. In addition to planning for these natural hazard disasters, emergency departments (EDs) should prepare for chemical, biological, radiological, and nuclear (CBRN) incidents that result in surges of patient presentations. Chemical, biological, radiological, and nuclear incidents differ in preparedness to natural hazards, requiring an understanding of patient management and health system-related challenges. Methods This scoping review used the Arksey and O’Malley five-step framework. Manuscripts were retrieved from four databases and search engines using keywords relating to impacts on the ED from real world CBRN event(s). Analysis focused on the characteristics of CBRN event, ED impact, and lessons learnt against four surge capacity domains that including staff, stuff, space, and systems. Results A total of 44 paper were included in this review. Most of the incidents were chemical in nature (n = 36/44, 81.8 %). The majority of CBRN incidents were accidental (n = 34/44, 77.3 %). Between 1 and 1470 people (Mdn=56, IQR: 18–228) presented to an ED from each event. Most patients were discharged from the ED, but this was variably reported. Some key lessons related to secondary exposure to ED staff, repurposing spaces, and coordination of CBRN incidents. Conclusion With the increasing number of CBRN incidents, strategies to strengthen EDs and limit the impact from a surge in patient presentations are paramount. An understanding of local CBRN risk to inform a top-hazards approach to CBRN preparedness, and the implementation of pre-emptive CBRN clinical pathways is recommended. Additionally, strategies should be implemented to protect staff from the risk of secondary exposure to a CBRN event. These strategies may include adequate education, training, and personal protective equipment for staff.

Background: Central venous catheters are commonly used in healthcare, but they come with a range of potential complications. Over the last 15 years, an influx of securement and dressing products has been released, with unknown overall effectiveness to prevent these complications. Objective: To compare the effects of dressings and securement devices for central venous catheters on a range of common complications including catheter-related bloodstream infection, catheter tip colonisation, entry/exitsite infection, skin colonisation, skin irritation, failed catheter securement, dressing durability and mortality. Design: Systematic review with meta-analysis. Methods: Following standard Cochrane methods, a systematic search of Cochrane Wounds Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, EBSCO CINAHL, and multiple clinical trial registries was completed in November 2022. Randomised controlled trials evaluating the effectiveness of dressing and securement devices for all CVC types were included. A random-effects model was used during the meta-analysis. Results were expressed using risk ratio (RR), rate ratio, or mean difference (MD), with 95 % confidence intervals (CIs). Methodological quality and bias were assessed. Results: We included 46 studies involving 10,054 participants. All studies had either an unclear or highperformance bias. The blinding of outcome assessment was unclear in most studies. Chlorhexidine gluconateimpregnated dressings, compared with standard polyurethane dressings, may reduce the incidence (7 studies; N = 5816; RR 0.60, 95 % CI 0.44-0.83; low certainty evidence) and rate (4 studies; N = 4447; RR 0.51, 95 % CI 0.32-0.79; moderate certainty evidence) of catheter-related bloodstream infection and catheter tip colonisation (8 studies; N = 4788; RR 0.70, 95 % CI 0.52-0.95; very low certainty evidence). Medication-impregnated dressings may reduce the incidence of catheter-related bloodstream infection (6 studies; N = 5687; RR 0.60, 95 % CI 0.39-0.93; low certainty evidence) and catheter-tip colonisation (7 studies; N = 4769; RR 0.60, 95 % CI 0.47-0.76; low certainty evidence) relative to non-impregnated dressing types. Tissue adhesive may increase the risk of skin irritation or damage compared with integrated securement dressings (3 studies; N = 166; RR 1.88, 95 % CI 1.09-3.24; low certainty evidence) or sutureless securement devices (4 studies; N = 241; RR 1.64, 95 % CI 1.10-2.44; moderate certainty evidence). Tissue adhesive increased dressing durability compared with integrated securement dressings (MD 43.03 h, 95 % CI 4.88-81.18; moderate certainty evidence) and sutureless securement devices (MD 42.90 h, 4.64-81.16; moderate certainty evidence). Tissue adhesive increased failed catheter securement rate compared with suture (2 studies; N = 103; RR 9.33, 95 % CI 1.10-79.21; moderate certainty evidence).Conclusions: The findings of the review provide insights and guidance for clinicians in selecting the appropriate dressings and securements for catheters. Findings should be interpreted with caution due to heterogeneity in catheters and patient types. Registration: #CD010367. Tweetable abstract: Time to implement chlorhexidine gluconate-impregnated dressings to prevent catheter related bloodstream infections; a meta-analysis by @GraceNP and team. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

BACKGROUND:Work-integrated learning and performance is intimately linked with assessment and feedback; however, empirical evidence concerning the impact of feedback on student performance in workplace settings is limited. A novel practice-based feedback intervention-the REMARK (nuRse fEedback iMplementAtion frameworRK) program-was developed and implemented. Sustainable feedback processes that involve both learners and learning partners can ultimately maximise learning outcomes, optimise self-regulation, and impact performance.OBJECTIVES:To determine the impact of implementing an educational intervention based on best practice principles of feedback on undergraduate nursing student performance during clinical placements in acute healthcare settings.METHODS:A non-equivalent, quasi-experimental design was used. A pre- and post-assessment strategy for both control and intervention groups was employed. The REMARK program was based on known attributes of effective feedback critiqued in the literature that foster interactions between a learner and learning partner and, hence, support dialogic feedback.RESULTS:Clinical assessment data of 214 final-year nursing students collected at three time points were analysed. Using multivariate modelling, the results indicated that students participating in the REMARK programme (intervention group) had statistically higher performance scores than students in the control group when time and placement setting were controlled.CONCLUSIONS:This research provides evidence that engagement with an intervention based on attributes of effective feedback improves nursing students' workplace performance during clinical placement. To achieve the greatest advantage, incorporating strategies that encourage students to adopt an active role in feedback conversations that relate to the student's learning goals are recommended.

Introduction:Disasters occur globally and can impact emergency department (ED) services. Chemical, biological, radiological, and nuclear (CBRN) events have different characteristics in terms of onset and duration when compared to other disasters, such as wildfires, floods, and hurricanes. It is important to have an understanding of the impact of CBRN events on EDs to inform disaster preparedness. The purpose of this paper is to identify peer-reviewed published literature that describes the impact on EDs from CBRN events.Method:An integrative literature methodology was used, guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) Guidelines. MEDLINE, PsycINFO, CINAHL, Pubmed, and Scopus were searched using terms relating to CBRN events and EDs. Papers were included if they focused on the impact of real-world CBRN event(s). Information from each included paper was extracted into a table, including author(s), CBRN event characteristics, ED response characteristics, patient presentation characteristics, and outcome characteristics.Results:Of the 15,982 studies that were identified from the database searches, 4,012 were duplicates and 11,696 were irrelevant at the title and abstract screening stage. Therefore, 274 were screened at the full-text stage resulting in 44 studies for inclusion. Included papers were mostly from the United States of America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%). Most of the events were chemical (n=36/44, 81.9%), with Chlorine (n=9/36, 25%) being the most frequently reported chemical agent. Between 1 and 5,500 people [M=54, IQR: 22-253] presented to EDs because of CBRN events.Conclusion:Emergency departments assess and manage patients who present following CBRN events. Of these patients, the majority do not require hospital admission, suggesting that the ED is integral in the health response to CBRN events. As such, EDs should be adequately prepared, from a resource and process perspective to assess, manage and discharge large numbers of CBRN-related patients.

Background: Despite a growing body of research into end-of-life care (EOLC) in intensive care units (ICUs), few studies have concurrently explored the perspectives of families and clinicians.Objective: The objective of this study was to identify the characteristics of high-quality EOLC in the ICU from family and clinician perspectives and by examining the care documented in medical records.Methods: A convergent mixed-methods study incorporating electronic health record audits (n = 20), structured interview surveys with families (n = 20), clinician surveys (n = 189), and focus groups (n = 10) was undertaken at a 30-bed, level 3 ICU at a metropolitan public adult teaching hospital in Australia. Descriptive statistics were calculated from quantitative data, and inductive thematic analysis was used to analyse qualitative data.Results: Overall, families were very satisfied with EOLC and the quality of communication yet, felt that earlier, clearer communication that the patient was dying was required. Families spoke of the attentiveness, or lack thereof, by ICU clinicians and the opportunity to be present for the patient's death. The majority of ICU clinicians felt EOLC could be improved. Nurses highlighted communication challenges when family meetings were delayed. Some nurses expressed a lack of clarity of how to withdraw care, resulting in hesitancy to cease potentially inappropriate care, and to provide EOLC outside ICU practice norms. In many instances, observations, invasive monitoring, and interventions were documented after EOLC commenced. A lack of documented personal cares was also noted.Conclusions: This study provides new insights into EOLC from the dual perspectives of families and clinicians. There is a need for institutional guidelines to support ICU clinicians' EOLC practices and education to improve clinician confidence with communication.Crown Copyright & COPY; 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.

Background: The effect of the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and spontaneous breathing trials; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment) on patient outcomes such as delirium is potentially optimised when the bundle is implemented in its entirety.Objective: To systematically synthesise the evidence on the effectiveness of the ABCDEF bundle delivered in its entirety on delirium, function, and quality of life in adult intensive care unit patients.Design: Systematic review and meta-analysis.Data source: Electronic databases including MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Joanna Briggs Institute's Evidence Based Practice, Australian New Zealand Clinical Trials Registry, and Embase were searched from 2000 until December 2021.Review methods: Inclusion criteria included (1) adult intensive care unit patients (2) studies that described the ABCDE or ABCDEF bundle in its entirety (3) studies that evaluated delirium, functional outcomes, or quality of life. Studies were excluded if they investigated long-term intensive care unit rehabilitation patients. Two reviewers independently screened records and full text, extracted data, and undertook quality appraisals with discrepancies discussed until consensus was reached. Random effects meta-analyses were conducted for delirium but was not possible for other outcomes. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess the certainty of the synthesised findings of the body of evidence. The study protocol was registered on PROSPERO (CRD 42019126407).Results: A total of 18 studies (29,576 patients) were included in the descriptive synthesis. Meta-analysis of six studies (2000 patients) identified decreased delirium incidence following implementation of the ABCDEF bundle when compared with standard practice, (risk ratio = 0.57; CI, 0.36-0.90 p = 0.02) although heterogeneity was high (I2 = 92%). When compared with standard practice, a meta-analysis of five studies (3418 patients) showed the ABCDEF bundle statistically significantly reduced the duration of intensive care unit delirium (mean difference (days) - 1.37, 95% CI -2.61 to -0.13 p = 0.03; I2 96%). Valid functional assessments were included in two studies, and quality of life assessment in one.Conclusions: Although the evidence on the effect of the ABCDEF bundle delivered in its entirety is limited, positive patient delirium outcomes have been shown in this meta-analysis. As this meta-analysis was based on only 4736 patients in eight studies, further evidence is required to support its use in the adult intensive care unit. Registration Details: PROSPERO (CRD 42019126407).(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Patient handover continues to be an international health priority in the prevention of pa-tient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams.Objectives/aim: To design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients. Methods: A multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention.Results: Eleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient intro-duction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems. Conclusion: Precise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma pa-tients. Further improvements are required to reduce the failure to hand over essential patient information.Crown Copyright & COPY; 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.

Background: Peripheral intravenous catheters are the most widely used invasive device in hospitals but have serious risks. Objective: To determine if a structured assessment and decision tool (I-DECIDED (R)) improves daily peripheral intravenous catheter assessment and care decisions. Design: Prospective, interrupted time-series study. Settings: Seven adult inpatient wards in three Australian hospitals. Participants: 825 adults with 867 peripheral intravenous catheters. Methods: Between August 2017 and December 2018, peripheral intravenous catheter assessments and chart audits were undertaken with informed patient consent. Following a 4-month pre-intervention period (with 2weekly measures), the I-DECIDED (R) tool was implemented over 3 months (no data collection) using multiple strategies (stakeholder meetings, vascular access device form, education sessions, ward champions, lanyard cards, and posters), followed by a 4-month post-intervention period (with 2-weekly measures). Primary outcomes were device utilization (number of peripheral intravenous catheters per total number of patients screened); idle/unused catheters; insertion site complications, substandard dressing quality; and primary bloodstream infections. Results: Of 2055 patients screened, 1175 (57.2%) had a peripheral intravenous catheter, and 825 patients (867 catheters) consented and were included in the final analysis. Device utilization increased from 42.0% of catheters at baseline to 49.6% post-intervention (absolute risk difference [ARD] 7.5%, 95% confidence interval [CI] 4.8, 10.3; relative risk [RR] 1.18, 95% CI 1.11, 1.25; p < 0.001). The proportion of idle catheters reduced from 12.7% to 8.3% (ARD -4.4%, 95% CI -8.5, -0.3; RR 0.66, 95% CI 0.44, 0.97; p = 0.035). Peripheral intravenous catheter complications reduced from 16.1% to 10.9% (ARD -5.2%, 95% CI -9.7, -0.6; RR 0.68, 95% CI 0.48, 0.96; p = 0.026). Substandard dressings reduced from 24.6% to 19.5% (ARD -5.2%, 95% CI -10.7, 0.4; RR 0.79, 95% CI 0.61, 1.02; p = 0.067). Only one primary bloodstream infection occurred (post-intervention). Conclusions: Implementation of a comprehensive device assessment and decision tool (I-DECIDED (R)) reduced idle catheters and catheter complications, despite higher device utilization. Dressing quality improved but was not statistically significant. Further implementation of the tool could improve hospital safety for patients with an intravenous catheter. ANZCTR trial registration: ACTRN12617000067370. Date of registration 13 January 2017. Date of first data collection 3rd August 2017. Tweetable abstract: #IDECIDEDassessment reduces prevalence of idle peripheral catheters and device complications. (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http:// creativecommons.org/licenses/by-nc/4.0/).

Background: Intensive care units (ICUs) are emotionally demanding workplaces. Exposure to stress can negatively impact ICU staff members' emotional resilience, health, and capacity to provide care. Despite recognition of the benefits of promoting "healthy workplaces", there are limited interventional studies aimed at improving the well-being of ICU staff.Aim: The aim of this study was to assess the effectiveness of a multifaceted intervention for improving well-being of staff working in a tertiary ICU.Methods: A before-and-after interventional study was conducted over a 2-year period, between 2019 and 2021. Interventions included social activities, fitness, nutrition, and emotional support. An electronic version of the PERMA-Profiler questionnaire was used to assess the well-being of a convenience sample of ICU staff before (n = 96) and after (n = 137) the intervention. Ten focus groups (each involving 12-18 nurses) were held to explore nurses' perceptions of the intervention's effectiveness.Results: After the intervention, a significantly greater proportion of participants described their work week as draining (32% vs 19%, c2 = 4.4 df + 1, P = 0.03) and at least a bit harder than normal (38% vs 22%, c2 = 6.4 df + 1, p = 0.01) compared to baseline surveys. However, well-being scores after the inter-vention (mean = 6.95, standard deviation = 1.28) were not statistically different (p = 0.68) from baseline scores (mean = 7.02, standard deviation = 1.29). Analysis of focus groups data revealed three key cat-egories: boosting morale and fostering togetherness, supporting staff, and barriers to well-being.Conclusions: After the intervention, there was a preserved level of well-being from baseline despite a statistically significant increase in staff reporting the work week as draining and at least a little bit harder than normal. These findings must be considered in light of the COVID-19 pandemic, which started after baseline data collection and continues to impact the community, including staff workload and pressures in intensive care. The study findings may inform strategies for improving ICU staff members' well-being. CrownCopyright (c) 2022 Published by Elsevier Ltd on behalf of Australian College of Critical Care Nurses Ltd. All rights reserved.

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

BACKGROUND:Cervical collars are used as standard care for neck immobilisation after cervical spine injury. Although evidence for the most effective type of collar is lacking, there is evidence regarding adverse patient outcomes when managed in a semi or rigid collar. In response to the evidence of complications and adverse effects when using a hard collar, a large Australian adult trauma hospital that specializes in spinal care, changed its policy from hard to soft collars when managing acute cervical spine injury.OBJECTIVE:The aim of this study was to investigate patients' experiences and outcomes when wearing a soft collar for acute cervical spine injury management in hospital.METHOD:A single centre mixed method sequential study design was used.RESULTS:Medical records from 136 patients were examined and no adverse events resulting from collar use were recorded. Interviews with 20 patients revealed that they understood the value of wearing a soft collar. The soft collars were considered supportive and well tolerated, with good adherence to recommendations for use.CONCLUSIONS:Understanding the patients' experiences informs better care management. This study suggests that soft collars are well tolerated, do not result in pressure injuries or other adverse events and are suitable for managing acute cervical spine injury.

Introduction: Intensive Care Units (ICU) are inherently stressful workplaces. Stress impacts staff's emotional resilience, health, and capacity to provide care. Many industries acknowledge the advantages of promoting "healthy workplaces". Despite the benefits, limited research has explored how wellbeing can be improved for ICU staff.

Introduction: The effect of the ABCDEF bundle on patient outcomes such as delirium is potentially optimized when the bundle is implemented in its entirety.

Background/objective: Endotracheal suction is an invasive and potentially harmful technique used for airway clearance in mechanically ventilated children. Choice of suction intervention remains a complex and variable process. We sought to develop appropriate use criteria for endotracheal suction interventions used in paediatric populations. Methods: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop the Paediatric AirWay Suction appropriateness guide. This included defining key terms, synthesising current evidence, engaging an expert multidisciplinary panel, case scenario development, and two rounds of appropriateness ratings (weighing harm with benefit). Indications (clinical scenarios) were developed from common applications or anticipated use, current practice guidelines, clinical trial results, and expert consultation. Results: Overall, 148 (19%) scenarios were rated as appropriate (benefit outweighs harm), 542 (67%) as uncertain, and 94 (11%) as inappropriate (harm outweighs benefit). Disagreement occurred in 24 (3%) clinical scenarios, namely presuction and postsuction bagging across populations and age groups. In general, the use of closed suction was rated as appropriate, particularly in the subspecialty population `patients with highly infectious respiratory disease'. Routine application of 0.9% saline for nonrespiratory indications was more likely to be inappropriate/uncertain than appropriate. Panellists preferred clinically indicated suction versus routine suction in most circumstances. Conclusion: Appropriate use criteria for endotracheal suction in the paediatric intensive care have the potential to impact clinical decision-making, reduce practice variability, and improve patient outcomes. Furthermore, recognition of uncertain clinical scenarios facilitates identification of areas that would benefit from future research. (c) 2021 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd.

Introduction: There is a growing body of research into end-of-life care (EOLC) both nationally and internationally. However, researchers tend to focus on clinicians’ perception of providing EOLC with limited research exploring the experience of families. Positive EOLC experiences may lessen family’s level of distress and risk of experiencing complicated/ prolonged grief. Research exploring families experience with EOLC is required to inform practice improvements.