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Intensive care nurses face noise, distractions, small workspace, and other obstacles to providing care to critically ill patients

A hospital intensive care unit (ICU) is typically an emotionally intense, loud, cramped, and stressful environment. ICU nurses face numerous obstacles to providing care to their critically ill patients, according to a new study of 217 nurses from 17 ICUs at 7 Wisconsin hospitals.

Nearly half (46 percent) of the nurses were bothered by the noisy work environment. Others were distracted by family members (42 percent) and the hectic (40 percent) and crowded (37 percent) work environment. Another third spent a considerable amount of time teaching families about appropriate visiting times and support (34 percent), looking for equipment that someone else was using (32 percent), or looking for supplies in patient rooms that were not well-stocked (32 percent). One-fifth to one-fourth of nurses also had to deal with insufficient work space to complete paperwork (26 percent), looking for supplies (24 percent) or patients' charts (23 percent), receiving many phone calls from families (23 percent), and misplaced equipment (20 percent). In addition, 18 percent of nurses received inadequate information from physicians and 21 percent faced delays in seeing new medical orders.

Since many of the ICUs still used paper-based charts, nurses had to look in the chart to see if the doctor wrote a new order. Yet a variety of caregivers need the chart to provide care in the ICU from time to time. Sometimes it could take 2 to 3 hours for a nurse to get the chart and find out about a new order, a delay that could have a significant impact on critically ill patients. Also, some nurses had two problems with shift changes: 18 percent thought that it took too long and 9 percent felt they received inadequate information from the previous shift's nurse.

Redesigning the ICU environment to minimize these obstacles may improve the ability of ICU nurses to deliver high-quality and safe patient care, conclude the researchers. The study was supported by the Agency for Healthcare Research and Quality (HS14517).

See "Performance obstacles of intensive care nurses," by Ayse P. Gurses, Ph.D., and Pascale Carayon, Ph.D., in the May 2007 Nursing Research 56(3), pp. 185-194.

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