Investigating functional barriers of intensive care units (ICU) from the point of view of nurses working in hospitals affiliated to Gilan University of Medical Sciences in 2013

Dissertation for obtaining a special nursing master's degree

Abstract:

Introduction:  The work environment of nurses working in intensive care units can have a major impact on the outcomes related to nurses as well as on patient safety.  Studying the factors in the working environment of nurses can provide useful and specific information for redesigning the work and thus improving the work of nurses and increasing patient safety. Functional barriers are factors related to the work environment that prevent special care nurses from providing care and performing their duties.

Aim: The present study was conducted with the aim of determining and investigating functional barriers in care departments from the point of view of nurses, which covers all parts of the work system model, determining the relationship between different types of functional barriers and determining the relationship between individual-occupational characteristics and functional barriers.

Materials and methods: This study was descriptive. The studied samples included all available nurses (130 people). This study was conducted in 10 special departments located in hospitals affiliated to Gilan University of Medical Sciences. The data obtained from the study were analyzed using multivariate statistical tests. Functional barriers reported by nurses and also the relationship between them were calculated.

Results: The results of the study show that nurses working in intensive care units experience a wide range of functional barriers, which cover all parts of the work system model. The most common functional barriers experienced include: Lack of tools and equipment in the department (50%), forced to use worn out tools and equipment (49.6%), failure to provide sufficient information about patients from the doctor (41.5%), talking too much on the phone of the patient's family (37.7%), inadequately equipping the beds or rooms assigned to the nurse (33.8%), spending too much time for inter-departmental coordination in the hospital (32.3%), malfunctioning due to the excessive presence of the family The patient (25.4%), disorderly placement of equipment in the ward (24.6%), prolongation of shift delivery due to providing information with unnecessary details (20.8%), spending significant time to educate patients and their families (20%) and lack of medicines needed by the patient in the ward (19.2%).   .                                                                                                                                      

Conclusion: functional barriers cover all parts of the work system model (environment, organization, technology and equipment and tasks).  Nurses working in intensive care units experience a wide range of functional barriers. Future research should be done on the impact of these obstacles on the workload of nurses, the quality of their work life, the quality and safety of the care provided, and also on the system of special departments to remove these obstacles.

Keywords: Special care, special care nurse, functional barriers, working environment

Statement of the problem:

The term special care includes a series of activities that are carried out in the form of providing continuous, accurate and dedicated care by a skilled care team and using advanced equipment and facilities (1). Studies have shown that providing care to patients hospitalized in special departments who are in critical situations has been able to reduce irreversible outcomes or mortality by 60% (2). The skill and experience of special nurses, which is the result of their work experience in the special care department and performing many complex treatment processes and interventions, and their ability to respond to potential issues and problems of critically ill patients with complex problems during admission or during hospitalization, adds to the quality of care in these departments (3). This shows the importance of the key role of nurses working in these departments in order to provide and maintain the recovery of sick patients hospitalized in the special department (4).Therefore, in many cases, their immediate unavailability at the bedside of patients, or the lack of the number of these nurses, who are also a source of information and support for nurses and doctors with less experience, increases the risks and deaths caused by potential and irreparable complications in them (3).

Abi[1], during a study he conducted on ensuring the quality of care in the special department, states that special department nurses spend almost two-thirds of their time on care. directly and the rest of it is spent on indirect care of the patient (5). Gliss [2] considers direct nursing care to be the care that is performed at the patient's bedside, such as: feeding, changing position, massage, exercise, etc. Also, indirect care refers to matters such as: preparing medicine, recording information, establishing business relationships, accompanying visitors, etc., which are done away from the patient's bedside (6). Since the method of division of work in special departments is the case method [3] and in the case method, each nurse is responsible for providing all nursing care (direct and indirect), so in many cases, irreparable consequences can be the result of disruption in the performance of nurses due to the simultaneous provision of direct and indirect care (7, 6). Another important point is that the direct care that special department nurses provide to patients is used to predict the allocation of labor. On the same basis, Buchen [4] suggests that paying attention to the nursing workforce is a method of guaranteeing the quality of care in the health care system. Therefore, it is better to examine the quality of care with patient-related outcomes in acute care units.

Approaching the nature of the special department and the patients admitted in it, it can be said that there are many situations in the special department that are associated with work pressure on nurses (8). Employees of special departments, in order to provide care that includes a series of multifaceted activities, are constantly faced with a large amount of information, multiplicity of tasks, time limit and interventions of others (9). Special department nurses, in order to provide care services that are always performed with the aim of maintaining the function of critical body systems of critically ill patients, on the one hand, they must investigate, separate and resolve a complex network of factors that cause imagined and unimagined outcomes in patients. And on the other hand, at the same time, they should provide clear and correct information to clients and their families who are facing mental tensions and actually interact with their most intense emotional angles, which is indicative of their workload (10, 8, 4). Decision making and problem solving should be low. Interference between time limits and the extent of job expectations and tasks leads to stress in care providers and as a result increase the workload and subsequently reduce the quality of patient care. These factors cause patient and staff dissatisfaction (11). French [6] and his colleagues also found in a study that workload is the most specific stress in the work environment and a higher level of stress is associated with a lower level of job satisfaction (12).

The results of other studies conducted regarding the workload of nurses in special care departments indicate that in 28% of cases, nurses or employees working in these departments face heavy and intense workload. Heavy workload is considered as the biggest factor of occupational stress affecting the performance of special care nurses, which in 13% of cases causes adverse complications, including deaths due to the low quality of care provided (13). Therefore, the category of workload and manpower, as well as time limitations, insufficient supervision and support, chaos and generally stressful environment, which are part of the set of factors related to the work and work environment of the special care department, are important as influencing factors on issues related to patients and nurses of special departments (14).      

Since the performance of professional nurses as providers of care services is related to the environment in which these actions are performed, the inappropriate conditions and facilities of the work environment can have adverse effects on the patient, his family and also the employees.