And I'm impressed we got a pretty good showing, because it's always hard the last day. But I'm just going to show you two really influential studies and talk about our methods for our year in review, and then follow with two other topics. So to start, I just want to acknowledge my funding. So our learning objectives for this year in review, mainly to discuss the key findings, implications, and implementation of presented studies, and to implement evidence from these nursing studies into practice, research, and education. And I think what I really encourage all of you to think about during this time is, where can we apply these findings into clinical practice? And I really want to hear from all of you on what are your thoughts? What does this make you think about? So the inclusion criteria for looking at our studies was that this research must be led by a nurse researcher as the primary senior author, or include a nurse in the research team. I think it's really important when you conduct a research study, especially of nursing, that you have nursing representation on your team, because we have important contributions and perspectives to provide. Topics should be of significant relevance to the field of nursing, and must be published within October 2022 to September 2023. So this led us to have, we searched three databases, and we also looked at the current research priorities, and had 647 studies, and then came down from there to look at five top studies from each specific theme. And then using subgroup mentors, we picked select studies to really present to you during this presentation. So three real topics we're gonna be talking about first. The nursing workforce, delirium, state of the science, nursing literature, and some late-breaking nursing studies. So to start out, talking about the nursing workforce. So the first study I wanted to talk about was published in the American Journal of Respiratory and Critical Care Medicine, Nurse-Nurse Familiarity and Mortality in the Critical Yale. So just to start out our conversation, nursing teams, I'm sure, as you know, are vital in the ICU. And the patient-to-nurse ratios has a significant impact on outcomes. Nurses working together is thought to improve teamwork and patient care efficiency. And I'm sure, as you know, when you work on a unit and you've worked with these nurses before, you know how they function, you can anticipate each other's needs, that things go, flow a little bit better sometimes. And when you work together long-term, a lot of times you have improved communication and decision-making. So the objective of the study was to look at how nurse-nurse familiarity impacts inpatient deaths during an ICU stay. So it was a retrospective observational study in eight academic ICUs. And basically the outcome that they're looking at was a shift with at least one inpatient death. And this excluded patients with a decision of four goes. This is basically CMO patients. And so it basically used a Poisson regression, which basically looks at the count of deaths and controlled for patient characteristics, patient-to-nurse and patient-to-assistant ratios, which is something unique to the location in France that they were conducting this. It's almost similar to an aid. So patient-to-assistant ratios and nurse experience length and workload. So this nurse-nurse familiarity, they looked at scheduling data and basically looked at how much do certain nurses work together? And the median of the sample was 50. So they basically said it was suboptimal collaborations if it was less than 50. And they looked at this over 12-hour shifts. And so I'm gonna walk you through this. So shifts with low nurse-nurse familiarity were associated with an increased risk of patient death. So low nurse-nurse familiarity associated with a higher risk and this was even higher if it was over two consecutive shifts and got even higher over three. And so then they also looked at this in combination with suboptimal nurse-to-patient ratios, which also further exacerbated the risk. And then looking at it over two shifts plus the suboptimal ratios and it just kept getting stronger and stronger as we kept adding more, either low familiarity and low patient-to-nurse ratios. And lastly, in the last regression, combining it all, they also looked at it with suboptimal assistant-nurse ratios. So looking at when you don't have the supports as a nurse, being like a patient care technician, nursing care assistant, it had the largest effect of them all. 2.4 times the risk of patient deaths when you have low nurse-nurse familiarity over three consecutive shifts, suboptimal patient-to-nurse ratios and assistant-nurse ratios, showing that these components are really important to having positive patient outcomes. So then study two. And this is all gonna really resonate with everyone, I believe. It's looking at nurse workforce deployment. And this is specifically in Victoria, Australia. And this is led by a nurse. So basically inadequate nurse-staffing ratios lead to impact patient and nurse outcomes, which I'm sure all of us, it resonates. And the COVID-19 pandemic, we had an increase in severely ill patients and we had to do creative things with our nursing workforce, different staffing models in order to meet the demand. So we're gonna talk about how we basically met the increasing demand and how we kind of worked with our nursing workforce to creatively meet these needs. So basically this study categorized ICU skill mix into four groups, looking at experienced critical care nurses, early career critical care nurses, redeployed nurses with no ICU experience, and then lastly, nursing students and allied health professionals. So they categorized the first two as, and I'm not sure if I agree with this, but they categorized the first two as what they call CCRNs, which I think is kind of misleading, but basically saying that these are critical care registered nurses. And then the last two, obviously no ICU experience. So the study design was a retrospective cohort study and the outcome was insufficient ICU skill mix. So they were basically saying when you have more patients needing one-to-one nursing care than the amount of CCRN staff that you have. So basically saying you don't have the amount of nurses to give this critical ICU care than what you need on your unit. So this was kind of the breakdown of what their workforce looked like. So you can see the experienced ICU nurses are in light blue. The green is the early career ICU nurses. The redeployed are in purple and the dark purple is like the nursing students, allied health professionals. And you can see over the time of the pandemic that need decreased, which I think all of us understand here, but just to kind of give you an idea of what the workforce looked like. And so what's really interesting is that the study kind of did a counterfactual analysis and basically said, if there'd been no redeployment of staff to the ICU, reduced nursing ratios with the inability to provide one-to-one care, we would have had it on 15.2% of days in 91.7% of ICUs, saying that we had to do this. We didn't really have a choice and patients would have suffered if we didn't do this. And so you can kind of see this right here and that's over the whole study period. And then you can also look during the peak phase and the post-peak phase. So it's an interesting thing to think about. So I kind of want to give you some questions to leave you with for Q&A to talk about. And from there, you just keep these in mind and then we'll have Q&A at the end. So how can we think about nurse-to-nurse familiarity and the way we structure nurse teams? And maybe not even just nurses, maybe we can extend this to PTs, RTs, other healthcare professionals. What mechanisms do you think might lead to nurse familiarity leading to lower mortality? What's happening there? Like what happens when you guys know how each other work and you collaborate? How can hospitals better prepare non-ICU nurses for redeployment? And so I think that's a really topical concept. And I get floated to, as a more surg-onc, surgical ICU nurse to CT ICU, how can I be better prepared to make that floating journey? And what might be the impact on the mental and physical wellbeing of nurses of that redeployment and floating? So with that, I am going to hand it off to our next presenter. And.

nursing studies

ICU mortality

COVID-19 pandemic

nurse redeployment

Victoria Australia