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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Current concepts in fluid therapy and non-invasive haemodynamic monitoring

Abstract

Advantages of goal directed therapy (GDT) have recently become more and more difficult to prove in the face of newly implemented protocolised patient care approaches that also clearly improve patient outcome. However, individualised approach using GDT has been suggested to be superior to protocolised care and large meta-analyses still consistently show beneficial effects of GDT. Concerns of invasiveness were the reason why some patients’ haemodynamics was not measured and in turn were not included in any GDT protocols. Recently, non-invasive devices to measure arterial blood pressure and haemodynamic variables emerged, and although they are very appealing and easy to use, they require further validation both by comparison to more invasive methods and by outcome trials.

Keywords: Haemodynamic monitoring, non-invasive haemodynamic monitoring, goal-directed therapy, fluid therapy, validation

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Knowledge, attitudes, behaviour and training needs of ICU nurses on medication errors in the use of IV drugs: a pilot study

Abstract

Background. Prior studies have shown that lack of knowledge and training, incorrect behaviours and attitudes put Intensive care unit (ICU) patients at risk. The aim of this study was to assess knowledge, attitudes and professional behaviour of Italian nurses towards preparation and administration of intravenous medications in ICUs. Reliability and validity of the questionnaire were assessed as well.

Methods. A survey was conducted on a sample of Italian nurses in 2015 through a self-administered questionnaire. Reliability was tested and content validity was evaluated using Cronbach’s alpha. Multiple logistic regression models were built to identify predictors of knowledge, attitudes and behaviours.

Results. In total, 123 nurses completed the questionnaire. For the variable ‘adequate knowledge’ nurses were divided in those who had correctly answered 7 of 8 questions on knowledge and everyone else, while for ‘attitudes and professional behaviour’ responders were grouped into those who showed a positive attitude and appropriate behaviour and everyone else. Results of the multiple logistic regression analyses show some association, although not statistically significant, between correct behaviour, positive attitudes and the years of work experience. It is interesting to note that appropriate knowledge weighs negatively on correct behaviour (OR 0.06, 95% CI 0.04-0.42). Moreover, graduate nurses have more appropriate knowledge than those who are not. A high level of interest for specific training was reported by almost all responders. Cronbach’s alpha for all three sections together resulted in a value of 0.49.

Conclusions.This pilot study demonstrated the need to amend the questionnaire, especially the knowledge and behaviour sections, in which the Cronbach’s alpha was less than 0.7. Targeted educational programs are needed to improve the expertise of nurses to reduce medication errors during preparation and administration of IV medications in the ICU.

Key words: medication errors, attitudes, knowledge, professional behavior, ICU nurses, cross-sectional survey, Cronbach’s alpha, validation


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