Critical care has faced unprecedented challenges in the recent past, including the COVID-19 pandemic and deterioration of the health care work environment. Research is crucial in discovering innovative solutions to these challenges, but the pandemic made critical care nursing research more difficult. Increased demands of caring for patients with high acuity and high mortality resulted in less time and energy for nurses at the bedside to participate in research. Nurse researchers had reduced access to critically ill patients, and medical studies of COVID-19 treatments often were prioritized over studies focused on nursing care or the work environment.
Despite these complicated constraints, researchers have persisted. And, as the research journal for the American Association of Critical-Care Nurses (AACN), the American Journal of Critical Care (AJCC) has continued to publish research of relevance to critical care nursing and interdisciplinary teamwork. Our primary goal is to provide our readers with reports of high-quality, timely clinical research that can inform and improve the care of critically ill patients and their families. In this editorial, we reflect on recent themes in research published in AJCC and provide examples from 2023 papers. We also alert readers to research events that will be offered at this month’s National Teaching Institute (NTI 2023) meeting in Philadelphia, Pennsylvania, May 22-24, 2023.
Between January 2022 (Volume 31, Issue 1) and the current May 2023 journal issue (Volume 32, Issue 3), AJCC published 71 reports of original research. These recent papers addressed a wide range of research topics, including bedside patient care, palliative and end-of-life care, intensive care unit (ICU) survivorship, measurement and prediction of patient problems, family concerns, communication, moral distress, and healthy work environment. The needs of patients across the lifespan were represented.
From a topical review of these recently published research papers, 3 overarching focal areas of high interest to bedside care emerged as themes. The first theme, improving patient care, was the predominate focus of many papers. The second theme, family well-being, remained an important concern. The third theme, understanding and improving the critical care work environment, was also well represented among recent papers. Appropriately, each of these themes is well aligned with the AACN vision, which states “AACN is dedicated to creating a healthcare system driven by the needs of patients and families where acute and critical care nurses make their optimal contribution.”1
Research to improve patient care at the bedside is foundational to nursing research. This focus has always been a primary emphasis for AJCC, and recent papers reflect the journal’s commitment to publishing rigorous clinical research that is applicable to bedside care. As an example, a paper in the March 2023 issue of AJCC reports the results of a randomized controlled trial of a live music intervention in the ICU.2 The trial demonstrated that a 30-minute live music intervention provided by a board-certified music therapist significantly reduced agitation, pain, and heart rate in a group of adults receiving mechanical ventilation, compared with a usual care group who did not receive the live music intervention. Notably, this nurse-led research was conducted in a Beacon unit of a Magnet-designated community hospital, and the collaboration between nursing and music therapy highlighted the power of interdisciplinary care in improving patient outcomes. Because providing evidence of the effectiveness of nonpharmacologic interventions in reducing agitation and pain is crucial to informing practice, this article was selected as a continuing education offering.
“Recent papers reflect the journal’s commitment to publishing rigorous clinical research that is applicable to bedside care.”
The work of the critical care team encompasses meeting the needs of patients’ families, and effective teams understand that the well-being of the family is intricately linked to the patient’s outcomes. The experiences and concerns of families, and measures to alleviate their ICU-related stress and suffering, are important areas of research that are well represented in AJCC. In a qualitative study reported in the January 2023 issue of AJCC, Blok and colleagues described the multiple factors that contribute to distress of family caregivers; the concerns were wide ranging and included factors related to the ICU environment as well as stressors external to the ICU.3 In order to disseminate these findings more broadly, this article was featured as a continuing education offering, and an interview with the nurse researcher who led the study was featured as a video on the AJCC website.4
AACN has been a leader in building and disseminating evidence about healthy work environments, including advocating for nurse well-being as a prerequisite for safe, high-quality patient care. AACN has published data about nurses’ well-being and about the positive effects of healthy work environments.5,6 AACN was the convener for the Partners for Safe Staffing, a multiorganizational effort to address health care team staffing solutions that led to the initiation of both a Nurse Staffing Think Tank and a Nurse Staffing Task Force.7 The importance of nurse well-being was explicitly noted in The Future of Nursing 2020-2030; recommendation 3 of that report states,
By 2021, nursing education programs, employers, nursing leaders, licensing boards, and nursing organizations should initiate the implementation of structures, systems, and evidence based interventions to promote nurses’ health and well-being, especially as they take on new roles to advance health equity.8(p13)
Building the evidence to support the health and well-being of critical care nurses and ICU team members is an important priority for AJCC and is reflected in the research we publish in this focal area. This issue of AJCC includes exciting results from long-term longitudinal follow-up of participants in the Mindful Ethical Practice and Resilience Academy (MEPRA).9,10 MEPRA is an experiential educational program designed to improve nurses’ skills in mindfulness, resilience, and competence to confront ethical challenges. In an earlier AJCC publication, the researchers reported that MEPRA was effective in the period immediately following the intervention.9 New results demonstrate that the positive benefits of MEPRA continued to persist at the longest follow-up measurement— 6 months after the intervention.10 This research is important; it provides evidence and direction for health care systems to improve nurse well-being in alignment with AACN healthy work environment standards and the recommendation from The Future of Nursing 2020-2030. It is also featured as a continuing education offering.
The needs of COVID-19 patients have appropriately garnered much attention during the pandemic. Between January 2022 and May 2023, 16 AJCC papers (23%) specifically focused on COVID-19. Interestingly, although focused on COVID-19, these papers aligned well with the 3 general themes previously described. COVID-19 patient problems and care were examined in 5 papers, 5 concerned the needs of family members of COVID-19 patients, and 6 studied work environment issues (4 describing nurses’ and staff experiences related to the pandemic, and 2 describing risks of transmission of COVID-19 infection to health care workers). These papers most likely have relevance beyond COVID-19. Conversely, research studies that were not specific to COVID-19 patients might have broad applicability to their care as well. Elements of care that are unique to COVID-19, and how care of these patients is similar to or different from care of other critically ill patients, are topics that require further delineation.
“Overarching themes of AJCC articles published since January 2022 are improving patient care, family well-being, and healthy work environment.”
There is more to come at NTI 2023. The research that will be presented there promises to be engaging, motivating, and useful for practice. On Monday afternoon, May 22, 2023, Dr Cynthia Rushton will highlight her long and successful research trajectory as she presents the 2023 AACN Distinguished Research Lecture, “Transforming Moral Suffering by Cultivating Moral Resilience and Ethical Practice.” NTI attendees can find her lecture on the conference schedule as activity #C75M412. As is customary for AACN Distinguished Research Lectures, the abstract for the presentation is published in this issue of AJCC and available before her lecture.11 The complete Distinguished Research Lecture paper will be published in the July issue of AJCC.
It is also customary that the May issue of AJCC includes an online article containing all of the research abstracts to be presented at that year’s NTI; the research abstracts can be accessed on the AJCC website (ajcconline.org) via the May issue’s table of contents. We encourage NTI attendees to review the research abstracts in advance of the meeting as they plan their NTI schedules. At NTI 2023, 4 award-winning research abstracts will be featured in 2 oral presentation sessions (Tuesday, May 23, activity #C60M406 and Wednesday, May 24, activity #C60M407). An additional 20 research abstracts will be presented as posters in the Research Poster session on Monday, May 22 (activity #POS115). As might be expected, the research abstracts to be presented at NTI 2023 also fit nicely into the overarching themes of improving patient care, family well-being, and healthy work environment.
Every year, NTI offers a celebration of nursing practice and research. If you are able to join the exceptional community of nurses who attend NTI 2023, we hope that you will choose to experience the Distinguished Research Lecture and other research presentations. Nonetheless, you can always find research that underpins the practice of acute and critical care nurses and the interdisciplinary team in the pages of AJCC.
The statements and opinions contained in this editorial are solely those of the coeditors in chief.
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