Abstracts / Australian Critical Care 35 (2022) S1eS22 S11

CRITICAL CARE NURSES PERCEPTIONS OF THE ANGEL HERO LABEL Results: Fifteen clinicians participated; 10 registered nurses and 5
USED TO DESCRIBE THEIR ROLES AND PRACTICE DURING COVID-19 medical staff. Thematic analysis revealed the main barriers affecting
delirium best-practice were i) the physical environment, including iat-
Dr Jessica Stokes-Parish 1, Associate Prof Deb Massey 5, Dr rogenic high noise levels and lighting, ii) cocktail of treatments with
Rosalind Elliott 4, Nicki Credland 2, David Barrett 2, Dr Kaye Rolls 3 continuance of frequent observations, reliance on multiple pharmaco-
logical agents and use of restraints, iii) accessing evidence-based practice
1
Bond University, Robina, Australia; 2 University of Hull; 3 University of including a lack of awareness of current guidelines and use of previous
Wollongong; 4 Northern Sydney Local Health District; 5 Southern Cross experience to guide practice, and iv) reactionary approach to treatment
University rather than prevention. Enablers of best-practice approaches were
Introduction: COVID-19 pandemic significantly raised the profile and shown in the themes of i) family engagement, connecting with the
visibility of critical care nurses and nursing. One notable characteristic family, ii) leadership, including support by peers and peer leaders,
of the increased profile of nurses is the tendency for the media and iii) exemplary practice, highlighted by going the extra mile and patient
public to use terms of reverence such as angel or hero. These labels are focussed care.
undoubtedly bestowed on critical care nurses with good intentions, Conclusions: This study highlights the existence of facilitators and barriers
presumably in an attempt to acknowledge the courage, care and to the adoption of evidence -based practice approaches. Further research is
commitment that underpins their role. However, there is concern required to develop site-specific evidence adoption strategies to address
amongst critical care nurses about the use of these labels because of the the iatrogenic complication of delirium.
negative impacts on the work environment for example, access to
adequate personal protective equipment, safe staff ratios and appro- THE ABCDEF BUNDLE DELIVERED IN ITS ENTIRETY REDUCES DELIRIUM
priate renumeration. However, the impact of the angel/hero label on INCIDENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS
critical care nurses’ roles practice and identity is not well understood.
An understanding of this is important for critical care nurses in Australia Ms Kellie Sosnowski 1, 2, 3, Associate Prof Frances Lin 6, Prof
and New Zealand in order for policy makers to understand the effect of Wendy Chaboyer 3, 5, Dr Kristen Ranse 1,4, Dr
2, 7, 8 1, 3, 4
this narrative. Aaron Heffernan , Emeritus Prof Marion Mitchell
Objectives: The objective of this work was to explore critical care nurses’
1
perceptions about how their role and professional identify has been con- School of Nursing and Midwifery, Griffith University, Australia; 2 Logan
structed by the media and public during COVID-19. Hospital, Intensive Care Unit, Meadowbrook, Australia; 3 Menzies Health
Methods: We conducted a descriptive, qualitative study with critical care Institute, Griffith University, Australia; 4 Princess Alexandra Hospital,
nurses via digital platforms (e.g. Zoom and Teams). We used semi Intensive Care Unit, Woolloongabba, Australia; 5 NHMRC Centre of Research
structured interviews to explore the concepts of the angel and hero, using Excellence in Wiser Wound Care, Australia; 6 School of Nursing, Midwifery
a series of images from health services and the media to stimulate con- and Paramedicine, University of the Sunshine Coast, Australia; 7 School of
versation. Interviews were recorded, transcribed and analysed Medicine and Dentistry, Griffith University, Australia; 8 Faculty of Medicine,
thematically. University of Queensland, Australia
Results: Twenty-four critical care nurses were recruited from four coun- Introduction: The effect of the ABCDEF bundle on patient outcomes such as
tries. At the time of submission, preliminary themes identified from the delirium is potentially optimized when the bundle is implemented in its
analysis were discomfort, diminishing and dismissal. entirety.
Conclusion(s): Overall, critical care nurses were uncomfortable with the Objectives: To systematically synthesise the evidence on the
use of the term’s angels and heroes to describe their work during effectiveness of the ABCDEF bundle delivered in its entirety
COVID-19 and felt it did not accurately represent nursing work or on delirium, function, and quality of life in adult intensive care unit
nurses. patients.
Methods: Databases (n ¼ 8) were searched from 2000 to 2021. Inclusion
EXPLORATION INTO THE FACTORS INFLUENCING EVIDENCE UPTAKE OF criteria included i) critically ill adult patients ii) studies that described the
DELIRIUM MANAGEMENT IN INTENSIVE CARE. A QUALITATIVE ABCDE or ABCDEF bundle in its entirety iii) studies that evaluated delirium,
DESCRIPTIVE STUDY functional outcomes, or quality of life. Studies were excluded if they
investigated long-term rehabilitation patients. Two reviewers indepen-
Ms Jessica Brown 1, Ms Jessica Ingleman 1, 2, Prof Jed Duff 1, 2, Prof dently screened records and full text, extracted data, and undertook
Fiona Coyer 1, 2 quality appraisals with discrepancies discussed until consensus was
reached. A random effects meta-analysis was conducted for delirium but
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RBWH, Herston, Australia; 2 QUT, Kelvin Grove, Australia was not possible for other outcomes.
Introduction: Delirium remains a commonly under recognised or mis- Results: We included 18 studies (29 576 patients) in the descriptive syn-
diagnosed patient complication of admission to the ICU. thesis and seven studies (2 050 patients) in the meta-analysis. Most
Objectives: To explore clinicians’ perceptions of factors that affect the studies reported decreased delirium incidence following implementation
delivery of evidence-based practice for the assessment and management of the ABCDEF bundle. When compared with standard practice, the ABC-
of delirium in adult intensive care unit (ICU) patients. DEF bundle reduced the incidence of delirium (Risk Ratio ¼ 0.58; CI, 0.39 -
Methods: This study, conducted in the 27-bed ICU of a major metropol- 0.88 p ¼ 0.010) although heterogeneity was high (I2 ¼ 91%). There was no
itan quaternary public hospital in Queensland, Australia, used a qualita- significant difference in results when stratified by study design. Valid
tive descriptive design with purposive sampling and semi-structured in- functional assessments were included in two studies, and quality of life
depth one on one interviews. Clinicians, medical staff and registered assessment in one.
nurses, employed in the study setting with greater than 12-months ICU Conclusion(s): Although the evidence on the effect of the ABCDEF bundle
experience were recruited. Interviews were audio recorded and tran- delivered in its entirety is limited, positive patient delirium outcomes have
scribed verbatim. Transcripts were cross-checked by participants for ve- been shown in this meta-analysis. As this meta-analysis was based on only
racity. Data were analysed using Braun and Clark’s six phases for thematic 2050 patients in seven studies, further evidence is required to support its
analysis. use in the adult ICU.