Preferences of ICU Nurses for Improving Their Work System: A Sequential Exploratory Mixed-Methods Study

Patients admitted to intensive care units (ICU) generally require expensive, advanced technological interventions as well as a high level of specialised and timely care to survive their medical crisis. Work in this setting can generate significant pressures for ICU nurses.

To understand and prioritise ICU nurses' preferences for improving their work system based on the five components of the Systems Engineering Initiative for Patient Safety (SEIPS) model.

Using a sequential exploratory mixed-methods design, qualitative interview data were first collected from ICU nurses employed in a tertiary hospital in Iran to identify interventions for improving their work system. Data saturation guided sample size. Directed content analysis was used for extracting themes representing areas for intervention. The qualitative data were then integrated into an Analytic Hierarchy Process for weighting and prioritising the identified interventions using quantitative pairwise comparisons and mathematical calculations.

Fourteen ICU nurses were interviewed. Directed content analysis of the transcribed data yielded 17 themes impacting nurses' well-being and performance. The Analytic Hierarchy Process indicated that the themes with the highest priority for improving the ICU work system for nurses were Workload and Staffing, and micro-level Support and Resources-associated with SEIPS Organisation and Person components, respectively. Notable intervention importance was also found for themes Collaboration and Support, Equipment and Technology Enhancement, Culture and Management, and Spatial Design and Arrangement.

ICU nurses identified a high number of challenges in their work environment. Modern decision-making analyses were able to quantify and prioritise their preferences. These provide direction for designing future interventions.

As technological advances continue to support patient survival, there is a need for judicious decision-making in providing immediate and long-term solutions for associated changes in the work system faced by critical care nurses to ensure nurse well-being and patient care.