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Liyew TM, Mersha AT, Admassie BM, Arefayne NR. Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study. Patient Relat Outcome Meas 2024; 15:105-119. [PMID: 38680729 PMCID: PMC11048314 DOI: 10.2147/prom.s453246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Background Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit. Methods A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant. Results The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction. Conclusion and recommendation The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.
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Affiliation(s)
- Temesgen Misganaw Liyew
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Abraham Tarekegn Mersha
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Belete Muluadam Admassie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Nurhusen Riskey Arefayne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
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Reifarth E, Böll B, Kochanek M, Garcia Borrega J. Communication strategies for effective family-clinician conversations in the intensive care unit: A mixed methods study. Intensive Crit Care Nurs 2023; 79:103497. [PMID: 37542801 DOI: 10.1016/j.iccn.2023.103497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES To explore the perspectives of intensive care patients' family members and clinicians on conveying information during family-clinician conversations. SETTING Two medical intensive care units of a German academic tertiary care hospital. RESEARCH METHODOLOGY AND DESIGN This study followed a mixed methods design using a digital survey on family-clinician conversations with open- and closed-ended questions, metric scales, and free-text options. Quantitative analysis was performed to determine similarities and differences. Qualitative directed content analysis was conducted to code all free-text responses into themes. FINDINGS The responses of 100 family members, 42 nurses, and 28 physicians were analysed (response rate: 47%). All groups preferred face-to-face communication, the ask-tell-ask method, recipient design, and explaining medical terminology. The groups further commented on empathic communication by advocating the acknowledgement of the large amount of information. Qualitative themes highlighting the importance of bedside manners and written information were unique to the family members. Closed-ended questions were identified as potential trouble sources. Two communication strategies were rated as more suitable by the family members than by the physicians: being offered to choose between a summary or a detailed report at the beginning (p =.012;r = 0.288) and receiving a summary and having all questions answered at the end of a conversation (p =.023;r = 0.240). CONCLUSION The shared preferences supported existing expert recommendations, the differing preferences corroborated the importance of relational aspects of communication and additional written information. More research is needed on empathic communication aspects. IMPLICATIONS FOR CLINICAL PRACTICE To facilitate understanding, the clinicians may apply recipient design and the ask-tell-ask method, explain medical terminology, summarise important information, and proactively elicit questions. They may use empathic phrasing, demonstrate a respectful demeanour, and reflect on their current use of closed-ended questions and on the relational messages of their communication.
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Affiliation(s)
- Eyleen Reifarth
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Boris Böll
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Matthias Kochanek
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
| | - Jorge Garcia Borrega
- Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO), Cologne, Germany.
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Sharieff S, Sajjal A, Idrees A, Rafai W. Patient and Family Satisfaction in the Intensive Care Unit of a Quaternary Care Center. Cureus 2023; 15:e45795. [PMID: 37872908 PMCID: PMC10590672 DOI: 10.7759/cureus.45795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Patient and family satisfaction is an indicator of quality assessment of care provided in the intensive care unit (ICU) ensuring that the quality of services provided meets not only the patients' but also their families' needs. Investigating how different variables affect their satisfaction ratings is important. We assessed patient and family satisfaction in a quaternary care center in Pakistan. METHODS The study was a cross-sectional survey of adult patients and families treated between December 1, 2022 and April 30, 2023 in the ICU at Pakistan Kidney and Liver Institute and Research Center (PKLI-RC), Lahore, Pakistan. We used family satisfaction in ICU 24 (FS-ICU 24) to measure satisfaction in a number of domains on a scale of 1-5 (1 = Very Dissatisfied, 5 = Fully Satisfied). RESULTS Of the 330 patients admitted to ICU during the study period, all patients and/or one of their family members (100%) participated in the study. Out of these, 209 (63%) were male. The mean age was 42 ± 15 years, and the overall mean patient and family satisfaction scores were 4.69 ± 0.69 and 4.55 ± 0.52, respectively. The mean score in all domains was > 4, with the exception of pain management in which it was 3.98 ± 0.53. CONCLUSION Patients and their families' satisfaction is an important measure of ICU quality. Not only the patients and their families were satisfied with our ICU quality of care but they also appreciated involvement in the decision-making process and quality assessment. There is a need for further research for improvement in the pain domain.
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Affiliation(s)
- Saleem Sharieff
- Intensive Care Unit, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
- Intensive Care Unit, Grand River Hospital, Kitchener, CAN
| | - Ayesha Sajjal
- Intensive Care Unit, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Asim Idrees
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Wajid Rafai
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
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Delgado-Hito P, Alcalà-Jimenez I, Martinez-Momblan MA, de la Cueva-Ariza L, Adamuz-Tomás J, Cuzco C, Benito-Aracil L, Romero-García M. Satisfaction of intensive care unit patients linked to clinical and organisational factors: A cross-sectional multicentre study. Aust Crit Care 2023; 36:716-722. [PMID: 36456425 DOI: 10.1016/j.aucc.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The satisfaction of critical care patients with the nursing care they receive is a key indicator of the quality of hospital care. OBJECTIVES The objectives of this study were to analyse the level of satisfaction of critical care patients in relation to the nursing care received and to determine the relationship between the level of satisfaction and sociodemographic, clinical, and organisational variables. DESIGN This was a prospective, descriptive correlational study. SETTING AND METHODS The population consisted of all patients discharged from the intensive care units (ICUs) of 19 hospitals in Spain between December 2018 and December 2019. The level of satisfaction was measured using the validated Nursing Intensive Care Satisfaction Scale, and sociodemographic, clinical, and organisational data were collected. RESULTS Participants' mean age (n = 677) was 59.7 (standard deviation: 16.1), and 62.8% of them were men (n = 426). Satisfaction with the nursing care received was 5.66 (SD: 0.68) out of a possible 6. The score for overall satisfaction presented statistically significant relationships with the hours of mechanical ventilation (p = 0.034), with the participant's perception of own health status (p = 0.01), with the participant's perceived degree of own recovery (p = 0.01), with the hospital's complexity level (p = 0.002), with the type of hospital (p = 0.005), and with the type of ICU (p = 0.004). Finally, the logistic regression model shows that the Nursing Intensive Care Satisfaction Scale score was not linked to age or sex but did have a statistically significant relationship with the perceived degree of recovery (p < 0.001) and the type of ICU (p=<0.001). The variables that predicted satisfaction were age, degree of recovery, and the type of ICU. CONCLUSION Several studies show that patient satisfaction is related to the patient's perceived health status and perceived degree of recovery, a finding that is confirmed in our study. Our study moves beyond these outcomes to show that the hours of mechanical ventilation and the characteristics of the hospital also have a significant relationship with patients' satisfaction.
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Affiliation(s)
- Pilar Delgado-Hito
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
| | | | - Maria Antonia Martinez-Momblan
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain
| | - Laura de la Cueva-Ariza
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
| | - Jordi Adamuz-Tomás
- Nursing Knowledge Management and Information Systems Department, Bellvitge University Hospital (IDIBELL), L'Hospitalet de Llobregat, Catalunya, Spain; School of Nursing, Medicine and Health Science Faculty, University of Barcelona, Barcelona, Spain
| | - Cecilia Cuzco
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito-Aracil
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain.
| | - Marta Romero-García
- School of Nursing, University of Barcelona (Barcelona), Spain; Fundamental Care and Medical-Surgical Nursing Department, Spain; IDIBELL, Institute of Biomedical Research, Spain; International Research Project for the Humanization of Health Care, Proyecto HU-CI, Spain
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Renckens SC, Pasman HR, Klop HT, du Perron C, van Zuylen L, Steegers MAH, Ten Tusscher BL, Abbink FCH, de Ruijter W, Vloet LCM, Koster SCE, Onwuteaka-Philipsen BD. Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:763. [PMID: 37464434 DOI: 10.1186/s12913-023-09756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences. METHODS We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support. RESULTS A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support. CONCLUSIONS Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.
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Affiliation(s)
- Sophie C Renckens
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands.
| | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Viaa University of Applied Sciences, Zwolle, The Netherlands
| | - Chantal du Perron
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique A H Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Lilian C M Vloet
- Foundation Family and Patient Centered Intensive Care (FCIC), Alkmaar, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Stephanie C E Koster
- Department of Anaesthesiology and Department of Intensive Care Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
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6
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Siddiqui S, Lutz G, Tabatabai A, Nathan R, Anders M, Gibbons M, Russo M, Whitehead S, Rock P, Scalea T, Kheirbek RE. Early Guided Palliative Care Communication for Patients With COVID-19 Receiving ECMO. Am J Crit Care 2023; 32:166-174. [PMID: 36775881 DOI: 10.4037/ajcc2023184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) combined with COVID-19 presents challenges (eg, isolation, anticipatory grief) for patients and families. OBJECTIVE To (1) describe characteristics and outcomes of patients with COVID-19 receiving ECMO, (2) develop a practice improvement strategy to implement early, semistructured palliative care communication in ECMO acknowledgment meetings with patients' families, and (3) examine family members' experiences as recorded in clinicians' notes during these meetings. METHODS Descriptive observation of guided, in-depth meetings with families of patients with COVID-19 receiving ECMO, as gathered from the electronic medical record of a large urban academic medical center. Most meetings were held within 3 days of initiation of ECMO. RESULTS Forty-three patients received ECMO between March and October 2020. The mean patient age was 44 years; 63% of patients were Hispanic/Latino, 19% were Black, and 7% were White. Documentation of the ECMO acknowledgment meeting was completed for 60% of patients. Fifty-six percent of patients survived to hospital discharge. Family discussions revealed 7 common themes: hope, reliance on faith, multiple family members with COVID-19, helping children adjust to a new normal, visitation restrictions, gratitude for clinicians and care, and end-of-life discussions. CONCLUSION Early and ongoing provision of palliative care is feasible and useful for highlighting a range of experiences related to COVID-19. Palliative care is also useful for educating patients and families on the benefits and limitations of ECMO therapy.
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Affiliation(s)
- Safanah Siddiqui
- Safanah Siddiqui is a fellow, Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston
| | - Gabriel Lutz
- Gabriel Lutz is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine, Baltimore
| | - Ali Tabatabai
- Ali Tabatabai is an adjunct associate professor, Department of Medicine, Division of Education, University of Maryland School of Medicine
| | - Rachel Nathan
- Rachel Nathan is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
| | - Megan Anders
- Megan Anders is an associate professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Miranda Gibbons
- Miranda Gibbons is a clinical systems analyst, Department of Anesthesiology, University of Maryland School of Medicine
| | - Marguerite Russo
- Marguerite Russo is a nurse practitioner, University of Maryland Medical Center, and an adjunct associate professor, University of Maryland School of Nursing, Baltimore
| | - Sarah Whitehead
- Sarah Whitehead is a nurse practitioner, University of Maryland Medical Center
| | - Peter Rock
- Peter Rock is a professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Thomas Scalea
- Thomas Scalea is a professor, Department of Surgery, University of Maryland School of Medicine, and director of the R. Adams Cowley Shock Trauma Center, Baltimore
| | - Raya E Kheirbek
- Raya E. Kheirbek is a professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
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7
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Ponnapa Reddy MR, Kadam U, Lee JDY, Chua C, Wang W, McPhail T, Lee J, Yarwood N, Majumdar M, Subramaniam A. Family satisfaction with intensive care unit communication during the COVID-19 pandemic: a prospective multicentre Australian study Family Satisfaction - COVID ICU. Intern Med J 2022; 53:481-491. [PMID: 36346289 PMCID: PMC9877714 DOI: 10.1111/imj.15964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Virtual communication has become common practice during the coronavirus disease 2019 (COVID-19) pandemic because of visitation restrictions. AIMS The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS-ICU) care involving virtual communication strategies during the COVID-19 pandemic period. METHODS In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS-ICU 24-questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS-ICU/dm (satisfaction with information/decision-making) and FS-ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. RESULTS Seventy-three of the 227 patients' NOK who initially agreed completed the FS-ICU questionnaire (response rate 32.2%). The mean FS-ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS-ICU/total scores between survivors (n = 65; 89%) and non-survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS-ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS-ICU/dm. CONCLUSIONS There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.
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Affiliation(s)
- Mallikarjuna Reddy Ponnapa Reddy
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineCalvary Public HospitalBruceAustralian Capital TerritoryAustralia
| | - Umesh Kadam
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia,Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - John Dong Young Lee
- Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Clara Chua
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Wei Wang
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tomecka McPhail
- Department of Social WorkWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Jodie Lee
- Department of Social WorkMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Naomi Yarwood
- Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - Mainak Majumdar
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Ashwin Subramaniam
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Peninsula Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
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8
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Brekelmans A, Ramnarain D, de Haas M, Ruitinga R, Pouwels S. Evaluation of ICU end-of-life and bereavement care by relatives of deceased ICU patients. Respir Med 2022; 202:106972. [DOI: 10.1016/j.rmed.2022.106972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022]
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9
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Drury A, Muscat DM, Wibrow B, Jacques A, Anstey M. Integrating the Choosing Wisely 5 Questions into Family Meetings in the Intensive Care Unit: A Randomized Controlled Trial Investigating the Effect on Family Perceived Involvement in Decision-Making. J Patient Exp 2022; 9:23743735221092623. [PMID: 35434292 PMCID: PMC9006367 DOI: 10.1177/23743735221092623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family members often act as surrogate decision makers for patients in the intensive care unit (ICU). The use of printed prompts may assist with families feeling empowered to fulfill this role. Prospective, randomized controlled trial in 3 ICUs in Western Australia. In the intervention arm, families received the Choosing Wisely 5 questions as printed prompts prior to a family meeting, and the control arm did not receive prompts. The primary outcome was family perceived involvement in decision-making. Outcomes were measured using a survey. Sixty families participated in the study. The majority of families (87.1% control, 79.3% intervention; P = .334) reported feeling “very included” in decision-making. There was no difference in secondary outcomes, including minimal uptake of the questions by the intervention arm. This has been the first randomized trial evaluating the use of a decision-making tool for families in the ICU. Despite ceiling effects in outcome measures, these results suggest room for future study of the Choosing Wisely 5 questions in the ICU.
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Affiliation(s)
- Ashleigh Drury
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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10
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Chiang MC, Huang CC, Hu TH, Chou WC, Chuang LP, Tang ST. Factors associated with bereaved family surrogates' satisfaction with end-of-life care in intensive care units. Intensive Crit Care Nurs 2022; 71:103243. [PMID: 35396097 DOI: 10.1016/j.iccn.2022.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Family satisfaction with end-of-life care in the intensive care unit constitutes an important outcome for evaluating end-of-life care quality. Research on this topic focuses on linking end-of-life care processes to family-surrogate satisfaction with the patient's end-of-life care but has seldom examined patient- and family-surrogate-based factors. We aimed to comprehensively and simultaneously examine factors facilitating or deterring family satisfaction with end-of-life care in the intensive care unit from patient- and family-surrogate perspectives. METHODS For this secondary-analysis study, 278 Taiwanese family surrogates were surveyed one-month post-patient death using the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU), which measures care and decision-making. Associations between family satisfaction with end-of-life care and patient and family characteristics, patient disease severity, and length of intensive care stay were examined by multivariate, multilevel linear regression models. RESULTS Female family surrogates were more satisfied with patients' end-of-life care than male family surrogates when patients had a higher APACHE II but a lower SOFA score. Adult-child surrogates had lower FS-ICU Care scores than other family surrogates. Higher satisfaction with ICU decision-making was associated with patients' higher APACHE II but lower SOFA scores, longer stay and family socio-demographics, including being unmarried, educational attainment above junior high school and reported financial sufficiency to make ends meet. CONCLUSION Patient disease severity and family-surrogate characteristics are significantly associated with surrogates' satisfaction with patients' end-of-life care in the intensive care unit. Specific interventions should be tailored to the needs of high-risk family surrogates to increase their satisfaction with this care.
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Affiliation(s)
- Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, ROC.
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11
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Garg SK. Patients\' Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022; 26:161-163. [PMID: 35712749 PMCID: PMC8857726 DOI: 10.5005/jp-journals-10071-24120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Garg SK. Patients’ Family Satisfaction in Intensive Care Unit: A Leap Forward. Indian J Crit Care Med 2022;26(2):161–163.
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Affiliation(s)
- Sunil Kumar Garg
- Sunil Kumar Garg, Department of Critical Care, NMC Healthcare, Dubai, United Arab Emirates, Phone: +91-11-22334455, e-mail:
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12
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Fathallah I, Drira H, Habacha S, Kouraichi S. Can We Satisfy Family in Intensive Care Unit: A Tunisian Experience? Indian J Crit Care Med 2022; 26:185-191. [PMID: 35712731 PMCID: PMC8857707 DOI: 10.5005/jp-journals-10071-24104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ines Fathallah
- University of Tunis El Manar, University of Medicine of Tunis, Ben Arous Regional Hospital, Tunis, Tunisia
- Ines Fathallah, University of Tunis El Manar, University of Medicine of Tunis, Ben Arous Regional Hospital, Tunis, Tunisia, e-mail:
| | - Houda Drira
- University of Tunis El Manar, University of Medicine of Tunis, Ben Arous Regional Hospital, Tunis, Tunisia
| | - Sahar Habacha
- University of Tunis El Manar, University of Medicine of Tunis, Ben Arous Regional Hospital, Tunis, Tunisia
| | - Sahar Kouraichi
- University of Tunis El Manar, University of Medicine of Tunis, Ben Arous Regional Hospital, Tunis, Tunisia
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13
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Padilla Fortunatti C, De Santis JP, Munro CL. Family Satisfaction in the Adult Intensive Care Unit: A Concept Analysis. ANS Adv Nurs Sci 2021; 44:291-305. [PMID: 33624988 DOI: 10.1097/ans.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Admission of patients to an intensive care unit is often a stressful event for family members. In the context of patient- and family-centered care, family satisfaction is recognized as a quality indicator of intensive care unit care. However, family satisfaction has not been consistently used or conceptualized in the literature. A modified version of Walker and Avant's method for concept analysis was utilized to examine the concept of family satisfaction in the adult intensive care unit. Antecedents, attributes, consequences, and empirical referents of family satisfaction are presented and implications for practice, research, and policy.
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Affiliation(s)
- Cristobal Padilla Fortunatti
- University of Miami, School of Nursing & Health Studies, Coral Gables, Florida (Ms Padilla Fortunatti and Drs De Santis and Munro); and Department of the Adult and the Senescent, Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile (Ms Padilla Fortunatti)
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14
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Lamiani G, Mistraletti G, Moreschi C, Andrighi E, Vegni E. Cultivating Empathy and Soft Skills Among Intensive Care Residents: Effects of a Mandatory, Simulation-Based, Experiential Training. Ann Transplant 2021; 26:e931147. [PMID: 34385409 PMCID: PMC8369950 DOI: 10.12659/aot.931147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Communication with families is crucial in ICU care. However, only a few residency programs include communication and relationship training in their curricula. This study aimed to assess the impact of a communication-skill course on residents’ empathy and self-reported skills. Material/Methods A single-center, observational study was conducted. Since 2017, the 4th-year residents of the Anaesthesia and Intensive Care School, University of Milan attended the mandatory “Program to Enhance Relational and Communication Skills in ICU (PERCS-ICU)”. PERCS-ICU lasted 10 hours and involved small groups of residents. The course was articulated around the simulation and debriefing of 3 difficult conversations with trained actors. Before and after the course, residents completed the Jefferson Scale of Empathy and a questionnaire measuring self-assessed preparation, communication skills, relational skills, confidence, anxiety, emotional awareness, management of emotions, and self-reflection when conducting difficult conversations. The quality and usefulness of the course and the case scenario were assessed on a 5-point Likert scales. Results Between 2017 and 2019, 6 PERCS-ICU courses were offered to 71 residents, 69 of whom completed the questionnaires. After the course, residents reported improvements in empathy (p<.05), preparation (p<.001), communication skills (p<.005), confidence (p<.001), self-reflection (p<.001), and emotional awareness (p<.001). Residents perceived the course as very useful (mean=4.79) and high-quality (mean=4.58). The case scenario appeared very realistic (mean=4.83) and extremely useful (mean=4.91). All residents recommended the course to other colleagues. Conclusions PERCS-ICU proved to be a well-received and effective course to improve residents’ empathy and some self-reported skills. The long-term effects remain to be investigated.
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Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Mistraletti
- Unit of Anesthesia and Intensive Care, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Elisa Andrighi
- Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy.,Unit of Clinical Psychology, ASST Santi Paolo e Carlo, Milan, Italy
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15
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Khan S, Digby R, Giordano NA, Hade S, Bucknall TK. A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit. Aust Crit Care 2021; 35:264-272. [PMID: 34384649 DOI: 10.1016/j.aucc.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically. OBJECTIVE The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU). METHODS A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100). RESULTS In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff. CONCLUSION Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
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Affiliation(s)
- Shahrukh Khan
- School of Nursing&Midwifery, Deakin University, Geelong, Australia
| | - Robin Digby
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Nicholas A Giordano
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Sharon Hade
- Nursing Services, Alfred Health, Melbourne, Australia; Intensive Care Unit, Alfred Health, Australia
| | - Tracey K Bucknall
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia.
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16
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Safitri D, Kurnia A, Al Jihad M. Family Experience during Patient Assistance Process in General Intensive Care Unit: A Phenomenology Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Intensive care unit (ICU) treatment can lead to fear, anxiety, depression, panic, and tension in the family. Place of the family as active presence, guardian, facilitator, historian, and coaching of the family cannot be separated from the recovery process. During the assistance of ICU patients, the family is faced with a strange environment, strict rules, emotional stress, and everyday life changes that have caused them to encounter psychological and physiological concerns.
AIM: This study aims to describe and interpret of the family’s experience during assistance patient in the ICU.
METHODS: A phenomenological methodology is used to explore experience of family. In-depth interviews were conducted on nine participants who were selected using purposive sampling. Data were analyzed by Colaizzi techniques, began with read transcripts, look for phenomenon, formulated data, organized, and verified to the participants.
RESULTS: The result is presented in three themes; physically and psychologically tired; good language is a medicine, strengthens each other’s companion.
CONCLUSION: The support of the patient in the ICU helps the family face a number of stressful circumstances. Adaptive coping and psychosocial help from health care workers and friends build a supportive family to cope with the difficulties when supporting patients in the ICU.
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17
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Brandao Barreto B, Luz M, do Amaral Lopes SAV, Rosa RG, Gusmao-Flores D. Exploring family members' and health care professionals' perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Med 2021; 47:737-749. [PMID: 34117901 DOI: 10.1007/s00134-021-06443-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although the intensive care unit (ICU) diary has been proposed as a tool for preventing psychiatric symptoms in survivors of critical illness, relatives and health care providers may benefit from it too. This study aims to summarize the current qualitative evidence on families' and health care professionals' experiences of writing in and reading the ICU diaries. METHODS We searched MEDLINE, OVID, Embase, and EBSCOhost from inception to February 2021, and included all the studies that presented any qualitative finding regarding relatives' and health care providers' experiences of writing in and reading an ICU diary. We used modified Critical Appraisal Skills Programme (CASP) and Confidence in the Evidence from Reviews of Qualitative Research (CERQual) for quality assessment. A thematic synthesis approach was used to analyze and synthesize the qualitative data. RESULTS Twenty-eight studies were analyzed (15 including family members and 13 including health care professionals). For family members, the ICU diary is an important source of medical information, provides a way for them to register their presence at patient's bedside and express their feelings, and contributes to humanizing the ICU staff. This impression is shared by relatives of patients who did not survive critical illness. Health care providers believe the diary is beneficial for themselves and others; however, they are concerned with possible negative impressions from patients and family that could lead to judicial problems. They also remark on several obstacles they face when constructing the diaries (workload, creativity, and environment for writing), which can make it a distressful process. CONCLUSION This qualitative synthesis shows that family members and health care professionals consider the ICU diary a valuable intervention. It also brings evidence to challenges faced during diary writing, which should be carefully approached in order to reduce the stress associated with this process.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil. .,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Mariana Luz
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Selma Alves Valente do Amaral Lopes
- Department of Paediatrics, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Neonatal Intensive Care Unit, Hospital Martagão Gesteira, Salvador, Bahia, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Departamento de Medicina Interna E Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Intensive Care Unit, Hospital da Cidade, Salvador, Bahia, Brazil
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18
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Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Vranceanu AM, Rosand J, Hwang DY. Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making. Neurocrit Care 2021; 35:714-722. [PMID: 33821402 PMCID: PMC8021441 DOI: 10.1007/s12028-021-01211-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients. METHODS We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses. RESULTS Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13-3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family's decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93-3.51]; p = 0.08). CONCLUSIONS Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, Yale University, New Haven, CT, USA.,Yale New Haven Hospital, New Haven, CT, USA
| | - Qiang Zhang
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Derek Ou
- Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Long Island, NY, USA
| | - James Garritano
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | | | - Andrea K Knies
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Belinda Nhundu
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cynthia Bautista
- School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
| | - Kevin B Huang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Yale New Haven Hospital, New Haven, CT, USA. .,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
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19
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Haave RO, Bakke HH, Schröder A. Family satisfaction in the intensive care unit, a cross-sectional study from Norway. BMC Emerg Med 2021; 21:20. [PMID: 33588760 PMCID: PMC7885442 DOI: 10.1186/s12873-021-00412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. METHOD The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. RESULTS The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.
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Affiliation(s)
- Randi Olsson Haave
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Agneta Schröder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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20
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Naef R, von Felten S, Ernst J. Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model. Biopsychosoc Med 2021; 15:4. [PMID: 33588895 PMCID: PMC7885222 DOI: 10.1186/s13030-021-00206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients. METHODS We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. RESULTS A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress. CONCLUSIONS Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Stefanie von Felten
- Department of Biostatistics, Institute of Epidemiology, Biostatistics, and Prevention, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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21
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Liang Y, Li J, Pan W. Family satisfaction in the intensive care unit: The influence of disease severity, care relationship, patient anxiety and patient pain. Intensive Crit Care Nurs 2020; 63:102995. [PMID: 33349481 DOI: 10.1016/j.iccn.2020.102995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/15/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is little empirical evidence that can be used to identify factors associated with family satisfaction in the context of the intensive care unit, especially from the perspectives of the patient and patient-family member interactions. OBJECTIVES To explore the influence of disease severity, care relationship, anxiety, and pain of patients on family satisfaction in the intensive care unit. STUDY DESIGN A cross-sectional descriptive and exploratory study was conducted in the Surgical unit in the Zhongshan Hospital Fudan University, Shanghai, China. METHODS A total of 227 patients and their family member dyads were included and surveyed. The dependent variable family satisfaction was measured by the Chinese version of the critical care family satisfaction survey. The independent variables included patient characteristics, care relationship, disease severity, patient anxiety, and patient pain. Disease severity was assessed by The Acute Physiology and Chronic Health Evaluation II. Patient anxiety was measured using the Self-Rating Anxiety Scale. Patient pain was measured with Numeric rating scale. RESULTS Patients with higher self-rating anxiety scores (OR 0.92, 95% CI 0.87-0.97) were less likely to have higher family satisfaction for their family member dyad. However, those with mild perceived pain (OR 5.21, 95% CI 1.97-13.80) were more likely to have higher family satisfaction for their family member dyad. Disease severity and care relationship showed no significant associations with family satisfaction. CONCLUSIONS Future interventions may include open communication with family members giving explanations regarding the physical and psychological condition of the patient, care delivered and interventions received.
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Affiliation(s)
- Yan Liang
- School of Nursing, Fudan University, China
| | | | - Wenyan Pan
- Zhongshan Hospital, Fudan University, China.
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22
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McLennan M, Aggar C. Family satisfaction with care in the intensive care unit: A regional Australian perspective. Aust Crit Care 2020; 33:518-525. [DOI: 10.1016/j.aucc.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
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Mistraletti G, Gristina G, Mascarin S, Iacobone E, Giubbilo I, Bonfanti S, Fiocca F, Fullin G, Fuselli E, Bocci MG, Mazzon D, Giusti GD, Galazzi A, Negro A, De Iaco F, Gandolfo E, Lamiani G, Del Negro S, Monti L, Salvago F, Di Leo S, Gribaudi MN, Piccinni M, Riccioni L, Giannini A, Livigni S, Maglione C, Vergano M, Marinangeli F, Lovato L, Mezzetti A, Drigo E, Vegni E, Calva S, Aprile A, Losi G, Fontanella L, Calegari G, Ansaloni C, Pugliese FR, Manca S, Orsi L, Moggia F, Scelsi S, Corcione A, Petrini F. How to communicate with families living in complete isolation. BMJ Support Palliat Care 2020:bmjspcare-2020-002633. [PMID: 33060189 DOI: 10.1136/bmjspcare-2020-002633] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 12/23/2022]
Abstract
IMPORTANCE During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals. OBJECTIVE This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient's relatives under circumstances of complete isolation. EVIDENCE REVIEW PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure. FINDINGS Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation. CONCLUSIONS AND RELEVANCE The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy
- SC Anestesia e Rianimazione, Ospedale San Paolo - Polo Universitario, ASST Santi Paolo e Carlo, Milano, Italy
| | - Giuseppe Gristina
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Roma, Italy
| | - Sara Mascarin
- Educational Services for Health and Social Development, Officina Comunicativa, Treviso, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Silvia Bonfanti
- Department of Palliative Care, Azienda USL di Piacenza, Piacenza, Italy
| | - Federico Fiocca
- Anestesia e Rianimazione 1, ASST Spedali Civili, Brescia, Italy
| | - Giorgio Fullin
- General and Neurosurgical ICU, Ospedale dell'Angelo, Aulss 3 Serenissima Veneto, Venezia, Italy
| | - Ennio Fuselli
- UOC Anestesia Rianimazione 1 Dip.to Emergenza Accettazione, A. O. San Camillo-Forlanini, Roma, Italy
| | - Maria Grazia Bocci
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Terapia Intensiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Davide Mazzon
- UOC Anestesia e Rianimazione, Ospedale di Belluno, Aulss 1 Dolomiti, Belluno, Italy
| | | | - Alessandro Galazzi
- Direction of Healthcare Professions, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Fabio De Iaco
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Enrico Gandolfo
- Emergency Department, Martini Hospital, ASL Città di Torino, Torino, Italy
| | - Giulia Lamiani
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Silvia Del Negro
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Laura Monti
- Servizio Psicologia Ospedaliera, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Fabrizia Salvago
- Dipartimento di Neuroscienze, Azienda Ospedaliera G Brotzu, Cagliari, Italy
| | - Silvia Di Leo
- Psycho-oncology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mariassunta Piccinni
- Department of Political Science, Law and International Studies, Università degli Studi di Padova, Padova, Italy
| | | | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Sergio Livigni
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Carla Maglione
- Società Italiana Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Napoli, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Franco Marinangeli
- Department of Anesthesiology and Intensive Care, University of L'Aquila, L'Aquila, Italy
| | - Luisa Lovato
- UO Anestesia e Rianimazione 1, Ospedale Santa Chiara, Trento, Italy
| | | | - Elio Drigo
- Associazione Nazionale Infermieri di Area Critica (Aniarti), Udine, Italy
| | - Elena Vegni
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
- UOC Clinical Psychology, ASST Santi Paolo e Carlo, Milano, Italy
| | - Sally Calva
- Educational Services for Health and Social Development, Officina Comunicativa, Torino, Italy
| | - Anna Aprile
- Department of Molecular Medicine, Università degli Studi di Padova, Padova, Italy
| | | | - Lucia Fontanella
- Dipartimento di Scienze del Linguaggio e Letterature moderne e comparate, Università degli Studi di Torino, Torino, Italy
| | | | | | | | - Salvatore Manca
- SC Medicina e Chirurgia di Accettazione e di Urgenza, Ospedale di Oristano, Oristano, Italy
| | - Luciano Orsi
- Società Italiana di Cure Palliative (SICP), Milano, Italy
| | - Fabrizio Moggia
- DATeR Processo Assistenziale nelle Cure Palliative, Azienda USL di Bologna, Bologna, Italy
| | - Silvia Scelsi
- Dipartimento Infermieristico e delle professioni tecnico sanitarie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Antonio Corcione
- UOC Anestesia e TIPO, Azienda dei Colli, Ospedale Monaldi-Cotugno, Napoli, Italy
| | - Flavia Petrini
- Perioperative Medicine, Pain Therapy, ICU and Emergency Department, ASL2 - Chieti Pescara University, Chieti, Italy
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Newey CR, George P, Honomichl R, Gomes J, Maraj A, Kinzy T, Conley S, Douglas B, Stoltz M, Hang D, Omer T, Abubakr S, Lynch G, Dani D, Katzan I. Satisfaction with Care and Satisfaction with Decision Making are Similar Regardless of Staffing Model in a Neurocritical Care Unit. Neurocrit Care 2020; 34:13-20. [PMID: 32323147 PMCID: PMC7222902 DOI: 10.1007/s12028-020-00967-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Introduction Patient-centered care, particularly shared medical decision making, is difficult to measure in critically ill patients where decisions are often made by a designated surrogate, often receiving information from multiple providers with varying degrees of training. The purpose of this study was to compare short-term satisfaction with care and decision making in patients or surrogates between two neurocritical care units [one staffed by a neurocritical care attending and advanced practice providers (APPs) and one staffed by a neurocritical care attending and resident/fellow trainees] using the Family Satisfaction in the ICU (FS-ICU) survey. Methods Over a 6-month period, the FS-ICU was administered on a tablet device to patients or surrogates at least 24 h after admission and stored on REDCap database. Results One hundred and thirty-four patients or surrogates completed the FS-ICU. The response rates were 59.97% and 46.58% in the APP and trainee units, respectively. There were no differences in patient age, sex, ventilator days or ICU length of stay. Overall, there were no differences in satisfaction with care or perceived shared medical making between the units. Respondents who identified their relationship with the patient as “other” (not a spouse, parent, nor a sibling) were less satisfied with care. Additionally, surrogates who identified as parents of the patient were more satisfied with degree of shared medical decision making. Conclusion This study showed that: (1) collecting FS-ICU in a neurocritical care unit is feasible, (2) overall there is no difference in short-term satisfaction with care or shared decision making between a NICU staffed with trainees compared to one staffed with APPs, and (3) parents of patients have a higher short-term satisfaction with degree of shared medical decision making.
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Affiliation(s)
- Christopher R Newey
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA.
- Neurological Institute, Epilepsy Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Pravin George
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Ryan Honomichl
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joao Gomes
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Anita Maraj
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Tyler Kinzy
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Case Western Reserve University, Cleveland, OH, 44195, USA
| | - Sarah Conley
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Bradley Douglas
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Michael Stoltz
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - David Hang
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Tarig Omer
- Anesthesiology Institute, Cardiothoracic Anesthesia Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Samer Abubakr
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Gwen Lynch
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Dhimant Dani
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
| | - Irene Katzan
- Neurological Institute, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Avenue, Mailcode 80, Cleveland, OH, 44195, USA
- Neurological Institute, Patient Centered Outcome Center, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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The intensive care unit: How to make this unfriendly environment geriatric-friendly. Eur J Surg Oncol 2020; 46:379-382. [PMID: 31973926 DOI: 10.1016/j.ejso.2019.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 01/23/2023] Open
Abstract
Patients 80 years old or older are increasingly being admitted to intensive care units, particularly in western countries, where life expectancy is constantly increasing. The benefits of intensively treating critically ill elderly patients are uncertain. The high mortality rate in the presence of underlying chronic diseases is a factor. More generally, frailty, defined as an impaired resilience following a health stressor event, must be taken into account. No consensus exists on the risk-benefit ratio to admit octogenarians to the ICU. Treatment decisions should account for life expectancy but also tailored to the needs and wishes of patients and next-of-kins. The cohort of elderly patients is known to be the most vulnerable to functional decline and cognitive impairment, including neuropsychological complications, such as delirium.. Interventions directed at reducing the incidence of delirium may mitigate brain injury associated with critical illness, potentially being the single most effective intervention in this population. A multimodal approach to analgesia should be considered to avoid untreated pain and its consequences. Sleep protocols can effectively reduce the risk of delirium. Notably, the deployment of "sleep bundles" (regular sleep-wake rhythms, reduced night-time light, noise control strategies), may be helpful. As well, adequate nutritional support, spontaneous awakening trials, early mobilization, and physical therapy are crucial to prevent physical deconditioning. The psychological consequences of critical illness for both patients and caregivers are also being increasingly recognized. Attention to the needs of families is essential, due to its positive effects on patients and as a quality improvement goal by itself. Death and dying in the ICU is a more frequent outcome in the elderly population. A real culture for the management of distress and grieving is a required skill for the ICU staff. Privacy and adequate palliative care should be contemplated for an ethical and comfortable end of life.
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Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, Pothirat C, Liwsrisakun C, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020; 24:946-954. [PMID: 33281320 PMCID: PMC7689133 DOI: 10.5005/jp-journals-10071-23559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand. Materials and methods The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptation guidelines. After reliability and validity testing, we consecutively surveyed the satisfaction of family members of ICU patients over 1 year. Adult family members of patients admitted to medical or surgical ICUs for 48 hours or more who had visited the patients at least once during the ICU stay were included. Results In all, 315 (95%) of 332 surveys were returned from family members. Cronbach's α of the Thai FS-ICU 24 questionnaire was 0.95. Factor analysis demonstrated good construct validity. The mean (±SD) of total satisfaction score, overall ICU care subscale, and decision-making subscale were 81.5 ± 14.3, 81.0 ± 15.6, and 82.0 ± 14.0. Items with the lowest scores were the waiting room atmosphere and the frequency of doctors communicating with family members about the patient's condition. The mean total satisfaction score tended to be higher in family members of survivors than in family members of nonsurvivors (81.9 ± 13.8 vs 77.7 ± 16.2, p value = 0.059). The overall satisfaction scores between medial ICU and surgical ICU were not significantly different. Conclusion The Thai version of FS-ICU questionnaire was found to have acceptable reliability and validity in a Thai population and can be used to drive improvements in ICU care. Trial registration www.clinicaltrials.in.th, TCR20160603002 How to cite this article Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, et al. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020;24(10):946–954.
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Affiliation(s)
| | | | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Queen's University; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Panida Chanayat
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juthamas Inchai
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Atikun Limsukon
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Abstract
Stroke is a sudden, unexpected illness with an uncertain prognosis for functional recovery. Ethical issues in the care of patients with stroke include assessment of decision-making capacity when cognition or communication is impaired, prognostication, evaluation of quality of life, withdrawal or withholding of life-sustaining treatment, and how to optimize surrogate decision making. Skilled communication between clinicians and patients or their surrogates promotes shared decision making and may prevent ethical conflict. Nurses with an understanding of the ethics of stroke care play an important role in the care of patients with stroke and their families.
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Mistraletti G, Mezzetti A, Anania S, Ionescu Maddalena A, Del Negro S, Giusti GD, Gili A, Iacobone E, Pulitanò SM, Conti G, Bocci MG. Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study. Contemp Clin Trials 2019; 86:105847. [PMID: 31525488 DOI: 10.1016/j.cct.2019.105847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME correct understanding of the prognosis. SECONDARY OUTCOMES correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS 2100 ICU relatives of critically ill patients. INTERVENTIONS The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER NCT03438175.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Andrea Mezzetti
- AUSL Toscana Centro, SOS 118 Emergenza Territoriale, Empoli, Italy
| | - Stefania Anania
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Alessandra Ionescu Maddalena
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Del Negro
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | | | - Alessio Gili
- Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Italy
| | - Emanuele Iacobone
- SAR, Dipartimento Emergenza-Urgenza, AV3 Ospedale di Macerata, ASUR Marche, Italy
| | - Silvia Maria Pulitanò
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giorgio Conti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Grazia Bocci
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Family ratings of ICU care. Is there concordance within families? J Crit Care 2019; 55:108-115. [PMID: 31715527 DOI: 10.1016/j.jcrc.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/09/2019] [Accepted: 10/23/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine heterogeneity of quality-of-care ratings within families and to examine possible predictors of concordance. MATERIALS AND METHODS We examined two aspects of agreement within families: response similarity and the amount of exact concordance in responses in a cohort of Danish ICU family members participating in a questionnaire survey (the European Quality Questionnaire: euroQ2). RESULTS Two hundred seventy-four family respondents representing 122 patients were included in the study. Identical ratings between family members occurred in 28%-59% of families, depending upon the specific survey item. In a smaller sample of 28 families whose patients died, between 39% and 86% gave identical responses to items rating end-of-life care. There was more response variance within than between families, yielding low estimates of intrafamily correlation. Statistics correcting for chance agreement also suggested modest within-family agreement. CONCLUSIONS The finding that variance is higher within than between families suggests the value of including multiple participants within a family in order to capture varying points of view.
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Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care. Crit Care Med 2019; 46:602-611. [PMID: 29300237 DOI: 10.1097/ccm.0000000000002963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. DESIGN Pre- and postimplementation (pre-I and post-I) design. SETTING Single academic neuroscience ICU. PATIENTS Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission. INTERVENTION The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week. MEASUREMENTS AND MAIN RESULTS One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03). CONCLUSIONS Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | | | | | - Kathleen M Akgün
- Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT
| | - David M Greer
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Evie G Marcolini
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Emily J Gilmore
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | | | | | - Kevin N Sheth
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - David Y Hwang
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
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Ferrando P, Gould DW, Walmsley E, Richards-Belle A, Canter R, Saunders S, Harrison DA, Harvey S, Heyland DK, Hinton L, McColl E, Richardson A, Richardson M, Wright SE, Rowan KM. Family satisfaction with critical care in the UK: a multicentre cohort study. BMJ Open 2019; 9:e028956. [PMID: 31434771 PMCID: PMC6707657 DOI: 10.1136/bmjopen-2019-028956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. DESIGN Prospective cohort study nested within a national clinical audit database. SETTING Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. PARTICIPANTS Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. INTERVENTIONS Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. MAIN OUTCOME MEASURES Family satisfaction was measured using the FS-ICU-24 questionnaire. MAIN RESULTS A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. CONCLUSIONS Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. TRIAL REGISTRATION NUMBER ISRCTN47363549.
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Affiliation(s)
- Paloma Ferrando
- Intensive Care National Audit and Research Centre, London, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Emma Walmsley
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Ruth Canter
- Intensive Care National Audit and Research Centre, London, UK
| | - Steven Saunders
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Sheila Harvey
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Lisa Hinton
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elaine McColl
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette Richardson
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Stephen E Wright
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
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Maxim T, Alvarez A, Hojberg Y, Antoku D, Moneme C, Singleton A, Park C, Matsushima K. Family satisfaction in the trauma and surgical intensive care unit: another important quality measure. Trauma Surg Acute Care Open 2019; 4:e000302. [PMID: 31467981 PMCID: PMC6699722 DOI: 10.1136/tsaco-2019-000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/01/2019] [Accepted: 07/24/2019] [Indexed: 11/04/2022] Open
Abstract
Background A growing body of research has explored patient satisfaction as one of the healthcare quality measures. To date, scarce data are available regarding family experience in the trauma and surgical intensive care unit (TSICU). The purpose of this study was to describe and analyze the results of a family satisfaction survey in the TSICU. Methods Family members of patients at a level 1 trauma center were invited to participate in this study after 72 hours of intensive care unit stay. Participants completed a modified version of the Family Satisfaction in the Intensive Care Unit questionnaire, a validated survey measuring family satisfaction with care and decision-making. Data collection spanned from April 2016 to July 2017. Patient characteristics were compiled from the medical record. Quantitative analysis was performed using a 5-point Likert score, converted to a scale of 0 (poor) to 100 (excellent). Results The overall response rate was 78.6%. Of the 103 family members for 88 patients, most were young (median age: 41 years) and female (75%). Language fluency was 44.6% English-only, 31.7% Spanish-only, and 23.8% bilingual. Mean summary family satisfaction scores (±SD) were 80.6±26.4 for satisfaction with care, 79.3±27.1 for satisfaction with decision-making, and 80.1±26.7 for total satisfaction. Respondents were less satisfied with the frequency of communication with physicians (70.7±27.4) and language translation (73.2±31.2). Discussion Overall family satisfaction with the care provided to patients in the TSICU is high, although opportunities for improvement were noted in the frequency of communication between physicians and family and language translation services. Further quality improvement projects are warranted. Level of evidence Care management study: level V.
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Affiliation(s)
- Tom Maxim
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Agustin Alvarez
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Yvonne Hojberg
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Derek Antoku
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Chioma Moneme
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Andrew Singleton
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Caroline Park
- Surgery, University of Southern California, Los Angeles, California, USA
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Lai VKW, Li JCH, Lee A. Psychometric validation of the Chinese patient- and family satisfaction in the intensive care unit questionnaires. J Crit Care 2019; 54:58-64. [PMID: 31352270 DOI: 10.1016/j.jcrc.2019.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the psychometric properties of the Chinese version of the 23-item Patient Satisfaction in the Intensive Care Unit (PS-ICU-23) and 24-item Family Satisfaction in the Intensive Care Unit (FS-ICU-24) questionnaires. MATERIALS AND METHODS Patients (n = 243) discharged from an intensive care unit (ICU) in Hong Kong and family members (n = 237) completed the translated questionnaires. We used confirmatory factor analysis to assess the construct validity and measurement equivalence across groups (gender, mechanical ventilation, casemix, length of stay in ICU), coefficient alpha for internal consistency (reliability) and concordance correlation coefficient (ρc) for agreement between patients' and family members' perspective on satisfaction. RESULTS A three-factor model provided a better fit than the two-factor model for both PS-ICU-23 and FS-ICU-24 questionnaires. Factorial equivalence was present across groups in both questionnaires. Internal consistency was adequate for PS-ICU-23 (coefficient alpha overall domain 0.85; care subscale, 0.83; information subscale, 0.90; decision-making process subscale, 0.67) and for FS-ICU-24 (coefficient alpha overall scale 0.86; care subscale, 0.84; information subscale, 0.89; decision-making process subscale, 0.65). Overall ICU satisfaction agreement was moderate (0.40). CONCLUSIONS Both Chinese PS-ICU-23 and FS-ICU-24 questionnaires have sound psychometric properties but family satisfaction may not be a good proxy for patient satisfaction in ICU.
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Affiliation(s)
- Veronica Ka Wai Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | | | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Scott P, Thomson P, Shepherd A. Families of patients in ICU: A Scoping review of their needs and satisfaction with care. Nurs Open 2019; 6:698-712. [PMID: 31367391 PMCID: PMC6650754 DOI: 10.1002/nop2.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well-being and health. DESIGN Scoping review. METHODS Several selective databases were searched. English-language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured. RESULTS From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well-being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes.
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Affiliation(s)
- Pamela Scott
- Intensive Care UnitForth Valley Royal HospitalLarbertUK
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Hsu SH, Campbell C, Weeks AK, Herklotz M, Kostelecky N, Pastores SM, Halpern NA, Voigt LP. A pilot survey of ventilated cancer patients' perspectives and recollections of early mobility in the intensive care unit. Support Care Cancer 2019; 28:747-753. [PMID: 31144173 PMCID: PMC7223790 DOI: 10.1007/s00520-019-04867-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
Purpose To determine the level of recall, satisfaction, and perceived benefits of early mobility (EM) among ventilated cancer patients after extubation in the intensive care unit (ICU). Methods A survey of patients’ perceptions and recollections of EM was administered within 72 h of extubation. Data on recall of EM participation, activities achieved, adequacy of staffing and rest periods, strength to participate, activity level of difficulty, satisfaction with staff instructions, breathing management, and overall rating of the experience were analyzed. The Confusion Assessment Method for ICU (CAM-ICU) was used for delirium screening. Results Fifty-four patients comprised the study group. Nearly 90% reported satisfaction with instructions, staffing, rest periods, and breathing management during EM. Participants indicated that EM maintained their strength (67%) and gave them control over their recovery (61%); a minority felt optimistic (37%) and safe (22%). Patients who achieved more sessions and “out-of-bed” exercises had better recall of actual activities compared with those who exercised in bed. Overall, patients with CAM-ICU-positive results (33%) performed less physical and occupational therapy exercises. Conclusions Ventilated cancer patients reported an overall positive EM experience, but factual memory impairment of EM activities was common. These findings highlight the needs and the importance of shaping strategies to deliver a more patient focused EM experience. Electronic supplementary material The online version of this article (10.1007/s00520-019-04867-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven H Hsu
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA.,Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Claudine Campbell
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda K Weeks
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maryann Herklotz
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Kostelecky
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Stephen M Pastores
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Neil A Halpern
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Louis P Voigt
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA.
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Schwarzkopf D. [Nonbeneficial care-a burden for clinicians and relatives]. Med Klin Intensivmed Notfmed 2019; 114:222-228. [PMID: 30918982 DOI: 10.1007/s00063-019-0531-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ethically demanding decisions in intensive care as well as the perception of nonbeneficial care can be a burden for clinicians and patients' relatives. OBJECTIVES An overview of prevalence, causes, and consequences of perceived nonbeneficial care and possible interventions is provided. MATERIALS AND METHODS Narrative review. RESULTS AND CONCLUSIONS The perception of nonbeneficial care is a subjective moral judgement. Almost every ICU clinician regularly perceives nonbeneficial care. There is clear evidence that perceived nonbeneficial care is associated with burnout of clinicians and intention to leave the job. For relatives being involved in end-of-life decisions is of particular burden. Clinicians often state that relatives' whishes are the reason for nonbeneficial life-sustaining treatment. A good ethical climate as well as good nurse-physician collaboration are associated with less perception of nonbeneficial care and shorter time to therapy limitations. Structured communication to plan therapy involving relatives might reduce nonbeneficial care and together with supporting interventions reduce staff burnout. Improving communication by consultants in charge has been shown to reduce the burden of relatives. In future, co-treating surgeons must be more strongly involved in interventions.
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Affiliation(s)
- D Schwarzkopf
- Klinik für Anästhesiologie und Intensivmedizin, Center for Sepsis Control and Care, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Björk K, Lindahl B, Fridh I. Family members' experiences of waiting in intensive care: a concept analysis. Scand J Caring Sci 2019; 33:522-539. [PMID: 30866083 DOI: 10.1111/scs.12660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis. METHOD Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data. FINDINGS In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties. CONCLUSIONS The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.
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Affiliation(s)
- Kristofer Björk
- Department of Intensive Care, Northern Älvsborgs County Hospital, Trollhättan, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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JanardhanIyengar SM, Srinivasan R, Venkateshmurthy BM, Katari Y, Hiremathada S. Family Satisfaction in a Medical College Multidisciplinary Intensive Care Unit (ICU)-How Can We Improve? Indian J Crit Care Med 2019; 23:83-88. [PMID: 31086452 PMCID: PMC6487606 DOI: 10.5005/jp-journals-10071-23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims In recent years, patient and family-centered implications are being recognized as important outcome measures and one of the quality indicators of health care system worldwide. Most of the Intensive Care Unit patients cannot make decisions themselves, accordingly family members are surrogate decision-makers and judges of care quality. This study was conducted as a prospective observational study using Family Satisfaction-Intensive Care Unit questionnaire to ascertain the level of family satisfaction of care and their involvement in the decision making process of their patient's treatment. Materials and methods The study was conducted over 3 months with 100 family members by FS-ICU questionnaire survey method. After 48 hours of ICU admission, the questionnaire was administered to an eligible family member by a resident who was not involved in the treatment of the patient, in a language understood by them (English/Kannada). Each question was scored using 5 point Likert response Scale and the scores were transformed into 0 (least satisfied) to100 (most satisfied) scale. Results Satisfaction with overall care was 65.31±23.62 (FS-ICU/Care). Satisfaction with decision making process was 73.06±22.154 (FS-ICU/ DM). Individual factors which contributed to lower scores were management of pain and agitation of the patient, waiting room atmosphere and emotional support. Conclusion This study identified the individual factors which contributed to the high and low satisfaction scores. With this baseline data as reference, there is scope to enhance the aspects of quality care for patients and their family members. How to cite this article JanardhanIyengar SM, Srinivasan R et al. Family Satisfaction in a Medical College Multidisciplinary Intensive Care Unit (ICU)-How Can We Improve? Indian J of Crit Care Med 2019;23(2):83-88.
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Affiliation(s)
| | - Rangalakshmi Srinivasan
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | | | - Yeshaswini Katari
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sahajananda Hiremathada
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
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Jerng JS, Huang SF, Yu HY, Chan YC, Liang HJ, Liang HW, Sun JS. Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan. Crit Care 2018; 22:335. [PMID: 30522508 PMCID: PMC6282256 DOI: 10.1186/s13054-018-2271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings. Methods From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool. Results We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints. Conclusions A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families. Electronic supplementary material The online version of this article (10.1186/s13054-018-2271-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yu Yu
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Ju Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, 100, Taiwan.
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Anstey MH, Litton E, Jha N, Trevenen ML, Webb S, Mitchell IA. A comparison of the opinions of intensive care unit staff and family members of the treatment intensity received by patients admitted to an intensive care unit: A multicentre survey. Aust Crit Care 2018; 32:378-382. [PMID: 30446268 DOI: 10.1016/j.aucc.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/16/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Achieving shared decision-making in the intensive care unit (ICU) is challenging because of limited patient capacity, leading to a reliance on surrogate decision-makers. Prior research shows that ICU staff members often perceive that patients receive inappropriate or futile treatments while some surrogate decision-makers of patients admitted to the ICU report inadequate communication with physicians. Therefore, understanding the perceptions of both ICU staff and surrogate decision-makers around wishes for ICU treatments is an essential component to improve these situations. OBJECTIVES The objectives of this study were to compare perceptions of ICU staff with surrogate decision-makers about the intensity and appropriateness of treatments received by patients and analyse the causes of any incongruence. METHODS A multicentred, single-day survey of staff and surrogate decision-makers of ICU inpatients was conducted across four Australian ICUs in 2014. Patients were linked to a larger prospective observational study, allowing comparison of patient outcomes. RESULTS Twelve of 32 patients were identified as having a mismatch between staff and surrogate decision-maker perceptions. For these 12 patients, all 12 surrogate decision-makers believed that the treatment intensity the patient was receiving was of the appropriate intensity and duration. Mismatched patients were more likely to be emergency admissions to ICU compared with nonmismatched patients (0.0% vs 42.1%, p = 0.012) and have longer ICU admissions (7.5 vs 3, p = 0.022). There were no significant differences in perceived communication (p = 0.61). CONCLUSIONS Family members did not share the same perceptions of treatment with ICU staff. This may result from difficulty in prognostication; challenges in conveying poor prognoses to surrogate decision-makers; and the accuracy of surrogate decision-makers.
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Affiliation(s)
- Matthew H Anstey
- Sir Charles Gairdner Hospital, Perth, Australia; Curtin University, School of Public Health, Australia.
| | - Edward Litton
- Fiona Stanley Hospital, Australia; St John of God Hospital, Subiaco, Western Australia 6009, Australia
| | - Nihar Jha
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Steve Webb
- St John of God Hospital, Subiaco, Western Australia 6009, Australia; Monash University, Australia
| | - Imogen A Mitchell
- The Canberra Hospital, Australia; Australian National University Medical School, Australia
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Dale B, Frivold G. Psychometric testing of the Norwegian version of the questionnaire Family Satisfaction in the Intensive Care Unit (FS-ICU-24). J Multidiscip Healthc 2018; 11:653-659. [PMID: 30510429 PMCID: PMC6231505 DOI: 10.2147/jmdh.s184003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The questionnaire, Family Satisfaction in the Intensive Care Unit (FS-ICU-24), was developed to assess relatives' satisfaction with care and involvement in decision-making processes when a close family member stays in the ICU. AIM This study was aimed at describing the translation and exploring the psychometric properties of the Norwegian version of the questionnaire. METHODS The study design was a cross-sectional survey. After translating the questionnaire according to recommended procedures, 123 close relatives of patients, recently treated in ICU, responded to a mailed questionnaire including the FS-ICU-24-No. Item-to-total correlations and Cronbach's alpha coefficient were assessed for estimating reliability and construct validity was assessed by the "known groups" technique and explorative factor analysis. RESULTS The Cronbach's alpha coefficient of 0.96 and significant item-to-total correlations supported the homogeneity of the instrument. The construct validity was reflected in significant differences in median scores on the total scale and subscales between the group reporting lower degrees of satisfaction and the group reporting higher degrees of satisfaction. Two fixed factors with an eigenvalue >1, and an explained variance of 62.5%, emerged from the factor analysis. CONCLUSION The FS-ICU-24-No showed promising psychometric properties regarding reliability in this study group, which may indicate that the instrument is suitable for assessing family members' satisfaction with care and decision making in Norwegian ICU.
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Affiliation(s)
- Bjørg Dale
- Centre for Caring Research, Southern Norway, University of Agder, Faculty of Health and Sport Sciences, Grimstad, Norway,
| | - Gro Frivold
- University of Agder, Faculty of Health and Sport Sciences, Grimstad, Norway
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Alonso-Ovies Á, Heras la Calle G. Tell me what you need. I hear you. Med Intensiva 2018; 43:193-194. [PMID: 30391044 DOI: 10.1016/j.medin.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Á Alonso-Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España; Proyecto HUCI.
| | - G Heras la Calle
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz (Madrid), España; Proyecto HUCI
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Ågård AS, Hofhuis JGM, Koopmans M, Gerritsen RT, Spronk PE, Engelberg RA, Randall Curtis J, Zijlstra JG, Jensen HI. Identifying improvement opportunities for patient- and family-centered care in the ICU: Using qualitative methods to understand family perspectives. J Crit Care 2018; 49:33-37. [PMID: 30359923 DOI: 10.1016/j.jcrc.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The purposes of the study were to provide richer context for families' quantitative assessments of the quality of ICU care, and to describe further quality areas of importance for family members. MATERIALS AND METHODS Free-text comments from 1077 family members of 920 patients focusing on family evaluation of ICU quality of care were analyzed using content analysis. Twenty-one Danish and Dutch ICUs participated from October 2014 to June 2015. RESULTS Four themes emerged as important to families: information, clinician skills, ICU environment, and discharge from the ICU. Families highlighted the importance of receiving information that was accessible, understandable and honest. They indicated that quality care was ensured by having clinicians who were both technically and interpersonally competent. The ICU environment and the circumstances of the transfer out of the ICU were described as contributing to quality of care. The comments identified room for improvement within all themes. CONCLUSIONS The study highlights the importance of including both technical and emotional care for patients and families and the consequent need to focus on clinicians' mastery of interpersonal skills.
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Affiliation(s)
- Anne Sophie Ågård
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Århus N, Denmark; Department of Science in Nursing, Institute of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - José G M Hofhuis
- Department of Intensive Care Medicine Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands.
| | - Matty Koopmans
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands.
| | - Rik T Gerritsen
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands.
| | - Peter E Spronk
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA.
| | - J Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA.
| | - Jan G Zijlstra
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B.Winsløwsvej 19, 5000 Odense, Denmark.
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Bäckström J, Willebrand M, Sjöberg F, Haglund K. Being a family member of a burn survivor – Experiences and needs. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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IJssennagger CE, Ten Hoorn S, Van Wijk A, Van den Broek JM, Girbes AR, Tuinman PR. Caregivers' perceptions towards communication with mechanically ventilated patients: The results of a multicenter survey. J Crit Care 2018; 48:263-268. [PMID: 30245368 DOI: 10.1016/j.jcrc.2018.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/13/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate ICU health care providers' perception towards communication and associated problems with mechanically ventilated (MV) patients. The primary aim was to quantify the extent of the problem and to determine its effect on patient care and job satisfaction. METHODS A multicenter survey study was conducted among nurses, residents and intensivists of 15 ICUs in the Netherlands using an online questionnaire. RESULTS Out of 1740 caregivers, 457 responses were received. Communication difficulties were experienced in half of the interactions with MV patients. Over 75% of participants indicated that patient care was negatively affected. Job satisfaction was negatively affected in 43% of the participants, primarily with feelings of unfulfillment (76%) and frustration (72%). Patient factors considered relevant to communication difficulties were delirium, disease severity and anxiety, among others. To facilitate communication, the use of basic gestures remained the most preferred method. CONCLUSIONS In half of the interactions with MV patients, health care professionals experience significant communication difficulties. The respondents indicated that these difficulties frequently lead to negative effects on patient care and job satisfaction. These results emphasize the need for improvements such as the development of communication protocols, skills training and continued research into new communication methods.
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Affiliation(s)
- C E IJssennagger
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
| | - S Ten Hoorn
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - A Van Wijk
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - J M Van den Broek
- Zaans Medisch Centrum, Department of Intensive Care Medicine, Zaandam, the Netherlands
| | - A R Girbes
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Research VUmc Intensive Care (REVIVE), Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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46
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McAdam JL, Puntillo K. Pilot Study Assessing the Impact of Bereavement Support on Families of Deceased Intensive Care Unit Patients. Am J Crit Care 2018; 27:372-380. [PMID: 30173170 DOI: 10.4037/ajcc2018575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients who die in an intensive care unit (ICU) may experience negative outcomes. However, few studies have assessed the effectiveness of bereavement care for families. OBJECTIVE To evaluate the effectiveness of bereavement follow-up on family members' anxiety, depression, posttraumatic stress, prolonged grief, and satisfaction with care. METHODS A cross-sectional, prospective pilot study of 40 family members of patients who died in 2 tertiary care ICUs. Those in the medical-surgical ICU received bereavement follow-up (bereavement group); those in the cardiac ICU received standard care (nonbereavement group). Both groups completed surveys 13 months after the death. Surveys included the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, Family Satisfaction With Care in the Intensive Care Unit, Prolonged Grief Disorder, and a bereavement survey. RESULTS Of 30 family members in the bereavement group and 10 in the nonbereavement group, most were female and spouses, with a mean (SD) age of 60.1 (13.3) years. Significantly more participants in the nonbereavement group than in the bereavement group had prolonged grief. Posttraumatic stress, anxiety, depression, and satisfaction with care were not significantly different in the 2 groups. However, overall posttraumatic stress scores were higher in the nonbereavement group than the bereavement group, indicating a higher risk of posttraumatic stress disorder. CONCLUSIONS Bereavement follow-up after an ICU death reduced family members' prolonged grief and may also reduce their risk of posttraumatic stress disorder. This type of support did not have a measurable effect on depression or satisfaction with ICU care.
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Affiliation(s)
- Jennifer L. McAdam
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
| | - Kathleen Puntillo
- Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, San Francisco, California
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Padilla Fortunatti C, Rojas Silva N. Families on adult intensive care units: Are they really satisfied? A literature review. Aust Crit Care 2018; 31:318-324. [DOI: 10.1016/j.aucc.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/05/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022] Open
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Min J, Kim Y, Lee JK, Lee H, Lee J, Kim KS, Cho YJ, Jo YH, Ryu HG, Kim K, Lee SM, Lee YJ. Survey of family satisfaction with intensive care units: A prospective multicenter study. Medicine (Baltimore) 2018; 97:e11809. [PMID: 30095649 PMCID: PMC6133602 DOI: 10.1097/md.0000000000011809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Although family satisfaction is an important indicator for quality improvement of intensive care units (ICUs), few studies have translated family satisfaction data into quality improvement in Asia. A prospective multicenter study was conducted to evaluate family satisfaction regarding the care of patients and their family.The family satisfaction in the ICU (FS-ICU) questionnaire was administered from January 2015 to February 2016 at ICUs of 3 tertiary teaching hospitals in South Korea. Family members of adult patients, staying at an ICU for ≥48 hours, were included. Key factors affecting satisfaction were identified using quantitative and qualitative analyses.In total, 200 family members participated in this survey. The mean score for overall family satisfaction (FS-ICU/total) was 75.4 ± 17.7. The mean score for satisfaction with information/decision-making was greater than that for satisfaction with care (78.2 ± 18.2 vs 73.5 ± 19.4; P ≤ .001). Family members who agreed to not resuscitate and whose patient died at the ICU had lower FS-ICU/total scores. When compared with hospital A, hospital C was an independent predictor with an FS-ICU/total score of <75. Families reported the least satisfaction for the atmosphere of the ICU, including the waiting room atmosphere and management of agitation.We evaluated family satisfaction regarding ICUs for the first time in Asia using a validated tool. The decision to not resuscitate, ICU mortality, and ICU culture were associated with family satisfaction with critical care. Efforts should be targeted for improving factors that cause low family satisfaction when planning quality improvement interventions for ICUs in Asia.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | | | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
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Development and initial validation of the Swedish Family Satisfaction Intensive Care Questionnaire (SFS-ICQ). Intensive Crit Care Nurs 2018; 50:118-124. [PMID: 29935980 DOI: 10.1016/j.iccn.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families' satisfaction of quality of care in Swedish intensive care units. METHODS Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis. FINDINGS Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed. CONCLUSION A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents' understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.
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Neves JDL, Schwartz E, Guanilo MEE, Amestoy SC, Mendieta MDC, Lise F. AVALIAÇÃO DA SATISFAÇÃO DE FAMILIARES DE PACIENTES ATENDIDOS EM UNIDADES DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-070720180001800016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RESUMO Objetivo: analisar a produção científica relacionada às evidências acerca da satisfação de familiares de pacientes de UTI e os instrumentos utilizados para sua avaliação. Metodo: revisão integrativa na qual foram analisados artigos publicados entre 2005 e 2015, em inglês, português ou espanhol, nas bases de dados PUBMED/MEDLINE e LILACS e a biblioteca SciELO. Utilizou-se como estratégia de busca: personal satisfactional OR satisfaction AND family. Para coleta de dados dos artigos elaborou-se um instrumento com informações como: título, autores, ano de publicação e revista, objetivo do estudo, delineamento, participantes, local da pesquisa, temática principal e resultados. Resultados: atenderam aos critérios de inclusão 27 produções. Foram identificados quatro instrumentos utilizados para avaliar a satisfação de familiares de pacientes na UTI o Critical Care Family Satisfaction Survey, Family Satisfaction in the Intensive Care Unit, Critical Care Family Needs Inventory e o Quality of Dying and Death. Os estudos abordaram a satisfação dos familiares em relação às suas necessidades e tomadas de decisão, satisfação quanto a cuidados paliativos, evidenciou-se, ainda, estudos de adaptação transcultural e validação de instrumentos. Quanto ao nível de evidência, os estudos se concentram nos níveis II a VI. Conclusão: a análise da produção científica sobre a satisfação de familiares de pacientes de UTI permitiu evidenciar que o fator que mais contribui na promoção da satisfação da família foi a qualidade do atendimento.
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