751
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Azoulay E, Forel JM, Vinatier I, Truillet R, Renault A, Valade S, Jaber S, Durand-Gasselin J, Schwebel C, Georges H, Merceron S, Cariou A, Moussa M, Hraiech S, Argaud L, Leone M, Curtis JR, Kentish-Barnes N, Jouve E, Papazian L. Questions to improve family-staff communication in the ICU: a randomized controlled trial. Intensive Care Med 2018; 44:1879-1887. [PMID: 30374690 DOI: 10.1007/s00134-018-5423-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/17/2018] [Indexed: 01/15/2023]
Abstract
PURPOSE Relatives of intensive care unit (ICU) patients suffer emotional distress that impairs their ability to acquire the information they need from the staff. We sought to evaluate whether providing relatives with a list of important questions was associated with better comprehension on day 5. METHODS Randomized, parallel-group trial. Relatives of mechanically ventilated patients were included from 14 hospitals belonging to the FAMIREA study group in France. A validated list of 21 questions was handed to the relatives immediately after randomization. The primary endpoint was comprehension on day 5. Secondary endpoints were satisfaction (Critical Care Family Needs Inventory, CCFNI) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale, HADS). RESULTS Of 394 randomized relatives, 302 underwent the day-5 assessment of all outcomes. Day-5 family comprehension was adequate in 68 (44.2%) and 75 (50.7%) intervention and control group relatives (P = 0.30), respectively. Over the first five ICU days, median number of family-staff meetings/patient was 6 [3-9], median total meeting time was 72.5 [35-110] min, and relatives asked a median of 20 [8-33] questions including 11 [6-13] from the list, with no between-group difference. Satisfaction and anxiety/depression symptoms were not significantly different between groups. The only variable significantly associated with better day-5 comprehension by multivariable analysis was a higher total number of questions asked before day 5. CONCLUSIONS Providing relatives with a list of questions did not improve day-5 comprehension, secondary endpoints, or information time. Further research is needed to help families obtain the information they need. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02410538.
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Affiliation(s)
- Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
| | | | - Isabelle Vinatier
- Surgical ICUs From Montpellier or Marseille Hospitals, Medical-Surgical ICUs From La Roche sur Yon, La Roche sur Yon, France
| | - Romain Truillet
- Statistical Department of Marseille, AP-HM, Marseille, France
| | | | - Sandrine Valade
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Samir Jaber
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | | | | | | | | | - Alain Cariou
- Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France
| | | | | | | | - Marc Leone
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - Nancy Kentish-Barnes
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, ECSTRA Team, and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Elisabeth Jouve
- Statistical Department of Marseille, AP-HM, Marseille, France
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752
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Latour JM, Coombs M. Family-centred care in the intensive care unit: More than just flexible visiting hours. Intensive Crit Care Nurs 2018; 50:1-2. [PMID: 30348476 DOI: 10.1016/j.iccn.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, 8-11 Kirkby Place, Room 205, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Level 7 Clinical Services Block, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand.
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753
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Lewis SR, Pritchard MW, Schofield‐Robinson OJ, Evans DJW, Alderson P, Smith AF. Information or education interventions for adult intensive care unit (ICU) patients and their carers. Cochrane Database Syst Rev 2018; 10:CD012471. [PMID: 30316199 PMCID: PMC6517066 DOI: 10.1002/14651858.cd012471.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND During intensive care unit (ICU) admission, patients and their carers experience physical and psychological stressors that may result in psychological conditions including anxiety, depression, and post-traumatic stress disorder (PTSD). Improving communication between healthcare professionals, patients, and their carers may alleviate these disorders. Communication may include information or educational interventions, in different formats, aiming to improve knowledge of the prognosis, treatment, or anticipated challenges after ICU discharge. OBJECTIVES To assess the effects of information or education interventions for improving outcomes in adult ICU patients and their carers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO from database inception to 10 April 2017. We searched clinical trials registries and grey literature, and handsearched reference lists of included studies and related reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs), and planned to include quasi-RCTs, comparing information or education interventions presented to participants versus no information or education interventions, or comparing information or education interventions as part of a complex intervention versus a complex intervention without information or education. We included participants who were adult ICU patients, or their carers; these included relatives and non-relatives, including significant representatives of patients. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and applied GRADE criteria to assess certainty of the evidence. MAIN RESULTS We included eight RCTs with 1157 patient participants and 943 carer participants. We found no quasi-RCTs. We identified seven studies that await classification, and three ongoing studies.Three studies designed an intervention targeted at patients, four at carers, and one at both patients and carers. Studies included varied information: standardised or tailored, presented once or several times, and that included verbal or written information, audio recordings, multimedia information, and interactive information packs. Five studies reported robust methods of randomisation and allocation concealment. We noted high attrition rates in five studies. It was not feasible to blind participants, and we rated all studies as at high risk of performance bias, and at unclear risk of detection bias because most outcomes required self reporting.We attempted to pool data statistically, however this was not always possible due to high levels of heterogeneity. We calculated mean differences (MDs) using data reported from individual study authors where possible, and narratively synthesised the results. We reported the following two comparisons.Information or education intervention versus no information or education intervention (4 studies)For patient anxiety, we did not pool data from three studies (332 participants) owing to unexplained substantial statistical heterogeneity and possible clinical or methodological differences between studies. One study reported less anxiety when an intervention was used (MD -3.20, 95% confidence interval (CI) -3.38 to -3.02), and two studies reported little or no difference between groups (MD -0.40, 95% CI -4.75 to 3.95; MD -1.00, 95% CI -2.94 to 0.94). Similarly, for patient depression, we did not pool data from two studies (160 patient participants). These studies reported less depression when an information or education intervention was used (MD -2.90, 95% CI -4.00 to -1.80; MD -1.27, 95% CI -1.47 to -1.07). However, it is uncertain whether information or education interventions reduce patient anxiety or depression due to very low-certainty evidence.It is uncertain whether information or education interventions improve health-related quality of life due to very low-certainty evidence from one study reporting little or no difference between intervention groups (MD -1.30, 95% CI -4.99 to 2.39; 143 patient participants). No study reported adverse effects, knowledge acquisition, PTSD severity, or patient or carer satisfaction.We used the GRADE approach and downgraded certainty of the evidence owing to study limitations, inconsistencies between results, and limited data from few small studies.Information or education intervention as part of a complex intervention versus a complex intervention without information or education (4 studies)One study (three comparison groups; 38 participants) reported little or no difference between groups in patient anxiety (tailored information pack versus control: MD 0.09, 95% CI -3.29 to 3.47; standardised general ICU information versus control: MD -0.25, 95% CI -4.34 to 3.84), and little or no difference in patient depression (tailored information pack versus control: MD -1.26, 95% CI -4.48 to 1.96; standardised general ICU information versus control: MD -1.47, 95% CI -6.37 to 3.43). It is uncertain whether information or education interventions as part of a complex intervention reduce patient anxiety and depression due to very low-certainty evidence.One study (175 carer participants) reported fewer carer participants with poor comprehension among those given information (risk ratio 0.28, 95% CI 0.15 to 0.53), but again this finding is uncertain due to very low-certainty evidence.Two studies (487 carer participants) reported little or no difference in carer satisfaction; it is uncertain whether information or education interventions as part of a complex intervention increase carer satisfaction due to very low-certainty evidence. Adverse effects were reported in only one study: one participant withdrew because of deterioration in mental health on completion of anxiety and depression questionnaires, but the study authors did not report whether this participant was from the intervention or comparison group.We downgraded certainty of the evidence owing to study limitations, and limited data from few small studies.No studies reported severity of PTSD, or health-related quality of life. AUTHORS' CONCLUSIONS We are uncertain of the effects of information or education interventions given to adult ICU patients and their carers, as the evidence in all cases was of very low certainty, and our confidence in the evidence was limited. Ongoing studies may contribute more data and introduce more certainty when incorporated into future updates of the review.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Michael W Pritchard
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | | | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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754
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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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755
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Sabnis A, Hagen E, Tarn DM, Zeltzer L. Increasing Timely Family Meetings in Neonatal Intensive Care: A Quality Improvement Project. Hosp Pediatr 2018; 8:679-685. [PMID: 30309897 DOI: 10.1542/hpeds.2018-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions. METHODS A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed. RESULTS TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings. CONCLUSIONS An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals' attitudes about providing and documenting family meetings.
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Affiliation(s)
- Animesh Sabnis
- Division of Neonatology and Developmental Biology, Departments of Pediatrics,
| | - Eunice Hagen
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Lonnie Zeltzer
- Anesthesiology, and.,Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
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756
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Kongsuwan W, Borvornluck P, Locsin RC. The lived experience of family caregivers caring for patients dependent on life-sustaining technologies. Int J Nurs Sci 2018; 5:365-369. [PMID: 31406849 PMCID: PMC6626285 DOI: 10.1016/j.ijnss.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the meaning of the lived experience of family caregivers caring for their loved ones who were dependent upon life-sustaining technologies while in the hospital. METHODS This study followed van Manen's hermeneutic phenomenological approach to generate and analyze data to describe the experience of ten family caregivers who met the following inclusion criteria: a family member who participated actively in caring for the loved one who was dependent upon technologies for human care. Data were collected using individual in-depth interviews. The interview transcriptions were analyzed using van Manen's phenomenological approach, while Lincoln and Guba's criteria were used to establish trustworthiness of the study. FINDINGS Four thematic categories structured the meaning of the experience: Being an invisible person; supporting patients' wholeness; struggling to trust technologies for human care; and living in uncertainty. These thematic categories were reflective of Van Manen's four lived worlds of body, relation, space, and time. CONCLUSION Understanding the experience of family caregivers challenges nurses to express their technological competencies in caring more fully in their human care. Locsin's theory of Technological Competency as Caring in Nursing was used to explain and describe the meaning of the experiences of family caregivers caring for patients who were dependent upon technologies for human care, and foster nursing practice as caring in nursing.
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Affiliation(s)
- Waraporn Kongsuwan
- Adult and Elderly Nursing Department, Faculty of Nursing, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Pongpaka Borvornluck
- Medical Equipment Center, Department of Nursing, Songklanagarind Hospital, Faculty of Medicine, Hat Yai, Songkhla, 90112, Thailand
| | - Rozzano C. Locsin
- Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
- Florida Atlantic University, Boca Raton, FL, 33431, USA
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757
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Hermes C, Acevedo-Nuevo M, Berry A, Kjellgren T, Negro A, Massarotto P. Gaps in pain, agitation and delirium management in intensive care: Outputs from a nurse workshop. Intensive Crit Care Nurs 2018; 48:52-60. [DOI: 10.1016/j.iccn.2018.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/16/2018] [Accepted: 01/28/2018] [Indexed: 11/27/2022]
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758
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Segers E, Ockhuijsen H, Baarendse P, van Eerden I, van den Hoogen A. The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents' satisfaction and length of stay: A systematic review. Intensive Crit Care Nurs 2018; 50:63-70. [PMID: 30249426 DOI: 10.1016/j.iccn.2018.08.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the impact of family centred care interventions on parents' satisfaction and length of stay for patients admitted to a paediatric intensive care unit or a neonatal intensive care unit. METHODS A systematic review was conducted. Searches have been done in Cinahl, Cochrane, Embase and PubMed from February 2016 till October 2017. All included studies were quality appraised. Due to the heterogeneity of interventions findings were narratively reviewed. RESULTS Seventeen studies were included in this review of which 12/17 studies investigated parents' satisfaction and 7/17 length of stay. For this review two types of interventions were found. Interventions improving parents-professional collaboration which increased parents' satisfaction, and interventions improving parents' involvement which decreased length of stay. Overall quality of the included studies was weak to good. CONCLUSIONS Strong evidence was found for a significant decrease in length of stay when parents where participating in caring for their infant in a neonatal intensive care unit. Moderate evidence was found in parents' satisfaction, which increased when collaboration between parents and professionals at a neonatal intensive care unit improved. Studies performed in a paediatric intensive care setting were of weak to moderate quality and too few to show evidence regarding parents satisfaction and length of stay.
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Affiliation(s)
- Elisabeth Segers
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
| | - Henrietta Ockhuijsen
- Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Petra Baarendse
- Expert Team, Board of Directors, University Medical Center Utrecht, the Netherlands.
| | - Irene van Eerden
- Department of Children, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands.
| | - Agnes van den Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands.
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759
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Sarti AJ, Sutherland S, Healey A, Dhanani S, Landriault A, Fothergill-Bourbonnais F, Hartwick M, Beitel J, Oczkowski S, Cardinal P. A Multicenter Qualitative Investigation of the Experiences and Perspectives of Substitute Decision Makers Who Underwent Organ Donation Decisions. Prog Transplant 2018; 28:343-348. [PMID: 30222045 DOI: 10.1177/1526924818800046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Organ donation research has centered on improving donation rates rather than focusing on the experience and impact on substitute decision makers. The purpose of this study was to document donor and nondonor family experiences, as well as lasting impacts of donation. METHODS We used a qualitative exploratory design. Semistructured interviews of 27 next-of-kin decision makers were conducted, transcribed verbatim, and entered into qualitative software. We analyzed the process-based reflections using inductive coding and thematic analysis techniques. RESULTS Four broad and interrelated themes emerged from the data: empathetic care, information needs, donation decision, and impact and follow-up. The donation experience left lasting impacts on family members due to lingering, unanswered questions. Suggested solutions to improve the donor experience for families included providers employing multimodal communication, ensuring a proper setting for family meetings, and the presence of a support person. DISCUSSION We now have improved our understanding of the donation process from the perspective of and final impression from the next of kin. To our knowledge, this is the largest cohort interviewed in Canada. We have explored families' experiences, which included but did not end with donation. We learned that despite being appreciative of nurses, physicians, and organ and tissue donation coordinators, family members were often troubled by unanswered questions. CONCLUSION This study described donor and nondonor family experiences with donation as well as lasting impacts. Addressing unanswered questions should be done in a place sufficiently remote from the donation event to enhance the family members' understanding and well-being.
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Affiliation(s)
- Aimee J Sarti
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Andrew Healey
- 2 Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- 3 Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Angele Landriault
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | | | - Michael Hartwick
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Janice Beitel
- 6 Trillium Gift of Life Network (TGLN), Toronto, Ontario, Canada
| | - Simon Oczkowski
- 7 Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Pierre Cardinal
- 1 Department of Critical Care, The Ottawa Hospital, Ottawa, Ontario, Canada.,4 Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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760
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Abstract
PURPOSE OF REVIEW End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. RECENT FINDINGS EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave. The impact of EOL care on families is part of the acute Family Intensive Care Unit Syndrome (FICUS) and the Post Intensive Care Syndrome-Family (PICS-F). Family-centered care (FCC) acknowledges the importance of relatives in the ICU. Several interventions have been evaluated, but evidence for their effectiveness is at best moderate. Some interventions even increased family stress. Interventional studies, which address clinician burnout are rare. SUMMARY EOL care is associated with negative outcomes for ICU clinicians and relatives, but strength of evidence for interventions is weak because we lack understanding of associated factors like work conditions, organizational issues or individual attitudes. In order to develop complex interventions that can successfully mitigate stress related to EOL care, more research is necessary, which takes into account all potential determinants.
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761
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Hartog CS, Hoffmann F, Mikolajetz A, Schröder S, Michalsen A, Dey K, Riessen R, Jaschinski U, Weiss M, Ragaller M, Bercker S, Briegel J, Spies C, Schwarzkopf D. [Non-beneficial therapy and emotional exhaustion in end-of-life care : Results of a survey among intensive care unit personnel]. Anaesthesist 2018; 67:850-858. [PMID: 30209513 DOI: 10.1007/s00101-018-0485-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND End-of-life care (EOLC) in the intensive care unit (ICU) is becoming increasingly more common but ethical standards are compromised by growing economic pressure. It was previously found that perception of non-beneficial treatment (NBT) was independently associated with the core burnout dimension of emotional exhaustion. It is unknown whether factors of the work environment also play a role in the context of EOLC. OBJECTIVE Is the working environment associated with perception of NBT or clinician burnout? MATERIAL AND METHODS Physicians and nursing personnel from 11 German ICUs who took part in an international, longitudinal prospective observational study on EOLC in 2015-2016 were surveyed using validated instruments. Risk factors were obtained by multivariate multilevel analysis. RESULTS The participation rate was 49.8% of personnel working in the ICU at the time of the survey. Overall, 325 nursing personnel, 91 residents and 26 consulting physicians participated. Nurses perceived NBT more frequently than physicians. Predictors for the perception of NBT were profession, collaboration in the EOLC context, excessively high workload (each p ≤ 0.001) and the numbers of weekend working days per month (p = 0.012). Protective factors against burnout included intensive care specialization (p = 0.001) and emotional support within the team (p ≤ 0.001), while emotional exhaustion through contact with relatives at the end of life and a high workload were both increased (each p ≤ 0.001). DISCUSSION Using the example of EOLC, deficits in the work environment and stress factors were uncovered. Factors of the work environment are associated with perceived NBT. To reduce NBT and burnout, the quality of the work environment should be improved and intensive care specialization and emotional support within the team enhanced. Interprofessional decision-making among the ICU team and interprofessional collaboration should be improved by regular joint rounds and interprofessional case discussions. Mitigating stressful factors such as communication with relatives and high workload require allocation of respective resources.
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Affiliation(s)
- Christiane S Hartog
- Klinik für Anästhesie m.S. operative Intensivmedizin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Klinik Bavaria Kreischa, Kreischa, Deutschland.
| | - F Hoffmann
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinik Jena, Jena, Deutschland
| | - A Mikolajetz
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinik Jena, Jena, Deutschland
| | - S Schröder
- Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Krankenhaus Düren, Düren, Deutschland
| | - A Michalsen
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Medizin Campus Bodensee - Klinik Tettnang, Tettnang, Deutschland
| | - K Dey
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland
| | - R Riessen
- Medizinische Klinik, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - U Jaschinski
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Augsburg, Augsburg, Deutschland
| | - M Weiss
- Klinik für Anästhesiologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - M Ragaller
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - S Bercker
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Briegel
- Klinik für Anästhesiologie, Klinikum der Universität, LMU München, München, Deutschland
| | - C Spies
- Klinik für Anästhesie m.S. operative Intensivmedizin, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - D Schwarzkopf
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinik Jena, Jena, Deutschland
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762
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Ludmir J, Liu X, Gupta A, Ramani GV, Liu SS, Zakaria S, Verceles AC, Shah NG, McCurdy MT, Dammeyer JA, Netzer G. Cardiologist perceptions of family-centred rounds in cardiovascular clinical care. Open Heart 2018; 5:e000834. [PMID: 30228906 PMCID: PMC6135426 DOI: 10.1136/openhrt-2018-000834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 11/04/2022] Open
Abstract
Objective Few data exist regarding physician attitudes and implementation of family-centred rounds (FCR) in cardiovascular care. This study aimed to assess knowledge and attitudes among cardiologists and cardiology fellows regarding barriers and benefits of FCRs. Methods An electronic, web-based questionnaire was nationally distributed to cardiology fellows and attending cardiologists. Results In total, 118 subjects were surveyed, comprising cardiologists (n=64, 54%) and cardiology fellows (n=54, 46%). Overall, 61% of providers reported participating in FCRs and 64% felt family participation on rounds benefits the patient. Both fellows and cardiologists agreed that family rounds eased family anxiety (fellows, 63%; cardiologists, 56%; p=0.53), improved communication between the medical team and the patient and family (fellows, 78%; cardiologists, 61%; p=0.18) and improved patient safety (fellows, 59%; cardiologists, 47%; p=0.43). Attitudes regarding enhancement of trainee education were similar (fellows, 69%; cardiologists, 55%; p=0.19). Fellows and cardiologists felt that family increased the duration of rounds (fellows, 78%; cardiologists, 80%; p=0.18) and led to less efficient rounds (fellows, 54%; cardiologists, 58%; p=0.27). Conclusion The majority of cardiologists and fellows believed that FCRs benefited families, communication and patient safety, but led to reduced efficiency and longer duration of rounds.
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Affiliation(s)
- Jonathan Ludmir
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Xinggang Liu
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anuj Gupta
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gautam V Ramani
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stanley S Liu
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sammy Zakaria
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nirav G Shah
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael T McCurdy
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Dammeyer
- Critical Care Medicine Unit, University of Michigan Hospitals, Ann Arbor, Michigan, USA
| | - Giora Netzer
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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763
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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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764
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Haines KJ. Engaging Families in Rehabilitation of People Who Are Critically Ill: An Underutilized Resource. Phys Ther 2018; 98:737-744. [PMID: 30113660 DOI: 10.1093/ptj/pzy066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 08/01/2018] [Indexed: 11/12/2022]
Abstract
Rehabilitation of people who are critically ill has received increased attention in recent years, although this has not extended to specifically facilitating family involvement. Engaging families in the rehabilitation arc has the potential to optimize outcomes. Likely benefits include redirecting family psychological distress into an active participatory role, humanizing the patient illness and recovery experience, and supporting staff and the health care system beyond the constraints of therapy time. This viewpoint explores why families should be engaged in critical care rehabilitation, gives an overview of the evidence for family participation in bedside care, and provides practical implementation strategies and signpost areas for future research.
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Affiliation(s)
- Kimberley J Haines
- Physiotherapy Department, Western Health, Furlong Road, St Albans, Victoria 3021, Australia; and Australia and New Zealand Research Centre, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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765
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Devlin JW, Skrobik Y, Rochwerg B, Nunnally ME, Needham DM, Gelinas C, Pandharipande PP, Slooter AJC, Watson PL, Weinhouse GL, Kho ME, Centofanti J, Price C, Harmon L, Misak CJ, Flood PD, Alhazzani W. Methodologic Innovation in Creating Clinical Practice Guidelines: Insights From the 2018 Society of Critical Care Medicine Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption Guideline Effort. Crit Care Med 2018; 46:1457-1463. [PMID: 29985807 DOI: 10.1097/ccm.0000000000003298] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To describe novel guideline development strategies created and implemented as part of the Society of Critical Care Medicine's 2018 clinical practice guidelines for pain, agitation (sedation), delirium, immobility (rehabilitation/mobility), and sleep (disruption) in critically ill adults. DESIGN We involved critical illness survivors from start to finish, used and expanded upon Grading of Recommendations, Assessment, Development and Evaluation methodology for making recommendations, identified evidence gaps, and developed communication strategies to mitigate challenges. SETTING/SUBJECTS Thirty-two experts from five countries, across five topic-specific sections; four methodologists, two medical librarians, four critical illness survivors, and two Society of Critical Care Medicine support staff. INTERVENTIONS Unique approaches included the following: 1) critical illness survivor involvement to help ensure patient-centered questions and recommendations; 2) qualitative and semiquantitative approaches for developing descriptive statements; 3) operationalizing a three-step approach to generating final recommendations; and 4) systematic identification of evidence gaps. MEASUREMENTS AND MAIN RESULTS Critical illness survivors contributed to prioritizing topics, questions, and outcomes, evidence interpretation, recommendation formulation, and article review to ensure that their values and preferences were considered in the guidelines. Qualitative and semiquantitative approaches supported formulating descriptive statements using comprehensive literature reviews, summaries, and large-group discussion. Experts (including the methodologists and guideline chairs) developed and refined guideline recommendations through monthly topic-specific section conference calls. Recommendations were precirculated to all members, presented to, and vetted by, most members at a live meeting. Final electronic voting provided links to all forest plots, evidence summaries, and "evidence to decision" frameworks. Written comments during voting captured dissenting views and were integrated into evidence to decision frameworks and the guideline article. Evidence gaps, reflecting clinical uncertainty in the literature, were identified during the evidence to decision process, live meeting, and voting and formally incorporated into all written recommendation rationales. Frequent scheduled "check-ins" mitigated communication gaps. CONCLUSIONS Our multifaceted, interdisciplinary approach and novel methodologic strategies can help inform the development of future critical care clinical practice guidelines.
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Affiliation(s)
- John W Devlin
- School of Pharmacy, Northeastern University, Boston, MA
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA
| | - Yoanna Skrobik
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- Regroupement de Soins Critiques Respiratoires, Réseau de Santé Respiratoire, Montreal, QC, Canada
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Bram Rochwerg
- Department of Medicine (Critical Care), McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
| | - Mark E Nunnally
- Division of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, NY
- Division of Medicine, New York University Langone Health, New York, NY
- Division of Neurology, New York University Langone Health, New York, NY
- Division of Surgery, New York University Langone Health, New York, NY
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Celine Gelinas
- Ingram School of Nursing, McGill University, Montreal, QC, Canada
| | - Pratik P Pandharipande
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Paula L Watson
- Division of Sleep Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Gerald L Weinhouse
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital and School of Medicine, Harvard University, Boston, MA
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - John Centofanti
- Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada
| | - Carrie Price
- Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Lori Harmon
- Society of Critical Care Medicine, Mount Prospect, IL
| | - Cheryl J Misak
- Department of Philosophy, University of Toronto, Toronto, CA
| | - Pamela D Flood
- Division of Anesthesiology, Stanford University Hospital, Palo Alto, CA
| | - Waleed Alhazzani
- Department of Health Research Methods, Impact and Evidence, McMaster University, Hamilton, ON, Canada
- Department of Medicine (Critical Care and Gastroenterology), McMaster University, Hamilton, ON, Canada
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766
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Smith W. Concept Analysis of Family-Centered Care of Hospitalized Pediatric Patients. J Pediatr Nurs 2018; 42:57-64. [PMID: 30219300 DOI: 10.1016/j.pedn.2018.06.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
AIM The purpose of this concept analysis is to provide a background of family-centered care of the hospitalized pediatric patient, clarify its components, and validate its significance to nursing practice and research. BACKGROUND The concept of family-centered care in the hospital environment has been discussed in the literature for over 60 years, yet its principles remain unclear and poorly implemented. Further analysis of this concept is warranted and has the potential to promote its integration into current nursing practice by increasing awareness and clarifying the essential attributes. DATA SOURCES A systematic review of the literature yielded thousands of resources which were narrowed to a comprehensive list of 37 sources rich in valuable and applicable content. REVIEW METHODS This analysis utilized the 8-step methodology of concept analysis described by Walker and Avant. FINDINGS The majority of research investigating the concept of family-centered care and the hospitalized pediatric patient found was focused on defining family-centered care and surveying both families and nurses on their understanding of the concept. Little research was found exploring the relationship of family-centered care with patient and family outcomes, or patient and family satisfaction. CONCLUSION Family-centered care of the pediatric patient in the hospital environment remains an abstract concept. It is recommended as a cornerstone of modern nursing practice, yet nurses report they lack sufficient education regarding its operationalization into practice. Elucidation of characteristics coupled with education regarding principles of the concept has the potential to augment further integration of family-centered care in the hospital environment.
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Affiliation(s)
- Wendi Smith
- Villanova University, Fitzpatrick College of Nursing, Villanova, PA, USA.
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767
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Padilla-Fortunatti C, Rojas-Silva N, Arechabala-Mantuliz MC. Analysis of the difference between importance and satisfaction of the needs of family members of critical patients. Med Intensiva 2018; 43:217-224. [PMID: 30172613 DOI: 10.1016/j.medin.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/20/2018] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To analyze the difference between the degree of importance and satisfaction of the needs of family members of patients in an Intensive Care Unit (ICU). DESIGN A descriptive, cross-sectional analytical study was carried out. SETTING Medical - surgical ICU of a university hospital in Chile. PARTICIPANTS Family members of critical patients with a length of stay of ≥ 48hours, over 18 years of age, and with at least one visit to the patient. VARIABLES OF INTEREST The Critical Care Family Needs Inventory questionnaire was used to determine the difference between the degree of importance and satisfaction of the needs of the family members. In addition, the needs were classified according to the categories proposed by importance - performance analysis (IPA). RESULTS A total of 253 family members were recruited, observing a negative gap (satisfaction <importance) in 100% of communication needs and in 51.9% of support needs. In turn, 8.9% of the needs were priority needs according to the IPA, including assistance with financial problems, contact in case of changes in the patient condition, talk about the possibility of death, and the reception of guidance at the patient bedside. CONCLUSIONS A high level of importance, compared to low levels of satisfaction, determines a negative gap in most of the needs of the family of the critical patient, particularly those referred to communication. Despite this, a low proportion of the needs should be addressed on a priority basis.
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Affiliation(s)
- C Padilla-Fortunatti
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Unidad de Paciente Crítico, Hospital Clínico UC-CHRISTUS, Santiago, Chile
| | - N Rojas-Silva
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile.
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768
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Law AC, Roche S, Reichheld A, Folcarelli P, Cocchi MN, Howell MD, Sands K, Stevens JP. Failures in the Respectful Care of Critically Ill Patients. Jt Comm J Qual Patient Saf 2018; 45:276-284. [PMID: 30170754 DOI: 10.1016/j.jcjq.2018.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The emotional toll of critical illness on patients and their families can be profound and is emerging as an important target for value improvement. One source of emotional harm to patients and families may be care perceived as inadequately respectful. The prevalence and risk factors for types of emotional harms is under-studied. METHODS This prospective cohort study was conducted in nine ICUs at a tertiary care academic medical center in the United States. Prevalence of inadequate respect for (a) the patient and (b) the family, as well as prevalence of perceived lack of control over the care of their loved ones, was assessed by the Family Satisfaction with Care in the Intensive Care Unit instrument. The relationship between these outcomes with demographic and clinical covariates was assessed. Stratification by patient survivorship was performed in sensitivity analysis. RESULTS Of more than 1,500 respondents, 16.9% and 21.8% reported that the patient or the family member, respectively, received inadequate respect. No clinical characteristics of the patients were associated with inadequate respect for either the patient or the family member. By comparison, more than half of respondents reported a lack of control over their loved one's care; this finding was associated with multiple clinical factors. Prevalence and associated factors differed by patient survivorship status. CONCLUSION Care that is inadequately respectful to patients and families in the setting of critical illness is prevalent but does not appear to be associated with clinical characteristics. The incidence of such emotional harms is nuanced, difficult to predict, and deserves further investigation.
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769
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Abstract
BACKGROUND Examine the association of a daily palliative care needs checklist on outcomes for family members of patients discharged from the neurosciences intensive care unit (neuro-ICU). METHODS We conducted a prospective, longitudinal cohort study in a single, thirty-bed neuro-ICU in a regional comprehensive stroke and level 1 trauma center. One of two neuro-ICU services that admit patients to the same ICU on alternating days used a palliative care needs checklist during morning work rounds. Between March and October, 2015, surveys were mailed to family members of patients discharged from the neuro-ICU. RESULTS Nearly half of surveys (n = 91, 48.1%) were returned at a median of 4.7 months. At the time of survey completion, mean Modified rankin scale score (mRS) of neuro-ICU patients was 3.1 (SD 2). Overall ratings of quality of care were relatively high (82.2 on a 0-100 scale) with 32% of family members meeting screening criteria for depressive syndrome. The primary outcome measuring family satisfaction, consisting of eight items from the Family Satisfaction in the ICU questionnaire, did not differ significantly between families of patients from either ICU service nor did family ratings of depression (PHQ-8) and post-traumatic stress (PCL-17). CONCLUSIONS Among families of patients discharged from the neuro-ICU, the daily use of a palliative care needs checklist had no measurable effect on family satisfaction scores or long-term psychological outcomes. Further research is needed to identify optimal interventions to meet the palliative care needs specific to family members of patients treated in the neuro-ICU.
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770
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Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol 2018; 18:106. [PMID: 30111299 PMCID: PMC6094470 DOI: 10.1186/s12871-018-0574-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/03/2018] [Indexed: 12/15/2022] Open
Abstract
Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering when “curative” therapies are futile. In the Intensive Care Unit (ICU), critically ill patients receive life-sustaining therapies with the goal of restoring or maintaining organ function. Palliative Care in the ICU is a widely discussed topic and it is increasingly applied in clinics. It encompasses symptoms control and end-of-life management, communication with relatives and setting goals of care ensuring dignity in death and decision-making power. However, effective application of Palliative Care in ICU presupposes specific knowledge and training which anesthesiologists and critical care physicians may lack. Moreover, logistic issues such protocols for patients’ selection, application models and triggers for consultation of external experts are still matter of debate. The aim of this review is to provide the anesthesiologists and intensivists an overview of the aims, current evidence and practical advices about the application of palliative care in ICU.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
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771
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Abstract
Research highlights the psychosocial impact of critical illness on family who typically adopt a caregiver role to the survivor. We review evidence on informal caregiver psychosocial outcomes and interventional studies designed to improve them. We argue informal caregivers have distinct and complex needs that differ from patients. Interventional studies ought to be designed for this cohort with careful attention paid to the timing of interventions. We consider the influence of social isolation on recovery and discuss service improvement approaches to build social support networks to enhance recovery, where caregivers and survivors are involved in the design of aftercare programs.
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, 176 Furlong Road, St Albans, Melbourne, Victoria 3021, Australia; Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow G4 0SF, Scotland; School of Medicine, Dentistry and Nursing, University of Glasgow, University Avenue, Glasgow G12 8QQ, Scotland
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772
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Hoffmann M, Holl AK, Burgsteiner H, Eller P, Pieber TR, Amrein K. Prioritizing information topics for relatives of critically ill patients : Cross-sectional survey among intensive care unit relatives and professionals. Wien Klin Wochenschr 2018; 130:645-652. [PMID: 30094664 PMCID: PMC6244832 DOI: 10.1007/s00508-018-1377-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/23/2018] [Indexed: 11/29/2022]
Abstract
A patient’s admission to an intensive care unit (ICU) has a significant impact on family members and other relatives. In order for them to be able to cope with such a stressful situation, the availability of appropriate understandable and accessible information is crucial. The information asymmetry between relatives and medical professionals may adversely affect satisfaction of relatives and their risk of subsequent anxiety, depression and stress symptoms. The aim of this study was therefore to understand which topics are most important to the relatives of ICU patients and to quantify the perceptions of medical professionals regarding the information needs of relatives. A cross-sectional survey was conducted in 2015. The survey had 42 questions, such as ‘diagnosis’, ‘treatment’, ‘comfort’, ‘family’ and ‘end of life’. In total, the survey was handed out to four different groups. A total of 336 persons answered the survey (26 relatives, 28 ICU physicians, 202 ICU nurses and 80 ICU medical professionals in a closed Facebook© group [Facebook, Menlo Park, California, USA]). Relatives ranked the five most important topics as follows: ‘recent events (crisis)’, ‘my participation’, ‘contamination in hospital’, ‘physical pain’, and ‘probability’. Several significant differences (p<0.001) were detected, for example for the topics fever, medication, recent events (crisis), appointments, relapse, and investigations. Even the topic with the lowest ranking (religion) had a score of 3.15 (min. 1.00, max. 5.00) among relatives. The ICU professionals appear to have divergent opinions regarding the most important topics for ICU relatives as compared to relatives themselves.
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Affiliation(s)
- Magdalena Hoffmann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. .,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria. .,Research Unit for Safety in Health, Medical University of Graz, Graz, Austria.
| | - Anna K Holl
- Department for Psychiatry, University Hospital Graz, Graz, Austria
| | - Harald Burgsteiner
- Institute for Digital Competence and Media Education, University College of Teacher Education Styria, Graz, Austria
| | - Philipp Eller
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.,Joanneum Research, Graz, Austria
| | - Karin Amrein
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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773
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Hoffmann M, Taibinger M, Holl AK, Burgsteiner H, Pieber TR, Eller P, Sendlhofer G, Amrein K. [Online information for relatives of critically ill patients : Pilot test of the usability of an ICU families website]. Med Klin Intensivmed Notfmed 2018; 114:166-172. [PMID: 30083872 DOI: 10.1007/s00063-018-0467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Relatives of intensive care patients have a very high need for information. This is due to the acute and serious, often life-threatening illness of the patients and the very complex and technical environment of an intensive care unit (ICU). Unmet needs for information can increase anxiety, sleep disorders, stress, and depressive symptoms in the relatives. OBJECTIVES The potential of the ICU families website in terms of usability and functionality during real-time testing were evaluated. METHODS The ICU families project created a dynamic online information platform in the form of a password-protected website. It contains pictures, written explanations, 5 movies, a forum and a diary function. The usability of the website was tested among 10 lay people and 10 experts (7 nurses and 3 physicians) according to the Think Aloud Method. RESULTS The outcome is qualitative feedback based on video documentation by laypeople and suggestions by experts. Criticisms mentioned by the test subjects were insufficient image material, small size of the operator contact link and lack of a home button. With a mean of 9.1 (rating scale, 0 = very poor, 10 = very good), the website was almost universally recommended by the experts. CONCLUSIONS This usability test of a website for relatives of ICU patients conducted among 20 test subjects showed the biggest challenges related to solving individual test scenarios and provided valuable hints for improving website usability. Features of the website highlighted as positive were the clear layout, the symbols, the diary and the consideration of children. This information was used to improve the site for subsequent roll-out in a randomized, controlled and multicentre study.
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Affiliation(s)
- M Hoffmann
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich. .,Research Unit for Safety in Health, Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Österreich. .,Stabsstelle Qualitäts- und Risikomanagement, LKH-Univ. Klinikum, Graz, Österreich.
| | | | - A K Holl
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, LKH-Univ. Klinikum, Graz, Österreich
| | - H Burgsteiner
- Institut für Digitale Kompetenz und Medienpädagogik, Pädagogische Hochschule Steiermark, Graz, Österreich
| | - T R Pieber
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich.,Joanneum Research, Health, Graz, Österreich
| | - P Eller
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - G Sendlhofer
- Research Unit for Safety in Health, Klinische Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Medizinische Universität Graz, Graz, Österreich.,Stabsstelle Qualitäts- und Risikomanagement, LKH-Univ. Klinikum, Graz, Österreich
| | - K Amrein
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
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774
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Abstract
Although family is an essential unit of every society, many intensive care units continue to impose limitations on families' access to their loved ones. Unlimited family presence is backed both by data and the guidelines of multiple professional societies. We propose that the obligation to protect the integrity and needs of our patients and families extends past our immediate relationship to them at the bedside, and is also a societal imperative. In a society rife with implicit bias, restrictions on family visitation risk selective enforcement of these rules, and further propagate social injustice. Restrictions on family presence, including rigid hours, reflect an arbitrary vision based on increasingly obsolete socioeconomic realities. The time is now to open our intensive care units both on behalf of our patients and families, and for the betterment of our society as a whole.
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775
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Meiers SJ, Eggenberger SK, Krumwiede N. Development and Implementation of a Family-Focused Undergraduate Nursing Curriculum: Minnesota State University, Mankato. JOURNAL OF FAMILY NURSING 2018; 24:307-344. [PMID: 30101655 DOI: 10.1177/1074840718787274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Nurse educators have the responsibility to create learning experiences centered on the scientific and praxis foci of the nursing discipline to advance nursing practice with families. Although the nursing profession has ample knowledge about the importance of family nursing and the value of family-focused actions, there is a lack of curricular and teaching models that address nursing practice with families in numerous courses and learning experiences. This article describes the development of a family-focused undergraduate curriculum and teaching-learning practices at Minnesota State University, Mankato in the United States. A vision and mission centered on the nursing of families, a family care teaching model, a framework of family constructs, and taxonomy of significant learning strategies guided faculty in creating learner-centered experiences. Course objectives, competencies, and teaching-learning practices in this curriculum are described. This manuscript may guide the development of innovative teaching-learning practices that integrate family nursing constructs and family nursing actions from a variety of family nursing models and theories. Initial evaluation suggests that this curriculum can increase students' knowledge of family and instill a passion for family care in undergraduate programs.
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776
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Abstract
OBJECTIVES To examine the circumstance of death in the PICU in the setting of ongoing curative or life-prolonging goals. DATA SOURCES Multidisciplinary author group, international expert opinion, and use of current literature. DATA SYNTHESIS We describe three common clinical scenarios when curative or life-prolonging goals of care are pursued despite a high likelihood of death. We explore the challenges to providing high-quality end-of-life care in this setting. We describe possible perspectives of families and ICU clinicians facing these circumstances to aid in our understanding of these complex deaths. Finally, we offer suggestions of how PICU clinicians might improve the care of children at the end of life in this setting. CONCLUSIONS Merging curative interventions and optimal end-of-life care is possible, important, and can be enabled when clinicians use creativity, explore possibilities, remain open minded, and maintain flexibility in the provision of critical care medicine. When faced with real and perceived barriers in providing optimal end-of-life care, particularly when curative goals of care are prioritized despite a very poor prognosis, tensions and conflict may arise. Through an intentional exploration of self and others' perspectives, values, and goals, and working toward finding commonality in order to align with each other, conflict in end-of-life care may lessen, allowing the central focus to remain on providing optimal support for the dying child and their family.
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777
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The Relevance of Parental Presence at the Bedside in Family-Partnered Care. Pediatr Crit Care Med 2018; 19:789-790. [PMID: 30095720 DOI: 10.1097/pcc.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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778
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Girbes AR, van Galen T, Signo S. The journey continues after the war-zone minefield. J Crit Care 2018; 46:139-140. [DOI: 10.1016/j.jcrc.2018.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/18/2018] [Indexed: 11/24/2022]
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779
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Nydahl P, Fischill M, Deffner T, Neudeck V, Heindl P. [Diaries for intensive care unit patients reduce the risk for psychological sequelae : Systematic literature review and meta-analysis]. Med Klin Intensivmed Notfmed 2018; 114:68-76. [PMID: 29995235 DOI: 10.1007/s00063-018-0456-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications. METHODS The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment. RESULTS The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%. CONCLUSION ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland. .,Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | | | - T Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - P Heindl
- Internistischer Intensivbehandlungsbereich, Notfallmedizin und Intensivbehandlung für Brandverletzte, Allgemeines Krankenhaus der Stadt Wien, Medizinischer Universitätscampus, Wien, Österreich
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780
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Kalocsai C, Amaral A, Piquette D, Walter G, Dev SP, Taylor P, Downar J, Gotlib Conn L. "It's better to have three brains working instead of one": a qualitative study of building therapeutic alliance with family members of critically ill patients. BMC Health Serv Res 2018; 18:533. [PMID: 29986722 PMCID: PMC6038351 DOI: 10.1186/s12913-018-3341-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses. Methods We used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used. Results Participating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment. Conclusions Multiple opportunities exist to improve family-provider relationships in the ICU. The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment. Electronic supplementary material The online version of this article (10.1186/s12913-018-3341-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Csilla Kalocsai
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada. .,Patient/Client and Family Education, Centre for Mental Health and Addiction, 33 Russell Street, Toronto, Ontario, M5S 3M1, Canada.
| | - Andre Amaral
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Dominique Piquette
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada.,Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Grace Walter
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Shelly P Dev
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James Downar
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada.,Palliative Medicine, University of Toronto, Toronto, Canada
| | - Lesley Gotlib Conn
- Trauma, Emergency and Critical Care Research, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
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781
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Hollman Frisman G, Wåhlin I, Orvelius L, Ågren S. Health-promoting conversations-A novel approach to families experiencing critical illness in the ICU environment. J Clin Nurs 2018; 27:631-639. [PMID: 28722814 DOI: 10.1111/jocn.13969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify and describe the outcomes of a nurse-led intervention, "Health-promoting conversations with families," regarding family functioning and well-being in families with a member who was critically ill. BACKGROUND Families who have a critically ill family member in an intensive care unit face a demanding situation, threatening the normal functioning of the family. Yet, there is a knowledge gap regarding family members' well-being during and after critical illness. DESIGN The study used a qualitative inductive-descriptive design. METHODS Eight families participated in health-promoting conversations aimed to create a context for change related to the families' identified problems and resources. Fifteen qualitative interviews were conducted with 18 adults who participated in health-promoting conversations about a critical illness in the family. Eight participants were patients (six men, two women) and 10 were family members (two male partners, five female partners, one mother, one daughter, one female grandchild). The interviews were analysed by conventional content analysis. RESULTS Family members experienced strengthened togetherness, a caring attitude and confirmation through health-promoting conversations. The caring and calming conversations were appreciated despite the reappearance of exhausting feelings. Working through the experience and being confirmed promoted family well-being. CONCLUSION Health-promoting conversations were considered to be healing, as the family members take part in sharing each other's feelings, thoughts and experiences with the critical illness. RELEVANCE TO CLINICAL PRACTICE Health-promoting conversations could be a simple and effective nursing intervention for former intensive care patients and their families in any cultural context.
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Affiliation(s)
- Gunilla Hollman Frisman
- Department of Medical and Health Sciences, Anesthetics, Operations and Specialty Surgery Center, Linköping University, Linköping, Sweden
| | - Ingrid Wåhlin
- Intensive Care Department, Kalmar Hospital, Kalmar, Sweden.,School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | - Lotti Orvelius
- Department of Anaesthesiology and Intensive Care and Department of Clinical Experimental Medicine, Linköping University, Linköping, Sweden
| | - Susanna Ågren
- Department of Cardiothoracic Surgery and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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782
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Jones C, Puntillo K, Donesky D, McAdam JL. Family Members' Experiences With Bereavement in the Intensive Care Unit. Am J Crit Care 2018; 27:312-321. [PMID: 29961667 DOI: 10.4037/ajcc2018262] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Losing a loved one in the intensive care unit can be challenging for families. Providing bereavement support may assist in the grieving process. OBJECTIVE To describe family members' experiences with bereavement after the death of a loved one in the intensive care unit. METHODS This secondary analysis used an exploratory, descriptive design to study family members' experiences with bereavement. Family members of patients from 2 intensive care units in a tertiary medical center in the western United States participated. Audiotaped telephone interviews using a semistructured questionnaire were conducted. A qualitative, descriptive technique was used for data analysis. Two independent raters coded transcripts of audiotaped interviews with family members about their bereavement experiences. RESULTS Seventeen family members participated in the study. Most participants were female (n = 12; 71%) and spouses of deceased patients (n = 14; 82%), and their mean (SD) age was 62.4 (10.0) years. Three themes emerged: (1) bereavement was an individual experience; (2) situations occurring during the intensive care unit encounter remained significant for family members beyond a year after the death; and (3) social, cultural, spiritual, and religious events after the death hold importance for families of patients in the intensive care unit. CONCLUSIONS Bereavement is a challenging experience for families of deceased intensive care unit patients. The themes identified in this study add insight into the experiences of these family members. The results of this study may guide future interventions to help support bereaved families of intensive care unit patients.
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Affiliation(s)
- Casey Jones
- Casey Jones is a visiting assistant lecturer, Global Health Service Partnership, Muni University, Uganda. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, School of Nursing, San Francisco, California. Doranne Donesky is an assistant professor at University of California, San Francisco, School of Nursing. Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California
| | - Kathleen Puntillo
- Casey Jones is a visiting assistant lecturer, Global Health Service Partnership, Muni University, Uganda. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, School of Nursing, San Francisco, California. Doranne Donesky is an assistant professor at University of California, San Francisco, School of Nursing. Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California
| | - Doranne Donesky
- Casey Jones is a visiting assistant lecturer, Global Health Service Partnership, Muni University, Uganda. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, School of Nursing, San Francisco, California. Doranne Donesky is an assistant professor at University of California, San Francisco, School of Nursing. Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California
| | - Jennifer L. McAdam
- Casey Jones is a visiting assistant lecturer, Global Health Service Partnership, Muni University, Uganda. Kathleen Puntillo is a professor emeritus at University of California, San Francisco, School of Nursing, San Francisco, California. Doranne Donesky is an assistant professor at University of California, San Francisco, School of Nursing. Jennifer L. McAdam is an associate professor at Samuel Merritt University, School of Nursing, Oakland, California
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783
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Koren D, Laidsaar-Powell R, Tilden W, Latt M, Butow P. Health care providers' perceptions of family caregivers' involvement in consultations within a geriatric hospital setting. Geriatr Nurs 2018; 39:419-427. [DOI: 10.1016/j.gerinurse.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
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784
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Zupanets IA, Dobrova VY, Ratushna KL, Silchenko SO. Introduction of open visiting policy in intensive care units in Ukraine: policy analysis and the ethical perspective. Asian Bioeth Rev 2018; 10:105-121. [PMID: 33717281 PMCID: PMC7747421 DOI: 10.1007/s41649-018-0057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/03/2018] [Indexed: 10/26/2022] Open
Abstract
Open visiting policy (OVP) in intensive care units (ICU) is considered a favorable visiting regime that may benefit patients and their family members as well as medical staff. The article examines the conditions and causes of OVP-making process in Ukraine and presents the ethical analysis of its implications with respect to the key stakeholders: ICU patients, family members, and medical staff. The OVP, established by the Ministry of Health in June, 2016, changes current approaches to the recognition of the role of families in critically ill patients' care dramatically; it does, however, have serious shortcomings. The analysis of risks and benefits showed that OVP does not adequately cater to the needs of all the key players-family members, patients, and medical staff. Moreover, there is no clear mechanism to control OVP implementation via feedback from all the key players (particularly patients and their families). These issues give rise to a concern that the implementation of OVP will die on the vine. In order to prevent this, a range of measures is required: the optimization of the ICU facilities and internal procedures, supervision of OVP implementation by policy-makers, training of medical staff, and providing family members with educational programs. Considering current shortcomings, it is crucially important to develop clear and consistent internal guidelines in hospitals that will guarantee the introduction of open ICU visiting and quality of critical care provisions.
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785
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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786
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Impressions of Early Mobilization of Critically Ill Children-Clinician, Patient, and Family Perspectives. Pediatr Crit Care Med 2018; 19:e350-e357. [PMID: 29649021 DOI: 10.1097/pcc.0000000000001547] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. DESIGN A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. SETTING McMaster Children's Hospital PICU, Hamilton, ON, Canada. PARTICIPANTS Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). INTERVENTION Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. MEASUREMENTS AND MAIN RESULTS Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. CONCLUSIONS Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU.
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787
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Factors associated with nurses' perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: A cross-sectional survey. Int J Nurs Stud 2018; 87:103-112. [PMID: 30096577 DOI: 10.1016/j.ijnurstu.2018.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Family presence during resuscitation is not widely implemented in clinical practice. Prior research about nurse factors that may influence their decision to invite family members to remain in the room during resuscitation is contradictory and inconclusive. OBJECTIVES To describe intensive care unit nurses' perceptions, self-confidence, and invitations of family presence during resuscitation, and to evaluate differences according to nurse factors. DESIGN A cross-sectional survey design was used for descriptive and correlational analyses. SETTING Data collection occurred online. PARTICIPANTS A convenience sample of 395 nurses working in intensive care units across the United States was obtained. METHODS Participants completed a survey to collect personal, professional, and workplace information. The Family Presence Risk-Benefit Scale and Family Presence Self-confidence Scale were administered, and frequency of inviting family members to be in the room during resuscitation was collected by self-report. Following descriptive analysis of univariate distributions, a series of hierarchical OLS regression analyses was used to identify which personal, professional, or workplace factors yielded the largest unique impact on nurse perceptions, self-confidence, and invitations of family presence during resuscitation. RESULTS Despite high frequency of performing resuscitative care, one-third of participants had never invited family members to be in the room during resuscitation during their careers, and another 33% had invited family members to be present just 1-5 times. Having had clinical experience with family presence during resuscitation was the strongest predictor of positive perceptions, higher self-confidence, and increased invitations. In addition, having received education on family presence during resuscitation and a written facility policy were found to be key professional and workplace predictors of perceptions and invitations. CONCLUSIONS Nurses who work in a facility with a policy on family presence during resuscitation, are educated on it, and have experienced it in the clinical setting are more likely to have positive perceptions and higher self-confidence, and to invite family members to be in the room during resuscitation with increased frequency. Nurses in leadership roles should create policies for their units and provide education to nurses and other healthcare providers. Due to the apparent importance of clinical experience with family presence during resuscitation, it is recommended to initially provide this experience using simulation and role modeling.
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788
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Alfheim HB, Hofsø K, Småstuen MC, Tøien K, Rosseland LA, Rustøen T. Post-traumatic stress symptoms in family caregivers of intensive care unit patients: A longitudinal study. Intensive Crit Care Nurs 2018; 50:5-10. [PMID: 29937075 DOI: 10.1016/j.iccn.2018.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To describe the prevalence and trajectory of family caregivers' post-traumatic stress symptoms during the first year after a patient's admission to the intensive care unit and identify associations between family caregivers' background characteristics, hope and post-traumatic stress symptoms. RESEARCH METHODOLOGY/DESIGNS Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed. SETTING Four intensive care units in a university hospital in Norway. MAIN OUTCOME MEASURES Impact of Event Scale-Revised and Herth Hope Index. RESULTS On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels. CONCLUSIONS Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms.
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Affiliation(s)
- Hanne Birgit Alfheim
- Postoperative and Intensive Care and Department, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456 Oslo, Norway.
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo and Akershus University College of Applied Sciences, P.O. Box 4 St. Olavs plass, N-0130 Oslo, Norway.
| | - Kirsti Tøien
- Postoperative and Intensive Care and Department, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway.
| | - Leiv Arne Rosseland
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078 Blindern, NO-0316 Oslo, Norway.
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789
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White DB, Angus DC, Shields AM, Buddadhumaruk P, Pidro C, Paner C, Chaitin E, Chang CCH, Pike F, Weissfeld L, Kahn JM, Darby JM, Kowinsky A, Martin S, Arnold RM. A Randomized Trial of a Family-Support Intervention in Intensive Care Units. N Engl J Med 2018; 378:2365-2375. [PMID: 29791247 DOI: 10.1056/nejmoa1802637] [Citation(s) in RCA: 310] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients' preferences. METHODS We conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multicomponent family-support intervention delivered by the interprofessional ICU team with usual care. The primary outcome was the surrogates' mean score on the Hospital Anxiety and Depression Scale (HADS) at 6 months (scores range from 0 to 42, with higher scores indicating worse symptoms). Prespecified secondary outcomes were the surrogates' mean scores on the Impact of Event Scale (IES; scores range from 0 to 88, with higher scores indicating worse symptoms), the Quality of Communication (QOC) scale (scores range from 0 to 100, with higher scores indicating better clinician-family communication), and a modified Patient Perception of Patient Centeredness (PPPC) scale (scores range from 1 to 4, with lower scores indicating more patient- and family-centered care), as well as the mean length of ICU stay. RESULTS A total of 1420 patients were enrolled in the trial. There was no significant difference between the intervention group and the control group in the surrogates' mean HADS score at 6 months (11.7 and 12.0, respectively; beta coefficient, -0.34; 95% confidence interval [CI], -1.67 to 0.99; P=0.61) or mean IES score (21.2 and 20.3; beta coefficient, 0.90; 95% CI, -1.66 to 3.47; P=0.49). The surrogates' mean QOC score was better in the intervention group than in the control group (69.1 vs. 62.7; beta coefficient, 6.39; 95% CI, 2.57 to 10.20; P=0.001), as was the mean modified PPPC score (1.7 vs. 1.8; beta coefficient, -0.15; 95% CI, -0.26 to -0.04; P=0.006). The mean length of stay in the ICU was shorter in the intervention group than in the control group (6.7 days vs. 7.4 days; incidence rate ratio, 0.90; 95% CI, 0.81 to 1.00; P=0.045), a finding mediated by the shortened mean length of stay in the ICU among patients who died (4.4 days vs. 6.8 days; incidence rate ratio, 0.64; 95% CI, 0.52 to 0.78; P<0.001). CONCLUSIONS Among critically ill patients and their surrogates, a family-support intervention delivered by the interprofessional ICU team did not significantly affect the surrogates' burden of psychological symptoms, but the surrogates' ratings of the quality of communication and the patient- and family-centeredness of care were better and the length of stay in the ICU was shorter with the intervention than with usual care. (Funded by the UPMC Health System and the Greenwall Foundation; PARTNER ClinicalTrials.gov number, NCT01844492 .).
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Affiliation(s)
- Douglas B White
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Derek C Angus
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Anne-Marie Shields
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Praewpannarai Buddadhumaruk
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Caroline Pidro
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Cynthia Paner
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Elizabeth Chaitin
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Chung-Chou H Chang
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Francis Pike
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Lisa Weissfeld
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Jeremy M Kahn
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Joseph M Darby
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Amy Kowinsky
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Susan Martin
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
| | - Robert M Arnold
- From the Program on Ethics and Decision Making in Critical Illness (D.B.W., A.-M.S., P.B.), Clinical Research, Investigation, and Systems Modeling of Acute Illness Center (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K.), Department of Critical Care Medicine (D.B.W., D.C.A., A.-M.S., P.B., C. Pidro, C.-C.H.C., J.M.K., J.M.D.), and the Section of Palliative Care and Medical Ethics, Division of General Internal Medicine (R.M.A.), Department of Medicine (C.-C.H.C., R.M.A.), University of Pittsburgh School of Medicine, and the Intensive Care Unit Service Center (D.B.W., D.C.A., J.M.K.), the Wolff Center (C. Paner, A.K., S.M.), and the Palliative and Supportive Institute (E.C., R.M.A.), UPMC Health System - all in Pittsburgh; Eli Lilly, Indianapolis (F.P.); and the Statistics Collaborative, Washington, DC (L.W.)
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790
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Experiences of family caregivers the first six months after patient diagnosis of necrotising soft tissue infection: A thematic analysis. Intensive Crit Care Nurs 2018; 49:28-36. [PMID: 29937074 DOI: 10.1016/j.iccn.2018.05.005] [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: 01/05/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Necrotising soft tissue infection, or necrotising fasciitis, is a rapidly progressing disease requiring immediate diagnosis and treatment consisting of antimicrobial therapy, hyperbaric oxygen, debridement surgery and treatment in the intensive care unit. The harrowing illness trajectory affects the family caregivers potentially producing long-term psychological issues. OBJECTIVES We aimed to explore the experiences and coping strategies of family caregivers during the first six months after patient diagnosis of necrotising soft tissue infection. METHODS Our study had a prospective, explorative, qualitative design using semi-structured interviews and thematic analysis to understand necrotising soft tissue infection as an intrinsic and instrumental case. Family caregivers (n = 25) were recruited at three university hospitals in Denmark and Sweden. FINDINGS We identified three chronological themes describing issues of importance to the family caregivers. In the intensive care unit: Coping with illness and intensive care; In the ward: Coping with injury and post-intensive care and At home: Coping with recovery and new home life. CONCLUSION Challenges facing family caregivers of necrotising soft tissue infections survivors are still under-recognised. Healthcare professionals need to ensure that families and stakeholders throughout the patient trajectory have access to and co-create timely information and care plans to bridge the knowledge gap across care environments and to relieve family responsibility.
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791
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Haugdahl HS, Eide R, Alexandersen I, Paulsby TE, Stjern B, Lund SB, Haugan G. From breaking point to breakthrough during the ICU stay: A qualitative study of family members’ experiences of long-term intensive care patients’ pathways towards survival. J Clin Nurs 2018; 27:3630-3640. [DOI: 10.1111/jocn.14523] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Hege S Haugdahl
- Levanger Hospital; Nord-Trøndelag Hospital Trust; Levanger Norway
- Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Regina Eide
- St. Olav University Hospital; Trondheim Norway
| | | | | | - Berit Stjern
- Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Stine Borgen Lund
- Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Gørill Haugan
- Norwegian University of Science and Technology (NTNU); Trondheim Norway
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792
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Smith MA, Clayman ML, Frader J, Arenson M, Haber-Barker N, Ryan C, Emanuel L, Michelson K. A Descriptive Study of Decision-Making Conversations during Pediatric Intensive Care Unit Family Conferences. J Palliat Med 2018; 21:1290-1299. [PMID: 29920145 DOI: 10.1089/jpm.2017.0528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Little is known about how decision-making conversations occur during pediatric intensive care unit (PICU) family conferences (FCs). OBJECTIVE Describe the decision-making process and implementation of shared decision making (SDM) during PICU FCs. DESIGN Observational study. SETTING/SUBJECTS University-based tertiary care PICU, including 31 parents and 94 PICU healthcare professionals involved in FCs. MEASUREMENTS We recorded, transcribed, and analyzed 14 PICU FCs involving decision-making discussions. We used a modified grounded theory and content analysis approach to explore the use of traditionally described stages of decision making (DM) (information exchange, deliberation, and determining a plan). We also identified the presence or absence of predefined SDM elements. RESULTS DM involved the following modified stages: information exchange; information-oriented deliberation; plan-oriented deliberation; and determining a plan. Conversations progressed through stages in a nonlinear manner. For the main decision discussed, all conferences included a presentation of the clinical issues, treatment alternatives, and uncertainty. A minority of FCs included assessing the family's understanding (21%), assessing the family's need for input from others (28%), exploring the family's desired decision-making role (35%), and eliciting the family's opinion (42%). CONCLUSIONS In the FCs studied, we found that DM is a nonlinear process. We also found that several SDM elements that could provide information about parents' perspectives and needs did not always occur, identifying areas for process improvement.
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Affiliation(s)
- Michael A Smith
- 1 Department of Pediatrics, University of California San Francisco , San Francisco, California
| | - Marla L Clayman
- 2 Health and Social Development, American Institutes for Research , Washington, DC
| | - Joel Frader
- 3 Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,4 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Melanie Arenson
- 5 Department of Psychology, University of Maryland , College Park, Maryland
| | - Natalie Haber-Barker
- 6 Department of Sociology, Iron Workers Local 395 Apprenticeship School, Ivy Tech College , Lake Station, Indiana
| | - Claire Ryan
- 7 Department of Orthopedics, University of Texas at Austin Dell Medical School , Austin, Texas
| | - Linda Emanuel
- 8 Department of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,9 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Kelly Michelson
- 4 Department of Pediatrics, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,10 Division of Pediatric Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
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793
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Traditional open bay neonatal intensive care units can be redesigned to better suit family centered care application. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jnn.2017.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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794
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Abstract
Intensive care units (ICUs) provide care to the most severely ill hospitalized patients. Although ICUs increasingly rely on interprofessional teams to provide critical care, little about actual teamwork in this context is well understood. The ICU team is typically comprised of physicians or intensivists, clinical pharmacists, respiratory therapists, dieticians, bedside nurses, clinical psychologists, and clinicians-in-training. ICU teams are distinguished from other health care teams in that they are low in temporal stability, which can impede important team dynamics. Furthermore, ICU teams must work in physically and emotionally challenging environments. Our review of the literature reveals the importance of information sharing and decision-making processes, and identifies potential barriers to successful team performance, including the lack of effective conflict management and the presence of multiple and sometimes conflicting goals. Key knowledge gaps about ICU teams include the need for more actionable data linking ICU team structure to team functioning and patient-, family-, ICU-, and hospital-level outcomes. In particular, research is needed to better delineate and define the ICU team, identify additional psychosocial phenomena that impact ICU team performance, and address varying and often competing indicators of ICU team effectiveness as a multivariate and multilevel problem that requires better understanding of the independent effects and interdependencies between nested elements (i.e., hospitals, ICUs, and ICU teams). Ultimately, efforts to advance team-based care are essential for improving ICU performance, but more work is needed to develop actionable interventions that ensure that critically ill patients receive the best care possible. (PsycINFO Database Record
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Affiliation(s)
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh
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795
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Sigurdson K, Morton C, Mitchell B, Profit J. Disparities in NICU quality of care: a qualitative study of family and clinician accounts. J Perinatol 2018; 38:600-607. [PMID: 29622778 PMCID: PMC5998372 DOI: 10.1038/s41372-018-0057-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify how family advocates and clinicians describe disparities in NICU quality of care in narrative accounts. STUDY DESIGN Qualitative analysis of a survey requesting disparity stories at the 2016 VON Quality Congress. Accounts (324) were from a sample of RNs (n = 114, 35%), MDs (n = 109, 34%), NNPs (n = 55, 17%), RN other (n = 4, 1%), clinical other (n = 25, 7%), family advocates (n = 16, 5%), and unspecified (n = 1, <1%). RESULTS Accounts (324) addressed non-exclusive disparities: 151 (47%) language; 97 (30%) culture or ethnicity; 72 (22%) race; 41 (13%) SES; 28 (8%) drug use; 18 (5%) immigration status or nationality; 16 (4%) sexual orientation or family status; 14 (4%) gender; 10 (3%) disability. We identified three types of disparate care: neglectful care 85 (26%), judgmental care 85 (26%), or systemic barriers to care 139 (44%). CONCLUSIONS Nearly all accounts described differential care toward families, suggesting the lack of equitable family-centered care.
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Affiliation(s)
- Krista Sigurdson
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA.
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA.
- Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Christine Morton
- California Maternal Quality Care Collaborative, Palo Alto, CA, USA
| | - Briana Mitchell
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA, USA
- California Perinatal Quality Care Collaborative, Palo Alto, CA, USA
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Klinedinst R, Kornfield ZN, Hadler RA. Palliative Care for Patients With Advanced Heart Disease. J Cardiothorac Vasc Anesth 2018; 33:833-843. [PMID: 29793760 DOI: 10.1053/j.jvca.2018.04.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Indexed: 11/11/2022]
Abstract
Over the past 2 decades, the discipline of palliative care has evolved and expanded such that it is now the standard of care for a variety of acute and chronic processes. Although there are recommendations encouraging incorporation of palliative care into the routine management of patients with chronic cardiac processes, such as congestive heart failure, implementation has been challenging, and nowhere more so than in the cardiac surgical population. However, as the boundaries of surgical care have expanded to include progressively more complex cases, increasing attention has been given to the integration of palliative care into their management. In this review article, the authors describe the existing evidence for palliative care team involvement in patients with non-operative and surgical cardiac diseases and examine future directions for growth in this field.
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Affiliation(s)
- Rachel Klinedinst
- Division of Palliative Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Z Noah Kornfield
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel A Hadler
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
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799
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Blair GJ, Mehmood T, Rudnick M, Kuschner WG, Barr J. Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review. J Intensive Care Med 2018; 34:183-190. [PMID: 29699467 DOI: 10.1177/0885066618771528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delirium is a multifactorial entity, and its understanding continues to evolve. Delirium has been associated with increased morbidity, mortality, length of stay, and cost for hospitalized patients, especially for patients in the intensive care unit (ICU). Recent literature on delirium focuses on specific pharmacologic risk factors and pharmacologic interventions to minimize course and severity of delirium. While medication management clearly plays a role in delirium management, there are a variety of nonpharmacologic interventions, pharmacologic minimization strategies, and protocols that have been recently described. A PubMed search was performed to review the evidence for nonpharmacologic management, pharmacologic minimization strategies, and prevention of delirium for patients in the ICU. Recent approaches were condensed into 10 actionable steps to manage delirium and minimize medications for ICU patients and are presented in this review.
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Affiliation(s)
- Gregory J Blair
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Talha Mehmood
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mona Rudnick
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ware G Kuschner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Pulmonary Section, Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Juliana Barr
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
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800
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An Integrated Framework for Effective and Efficient Communication with Families in the Adult Intensive Care Unit. Ann Am Thorac Soc 2018; 14:1015-1020. [PMID: 28282227 DOI: 10.1513/annalsats.201612-965oi] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The increased focus on patient and family-centered care in adult intensive care units (ICUs) has generated multiple platforms for clinician-family communication beyond traditional interdisciplinary family meetings (family meetings)-including family-centered rounds, bedside or telephone updates, and electronic family portals. Some clinicians and administrators are now using these platforms instead of conducting family meetings. For example, some institutions are moving toward using family-centered rounds as the main platform for clinician-family communication, and some physicians rely on brief daily updates to the family at the bedside or by phone, in lieu of family meetings. We argue that although each of these platforms is useful in some circumstances, there remains an important role for family meetings. We outline five goals of clinician-family communication-establishing trust, providing emotional support, conveying clinical information, understanding the patient as a person, and facilitating careful decision making-and we examine the extent to which various communication platforms are likely to achieve the goals. We argue that because no single platform can achieve all communication goals, an integrated strategy is needed. We present a model that integrates multiple communication platforms to effectively and efficiently support families across the arc of an ICU stay. Our framework employs bedside/telephone conversations and family-centered rounds throughout the admission to address high informational needs, along with well-timed family meetings that attend to families' emotions as well as patients' values and goals. This flexible model uses various communication platforms to achieve consistent, efficient communication throughout the ICU stay.
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