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Redley B, Phiri LM, Heyns T, Wang W, Han C. Family needs during critical illness in the Emergency Department: A retrospective factor analysis of data from three countries. J Clin Nurs 2019; 28:2813-2823. [DOI: 10.1111/jocn.14857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Bernice Redley
- Centre for Quality and Patient Safety Research – Monash Health Partnership, School of Nursing and Midwifery Deakin University Burwood Victoria Australia
| | - Lesego M. Phiri
- Department of Nursing Science University of Pretoria Pretoria South Africa
| | - Tanya Heyns
- Department of Nursing Science Sefako Makgatho Health Sciences University Ga‐Rankuwa South Africa
| | - Wei Wang
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences Monash University Frankston Victoria Australia
- Peninsula Health Frankston Victoria Australia
| | - Chin‐Yen Han
- Department of Nursing Chang Gung University of Science and Technology and Linkou Chang Gung Memorial Hospital Taoyuan City Taiwan, Republic of China
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Jo M, Song MK, Knafl GJ, Beeber L, Yoo YS, Van Riper M. Family-clinician communication in the ICU and its relationship to psychological distress of family members: A cross-sectional study. Int J Nurs Stud 2019; 95:34-39. [PMID: 31005678 DOI: 10.1016/j.ijnurstu.2019.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms. OBJECTIVES To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). DESIGN A cross-sectional study. SETTINGS AND PARTICIPANTS The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. METHODS Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. RESULTS The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = -.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. CONCLUSIONS The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.
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Affiliation(s)
- Minjeong Jo
- College of Nursing, Pusan National University, Republic of Korea.
| | - Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, United States
| | - George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, United States
| | - Yang-Sook Yoo
- College of Nursing, The Catholic University, Republic of Korea
| | - Marcia Van Riper
- School of Nursing, University of North Carolina at Chapel Hill, United States
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53
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Vester LB, Dreyer P, Holm A, Lorentzen V. The experience of being a couple during an intensive care unit admission. Nurs Crit Care 2019; 25:238-244. [PMID: 30907502 DOI: 10.1111/nicc.12421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/20/2018] [Accepted: 01/21/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In critical care nursing, a trend has been seen towards growing attention to the family experience of critical illness. Despite trends moving towards care of the family as a unit, previous research has focused on individual family members' experience of critical illness. Exploring the life world of the family, especially that of spouses and their interaction, is essential to providing family-centred critical care and has not previously been described. AIM To explore the lived experience of being a couple during admission to an intensive care unit. DESIGN Data were collected through dyadic semi-structured interviews with four couples who had experienced admission to an intensive care unit. Interviews were audio-taped and transcribed verbatim. METHOD Grounded in the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, using a method described by Dreyer and Pedersen. RESULTS By way of analysis, the life world of being a couple during admission to an intensive care unit was disclosed and divided into themes: For better and for worse; The meaningful proximity; and Being a couple. CONCLUSION Although critical illness brings a sudden disruption of a couple's twosomeness, the need to remain, act as and be seen and cared for as a couple persists during admission to an intensive care unit. Therefore, couples need to be cared for as individuals and as a unit, underlining the need to follow trends towards family-centred critical care.
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Affiliation(s)
- Louise B Vester
- Department of Intensive Care (East), Aarhus University Hospital, Aarhus, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Institute of Public Health, Section for Nursing, University of Aarhus, Aarhus, Denmark
| | - Anna Holm
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Lorentzen
- Institute of Public Health, Section for Nursing, University of Aarhus, Aarhus, Denmark.,Centre for Research in Clinical Nursing, Viborg, Denmark.,School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
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54
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Björk K, Lindahl B, Fridh I. Family members' experiences of waiting in intensive care: a concept analysis. Scand J Caring Sci 2019; 33:522-539. [PMID: 30866083 DOI: 10.1111/scs.12660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis. METHOD Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data. FINDINGS In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties. CONCLUSIONS The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.
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Affiliation(s)
- Kristofer Björk
- Department of Intensive Care, Northern Älvsborgs County Hospital, Trollhättan, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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55
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Mitchell M, Dwan T, Takashima M, Beard K, Birgan S, Wetzig K, Tonge A. The needs of families of trauma intensive care patients: A mixed methods study. Intensive Crit Care Nurs 2019; 50:11-20. [DOI: 10.1016/j.iccn.2018.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
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Chen DW, Gerolamo AM, Harmon E, Bistline A, Sicks S, Collins L. Interprofessional Collaborative Practice in the Medical Intensive Care Unit: a Survey of Caregivers' Perspectives. J Gen Intern Med 2018; 33:1708-1713. [PMID: 30112736 PMCID: PMC6153212 DOI: 10.1007/s11606-018-4623-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/15/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on caregivers, defined as designated family members or support persons, in the medical intensive care unit (MICU) has primarily focused on their emotional needs and experiences, thus leaving a gap in knowledge related to their perceptions of team dynamics. OBJECTIVE To examine caregivers' perceptions of team interactions and competencies for interprofessional collaborative practice (IPCP) and overall satisfaction with the MICU team. METHODS The Support Person Jefferson Teamwork Observation Guide (JTOG)™ was administered to a convenience sample of caregivers in the MICU at a large urban academic medical center between May 2016 and December 2016. RESULTS One hundred sixty-one JTOG surveys were completed. Caregivers agreed on the importance of healthcare professionals working together as a team to provide patient care (3.97 out of 4.0 on Likert response scale where 1 is "Not at all important" and 4 is 'Extremely important") and were satisfied with the MICU team (3.74 out of 4.0), positively evaluating the four core competencies for IPCP (3.55 for values/ethics, 3.58 for interprofessional communication, 3.61 for roles/responsibilities, and 3.64 for teams/teamwork) and the patient/family-centeredness sub-competency (3.58 out of 4.0). There was a strong positive correlation between caregivers' Global JTOG scores and overall satisfaction with the MICU team (r = 0.596, p < 0.01). Caregivers' comments about factors that affected their experience focused on aspects of interprofessional communication and patient/family-centeredness. CONCLUSION Findings underscore the importance of interprofessional communication and providing patient/family-centered care. Assessing caregivers' perceptions of IPCP can provide a critical lens into team functioning and, thus, be used to identify teams' strengths as well as opportunities for improvement.
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Affiliation(s)
- Debbie W Chen
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Elissa Harmon
- Department of Nursing, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Anna Bistline
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Shoshana Sicks
- Jefferson Center for Interprofessional Practice and Education, Philadelphia, PA, USA
| | - Lauren Collins
- Jefferson Center for Interprofessional Practice and Education, Philadelphia, PA, USA.,Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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57
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Smithburger PL, Korenoski AS, Kane-Gill SL, Alexander SA. Perceptions of Family Members, Nurses, and Physicians on Involving Patients' Families in Delirium Prevention. Crit Care Nurse 2018; 37:48-57. [PMID: 29196587 DOI: 10.4037/ccn2017901] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium occurs in up to 80% of patients admitted to an intensive care unit. Nonpharmacologic delirium-prevention strategies, which are commonly used by the bedside nurse, have reduced the incidence and duration of delirium in patients in the intensive care unit. With increasing demands on the nurse, strategies such as including the patient's family in delirium prevention activities should be investigated. OBJECTIVE To determine opinions and willingness of health care providers to involve patients' families in nonpharmacologic delirium-prevention activities in the intensive care unit, and of patients' families to be involved. METHODS Two surveys, one for intensive care unit nurses and physicians and one for patients' families, were developed and administered. The provider survey focused on current delirium-prevention practices and opinions about family involvement. The family survey concentrated on barriers and willingness to participate in prevention activities. RESULTS Sixty nurses and 58 physicians completed the survey. Most physicians (93%) and all nurses believed families could assist with delirium prevention. Only 50% reported speaking with family members about delirium and delirium prevention. The family survey was completed by 60 family members; 38% reported a provider spoke with them about delirium. Family members reported high levels of comfort in participating in delirium-prevention activities. CONCLUSIONS Health care providers and family members are supportive of the latter performing delirium-prevention activities. Family of patients in the intensive care unit may work collaboratively with nurses to reduce the incidence and duration of delirium in these patients.
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Affiliation(s)
- Pamela L Smithburger
- Pamela L. Smithburger is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. She practices in the medical intensive care unit at UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania. .,Amanda S. Korenoski is an assistant professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy. She is also the managing director of the Pittsburgh Poison Center, Pittsburgh, Pennsylvania. .,Sandra L. Kane-Gill is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy. .,Sheila A. Alexander is an associate professor of Acute and Tertiary Care Nursing at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania.
| | - Amanda S Korenoski
- Pamela L. Smithburger is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. She practices in the medical intensive care unit at UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.,Amanda S. Korenoski is an assistant professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy. She is also the managing director of the Pittsburgh Poison Center, Pittsburgh, Pennsylvania.,Sandra L. Kane-Gill is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy.,Sheila A. Alexander is an associate professor of Acute and Tertiary Care Nursing at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Sandra L Kane-Gill
- Pamela L. Smithburger is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. She practices in the medical intensive care unit at UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.,Amanda S. Korenoski is an assistant professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy. She is also the managing director of the Pittsburgh Poison Center, Pittsburgh, Pennsylvania.,Sandra L. Kane-Gill is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy.,Sheila A. Alexander is an associate professor of Acute and Tertiary Care Nursing at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Sheila A Alexander
- Pamela L. Smithburger is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania. She practices in the medical intensive care unit at UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania.,Amanda S. Korenoski is an assistant professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy. She is also the managing director of the Pittsburgh Poison Center, Pittsburgh, Pennsylvania.,Sandra L. Kane-Gill is an associate professor of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy.,Sheila A. Alexander is an associate professor of Acute and Tertiary Care Nursing at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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58
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Ottrey E, Palermo C, Huggins CE, Porter J. Exploring staff perceptions and experiences of volunteers and visitors on the hospital ward at mealtimes using an ethnographic approach. J Clin Nurs 2018; 27:e1571-e1579. [PMID: 29493833 DOI: 10.1111/jocn.14318] [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] [Accepted: 02/18/2018] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES To explore multiple perspectives and experiences of volunteer and visitor involvement and interactions at hospital mealtimes. In addition, to understand how the volunteer and visitor role at mealtimes is perceived within the hospital system. BACKGROUND Mealtime assistance can improve patients' food intake and mealtime experience. Barriers to providing mealtime assistance include time pressures, staff availability and inadequate communication. Volunteers and visitors can encourage and assist patients at mealtimes. There is a lack of evidence on the relationship between hospital staff, volunteers and visitors. DESIGN A qualitative, ethnographic approach. METHODS Sixty-seven hours of fieldwork were conducted on two subacute wards within an Australian healthcare network in 2015. Mealtime practices and interactions of hospital staff, volunteers and visitors were observed. Sixty-one staff, volunteers and visitors were interviewed in 75 ethnographic and semi-structured interviews. Data were inductively and thematically analysed. RESULTS Three key themes emerged as follows: "help"-volunteers and visitors were considered helpful when they assisted patients at mealtimes, supported well-being and aided staff-patient communication; "hindrance"-staff perceived visitors as negative presences when they inhibited patient progress and impacted staff work practices; and "reality of practice"-visiting hours, visitor engagement in patient therapy and communication between staff, volunteers and visitors were important practical considerations of mealtime involvement. CONCLUSIONS The findings show how and why volunteers and visitors can be helpful and unhelpful at hospital mealtimes on subacute wards. More research on the role and contribution of volunteers and visitors on hospital wards will inform future practice in healthcare settings. RELEVANCE TO CLINICAL PRACTICE This healthcare organisation should continue to encourage volunteer and visitor involvement at hospital mealtimes. More effort is needed to educate visitors about patients' therapeutic goals and the importance of nutrition. The working relationship between hospital staff, volunteers and visitors should be strengthened to improve nutritional care.
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Affiliation(s)
- Ella Ottrey
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Dietetics Department, Eastern Health, Box Hill, VIC, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Catherine E Huggins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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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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60
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Kynoch K, Chang A, Coyer F, McArdle A. Developing a model of factors that influence meeting the needs of family with a relative in ICU. Int J Nurs Pract 2018; 25:e12693. [PMID: 30091252 DOI: 10.1111/ijn.12693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 06/26/2018] [Accepted: 07/11/2018] [Indexed: 11/29/2022]
Abstract
AIM To develop a model of factors influencing meeting family needs when a relative was admitted to the intensive care unit (ICU). BACKGROUND Studies identify individual factors impact on the needs of family members with a relative in ICU. No studies have reported on relationships between these factors and/or the extent of influence of multiple factors on family needs. DESIGN Observational, correlational, and predictive study design. METHODS Data were collected from August 2013 to June 2014 using validated scales and a demographic tool. The setting was a large tertiary referral hospital in Brisbane, Australia. Structural equation modelling was undertaken. RESULTS One hundred and seventy ICU family members participated. Factors included in the developed model were consistent with the literature. Family member anxiety had direct and significant influence on ICU family needs (β = 0.21). Gender was also found to have direct influence (β = 0.19), suggesting female family members were more likely to report needs being met. Family member coping self-efficacy (β = -0.40) and family member depression (β = -0.33) were mediating variables. DISCUSSION Interventions to meet family needs within the ICU should take into account family member levels of anxiety, depression, and coping self-efficacy with consideration of gender. Further model validation is required to confirm findings.
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Affiliation(s)
- Kathryn Kynoch
- Evidence in Practice Unit and the Queensland Centre for Evidence-Based Nursing and Midwifery, Mater Health, South Brisbane, Queensland, Australia
| | - Anne Chang
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Annie McArdle
- Evidence in Practice Unit and the Queensland Centre for Evidence-Based Nursing and Midwifery, Mater Health, South Brisbane, Queensland, Australia
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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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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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Hetland B, Hickman R, McAndrew N, Daly B. Factors Influencing Active Family Engagement in Care Among Critical Care Nurses. AACN Adv Crit Care 2018; 28:160-170. [PMID: 28592476 DOI: 10.4037/aacnacc2017118] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Critical care nurses are vital to promoting family engagement in the intensive care unit. However, nurses have varying perceptions about how much family members should be involved. The Questionnaire on Factors That Influence Family Engagement was given to a national sample of 433 critical care nurses. This correlational study explored the impact of nurse and organizational characteristics on barriers and facilitators to family engagement. Study results indicate that (1) nurses were most likely to invite family caregivers to provide simple daily care; (2) age, degree earned, critical care experience, hospital location, unit type, and staffing ratios influenced the scores; and (3) nursing work-flow partially mediated the relationships between the intensive care unit environment and nurses' attitudes and between patient acuity and nurses' attitudes. These results help inform nursing leaders on ways to promote nurse support of active family engagement in the intensive care unit.
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Affiliation(s)
- Breanna Hetland
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Ronald Hickman
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Natalie McAndrew
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Barbara Daly
- Breanna Hetland is Postdoctoral Fellow, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH . Ronald Hickman is Associate Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio. Natalie McAndrew is Clinical Nurse Specialist, Medical Intensive Care Unit, The Medical College of Wisconsin-Froedtert Hospital, Milwaukee, Wisconsin. Barbara Daly is Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Davidson JE, Zisook S. Implementing Family-Centered Care Through Facilitated Sensemaking. AACN Adv Crit Care 2018; 28:200-209. [PMID: 28592480 DOI: 10.4037/aacnacc2017102] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Society of Critical Care Medicine has released updated recommendations for care of the family in neonatal, pediatric, and adult intensive care units. Translation of the recommendations into practice may benefit from a supporting theoretical framework. Facilitated sensemaking is a mid-range theory built from the same literature that formed the basis for recommendations within the guidelines. The process of facilitated sensemaking may be used to help nurses adopt the SCCM recommendations into practice through the development of caring relationships, promoting family presence, teaching family engagement strategies, and supporting families with communication, information gathering, and participation in decision-making.
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Affiliation(s)
- Judy E Davidson
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California, San Diego Health, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
| | - Sidney Zisook
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California, San Diego Health, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
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Kynoch K, Cabilan CJ, McArdle A. Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2018; 14:83-90. [PMID: 27941513 DOI: 10.11124/jbisrir-2016-003193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.
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Affiliation(s)
- Kate Kynoch
- Nursing Research Centre and the Queensland Centre for Evidence-Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence, Mater Misericordiae Limited, Brisbane, Australia
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Addressing spirituality during critical illness: A review of current literature. J Crit Care 2018; 45:76-81. [PMID: 29413727 DOI: 10.1016/j.jcrc.2018.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The purpose of this review is to provide an overview of research on spirituality and religiosity in the intensive care setting that has been published since the 2004-2005 American College of Critical Care Medicine (ACCM) Clinical Practice Guidelines for the Support of Family in the Patient-Centered Intensive Care Unit with an emphasis on its application beyond palliative and end-of-life care. MATERIALS AND METHODS ACCM 2004-2005 guidelines emphasized the importance of spiritual and religious support in the form of four specific recommendations: [1] assessment and incorporation of spiritual needs in ICU care plan; [2] spiritual care training for doctors and nurses; [3] physician review of interdisciplinary spiritual need assessments; and [4] honoring the requests of patients to pray with them. We reviewed 26 studies published from 2006 to 2016 and identified whether studies strengthened the grade of these recommendations. We further categorized findings of these studies to understand the roles of spirituality and religiosity in surrogate perceptions and decision-making and patient and family experience. CONCLUSIONS Spiritual care has an essential role in the treatment of critically ill patients and families. Current literature offers few insights to support clinicians in navigating this often-challenging aspect of patient care and more research is needed.
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Schnock KO, Ravindran SS, Fladger A, Leone K, Williams DM, Dwyer CL, Vu TG, Thornton K, Gazarian P. Identifying Information Resources for Patients in the Intensive Care Unit and Their Families. Crit Care Nurse 2017; 37:e10-e16. [DOI: 10.4037/ccn2017961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND
Providing information to patients in intensive care units and their families is challenging. Patients often are admitted unexpectedly and experience stress and uncertainty. One source of stress has been identified as unclear, uncoordinated, or inconsistent communication and information. Despite the need for information, no centrally located, easily accessible, standardized intensive care unit education content exists.
OBJECTIVE
To identify educational content for patients in the intensive care unit and their families across 4 different hospitals, develop a general content database, and organize the general content into a framework for education of patients and their families.
METHODS
Educational content for patients in the intensive care units of 4 participating hospitals was collected and a gap analysis was performed.
RESULTS
Key content format and categories were identified. Educational content was organized into an information pathway divided into 3 phases: intensive care unit arrival; understanding the intensive care unit and partnering in care; and intensive care unit transitions. The gap analysis revealed substantial variation in content format and categories.
CONCLUSIONS
Structuring a digital learning center using different stages of the patient’s stay in the intensive care unit and placing resources in the context of an information pathway can help coordinate education for these patients and their families, and creates a consistent communication guide for clinicians as well. The optimal digital format should be considered in designing the learning center.
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Affiliation(s)
- Kumiko O. Schnock
- Kumiko O. Schnock is a research associate, Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sucheta S. Ravindran
- Sucheta S. Ravindran is a medical student at Rush Medical College, Chicago, Illinois
| | - Anne Fladger
- Anne Fladger is a director, Medical Library at Brigham and Women’s Hospital
| | - Kathleen Leone
- Kathleen Leone is an adjunct faculty at Simmons College, Boston, Massachusetts
| | - Donna M. Williams
- Donna M. Williams is a nurse specialist cardiology at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Cynthia L. Dwyer
- Cynthia L. Dwyer is a clinical quality and innovation coach at the Armstrong Institute for Patient Safety and Quality, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Thanh-Giang Vu
- Thanh-Giang Vu is a resident physician, Department of Anesthesia, University of California, San Francisco, California
| | - Kevin Thornton
- Kevin Thornton is associate clinical professor in the Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - Priscilla Gazarian
- Priscilla Gazarian is the nursing program director and a nurse scientist at Brigham and Women’s Hospital and an associate professor of nursing at School of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts
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Abstract
Weight-loss surgery requires lifelong lifestyle modifications for the maintenance of weight loss and health effects, and can affect both the individual and family. Earlier research indicates that the quality of social relationships has positive and negative influences on wellbeing and health. There is little research on family-life after a member has undergone gastric bypass (GBP) against obesity. Thus, this study aimed to develop a classic grounded theory about families with a member treated with GBP against obesity. The study design used classic grounded theory and included data from 16 interviews. Families' shared a main concern of unexpected changes after GBP, resulting in the theory Stabilizing family life, explained as a social process to decrease uncertainty and find stability and well-being in family interactions. The social process develops differently which entail families: attaining unity, returning to old patterns, or disconnecting to find stability, depending on the discrepancy in expectations and knowledge. This is affected by the overall life situation, life-stage and relationship quality. The theory highlights unexpected change as a potential challenge for the family, as well as how they resolve this. Hence, the theory can be applied in care strategies for families. Identification of families needing support to stabilize family life after GBP requires further research.
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Affiliation(s)
- Ami Bylund
- Department of Health and Caring Sciences, Linnaeus University, Kalmar and Växjö, Sweden
- Karolinska Institute, Department of Surgical Science at Danderyd Hospital and Department of Surgery, Ersta Hospital, Stockholm, Sweden
| | - Eva Benzein
- Department of Health and Caring Sciences, Linnaeus University, Kalmar and Växjö, Sweden
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Kalmar and Växjö, Sweden
| | - Anna Sandgren
- Department of Health and Caring Sciences, Linnaeus University, Kalmar and Växjö, Sweden
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Kalmar and Växjö, Sweden
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A qualitative study of factors that influence active family involvement with patient care in the ICU: Survey of critical care nurses. Intensive Crit Care Nurs 2017; 44:67-75. [PMID: 29169879 DOI: 10.1016/j.iccn.2017.08.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/08/2017] [Accepted: 08/25/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Family caregiver involvement may improve patient and family outcomes in the intensive care unit. This study describes critical care nurses' approaches to involving family caregivers in direct patient care. RESEARCH METHODOLOGY & DESIGN This is a qualitative content analysis of text captured through an electronic survey. SETTING A convenience sample of 374 critical care nurses in the United States who were subscribers to one of the American Association of Critical Care Nurses social media sites or electronic newsletters. MAIN OUTCOME MEASURE Critical care nurses' responses to five open-ended questions about their approaches to family involvement in direct patient care. FINDINGS Nurse, patient and family caregiver factors intersected in the context of the professional practice environment and the available resources for family care. Two main themes were identified: "Involving family caregivers in patient care in the intensive care unit requires careful ssessment" and "There are barriers and facilitators to caregiver involvement in patient care in the intensive care unit." CONCLUSION Patient care demands, the professional practice environment and a lack of resources for families hindered nursing family caregiver involvement. Greater attention to these barriers as they relate to family caregiver involvement and clinical outcomes should be a priority in future research.
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71
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LeBlanc A, Bourbonnais FF, Harrison D, Tousignant K. The experience of intensive care nurses caring for patients with delirium: A phenomenological study. Intensive Crit Care Nurs 2017; 44:92-98. [PMID: 28993046 DOI: 10.1016/j.iccn.2017.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The purpose of this research was to seek to understand the lived experience of intensive care nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive care nurses' experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or hinder intensive care nurses caring for these patients. RESEARCH METHODOLOGY This study utilised an interpretive phenomenological approach as described by van Manen. SETTING Individual conversational interviews were conducted with eight intensive care nurses working in a tertiary level, university-affiliated hospital in Canada. FINDINGS The essence of the experience of nurses caring for patients with delirium in intensive care was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's aReally Big Job; Everyone Is Unique; Riding It Out With Families and Taking Every Experience With You. CONCLUSION The findings contribute to an understanding of how intensive care nurses help patients and their families through this complex and distressing experience.
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Affiliation(s)
- Allana LeBlanc
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada.
| | | | - Denise Harrison
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Kelly Tousignant
- University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
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A survey of next of kin needs of trauma patients admitted to Intensive Care Units in South Africa. Intensive Crit Care Nurs 2017; 43:136-142. [PMID: 28935343 DOI: 10.1016/j.iccn.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 07/06/2017] [Accepted: 07/15/2017] [Indexed: 11/22/2022]
Abstract
AIM To conduct a cross-sectional survey of next of kin needs of critically injured trauma patients admitted to Intensive Care Units in South Africa. METHODS The needs of next of kin of trauma patients (in public and private hospitals) who were critically injured and required admission to Intensive Care Units were surveyed at two points: on admission within first 24hours and on Day 3/day of transfer if earlier. RESULTS A total of 162 next of kin participated (114 from state and 48 from private) and Critical Care Family Needs Inventory subscale scores obtained at admission and at Day 3/day of transfer if earlier indicated a trend toward reporting increased needs. In all the needs ratings, the top domains were those of Assurance and Information. CONCLUSION The next of kin have a great number of needs that are currently not being met (both in the state and the private hospital and these needs actually increase over time. This study can help nurses understand the needs of next of kin in the Intensive Care Unit and that these needs change over the hospitalization period.
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Wetzig K, Mitchell M. The needs of families of ICU trauma patients: an integrative review. Intensive Crit Care Nurs 2017; 41:63-70. [DOI: 10.1016/j.iccn.2017.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/09/2016] [Accepted: 02/17/2017] [Indexed: 10/19/2022]
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A Review of the Perceptions of Healthcare Providers and Family Members Toward Family Involvement in Active Adult Patient Care in the ICU. Crit Care Med 2017; 44:1191-7. [PMID: 26958747 DOI: 10.1097/ccm.0000000000001641] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this article is to provide a summary of the perceptions of healthcare providers and family members toward their role in active patient care in the ICU and compare the views of healthcare providers with those of relatives of critically ill patients. DATA SOURCES The search was conducted using PubMed as the primary search engine and EMBASE as a secondary search engine. STUDY SELECTION Studies were included if they were conducted in the ICU, had an adult patient population, and contained a discussion of active patient care, including perspective or actions of family members or healthcare providers about the active participation. DATA EXTRACTION Titles and abstracts of articles identified through PubMed and EMBASE were assessed for relevancy of family involvement. The full article was reviewed of titles and abstracts involving family involvement of care in the ICU to assess if the topic was active care and if the article involved perceptions of healthcare providers or family members. The references of all selected articles were then evaluated for the inclusion of additional studies. DATA SYNTHESIS Articles including perceptions of healthcare providers were grouped separately from articles including attitudes of family members. Articles that contained the perceptions of both healthcare providers and family members were considered in both groups but were evaluated with each perspective separately. Examples of specific patient care tasks that were mentioned in each article were identified. CONCLUSIONS A positive attitude exists among both family members and providers toward the involvement of family members in active care tasks. Providers and family members share the attitude that a partnership is necessary and that encouragement for family members to participate is essential. The findings in this review support the need for more objective research regarding how families are caring for their loved ones and how family involvement in care is affecting patient and family outcomes.
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76
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Reuter-Rice K, Doser K, Eads JK, Berndt S. Pediatric Traumatic Brain Injury: Families and Healthcare Team Interaction Trajectories During Acute Hospitalization. J Pediatr Nurs 2017; 34:84-89. [PMID: 28081932 PMCID: PMC5444971 DOI: 10.1016/j.pedn.2016.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify common or unique family-healthcare team interactions during acute hospitalization for pediatric patients with a traumatic brain injury (TBI) using a life course trajectory (LCT) theoretical approach. DESIGN AND METHODS A 3-year prospective observational study of 35 children, ages 5 days to 15 years who were admitted to an urban Level-1 trauma hospital for a TBI. We defined brain injury severity using the admission Glasgow Coma Scale score (mild 13-15, moderate 9-12, and severe 3-8). Using a life course trajectory theoretical approach, we extracted from the patient's electronic health record the first eight-days of hospitalization and plotted the number and type of daily family-healthcare team interactions to visualize patterns or phases. RESULTS A general trajectory for each severity group was determined. When individually compared, family trajectories were similar based on injury severity. Visual interpretations of family-healthcare interactions based on the brain injury severity yielded three phases. The interactions phases included: (1) information seeking, (2) watchful waiting and (3) decision making. CONCLUSION Using a LCT approach, phases identified based on injury severity and family interactions support the need for proper timing of tailored communication and support. The findings also support the development of future best care practices that facilitate family's needs, decrease caregiver burden to improve functional outcomes.
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Affiliation(s)
- Karin Reuter-Rice
- Duke University School of Nursing, Durham, NC, USA; Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA; Duke Institute for Brain Sciences, Durham, NC, USA.
| | - Karoline Doser
- Survivorship Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
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van Mol MMC, Boeter TGW, Verharen L, Kompanje EJO, Bakker J, Nijkamp MD. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals. J Clin Nurs 2017; 26:3212-3223. [DOI: 10.1111/jocn.13669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Margo MC van Mol
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Trudi GW Boeter
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | | | - Erwin JO Kompanje
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Jan Bakker
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine; Department of Medicine; Columbia University Medical Center; New York NY USA
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
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78
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Understanding family assessment in the Australian context; what are adult oncology nursing practices? Collegian 2017. [DOI: 10.1016/j.colegn.2016.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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79
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Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study. Aust Crit Care 2017; 30:91-97. [DOI: 10.1016/j.aucc.2016.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/20/2015] [Accepted: 01/11/2016] [Indexed: 11/18/2022] Open
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Mitchell ML, Kean S, Rattray JE, Hull AM, Davis C, Murfield JE, Aitken LM. A family intervention to reduce delirium in hospitalised ICU patients: A feasibility randomised controlled trial. Intensive Crit Care Nurs 2017; 40:77-84. [PMID: 28254205 DOI: 10.1016/j.iccn.2017.01.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 12/07/2016] [Accepted: 01/01/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Family members could play an important role in preventing and reducing the development of delirium in Intensive Care Units (ICU) patients. This study sought to assess the feasibility of design and recruitment, and acceptability for family members and nurses of a family delivered intervention to reduce delirium in ICU patients. METHOD A single centre randomised controlled trial in an Australian medical/surgical ICU was conducted. Sixty-one family members were randomised (29 in intervention and 32 in non-intervention group). Following instructions, the intervention comprised the family members providing orientation or memory clues (family photographs, orientation to surroundings) to their relative each day. In addition, family members conducted sensory checks (vision and hearing with glasses and hearing aids); and therapeutic or cognitive stimulation (discussing family life, reminiscing) daily. Eleven ICU nurses were interviewed to gain insight into the feasibility and acceptability of implementing the intervention from their perspective. RESULTS Recruitment rate was 28% of eligible patients (recruited n=90, attrition n=1). Following instruction by the research nurse the family member delivered the intervention which was assessed to be feasible and acceptable by family members and nurses. Protocol adherence could be improved with alternative data collection methods. Nurses considered the activities acceptable. CONCLUSION The study was able to recruit, randomise and retain family member participants. Further strategies are required to assess intervention fidelity and improve data collection.
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Affiliation(s)
- Marion L Mitchell
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Princess Alexandra Hospital Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Susanne Kean
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
| | - Janice E Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK.
| | - Alastair M Hull
- Perth Royal Infirmary, NHS Tayside, Dundee, UK; Department of Psychiatry, University of Dundee, Dundee, UK.
| | - Chelsea Davis
- Princess Alexandra Hospital Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - Jenny E Murfield
- Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia.
| | - Leanne M Aitken
- NHMRC Centre for Research Excellence in Nursing, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan Campus, Brisbane, Queensland, Australia; Princess Alexandra Hospital Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Health Sciences, City University London, London, UK.
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Abstract
The use of social media to find and disseminate health information is rapidly increasing worldwide. It is essential for family nurses to participate in this trend, and to meet our clients where they are, on social media. Nurses can use social media to promote family health, reduce illness suffering, and meet family needs for information and support. As well, social media provides a way to build relationships with families outside of the physical health care setting or clinic. It is important to understand the types and potential uses of social media, as well as the risks and pitfalls. Standards for e-professionalism must be maintained. Through using social media, family nurses can increase their reach and effectiveness for family health promotion.
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82
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Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect 2016; 19:1183-1202. [PMID: 27878937 PMCID: PMC5139045 DOI: 10.1111/hex.12402] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings. OBJECTIVE This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined. METHODS Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis. FINDINGS A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care. CONCLUSION Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Sarah E. McMillan
- Collaborative Academic PracticeUniversity Health NetworkTorontoONCanada
| | - Scott Reeves
- Centre for Health and Social Care ResearchKingston University and St. George's University of LondonLondonUK
| | | | | | - Simon Kitto
- Department of Innovation in Medical EducationFaculty of MedicineUniversity of OttawaOttawaONCanada
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Palonen M, Kaunonen M, Åstedt-Kurki P. Family involvement in emergency department discharge education for older people. J Clin Nurs 2016; 25:3333-3344. [PMID: 27218600 DOI: 10.1111/jocn.13399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To report findings concerning family involvement in emergency department discharge education for older people. BACKGROUND The current trend of population ageing in Western countries has caused an increase in emergency department visits. Due to the continuing improvement in the mental and physical status of older people, they are frequently discharged home. Proper discharge education enables older people and their families to better understand how they can cope with the medical issue at home. Given the lack of research, we know relatively little about the significance of family involvement in older people's emergency department discharge education. DESIGN A descriptive qualitative design was used. METHODS Qualitative thematic interviews of seven older patients, five family members and fifteen nurses were conducted. Data were analysed using content analysis. RESULTS Family involvement in discharge education was seen as turbulent. The experiences were twofold: family involvement was acknowledged, but there was also a feeling that family members were ostracised. Families were seen as a resource for nurses, but as obliged initiators of their own involvement. CONCLUSIONS Our findings suggest that family members are not considered participants in emergency department care. For a family-friendly approach, actions should be taken on both individual and organisational levels. RELEVANCE TO CLINICAL PRACTICE The findings support healthcare providers and organisation leaders in promoting family involvement in discharge education for older people. Families can be encouraged to be involved without feeling responsible for the interaction.
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Affiliation(s)
- Mira Palonen
- School of Health Sciences, University of Tampere, Tampere, Finland.
| | - Marja Kaunonen
- School of Health Sciences, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, General Administration, Tampere, Finland
| | - Päivi Åstedt-Kurki
- School of Health Sciences, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, General Administration, Tampere, Finland
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84
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Kisorio LC, Langley GC. End-of-life care in intensive care unit: Family experiences. Intensive Crit Care Nurs 2016; 35:57-65. [DOI: 10.1016/j.iccn.2016.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 02/29/2016] [Accepted: 03/16/2016] [Indexed: 11/27/2022]
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85
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Sevinç S, Ajghif M, Uzun Ö, Gülbil U. Expectations of relatives of Syrian patients in intensive care units in a state hospital in Turkey. J Clin Nurs 2016; 25:2232-41. [DOI: 10.1111/jocn.13254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Sibel Sevinç
- Nursing Department; School of Health; Kilis 7 Aralık University; Kilis Turkey
| | - Mohammad Ajghif
- Eastern Languages and Literatures Department (Arabic Language and Literature); Faculty of Art and Sciences; Kilis 7 Aralık University; Kilis Turkey
| | - Özge Uzun
- İzmir University, Faculty of Health Science; Nursing Department, Sağlık Kampüsü; Örnekköy Karşıyaka/İzmir
| | - Uğur Gülbil
- Eastern Languages and Literatures Department (Arabic Language and Literature); Faculty of Art and Sciences; Kilis 7 Aralık University; Kilis Turkey
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86
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Akroute AR, Bondas T. Critical care nurses and relatives of elderly patients in intensive care unit–Ambivalent interaction. Intensive Crit Care Nurs 2016; 34:59-72. [DOI: 10.1016/j.iccn.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/19/2015] [Accepted: 08/07/2015] [Indexed: 12/31/2022]
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87
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Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units. Intensive Crit Care Nurs 2015; 31:366-74. [PMID: 26279389 DOI: 10.1016/j.iccn.2015.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 02/13/2015] [Accepted: 04/08/2015] [Indexed: 11/22/2022]
Abstract
AIM The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. DESIGN A comparative, descriptive cross-sectional study. SETTING Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. METHODS A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. RESULTS A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. CONCLUSION The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. RELEVANCE TO CLINICAL PRACTICE Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction.
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88
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Catlin A, Ford M, Maloney C. Determining Family Needs on an Oncology Hospital Unit Using Interview, Art, and Survey. Clin Nurs Res 2015; 25:209-31. [DOI: 10.1177/1054773815578806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A movement worldwide, and specifically new to our hospital, is the implementation of Patient- and Family-Centered Care. We were unsure, however, what the needs were of our patients’ families. This triangulated study, on a 28-bed oncology unit, studied family members at the bedside. We asked family members what their needs were in a three-step process (open-ended interview, use of the Draw a Bridge art therapy technique, and the Family Inventory of Needs survey). Nineteen interviews revealed needs for physical comfort, emotional support, cultural sensitivity, recognition of help provided by family members and improved pain management. Art therapy revealed the stress of caregiving and helped to uncover unmet needs for interviewers to explore. The FIN identified that care at home after discharge was a major worry. Knowledge of family members’ needs while a loved one is in the hospital allows for planning and provision of modalities to assist them in their caregiving.
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Affiliation(s)
| | | | - Carrie Maloney
- Kaiser Permanente Rehabilitation Hospital in Vallejo, CA, USA
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89
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Al Mutair A, Plummer V, O'Brien AP, Clerehan R. Attitudes of healthcare providers towards family involvement and presence in adult critical care units in Saudi Arabia: a quantitative study. J Clin Nurs 2015; 23:744-55. [PMID: 24734275 DOI: 10.1111/jocn.12520] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe healthcare providers' attitudes to family involvement during routine care and family presence during resuscitation or other invasive procedures in adult intensive care units in Saudi Arabia. BACKGROUND Previous research has shown that healthcare professionals have revealed a diversity of opinions on family involvement during routine care and family presence during resuscitation or other invasive procedures. Attitude assessment can provide an indication of staff acceptance or rejection of the practice and also help identify key potential barriers that will need to be addressed. It has also been evident that participation in the care has potential benefits for patients and families as well as healthcare providers. DESIGN A quantitative descriptive design. METHODS A questionnaire was used with a convenience sample of 468 healthcare providers who were recruited from eight intensive care units. RESULTS The analysis found that healthcare providers had positive attitudes towards family involvement during routine care, but negative attitudes towards family presence during resuscitation or other invasive procedures. Physicians expressed more opposition to the practice than did nurses and respiratory therapists. Staff indicated a need to develop written guidelines and policies, as well as educational programmes, to address this sensitive issue in clinical practice. CONCLUSION Family is an important resource in patient care in the context of the critical care environment. Clinical barriers including resources, hospital policies and guidelines, staff and public education should be taken into account to facilitate family integration to the care model. RELEVANCE TO CLINICAL PRACTICE The findings can help to develop policies and guidelines for safe implementation of the practice. They can also encourage those who design nursing and other medical curricula to place more emphasis on the role of the family especially in critical care settings.
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90
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Lindahl J, Elmqvist C, Thulesius H, Edvardsson D. Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire-family version. Scand J Caring Sci 2015; 29:859-64. [PMID: 25648407 DOI: 10.1111/scs.12198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed. SETTING Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden. METHOD The Person-centred Climate Questionnaire-Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, everydayness and hospitality--three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P. AIM The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context. RESULTS The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7. CONCLUSION In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.
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Affiliation(s)
- Jeanette Lindahl
- Centre for Acute & Critical Care, Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre for Acute & Critical Care, Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
| | - Hans Thulesius
- Family Medicine, Department of Clinical Sciences, Lund University, Malmö and Kronoberg County Council, Växjö, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Australia.,Department of Nursing, Umeå University, Sweden
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91
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McConnell B, Moroney T. Involving relatives in ICU patient care: critical care nursing challenges. J Clin Nurs 2015; 24:991-8. [PMID: 25597494 DOI: 10.1111/jocn.12755] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the barriers critical care nurses experience to relative involvement in intensive care unit patient care. BACKGROUND Previous studies have discussed the experiences of relatives visiting an intensive care unit, the needs of relatives in the intensive care environment, critical care nurse and relative interaction, intensive care unit visiting policies and the benefits of including relatives in patient care. The barriers that critical care nurses experience to relative involvement in patient care have received minimal exploration. DESIGN Critical care nurses were recruited for a mixed methods study. An explanatory mixed method design was used, with two phases. Phase 1 was Quantitative and Phase 2 was Qualitative. METHODS Data collection occurred over five months in 2012-2013. Phase 1 used an online questionnaire (n = 70), and semi-structured interviews (n = 6) were conducted in Phase 2. Phase 1 participants were 70 critical care nurses working in Australian intensive care units and six critical care nurses were recruited from a single Sydney intensive care unit for Phase 2. Through sequential data collection, Phase 1 results formed the development of Phase 2 interview questions. RESULTS Participants reported various barriers to relative involvement in critically ill patient care. Factors related to the intensive care unit patient, the intensive care unit relative, the critical care nurse and the intensive care environment contributed to difficulties encompassing relative involvement. CONCLUSIONS This study has identified that when considering relative involvement in patient care, critical care nurses take on a paternalistic role. The barriers experienced to relative involvement result in the individual critical care nurse deciding to include or exclude relatives from patient care. RELEVANCE TO CLINICAL PRACTICE Knowledge of the barriers to relative involvement in critically ill patient care may provide a basis for improving discussion on this topic and may assist intensive care units to implement strategies to reduce barriers.
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92
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Fridh I. Caring for the dying patient in the ICU – The past, the present and the future. Intensive Crit Care Nurs 2014; 30:306-11. [DOI: 10.1016/j.iccn.2014.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 10/24/2022]
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93
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94
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Percepción de las enfermeras sobre la comunicación con la familia de pacientes ingresados en un servicio de medicina intensiva. ENFERMERIA INTENSIVA 2014; 25:137-45. [DOI: 10.1016/j.enfi.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 09/19/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022]
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95
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Jacelon CS, Henneman EA. Dignity in the older critically ill adult: the family member's perspective. Heart Lung 2014; 43:432-6. [PMID: 25000847 DOI: 10.1016/j.hrtlng.2014.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/30/2014] [Accepted: 06/01/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the meaning and relative importance that family members of older patients in the intensive care unit (ICU) ascribed to dignity. BACKGROUND Dignity is a core value of the nursing profession and of critical care nursing practice. Although there is a substantial body of research supporting the needs of family members of patients in the ICU, little is known about the needs of family members of older, critically ill patients, particularly as they relate to patient dignity. METHODS A qualitative, descriptive approach using unstructured interviews was used. Data consisted of audio taped interviews of study participants. Data were analyzed using the constant comparative method. RESULTS Three major themes were identified including: 1) the older patient's health status and ICU experiences; 2) family roles, relationships, and goals; and 3) staff interactions with family members. CONCLUSION Insight into the concerns of family members related to the dignity of the older critically ill patient may be useful in guiding nurses as they provide care in what are often fast-paced, highly technical environments. Meeting well established family needs as well as attending to the unique concerns identified in this study will assist nurses in supporting the older, critically ill patient's dignity.
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Affiliation(s)
- Cynthia S Jacelon
- College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01301, USA.
| | - Elizabeth A Henneman
- College of Nursing, University of Massachusetts Amherst, 651 North Pleasant Street, Amherst, MA 01301, USA
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96
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Rahmqvist Linnarsson J, Benzein E, Årestedt K. Nurses' views of forensic care in emergency departments and their attitudes, and involvement of family members. J Clin Nurs 2014; 24:266-74. [DOI: 10.1111/jocn.12638] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Eva Benzein
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Center for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
| | - Kristofer Årestedt
- Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Department of Medical Health Sciences; Linköping University; Linköping Sweden
- Palliative Research Centre; Ersta Sköndal University College and Ersta hospital; Stockholm Sweden
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97
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Al-Mutair AS, Plummer V, Clerehan R, O'Brien A. Needs and experiences of intensive care patients' families: a Saudi qualitative study. Nurs Crit Care 2013; 19:135-44. [PMID: 24118629 DOI: 10.1111/nicc.12040] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/20/2013] [Accepted: 06/22/2013] [Indexed: 11/28/2022]
Abstract
AIM To identify the perceived needs of Saudi families of patients in Intensive Care in relation to their culture and religion. BACKGROUND Admission of a family member to an intensive care unit (ICU) is a deeply distressing and often unexpected life event to the family. Families of critically ill patients have needs that should be acknowledged and met by the ICU team. Literature is virtually silent on the issue of recognizing the ICU family needs in relation to the influence of their cultural values and religious beliefs. DESIGN A descriptive exploratory qualitative study. METHOD Individual, semi-structured interviews of a purposive sample of 12 family members were carried out between November 2011 and February 2012. The closest family members were recruited to participate in the interviews with a mean age of 44·25 years in eight mixed medical-surgical ICUs of eight major trauma hospitals in Saudi Arabia. RESULTS The family needs and experiences are described via six major themes: looking for information, maintaining reassurance, spiritual healing, maintaining close proximity, involvement in care and support not being facilitated. The results indicated that family members sought to access information readily to diminish their anxiety. They also needed to be reassured that the best care was being delivered to their loved one and to feel supported during this critical time. Saudi families have cultural and spiritual healing beliefs and practices including faith in God and that God is the ultimate healer, reading of the Qur'an, prayer and charity. These lessen their stress and connect them to hold on to hope. In addition, maintaining proximity to their ill family member was considered of the greatest importance to the families. CONCLUSION The study provided an in-depth understanding of the family members' experience of having a relative in Intensive Care and focussed on a range of unmet needs, particularly those related to culture and religion. The ICU team need to work collaboratively with family members to improve their experience. RELEVANCE TO PRACTICE The recognition of family needs, experiences and situations can enhance the care provided by the critical care team to patients and families.
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Affiliation(s)
- Abbas S Al-Mutair
- AS Al-Mutair, MN, CCN Post Grad Dip, RN, PhD Candidate, Nursing School, Monash University, Melbourne, Australia
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