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Family intervention for delirium for patients in the intensive care unit: A systematic meta-analysis. J Clin Neurosci 2021; 96:114-119. [PMID: 34838428 DOI: 10.1016/j.jocn.2021.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/24/2022]
Abstract
Delirium is one of the common manifestations of acute brain dysfunction in critically ill patients. We aimed to evaluate the effect of family intervention on reducing the delirium incidence in patients hospitalized in the intensive care unit (ICU). We searched electronic databases for randomized clinical trials, cohort, and before-and-after studies up to September 2021 using the MeSH terms ("family" OR "family caregiver") AND ("delirium"). A total of 6 studies including 4199 patients were analyzed. Compared to the control group, the risk of delirium was 24% lower in the family intervention group (OR 0·76 [0·67-0·86], P = 0.20, I2 = 31%). Pooled data from two trials showed that family intervention was associated with fewer delirium days (SMD: -1.13, 95% CI: -1.91 to -0.34; P = 0.08; I2 = 67%;). However, there were no significant differences between the two groups in the length of ICU stay, mechanical ventilation duration, and mortality (ICU stay days: MD: -0.62 days; 95% CI: -1.49 to 0.24; P = 0.14; I2 = 72%; mechanical ventilation days: MD: -0.48 days; 95% CI: -2.10 to 1.13; P = 0.56; I2 = 0%; mortality: OR: 0.68, 95% CI: 0.22 to 2.09; P = 0.08; I2 = 67%). Current evidence supports the use of family intervention in reducing the delirium risk and delirium days in hospitalized ICU patients. However, its effects on reducing ICU stay length, ventilation duration, and mortality require further study. Future research should consider identifying the specific family intervention strategies and their duration.
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102
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Effect of Patient and Family Centred Care interventions for adult intensive care unit patients and their families: A systematic review and meta-analysis. Intensive Crit Care Nurs 2021; 69:103156. [PMID: 34753631 DOI: 10.1016/j.iccn.2021.103156] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess the evidence for the feasibility and effect of patient and familycentred care interventions provided in the intensive care unit, single or multicomponent, versus usual care, for reducing delirium, anxiety, depression and post-traumatic stress disorder in patients and family-members. DESIGN A systematic review and meta-analysis following the PRISMA guidelines and GRADE approach. A systematic literature search of relevant databases, screening and inclusion of studies, data extraction and assessment of risk of bias according to Cochrane methodology. The study is preregistered on PROSPERO (CRD42020160768). SETTING Adult intensive care units. RESULTS Nine randomised controlled trials enrolling a total of 1170 patients and 1226 family-members were included. We found moderate to low certainty evidence indicating no effect of patient and family centred care on delirium, anxiety, depression, post-traumatic stress disorder, in-hospital mortality, intensive care length of stay or family-members' anxiety, depression and post-traumatic stress disorder. No studies looked at the effect of patient and family centred care on pain or cognitive function in patients. Evaluation of feasibility outcomes was scarce. The certainty of the evidence was low to moderate, mainly due to substantial risk of bias in individual studies and imprecision due to few events and small sample size. CONCLUSION It remains uncertain whether patient and family centred care compared to usual care may reduce delirium in patients and psychological sequelae of intensive care admission in patients and families due to limited evidence of moderate to low certainty. Lack of systematic process evaluation of intervention feasibility as recommended by the Medical Research Council to identify barriers and facilitators of patient and family centred care in the adult intensive care unit context, further limits the conclusions that can be drawn.
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103
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Najjar C, Dima D, Goldfarb M. Patient and Family Perspectives on Early Mobilization in Acute Cardiac Care. CJC Open 2021; 4:230-236. [PMID: 35198941 PMCID: PMC8843890 DOI: 10.1016/j.cjco.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Emerging evidence indicates that engaging family members in early mobilization may benefit both patients and family members. However, little is known about the effect of patient and family-member experience and perspectives on mobilization in acute cardiac care. Our goal was to assess the perspectives and experience of patients and their family members regarding early mobilization in acute cardiac care, to better understand patient-related barriers to mobilization and assist in the development of mobilization strategies that increase family-member engagement in care. Methods Patient and family-member surveys were developed to assess attitudes and knowledge about mobilization, family-members’ roles in providing care, and mobilization care the patients received. Surveys were distributed to patients and their family members over a 4-month period. Results A total of 101 participants completed the survey (patients, n = 78; family members, n = 23). Most patients (n = 54; 69.2%) agreed or strongly agreed that early mobilization should be routinely performed. Of 72 patients who underwent early mobilization, 60 (83.3%) felt that mobilization helped their recovery. The majority of family members were interested in being involved with mobilization (n = 19; 82.6%). One quarter of family members felt that mobilizing their relatives too soon after admission was potentially dangerous (n = 6; 26.1%). Conclusions Most patients wish to be mobilized early after admission, and family members want to participate in mobilization efforts. These findings should inform efforts to overcome patient- and family-related barriers to mobilization.
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104
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Zavalkoff S, Mazaniello-Chezol M, O'Donnell S, Cunningham K, Almazyad M, O'Reilly A, Macedo K, Lammeree K, Mitchell E, Roussianos C, Antonacchi M, Cunnigham G, Park M, Gottesman R. Improving transparent team communication with the 'Glass Door' decal communication tool: a mixed methods analysis of family and staff perspectives. BMJ Open Qual 2021; 10:bmjoq-2021-001507. [PMID: 34593521 PMCID: PMC8487207 DOI: 10.1136/bmjoq-2021-001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the value and perspectives of intensive care unit (ICU) healthcare professionals (HCPs) and families about the Glass Door (GD) decal team communication tool. Design Quality improvement methodology was used to design, test and implement the GD. Uptake was measured through audit. Impact was assessed through mixed methodology (survey of ICU HCPs (n=96) and semi-structured interviews of HCPs (n=10) and families (n=7)). Setting Eighteen bed, closed, mixed medical–surgical–cardiac ICU in a tertiary care, university-affiliated, paediatric hospital. Population Interdisciplinary ICU HCPs and families of children admitted to the ICU. Intervention A transparent template (the GD) applied to the outside of ICU patients’ doors with sections for HCPs names, physiological goals and planned tests and treatments for the day. Medical staff completed the GD in rounds (AM and PM) and any HCP caring for the patient updated it throughout the day. Measurements and main results After 3 months, 96% of 613 doors were employed of which 99% respected confidentiality. ICU HCPs reported improved understanding of the patient’s plan (84% today vs 59% pre-GD, p<0.001) and sense that families were up-to-date (79% today vs 46% pre-GD, p<0.001). Based on semi-structured interviews, the GD promoted a shared understanding of the plan contributing to care continuity. The GD reassured families the team is working together and fostered family engagement in the care. Routine family experience surveys showed no change in families’ sense of privacy during admission; families denied the GD’s anticipated compromise of confidentiality. Conclusions The GD decal communication tool, visible on the patient’s door, improved ICU HCPs’ perceived knowledge of their patient’s plan. The GD improved the shared mental model, facilitated teaching and information transfer and fostered family engagement. Challenges included knowing the rules for use and consistent application. Concerns initially raised by HCPs about confidentiality were denied by families.
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Affiliation(s)
- Samara Zavalkoff
- Pediatric Critical Care, McGill University, Montreal, Québec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Maud Mazaniello-Chezol
- Family Medicine, McGill University, Montreal, Québec, Canada.,Montreal Children's Hospital, Montreal, Québec, Canada
| | - Shauna O'Donnell
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.,Montreal Children's Hospital, Montreal, Québec, Canada
| | | | - Mohammed Almazyad
- Pediatrics, King Saud University College of Medicine, Riyadh, Saudi Arabia
| | | | - Kimberley Macedo
- Family Partner, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Kimberly Lammeree
- Family Partner, Montreal Children's Hospital, Montreal, Québec, Canada
| | | | | | | | | | - Matthew Park
- Montreal Children's Hospital, Montreal, Québec, Canada
| | - Ronald Gottesman
- Pediatric Critical Care, McGill University, Montreal, Québec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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105
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Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler R, Hernández L, Kho ME, Kredentser M, Makuk K, Murthy S, Niven DJ, Olafson K, Parhar KKS, Patten SB, Rewa OG, Rochwerg B, Sept B, Soo A, Spence K, Spence S, Straus S, West A, Parsons Leigh J, Fiest KM. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:347. [PMID: 34563234 PMCID: PMC8465762 DOI: 10.1186/s13054-021-03763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals.
Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03763-7.
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Affiliation(s)
- Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie C Anglin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kendiss Olafson
- Department of Medicine, University of Manitoba, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Chinook Regional Hospital, Lethbridge County, Alberta, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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106
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Petushek EJ, Mørtvedt AI, Nelson BL, Hamati MC. The Effect of a Brief, Web-Based Animated Video for Improving Comprehension and Implementation Feasibility for Reducing Anterior Cruciate Ligament Injury: A Three-Arm Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9092. [PMID: 34501680 PMCID: PMC8431316 DOI: 10.3390/ijerph18179092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
Neuromuscular injury prevention training (IPT) has been shown to reduce anterior cruciate ligament (ACL) injury risk by approximately 50%, but the implementation rate is low. One of the most important modifiable barriers for implementation is coaches' comprehension of risk and intervention strategies. This study aimed to evaluate the effect of a brief, web-based, animated video on ACL injury prevention comprehension and IPT implementation feasibility. Coaches in landing and cutting sports were recruited and randomized into three groups. (1) Intervention: brief multimedia animated video about ACL injury and prevention. (2) Active control: commonly accessed, text-based web resource about ACL injury and prevention. (3) Placebo control: brief multimedia video about concussions. Overall ACL comprehension-composed of basic ACL knowledge, risk knowledge, prevention knowledge, and severity knowledge-as well as implementation feasibility were all measured prior to and immediately following the interventions. Overall ACL comprehension improved the most in the animated video group (Cohen's d = 0.86) and, to a lesser degree, in the active control web-based article group (Cohen's d = 0.39). Both video and web-based article groups had greater implementation feasibility compared to the control group (p = 0.01). Overall, these initial results suggest that a brief, web-based, animated video has the potential to be a superior method for informing stakeholders in order to reduce traumatic injuries in sport.
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Affiliation(s)
- Erich J. Petushek
- Department of Cognitive and Learning Sciences, Michigan Technological University, Houghton, MI 49931, USA; (A.I.M.); (B.L.N.)
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA
| | - Anne Inger Mørtvedt
- Department of Cognitive and Learning Sciences, Michigan Technological University, Houghton, MI 49931, USA; (A.I.M.); (B.L.N.)
| | - Brittany L. Nelson
- Department of Cognitive and Learning Sciences, Michigan Technological University, Houghton, MI 49931, USA; (A.I.M.); (B.L.N.)
| | - Mary C. Hamati
- Department of Orthopedics, School of Medicine, University of Colorado, Aurora, CO 80045, USA;
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107
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Khan S, Digby R, Giordano NA, Hade S, Bucknall TK. A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit. Aust Crit Care 2021; 35:264-272. [PMID: 34384649 DOI: 10.1016/j.aucc.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically. OBJECTIVE The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU). METHODS A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100). RESULTS In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff. CONCLUSION Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
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Affiliation(s)
- Shahrukh Khan
- School of Nursing&Midwifery, Deakin University, Geelong, Australia
| | - Robin Digby
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Nicholas A Giordano
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Sharon Hade
- Nursing Services, Alfred Health, Melbourne, Australia; Intensive Care Unit, Alfred Health, Australia
| | - Tracey K Bucknall
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia.
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108
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Thirsk LM, Vandall-Walker V, Rasiah J, Keyko K. A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study. JOURNAL OF FAMILY NURSING 2021; 27:199-211. [PMID: 33769127 PMCID: PMC8361475 DOI: 10.1177/1074840721999372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.
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Affiliation(s)
| | | | | | - Kacey Keyko
- Edmonton Southside Primary Care
Network, Alberta, Canada
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109
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Pretorius RL, Heyns T, Filmalter CJ, Botma Y. Stakeholders' perceptions of family-centred care in the intensive care unit: An associative group analysis. Intensive Crit Care Nurs 2021; 67:103113. [PMID: 34246524 DOI: 10.1016/j.iccn.2021.103113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore different stakeholders' including nurses, health care professionals and family member's perceptions of ideal family-centred care in an intensive care unit. RESEARCH DESIGN AND METHODS We used a mixed method approach to identify perceptions of family-centred care with 60 stakeholders of equal numbers who voluntarily participated in the study. Data were collected over one month using an associative group analysis method. The responses were ranked, scored, thematically themed and weighted. SETTING A 23 bed adult intensive care unit in an urban private hospital in South Africa. FINDINGS According to the stakeholders' responses, ideal family-centred care should be built around communication based on expectations and engagement. In addition, the physical environment should allow for overall comfort and spiritual care must be incorporated. CONCLUSION Stakeholders had similar perceptions on the main themes however; nuances of different perspectives were identified showing some of the complexities related to family-centred care. Spiritual care was highlighted by the family members, revealing the need to broaden the care perspectives of healthcare providers.
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Affiliation(s)
- Rachele L Pretorius
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa.
| | - Tanya Heyns
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa.
| | - Celia J Filmalter
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Yvonne Botma
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Honarmand K, Mehta S. Consequences of visitor restriction policies in the intensive care unit during the COVID-19 pandemic. Can J Anaesth 2021; 68:1465-1470. [PMID: 34212307 PMCID: PMC8247615 DOI: 10.1007/s12630-021-02048-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kimia Honarmand
- Department of Medicine, Division of Critical Care, Western University, London, ON, Canada.
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Guáqueta Parada SR, Henao-Castaño ÁM, Motta Robayo CL, Triana Restrepo MC, Burgos Herrera JD, Neira Fernández KD, Peña Almanza BA. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Durante el ingreso y permanencia del paciente en la unidad de cuidado intensivo, es imperativo considerar la satisfacción de las necesidades comunicacionales e informativas de la familia del paciente. Objetivo: Integrar los resultados de investigación sobre las intervenciones llevadas a cabo para satisfacer la necesidad de información de las familias de los pacientes en la unidad de cuidado intensivo. Materiales y Métodos: Se realizó una revisión integrativa de estudios en bases de datos Sciencedirect, PubMed, Biblioteca Virtual en Salud y Scielo, con la estrategia de búsqueda [Critical care] and [Needs assessment] and [Family] con criterios de inclusión de estudios publicados entre el año 2009 y el 2019 en idioma inglés, español y portugués disponibles en texto completo Resultados: Después de la lectura analítica de 41 estudios seleccionados se organizaron en 5 temas; uso de folletos de información, sesiones educativas, llamadas telefónicas, uso de tecnologías de la información y comunicación y reuniones familiares. Conclusión: Las intervenciones de enfermería que se han utilizado en la satisfacción de la necesidad de información de la familia son muy variadas e incluyen entre otras los folletos o el uso de TICs, sin embargo la intervención que responde en mayor medida a esta necesidad son las reuniones formales con la familia. Las intervenciones reportadas en los resultados de investigación para responder a la necesidad de información son herramientas clave para que el personal de enfermería las utilice según los recursos con los cuales dispone en su entorno laboral como salas de información para la familia.
Como citar este artículo: Guáqueta Parada Sandra Rocio, Henao Castaño Ángela María, Motta Robayo Claudia Lorena, Triana Restrepo Martha Cecilia, Burgos Herrera Juan David, Neira Fernández Karen Daniela, Peña Almanza Berni Alonso. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. Revista Cuidarte. 2021;12(2):e1775. http://dx.doi.org/10.15649/cuidarte.1775
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Mroz EL, Olasoji E, Henke C, Lim C, Pacheco SC, Swords G, Hester J, Weisbrod N, Babi MA, Busl K, Baron-Lee J. Applying the Care and Communication Bundle to Promote Palliative Care in a Neuro-Intensive Care Unit: Why and How. J Palliat Med 2021; 24:1849-1857. [PMID: 34191600 DOI: 10.1089/jpm.2020.0730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Delivery of palliative care in neurointensive care units (neuro-ICUs) can be inconsistent, often due to absence of formal care triggers. The Care and Communication Bundle (CCB) of Quality Indicators provides a standardized process to deliver effective palliative care services in ICUs, but application of these indicators in this setting has not yet been systemically assessed. Objectives: To evaluate the fit of a CCB in the neuro-ICU through a novel scoring system and identify barriers to adherence. Design: CCB standards for a neuro-ICU were delineated. Assessment of documented indicators and barriers was conducted through electronic medical record retrospective review. Setting/Subjects: A 30-bed neuro-ICU in a large Academic Medical Center in the Southeastern United States. Chart reviews were conducted for 133 critically ill neurology and neurosurgery patients who expired between November 2018 and January 2020. Results: Results demonstrate moderate adherence to CCB standards, including excellent consistency in establishment of patient-centered communication and referral to supportive services (e.g., social work, spiritual support). Identified areas for improvement include documentation of patient and family involvement in care process (i.e., advance directive completion, interdisciplinary team meetings). Conclusions: Application of the CCB in the neuro-ICU is useful for examining adherence to time-based triggers of palliative care standards. The novel scoring system offers opportunities to motivate improvement and reduce variation in palliative care integration.
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Affiliation(s)
- Emily L Mroz
- Department of Psychology, University of Florida, Gainesville, Florida, USA.,Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Esther Olasoji
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Charlotte Henke
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Christina Lim
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Sean C Pacheco
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Gabriel Swords
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Jeannette Hester
- Neuromedicine Intensive Care Unit, Department of Nursing and Patient Services, UF Health Shands Hospital, Gainesville, Florida, USA
| | - Neal Weisbrod
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Marc A Babi
- Department of Neurology, University of Florida, Gainesville, Florida, USA
| | - Katharina Busl
- Department of Neurology, University of Florida, Gainesville, Florida, USA
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Harvey MA. The Evolution From Visitors to Family to Partners in Care of the Critically Ill-Always Humane, Now Evidence-Based. Crit Care Med 2021; 49:165-166. [PMID: 33337747 DOI: 10.1097/ccm.0000000000004713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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114
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Felten-Barentsz KM, van de Wetering-van Dongen VA, Vloet L, Koenders N, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Family participation during physical activity in the intensive care unit: A longitudinal qualitative study. J Crit Care 2021; 65:42-48. [PMID: 34082254 DOI: 10.1016/j.jcrc.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Family-centered care has been implemented in the ICU to meet relatives' needs concerning information, support, participation and shared decision making. This study explores the needs, beliefs, feelings and behaviors of relatives of patients admitted to the ICU regarding participation during physical activity. METHODS Longitudinal qualitative study design following a grounded theory approach. Relatives were interviewed at 4, 8 and 12 days after the patient's ICU-admission. Data were analyzed using constant comparison. RESULTS Twenty-five interviews were conducted in ten relatives. Relatives believed that physical activity in the ICU improves recovery. Participating in physical activity decreased their feelings of powerlessness and uselessness. Relatives mentioned that they would be stimulated to participate if they were invited, guided and informed by healthcare providers. The perceived reticence of healthcare providers, patient's health-changing capacity and the inability to communicate led to a more passive attitude towards participation. CONCLUSIONS The conceptual model shows how family participation during physical activity changes from a passive role, with negative beliefs and feelings of uselessness and powerlessness, to a more proactive participatory role. Relatives felt more useful and like they were part of the team. Providing relatives with additional information might be a viable strategy to help and stimulate participation.
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Affiliation(s)
- Karin M Felten-Barentsz
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Veerle A van de Wetering-van Dongen
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lilian Vloet
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Coelho AC, Santos VB, de Barros ALBL. Stressors in intensive cardiac care units: Patients' perceptions. Nurs Crit Care 2021; 27:195-203. [PMID: 33949036 DOI: 10.1111/nicc.12641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) are often admitted to intensive cardiac care units (ICCUs) to have their vital signs and ventricular function monitored. In most cases, they are conscious and bedbound, causing high stress and anxiety levels. AIMS AND OBJECTIVES To assess the stressors affecting patients admitted to ICCUs. DESIGN This is a cross-sectional study performed in a public hospital in São Paulo, Brazil. METHODS A sample of 100 patients with ACS admitted to an ICCU, after 24 hours of hospitalization, was recruited. Sociodemographic and clinical data were collected, and the Intensive Care Unit Stressor Assessment Scale (ICESS) was applied to investigate stressors. The ICESS' internal consistency was estimated by Cronbach's alpha, and the stressors were analysed by descriptive statistics, association tests, and correlation tests. RESULTS Most patients were male, married, and aged 51 to 60 years. The ICESS showed an excellent internal consistency. The mean score identified in patients pointed to a non-stressed to moderately stressed condition. The indicators considered to be more stressful were as follows: "Not knowing ICU length of stay," "Being unable to fulfil family roles," "Missing husband or wife," and "Loss of self-control." CONCLUSIONS Stress levels were considered to be non-stressful to moderately stressful. The main stressors were related to psychological distress and physical discomfort dimensions. RELEVANCE TO CLINICAL PRACTICE Mapping the main stressors of patients with coronary artery disease will allow health professionals to implement strategies to reduce them and consequently reduce their anxiety levels.
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Affiliation(s)
- Aluê Constantino Coelho
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
| | - Vinicius Batista Santos
- Department of Clinical and Surgical Nursing, Paulista Nursing School, Federal University of São Paulo-UNIFESP, São Paulo, Brazil
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Munshi L, Evans G, Raza F. Pourquoi l’interdiction des visites dans les hôpitaux durant l’actuelle pandémie de COVID-19 devrait être assouplie. CMAJ 2021; 193:E505-E507. [PMID: 33824154 PMCID: PMC8049639 DOI: 10.1503/cmaj.202636-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laveena Munshi
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont.
| | - Gerald Evans
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont
| | - Fahad Raza
- Division interdépartementale de médecine des soins intensifs, Département de médecine (Munshi), Système de santé Sinaï et Réseau universitaire de santé, Université de Toronto; Institut de gestion, d'évaluation et de politiques de santé (Munshi, Razak), Université de Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division d'infectiologie, Département de médecine (Evans), Centre des sciences de la santé de Kingston, Université Queen's, Kingston, Ont.; Service de médecine (Razak), Hôpital St. Michael, Unity Health; Division de médecine interne générale, Département de médecine (Razak), Université de Toronto; Institut du savoir Li Ka Shing (Razak), Hôpital St. Michael, Toronto, Ont
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Mechanism of a Flexible ICU Visiting Policy for Anxiety Symptoms Among Family Members in Brazil: A Path Mediation Analysis in a Cluster-Randomized Clinical Trial. Crit Care Med 2021; 49:1504-1512. [PMID: 33870915 DOI: 10.1097/ccm.0000000000005037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care. DESIGN We embedded a multivariable path mediation analysis within a cluster-randomized crossover trial as a secondary analysis of The ICU Visits Study (ClinicalTrials.gov number: NCT02932358). SETTING Thirty-six medical-surgical ICUs in Brazil. PATIENTS Closest relatives of adult ICU patients. INTERVENTIONS Flexible visitation (12 hr/d) supported by family education or usual restricted visitation (median, 1.5 hr/d). MEASUREMENTS AND MAIN RESULTS Overall, 863 family members were assessed (mean age, 44.7 yr; women, 70.1%). Compared with the restricted visitation (n = 436), flexible visitation (n = 427) resulted in better mean anxiety scores (6.1 vs 7.8; mean difference, -1.78 [95% CI, -2.31 to -1.22]), as well as higher standardized scores of satisfaction (67% [95% CI, 55-79]) and involvement in patient care (77% [95% CI, 64-89]). The mediated effect of flexible visitation on mean anxiety scores through each incremental SD of satisfaction and involvement in patient care were -0.47 (95% CI, -0.68 to -0.24) and 0.29 (95% CI, 0.04-0.54), respectively. Upon exploratory analyses, emotional support, helping the ICU staff to understand patient needs, helping the patient to interpret ICU staff instructions, and patient reorientation were the domains of involvement in patient care associated with increased anxiety. CONCLUSIONS A flexible ICU visiting policy reduces anxiety symptoms among family members and appears to work by increasing satisfaction. However, increased participation in some activities of patient care as a result of flexible visitation was associated with higher severity of anxiety symptoms.
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Nadig NR, Sterba KR, Simpson AN, Ruggiero KJ, Hough CT, Goodwin AJ, White K, Ford DW. Psychological Outcomes in Family Members of Patients With Acute Respiratory Failure: Does Inter-ICU Transfer Play a Role? Chest 2021; 160:890-898. [PMID: 33753046 DOI: 10.1016/j.chest.2021.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/18/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Family members of patients admitted to the ICU experience a constellation of sequelae described as postintensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown. RESEARCH QUESTION Is inter-ICU transfer associated with poor psychological outcomes in families of patients with acute respiratory failure? STUDY DESIGN AND METHODS Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital). Data included demographics, admission source, and outcomes. Admission source was classified as inter-ICU transfer (n = 39) for patients admitted to the ICU from other hospitals and direct admit (n = 43) for patients admitted from the ED or the operating room of the same hospital. We used quantitative surveys to evaluate psychological distress (Hospital Anxiety and Depression Scale [HADS]) and posttraumatic stress (Post-Traumatic Stress Scale; PTSS) and examined clinical, family, and satisfaction factors associated with psychological outcomes. RESULTS Families of transferred patients travelled longer distances (mean ± SD, 109 ± 106 miles) compared with those of patients directly admitted (mean ± SD, 65 ± 156 miles; P ≤ .0001). Transferred patients predominantly were admitted to the neuro-ICU (64%), had a longer length of stay (direct admits: mean ± SD, 12.7 ± 9.3 days; transferred patients: mean ± SD, 17.6 ± 9.3 days; P < .01), and a higher number of ventilator days (direct admits: mean ± SD, 6.9 ± 8.6 days; transferred: mean ± SD, 10.6 ± 9.0 days; P < .01). Additionally, they were less likely to be discharged home (direct admits, 63%; transferred, 33%; P = .08). In a fully adjusted model of psychological distress and posttraumatic stress, family members of transferred patients were found to have a 1.74-point (95% CI, -1.08 to 5.29; P = .30) higher HADS score and a 5.19-point (95% CI, 0.35-10.03; P = .03) higher PTSS score than those of directly admitted family members. INTERPRETATION In this exploratory study, posttraumatic stress measured by the PTSS was higher in the transferred families, but these findings will need to be replicated to infer clinical significance.
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Affiliation(s)
- Nandita R Nadig
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Annie N Simpson
- Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Catherine T Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA
| | - Andrew J Goodwin
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | - Kyle White
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
| | - Dee W Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC
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Weekly Internal Ethical Case Discussions in an ICU-Results Based on 9 Years of Experience With a Highly Structured Approach. Crit Care Explor 2021; 3:e0352. [PMID: 33786431 PMCID: PMC7994040 DOI: 10.1097/cce.0000000000000352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives Various ethical challenges are prevalent in ICUs. In order to handle these problems, a highly structured internal ethical case discussion within the multiprofessional team was implemented in 2011 in a Swiss ICU and has been regularly practiced almost weekly until present. To explore the results of all ethical case discussions taking place in a general ICU and to discuss the outcomes of the patients. To identify the conditions facilitating the implementation of regular ethical case discussions. Design Retrospective case series analysis. Setting Mixed academic ICU. Patients AND INTERVENTION All patients who had an ethical case discussion between January 2011 and December 2019 following the approach called Modular, Ethical, Treatment decisions, Allocation of resources at the micro-level, and Process. MEASUREMENTS AND Main Results Weekly ethical case discussions held regularly on a fixed date were found to be practical for the observed ICU. A total of 314 ethical case discussions were realized in 281 patients. Median patient age was 70 years (interquartile range, 62-77 yr); two thirds were men. The results were categorized into the following groups: established therapy continues, complications to be treated (n = 53; 16.9%); therapy continues, patient's will to be explored further (n = 77; 24.5%); therapy continues, complications to be treated only after evaluation (n = 62; 19.7%); therapy continues with limitations (e.g., do-not-resuscitate order) (n = 98; 31.2%); and change of treatment plan to end-of-life care (n = 17; 5.4%). Of the discussed patients, 115 (40.9%) died in the ICU and 29 (10.3%) after transfer to the normal ward. Seven patients (2.5%) were transferred to a hospice and 55 (19.6%) to another hospital. Sixty-nine (24.6%) were discharged to a rehabilitative facility and six returned home. Conclusions Regular ethical case discussions can be successfully implemented, enabling careful review of the patient's will and balancing it with the prognosis of the disease. This facilitates a necessary change of the therapeutic goal whenever appropriate.
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Aghaei MH, Vanaki Z, Mohammadi E. Inducing a sense of worthiness in patients: the basis of patient-centered palliative care for cancer patients in Iran. BMC Palliat Care 2021; 20:38. [PMID: 33653323 PMCID: PMC7927376 DOI: 10.1186/s12904-021-00732-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. METHOD For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman's method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. RESULTS From content analysis, 3 main categories; considering patient's spirituality, maintaining patient's dignity during care, and reducing patient's suffering, were found. The essence of these categories reflect on the care-providers' consideration and effort in "inducing a sense of worthiness" in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. CONCLUSION For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.
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Affiliation(s)
| | - Zohreh Vanaki
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Eesa Mohammadi
- Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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121
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Parsons Leigh J, Krewulak KD, Zepeda N, Farrier CE, Spence KL, Davidson JE, Stelfox HT, Fiest KM. Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study. Can J Anaesth 2021; 68:358-366. [PMID: 33210217 PMCID: PMC7902561 DOI: 10.1007/s12630-020-01866-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care. METHODS In this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta. RESULTS Key themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU) care team may not use a family member's results, intensification of work load), 2) considerations regarding feasibility (e.g., insufficient knowledge, healthcare team buy-in), and 3) overarching strategies to support implementation into routine patient care (e.g., value of family-administered delirium detection for patients and families is well understood in the clinical context, regular communication between the family and ICU providers, an electronic version of the tool). CONCLUSIONS Patients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT03379129); registered 15 December 2017.
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Affiliation(s)
- Jeanna Parsons Leigh
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Nubia Zepeda
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Christian E Farrier
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Judy E Davidson
- Department of Education, Development and Research, University of California, San Diego Health, San Diego, CA, USA
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
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Lee SY, Brodyn AL, Koppel RS, Tyler CP, Geppert AA, Truehart AI, Gilliam ML. Provider and Patient Perspectives on a New Tangible Decision Aid Tool to Support Patient-Centered Contraceptive Counseling with Adolescents and Young Adults. J Pediatr Adolesc Gynecol 2021; 34:18-25. [PMID: 33096227 DOI: 10.1016/j.jpag.2020.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/30/2020] [Accepted: 10/17/2020] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE Despite the benefits of patient-centered contraceptive care, many adolescents and young adults do not receive such care. The objective of this study was to develop and evaluate Hello Options, a tangible decision aid to support patient-centered contraceptive counseling with adolescents and young adults in a clinic setting. DESIGN, SETTING, PARTICIPANTS, INTERVENTION, AND MAIN OUTCOME MEASURES: Hello Options is a contraceptive counseling decision aid tool (hereafter referred to as "the Tool") that allows patients to see and feel life-size "tangible" models of the range of contraceptive methods. The Tool was developed by a team of designers, adolescents, clinicians, and researchers using human-centered design. From December 2019 to March 2020, we conducted a pilot study to evaluate the usability, feasibility, and acceptability of the Tool with 10 contraceptive care providers and 40 adolescent and young adult patients (aged 12-29 years) at two Chicago clinics. We calculated descriptive statistics for patient survey data, and qualitatively analyzed provider interview transcripts for salient themes using recursive abstraction. RESULTS Patients had positive reactions to the Tool, reporting that it allowed them to better understand how contraceptive methods work in their body and that it allowed them to make more informed decisions. Furthermore, providers commented that the Tool facilitated conversations with their patients, helped dispel myths about particular methods, and eased patients' anxieties. Limitations mentioned included storage and portability concerns, and time constraints for counseling. CONCLUSION Hello Options is a useful, feasible, and acceptable decision aid that can support the provision of patient-centered contraceptive care for young people.
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Affiliation(s)
- Soo Young Lee
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL.
| | - Adriana L Brodyn
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Rebecca S Koppel
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Crystal P Tyler
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Amanda A Geppert
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
| | - Amber I Truehart
- Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Melissa L Gilliam
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3) at the University of Chicago, Chicago, IL
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Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation. Aust Crit Care 2021; 34:594-603. [DOI: 10.1016/j.aucc.2020.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022] Open
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Almansour I, Abdel Razeq NM. Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study. J Clin Nurs 2021; 30:861-873. [PMID: 33377560 DOI: 10.1111/jocn.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed. BACKGROUND Improving end-of-life care requires a focus on adequate family-professionals prognostic communication, while maintaining a realistic level of hope and family support. DESIGN A descriptive qualitative approach was applied. METHODS Semi-structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed. RESULTS Two main categories emerged from the data of this study: 'perspectives on optimistic hope' and 'approaches to prognostic communication'. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope. CONCLUSIONS Improving end-of-life care in intensive care units in Jordan requires a focus on family-professional communication. Jordanian intensive care doctors and nurses perceived honest family-professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication. RELEVANCE TO CLINICAL PRACTICE Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.
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Affiliation(s)
- Issa Almansour
- Clinical Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
| | - Nadin M Abdel Razeq
- Maternal and Child Health Nursing Department, The University of Jordan - School of Nursing, Amman, Jordan
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Ward TL, Raybould SJ, Mondal A, Lambert J, Patel B. Predicting the length of stay at admission for emergency general surgery patients a cohort study. Ann Med Surg (Lond) 2021; 62:127-130. [PMID: 33520208 PMCID: PMC7819802 DOI: 10.1016/j.amsu.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Predicting length of stay (LOS) is beneficial to patients and the health service. When a prolonged LOS is predicted, it gives the opportunity for focused therapies and allocation of resources to reduce this period. In emergency general surgery (EGS) there has been limited investigation of variables that may be important predictors of LOS. This study examines social characteristics alongside measures of severity of acute illness and co-morbidities in an adult EGS population to establish their contribution to LOS. Methods Data were collected prospectively from patients at admission including medical variables, demographics, and therapeutic requirements. The length of hospital admission was measured, and multiple regression analysis was used to identify variables which predicted the LOS. Results Data were collected from 105 patients. The regression model gave an R2 of 0.34, p = 0.0006. Barthal index (measure of independence in activities of daily living) was a significant predictor of LOS [logworth 1.649, p0.02243]. Housing status and Level of social support both correlated in one-way analysis with LOS. Conclusion There are non-surgical variables, measurable at admission which are of significant value in predicting LOS of EGS patients. This warrants further investigation through a larger study to better quantify the contributions of these variables, and establish potential early interventions to reduce the LOS. Barthal Index is a significant predictor of length of stay at admission for patients admitted under EGS. Unstable housing and a lack of social support independently correlate with a longer length of stay. It may be possible to intervene at admission to reduce the length of stay for patients admitted under EGS.
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Affiliation(s)
- T L Ward
- Barts and the London SMD, Dept. Surgery and Surgical Skills, Barts Cancer Institute, London, UK
| | - S J Raybould
- St Helen's and Knowsley Teaching Hospitals, Department of Anaesthetics, Prescot, UK
| | - A Mondal
- Barts and the London SMD, Dept. Surgery and Surgical Skills, Barts Cancer Institute, London, UK
| | - J Lambert
- Homerton University Hospitals Foundation Trust, Department of Surgery, Homerton Row, London, E9 6SR, UK
| | - B Patel
- Barts and the London SMD, Dept. Surgery and Surgical Skills, Barts Cancer Institute, London, UK.,Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR, UK
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Abstract
The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to stress over health care costs and lost wages. Patients are at risk for developing post-intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.
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127
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Coping strategies of family members of intensive care unit patients. Intensive Crit Care Nurs 2020; 63:102980. [PMID: 33342650 DOI: 10.1016/j.iccn.2020.102980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/13/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyse the coping strategies of family members of patients admitted to intensive care units. DESIGN A cross-sectional study developed with 70 relatives of patients admitted to the intensive care unit. SETTING An adult intensive care unit at a university hospital in Brazil. MAIN OUTCOME MEASURES Coping strategies were identified by the Folkman and Lazarus Inventory of Coping Strategies and statistically compared to the sociodemographic data of family members and patients' clinical data. RESULTS Coping strategies focused on emotion were the most used, especially those attributed to the escape-avoidance factor. There was a significant association (p < 0.05) between women and the use of adaptive strategies focused on the problem; less education and lower income with maladaptive strategies focused on emotion; second-degree relatives and the positive reassessment factor; participants involved in religious activities and the social support factor. Regarding the clinical variables, patients admitted to the intensive care unit for more than seven days showed an association (p < 0.05) with the social support factor. CONCLUSION Family members used adaptive coping strategies more focused on emotion. Additionally, the lower the educational and economic levels, the greater the use of maladaptive strategies focused on emotion.
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128
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Saeid Y, Salaree MM, Ebadi A, Moradian ST. Family Intensive Care Unit Syndrome: An Integrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:361-368. [PMID: 33344205 PMCID: PMC7737832 DOI: 10.4103/ijnmr.ijnmr_243_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
Background: Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors. Materials and Methods: The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005–2018 with the keywords “FICUS,” “intensive care unit,” “family,” “caregivers,” “anxiety,” “depression,” and “post-traumatic stress disorder” in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study. Results: Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS. Conclusions: On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term “FICUS” in the research literature. Thus, further research is needed to explore FICUS in the health field.
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Affiliation(s)
- Yaser Saeid
- Students Research Committee and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Salaree
- Health Research Center. Life style institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center and Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Munshi L, Evans G, Razak F. The case for relaxing no-visitor policies in hospitals during the ongoing COVID-19 pandemic. CMAJ 2020; 193:E135-E137. [PMID: 33355198 PMCID: PMC7954559 DOI: 10.1503/cmaj.202636] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont.
| | - Gerald Evans
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont
| | - Fahad Razak
- Interdepartmental Division of Critical Care Medicine, Department of Medicine (Munshi), Sinai Health System and University Health Network, University of Toronto; Institute of Health Policy, Management and Evaluation (Munshi, Razak), University of Toronto, Toronto, Ont.; Ontario COVID-19 Science Advisory Table (Munshi, Evans, Razak); Division of Infectious Disease, Department of Medicine (Evans), Kingston Health Sciences Centre, Queen's University, Kingston, Ont.; Department of Medicine (Razak), St. Michael's Hospital, Unity Health; Division of General Internal Medicine, Department of Medicine (Razak), University of Toronto; Li Ka Shing Knowledge Institute (Razak), St. Michael's Hospital, Toronto, Ont
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130
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McAndrew NS, Mark L, Butler M. Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit. Crit Care Nurse 2020; 40:42-51. [PMID: 33257964 DOI: 10.4037/ccn2020644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. OBJECTIVE To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. METHODS The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. RESULTS Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. CONCLUSIONS This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.
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Affiliation(s)
- Natalie S McAndrew
- Natalie S. McAndrew is an assistant professor, College of Nursing, University of Wisconsin-Milwaukee, and a nurse-scientist, Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Mark
- Laura Mark is a physician assistant in the cardiovascular intensive care unit, Froedtert Hospital, Froedtert & Medical College of Wisconsin
| | - Mary Butler
- Mary Butler is an assistant clinical professor, College of Nursing, University of Wisconsin-Milwaukee
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131
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Wong P, Redley B, Bucknall T. Families' control preference for participation in patient care in adult intensive care. Intensive Crit Care Nurs 2020; 62:102953. [PMID: 33189518 DOI: 10.1016/j.iccn.2020.102953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/28/2020] [Accepted: 08/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Understand families' preferences and observed participation in patient care in an adult ICU. RESEARCH METHODOLOGY The mixed-methods design used survey and naturalistic observation to collect data from a convenience sample of 30 family members of critically ill patients. SETTING Two public hospital intensive care units in Australia. MAIN OUTCOME MEASURES 1) Families' preferences for participation in decision-making and physical patient care activities in the adult intensive care unit, measured using a modified Control Preference Scale; 2) the type and frequency of family participation in patient care activities in the intensive care unit. RESULTS Almost half (47%) reported a preference to share in decision-making about care for their relative with healthcare professionals; 17% reported a preference for active participation in decision-making. Alternatively, most families preferred a passive (60%) role in the physical care of their relative ; 33% preferred shared participation with staff and very few (3%) preferred active participation with little involvement of staff. Of the 193 activities observed, family participation in physical care was the least frequent (24%). CONCLUSION Differences emerged in family preferences for participation in physical care compared to their involvement in decision-making about care for their relative. The findings indicate a need for tailored interventions to support family participation aligned with their preferences.
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Affiliation(s)
- Pauline Wong
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia.
| | - Bernice Redley
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research, 1 Gheringhap Street, Geelong, Victoria 3220, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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132
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Ree E. What is the role of transformational leadership, work environment and patient safety culture for person-centred care? A cross-sectional study in Norwegian nursing homes and home care services. Nurs Open 2020; 7:1988-1996. [PMID: 33072384 PMCID: PMC7544868 DOI: 10.1002/nop2.592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 11/08/2022] Open
Abstract
Aim To examine how transformational leadership, job demands, job resources and patient safety culture contribute in explaining person-centred care in nursing homes and home care services. Design Cross-sectional study. Methods Healthcare professionals in four Norwegian nursing homes (N = 165) and four home care services (N = 139) participated in 2018. Multiple regression analyses were used to examine to what degree transformational leadership, job demands, job resources and patient safety culture dimensions predicted person-centred care. Results Transformational leadership, job demands and job resources explained 41% of the variance in person-centred care, with work pace as the strongest predictor (β = 0.39 p < .001). The patient safety culture dimensions explained 57.5% of the variance in person-centred care, with staffing being the strongest predictor (β = 0.31 p < .001). There were small differences between nursing homes and home care. In total, transformational leadership, pace of work, staffing and factors related to communication were the strongest predictors for person-centred care.
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Affiliation(s)
- Eline Ree
- SHARE – Centre for Resilience in HealthcareFaculty of Health SciencesUniversity of StavangerStavangerNorway
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133
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Siddiqi H. To Suffer Alone: Hospital Visitation Policies During COVID-19. J Hosp Med 2020; 15:694-695. [PMID: 32853145 DOI: 10.12788/jhm.3494] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022]
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134
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McAndrew NS, Jerofke-Owen T, Fortney CA, Costa DK, Hetland B, Guttormson J, Harding E. Systematic review of family engagement interventions in neonatal, paediatric, and adult ICUs. Nurs Crit Care 2020; 27:296-325. [PMID: 33089659 DOI: 10.1111/nicc.12564] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this systematic review was to evaluate interventions that have been used to engage families in direct care activities (active family engagement) in adult, paediatric, and neonatal intensive care unit (ICU) settings. BACKGROUND Family engagement is universally advocated across ICU populations and practice settings; however, appraisal of the active family engagement intervention literature remains limited. SEARCH STRATEGY Ovid Medline, PsycArticles & PsycInfo, Scopus, and CINAHL were searched for family interventions that involved direct care of the patient to enhance the psychological, physical, or emotional well-being of the patient or family in neonatal, paediatric, or adult ICUs. INCLUSION/EXCLUSION CRITERIA Studies were included if an active family engagement intervention was evaluated. Studies were excluded if they were not published in English or reported non-interventional research. RESULTS A total of 6210 abstracts were screened and 19 studies were included. Most studies were of low to moderate quality and were conducted in neonatal ICUs within the United States. Intervention dosage and frequency varied widely across studies. The interventions focused on developmental care (neonatal ICU) and involved families in basic patient care. Family member outcomes measured included satisfaction, stress, family-centred care, confidence, anxiety, and depression. Most studies found improvements in one or more outcomes. CONCLUSIONS There is a paucity of literature about active family engagement interventions, especially in adult and paediatric populations. The optimal dosage and frequency of family engagement interventions remains unknown. Our systematic review found that data are limited on the relationship between family engagement and patient outcomes, and provides a timely appraisal to guide future research. RELEVANCE TO CLINICAL PRACTICE Further research on the efficacy of family engagement interventions is warranted. The translation of active family engagement interventions into clinical practice should also be supported.
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Affiliation(s)
- Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.,Froedtert & the Medical College of Wisconsin Froedtert Hospital, Milwaukee, Wisconsin, USA
| | | | - Christine A Fortney
- College of Nursing, The Ohio State University, Martha S. Pitzer Center for Women, Children & Youth, Columbus, Ohio, USA
| | - Deena K Costa
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Breanna Hetland
- Omaha Division, College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jill Guttormson
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Eric Harding
- Medical College of Wisconsin Libraries, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Survivors of Critical Illness and Their Relatives. A Qualitative Study on Hospital Discharge Experience. Ann Am Thorac Soc 2020; 16:1405-1413. [PMID: 31394924 DOI: 10.1513/annalsats.201902-156oc] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale: To target rehabilitation needs of survivors of critical illness and their relatives in a timely and adequate manner, a thorough needs assessment is recommended when hospital discharge planning is initiated. In light of existing evidence on physical and psychological consequences of critical illness for patients and family, it is currently unclear if current hospital discharge procedures suffice to meet the needs of this group.Objectives: To explore hospital discharge experience and to identify perceived barriers and enablers for a positive transition experience from hospital to home or rehabilitation facility as perceived by survivors of critical illness and their families.Methods: We performed a grounded theory study with semi-structured interviews among a group of survivors of critical illness and their relatives (n = 35) discharged from 16 hospitals across the Netherlands. Interviews were audio recorded and transcribed verbatim. Using constant comparative methods, initial and focused coding was applied to the data, which were further labeled into major categories and subcategories, ultimately leading to the identification of key concepts. Triangulation was applied through several reflexivity meetings at different stages of the study.Results: Twenty-two former intensive care unit patients and 13 relatives were interviewed. The mean age was 53 (standard deviation ± 11.2) and 60% were female. Median intensive care unit and hospital length of stay were 14 days (interquartile range, 9.75-24.5) and 35 days (interquartile range, 21.75-57.25), respectively. Thematic analyses led to identification of seven key concepts, representing barriers and enablers to a positive transition experience. "Existing in a fragmented reality," "being overlooked," and "feeling disqualified" were identified barriers and "feeling empowered," "encountering empathic and expert professionals," "managing recovery expectations," and "family engagement" were identified as enablers for a positive perceived transition experience.Conclusions: Findings of this study suggest that current hospital discharge practice for survivors of critical illness is driven by speed and efficiency, rather than by individual needs assessments, despite advocacies for patient- and family-centered care. Discharge strategies should be customized to facilitate adequate and comprehensive assessment of aftercare needs, conducted at the right time and within the right context, encouraging empowerment and a positive perceived transition from hospital to home.
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Nicolas-Robin A. ICU diary: Should we turn the page? More liberal visiting policies: Must the door stay closed? Anaesth Crit Care Pain Med 2020; 38:571-572. [PMID: 31785698 DOI: 10.1016/j.accpm.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Armelle Nicolas-Robin
- Pediatric palliative care mobile team, University Hospital Robert-Debré, Assistance Publique - Hôpitaux de Paris, Université de Paris, 48, boulevard Sérurier, 75019 Paris, France.
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Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs 2020; 61:102916. [PMID: 32807604 DOI: 10.1016/j.iccn.2020.102916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate family and health professional experience with a nurse-led family support intervention in intensive care. DESIGN Qualitative evaluation study. SETTING A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland. MAIN OUTCOME MEASURES Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies. FINDINGS Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families. CONCLUSIONS An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland; Institute of Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland.
| | - Paola Massarotto
- Institute of Intensive Medicine, University Hospital Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
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Hamilton R, Kleinpell R, Lipman J, Davidson JE. International facilitators and barriers to family engagement in the ICU: Results of a qualitative analysis. J Crit Care 2020; 58:72-77. [DOI: 10.1016/j.jcrc.2020.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/05/2020] [Accepted: 04/19/2020] [Indexed: 12/20/2022]
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139
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Karlsson J, Eriksson T, Lindahl B, Fridh I. Family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer: A phenomenological hermeneutical study. J Clin Nurs 2020; 29:3721-3730. [PMID: 32644235 DOI: 10.1111/jocn.15402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/23/2020] [Accepted: 06/21/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. BACKGROUND Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units (ICUs). These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for. DESIGN A qualitative design based on phenomenological hermeneutics. METHODS The study was conducted at two Swedish general ICUs. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research principles were applied in the conduct and reporting of this study. RESULTS Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close. CONCLUSIONS The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning. RELEVANCE TO CLINICAL PRACTICE The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.
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Affiliation(s)
- Jonas Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Eriksson
- 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.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wong P, Redley B, Digby R, Correya A, Bucknall T. Families’ perspectives of participation in patient care in an adult intensive care unit: A qualitative study. Aust Crit Care 2020; 33:317-325. [DOI: 10.1016/j.aucc.2019.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022] Open
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Rossiter C, Levett-Jones T, Pich J. The impact of person-centred care on patient safety: An umbrella review of systematic reviews. Int J Nurs Stud 2020; 109:103658. [PMID: 32593882 DOI: 10.1016/j.ijnurstu.2020.103658] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Nursing literature frequently emphasises the benefits of person-centred approaches for healthcare quality and safety. OBJECTIVE This umbrella review aimed to synthesise the combined evidence from systematic reviews assessing the impact of person-centred care interventions on patient safety. DESIGN A three-step review process included a preliminary review of literature, a comprehensive search, and manual searching of reference lists and forward citations of selected reviews. The review protocol was registered with Prospero (CRD42018090048). DATA SOURCES Reviewers searched 10 databases for systematic reviews published in English-language peer-reviewed journals between 2000 and 2019: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, JBI Database, Medline, ProQuest Health & Medicine, PROSPERO Register, PubMed and Scopus. REVIEW METHODS Covidence software was used to manage screening and eligibility. Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. RESULTS From an initial total of 3412 potential titles, 16 reviews met the inclusion criteria. The selected reviews examined the impact of person-centred care for diverse groups of patients (children, adults and older people) in varied settings. Most systematic reviews assessed experimental studies, generally comparing person-centred interventions with 'usual care', often demonstrating limited evidence of impact on safety. Reviews addressed several patient safety outcomes relevant to nursing, including falls, infections, medication use and misuse, and mortality rates. The systematic reviews were generally well conducted, although several included studies of poor or fair quality. Given the heterogeneity of the interventions, outcomes and research designs of studies included in the selected reviews, we were unable to draw unequivocal conclusions about the implications of person-centred care for patient safety in this umbrella review. However, there was some encouraging evidence that person-centred care initiatives may result in reduced rates of falls (in acute care and residential aged care settings). The review also highlighted reductions in agitation for people with dementia and some improvement in anti-psychotic medication use in older people with dementia. CONCLUSIONS Although abundant evidence exists demonstrating the positive effects of person-centred care on healthcare quality and on patient (and provider) wellbeing, there is little research focussing specifically on the impact of person-centred care on patient safety. Thus, there is scope for further high-quality nursing research into how person-centred interventions improve specific patient safety outcomes in order to inform more widespread adoption of person-centred practice.
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Affiliation(s)
- Chris Rossiter
- Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, NSW 2007, Australia.
| | - Tracy Levett-Jones
- Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, NSW 2007, Australia.
| | - Jacqueline Pich
- Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, NSW 2007, Australia.
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Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Barbosa LG, Frazão CDS. Impact of demonstration in a realistic simulation environment as a postoperative education in patients' experience. EINSTEIN-SAO PAULO 2020; 18:eAO4831. [PMID: 32215467 PMCID: PMC7069733 DOI: 10.31744/einstein_journal/2020ao4831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the impact of training in the Practical Life Room on patients experience during hospitalization. METHODS Subjects submitted to orthopedic surgeries were randomized to two groups (Control and Intervention) in the postoperative period. The Control Group received only the printed guidelines regarding the postoperative period, and the Intervention Group received the printed guidelines and a demonstration and training session with a physical therapist, in an environment created to simulate a house and its rooms (living room, bedroom, kitchen, laundry and bathroom). The participants of both groups answered the questionnaire Hospital Consumer Assessment of Healthcare Providers and Systems on the day of discharge. RESULTS Sixty-eight subjects were included in the study, 30 (44.1%) in the Control Group and 38 (55.9%) in the Intervention Group. The Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire score showed no significant difference between the groups (p=0.496). CONCLUSION There was no influence of the proposed intervention on the results of the Hospital Consumer Assessment of Healthcare Providers and Systems questionnaire, perhaps because of the limitation of the instrument or due to the fact it was employed when patients were still hospitalized. However, by reports from patients in the Intervention Group about felling better prepared and safer for performing daily activities, it is believed that patient education approaches through demonstration should be included as part of the process to prepare for discharge, whenever possible.
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Affiliation(s)
- Luciana Gardin Barbosa
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
| | - Cinthya da Silva Frazão
- Associação de Assistência à Criança DeficienteSão PauloSPBrazil Associação de Assistência à Criança Deficiente , São Paulo , SP , Brazil .
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Cornelius T, Vilchinsky N, Fait K, Matetzky S, Hod H. Early Exposure to Cardiac Treatment and Distress Among Patients and Their Caregiving Partners. Front Psychol 2020; 11:141. [PMID: 32116942 PMCID: PMC7029717 DOI: 10.3389/fpsyg.2020.00141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The experience of an acute coronary event (ACE), including early care and evaluation, can be a distressing and traumatic experience for patients and their romantic partners, who also act as caregivers. We hypothesized that, among partners who were present during the ACE, those who were also present during (1) transportation to the hospital and (2) initial medical treatment would experience greater (a) anxiety early post-event and (b) posttraumatic stress symptoms (PSS) related to the event 4 months later. The associations between partner presence with patient anxiety and PSS were also explored. Methods: Participants were ACE patients and their partners recruited between March 2015 and December 2016 from the Intensive Cardiac Care Unit (ICCU) of the Sheba Medical Center in Israel (N = 143; all patients were males and partners were females). Partners self-reported whether or not they were present during the cardiac event, the hospital drive, and initial care. Patients and partners self-reported anxiety in-hospital and PSS, keyed to the ACE, an average of 4 months later. Data were analyzed using General Estimating Equations (GEE) and Multilevel Modeling. Results: Neither patient anxiety nor PSS differed according to partner presence during the drive to the hospital. In contrast, partners had higher anxiety when they were not present at all (difference = 3.65, p = 0.019) and when present during the event and during the drive (difference = 2.93, p = 0.029) as compared to when they were present for the event but not for the drive. Partners who were present during the event, but not the drive, had lower PSS than those who were present for both the event and the drive (difference = −4.64, p = 0.026). Conclusions: Partners who accompany patients on the drive to the hospital may inadvertently put themselves at risk for greater distress following their loved one’s cardiac event. Future research should enroll couples in an acute care context to inform couple-targeted tailored interventions to reduce distress in patients and their caregiving partners.
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Affiliation(s)
- Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY, United States
| | - Noa Vilchinsky
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Keren Fait
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Shlomi Matetzky
- Intensive Cardiac Care Unit, Leviev Heart Institute, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hanoch Hod
- Intensive Cardiac Care Unit, Leviev Heart Institute, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Family participation in the care of older adult patients admitted to the intensive care unit: A scoping review. Geriatr Nurs 2020; 41:474-484. [PMID: 32059826 DOI: 10.1016/j.gerinurse.2020.01.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Family members' participation in care is internationally advocated as a way to improve patient outcomes admitted to the intensive care unit (ICU). OBJECTIVE to provide an overview of current understandings about family participation in the care of older adult patients admitted to ICU. DESIGN, DATA SOURCES, AND METHODS The Arksey and O'Malley's framework for scoping review was used. We searched PubMed, CINAHL, EmBase, Scopus, and Cochrane from their inception until 10 October 2019 to answer this question: What are the dimensions, prerequisites, facilitators, barriers, and consequences of family member's participation in the care of older adult patient admitted to ICU? RESULTS Of 3410 search results, 33 articles were included (10 descriptive; 3 interventional or quality improvement project; 12 qualitative; 5 reviews; 1 expert opinion; 1 evidence-practice recommendation and 1 clinical guideline). The included studies were conducted internationally (n = 7), USA (n = 8), Canada (n = 3), France (n = 2), Britannia, Australia (n = 6), (n = 2), and Sweden (n = 5). No article from Asian and African countries was retrieved. The supporting level of evidence for most studies (28 out of 33) was low. CONCLUSIONS This review showed that family members could participate in the provision of physical and non-physical care (emotional, mental, cognitive, and psychosocial) to older adult patients admitted to ICU. Their participation in ICU care has the potential to improve the physical, emotional, psychological and psychological outcomes of older adult patients and their family members as well as reduce the burden of the healthcare system. The barriers were grouped into patient-related factors, ICU staff-related factors, family-related factors, and ICU setting-related factors. In addition, several facilitators of participation in ICU care were discussed. THE IMPLICATION FOR FUTURE RESEARCH This review showed a lack of experimental studies on the effectiveness of family members' participation in ICU care for the patient, family, and care system. This provides an opportunity for future research to develop and test interventions based on the multiple dimensions described in this paper.
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Ervin JN. An acceptability pilot of the facilitating active management in lung illness with engaged surrogates (FAMILIES) study. Medicine (Baltimore) 2020; 99:e19272. [PMID: 32118736 PMCID: PMC7478694 DOI: 10.1097/md.0000000000019272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 01/10/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022] Open
Abstract
Approximately half of the surrogate decision makers of critically ill adults are at risk for negative emotional burden. Decision support and effective surrogate-clinician communication buffers against such experiences. The objective of this study is to evaluate the acceptability of a new surrogate-targeted educational tool that promotes engagement with clinicians and advocacy for 2 evidence-based practices in the provision of mechanical ventilation for acute respiratory failure: spontaneous awakening and breathing trials.A panel of 44 former patients and surrogates of a 20-bed medical intensive care unit in a large academic hospital responded to an online survey. Acceptability was measured on 3 dimensions: attitudes toward the content and delivery of information, objective knowledge translation, and subjective knowledge acquisition.More than 80% of participants found the tool to be easy to read, and over 90% felt that the tool provided actionable recommendations. A significant number of previously unsure participants were able to identify what spontaneous awakening and breathing trials are and when they occur, and 16% to 36% reported significant improvements in their subjective understanding of the target evidence-based practices, after being exposed to the educational tool.This line of work seeks to reduce surrogates' negative emotional burden while also promoting quality critical care. The educational tool provides a promising new way to promote surrogate-clinician communication, by increasing surrogates' knowledge about and encouraging advocacy for evidence-based practices in the provision of mechanical ventilation.
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Where are the family caregivers? Finding family caregiver-related content in foundational nursing documents. J Prof Nurs 2020; 36:76-84. [DOI: 10.1016/j.profnurs.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
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Isaacs D. Trust me I'm a doctor: Making decisions about children's direction of care. J Paediatr Child Health 2019; 55:1411-1413. [PMID: 31846156 DOI: 10.1111/jpc.14588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- David Isaacs
- Children's Hospital at Westmead, Sydney, New South Wales, Australia
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