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Li M, Shi T, Chen J, Ding J, Gao X, Zeng Q, Zhang J, Ma Q, Liu X, Yu H, Lu G, Li Y. The facilitators and barriers to implementing virtual visits in intensive care units: A mixed-methods systematic review. J Eval Clin Pract 2024. [PMID: 38993019 DOI: 10.1111/jep.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 05/25/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool. RESULTS A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality. CONCLUSION This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.
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Affiliation(s)
- Mengyao Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Tian Shi
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Juan Chen
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xianru Gao
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, China
| | - Yuping Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
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Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12:3873-3881. [PMID: 38994315 PMCID: PMC11235428 DOI: 10.12998/wjcc.v12.i19.3873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pressure ulcer (PU) are prevalent among critically ill trauma patients, posing substantial risks. Bundled care strategies and silver nanoparticle dressings offer potential solutions, yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated. AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients. METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit (ICU) were included in this study. Patients were randomly assigned to either the control group (conventional care with silver nanoparticle dressing, n = 49) or the intervention group (bundled care with silver nanoparticle dressing, n = 49). The PU Scale for Healing (PUSH) tool was used to monitor changes in status of pressure injuries over time. Assessments were conducted at various time points: Baseline (day 0) and subsequent assessments on day 3, day 6, day 9, and day 12. Family satisfaction was assessed using the Family Satisfaction ICU 24 questionnaire. RESULTS No significant differences in baseline characteristics were observed between the two groups. In the intervention group, there were significant reductions in total PUSH scores over the assessment period. Specifically, surface area, exudate, and tissue type parameters all showed significant improvements compared to the control group. Family satisfaction with care and decision-making was notably higher in the intervention group. Overall family satisfaction was significantly better in the intervention group. CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients. This approach holds promise for improving PUs management in the ICU, benefiting both patients and their families.
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Affiliation(s)
- Hong Yu
- Department of Intensive Care Unit, The First People's Hospital of Ziyang, Ziyang 641300, Sichuan Province, China
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Liyew TM, Mersha AT, Admassie BM, Arefayne NR. Family Satisfaction with Care Provided in Intensive Care Unit; a Multi-Center, Cross-Sectional Study. Patient Relat Outcome Meas 2024; 15:105-119. [PMID: 38680729 PMCID: PMC11048314 DOI: 10.2147/prom.s453246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Background Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit. Methods A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant. Results The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction. Conclusion and recommendation The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient's condition and treatment plan is essential.
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Affiliation(s)
- Temesgen Misganaw Liyew
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Abraham Tarekegn Mersha
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Belete Muluadam Admassie
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
| | - Nurhusen Riskey Arefayne
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia
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Pérez-Ortega S, Parellada-Vendrell M, Querol E, Prats J, Venturas M, Zabalegui A. Gender perspective in the implementation of hygiene in cardiology intensive care. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00015-6. [PMID: 38493071 DOI: 10.1016/j.enfie.2023.12.004] [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: 09/02/2023] [Accepted: 12/05/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.
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Affiliation(s)
- S Pérez-Ortega
- Unidad Cuidados Cardiológicos Agudos, Hospital Clínic Barcelona, Barcelona, Spain; Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain.
| | - M Parellada-Vendrell
- Unidad Cuidados Cardiológicos Agudos, Hospital Clínic Barcelona, Barcelona, Spain
| | - E Querol
- Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - J Prats
- Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - M Venturas
- Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Zabalegui
- Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Dirección Enfermería, Hospital Clínic Barcelona, Barcelona, Spain
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Vogel G, Joelsson-Alm E, Forinder U, Svensen C, Sandgren A. Shifting focus: A grounded theory of how family members to critically ill patients manage their situation. Intensive Crit Care Nurs 2023; 78:103478. [PMID: 37384978 DOI: 10.1016/j.iccn.2023.103478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home. RESEARCH METHODOLOGY/DESIGN We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021. SETTING Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals. FINDINGS The theory Shifting focus explains how family members' main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus. CONCLUSION Family members could stand in the shadow of the patients' critical illness and needs. This emotional adversity is processed through shifting focus from one's own needs and well-being to the patient's survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members' need for support and information, to reduce stress in everyday life, is needed. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.
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Affiliation(s)
- Gisela Vogel
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Ulla Forinder
- Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, SE-801 76 Gävle, Sweden.
| | - Christer Svensen
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, SE-352 52 Växjö, Sweden.
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Renckens SC, Pasman HR, Klop HT, du Perron C, van Zuylen L, Steegers MAH, Ten Tusscher BL, Abbink FCH, de Ruijter W, Vloet LCM, Koster SCE, Onwuteaka-Philipsen BD. Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:763. [PMID: 37464434 DOI: 10.1186/s12913-023-09756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences. METHODS We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support. RESULTS A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support. CONCLUSIONS Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.
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Affiliation(s)
- Sophie C Renckens
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands.
| | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Viaa University of Applied Sciences, Zwolle, The Netherlands
| | - Chantal du Perron
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique A H Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Lilian C M Vloet
- Foundation Family and Patient Centered Intensive Care (FCIC), Alkmaar, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Stephanie C E Koster
- Department of Anaesthesiology and Department of Intensive Care Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
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Ponnapa Reddy MR, Kadam U, Lee JDY, Chua C, Wang W, McPhail T, Lee J, Yarwood N, Majumdar M, Subramaniam A. Family satisfaction with intensive care unit communication during the COVID-19 pandemic: a prospective multicentre Australian study Family Satisfaction - COVID ICU. Intern Med J 2022; 53:481-491. [PMID: 36346289 PMCID: PMC9877714 DOI: 10.1111/imj.15964] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Virtual communication has become common practice during the coronavirus disease 2019 (COVID-19) pandemic because of visitation restrictions. AIMS The authors aimed to evaluate overall family satisfaction with the intensive care unit (FS-ICU) care involving virtual communication strategies during the COVID-19 pandemic period. METHODS In this prospective multicentre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all eligible ICU patients between 1 July 2020 and 31 October 2020 were requested to complete an adapted version of the FS-ICU 24-questionnaire. Group comparisons were analysed and calculated for family satisfaction scores: ICU/care (satisfaction with care), FS-ICU/dm (satisfaction with information/decision-making) and FS-ICU/total (overall satisfaction with the ICU). The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. RESULTS Seventy-three of the 227 patients' NOK who initially agreed completed the FS-ICU questionnaire (response rate 32.2%). The mean FS-ICU/total was 63.9 (standard deviation [SD], 30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [SD, 30.3) vs 65.4 (SD, 31.4); P < 0.001]. There was no difference in mean FS-ICU/total scores between survivors (n = 65; 89%) and non-survivors (n = 8, 11%). Higher patient Acute Physiology and Chronic Health Evaluation III score, female NOK and the patient dying in the ICU were independent predictors for FS-ICU/total score, while a telephone call at least once a day by an ICU doctor was related to family satisfaction for FS-ICU/dm. CONCLUSIONS There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Efforts should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.
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Affiliation(s)
- Mallikarjuna Reddy Ponnapa Reddy
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineCalvary Public HospitalBruceAustralian Capital TerritoryAustralia
| | - Umesh Kadam
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia,Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - John Dong Young Lee
- Department of Intensive Care MedicineMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Clara Chua
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Wei Wang
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tomecka McPhail
- Department of Social WorkWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Jodie Lee
- Department of Social WorkMonash Health Casey HospitalBerwickVictoriaAustralia
| | - Naomi Yarwood
- Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia
| | - Mainak Majumdar
- Department of Intensive Care MedicineWerribee Mercy HospitalWerribeeVictoriaAustralia
| | - Ashwin Subramaniam
- Department of Intensive Care MedicineFrankston HospitalFrankstonVictoriaAustralia,Department of Intensive Care MedicineEpworth Hospital GeelongWaurn PondsVictoriaAustralia,Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia,Peninsula Clinical SchoolMonash UniversityFrankstonVictoriaAustralia
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Drury A, Muscat DM, Wibrow B, Jacques A, Anstey M. Integrating the Choosing Wisely 5 Questions into Family Meetings in the Intensive Care Unit: A Randomized Controlled Trial Investigating the Effect on Family Perceived Involvement in Decision-Making. J Patient Exp 2022; 9:23743735221092623. [PMID: 35434292 PMCID: PMC9006367 DOI: 10.1177/23743735221092623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Family members often act as surrogate decision makers for patients in the intensive care unit (ICU). The use of printed prompts may assist with families feeling empowered to fulfill this role. Prospective, randomized controlled trial in 3 ICUs in Western Australia. In the intervention arm, families received the Choosing Wisely 5 questions as printed prompts prior to a family meeting, and the control arm did not receive prompts. The primary outcome was family perceived involvement in decision-making. Outcomes were measured using a survey. Sixty families participated in the study. The majority of families (87.1% control, 79.3% intervention; P = .334) reported feeling “very included” in decision-making. There was no difference in secondary outcomes, including minimal uptake of the questions by the intervention arm. This has been the first randomized trial evaluating the use of a decision-making tool for families in the ICU. Despite ceiling effects in outcome measures, these results suggest room for future study of the Choosing Wisely 5 questions in the ICU.
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Affiliation(s)
- Ashleigh Drury
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Danielle M Muscat
- Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
| | - Bradley Wibrow
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Matthew Anstey
- Intensive Care Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
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9
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Chiang MC, Huang CC, Hu TH, Chou WC, Chuang LP, Tang ST. Factors associated with bereaved family surrogates' satisfaction with end-of-life care in intensive care units. Intensive Crit Care Nurs 2022; 71:103243. [PMID: 35396097 DOI: 10.1016/j.iccn.2022.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Family satisfaction with end-of-life care in the intensive care unit constitutes an important outcome for evaluating end-of-life care quality. Research on this topic focuses on linking end-of-life care processes to family-surrogate satisfaction with the patient's end-of-life care but has seldom examined patient- and family-surrogate-based factors. We aimed to comprehensively and simultaneously examine factors facilitating or deterring family satisfaction with end-of-life care in the intensive care unit from patient- and family-surrogate perspectives. METHODS For this secondary-analysis study, 278 Taiwanese family surrogates were surveyed one-month post-patient death using the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU), which measures care and decision-making. Associations between family satisfaction with end-of-life care and patient and family characteristics, patient disease severity, and length of intensive care stay were examined by multivariate, multilevel linear regression models. RESULTS Female family surrogates were more satisfied with patients' end-of-life care than male family surrogates when patients had a higher APACHE II but a lower SOFA score. Adult-child surrogates had lower FS-ICU Care scores than other family surrogates. Higher satisfaction with ICU decision-making was associated with patients' higher APACHE II but lower SOFA scores, longer stay and family socio-demographics, including being unmarried, educational attainment above junior high school and reported financial sufficiency to make ends meet. CONCLUSION Patient disease severity and family-surrogate characteristics are significantly associated with surrogates' satisfaction with patients' end-of-life care in the intensive care unit. Specific interventions should be tailored to the needs of high-risk family surrogates to increase their satisfaction with this care.
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Affiliation(s)
- Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, ROC.
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Farley S, Bansal S, Barks MC, Pollak KI, Kaye EC, Quarles A, Briglia K, Johnson E, Lakis K, Lemmon ME. Role of Social Workers in Family Conferences for Critically Ill Infants. J Palliat Med 2022; 25:1236-1242. [PMID: 35285675 PMCID: PMC9347387 DOI: 10.1089/jpm.2021.0574] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Communication challenges in the neonatal intensive care unit include fragmented communication, challenges managing expectations amidst uncertainty, and navigating complex medical information. Social workers are well suited to mitigate these challenges. Objective: In this study, we aimed to characterize the extent and nature of social worker participation in family conferences for critically ill infants. Design: We used a longitudinal observational mixed-methods design, enrolling infants with a neurological condition, their parent(s), and their clinicians. All audio-recorded conferences were transcribed and de-identified. Emergent themes and subthemes were identified using conventional content analysis. Results: We enrolled 40 infants and 61 parents. Sixty-eight conferences were held and audio recorded for 24 infants. Social workers were present for 51 of these conferences (n = 51/68, 75%) across 18 cases (n = 18/24, 75%). We identified four themes, conceptualized as distinct roles played by social workers in family conferences: (1) Translator: social workers served as a communicative bridge between parents and the medical team; (2) Coordinator: social workers simplified logistics and connected parents to community resources, including home health agencies and financial assistance; (3) Expectation manager: social workers provided anticipatory guidance and helped parents conceptualize the remainder of the hospital stay, discharge, and life at home; and (4) Advocate: social workers validated parental values and concerns and provided immediate emotional support. Conclusions: Social workers participated in three-quarters of family conferences for critically ill infants. When they participated, they facilitated communication, coordinated care, managed expectations, and advocated for families. These findings underscore the important, varied, and concurrent roles social workers play in the care of critically ill infants. Future communication and family support interventions should leverage these distinct roles.
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Affiliation(s)
- Sam Farley
- Duke University, Durham, North Carolina, USA
| | | | - Mary Carol Barks
- Duke University, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathryn I. Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erica C. Kaye
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anna Quarles
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kathleen Briglia
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Erika Johnson
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kristen Lakis
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Palliative Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Monica E. Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
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11
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Reynolds HV, Von Dohren G, Tabah A. Mandated nursing ratios decrease mortality and costs in the hospital, and what about the ICU? Anaesth Crit Care Pain Med 2021; 40:100977. [PMID: 34748941 DOI: 10.1016/j.accpm.2021.100977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hannah Victoria Reynolds
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gary Von Dohren
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, ANZAC Avenue, Redcliffe, QLD 4020, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Brisbane, Queensland, Australia..
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12
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Religious Perspectives on Death by Neurological Criteria: The Role of the Hospital Chaplain. Neurocrit Care 2021; 35:301-303. [PMID: 34195897 DOI: 10.1007/s12028-021-01251-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 04/08/2021] [Indexed: 02/05/2023]
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13
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Padilla Fortunatti C, De Santis JP, Munro CL. Family Satisfaction in the Adult Intensive Care Unit: A Concept Analysis. ANS Adv Nurs Sci 2021; 44:291-305. [PMID: 33624988 DOI: 10.1097/ans.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Admission of patients to an intensive care unit is often a stressful event for family members. In the context of patient- and family-centered care, family satisfaction is recognized as a quality indicator of intensive care unit care. However, family satisfaction has not been consistently used or conceptualized in the literature. A modified version of Walker and Avant's method for concept analysis was utilized to examine the concept of family satisfaction in the adult intensive care unit. Antecedents, attributes, consequences, and empirical referents of family satisfaction are presented and implications for practice, research, and policy.
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Affiliation(s)
- Cristobal Padilla Fortunatti
- University of Miami, School of Nursing & Health Studies, Coral Gables, Florida (Ms Padilla Fortunatti and Drs De Santis and Munro); and Department of the Adult and the Senescent, Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile (Ms Padilla Fortunatti)
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14
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Padilla Fortunatti C, Munro CL. Factors associated with family satisfaction in the adult intensive care unit: A literature review. Aust Crit Care 2021; 35:604-611. [PMID: 34535370 DOI: 10.1016/j.aucc.2021.07.006] [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: 04/12/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients. REVIEW METHODS/DATA SOURCES A search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related. RESULTS The search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member-related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies. CONCLUSIONS A broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.
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Affiliation(s)
- Cristóbal Padilla Fortunatti
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA; Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile.
| | - Cindy L Munro
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA
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15
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Khan S, Digby R, Giordano NA, Hade S, Bucknall TK. A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit. Aust Crit Care 2021; 35:264-272. [PMID: 34384649 DOI: 10.1016/j.aucc.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically. OBJECTIVE The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU). METHODS A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100). RESULTS In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff. CONCLUSION Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
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Affiliation(s)
- Shahrukh Khan
- School of Nursing&Midwifery, Deakin University, Geelong, Australia
| | - Robin Digby
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Nicholas A Giordano
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Sharon Hade
- Nursing Services, Alfred Health, Melbourne, Australia; Intensive Care Unit, Alfred Health, Australia
| | - Tracey K Bucknall
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia.
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16
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Rae PJL, Pearce S, Greaves PJ, Dall'Ora C, Griffiths P, Endacott R. Outcomes sensitive to critical care nurse staffing levels: A systematic review. Intensive Crit Care Nurs 2021; 67:103110. [PMID: 34247936 DOI: 10.1016/j.iccn.2021.103110] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/29/2021] [Accepted: 06/04/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes. METHODS We published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented. RESULTS Our search returned 7960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24-3.50 times greater) and nosocomial infection (3.28-3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured. CONCLUSIONS A large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.
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Affiliation(s)
- Pamela J L Rae
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK. https://twitter.com/@DrPamelaJLRae
| | - Susie Pearce
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK. https://twitter.com/@susiempearce
| | - P Jane Greaves
- School of Health and Life Sciences, University of Northumbria, Newcastle Upon Tyne, UK. https://twitter.com/@JaneGreaves4
| | - Chiara Dall'Ora
- School of Health Sciences, University of Southampton, UK. https://twitter.com/@ora_dall
| | - Peter Griffiths
- School of Health Sciences, University of Southampton, UK. https://twitter.com/@workforcesoton
| | - Ruth Endacott
- School of Nursing & Midwifery, University of Plymouth, Plymouth PL4 8AA, UK; Royal Devon and Exeter Hospital, University of Plymouth Clinical School, Royal Devon and Exeter Hospital, Barrack Road Exeter EX2 5DW, UK; School of Nursing & Midwifery, Monash University, Melbourne, Vic 3199, Australia. https://twitter.com/@rdepu
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17
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Brandao Barreto B, Luz M, do Amaral Lopes SAV, Rosa RG, Gusmao-Flores D. Exploring family members' and health care professionals' perceptions on ICU diaries: a systematic review and qualitative data synthesis. Intensive Care Med 2021; 47:737-749. [PMID: 34117901 DOI: 10.1007/s00134-021-06443-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/22/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although the intensive care unit (ICU) diary has been proposed as a tool for preventing psychiatric symptoms in survivors of critical illness, relatives and health care providers may benefit from it too. This study aims to summarize the current qualitative evidence on families' and health care professionals' experiences of writing in and reading the ICU diaries. METHODS We searched MEDLINE, OVID, Embase, and EBSCOhost from inception to February 2021, and included all the studies that presented any qualitative finding regarding relatives' and health care providers' experiences of writing in and reading an ICU diary. We used modified Critical Appraisal Skills Programme (CASP) and Confidence in the Evidence from Reviews of Qualitative Research (CERQual) for quality assessment. A thematic synthesis approach was used to analyze and synthesize the qualitative data. RESULTS Twenty-eight studies were analyzed (15 including family members and 13 including health care professionals). For family members, the ICU diary is an important source of medical information, provides a way for them to register their presence at patient's bedside and express their feelings, and contributes to humanizing the ICU staff. This impression is shared by relatives of patients who did not survive critical illness. Health care providers believe the diary is beneficial for themselves and others; however, they are concerned with possible negative impressions from patients and family that could lead to judicial problems. They also remark on several obstacles they face when constructing the diaries (workload, creativity, and environment for writing), which can make it a distressful process. CONCLUSION This qualitative synthesis shows that family members and health care professionals consider the ICU diary a valuable intervention. It also brings evidence to challenges faced during diary writing, which should be carefully approached in order to reduce the stress associated with this process.
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Affiliation(s)
- Bruna Brandao Barreto
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil. .,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Mariana Luz
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Selma Alves Valente do Amaral Lopes
- Department of Paediatrics, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Neonatal Intensive Care Unit, Hospital Martagão Gesteira, Salvador, Bahia, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Dimitri Gusmao-Flores
- Intensive Care Unit of the Hospital da Mulher, Rua Barão de Cotegipe, 1153, Roma, Salvador, BA, 40411-900, Brazil.,Departamento de Medicina Interna E Apoio Diagnóstico, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Programa de Pós Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.,Intensive Care Unit, Hospital da Cidade, Salvador, Bahia, Brazil
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18
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Aghaie B, Anoosheh M, Foroughan M, Mohammadi E, Kazemnejad A. A Whirlpool of Stress in Families of Intensive Care Unit Patients: A Qualitative Multicenter Study. Crit Care Nurse 2021; 41:55-64. [PMID: 34061191 DOI: 10.4037/ccn2021322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of patients admitted to the intensive care unit must tolerate high levels of stress, making them emotionally and physically vulnerable. However, little is known about the kinds of stress family members may experience. OBJECTIVE To explore perceived stress in the families of patients admitted to the intensive care unit. METHODS This qualitative content analysis study involved 23 family members of patients admitted to intensive care units. Participants were drawn from family members of patients hospitalized in intensive care units of 3 public and 2 private hospitals. Data were collected through semistructured interviews. RESULTS Three themes emerged from the data: "distrust," "repeated stress exposure," and "a whirlpool of persistent negative emotional-physical state." The first theme had 2 categories: "fearful mindset" and "negative beliefs about professional caregivers." The second theme also had 2 categories: "fear of the future" and "sustained accumulation of tensions." The third theme had 3 categories: "impaired mental health," "impaired physical health," and "impaired family function." CONCLUSIONS The findings of this study may help critical care nurses better understand the nature and sources of family stresses during a patient's intensive care unit stay. Supervisory nurses should alert their staff to these issues so that family care programs can address them, thereby reducing family members' risk of posttraumatic stress disorder and post-intensive care syndrome-family.
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Affiliation(s)
- Bahman Aghaie
- Bahman Aghaie is an assistant professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
| | - Monireh Anoosheh
- Monireh Anoosheh is an associate professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahshid Foroughan
- Mahshid Foroughan is an associate professor, Research Center on Aging, Department of Gerontology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Esa Mohammadi
- Esa Mohammadi is a professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University
| | - Anoshirvan Kazemnejad
- Anoshirvan Kazemnejad is a professor, Department of Biostatistics, Faculty of Medicine, Tarbiat Modares University
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19
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Burlakov N, Rozani V, Bluvstein I, Kagan I. The Association Between Quality and Safety Climate of a Hospital Ward, Family Members' Empowerment, and Satisfaction With Provided Care. J Nurs Scholarsh 2021; 53:727-736. [PMID: 34048128 DOI: 10.1111/jnu.12682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization. DESIGN A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW. METHODS Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data. FINDINGS The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses' estimate. The significant predictors for family members' satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001). CONCLUSIONS Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients' hospitalization. CLINICAL RELEVANCE Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients' family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.
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Affiliation(s)
- Nataly Burlakov
- Senior Nurse, Intensive Care Unit, Bnei Zion Medical Center, Haifa, Israel
| | - Violetta Rozani
- Lecture, Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bluvstein
- Teacher, Department of Nursing, The Stanley Steyer School of Health Professions; School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Senior Lecturer, Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Eltaybani S, Ahmed FR. Family satisfaction in Egyptian adult intensive care units: A mixed-method study. Intensive Crit Care Nurs 2021; 66:103060. [PMID: 33875339 DOI: 10.1016/j.iccn.2021.103060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine family members' satisfaction in adult intensive care units. METHODOLOGY This is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion. SETTINGS Six adult intensive care units in university hospitals in Egypt. MAIN OUTCOME MEASURES Family satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews. RESULTS The mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members' satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (-2.41 [-3.23 to -1.59]), low economic status (-1.57 [-2.47 to -0.67]), and perceiving patient condition to be deteriorating (-0.99 [-1.93 to -0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment. CONCLUSIONS In Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-term Care Nursing, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo 113-0033, Japan; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt. https://twitter.com/@Sameh_Eltaybani
| | - Fatma Refaat Ahmed
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt; Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
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21
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Weber U, Zhang Q, Ou D, Garritano J, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Vranceanu AM, Rosand J, Hwang DY. Predictors of Family Dissatisfaction with Support During Neurocritical Care Shared Decision-Making. Neurocrit Care 2021; 35:714-722. [PMID: 33821402 PMCID: PMC8021441 DOI: 10.1007/s12028-021-01211-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a critical need to improve support for families making difficult shared decisions about patient care with clinicians in the neuroscience ICU (neuro-ICU). The aim of this study is to identify patient- and family-related factors associated with dissatisfaction with shared decision-making support among families of neuro-critically ill patients. METHODS We conducted a retrospective observational cohort study using survey data that had been collected from a consecutive sample of family members of patients in the neuro-ICU (one family member per patient) at two US academic centers. Satisfaction with shared decision-making support on ICU discharge had been measured among family members using one specific Likert scale item on the Family Satisfaction in the ICU 24 survey, a validated survey instrument for families of patients in the ICU. We dichotomized top-box responses for this particular item as an outcome variable and identified available patient- and family-related covariates associated with dissatisfaction (i.e., less than complete satisfaction) via univariate and multivariate analyses. RESULTS Among 355 surveys, 180 (49.5%) of the surveys indicated dissatisfaction with support during decision-making. In a multivariate model, no preexisting characteristics of families or patients ascertainable on ICU admission were predictive of dissatisfaction. However, among family factors determined during the ICU course, experiencing three or fewer formal family meetings (odds ratio 1.93 [confidence interval 1.13-3.31]; p = 0.01) was significantly predictive of dissatisfaction with decisional support in this cohort with an average patient length of stay of 8.6 days (SD 8.4). There was also a trend toward a family's decision to keep a patient as full code, without treatment limitations, being predictive of dissatisfaction (odds ratio 1.80 [confidence interval 0.93-3.51]; p = 0.08). CONCLUSIONS Family dissatisfaction with neuro-ICU shared decision-making support is not necessarily predicted by any preexisting family or patient variables but appears to correlate with participating in fewer formal family meetings during ICU admission. Future studies to improve family satisfaction with neurocritical care decision-making support should have broad inclusion criteria for participants and should consider promoting frequency of family meetings as a core strategy.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, Yale University, New Haven, CT, USA.,Yale New Haven Hospital, New Haven, CT, USA
| | - Qiang Zhang
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Derek Ou
- Donald and Barbara Zucker School of Medicine At Hofstra/Northwell, Long Island, NY, USA
| | - James Garritano
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | | | - Andrea K Knies
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Belinda Nhundu
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Cynthia Bautista
- School of Nursing and Health Studies, Fairfield University, Fairfield, CT, USA
| | - Kevin B Huang
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ana-Maria Vranceanu
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA.,Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Rosand
- Harvard Medical School, Harvard University, Boston, MA, USA.,Division of Neurocritical Care and the Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - David Y Hwang
- Yale New Haven Hospital, New Haven, CT, USA. .,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA. .,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, USA.
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22
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Haave RO, Bakke HH, Schröder A. Family satisfaction in the intensive care unit, a cross-sectional study from Norway. BMC Emerg Med 2021; 21:20. [PMID: 33588760 PMCID: PMC7885442 DOI: 10.1186/s12873-021-00412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. METHOD The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. RESULTS The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.
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Affiliation(s)
- Randi Olsson Haave
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Agneta Schröder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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23
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Feder S, Schulman-Green D, Akgün KM. Palliative Care During a Pandemic. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Analyzing clinical and system drivers of satisfaction in the intensive care unit as a component of high quality care. Heart Lung 2020; 50:277-283. [PMID: 33383546 DOI: 10.1016/j.hrtlng.2020.12.015] [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: 05/11/2020] [Revised: 12/06/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Quality improvement in the intensive care unit has transitioned from focusing on mortality to improving care and reducing morbidity. OBJECTIVE This study prospectively investigated clinical and system drivers of family satisfaction in a large quaternary hospital ICU. METHODS A validated tool was distributed to family members and a registry chart analysis was conducted. The aims were to assess associations with high or low family satisfaction to evaluate unit-level satisfaction. Candidate predictors were selected from univariate logistic regressions and finalized in a multivariate model by a stepwise selection approach. RESULTS Overall, 75% (n = 188) of respondents (n = 250) indicated high satisfaction. Respondents with higher satisfaction had a Plan of the Day posted (OR = 3.3, 95% CI: 1.63, 6.89, p = 0.001), and did not live with the patient (OR =0.5, 95% CI: 0.25, 0.96, p = 0.044). CONCLUSION This study indicates that communication and transparency of plans contributes to family satisfaction with ICU care.
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25
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Liang Y, Li J, Pan W. Family satisfaction in the intensive care unit: The influence of disease severity, care relationship, patient anxiety and patient pain. Intensive Crit Care Nurs 2020; 63:102995. [PMID: 33349481 DOI: 10.1016/j.iccn.2020.102995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/15/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is little empirical evidence that can be used to identify factors associated with family satisfaction in the context of the intensive care unit, especially from the perspectives of the patient and patient-family member interactions. OBJECTIVES To explore the influence of disease severity, care relationship, anxiety, and pain of patients on family satisfaction in the intensive care unit. STUDY DESIGN A cross-sectional descriptive and exploratory study was conducted in the Surgical unit in the Zhongshan Hospital Fudan University, Shanghai, China. METHODS A total of 227 patients and their family member dyads were included and surveyed. The dependent variable family satisfaction was measured by the Chinese version of the critical care family satisfaction survey. The independent variables included patient characteristics, care relationship, disease severity, patient anxiety, and patient pain. Disease severity was assessed by The Acute Physiology and Chronic Health Evaluation II. Patient anxiety was measured using the Self-Rating Anxiety Scale. Patient pain was measured with Numeric rating scale. RESULTS Patients with higher self-rating anxiety scores (OR 0.92, 95% CI 0.87-0.97) were less likely to have higher family satisfaction for their family member dyad. However, those with mild perceived pain (OR 5.21, 95% CI 1.97-13.80) were more likely to have higher family satisfaction for their family member dyad. Disease severity and care relationship showed no significant associations with family satisfaction. CONCLUSIONS Future interventions may include open communication with family members giving explanations regarding the physical and psychological condition of the patient, care delivered and interventions received.
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Affiliation(s)
- Yan Liang
- School of Nursing, Fudan University, China
| | | | - Wenyan Pan
- Zhongshan Hospital, Fudan University, China.
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26
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Hartfiel N, Sadera G, Treadway V, Lawrence C, Tudor Edwards R. A clinical librarian in a hospital critical care unit may generate a positive return on investment. Health Info Libr J 2020; 38:97-112. [PMID: 33196136 DOI: 10.1111/hir.12332] [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: 01/20/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Timely information provided by clinical librarians can contribute to outcomes such as improved patient care and time savings for hospital staff. What is unknown is the return on investment (ROI) of a clinical librarian on a critical care unit. OBJECTIVE The aim of this study was to assess the ROI, from the employer perspective, of placing a clinical librarian in a critical care unit in a large UK acute hospital. METHODS Using a mixed methods approach, ROI was estimated by comparing the total costs with the total monetised benefits of implementing the clinical librarian intervention. Total costs included salary and equipment costs. Total monetised benefits included time saving for hospital staff, support for professional development and improved patient care. RESULTS When total monetised benefits were compared with total costs, the 15-month clinical librarian intervention generated a positive ROI of £1.18-£3.03 for every £1 invested. DISCUSSION Using outcome measures derived from previous research, this novel study generated promising results indicative for commissioners seeking to improve patient care and deliver value for money. To improve generalisability, multisite studies using standardised ROI tools are recommended. CONCLUSION Employing a clinical librarian in a critical care unit can generate a positive ROI.
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Affiliation(s)
- Ned Hartfiel
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Girendra Sadera
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Victoria Treadway
- Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
| | - Catherine Lawrence
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
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McLennan M, Aggar C. Family satisfaction with care in the intensive care unit: A regional Australian perspective. Aust Crit Care 2020; 33:518-525. [DOI: 10.1016/j.aucc.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE Investigate clinical and system drivers of family satisfaction in the PICU. DESIGN Mixed methods qualitative and quantitative (observational) study. Qualitative interviews with families were performed as a pilot to inform modality of survey distribution based on family preferences. A validated pediatric satisfaction survey deployed to family members for 7 months with a corresponding chart review and administrative data collection. SETTING PICU in a tertiary children's hospital. PATIENTS Two hundred six families of patients admitted to the PICU more than 48 hours. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Families preferred surveys distributed electronically on a tablet in the PICU setting. The Pediatric Family Satisfaction-ICU survey was used to assess comfort with medical decision-making and communication with the care team. Capture rate of all eligible patients was 69.5% and response rate was 90.8%. Overall, 64.7% of respondents were highly satisfied, whereas over one third were not highly satisfied; families of Hispanic ethnicity (odds ratio of lower satisfaction of families with Hispanic ethnicity: 2.09; 95% CI, 1.01-4.33; p = 0.047) and high social stressors (odds ratio of higher satisfaction among high stressed subgroup: 0.49; 95% CI, 0.24-0.99; p = 0.047) reported statistically significant lower satisfaction. Additional free-text responses were identified in 21% of respondents, with the majority of comments indicating wishes for improvements clustered around communication with the medical team or sleeping environment of families and patients. CONCLUSIONS High capture rates of family satisfaction in the PICU can be obtained with a PICU-specific survey, limiting barriers to completion by including family preferences, and distributing in the PICU setting. Less than two-third of PICU families are highly satisfied; patients of Hispanic ethnicity and those with high social stressors predict low satisfaction, whereas illness severity, age, and PICU length of stay did not have statistical significance. Local improvement teams can use this approach to drive enhanced satisfaction.
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A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention. Pediatr Crit Care Med 2020; 21:e617-e627. [PMID: 32639470 DOI: 10.1097/pcc.0000000000002378] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. DESIGN Patient-level, randomized trial. SETTING Two university-based, tertiary-care children's hospital PICUs. PARTICIPANTS Parents of patients requiring more than 24 hours in the PICU. INTERVENTIONS PICU Supports included adding a trained navigator to the patient's healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. MEASUREMENTS AND MAIN RESULTS The primary outcome was percentage of "excellent" responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3-5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3-5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; SE, 4.53; 95% CI, -5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as "extremely" or "somewhat" helpful. CONCLUSIONS Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
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30
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Nguyen ATB, Nguyen NTK, Phan PH, van Eeuwijk P, Fink G. Parental satisfaction with quality of neonatal care in different level hospitals: evidence from Vietnam. BMC Health Serv Res 2020; 20:238. [PMID: 32192485 PMCID: PMC7082960 DOI: 10.1186/s12913-020-5070-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Most health systems provide the most specialized, and presumably also the highest quality of care at a central level. This study assessed parental satisfaction and its determinants in the context of neonatal care in a provincial as well as a national hospital of Vietnam. Methods In this cross-sectional quantitative study, parents of 340 preterm infants admitted to neonatal care units of a national and a provincial hospital in 2018 were interviewed using structured questionnaires. Unadjusted and adjusted linear regression models were used to assess the relationship between parental satisfaction and hospital rank. Results The mean parental satisfaction score was 3.74 at the provincial, and 3.56 at the national hospital. These satisfaction differences persisted when parent and child characteristics were adjusted for in multivariate analysis. Longer length of stay and worsening infant health status were associated with parents reporting lower levels of satisfaction with the quality of care being provided at the healthcare facility. Conclusions This study suggests that parents of preterm infants admitted in a provincial hospital were more satisfied with the quality of care received than those in a specialized national hospital. Length of stay and infant health status were the two most important determinants of level of parental satisfaction.
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Affiliation(s)
- An Thi Binh Nguyen
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | | | - Phuc Huu Phan
- Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Peter van Eeuwijk
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Institute of Social Anthropology, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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31
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Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, Pothirat C, Liwsrisakun C, Bumroongkit C, Deesomchok A, Theerakittikul T, Limsukon A. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020; 24:946-954. [PMID: 33281320 PMCID: PMC7689133 DOI: 10.5005/jp-journals-10071-23559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To examine reliability and validity of a Thai version of the Family Satisfaction with Intensive Care Unit (FS-ICU 24) questionnaire and use this survey in intensive care units (ICUs) in Thailand. Materials and methods The standard English FS-ICU questionnaire was translated into the Thai language using translation and culture adaptation guidelines. After reliability and validity testing, we consecutively surveyed the satisfaction of family members of ICU patients over 1 year. Adult family members of patients admitted to medical or surgical ICUs for 48 hours or more who had visited the patients at least once during the ICU stay were included. Results In all, 315 (95%) of 332 surveys were returned from family members. Cronbach's α of the Thai FS-ICU 24 questionnaire was 0.95. Factor analysis demonstrated good construct validity. The mean (±SD) of total satisfaction score, overall ICU care subscale, and decision-making subscale were 81.5 ± 14.3, 81.0 ± 15.6, and 82.0 ± 14.0. Items with the lowest scores were the waiting room atmosphere and the frequency of doctors communicating with family members about the patient's condition. The mean total satisfaction score tended to be higher in family members of survivors than in family members of nonsurvivors (81.9 ± 13.8 vs 77.7 ± 16.2, p value = 0.059). The overall satisfaction scores between medial ICU and surgical ICU were not significantly different. Conclusion The Thai version of FS-ICU questionnaire was found to have acceptable reliability and validity in a Thai population and can be used to drive improvements in ICU care. Trial registration www.clinicaltrials.in.th, TCR20160603002 How to cite this article Tajarernmuang P, Chittawatanarat K, Dodek P, Heyland DK, Chanayat P, Inchai J, et al. Validity and Reliability of a Thai Version of Family Satisfaction with Care in the Intensive Care Unit Survey. Indian J Crit Care Med 2020;24(10):946–954.
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Affiliation(s)
| | | | - Peter Dodek
- Center for Health Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Queen's University; Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Panida Chanayat
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juthamas Inchai
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | | | | | - Atikun Limsukon
- Department of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Teague P, Kraeuter S, York S, Scott W, Furqan MM, Zakaria S. The Role of the Chaplain as a Patient Navigator and Advocate for Patients in the Intensive Care Unit: One Academic Medical Center's Experience. JOURNAL OF RELIGION AND HEALTH 2019; 58:1833-1846. [PMID: 31230162 PMCID: PMC6759628 DOI: 10.1007/s10943-019-00865-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Effective communication between intensive care unit (ICU) staff, and patients and their families, can help increase understanding, trust, and goals-of-care decisions. Many strategies focus on enhancing communication by increasing family meetings or adding patient navigators. In our ICU, we implemented both strategies, uniquely appointing a chaplain for the patient navigator role. We then surveyed ICU staff on their perceptions of the chaplain/patient navigator, which yielded several valuable insights. Although all staff supported a strong chaplaincy presence, many had concerns about the dual chaplain/patient navigator role. Based on our mixed results, we encourage further exploration to optimize the chaplain role in the ICU.
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Affiliation(s)
- Paula Teague
- Department of Spiritual Care and Chaplaincy, Johns Hopkins University, Baltimore, MD, USA.
- Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA.
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Susan Kraeuter
- Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Sarah York
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Wayman Scott
- Department of Pastoral Counseling, Loyola University Maryland, Baltimore, MD, USA
| | - Muhammad M Furqan
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sammy Zakaria
- Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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33
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Weber U, Johnson J, Anderson N, Knies AK, Nhundu B, Bautista C, Huang KB, Hamza M, White J, Coppola A, Akgün KM, Greer DM, Marcolini EG, Gilmore EJ, Petersen NH, Timario N, Poskus K, Sheth KN, Hwang DY. Dedicated Afternoon Rounds for ICU Patients' Families and Family Satisfaction With Care. Crit Care Med 2019; 46:602-611. [PMID: 29300237 DOI: 10.1097/ccm.0000000000002963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE It was hypothesized that adding dedicated afternoon rounds for patients' families to supplement standard family support would improve overall family satisfaction with care in a neuroscience ICU. DESIGN Pre- and postimplementation (pre-I and post-I) design. SETTING Single academic neuroscience ICU. PATIENTS Patients in the neuroscience ICU admitted for longer than 72 hours or made comfort measures only at any point during neuroscience ICU admission. INTERVENTION The on-service attending intensivist and a neuroscience ICU nursing leader made bedside visits to families to address concerns during regularly scheduled, advertised times two afternoons each week. MEASUREMENTS AND MAIN RESULTS One family member per patient during the pre-I and post-I periods was recruited to complete the Family Satisfaction in the ICU 24 instrument. Post-I respondents indicated whether they had participated in the afternoon rounds. For primary outcome, the mean pre-I and post-I composite Family Satisfaction in the ICU 24 scores (on a 100-point scale) were compared. A total of 146 pre-I (March 2013 to October 2014; capture rate, 51.6%) and 141 post-I surveys (October 2014 to December 2015; 47.2%) were collected. There was no difference in mean Family Satisfaction in the ICU 24 score between groups (pre-I, 89.2 ± 11.2; post-I, 87.4 ± 14.2; p = 0.6). In a secondary analysis, there was also no difference in mean Family Satisfaction in the ICU 24 score between the pre-I respondents and the 39.0% of post-I respondents who participated in family rounds. The mean Family Satisfaction in the ICU 24 score of the post-I respondents who reported no participation trended lower than the mean pre-I score, with fewer respondents in this group reporting complete satisfaction with emotional support (75% vs. 54%; p = 0.002), coordination of care (82% vs. 68%; p = 0.03), and frequency of communication by physicians (60% vs. 43%; p = 0.03). CONCLUSIONS Dedicated afternoon rounds for families twice a week may not necessarily improve an ICU's overall family satisfaction. Increased dissatisfaction among families who do not or cannot participate is possible.
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Affiliation(s)
- Urs Weber
- Yale School of Medicine, New Haven, CT
| | | | | | | | | | | | | | | | | | | | - Kathleen M Akgün
- Department of Internal Medicine, Pulmonary, Critical Care and Sleep Medicine Section, VA Connecticut Healthcare System and Yale University School of Medicine, West Haven, CT
| | - David M Greer
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Evie G Marcolini
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Emily J Gilmore
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - Nils H Petersen
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | | | | | - Kevin N Sheth
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
| | - David Y Hwang
- Yale-New Haven Hospital, New Haven, CT.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, New Haven, CT
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Ferrando P, Gould DW, Walmsley E, Richards-Belle A, Canter R, Saunders S, Harrison DA, Harvey S, Heyland DK, Hinton L, McColl E, Richardson A, Richardson M, Wright SE, Rowan KM. Family satisfaction with critical care in the UK: a multicentre cohort study. BMJ Open 2019; 9:e028956. [PMID: 31434771 PMCID: PMC6707657 DOI: 10.1136/bmjopen-2019-028956] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. DESIGN Prospective cohort study nested within a national clinical audit database. SETTING Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. PARTICIPANTS Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. INTERVENTIONS Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. MAIN OUTCOME MEASURES Family satisfaction was measured using the FS-ICU-24 questionnaire. MAIN RESULTS A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. CONCLUSIONS Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. TRIAL REGISTRATION NUMBER ISRCTN47363549.
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Affiliation(s)
- Paloma Ferrando
- Intensive Care National Audit and Research Centre, London, UK
| | - Doug W Gould
- Intensive Care National Audit and Research Centre, London, UK
| | - Emma Walmsley
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Ruth Canter
- Intensive Care National Audit and Research Centre, London, UK
| | - Steven Saunders
- Intensive Care National Audit and Research Centre, London, UK
| | | | - Sheila Harvey
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - Lisa Hinton
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elaine McColl
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette Richardson
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Stephen E Wright
- Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
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35
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Maxim T, Alvarez A, Hojberg Y, Antoku D, Moneme C, Singleton A, Park C, Matsushima K. Family satisfaction in the trauma and surgical intensive care unit: another important quality measure. Trauma Surg Acute Care Open 2019; 4:e000302. [PMID: 31467981 PMCID: PMC6699722 DOI: 10.1136/tsaco-2019-000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/01/2019] [Accepted: 07/24/2019] [Indexed: 11/04/2022] Open
Abstract
Background A growing body of research has explored patient satisfaction as one of the healthcare quality measures. To date, scarce data are available regarding family experience in the trauma and surgical intensive care unit (TSICU). The purpose of this study was to describe and analyze the results of a family satisfaction survey in the TSICU. Methods Family members of patients at a level 1 trauma center were invited to participate in this study after 72 hours of intensive care unit stay. Participants completed a modified version of the Family Satisfaction in the Intensive Care Unit questionnaire, a validated survey measuring family satisfaction with care and decision-making. Data collection spanned from April 2016 to July 2017. Patient characteristics were compiled from the medical record. Quantitative analysis was performed using a 5-point Likert score, converted to a scale of 0 (poor) to 100 (excellent). Results The overall response rate was 78.6%. Of the 103 family members for 88 patients, most were young (median age: 41 years) and female (75%). Language fluency was 44.6% English-only, 31.7% Spanish-only, and 23.8% bilingual. Mean summary family satisfaction scores (±SD) were 80.6±26.4 for satisfaction with care, 79.3±27.1 for satisfaction with decision-making, and 80.1±26.7 for total satisfaction. Respondents were less satisfied with the frequency of communication with physicians (70.7±27.4) and language translation (73.2±31.2). Discussion Overall family satisfaction with the care provided to patients in the TSICU is high, although opportunities for improvement were noted in the frequency of communication between physicians and family and language translation services. Further quality improvement projects are warranted. Level of evidence Care management study: level V.
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Affiliation(s)
- Tom Maxim
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Agustin Alvarez
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Yvonne Hojberg
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Derek Antoku
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Chioma Moneme
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Andrew Singleton
- Surgery, University of Southern California, Los Angeles, California, USA
| | - Caroline Park
- Surgery, University of Southern California, Los Angeles, California, USA
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Sviri S, Geva D, vanHeerden PV, Romain M, Rawhi H, Abutbul A, Orenbuch-Harroch E, Bentur N. Implementation of a structured communication tool improves family satisfaction and expectations in the intensive care unit. J Crit Care 2019; 51:6-12. [DOI: 10.1016/j.jcrc.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/12/2019] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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JanardhanIyengar SM, Srinivasan R, Venkateshmurthy BM, Katari Y, Hiremathada S. Family Satisfaction in a Medical College Multidisciplinary Intensive Care Unit (ICU)-How Can We Improve? Indian J Crit Care Med 2019; 23:83-88. [PMID: 31086452 PMCID: PMC6487606 DOI: 10.5005/jp-journals-10071-23122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims In recent years, patient and family-centered implications are being recognized as important outcome measures and one of the quality indicators of health care system worldwide. Most of the Intensive Care Unit patients cannot make decisions themselves, accordingly family members are surrogate decision-makers and judges of care quality. This study was conducted as a prospective observational study using Family Satisfaction-Intensive Care Unit questionnaire to ascertain the level of family satisfaction of care and their involvement in the decision making process of their patient's treatment. Materials and methods The study was conducted over 3 months with 100 family members by FS-ICU questionnaire survey method. After 48 hours of ICU admission, the questionnaire was administered to an eligible family member by a resident who was not involved in the treatment of the patient, in a language understood by them (English/Kannada). Each question was scored using 5 point Likert response Scale and the scores were transformed into 0 (least satisfied) to100 (most satisfied) scale. Results Satisfaction with overall care was 65.31±23.62 (FS-ICU/Care). Satisfaction with decision making process was 73.06±22.154 (FS-ICU/ DM). Individual factors which contributed to lower scores were management of pain and agitation of the patient, waiting room atmosphere and emotional support. Conclusion This study identified the individual factors which contributed to the high and low satisfaction scores. With this baseline data as reference, there is scope to enhance the aspects of quality care for patients and their family members. How to cite this article JanardhanIyengar SM, Srinivasan R et al. Family Satisfaction in a Medical College Multidisciplinary Intensive Care Unit (ICU)-How Can We Improve? Indian J of Crit Care Med 2019;23(2):83-88.
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Affiliation(s)
| | - Rangalakshmi Srinivasan
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | | | - Yeshaswini Katari
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Sahajananda Hiremathada
- Department of Anesthesiology and Critical Care, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
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Jerng JS, Huang SF, Yu HY, Chan YC, Liang HJ, Liang HW, Sun JS. Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan. Crit Care 2018; 22:335. [PMID: 30522508 PMCID: PMC6282256 DOI: 10.1186/s13054-018-2271-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings. Methods From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool. Results We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints. Conclusions A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families. Electronic supplementary material The online version of this article (10.1186/s13054-018-2271-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yu Yu
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Ju Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, 100, Taiwan.
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Ågård AS, Hofhuis JGM, Koopmans M, Gerritsen RT, Spronk PE, Engelberg RA, Randall Curtis J, Zijlstra JG, Jensen HI. Identifying improvement opportunities for patient- and family-centered care in the ICU: Using qualitative methods to understand family perspectives. J Crit Care 2018; 49:33-37. [PMID: 30359923 DOI: 10.1016/j.jcrc.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE The purposes of the study were to provide richer context for families' quantitative assessments of the quality of ICU care, and to describe further quality areas of importance for family members. MATERIALS AND METHODS Free-text comments from 1077 family members of 920 patients focusing on family evaluation of ICU quality of care were analyzed using content analysis. Twenty-one Danish and Dutch ICUs participated from October 2014 to June 2015. RESULTS Four themes emerged as important to families: information, clinician skills, ICU environment, and discharge from the ICU. Families highlighted the importance of receiving information that was accessible, understandable and honest. They indicated that quality care was ensured by having clinicians who were both technically and interpersonally competent. The ICU environment and the circumstances of the transfer out of the ICU were described as contributing to quality of care. The comments identified room for improvement within all themes. CONCLUSIONS The study highlights the importance of including both technical and emotional care for patients and families and the consequent need to focus on clinicians' mastery of interpersonal skills.
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Affiliation(s)
- Anne Sophie Ågård
- Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Århus N, Denmark; Department of Science in Nursing, Institute of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - José G M Hofhuis
- Department of Intensive Care Medicine Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands.
| | - Matty Koopmans
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands.
| | - Rik T Gerritsen
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR Leeuwarden, the Netherlands.
| | - Peter E Spronk
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA.
| | - J Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA.
| | - Jan G Zijlstra
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B.Winsløwsvej 19, 5000 Odense, Denmark.
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Padilla Fortunatti C, Rojas Silva N. Families on adult intensive care units: Are they really satisfied? A literature review. Aust Crit Care 2018; 31:318-324. [DOI: 10.1016/j.aucc.2017.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/05/2017] [Accepted: 08/15/2017] [Indexed: 10/19/2022] Open
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Min J, Kim Y, Lee JK, Lee H, Lee J, Kim KS, Cho YJ, Jo YH, Ryu HG, Kim K, Lee SM, Lee YJ. Survey of family satisfaction with intensive care units: A prospective multicenter study. Medicine (Baltimore) 2018; 97:e11809. [PMID: 30095649 PMCID: PMC6133602 DOI: 10.1097/md.0000000000011809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Although family satisfaction is an important indicator for quality improvement of intensive care units (ICUs), few studies have translated family satisfaction data into quality improvement in Asia. A prospective multicenter study was conducted to evaluate family satisfaction regarding the care of patients and their family.The family satisfaction in the ICU (FS-ICU) questionnaire was administered from January 2015 to February 2016 at ICUs of 3 tertiary teaching hospitals in South Korea. Family members of adult patients, staying at an ICU for ≥48 hours, were included. Key factors affecting satisfaction were identified using quantitative and qualitative analyses.In total, 200 family members participated in this survey. The mean score for overall family satisfaction (FS-ICU/total) was 75.4 ± 17.7. The mean score for satisfaction with information/decision-making was greater than that for satisfaction with care (78.2 ± 18.2 vs 73.5 ± 19.4; P ≤ .001). Family members who agreed to not resuscitate and whose patient died at the ICU had lower FS-ICU/total scores. When compared with hospital A, hospital C was an independent predictor with an FS-ICU/total score of <75. Families reported the least satisfaction for the atmosphere of the ICU, including the waiting room atmosphere and management of agitation.We evaluated family satisfaction regarding ICUs for the first time in Asia using a validated tool. The decision to not resuscitate, ICU mortality, and ICU culture were associated with family satisfaction with critical care. Efforts should be targeted for improving factors that cause low family satisfaction when planning quality improvement interventions for ICUs in Asia.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | | | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
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Abstract
Hospitalization of a child is a stressful experience, increasing parents' anxiety and deteriorating their satisfaction with the health-care services. This study aimed to assess the level of stress that parents of hospitalized children experienced and evaluate the association of parent's stress and satisfaction and identify its predictors. Three hundred and fifty-two parents whose children were hospitalized in two pediatric hospitals were enrolled in the study, from February 2015 to April 2015. The Perceived Stress Scale was used to estimate parental stress and the Pyramid Questionnaire was used for assessing parents' overall satisfaction with care. Parents expressed mild to moderate overall levels of stress. Less-stressed parents felt more satisfied. Being single ( p < .001), having lower educational level ( p = .005), one's child been hospitalized for more than 14 days ( p = .001), and one's have visited the hospital many times in the past ( p = .014) were the predictors of experiencing high levels of stress. During pediatric hospitalization, parental needs (communication, interpersonal health care, continuous information, involvement in child's care) should be considered, so as stress levels to be decreased and parents get more satisfied by the quality of health care provided.
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Affiliation(s)
- Spyridoula Tsironi
- 1 Pediatric Hospital 'Aghia Sophia', Neonatal Intensive Care Unit, Athens, Greece
| | - George Koulierakis
- 2 Department of Sociology, National School of Public Health, Athens, Greece
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Neves JDL, Schwartz E, Guanilo MEE, Amestoy SC, Mendieta MDC, Lise F. AVALIAÇÃO DA SATISFAÇÃO DE FAMILIARES DE PACIENTES ATENDIDOS EM UNIDADES DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-070720180001800016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RESUMO Objetivo: analisar a produção científica relacionada às evidências acerca da satisfação de familiares de pacientes de UTI e os instrumentos utilizados para sua avaliação. Metodo: revisão integrativa na qual foram analisados artigos publicados entre 2005 e 2015, em inglês, português ou espanhol, nas bases de dados PUBMED/MEDLINE e LILACS e a biblioteca SciELO. Utilizou-se como estratégia de busca: personal satisfactional OR satisfaction AND family. Para coleta de dados dos artigos elaborou-se um instrumento com informações como: título, autores, ano de publicação e revista, objetivo do estudo, delineamento, participantes, local da pesquisa, temática principal e resultados. Resultados: atenderam aos critérios de inclusão 27 produções. Foram identificados quatro instrumentos utilizados para avaliar a satisfação de familiares de pacientes na UTI o Critical Care Family Satisfaction Survey, Family Satisfaction in the Intensive Care Unit, Critical Care Family Needs Inventory e o Quality of Dying and Death. Os estudos abordaram a satisfação dos familiares em relação às suas necessidades e tomadas de decisão, satisfação quanto a cuidados paliativos, evidenciou-se, ainda, estudos de adaptação transcultural e validação de instrumentos. Quanto ao nível de evidência, os estudos se concentram nos níveis II a VI. Conclusão: a análise da produção científica sobre a satisfação de familiares de pacientes de UTI permitiu evidenciar que o fator que mais contribui na promoção da satisfação da família foi a qualidade do atendimento.
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Long AC, Kross EK, Curtis JR. Family-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation. Curr Opin Crit Care 2018; 22:613-620. [PMID: 27685849 DOI: 10.1097/mcc.0000000000000360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. RECENT FINDINGS Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life. Novel measures include assessments of decisional conflict, decision regret, therapeutic alliance, and caregiver burden, as well as positive adaptations and resilience. SUMMARY Critical illness places a significant burden on family members. A wide variety of family-centered outcomes are available to guide improvements in care and communication. Future research should focus on developing sensitive and responsive measures that capture key elements of the family member experience during and after critical illness.
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Affiliation(s)
- Ann C Long
- aDivision of Pulmonary and Critical Care Medicine, Harborview Medical Center bCambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Fernández-Castillo A, Vílchez-Lara MJ. [Satisfaction with care received in pediatric emergency services: impact of family interaction and emotional disturbance]. CIENCIA & SAUDE COLETIVA 2018; 23:1033-1044. [PMID: 29694582 DOI: 10.1590/1413-81232018234.28492015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/23/2016] [Indexed: 11/22/2022] Open
Abstract
This study addresses the relationship between two key elements in satisfaction with pediatric emergency services, namely emotional disturbance and family interaction. The main goal is to determine whether family cohesion and adaptability and anger may be associated with differential levels of satisfaction among parents whose children were attended in pediatric emergency units. It is a descriptive study for which a sample of 711 parents whose children were attended in 6 pediatric emergency services was studied. The Spanish version of the State-Trait Anger Expression Inventory-2 (Staxi-2), the Satisfaction with Healthcare Services Scale and the Family Adaptability and Cohesion Evaluation Scale (Faces) were used respectively. Data analysis included a Spearman bivariate correlations analysis, Kruskal Wallis, Mann-Whitney test and path-analysis using a structural equations model. The results support the hypothesis that higher levels of family cohesion and adaptability as well as lower levels of anger are associated with higher levels of satisfaction among parents.
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Affiliation(s)
| | - María J Vílchez-Lara
- Servicio Andaluz de Salud, Hospital Universitario "Virgen de las Nieves", Granada, España
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Clark K, Milner KA, Beck M, Mason V. Measuring Family Satisfaction With Care Delivered in the Intensive Care Unit. Crit Care Nurse 2018; 36:e8-e14. [PMID: 27908955 DOI: 10.4037/ccn2016276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. OBJECTIVE To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. METHOD A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. RESULTS Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. CONCLUSION Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives.
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Affiliation(s)
- Kathleen Clark
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Kerry A Milner
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts. .,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing. .,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing. .,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts.
| | - Marlene Beck
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Virginia Mason
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
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Frivold G, Slettebø Å, Heyland DK, Dale B. Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study. Nurs Open 2017; 5:6-14. [PMID: 29344389 PMCID: PMC5762765 DOI: 10.1002/nop2.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death. Design A cross‐sectional survey study was conducted. Methods Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis. Results A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.
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Affiliation(s)
- Gro Frivold
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Åshild Slettebø
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Daren K Heyland
- Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada.,The Canadian Researchers at the End of Life Network Kingston ON Canada.,Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
| | - Bjørg Dale
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway.,Centre for Caring Research Southern Norway Grimstad Norway
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Jensen HI, Gerritsen RT, Koopmans M, Downey L, Engelberg RA, Curtis JR, Spronk PE, Zijlstra JG, Ørding H. Satisfaction with quality of ICU care for patients and families: the euroQ2 project. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:239. [PMID: 28882192 PMCID: PMC5590143 DOI: 10.1186/s13054-017-1826-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/24/2017] [Indexed: 08/26/2023]
Abstract
Background Families’ perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the “Family Satisfaction in the ICU” (euroFS-ICU). The aim of the study was to examine assessments of satisfaction with care in a large cohort of Danish and Dutch family members and to examine the measurement characteristics of the euroFS-ICU. Methods Data were from 11 Danish and 10 Dutch ICUs and included family members of patients admitted to the ICU for 48 hours or more. Surveys were mailed 3 weeks after patient discharge from the ICU. Selected patient characteristics were retrieved from hospital records. Results A total of 1077 family members of 920 ICU patients participated. The response rate among family members who were approached was 72%. “Excellent” or “Very good” ratings on all items ranged from 58% to 96%. Items with the highest ratings were concern toward patients, ICU atmosphere, opportunities to be present at the bedside, and ease of getting information. Items with room for improvement were management of patient agitation, emotional support of the family, consistency of information, and inclusion in and support during decision-making processes. Exploratory factor analysis suggested four underlying factors, but confirmatory factor analysis failed to yield a multi-factor model with between-country measurement invariance. A hypothesis that this failure was due to misspecification of causal indicators as reflective indicators was supported by analysis of a factor representing satisfaction with communication, measured with a combination of causal and reflective indicators. Conclusions Most family members were moderately or very satisfied with patient care, family care, information and decision-making, but areas with room for improvement were also identified. Psychometric assessments suggest that composite scores constructed from these items as representations of either overall satisfaction or satisfaction with specific sub-domains do not meet rigorous measurement standards. The euroFS-ICU and other similar instruments may benefit from adding reflective indicators. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1826-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100, Vejle, Denmark. .,Institute of Regional Health Research, University of Southern Denmark, J.B.Winsløwsvej 19, 5000, Odense, Denmark.
| | - Rik T Gerritsen
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands
| | - Matty Koopmans
- Center of Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands
| | - Lois Downey
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - Ruth A Engelberg
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - J Randall Curtis
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, USA
| | - Peter E Spronk
- Department of Intensive Care Medicine Gelre Hospitals Apeldoorn, Apeldoorn, The Netherlands.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G Zijlstra
- University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Helle Ørding
- Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Beriderbakken 4, 7100, Vejle, Denmark
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Oczkowski SJW, Au S, des Ordons AR, Gill M, Potestio ML, Smith O, Sinuff T, Stelfox HT, Fox-Robichaud AE. A modified Delphi process to identify clinical and research priorities in patient and family centred critical care. J Crit Care 2017; 42:243-247. [PMID: 28800520 DOI: 10.1016/j.jcrc.2017.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/14/2017] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify elements which enable patient and family centred care (PFCC) in the intensive care unit (ICU) and priorities for PFCC research. MATERIALS AND METHODS We engaged a panel of multidisciplinary stakeholders in a modified Delphi process. Items generated from a literature review and panelist suggestions were rated in 3 successive rounds on a scale from 1 to 7. Median score was used to rate each item's priority, with 5 or more indicating "essential priority," 4 or 5 "moderate priority" and 3 or less "low priority." Interquartile range (IQR) was used to measure consensus, with IQR of 1 indicating "high" consensus, 2 "moderate" consensus, and 3 or greater "low" consensus. RESULTS Six items were rated essential elements for facilitating PFCC with high consensus (flexible visiting hours, family participation in bedside care, trained family support person, interventions to facilitate continuity of care, staff education to support families, continuity of staff assignments). Three items were rated essential research topics: interventions to facilitate continuity of care following ICU discharge (moderate consensus), family participation in bedside care (low consensus), and decision aids for end of life decision-making (low consensus). CONCLUSIONS Stakeholders identified clear and distinct priorities for PFCC in clinical care and research, though there was greater consensus for clinical care.
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Affiliation(s)
- Simon J W Oczkowski
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada.
| | - Selena Au
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada; Division of Palliative Care, University of Calgary, Calgary, Canada
| | - Marlyn Gill
- PaCER (Patient and Community Engagement Research) Program, University of Calgary, Calgary, Canada
| | - Melissa L Potestio
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Orla Smith
- Critical Care Department, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, Canada.; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Canada; Sunnybrook Research Institute, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Alison E Fox-Robichaud
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada
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Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their Relatives: A Multicenter Prospective Study-The PARVENIR Study. Anesthesiology 2017; 124:1347-59. [PMID: 27035854 DOI: 10.1097/aln.0000000000001124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Noninvasive ventilation (NIV) requires a close "partnership" between a conscious patient and the patient's caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers' willingness to administer NIV and patients' and relatives' anxiety in relation to NIV. METHODS This is a prospective, multicenter questionnaire-based study. RESULTS Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5]; P < 0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session-related level of anxiety was observed in 37% of patients and 45% of relatives. "Dyspnea during NIV," "long NIV session," and "the need to have someone at the bedside" were identified as independent risk factors of high anxiety in patients. CONCLUSIONS Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59).
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