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Tronstad O, Patterson S, Zangerl B, Flaws D, Holdsworth R, Irvine L, Yerkovich S, Pearse I, Fraser JF. The introduction of a sound reduction bundle in the intensive care unit and its impact on sound levels and patients. Aust Crit Care 2024:S1036-7314(24)00053-5. [PMID: 38604917 DOI: 10.1016/j.aucc.2024.02.011] [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: 09/03/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND ICU outcomes are continuing to improve. However, this has not been matched by similar improvements of the ICU bedspace environment, which can detrimentally impact on patient outcomes. Excessive sound and noise, especially, has been linked with adverse and potentially preventable patient outcomes and staff errors. There are many sources of sound in the ICU, with alarms from bedside equipment frequently listed as a main source. The number of alarms is increasing in parallel with the introduction of new and more sophisticated technologies to monitor and support patients. However, most alarms are not accurate or critical and are commonly ignored by staff. OBJECTIVE The objective of this study was to evaluate the impact of a sound reduction bundle on sound levels, number of alarms, and patients' experience and perceived quality of sleep in the ICU. METHODS This was a pre-post, quasi-experimental study investigating the impact of three study interventions implemented sequentially (staff education, visual warnings when sound levels exceeded the preset levels, and monitor alarm reconfigurations). Effects of staff education were evaluated using pre-education and post-education questionnaires, and the impact on patients was evaluated via self-report questionnaires. A sound-level monitor was used to evaluate changes in sound levels between interventions. Alarm audits were completed before and after alarm reconfiguration. RESULTS Staff knowledge improved; however, sound levels did not change across interventions. The number of monthly monitor alarms reduced from 600,452 to 115,927. No significant differences were found in patients' subjective rating of their experience and sleep. CONCLUSION The interventions did not lead to a sound-level reduction; however, there was a large reduction in ICU monitor alarms without any alarm-related adverse events. As the sources of sound are diverse, multidimensional interventions, including staff education, alarm management solutions, and environmental redesign, are likely to be required to achieve a relevant, lasting, and significant sound reduction.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; School of Dentistry, University of Queensland, Brisbane, Australia
| | - Barbara Zangerl
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Lacey Irvine
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Qld University of Technology, Brisbane, Australia
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia; Intensive Care Unit, St. Andrews War Memorial Hospital, Brisbane, Australia
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Boerenbeker P, Brandén AS, Chaboyer W, Hilli Y, Johansson L. Family member's experiences with and evaluation of an ICU Liaison Nurse Service: A qualitative study. Nurs Crit Care 2023; 28:854-862. [PMID: 35396916 DOI: 10.1111/nicc.12775] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Family members of critically ill patients often experience anxiety when their relatives are transferred from ICU to another level of care. ICU liaison nurse (ICULN) visits have been associated with improved support for patients, their families and nursing staff but has not been extensively studied in the non-English speaking setting. Yet, cross-country variations such as how hospital care is delivered and by who means that innovations such as the ICULN may not be able to be simply transferred to other contexts and may not have similar outcomes. AIM The aim of this study was to investigate family member's experiences with and evaluation of ICULN support service in one Swedish ICU. STUDY DESIGN A qualitative evaluation study was undertaken, recruiting family members of former ICU patients. Audio-taped in-depth interviews were conducted. Data were analysed by content analysis. FINDINGS Fifteen family members were interviewed. Two categories: Minds the gap between intensive care and the next care level and providing stability in an uncertain situation were identified. The ICULN supported the family members both directly, when the ICULNs listened to their questions and met their needs, and indirectly, when the ICULNs took responsibility for the patients and their physical and psychological conditions and wellbeing. CONCLUSION Families valued and were satisfied with the ICULN service but also gave suggestions to improve the service in this particular hospital context. RELEVANCE TO CLINICAL PRACTICE The study showed that an ICULN support service met several needs of family members and therefore was a beneficial way to support patients and family members in the transition from the ICU to the ward.
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Affiliation(s)
| | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and the School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Yvonne Hilli
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Lotta Johansson
- Sahlgrenska University Hospital, Göteborg, Sweden
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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Sharieff S, Sajjal A, Idrees A, Rafai W. Patient and Family Satisfaction in the Intensive Care Unit of a Quaternary Care Center. Cureus 2023; 15:e45795. [PMID: 37872908 PMCID: PMC10590672 DOI: 10.7759/cureus.45795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Patient and family satisfaction is an indicator of quality assessment of care provided in the intensive care unit (ICU) ensuring that the quality of services provided meets not only the patients' but also their families' needs. Investigating how different variables affect their satisfaction ratings is important. We assessed patient and family satisfaction in a quaternary care center in Pakistan. METHODS The study was a cross-sectional survey of adult patients and families treated between December 1, 2022 and April 30, 2023 in the ICU at Pakistan Kidney and Liver Institute and Research Center (PKLI-RC), Lahore, Pakistan. We used family satisfaction in ICU 24 (FS-ICU 24) to measure satisfaction in a number of domains on a scale of 1-5 (1 = Very Dissatisfied, 5 = Fully Satisfied). RESULTS Of the 330 patients admitted to ICU during the study period, all patients and/or one of their family members (100%) participated in the study. Out of these, 209 (63%) were male. The mean age was 42 ± 15 years, and the overall mean patient and family satisfaction scores were 4.69 ± 0.69 and 4.55 ± 0.52, respectively. The mean score in all domains was > 4, with the exception of pain management in which it was 3.98 ± 0.53. CONCLUSION Patients and their families' satisfaction is an important measure of ICU quality. Not only the patients and their families were satisfied with our ICU quality of care but they also appreciated involvement in the decision-making process and quality assessment. There is a need for further research for improvement in the pain domain.
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Affiliation(s)
- Saleem Sharieff
- Intensive Care Unit, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
- Intensive Care Unit, Grand River Hospital, Kitchener, CAN
| | - Ayesha Sajjal
- Intensive Care Unit, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Asim Idrees
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
| | - Wajid Rafai
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Center, Lahore, PAK
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Song X, Liu X, Fang W, Wang Q, Zhang J, Tai Z, Wang C. Critical care medicine: ICU survey in the Shandong Province in 2023. Crit Care 2023; 27:231. [PMID: 37308916 DOI: 10.1186/s13054-023-04523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Xuan Song
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China
- Shandong Institute of Endocrine & Metabolic Diseases Affiliated to Shandong First Medical University, Jinan, 250062, Shandong, China
| | - Xinyan Liu
- ICU, Dong E Hospital, Liaocheng, 252200, Shandong, China
| | - Wei Fang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China
| | - Qizhi Wang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China
| | - Jicheng Zhang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China
| | - Zijian Tai
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China
| | - Chunting Wang
- ICU, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Jinan, 250014, Shandong, China.
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Bertuzzi A, Martin A, Clarke N, Springate C, Ashton R, Smith W, Orlowski A, McPherson D. Clinical, humanistic and economic outcomes, including experiencing of patient safety events, associated with admitting patients to single rooms compared with shared accommodation for acute hospital admissions: a systematic review and narrative synthesis. BMJ Open 2023; 13:e068932. [PMID: 37147093 PMCID: PMC10163491 DOI: 10.1136/bmjopen-2022-068932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Assess the impact of single rooms versus multioccupancy accommodation on inpatient healthcare outcomes and processes. DESIGN Systematic review and narrative synthesis. DATA SOURCES Medline, Embase, Google Scholar and the National Institute for Health and Care Excellence website up to 17 February 2022. ELIGIBILITY CRITERIA Eligible papers assessed the effect on inpatients staying in hospital of being assigned to a either a single room or shared accommodation, except where that assignment was for a direct clinical reason like preventing infection spread. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised narratively, according to the methods of Campbell et al. RESULTS: Of 4861 citations initially identified, 145 were judged to be relevant to this review. Five main method types were reported. All studies had methodological issues that potentially biased the results by not adjusting for confounding factors that are likely to have contributed to the outcomes. Ninety-two papers compared clinical outcomes for patients in single rooms versus shared accommodation. No clearly consistent conclusions could be drawn about overall benefits of single rooms. Single rooms were most likely to be associated with a small overall clinical benefit for the most severely ill patients, especially neonates in intensive care. Patients who preferred single rooms tended to do so for privacy and for reduced disturbances. By contrast, some groups were more likely to prefer shared accommodation to avoid loneliness. Greater costs associated with building single rooms were small and likely to be recouped over time by other efficiencies. CONCLUSIONS The lack of difference between inpatient accommodation types in a large number of studies suggests that there would be little effect on clinical outcomes, particularly in routine care. Patients in intensive care areas are most likely to benefit from single rooms. Most patients preferred single rooms for privacy and some preferred shared accommodation for avoiding loneliness. PROSPERO REGISTRATION NUMBER CRD42022311689.
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Affiliation(s)
| | | | | | | | - Rachel Ashton
- Ashton Editorial Consulting, London, UK
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Wayne Smith
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
| | - Andi Orlowski
- The Health Economics Unit, NHS England and NHS Improvement Midlands, West Bromwich, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Padilla-Fortunatti C, Rojas-Silva N, Molina-Muñoz Y, Avendaño-Jara S. Cultural adaptation and psychometric properties of the Chilean-Spanish version of the Family Satisfaction in the Intensive Care Unit - 24 questionnaire. Med Intensiva 2023; 47:140-148. [PMID: 36068147 DOI: 10.1016/j.medine.2022.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/31/2022] [Accepted: 02/03/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To adapt and validate the Spanish version of the Family Satisfaction in the Intensive Care Unit - 24 (FS ICU-24) questionnaire among relatives of critically ill patients in a teaching hospital in Chile. DESIGN Prospective observational study aimed to validate a measuring instrument. SETTING Medical-surgical intensive care unit (ICU) of a teaching hospital in Chile. PATIENTS OR PARTICIPANTS Two hundred and forty relatives of critically ill patients with at least48 h in the ICU, older than 18 years, and with at least one visit to the patient. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Content validity, construct validity, and reliability analysis of the Spanish version of the FS ICU-24 were evaluated. RESULTS The Spanish version of the FS ICU-24 was adapted, improving its understanding and clarity. The factor analysis showed an optimal solution of 3 factors for the Chilean-Spanish version of the FS ICU-24, which explain 51% of the total variance. Reliability was adequate for the global scale (α = 0.93) and the dimensions of satisfaction with patient and family care (α = 0.82), satisfaction with communication (α = 0.91) and satisfaction with decision-making (α = 0.71). CONCLUSIONS The Chilean-Spanish version of the FS ICU-24 proved to be valid and reliable for the evaluation of family satisfaction in the ICU. Having a valid instrument will allow health institutions to accurately identify areas for improvement in the care of the family members and the critically ill patient.
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Affiliation(s)
| | - Noelia Rojas-Silva
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | - Yerko Molina-Muñoz
- Escuela de Psicología, Universidad Adolfo Ibáñez, Peñalolén, Santiago, Chile
| | - Stefany Avendaño-Jara
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
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Padilla-Fortunatti C, Rojas-Silva N, Molina-Munoz Y, Avendano-Jara S. Adaptación cultural y propiedades psicométricas de la versión en español-chileno del cuestionario Family Satisfaction in the Intensive Care Unit – 24. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Schlömmer C, Schittek GA, Meier J, Hasibeder W, Valentin A, Dünser MW. The Austrian ICU survey : A questionnaire-based evaluation of intensive care medicine in Austria. Wien Klin Wochenschr 2022; 134:351-360. [PMID: 35084589 PMCID: PMC8792524 DOI: 10.1007/s00508-021-02002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/27/2021] [Indexed: 11/28/2022]
Abstract
Background While structures of intensive care medicine in Austria are well defined, data on organisational and medical practice in intensive care units (ICUs) have not been systematically evaluated. Methods In this explorative survey, organisational and medical details of ICUs in Austria were collected using an online questionnaire consisting of 147 questions. Results Out of 249 registered ICUs 73 (29.3%) responded, 60 were adult, 10 pediatric/neonatal ICUs and 19, 25 and 16 ICUs were located in level I, II and III hospitals, respectively. Of the respondents 89% reported that the ICU director was board-certified in intensive care medicine. Consultants were constantly present in 78% of ICUs during routine working hours and in 45% during nights and weekends. The nurse:bed ratio varied between 1:1 and 1:2 in 74% during day shifts and 60% during night shifts. Routine physiotherapist rounds were reported to take place daily except weekends in 67% of ICUs. Common monitoring techniques were reported to be in routine or occasional use in 85% and 83% of ICUs, respectively. The majority of ICUs provided daily visiting hours ranging between 2–12 h. Waiting rooms for relatives were available in 66% and an electronic documentation system in 66% of ICUs. Written protocols were available in 70% of ICUs. Conclusion The Austrian ICU survey suggests that ICUs in Austria are clearly structured, well-organized and well-equipped and have a high nurse:bed ratio. In view of the relatively low return rate we cannot exclude that a selection bias has led to overestimation of the survey findings. Supplementary Information The online version of this article (10.1007/s00508-021-02002-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christine Schlömmer
- Department of Anesthesia, Critical Care and Pain Medicine, Medical University Vienna, Vienna, Austria
| | - Gregor A Schittek
- Department of Anesthesiology and Intensive, Medical University Graz, Graz, Austria
| | - Jens Meier
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria
| | - Walter Hasibeder
- Department of Anaesthesiology and Critical Care Medicine, Hospital Zams, Zams, Austria
| | - Andreas Valentin
- Department of Internal and Critical Care Medicine, Hospital Schwarzach, Schwarzach, Austria
| | - Martin W Dünser
- Department of Anesthesiology and Critical Care Medicine, Kepler University Hospital and Johannes Kepler University Linz, Krankenhausstraße 9, 4020, Linz, Austria.
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Verderber S, Gray S, Suresh-Kumar S, Kercz D, Parshuram C. Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020). HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:368-415. [PMID: 34000842 PMCID: PMC8597197 DOI: 10.1177/19375867211009273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge. PURPOSE AND AIM This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities. METHOD AND RESULT Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications. CONCLUSIONS Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.
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Affiliation(s)
- Stephen Verderber
- Centre for Design + Health Innovation, John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Seth Gray
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
| | - Shivathmikha Suresh-Kumar
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Damian Kercz
- John H. Daniels Faculty of Architecture, Landscape and Design, University of Toronto, Ontario, Canada
| | - Christopher Parshuram
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Center for Safety Research, Toronto, Ontario, Canada
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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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Saha S, Noble H, Xyrichis A, Hadfield D, Best T, Hopkins P, Rose L. Mapping the impact of ICU design on patients, families and the ICU team: A scoping review. J Crit Care 2021; 67:3-13. [PMID: 34562779 DOI: 10.1016/j.jcrc.2021.07.002] [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: 12/25/2020] [Revised: 06/25/2021] [Accepted: 07/04/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Scoping review to map outcomes and describe effects of intensive care unit (ICU) design features on patients, family, and healthcare professionals (HCPs). MATERIALS AND METHODS Iteratively developed search strategy executed across seven databases. We included studies (January 2007 to May 2020) exploring ICU design features using any study design. We grouped studies into 12 design features and categorized outcomes into four domains. RESULTS Of 18,577 citations screened, 44 studies met inclusion criteria. Newly built or renovated ICUs/ICU rooms were evaluated in 27 (61%) studies; 17 (39%) evaluated existing designs/features. Most commonly evaluated design features were lighting (24, 55%), single vs multi-occupancy rooms/pods (17, 39%), and family-centered design (13, 30%). We identified 63 distinct outcomes in four domains; HCP-related (20, 45%); patient-related (20, 45%); family-related (11, 25%); and environment-related (7, 16%). Eleven (25%) studies measured patient/family-reported outcomes. In studies evaluating single occupancy rooms, three reported increased family satisfaction, two reported decreased delirium burden, while six reported negative consequences on HCP wellbeing and working. CONCLUSION Studies evaluating ICU design measure disparate outcomes. Few studies included patient/ family-reported outcomes; fewer measured objective environment characteristics. Single room layouts may benefit patients and family but contribute to adverse HCP-related outcomes.
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Affiliation(s)
- Sian Saha
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Harriet Noble
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
| | - Daniel Hadfield
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Thomas Best
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Philip Hopkins
- Critical Care, King's College Hospital, Denmark Hill, London SE5 9RS, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK
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Abdul Halain A, Tang LY, Chong MC, Ibrahim NA, Abdullah KL. Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. J Clin Nurs 2021; 31:497-507. [PMID: 34254377 DOI: 10.1111/jocn.15962] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To map research-based psychological distress among the family members with patients in the intensive care unit (ICU). BACKGROUND Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery. DESIGN The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist. METHODS A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed. RESULTS From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress. CONCLUSIONS Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members. RELEVANCE TO CLINICAL PRACTICE The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.
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Affiliation(s)
- Azura Abdul Halain
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Airini Ibrahim
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing School of Medical and Life Science, Sunway University, Selangor, Malaysia
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Williams H, Gow J, Rana R, Rouse A, Chinthamuneedi M, Beccaria G, Ralph N. Measuring the intensive care experience: A cross-sectional survey of patient and family experiences of critical care. J Clin Nurs 2021; 30:3623-3633. [PMID: 34096126 DOI: 10.1111/jocn.15884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/26/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To report patient and family intensive care experiences using the Measuring the Intensive Care Experience (MICE) tool across two intensive care units (ICU). BACKGROUND The patient and family experience of care is an important indicator for quality improvement of ICUs, yet few studies evaluate both patient and family experiences in relation to overall care quality as well as specifically measuring quality of medical care, nursing care and organisational care as well as overall experience of the quality of intensive care. DESIGN A cross-sectional survey. METHODS A 23 item survey was administered to ICU patients and their family members across two ICUs, a regional 189-bed hospital and a metropolitan 227-bed hospital in Queensland, Australia. The response rate was 272 of 394 ICU patients (36.4%). STROBE guidelines were used in reporting this study. RESULTS Findings indicate a highly positive overall experience of ICU care among patients and families. However, patients reported areas of unmet needs following their stay in ICU broadly related to (1) symptom management, education and information support, and (2) improving the incorporation of patient and family care ICU-related shared decision-making. CONCLUSIONS Supportive interventions are needed that target improve symptom management and inform and education ICU patients. RELEVANCE TO CLINICAL PRACTICE The MICE survey facilitated the identification of a range of areas requiring quality improvement. Improving the integration of patients and families into shared decision-making and support is a key aspect for quality improvement.
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Affiliation(s)
- Helen Williams
- St Vincent's Private Hospital, Toowoomba, Qld, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, Qld, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa.,Centre for Health Research, University of Southern Queensland, Springfield, Qld, Australia
| | - Rezwanul Rana
- School of Business, University of Southern Queensland, Toowoomba, Qld, Australia
| | - Alan Rouse
- St Vincent's Private Hospital, Toowoomba, Qld, Australia
| | | | - Gavin Beccaria
- Centre for Health Research, University of Southern Queensland, Springfield, Qld, Australia.,School of Psychology, University of Southern Queensland, Toowoomba, Qld, Australia
| | - Nicholas Ralph
- Centre for Health Research, University of Southern Queensland, Springfield, Qld, Australia.,School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Qld, Australia
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14
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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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15
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Martí-García C, Fernández-Alcántara M, Suárez López P, Romero Ruiz C, Muñoz Martín R, Garcia-Caro MP. Experiences of family caregivers of patients with terminal disease and the quality of end-of-life care received: a mixed methods study. PeerJ 2020; 8:e10516. [PMID: 33362972 PMCID: PMC7745673 DOI: 10.7717/peerj.10516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to analyze the perceptions and experiences of relatives of patients dying from a terminal disease with regard to the care they received during the dying process, considering the oncological or non-oncological nature of the terminal disease, and the place where care was provided (at home, emergency department, hospital room, or palliative care unit). For this purpose, we conducted a mixed-methods observational study in which two studies were triangulated, one qualitative using semi-structured interviews (n = 30) and the other quantitative, using questionnaires (n = 129). The results showed that the perception of relatives on the quality of care was highly positive in the quantitative evaluation but more critical and negative in the qualitative interview. Experience of the support received and palliative measures was more positive for patients attended in hospital in the case of oncological patients but more positive for those attended at home in the case of non-oncological patients.
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Affiliation(s)
- Celia Martí-García
- Department of Nursing, University of Málaga, Málaga, Spain.,Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain
| | | | | | | | - Rocío Muñoz Martín
- Distrito sanitario Granada-Metropolitano de Atención Primaria, Granada, Spain
| | - Mᵃ Paz Garcia-Caro
- Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain.,Department of Nursing, University of Granada, Granada, Spain
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16
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Hoffman M, Clerckx B, Janssen K, Segers J, Demeyere I, Frickx B, Merckx E, Hermans G, Van der Meulen I, Van Lancker T, Ceulemans N, Van Hollebeke M, Langer D, Gosselink R. Early mobilization in clinical practice: the reliability and feasibility of the 'Start To Move' Protocol. Physiother Theory Pract 2020; 38:908-918. [PMID: 32866055 DOI: 10.1080/09593985.2020.1805833] [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] [Indexed: 10/23/2022]
Abstract
PURPOSE The properties of a local Intensive Care Unit early mobilization protocol ('Start To Move As Soon As Possible') in critically ill patients, consisting of an objective diagnostic assessment linked to six treatment levels were evaluated. This study aimed to investigate whether the protocol can be reliably applied by different health-care providers (reliability), to examine the associations between prescribed and delivered treatments (feasibility) and to explore safety and patient satisfaction with the protocol. METHODS Cross-sectional observational study evaluating the reliability of the protocol between physiotherapist was evaluated with Cohen's kappa, percentage of agreement, and intraclass correlation coefficients in 61 patients. Feasibility was analyzed as agreement between prescribed and delivered treatments with Spearman's rank correlation coefficients in 60 patients. A satisfaction survey was used to evaluate patient satisfaction with the protocol. RESULTS Excellent agreement was observed between physiotherapists for diagnostic level assignment (Kappa = 0.92), while the majority of the treatment proposals per level showed moderate to substantial agreement between the physiotherapists (Kappa range: 0.40-0.89). Three hundred and thirteen treatments were prescribed. Perfect agreement was observed between prescribed and delivered treatments in level 0 (Spearman's rho 1.00) and excellent associations for levels 1-5 (0.941, 0.995, 0.951, 0.998, and 0.999), respectively. Unwanted safety events rate was 3%. Most patients (92%) were very satisfied with physiotherapy. CONCLUSION Excellent inter-rater agreement for diagnostic level assignment and moderate to substantial agreement for proposed treatments support the reliability of the protocol. Perfect to excellent associations between prescribed and delivered treatments supports its feasibility. Complications were rare, and most patients were very positive regarding the care provided by physiotherapists during their stay in the ICU.
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Affiliation(s)
- Mariana Hoffman
- Central Clinical School, Department of Allergy, Immunology and Respiratory Medicine, Monash University, Melbourne, Australia.,Federal University of Minas Gerais, Rehabilitation Science Program, Belo Horizonte, Brazil.,Department of Rehabilitation Sciences KU Leuven, Belgium
| | - Beatrix Clerckx
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Kristel Janssen
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Segers
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Inge Demeyere
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Bregje Frickx
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Else Merckx
- Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.,Division of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven - University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Marine Van Hollebeke
- Department of Rehabilitation Sciences KU Leuven, Belgium.,Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Langer
- Department of Rehabilitation Sciences KU Leuven, Belgium
| | - Rik Gosselink
- Department of Rehabilitation Sciences KU Leuven, Belgium.,Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium
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17
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Kang J, Cho YJ, Choi S. State anxiety, uncertainty in illness, and needs of family members of critically ill patients and their experiences with family-centered multidisciplinary rounds: A mixed model study. PLoS One 2020; 15:e0234296. [PMID: 32516349 PMCID: PMC7282650 DOI: 10.1371/journal.pone.0234296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/24/2020] [Indexed: 12/15/2022] Open
Abstract
This study aimed to determine whether family-centered multidisciplinary rounds could alleviate anxiety and uncertainty in illness and meet needs for critically ill patients’ families. A family-centered multidisciplinary rounds protocol was developed identifying needs of critically ill patients’ families, and family experiences were reviewed through in-depth interviews. A sequential mixed-methods study was utilized, combining survey data and semi-structured interviews in a tertiary medical intensive care unit in South Korea. A structured questionnaire assessed needs, anxiety, and uncertainty in illness for 50 participants. Interview data of 10 participants were analyzed using grounded theory. Assurance was the highest family need, followed by information need. Family needs differed according to gender, relationship to the patient, and length of intensive care unit stay. Participants reported family-centered multidisciplinary rounds provided a sense of relief, a chance to listen to medical staff, and a chance to provide medical staff with comprehensive information about patient care. Proximity needs were found to have a positive correlation with state anxiety, while comfort needs had a negative correlation with uncertainty in illness. Families reported family-centered multidisciplinary rounds were positive, useful experiences. Thus, standardization of family-centered multidisciplinary rounds is needed to meet families’ various needs.
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Affiliation(s)
- Jiyeon Kang
- Department of Anthropology, University of Virginia, Charlottesville, VA, United States of America
| | - Young-Jae Cho
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Korea
| | - Seunghye Choi
- College of Nursing, Gachon University, Yeonsu-gu, Incheon, Korea
- * E-mail:
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18
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Goldfarb M, Bibas L, Burns K. Patient and Family Engagement in Care in the Cardiac Intensive Care Unit. Can J Cardiol 2020; 36:1032-1040. [PMID: 32533931 DOI: 10.1016/j.cjca.2020.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/26/2022] Open
Abstract
Hospitalization in the cardiac intensive care unit can be a stressful experience for patients and families. Family members often feel overwhelmed by the severity of their loved one's illness, powerless to affect their care, and struggle to comprehend information regarding their loved one's current health status and treatment plan. Consequently, up to half of family members might develop psychological symptoms (depression, generalized anxiety, and post-traumatic stress disorder) and a syndrome of enduring psychological, cognitive, or emotional disturbances. Patient and family engagement (PFE) is an emerging approach that empowers family members to become essential and active partners in care delivery and research. In the patient care context, the goal of PFE is to improve the care experience and achieve better outcomes for patients and family members. As a result of societal trends, family members increasingly wish to directly participate in their relative's care and be informed and involved in decision-making. There is growing evidence that engaging family members in care improves patient- and family-important outcomes after acute and critical illness. Although the role for PFE in care and research has been explored in the general critical care context, efforts to inform clinicians who manage patients with acute cardiovascular disease about the relevance of PFE are limited. In this review, we describe opportunities for PFE in the cardiac intensive care unit, outline the current evidence base for PFE in patient care, identify barriers to PFE and how to overcome them, and highlight knowledge gaps and areas for future investigations.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Lior Bibas
- Division of Cardiology, Pierre-Boucher Hospital, Longueuil, Quebec, Canada
| | - Karen Burns
- Division of Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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19
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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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20
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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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21
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Jerng JS, Huang SF, Yu HY, Chan YC, Liang HJ, Liang HW, Sun JS. Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan. Crit Care 2018; 22:335. [PMID: 30522508 PMCID: PMC6282256 DOI: 10.1186/s13054-018-2271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings. Methods From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool. Results We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints. Conclusions A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families. Electronic supplementary material The online version of this article (10.1186/s13054-018-2271-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yu Yu
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Ju Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, 100, Taiwan.
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22
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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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23
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Development and initial validation of the Swedish Family Satisfaction Intensive Care Questionnaire (SFS-ICQ). Intensive Crit Care Nurs 2018; 50:118-124. [PMID: 29935980 DOI: 10.1016/j.iccn.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families' satisfaction of quality of care in Swedish intensive care units. METHODS Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis. FINDINGS Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed. CONCLUSION A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents' understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.
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24
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Lamiani G, Ciconali M, Argentero P, Vegni E. Clinicians’ moral distress and family satisfaction in the intensive care unit. J Health Psychol 2018; 25:1894-1904. [DOI: 10.1177/1359105318781935] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study explored the relationship between clinicians’ moral distress and family satisfaction with care in five intensive care units in Italy. A total of 122 clinicians (45 physicians and 77 nurses) and 59 family members completed the Italian Moral Distress Scale-Revised and the Family Satisfaction in the ICU questionnaire, respectively. Clinicians’ moral distress inversely correlated with family satisfaction related to the inclusion in the decision-making process. Specifically, physicians’ moral distress inversely correlated with satisfaction regarding the respect shown toward the patient. Nurses’ moral distress inversely correlated with satisfaction regarding breathlessness and agitation management, provision of emotional support, understanding of information, and inclusion in the decision-making process.
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Affiliation(s)
- Giulia Lamiani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Matteo Ciconali
- Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
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25
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Petersson E, Wångdahl L, Olausson S. ICU nurses' experiences of environmental elements and their meaning for patient care at an ICU: A qualitative content analysis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2057158518778997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In an intensive care unit (ICU), the environment is highly technological and staff are constantly present. The aim of this study was to describe environmental elements of an ICU room that nurses consider central for their provision of care. Data were collected using photovoice – photographs and in-depth interviews – and analysed using a qualitative content analysis approach. The care environment highly affected ICU nurses, in particular some elements such as medical equipment, work stations and beds. These were considered as an aid, but due to confined space some care was abstained from, maintaining privacy and confidentiality were a challenge, which led to frustration and stress. To provide care in an environment with good lightning, reduced noise and adequate space increases the wellbeing of the nurses, which indicates that an investment in a better care environment would be worthwhile.
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Affiliation(s)
| | | | - Sepideh Olausson
- Institute of Health and Care Sciences,The Sahlgrenska Academy at Gothenburg University, Sweden
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26
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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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Abstract
Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.
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Kynoch K, Chang A, Coyer F, McArdle A. The effectiveness of interventions to meet family needs of critically ill patients in an adult intensive care unit: a systematic review update. ACTA ACUST UNITED AC 2018; 14:181-234. [PMID: 27532144 DOI: 10.11124/jbisrir-2016-2477] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Attending to the needs of family members of critically ill patients is an important and necessary step in providing appropriate holistic care for both the patient and the family. Family interaction can significantly impact on the experience of critical illness, notwithstanding the challenge of meeting families' needs for many clinicians in the intensive care unit (ICU). Family needs have been extensively researched; however, a previous Joanna Briggs Institute (JBI) systematic review was the first published systematic review recommending effective interventions for addressing family needs of critically ill patients in an acute intensive care setting. Since its publication in 2011, additional research findings have been published and it was deemed appropriate to update the original systematic review. OBJECTIVES This systematic review aims to establish recent best practice in addressing the needs of family members with a relative or loved one admitted to an adult critical care unit. INCLUSION CRITERIA TYPES OF PARTICIPANTS Studies that included family members (including children) of adult patients in an ICU were considered for inclusion in this review. Patients with any clinical condition, length of stay or outcome were included. TYPES OF INTERVENTION(S) This review considered interventions that addressed the five previously identified categories of family needs: support - support groups, training in coping strategies and journal or diary writing; assurance - face-to-face meetings and participation in ward rounds; proximity - changes to visitation policies; information - staff and/or family education, handouts and brochures and the use of technology (e.g. SMS messages); and comfort - changes to the ICU physical environment. TYPES OF STUDIES This review considered any randomized controlled trials (RCTs) that evaluated the effectiveness of interventions in addressing family needs of critically ill patients in an adult ICU. In the absence of RCTs, other research designs such as quasi-experimental, as well as pre- and post-studies were considered for inclusion in the narrative summary to enable the identification of current approaches and possible future strategies for addressing family needs of critically ill patients. TYPES OF OUTCOMES This review considered studies that evaluated outcomes with a validated tool that measured information comprehension, coping mechanisms, anxiety, depression, stress and satisfaction. SEARCH STRATEGY An extensive search of the major databases was conducted. Databases searched included PubMed, CINAHL, psycINFO, Health source, Web of Science, EMBASE, the Cochrane Library and Database of Abstracts of Reviews of Effects. The original search of this review included published and unpublished studies and articles in English from 1980 to 2010. The updated search identified articles for inclusion from 2010 to 2014. METHODOLOGICAL QUALITY Quantitative articles selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review. Any disagreements that arose between the reviewers were resolved through discussion, or with a third reviewer. DATA EXTRACTION Data was extracted from the articles included in this review using standardized data extraction tools from the JBI Meta Analysis of Statistics Assessment and Review Instrument package. DATA SYNTHESIS The studies included in this review were not suitable for meta-analysis and therefore the results are presented as a narrative summary. RESULTS Originally, 14 studies and one dissertation met the inclusion criteria and were included in the review. Of these, 12 were quasi-experimental studies and three were prospective randomized trials. In this current update, 14 new articles were identified for inclusion - one RCT, 10 quasi-experimental studies and three observational studies. The settings were in ICUs in Sweden, USA, United Kingdom, the Netherlands, France, Hong Kong, Saudi Arabia and Iran. The evidence identified from all studies in the review includes the use of support groups for family members of patients admitted to an ICU, structured communication and/or education programs for family members, the use of leaflets or brochures to meet family information needs, use of a diary, changes in the physical environment and open or more flexible visiting hours. CONCLUSIONS This current update of the original review makes several reiterative and new recommendations for clinical practice to address family needs of patients admitted to a critical care unit; however, the need for significant further research in this area is again highlighted. Future intervention studies focusing on family needs could include the use of technology such as DVDs (Digital Versatile Discs) and SMS (Short Message Service) for informing families and interventions specifically designed to improve family comfort. IMPLICATIONS FOR PRACTICE Communication interventions help promote family involvement in their loved one's care and facilitate their decision-making capacity, as well as improving clinician and family interaction, family comprehension of their loved one's condition and also reduce the development of post-traumatic stress-related symptoms (Grade A). Family satisfaction may be increased with the provision of comfortable physical environments with noise reduction measures (Grade B). IMPLICATIONS FOR RESEARCH More rigorous high-quality studies investigating interventions to meet the needs of family with a relative in ICU are needed. The majority of included studies in this updated review focused on family satisfaction wherein more robust data on family needs would better inform health professionals in their practice.
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Affiliation(s)
- Kate Kynoch
- 1Nursing Research Center and the Queensland Center for Evidence-based Nursing and Midwifery, Mater Health Services, Queensland, Australia 2Queensland University of Technology, Queensland, Australia 3Royal Brisbane and Women's Hospital, Queensland, Australia
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Hartog CS, Jöbges S, Kumpf O, Janssens U. [Communicating with families in the ICU : Background and practical recommendations]. Med Klin Intensivmed Notfmed 2018; 113:231-242. [PMID: 29556682 DOI: 10.1007/s00063-018-0417-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/13/2018] [Accepted: 02/21/2018] [Indexed: 11/24/2022]
Abstract
Family members of adult intensive care patients are partners of the interdisciplinary team. Family members provide important contributions to patient-centered care in the intensive care unit (ICU) and beyond. At the same time, family members are stressed and are themselves in need of support ("family-centered care"). This is mainly provided through family conferences. Family members must always be treated respectfully and with consideration for their acute stress syndrome. A structured communication is recommended as well as written standard operating procedures (SOPs) or guidelines for the ICU team and brochures and written guidelines for relatives. Documentation of structured family conferences is an established quality indicator of intensive care.
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Affiliation(s)
- C S Hartog
- Patienten- und Angehörigenzentrierte Versorgung, Klinik Bavaria, An der Wolfsschlucht 1, 01731, Kreischa, Deutschland. .,Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Deutschland.
| | - S Jöbges
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Deutschland
| | - O Kumpf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte und Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, 10117, Berlin, Deutschland
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Eschweiler, Deutschland
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Padilla-Fortunatti C, Rojas-Silva N, Amthauer-Rojas M, Molina-Muñoz Y. Needs of relatives of critically ill patients in an academic hospital in Chile. ENFERMERIA INTENSIVA 2017; 29:32-40. [PMID: 29273546 DOI: 10.1016/j.enfi.2017.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/29/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To identify the importance of the needs of family members of patients in an intensive care unit (ICU). METHOD Descriptive, comparative and cross-sectional study based on a secondary data analysis of 251 relatives of ICU patients at a university hospital in Santiago, Chile. Using non-random sampling, the 'Critical Care Family Needs Inventory' was used to establish the family needs, as well as a sociodemographic questionnaire that included: age, gender, educational level, patient relationship and previous ICU experience. A descriptive statistical analysis, Student's T test and ANOVA were performed. RESULTS The most important family needs related to the dimensions of 'security' (mean=3.90) and 'information' (mean=3.76), while those of minor importance with 'support' (mean=3.09). In the latter, differences were observed at an older age (P<.05), an educational level (P<.001) and relationship with the patient (P<.05). CONCLUSIONS The most relevant needs for family members in the ICU are related to safety and information. Less important needs are influenced by certain sociodemographic variables. Identifying the degree of importance of family needs will allow the health team to improve its relationship with families in ICUs.
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Affiliation(s)
- C Padilla-Fortunatti
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile; Unidad de Paciente Crítico, Hospital Clínico Red de Salud UC-CHRISTUS, Santiago, Chile
| | - N Rojas-Silva
- Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - M Amthauer-Rojas
- Unidad de Paciente Crítico, Hospital Clínico Red de Salud UC-CHRISTUS, Santiago, Chile
| | - Y Molina-Muñoz
- Escuela de Psicología, Universidad Adolfo Ibáñez, Santiago, Chile
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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:1751-1761. [PMID: 28749855 DOI: 10.1097/ccm.0000000000002624] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine whether patient- and family-centered care interventions in the ICU improve outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. STUDY SELECTION We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. DATA EXTRACTION We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. DATA SYNTHESIS There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. CONCLUSIONS Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
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Long AC, Downey L, Engelberg RA, Nielsen E, Ciechanowski P, Curtis JR. Understanding Response Rates to Surveys About Family Members' Psychological Symptoms After Patients' Critical Illness. J Pain Symptom Manage 2017; 54:96-104. [PMID: 28552830 PMCID: PMC5523827 DOI: 10.1016/j.jpainsymman.2017.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Achieving adequate response rates from family members of critically ill patients can be challenging, especially when assessing psychological symptoms. OBJECTIVES To identify factors associated with completion of surveys about psychological symptoms among family members of critically ill patients. METHODS Using data from a randomized trial of an intervention to improve communication between clinicians and families of critically ill patients, we examined patient-level and family-level predictors of the return of usable surveys at baseline, three months, and six months (n = 181, 171, and 155, respectively). Family-level predictors included baseline symptoms of psychological distress, decisional independence preference, and attachment style. We hypothesized that family with fewer symptoms of psychological distress, a preference for less decisional independence, and secure attachment style would be more likely to return questionnaires. RESULTS We identified several predictors of the return of usable questionnaires. Better self-assessed family member health status was associated with a higher likelihood and stronger agreement with a support-seeking attachment style with a lower likelihood, of obtaining usable baseline surveys. At three months, family-level predictors of return of usable surveys included having usable baseline surveys, status as the patient's legal next of kin, and stronger agreement with a secure attachment style. The only predictor of receipt of surveys at six months was the presence of usable surveys at three months. CONCLUSION We identified several predictors of the receipt of surveys assessing psychological symptoms in family of critically ill patients, including family member health status and attachment style. Using these characteristics to inform follow-up mailings and reminders may enhance response rates.
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Affiliation(s)
- Ann C Long
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
| | - Lois Downey
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Elizabeth Nielsen
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Paul Ciechanowski
- Department of Psychiatry, University of Washington, Seattle, Washington, USA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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van Mol MMC, Boeter TGW, Verharen L, Kompanje EJO, Bakker J, Nijkamp MD. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals. J Clin Nurs 2017; 26:3212-3223. [DOI: 10.1111/jocn.13669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Margo MC van Mol
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Trudi GW Boeter
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | | | - Erwin JO Kompanje
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Jan Bakker
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine; Department of Medicine; Columbia University Medical Center; New York NY USA
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
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Devlin AS, Andrade CC. Quality of the Hospital Experience: Impact of the Physical Environment. HANDBOOK OF ENVIRONMENTAL PSYCHOLOGY AND QUALITY OF LIFE RESEARCH 2017. [DOI: 10.1007/978-3-319-31416-7_23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Patient, family-centred care interventions within the adult ICU setting: An integrative review. Aust Crit Care 2016; 29:179-193. [DOI: 10.1016/j.aucc.2016.08.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/28/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022] Open
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Holanda Peña MS, Talledo NM, Ots Ruiz E, Lanza Gómez JM, Ruiz Ruiz A, García Miguelez A, Gómez Marcos V, Domínguez Artiga MJ, Hernández Hernández MÁ, Wallmann R, Llorca Díaz J. Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. Med Intensiva 2016; 41:78-85. [PMID: 27793389 DOI: 10.1016/j.medin.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN A prospective, 5-month observational and descriptive study was carried out. SETTING ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.
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Affiliation(s)
- M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - N Marina Talledo
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - E Ots Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J M Lanza Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A Ruiz Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - A García Miguelez
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - V Gómez Marcos
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M J Domínguez Artiga
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M Á Hernández Hernández
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España; Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - R Wallmann
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
| | - J Llorca Díaz
- Medicina Preventiva y Salud Pública, Universidad de Cantabria, Santander, España
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Minton C, Batten L. Rethinking the intensive care environment: considering nature in nursing practice. J Clin Nurs 2016; 25:269-77. [PMID: 26769214 DOI: 10.1111/jocn.13069] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. BACKGROUND The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. DESIGN This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. METHODS Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. CONCLUSION There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. RELEVANCE TO CLINICAL PRACTICE Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- Research Centre for Maori Health and Development, Palmerston North, New Zealand
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Lai VKW, Lee A, Leung P, Chiu CH, Ho KM, Gomersall CD, Underwood MJ, Joynt GM. Patient and family satisfaction levels in the intensive care unit after elective cardiac surgery: study protocol for a randomised controlled trial of a preoperative patient education intervention. BMJ Open 2016; 6:e011341. [PMID: 27334883 PMCID: PMC4932258 DOI: 10.1136/bmjopen-2016-011341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Patients and their families are understandably anxious about the risk of complications and unfamiliar experiences following cardiac surgery. Providing information about postoperative care in the intensive care unit (ICU) to patients and families may lead to lower anxiety levels, and increased satisfaction with healthcare. The objectives of this study are to evaluate the effectiveness of preoperative patient education provided for patients undergoing elective cardiac surgery. METHODS AND ANALYSIS 100 patients undergoing elective coronary artery bypass graft, with or without valve replacement surgery, will be recruited into a 2-group, parallel, superiority, double-blinded randomised controlled trial. Participants will be randomised to either preoperative patient education comprising of a video and ICU tour with standard care (intervention) or standard education (control). The primary outcome measures are the satisfaction levels of patients and family members with ICU care and decision-making in the ICU. The secondary outcome measures are patient anxiety and depression levels before and after surgery. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (reference number CREC 2015.308). The findings will be presented at conferences and published in peer-reviewed journals. Study participants will receive a 1-page plain language summary of results. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15006971.
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Affiliation(s)
- Veronica Ka Wai Lai
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Patricia Leung
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chun Hung Chiu
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Man Ho
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charles David Gomersall
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Malcolm John Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong
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Kaur H, Rohlik GM, Nemergut ME, Tripathi S. Comparison of staff and family perceptions of causes of noise pollution in the Pediatric Intensive Care Unit and suggested intervention strategies. Noise Health 2016; 18:78-84. [PMID: 26960784 PMCID: PMC4918686 DOI: 10.4103/1463-1741.178480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Noise and excessive, unwanted sound in the Pediatric Intensive Care Unit (PICU) is common and has a major impact on patients' sleep and recovery. Previous research has focused mostly on absolute noise levels or included only staff as respondents to acknowledge the causes of noise and to plan for its reduction. Thus far, the suggested interventions have not ameliorated noise, and it continues to serve as a barrier to recovery. In addition to surveying PICU providers through internet-based software, patients' families were evaluated through in-person interviews utilizing a pretested instrument over 3 months. Families of patients admitted for more than 24 h were considered eligible for evaluation. Participants were asked to rank causes of noise from 1 to 8, with eight being highest, and identified potential interventions as effective or ineffective. In total, 50 families from 251 admissions and 65 staff completed the survey. Medical alarms were rated highest (mean ± standard deviation [SD], 4.9 ± 2.1 [2.8-7.0]), followed by noise from medical equipment (mean ± SD, 4.7 ± 2.1 [2.5-6.8]). This response was consistent among PICU providers and families. Suggested interventions to reduce noise included keeping a patient's room door closed, considered effective by 93% of respondents (98% of staff; 88% of families), and designated quiet times, considered effective by 82% (80% of staff; 84% of families). Keeping the patient's door closed was the most effective strategy among survey respondents. Most families and staff considered medical alarms an important contributor to noise level. Because decreasing the volume of alarms such that it cannot be heard is inappropriate, alternative strategies to alert staff of changes in vital signs should be explored.
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Affiliation(s)
- Harsheen Kaur
- Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Wright SE, Walmsley E, Harvey SE, Robinson E, Ferrando-Vivas P, Harrison DA, Canter RR, McColl E, Richardson A, Richardson M, Hinton L, Heyland DK, Rowan KM. Family-Reported Experiences Evaluation (FREE) study: a mixed-methods study to evaluate families’ satisfaction with adult critical care services in the NHS. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BackgroundTo improve care it is necessary to feed back experiences of those receiving care. Of patients admitted to intensive care units (ICUs), approximately one-quarter die, and few survivors recollect their experiences, so family members have a vital role. The most widely validated tool to seek their views is the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU).ObjectivesTo test face and content validity and comprehensibility of the FS-ICU (phase 1). To establish internal consistency, construct validity and reliability of the FS-ICU; to describe family satisfaction and explore how it varies by family member, patient, unit/hospital and other contextual factors and by country; and to model approaches to sampling for future use in quality improvement (phase 2).DesignMixed methods: qualitative study (phase 1) and cohort study (phase 2).SettingNHS ICUs (n = 2, phase 1;n = 20, phase 2).ParticipantsHealth-care professionals, ex-patients, family members of ICU patients (n = 41, phase 1). Family members of ICU patients (n = 12,303, phase 2).InterventionsNone.Main outcome measuresKey themes regarding each item of the 24-item FS-ICU (FS-ICU-24) (phase 1). Overall family satisfaction and domain scores of the FS-ICU-24 (phase 2).ResultsIn phase 1, face validity, content validity and comprehensibility were good. Adaptation to the UK required only minor edits. In phase 2, one to four family members were recruited for 60.6% of 10,530 patients (staying in ICU for 24 hours or more). Of 12,303 family members, 7173 (58.3%) completed the questionnaire. Psychometric assessment of the questionnaire established high internal consistency and criterion validity. Exploratory factor analysis indicated new domains:satisfaction with care,satisfaction with informationandsatisfaction with the decision-making process. All scores were high with skewed distributions towards more positive scores. For family members of ICU survivors, factors associated with increased/decreased satisfaction were age, ethnicity, relationship to patient, and visit frequency, and patient factors were acute severity of illness and invasive ventilation. For family members of ICU non-survivors, average satisfaction was higher but no family member factors were associated with increased/decreased satisfaction; patient factors were age, acute severity of illness and duration of stay. Neither ICU/hospital factors nor seasonality were associated. Funnel plots confirmed significant variation in family satisfaction across ICUs. Adjusting for family member and patient characteristics reduced variation, resulting in fewer ICUs identified as potential outliers. Simulations suggested that family satisfaction surveys using short recruitment windows can produce relatively unbiased estimates of average family satisfaction.ConclusionsThe Family-Reported Experiences Evaluation study has provided a UK-adapted, psychometrically valid questionnaire for overall family satisfaction and three domains. The large sample size allowed for robust multilevel multivariable modelling of factors associated with family satisfaction to inform important adjustment of any future evaluation.LimitationsResponses to three free-text questions indicate the questionnaire may not be sensitive to all aspects of family satisfaction.Future workReservations remain about the current questionnaire. While formal analysis of the free-text questions did not form part of this proposal, brief analysis suggested considerable scope for improvement of the FS-ICU-24.Study registrationCurrent Controlled Trials ISRCTN47363549.Funding detailsThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Stephen E Wright
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma Walmsley
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Sheila E Harvey
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Emily Robinson
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Paloma Ferrando-Vivas
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - David A Harrison
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Ruth R Canter
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Elaine McColl
- Newcastle Clinical Trials Unit, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette Richardson
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Lisa Hinton
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada
- Department of Critical Care Medicine, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
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LaVela SL, Etingen B, Hill JN, Miskevics S. Patient Perceptions of the Environment of Care in Which Their Healthcare is Delivered. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:31-46. [DOI: 10.1177/1937586715610577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To measure patients’ perceptions of the environment of care (EOC), with a focus on the physical environment, in which healthcare is delivered. Background: The EOC may impact patient experiences, care perceptions, and health outcomes. EOC may be improved through redesign of existing physical structures or spaces or by adding nurturing amenities. Methods: Demographics, health status, hospital use, and data on the environment (physical, comfort, orientation, and privacy) were collected via a mailed cross-sectional survey sent to patients seen at four hospital Centers of Innovation (COIs; that implemented many modifications to the healthcare environment to address physical, comfort, orientation, and privacy factors) and four matched controls, supplemented with checklist and VA administrative data. A modified Perceived Hospital Environment Quality Indicators instrument was used to measure patients’ EOC perceptions. Results: Respondents (3,321/5,117; 65% response) rated, [mean ( SD)], exterior space highest, 3.09 (0.73), followed by interior space, 2.96 (0.74), and privacy, 2.44 (1.01). COIs had significantly higher ratings than controls on interior space (2.99 vs. 2.96, p = .02) and privacy (2.48 vs. 2.38, p = .005) but no differences for exterior space. Subscales with significantly higher ratings in COIs (vs. controls) in interior space were “spatial–physical comfort” and “orientation,” for example, clean, good signage, spacious rooms, and for privacy included “not too crowded” and “able to talk without being overheard.” Checklist findings confirmed the presence of EOC innovations rated highly by patients. Conclusions: Patients identified cleanliness, good signs/information points, adequate seating, nonovercrowding, and privacy for conversations as important. Hospital design modifications, with particular attention to the physical environment, can improve patient EOC perceptions.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, IL, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Jennifer N. Hill
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
| | - Scott Miskevics
- Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA
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Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties. Crit Care Med 2015; 43:1731-44. [PMID: 25821917 DOI: 10.1097/ccm.0000000000000980] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. DATA SOURCES We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. STUDY SELECTION Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. DATA EXTRACTION Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. DATA SYNTHESIS The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. CONCLUSIONS Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.
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Paul RG, Finney SJ. Family satisfaction with care on the ICU: essential lessons for all doctors. Br J Hosp Med (Lond) 2015; 76:504-9. [DOI: 10.12968/hmed.2015.76.9.504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard G Paul
- NIHR Clinical Research Fellow in Adult Intensive Care, Royal Brompton Hospital, London SW3 6NP
| | - Simon J Finney
- Consultant in Adult Intensive Care in the Adult Intensive Care Unit, Royal Brompton Hospital, London SW3 6NP
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Salins N. Measuring family satisfaction in an Indian Intensive Care Unit. Indian J Crit Care Med 2015; 19:505-6. [PMID: 26430334 PMCID: PMC4578192 DOI: 10.4103/0972-5229.164794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rippin AS, Zimring C, Samuels O, Denham ME. Finding a Middle Ground: Exploring the Impact of Patient- and Family-Centered Design on Nurse-Family Interactions in the Neuro ICU. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:80-98. [PMID: 26187793 DOI: 10.1177/1937586715593551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This comparative study of two adult neuro critical care units examined the impact of patient- and family-centered design on nurse-family interactions in a unit designed to increase family involvement. BACKGROUND A growing evidence base suggests that the built environment can facilitate the delivery of patient- and family-centered care (PFCC). However, few studies examine how the PFCC model impacts the delivery of care, specifically the role of design in nurse-family interactions in the adult intensive care unit (ICU) from the perspective of the bedside nurse. METHODS Two neuro ICUs with the same patient population and staff, but with different layouts, were compared. Structured observations were conducted to assess changes in the frequency, location, and content of interactions between the two units. Discussions with staff provided additional insights into nurse attitudes, perceptions, and experiences caring for families. RESULTS Nurses reported challenges balancing the needs of many stakeholders in a complex clinical environment, regardless of unit layout. However, differences in communication patterns between the clinician- and family-centered units were observed. More interactions were observed in nurse workstations in the PFCC unit, with most initiated by family. While the new unit was seen as more conducive to the delivery of PFCC, some nurses reported a loss of workspace control. CONCLUSIONS Patient- and family-centered design created new spatial and temporal opportunities for nurse-family interactions in the adult ICU, thus supporting PFCC goals. However, greater exposure to unplanned family encounters may increase nurse stress without adequate spatial and organizational support.
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Affiliation(s)
| | | | - Owen Samuels
- Neuroscience Critical Care, Emory Healthcare, Atlanta, GA, USA
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Auriemma CL, Lyon SM, Strelec LE, Kent S, Barg FK, Halpern SD. Defining the Medical Intensive Care Unit in the Words of Patients and Their Family Members: A Freelisting Analysis. Am J Crit Care 2015; 24:e47-55. [PMID: 26134339 DOI: 10.4037/ajcc2015717] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND No validated conceptual framework exists for understanding the outcomes of patient- and family-centered care in critical care. OBJECTIVE To explore the meaning of intensive care unit among patients and their families by using freelisting. METHODS The phrase intensive care unit was used to prompt freelisting among intensive care unit patients and patients' family members. Freelisting is an anthropological technique in which individuals define a domain by listing all words that come to mind in response to a topic. Salience scores, derived from the frequency with which a word was mentioned, the order in which it was mentioned, and the length of each list, were calculated and analyzed. RESULTS Among the 45 participants, many words were salient to both patients and patients' family members. Words salient solely for patients included consciousness, getting better, noisy, and personal care. Words salient solely for family members included sadness, busy, professional, and hope. The words suffering, busy, and team were salient solely for family members of patients who lived, whereas sadness, professionals, and hope were salient solely for family members of patients who died. The words caring and death were salient for both groups. CONCLUSIONS Intensive care unit patients and their families define intensive care unit by using words to describe sickness, caring, medical staff, emotional states, and physical qualities of the unit. The results validate the importance of these topics among patients and their families in the intensive care unit and illustrate the usefulness of freelisting in critical care research.
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Affiliation(s)
- Catherine L Auriemma
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Sarah M Lyon
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Lauren E Strelec
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Saida Kent
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Frances K Barg
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine
| | - Scott D Halpern
- Catherine L. Auriemma is a resident physician in internal medicine, University of California San Francisco and a research trainee with the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia. Sarah M. Lyon is an instructor of medicine in the Division of Pulmonary, Allergy, and Critical Care Medicine at the University of Pennsylvania Perelman School of Medicine. Lauren E. Strelec and Saida Kent are research assistants with the FIELDS Program, University of Pennsylvania. Frances K. Barg is an associate professor in the Department of Family Medicine and Community Health and the Department of Anthropology, University of Pennsylvania School of Arts and Sciences. Scott D. Halpern is director of the FIELDS Program and an associate professor in the Departments of Medicine, Epidemiology, and Medical Ethics and Health Policy, as well as senior fellow in the Leonard Davis Institute of Health Economics, all at the University of Pennsylvania Perelman School of Medicine.
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Warrillow S, Farley KJ, Jones D. Ten practical strategies for effective communication with relatives of ICU patients. Intensive Care Med 2015; 41:2173-6. [PMID: 25904186 DOI: 10.1007/s00134-015-3815-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/07/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Stephen Warrillow
- Department of Intensive Care, Austin Hospital, Austin Health, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia. .,The University of Melbourne, Melbourne, Australia.
| | - K J Farley
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Daryl Jones
- Department of Intensive Care, Austin Hospital, Austin Health, 145 Studley Road Heidelberg, Melbourne, VIC, 3084, Australia.,The University of Melbourne, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Critical Care Outreach, Austin Hospital, Melbourne, Australia
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OʼHara S. Planning intensive care unit design using computer simulation modeling: optimizing integration of clinical, operational, and architectural requirements. Crit Care Nurs Q 2015; 37:67-82. [PMID: 24309461 DOI: 10.1097/cnq.0000000000000006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nurses have increasingly been regarded as critical members of the planning team as architects recognize their knowledge and value. But the nurses' role as knowledge experts can be expanded to leading efforts to integrate the clinical, operational, and architectural expertise through simulation modeling. Simulation modeling allows for the optimal merge of multifactorial data to understand the current state of the intensive care unit and predict future states. Nurses can champion the simulation modeling process and reap the benefits of a cost-effective way to test new designs, processes, staffing models, and future programming trends prior to implementation. Simulation modeling is an evidence-based planning approach, a standard, for integrating the sciences with real client data, to offer solutions for improving patient care.
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Affiliation(s)
- Susan OʼHara
- O'Hara HealthCare Consultants, LLC, Marlborough, Massachusetts
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Siddiqui ZK, Zuccarelli R, Durkin N, Wu AW, Brotman DJ. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building. J Hosp Med 2015; 10:165-71. [PMID: 25652720 DOI: 10.1002/jhm.2297] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 11/07/2014] [Accepted: 11/14/2014] [Indexed: 11/06/2022]
Abstract
IMPORTANCE There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. OBJECTIVE To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. DESIGN Natural experiment utilizing a pre-post design with concurrent controls. SETTING Academic tertiary care hospital. PARTICIPANTS We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. EXPOSURE Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. MAIN OUTCOMES AND MEASURES The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. RESULTS The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical providers, ancillary staff, and only 1 of 4 measures of overall satisfaction improved. The most prominent increase was with pleasantness of décor (33.6% vs 64.8%) and visitor accommodation and comfort (50.0% vs 70.3%). CONCLUSION AND RELEVANCE Patients responded positively to pleasing surroundings and comfort, but were able to discriminate their experiences with the hospital environment from those with physicians and nurses. The move to a new building had significant impact on only 1 of the 4 measures of overall patient satisfaction, as clinical care is likely to be the most important determinant of this outcome. Hospital administrators should not use outdated facilities as an excuse for suboptimal provider satisfaction scores.
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Affiliation(s)
- Zishan K Siddiqui
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Improving the patient’s environment: the ideal intensive care unit. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-014-1012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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