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Chung NR, Chae SM. Mothering children at a paediatric intensive care unit with strict visiting hours: A qualitative study. Nurs Crit Care 2023. [PMID: 37818784 DOI: 10.1111/nicc.12985] [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: 11/10/2022] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Although a child- and family-centred care (CFCC) philosophy has been emphasized and adopted for decades in paediatric critical care settings in several countries, numerous issues from parents' perspectives regarding the philosophy remain unresolved. To facilitate the full translation of CFCC into clinical practice, health care professionals need an in-depth understanding of family experiences. Real-life mothering experiences, including maternal roles and identities, remain largely unknown at paediatric intensive care units (PICUs) in the Republic of Korea, where family visitation, presence, and participation are restricted. AIM To explore mothering experiences at a PICU where family visitation is strictly constrained, and to identify maternal needs and values. STUDY DESIGN We conducted a qualitative descriptive study of eight individual in-depth interviews with seven mothers of hospitalized children. Qualitative data were analysed using inductive thematic analysis. FINDINGS Five major themes, along with four subthemes, emerged: (1) shifts in maternal roles and responsibilities, (2) shifts in interpersonal relationships, (3) desire for CFCC in the PICU, (4) practising self-defined mothering roles, and (5) reconstructing maternal identities. The themes revealed the experiences of becoming mothers of a child in a constrained PICU. Ultimately, mothers demanded that the unit improve its physical and cultural environments through, for example, liberalized family visitation and participation in the care of their children. CONCLUSIONS Nursing professionals should lead the charge for humanizing a restrictive PICU in the Republic of Korea by ensuring a safe and open environment and mothering continuity based on child- and family-centred holistic care. RELEVANCE TO CLINICAL PRACTICE Effective interventions must be developed and tested to globally establish and fully implement strong evidence-based CFCC in PICUs; constant co-commitment among children, families, health care professionals, and institutions is also necessary.
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Affiliation(s)
- Na-Ry Chung
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Mi Chae
- Seoul National University College of Nursing, The Research Institute of Nursing Science, Seoul, Republic of Korea
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Lee J, Choi S. The experience of fathers whose infants were hospitalized in Neonatal Intensive Care Unit in South Korea: A scoping review. J Pediatr Nurs 2023; 72:36-44. [PMID: 37037103 DOI: 10.1016/j.pedn.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/03/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023]
Abstract
PROBLEM The purpose of this scoping review was to map and organize the previous studies conducted among fathers whose infants experienced admission to neonatal intensive care units (NICUs) in South Korea. ELIGIBILITY CRITERIA A scoping review was conducted based on Arksey and O'Malley using the JBI template. The review was described by PRISMA-ScR. The studies were reviewed through five electronic databases (PubMed, CINAHL, Web of Science, RISS and KMbase) since 1996. Each study was analyzed, extracted, and summarized into the following domains: general characteristics (language, design, data collection methods, intervention, data collection site, and time) and fathers' characteristics (types of fathers, mean age, variables related to the fathers, and measurements). SAMPLE A total of 290 studies were identified after screening titles and abstracts, and 32 full-text articles were retrieved for eligibility. Finally, 15 articles were included in the review. RESULTS Four themes were derived after review: paternal stress, paternal attachment, fathers' adaptation, and fathers' support needs. CONCLUSIONS Infants' hospitalization in NICUs causes stress for fathers but they overcome difficulties and play multiple roles as guardians, caregivers, and decision-makers of their spouses and infants over time. Paternal attachment increases significantly after participating in tactile and educational interventions. Fathers rely on nurses and they want to receive support from nurses. IMPLICATIONS It is necessary for NICU nurses to understand and support fathers whose infants are hospitalized in NICUs. Medical institutions should provide nursing interventions and education for fathers to relieve their stress, help their adaptation, and improve attachment.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing, Catholic University of Pusan, 57 Oryundae-ro, Geumjung-gu, Busan 46252, Republic of Korea.
| | - Sunyeob Choi
- Ewha Womans University, College of Nursing, 52 Ewhayeodae-gil, Seodamaemun-gu, Seoul 03760, Republic of Korea.
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Abstract
OBJECTIVES To assess the interplay between individual and organizational factors on moral distress in PICUs. DESIGN Cross-sectional, article-based survey administered between June and August 2017. SETTING Twenty-three Italian PICUs. SUBJECTS Of 874 eligible clinicians, 635 responded to the survey (75% response rate), and 612 correctly completed the survey. Clinicians were 74% female; 66% nurses and 34% physicians; and 51% had between 6 and 20 years of experience from graduation. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Clinicians completed the "Italian Moral Distress Scale-Revised," the "Connor-Davidson Resilience Scale," and a sociodemographic questionnaire inquiring about sex, profession, years of experience, and spiritual/religious belief. PICU organizational characteristics were also collected (e.g., number of admissions, mortality rate, nurse-patient ratio, presence of parents in PICU, presence of parents during physical examination). To identify individual predictors of moral distress, we used stepwise linear regression. To determine the impact of organizational factors on moral distress, we used analysis of covariance, controlling for those individual factors that emerged as significant in the regression model. Moral distress was associated with being a nurse (B = -0.094; p < 0.05) and not having spiritual/religious belief (B = 0.130; p < 0.01), but not with resilience. Clinicians working in PICUs with a medium number of admissions per year (between 264 and 468), a lower nurse:patient ratio (1:3), and where parents' presence during physical examination were never allowed experienced higher moral distress even controlling for profession and spiritual/religious belief. CONCLUSIONS Organizational factors (medium number of admissions, lower nurse:patient ratio, and parental exclusion from physical examination) played a stronger role than individual factors in increasing moral distress. To decrease moral distress, attention should be paid also to organizational aspects.
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Langer T, Depalo FC, Forlini C, Landini S, Mezzetti A, Previtali P, Monti G, de Toma C, Biscardi D, Giannini A, Fumagalli R, Mistraletti G. Communication and visiting policies in Italian intensive care units during the first COVID-19 pandemic wave and lockdown: a nationwide survey. BMC Anesthesiol 2022; 22:187. [PMID: 35710331 PMCID: PMC9203262 DOI: 10.1186/s12871-022-01726-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/09/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. METHODS A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. RESULTS Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0-6]%, 0 [0-4]% and 11 [2-25]%, respectively, p < 0.001). Habits of pediatric ICUs were less affected by the pandemic. CONCLUSIONS Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.
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Affiliation(s)
- Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesca Carmela Depalo
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Clarissa Forlini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Silvia Landini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Paola Previtali
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Gianpaola Monti
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Carolina de Toma
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Davide Biscardi
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy. .,Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
| | - Giovanni Mistraletti
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Testoni I, Iacona E, Palazzo L, Barzizza B, Baldrati B, Mazzon D, Navalesi P, Mistraletti G, Leo DD. Death Notification in Italian Critical Care Unites and Emergency Services. A Qualitative Study with Physicians, Nurses and Relatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413338. [PMID: 34948947 PMCID: PMC8708256 DOI: 10.3390/ijerph182413338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
This qualitative study was conducted in critical care units and emergency services and was aimed at considering the death notification (DN) phenomenology among physicians (notifiers), patient relatives (receivers) and those who work between them (nurses). Through the qualitative method, a systemic perspective was adopted to recognise three different categories of representation: 23 clinicians, 13 nurses and 11 family members of COVID-19 victims were interviewed, totalling 47 people from all over Italy (25 females, mean age: 46,36; SD: 10,26). With respect to notifiers, the following themes emerged: the changes in the relational dimension, protective factors and difficulties related to DN. With respect to receivers, the hospital was perceived as a prison, bereavement between DN, lost rituals and continuing bonds. Among nurses, changes in the relational dimension, protective factors and the impact of the death. Some common issues between physicians and nurses were relational difficulties in managing distancing and empathy and the support of relatives and colleagues. The perspective of receivers showed suffering related to loss and health care professionals’ inefficacy in communication. Specifically, everyone considered DNs mismanaged because of the COVID-19 emergency. Some considerations inherent in death education for DN management among health professionals were presented.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
- Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
- Correspondence: ; Tel.: +39-049-827-6646
| | - Erika Iacona
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Lorenza Palazzo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Beatrice Barzizza
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Beatrice Baldrati
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Davide Mazzon
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35122 Padova, Italy; (E.I.); (L.P.); (B.B.); (B.B.); (D.M.)
| | - Paolo Navalesi
- Anesthesia and Intensive Care Unit, University Hospital of Padova, 35128 Padova, Italy;
- Department of Surgery and Medicine, University of Padua, 35128 Padova, Italy
| | - Giovanni Mistraletti
- Department of Medical-Surgical Pathophysiology and Transplantation, University of Milano, 20142 Milano, Italy;
| | - Diego De Leo
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane 4122, Australia;
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Frivold G, Ågård AS, Jensen HI, Åkerman E, Fossum M, Alfheim HB, Rasi M, Lind R. Family involvement in the intensive care unit in four Nordic countries. Nurs Crit Care 2021; 27:450-459. [PMID: 34405494 DOI: 10.1111/nicc.12702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/20/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement. AIMS AND OBJECTIVES To describe family involvement, communication practices and visiting policies in adult ICUs. DESIGN A cross-sectional survey. METHOD A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries. RESULTS The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments. CONCLUSIONS The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.
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Affiliation(s)
- Gro Frivold
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Anne Sophie Ågård
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,Department of Science in Nursing, Aarhus University, Aarhus, Denmark
| | - Hanne Irene Jensen
- Departments of Anaesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Eva Åkerman
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hanne Birgit Alfheim
- Faculty of Health, VID Specialized University, Oslo, Norway.,Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Matias Rasi
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ranveig Lind
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Intensive Care Unit, University Hospital of North Norway, Tromsø, Norway
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Jensen HI, Halvorsen K, Jerpseth H, Fridh I, Lind R. Practice Recommendations for End-of-Life Care in the Intensive Care Unit. Crit Care Nurse 2021; 40:14-22. [PMID: 32476029 DOI: 10.4037/ccn2020834] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
TOPIC A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices. CLINICAL RELEVANCE Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members. PURPOSE OF PAPER To provide recommendations for high-quality end-of-life care for patients and family members. CONTENT COVERED This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.
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Affiliation(s)
- Hanne Irene Jensen
- Hanne Irene Jensen is an associate professor at the Department of Anaesthesiology and Intensive Care, Vejle and Middelfart Hospitals, Vejle, Denmark, and the University of Southern Denmark, Odense, Denmark
| | - Kristin Halvorsen
- Kristin Halvorsen is a professor and researcher and Heidi Jerpseth is an associate professor and researcher at Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Heidi Jerpseth
- Kristin Halvorsen is a professor and researcher and Heidi Jerpseth is an associate professor and researcher at Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Isabell Fridh
- Isabell Fridh is an associate professor at the Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Ranveig Lind
- Ranveig Lind is an associate professor at UiT, the Arctic University of Norway, and a research nurse in the intensive care unit at University Hospital of North Norway, Tromsø, Norway
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Mistraletti G, Giannini A, Gristina G, Malacarne P, Mazzon D, Cerutti E, Galazzi A, Giubbilo I, Vergano M, Zagrebelsky V, Riccioni L, Grasselli G, Scelsi S, Cecconi M, Petrini F. Why and how to open intensive care units to family visits during the pandemic. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:191. [PMID: 34078445 PMCID: PMC8171999 DOI: 10.1186/s13054-021-03608-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Since the lockdown because of the pandemic, family members have been prohibited from visiting their loved ones in hospital. While it is clearly complicated to implement protocols for the admission of family members, we believe precise strategic goals are essential and operational guidance is needed on how to achieve them. Even during the pandemic, we consider it a priority to share strategies adapted to every local setting to allow family members to enter intensive care units and all the other hospital wards.
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Affiliation(s)
- Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. .,SC Anesthesia and Intensive Care, San Paolo Hospital - Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Giuseppe Gristina
- Italian Society of Anaesthesia, Analgesia, Reanimation, and Intensive Care Medicine (SIAARTI) Ethics, Rome, Italy
| | | | - Davide Mazzon
- UOC Anesthesia and Intensive Care, Belluno Hospital, Belluno, Italy
| | - Elisabetta Cerutti
- Department of Anesthesia and Transplant, Surgical Intensive Care, AOU Ospedali Riuniti, Ancona, Italy
| | - Alessandro Galazzi
- Direction of Healthcare Professions, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ilaria Giubbilo
- General and Neurosurgical ICU, Ospedale dell'Angelo, AULSS 3 Serenissima Veneto, Venice, Italy
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Vladimiro Zagrebelsky
- Director, Laboratorio dei Diritti Fondamentali, Collegio Carlo Alberto, Turin, Italy
| | | | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Scelsi
- Chair Aniarti, Director of Health Profession Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Flavia Petrini
- SIAARTI President - Retired Full Professor of Anesthesia and Intensive Care, Chieti-Pescara University, Chieti, Italy
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Laurent A, Nguyen S, Leclerc P, Capellier G. L’enfant visiteur en réanimation adulte : vécu psychologique de la visite et dispositifs d’accompagnement. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ewens B, Collyer D, Kemp V, Arabiat D. The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review. Aust Crit Care 2021; 34:604-619. [PMID: 33736910 DOI: 10.1016/j.aucc.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
AIM The aim of the study was to identify the enablers and/or barriers to children visiting their ill parent/carer in intensive care units by examining the visiting policies as practiced or perceived by nurses and experienced or perceived by parents and caregivers. REVIEW METHOD This is a scoping review following Joanna Briggs Institute Protocol Guidelines. DATA SOURCES An extensive literature search of Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsychINFO, PubMed, and Excerpta Medica dataBASE databases, using key terms, was conducted between May 2019 and July 2020; studies published between 1990 and 2020 were considered for inclusion. Double screening, extraction, and coding of the data using thematic analysis and frequency counts were used. RESULTS Fifteen barriers, 19 facilitators, nine situationally contingent factors, and six personal judgement considerations were identified that influenced children visiting their ill parent/carer in intensive care units. Most barriers (n = 10) were related to organisational factors including restrictive policies, nurses' level of education, age, working hours, nurses' attitudes, and lack of required skills to promote emotional resilience and/or to communicate with children. Family perception factors relating to parents' perceptions, attitudes and concerns of staff/parents, and anticipated behaviours of children were also identified as both barriers and facilitators. CONCLUSIONS There is a lack of consistency in the application of policies and procedures to facilitate children visiting their loved ones in an intensive care unit. Without key involvement from the nurses and healthcare team, there may have been opportunities lost to optimise family-centred care practices in critical care settings.
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Affiliation(s)
- Beverley Ewens
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Doreen Collyer
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Vivien Kemp
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Diana Arabiat
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Maternal and Child Nursing Department, School of Nursing, The University of Jordan, Amman, 11942, Jordan
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Liang S, Chau JPC, Lo SHS, Li S, Gao M. Implementation of ABCDEF care bundle in intensive care units: A cross-sectional survey. Nurs Crit Care 2021; 26:386-396. [PMID: 33522036 DOI: 10.1111/nicc.12597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Delirium affects up to 80% of patients in intensive care units (ICUs) and is associated with higher mortality, physical dependence, and health care costs. The 2018 pain, agitation, delirium, immobility, and sleep guideline recommended ABCDEF care bundle for delirium prevention and management. However, limited information is available regarding the adoption of the care bundle in ICUs in Mainland China. AIMS AND OBJECTIVES To assess the current implementation of the ABCDEF care bundle for delirium prevention as reported by ICU nurses in Mainland China. DESIGN A cross-sectional study was conducted. METHODS A cross-sectional online survey using a validated questionnaire about the practices of the ABCDEF care bundle was conducted among 334 registered nurses in 167 ICUs of 65 cities in Mainland China. RESULTS Almost 50% of the sampled ICU nurses were unaware of the ABCDEF care bundle, though 86.83% of the surveyed ICUs implemented pain assessments and 95.51% implemented sedation assessments. Nearly half (46.41%) of the surveyed ICUs performed routine spontaneous awaking trials, with 21.26% performing them daily. Spontaneous breathing trials were performed in 38.32% of the surveyed ICUs. Only 47% of the surveyed ICUs routinely monitored patients for delirium. About one-third (38.35%) of the surveyed ICUs were supported by specialist teams that implemented the mobilization programmes. Most ICUs restricted the duration of family visits per day (<0.5 hour: 61.67%; 0.5-2 hours: 23.65%; >2 hours: 3.29%) and only 28.14% of the surveyed ICUs employed dedicated staff to support the families. CONCLUSIONS Although most of the surveyed ICUs implemented pain and sedation assessments, many of them did not implement structured delirium assessments. Early mobilization programmes and family participation should be encouraged. RELEVANCE TO CLINICAL PRACTICE Promoting the uses of a reliable delirium assessment tool such as Confusion Assessment Method for Intensive Care Unit patients, building an early mobilization team, and engaging family caregivers in the care plan may contribute to improved patients' clinical outcomes.
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Affiliation(s)
- Surui Liang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shunling Li
- The Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mingrong Gao
- The Surgical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Zuo J, Tao Y, Liu M, Feng L, Yang Y, Liao L. The effect of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury: A systematic review and meta-analysis. Int J Nurs Stud 2020; 115:103846. [PMID: 33485101 DOI: 10.1016/j.ijnurstu.2020.103846] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sensory stimulation has been used in the early rehabilitation of comatose patients with traumatic brain injury, but the effect of sensory stimulation involving family members is unclear. OBJECTIVES To evaluate the effects of family-centered sensory and affective stimulation on comatose patients with traumatic brain injury and explore the factors that affect the outcomes. DESIGN A systematic review with a meta-analysis. DATA SOURCES Electronic databases including PubMed, Web of Science, Google Scholar, Cochrane Library, CINAHL, China National Knowledge Infrastructure, and WanFang were searched from October 2019 to May 2020. REVIEW METHODS Two reviewers independently assessed eligibility of potential studies and extracted data. Quality of included studies was assessed according to the evaluation criteria of Cochrane Evaluation Manual 5.1.0. Outcome measures of the meta-analysis were the Glasgow Coma Scale scores, the Western Neuro Sensory Stimulation Profile scores, awakening time, and satisfaction rate. To explore whether there was a difference in the effect between variants of the intervention, variables as subgroups were time to start intervention, type of intervention, duration of each intervention, daily frequency of intervention, days of intervention, and patient's area. RESULT Seventeen randomized controlled trials were included in the review and meta-analysis. Most studies were of medium quality. The improvement of the Glasgow Coma Scale score is significantly greater with the intervention implemented within 24 h compared to the intervention implemented 24 h later (mean difference 3.91, 95% confidence interval 3.44-4.38 vs. mean difference 1.90, 95% confidence interval 1.69-2.12, respectively). The results of subgroup analyses show that auditory stimulation combined with tactile stimulation and multi-sensory stimulation are associated with better outcomes than a single use of auditory stimulation. Studies from Asia report more positive outcomes than those from America (mean difference 1.94, 95% confidence interval 1.73-2.16 vs. mean difference 0.44, 95% confidence interval -0.87-1.75). And the improvement of the Glasgow Coma Scale score with the stimulation performed by family members is greater than that with the stimulation implemented by nurses (mean difference 2.17, 95% confidence interval 1.67-2.66). Besides, it is associated with better awakening time, awakening rate, and satisfaction rate compared to routine care. CONCLUSION Early family-centered sensory and affective stimulation is more effective than routine care and nurse-implemented sensory stimulation in improving the level of consciousness and cognition of comatose patients with traumatic brain injury, and multi-sensory stimulation is more effective than single stimulation. More studies with larger sample size and high quality in different countries are warranted.
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Affiliation(s)
- Jiaojiao Zuo
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Yanling Tao
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, PR China.
| | - Min Liu
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Li Feng
- Department of Nursing, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan, PR China.
| | - Yang Yang
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
| | - Limei Liao
- University of Electronic Science and Technology of China, Chengdu 610054, Sichuan, PR China.
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van der Heijden MJE, van Mol MMC, Witkamp EFE, Osse RJ, Ista E, van Dijk M. Perspectives of patients, relatives and nurses on rooming-in for adult patients: A scoping review of the literature. Appl Nurs Res 2020; 55:151320. [PMID: 32868147 DOI: 10.1016/j.apnr.2020.151320] [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: 03/05/2020] [Revised: 05/22/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022]
Abstract
AIM To explore the perspectives of patients, their relatives and nurses on rooming-in for adult patients. BACKGROUND The practice of having family stay overnight with an adult patient in hospital is quite new. To support rooming-in programs, the perspectives from all stakeholders should be taken into account. METHODS All types of studies on rooming-in in adult healthcare settings were included in this scoping review. Rooming-in has been defined as the practice where 'family members or trusted others are facilitated to continuously stay with the patient and are provided with facilities to sleep in the patient's room'. RESULTS Seven studies were included: one randomized controlled trial, three qualitative studies, and three correspondence articles. Generally, patients felt safe in the presence of a family member, but could also feel restricted in their freedom and privacy. Family members saw a benefit for the patient, considered rooming-in a moral duty, and were happy to help. Nonetheless, family members reported rooming-in as physically and emotionally stressful. Nurses described that patients were less anxious and more easily adjusted to the hospital environment. CONCLUSIONS The reviewed studies suggest that patients, family members, and nurses have both positive and negative experiences with rooming-in. The concept of rooming-in varies from continuous presence and involvement of relatives to one overnight stay in the patient's room. Each interpretation has its own implications for policy, design, guidelines and feasibility of rooming-in. Nursing staff should be included in decision-making processes for this practice.
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Affiliation(s)
| | - Margo M C van Mol
- Department of Intensive Care Adults, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erica F E Witkamp
- Faculty of Nursing and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robert Jan Osse
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands
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Cavaliere F, Biancofiore G, Bignami E, De Robertis E, Giannini A, Grasso S, Piastra M, Scolletta S, Taccone FS, Terragni P. A year in review in Minerva Anestesiologica 2018. Critical care. Experimental and clinical studies. Minerva Anestesiol 2020; 85:95-105. [PMID: 30632731 DOI: 10.23736/s0375-9393.18.13524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Franco Cavaliere
- Institute of Anesthesia and Intensive Care, Sacred Heart Catholic University, Rome, Italy -
| | - Gianni Biancofiore
- Transplant Anesthesia and Critical Care, University School of Medicine, Pisa, Italy
| | - Elena Bignami
- Division of Anesthesiology, Critical Care and Pain Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Edoardo De Robertis
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University of Naples, Naples, Italy
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini, ASST - Spedali Civili di Brescia, Brescia, Italy
| | - Salvatore Grasso
- Division of Anesthesiology and Resuscitation, Department of Emergency and Organ Transplantation (DETO), Aldo Moro University of Bari, Policlinic Hospital, Bari, Italy
| | - Marco Piastra
- Pediatric Intensive Care Unit and Trauma Center, University Policlinic A. Gemelli IRCCS Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Sabino Scolletta
- Unit of Resuscitation, Critical Care, Anesthesia and Intensive Care, University Hospital of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierpaolo Terragni
- Division of Anesthesia and General Intensive Care, Department of Medical, Surgical and Experimental Sciences, Sassari University Hospital, University of Sassari, Sassari, Italy
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Akbari R, Karimi Moonaghi H, Mazloum SR, Bagheri Moghaddam A. Implementation of a flexible visiting policy in intensive care unit: A randomized clinical trial. Nurs Crit Care 2020; 25:221-228. [PMID: 31975479 DOI: 10.1111/nicc.12499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/09/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Visitation is one of the most critical needs of patients in intensive care units (ICUs). Clinicians should enable a more flexible visitation policy to prevent the adverse effects of a restricted approach. AIM AND OBJECTIVES This study aimed at investigating the relationship between increasing visitation time and patients' physiological parameters in intensive units. Additionally, nurses' beliefs and attitudes towards visiting is examined in this research. DESIGN Parallel randomized clinical trial. METHODS This study was conducted in four general medical ICUs in Iran. In total, 60 patients and 57 nurses participated in this study. The patients' physiological parameters were measured at particular times in both groups. Moreover, the nurses responded to the questionnaire on beliefs and attitudes towards visitation in intensive units before and after the intervention. RESULTS Among all the physiological parameters, systolic and diastolic blood pressure and heart rate had a significant decrease within the normal range 10 and 30 minutes after visiting in the intervention group (P < .05), and nurses' beliefs and attitudes score were at the middle of the survey scoring range (0-120). However, no significant difference was found between nurses' belief and attitude score and intervention in any groups (P > .05). CONCLUSION The findings indicate that increasing visitation times can lead to a positive effect on the stability and balance of patients' physiological parameters. RELEVANCE TO CLINICAL PRACTICE A more flexible visiting policy can provide a therapeutic environment where not only patients' physiological disorders are minimised as much as possible but also a higher level of patients' health and satisfaction are reached.
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Affiliation(s)
- Reihane Akbari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Karimi Moonaghi
- Nursing and Midwifery Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazloum
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghaddam
- Internal Medicine and Critical Care, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
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Mistraletti G, Mezzetti A, Anania S, Ionescu Maddalena A, Del Negro S, Giusti GD, Gili A, Iacobone E, Pulitanò SM, Conti G, Bocci MG. Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study. Contemp Clin Trials 2019; 86:105847. [PMID: 31525488 DOI: 10.1016/j.cct.2019.105847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME correct understanding of the prognosis. SECONDARY OUTCOMES correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS 2100 ICU relatives of critically ill patients. INTERVENTIONS The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER NCT03438175.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Andrea Mezzetti
- AUSL Toscana Centro, SOS 118 Emergenza Territoriale, Empoli, Italy
| | - Stefania Anania
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Alessandra Ionescu Maddalena
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Del Negro
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | | | - Alessio Gili
- Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Italy
| | - Emanuele Iacobone
- SAR, Dipartimento Emergenza-Urgenza, AV3 Ospedale di Macerata, ASUR Marche, Italy
| | - Silvia Maria Pulitanò
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giorgio Conti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Grazia Bocci
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Lee SJ, Choi EK, Park J, Kim HS. Correlations between a Flexible Parental Visiting Environment and Parental Stress in Neonatal Intensive Care Units. CHILD HEALTH NURSING RESEARCH 2019; 25:377-387. [PMID: 35004429 PMCID: PMC8650991 DOI: 10.4094/chnr.2019.25.4.377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022] Open
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Flexible Versus Restrictive Visiting Policies in ICUs: A Systematic Review and Meta-Analysis. Crit Care Med 2019; 46:1175-1180. [PMID: 29642108 DOI: 10.1097/ccm.0000000000003155] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To synthesize data on outcomes related to patients, family members, and ICU professionals by comparing flexible versus restrictive visiting policies in ICUs. DATA SOURCES Medline, Scopus, and Web of Science. STUDY SELECTION Observational and randomized studies comparing flexible versus restrictive visiting policies in the ICU and evaluating at least one patient-, family member-, or ICU staff-related outcome. DATA EXTRACTION Duplicate independent review and data abstraction. DATA SYNTHESIS Of 16 studies identified for inclusion, seven were meta-analyzed. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium (odds ratio, 0.39; 95% CI, 0.22-0.69; I = 0%) and lower severity of anxiety symptoms (mean difference, -2.20; 95% CI, -3.80 to -0.61; I = 71%). Flexible visiting policies were not associated with increased risk of ICU mortality (odds ratio, 0.71; 95% CI, 0.38-1.36; I = 86%), ICU-acquired infections (odds ratio, 0.98; 95% CI, 0.68-1.42; I = 11%), or longer ICU stay (mean difference, -0.26 d; 95% CI, -0.57 to 0.05; I = 54%). Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels. CONCLUSIONS Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU professionals. These conclusions are based on few studies, with small samples and moderate risk of bias.
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Page P, Simpson A, Reynolds L. Bearing witness and being bounded: The experiences of nurses in adult critical care in relation to the survivorship needs of patients and families. J Clin Nurs 2019; 28:3210-3221. [PMID: 31017337 DOI: 10.1111/jocn.14887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
AIM To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. BACKGROUND The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. DESIGN A constructivist grounded theory approach with constant comparative analysis. METHODS As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. CONCLUSION The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.
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Affiliation(s)
- Pamela Page
- Faculty of Health Social Care & Education, School of Nursing & Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - Alan Simpson
- School of Health Sciences, Centre for Mental Health Research, City, University of London, London, UK
| | - Lisa Reynolds
- Nursing Division, School of Health Sciences, City, University of London, London, UK
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Grignoli N, Di Bernardo V, Malacrida R. New perspectives on substituted relational autonomy for shared decision-making in critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:260. [PMID: 30309384 PMCID: PMC6182794 DOI: 10.1186/s13054-018-2187-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022]
Abstract
In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients’ preferences. New perspectives on substituted relational autonomy are needed for overcoming this climate of suspicion and are discussed through recent literature in the field of medical ethics.
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Affiliation(s)
- Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland. .,Clinical Ethics Commission, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland. .,Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, CH-6850, Mendrisio, Switzerland.
| | - Valentina Di Bernardo
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland.,Clinical Ethics Commission, Ente Ospedaliero Cantonale, CH-6500, Bellinzona, Switzerland.,Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, CH-6900, Lugano, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Via Lugano 4b, CH-6500, Bellinzona, Switzerland
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A Path to High-Quality Care. Crit Care Med 2018; 46:1203-1204. [DOI: 10.1097/ccm.0000000000003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wassenaar A, Schoonhoven L, Devlin JW, van Haren FMP, Slooter AJC, Jorens PG, van der Jagt M, Simons KS, Egerod I, Burry LD, Beishuizen A, Matos J, Donders ART, Pickkers P, van den Boogaard M. Delirium prediction in the intensive care unit: comparison of two delirium prediction models. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:114. [PMID: 29728150 PMCID: PMC5935943 DOI: 10.1186/s13054-018-2037-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
Abstract
Background Accurate prediction of delirium in the intensive care unit (ICU) may facilitate efficient use of early preventive strategies and stratification of ICU patients by delirium risk in clinical research, but the optimal delirium prediction model to use is unclear. We compared the predictive performance and user convenience of the prediction model for delirium (PRE-DELIRIC) and early prediction model for delirium (E-PRE-DELIRIC) in ICU patients and determined the value of a two-stage calculation. Methods This 7-country, 11-hospital, prospective cohort study evaluated consecutive adults admitted to the ICU who could be reliably assessed for delirium using the Confusion Assessment Method-ICU or the Intensive Care Delirium Screening Checklist. The predictive performance of the models was measured using the area under the receiver operating characteristic curve. Calibration was assessed graphically. A physician questionnaire evaluated user convenience. For the two-stage calculation we used E-PRE-DELIRIC immediately after ICU admission and updated the prediction using PRE-DELIRIC after 24 h. Results In total 2178 patients were included. The area under the receiver operating characteristic curve was significantly greater for PRE-DELIRIC (0.74 (95% confidence interval 0.71–0.76)) compared to E-PRE-DELIRIC (0.68 (95% confidence interval 0.66–0.71)) (z score of − 2.73 (p < 0.01)). Both models were well-calibrated. The sensitivity improved when using the two-stage calculation in low-risk patients. Compared to PRE-DELIRIC, ICU physicians (n = 68) rated the E-PRE-DELIRIC model more feasible. Conclusions While both ICU delirium prediction models have moderate-to-good performance, the PRE-DELIRIC model predicts delirium better. However, ICU physicians rated the user convenience of E-PRE-DELIRIC superior to PRE-DELIRIC. In low-risk patients the delirium prediction further improves after an update with the PRE-DELIRIC model after 24 h. Trial registration ClinicalTrials.gov, NCT02518646. Registered on 21 July 2015. Electronic supplementary material The online version of this article (10.1186/s13054-018-2037-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annelies Wassenaar
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Lisette Schoonhoven
- Faculty of Health Sciences and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Southampton, UK.,Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - John W Devlin
- School of Pharmacy, Northeastern University, Boston, USA.,Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, USA
| | - Frank M P van Haren
- Intensive Care Unit, The Canberra Hospital, Canberra, Australia.,Faculty of Health, University of Canberra, Canberra, Australia.,College of Health and Medicine, Australian National University, Canberra, Australia
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Philippe G Jorens
- Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Antwerp, Belgium
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands
| | - Ingrid Egerod
- Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lisa D Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Mount Sinai Hospital, Sinai Health System, Toronto, Canada
| | - Albertus Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Joaquim Matos
- Department of Intensive Care Medicine, Hospital Espírito Santo, Evora, Portugal
| | - A Rogier T Donders
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.,Radboud Center for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, the Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
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The authors reply. Crit Care Med 2018; 46:e480. [DOI: 10.1097/ccm.0000000000003031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rosa RG, Falavigna M, Robinson CC, da Silva DB, Kochhann R, de Moura RM, Santos MMS, Sganzerla D, Giordani NE, Eugênio C, Ribeiro T, Cavalcanti AB, Bozza F, Azevedo LCP, Machado FR, Salluh JIF, Pellegrini JAS, Moraes RB, Hochegger T, Amaral A, Teles JMM, da Luz LG, Barbosa MG, Birriel DC, Ferraz IDL, Nobre V, Valentim HM, Corrêa E Castro L, Duarte PAD, Tregnago R, Barilli SLS, Brandão N, Giannini A, Teixeira C. Study protocol to assess the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units: a cluster-randomised, crossover trial (The ICU Visits Study). BMJ Open 2018; 8:e021193. [PMID: 29654049 PMCID: PMC5905750 DOI: 10.1136/bmjopen-2017-021193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Flexible intensive care unit (ICU) visiting hours have been proposed as a means to improve patient-centred and family-centred care. However, randomised trials evaluating the effects of flexible family visitation models (FFVMs) are scarce. This study aims to compare the effectiveness and safety of an FFVM versus a restrictive family visitation model (RFVM) on delirium prevention among ICU patients, as well as to analyse its potential effects on family members and ICU professionals. METHODS AND ANALYSIS A cluster-randomised crossover trial involving adult ICU patients, family members and ICU professionals will be conducted. Forty medical-surgical Brazilian ICUs with RFVMs (<4.5 hours/day) will be randomly assigned to either an RFVM (visits according to local policies) or an FFVM (visitation during 12 consecutive hours per day) group at a 1:1 ratio. After enrolment and follow-up of 25 patients, each ICU will be switched over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome will be the cumulative incidence of delirium among ICU patients, measured twice a day using the Confusion Assessment Method for the ICU. Secondary outcome measures will include daily hazard of delirium, ventilator-free days, any ICU-acquired infections, ICU length of stay and hospital mortality among the patients; symptoms of anxiety and depression and satisfaction among the family members; and prevalence of burnout symptoms among the ICU professionals. Tertiary outcomes will include need for antipsychotic agents and/or mechanical restraints, coma-free days, unplanned loss of invasive devices and ICU-acquired pneumonia, urinary tract infection or bloodstream infection among the patients; self-perception of involvement in patient care among the family members; and satisfaction among the ICU professionals. ETHICS AND DISSEMINATION The study protocol has been approved by the research ethics committee of all participant institutions. We aim to disseminate the findings through conferences and peer-reviewed journals. TRIAL REGISTRATION NCT02932358.
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Affiliation(s)
- Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | - Maicon Falavigna
- Institute for Education and Research, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | | | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | | | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | - Cláudia Eugênio
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | - Tarissa Ribeiro
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
| | | | - Fernando Bozza
- Department of Critical Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | | | - Flávia Ribeiro Machado
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | - Taís Hochegger
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Alexandre Amaral
- Intensive Care Unit, Hospital de Urgências de Goiânia, Goiânia, Brazil
| | | | | | | | | | - Iris de Lima Ferraz
- Intensive Care Unit, Hospital de Urgência e Emergência de Rio Branco, Rio Branco, Brazil
| | - Vandack Nobre
- Intensive Care Unit, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Péricles Almeida Delfino Duarte
- Intensive Care Unit, Hospital do Câncer de Cascavel, Cascavel, Brazil
- Intensive Care, Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
| | | | | | - Nilton Brandão
- Department of Internal Medicine, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Alberto Giannini
- Unit of Pediatric Anesthesia and Intensive Care, Ospedale dei Bambini - ASST Spedali Civili, Brescia, Italy
| | - Cassiano Teixeira
- Intensive Care Unit, Hospital Moinhos de Vento (HMV), Porto Alegre, Brazil
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Prevalence of Anxiety and Depression Symptomatology in Adolescents Faced With the Hospitalization of a Loved One in the ICU*. Crit Care Med 2018; 46:e330-e333. [DOI: 10.1097/ccm.0000000000002964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Loudet CI, Marchena MC, Maradeo MR, Fernández SL, Romero MV, Valenzuela GE, Herrera IE, Ramírez MT, Palomino SR, Teberobsky MV, Tumino LI, González AL, Reina R, Estenssoro E. Reducing pressure ulcers in patients with prolonged acute mechanical ventilation: a quasi-experimental study. Rev Bras Ter Intensiva 2018; 29:39-46. [PMID: 28444071 PMCID: PMC5385984 DOI: 10.5935/0103-507x.20170007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/17/2016] [Indexed: 01/09/2023] Open
Abstract
Objective: To determine the effectiveness of a quality management program in reducing the incidence and severity of pressure ulcers in critical care patients. Methods: This was a quasi-experimental, before-and-after study that was conducted in a medical-surgical intensive care unit. Consecutive patients who had received mechanical ventilation for ≥ 96 hours were included. A "Process Improvement" team designed a multifaceted interventional process that consisted of an educational session, a pressure ulcer checklist, a smartphone application for lesion monitoring and decision-making, and a "family prevention bundle". Results: Fifty-five patients were included in Pre-I group, and 69 were included in the Post-I group, and the incidence of pressure ulcers in these groups was 41 (75%) and 37 (54%), respectively. The median time for pressure ulcers to develop was 4.5 [4 - 5] days in the Pre-I group and 9 [6 - 20] days in the Post-I group after admission for each period. The incidence of advanced-grade pressure ulcers was 27 (49%) in the Pre-I group and 7 (10%) in the Post-I group, and finally, the presence of pressure ulcers at discharge was 38 (69%) and 18 (26%), respectively (p < 0.05 for all comparisons). Family participation totaled 9% in the Pre-I group and increased to 57% in the Post-I group (p < 0.05). A logistic regression model was used to analyze the predictors of advanced-grade pressure ulcers. The duration of mechanical ventilation and the presence of organ failure were positively associated with the development of pressure ulcers, while the multifaceted intervention program acted as a protective factor. Conclusion: A quality program based on both a smartphone application and family participation can reduce the incidence and severity of pressure ulcers in patients on prolonged acute mechanical ventilation.
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Affiliation(s)
- Cecilia Inés Loudet
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina.,Disciplina de Farmacologia Aplicada, Seção de Terapia Intensiva, Facultad de Ciencias Médicas, Universidad Nacional de La Plata - La Plata, Buenos Aires, Argentina
| | - María Cecilia Marchena
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Roxana Maradeo
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Laura Fernández
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - María Victoria Romero
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Graciela Esther Valenzuela
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Isabel Eustaquia Herrera
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Martha Teresa Ramírez
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Silvia Rojas Palomino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Mariana Virginia Teberobsky
- Serviço de Dermatologia, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Leandro Ismael Tumino
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Ana Laura González
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Rosa Reina
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
| | - Elisa Estenssoro
- Unidade de Terapia Intensiva, Hospital Interzonal General de Agudos "General San Martín" - La Plata, Buenos Aires, Argentina
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Implementation and Operational Analysis of an Interactive Intensive Care Unit within a Smart Health Context. SENSORS 2018; 18:s18020389. [PMID: 29382148 PMCID: PMC5854996 DOI: 10.3390/s18020389] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/23/2018] [Accepted: 01/26/2018] [Indexed: 11/17/2022]
Abstract
In the context of hospital management and operation, Intensive Care Units (ICU) are one of the most challenging in terms of time responsiveness and criticality, in which adequate resource management and signal processing play a key role in overall system performance. In this work, a context aware Intensive Care Unit is implemented and analyzed to provide scalable signal acquisition capabilities, as well as to provide tracking and access control. Wireless channel analysis is performed by means of hybrid optimized 3D Ray Launching deterministic simulation to assess potential interference impact as well as to provide required coverage/capacity thresholds for employed transceivers. Wireless system operation within the ICU scenario, considering conventional transceiver operation, is feasible in terms of quality of service for the complete scenario. Extensive measurements of overall interference levels have also been carried out, enabling subsequent adequate coverage/capacity estimations, for a set of Zigbee based nodes. Real system operation has been tested, with ad-hoc designed Zigbee wireless motes, employing lightweight communication protocols to minimize energy and bandwidth usage. An ICU information gathering application and software architecture for Visitor Access Control has been implemented, providing monitoring of the Boxes external doors and the identification of visitors via a RFID system. The results enable a solution to provide ICU access control and tracking capabilities previously not exploited, providing a step forward in the implementation of a Smart Health framework.
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Worldwide Survey of the "Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment" (ABCDEF) Bundle. Crit Care Med 2017; 45:e1111-e1122. [PMID: 28787293 DOI: 10.1097/ccm.0000000000002640] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines. DESIGN Worldwide online survey. SETTING Intensive care. INTERVENTION A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle. MEASUREMENT AND MAIN RESULTS There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was "prescribed" by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits. CONCLUSIONS The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
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Effectiveness and Safety of an Extended ICU Visitation Model for Delirium Prevention: A Before and After Study. Crit Care Med 2017; 45:1660-1667. [PMID: 28671901 DOI: 10.1097/ccm.0000000000002588] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the effect of an extended visitation model compared with a restricted visitation model on the occurrence of delirium among ICU patients. DESIGN Prospective single-center before and after study. SETTING Thirty-one-bed medical-surgical ICU. PATIENTS All patients greater than or equal to 18 years old with expected length of stay greater than or equal to 24 hours consecutively admitted to the ICU from May 2015 to November 2015. INTERVENTIONS Change of visitation policy from a restricted visitation model (4.5 hr/d) to an extended visitation model (12 hr/d). MEASUREMENTS AND MAIN RESULTS Two hundred eighty-six patients were enrolled (141 restricted visitation model, 145 extended visitation model). The primary outcome was the cumulative incidence of delirium, assessed bid using the confusion assessment method for the ICU. Predefined secondary outcomes included duration of delirium/coma; any ICU-acquired infection; ICU-acquired bloodstream infection, pneumonia, and urinary tract infection; all-cause ICU mortality; and length of ICU stay. The median duration of visits increased from 133 minutes (interquartile range, 97.7-162.0) in restricted visitation model to 245 minutes (interquartile range, 175.0-272.0) in extended visitation model (p < 0.001). Fourteen patients (9.6%) developed delirium in extended visitation model compared with 29 (20.5%) in restricted visitation model (adjusted relative risk, 0.50; 95% CI, 0.26-0.95). In comparison with restricted visitation model patients, extended visitation model patients had shorter length of delirium/coma (1.5 d [interquartile range, 1.0-3.0] vs 3.0 d [interquartile range, 2.5-5.0]; p = 0.03) and ICU stay (3.0 d [interquartile range, 2.0-4.0] vs 4.0 d [interquartile range, 2.0-6.0]; p = 0.04). The rate of ICU-acquired infections and all-cause ICU mortality did not differ significantly between the two study groups. CONCLUSIONS In this medical-surgical ICU, an extended visitation model was associated with reduced occurrence of delirium and shorter length of delirium/coma and ICU stay.
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Latour JM, Coombs M. Family-centred care in Intensive Care: Moving the evidence forward-A call for papers. Intensive Crit Care Nurs 2017; 42:1-2. [PMID: 28789865 DOI: 10.1016/j.iccn.2017.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, 3 Portland Villas, Room 101, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Level 7 Clinical Services Block, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand.
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EMpowerment of PArents in THe Intensive Care Questionnaire: Translation and Validation in Italian PICUs. Pediatr Crit Care Med 2017; 18:e77-e85. [PMID: 27977540 DOI: 10.1097/pcc.0000000000001031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To translate and validate the EMpowerment of PArents in THe Intensive Care questionnaire to measure parent satisfaction and experiences in Italian PICUs. DESIGN Prospective, multicenter study. SETTING Four medical/surgical Italian PICUs in three tertiary hospitals. PATIENTS Families of children, 0-16 years old, admitted to the PICUs were invited to participate. Inclusion criteria were PICU length of stay greater than 24 hours and good comprehension of Italian language by parents/guardians. Exclusion criteria were readmission within 6 months and parents of a child who died in the PICU. INTERVENTIONS Distribution, at PICU discharge, of the EMpowerment of PArents in THe Intensive Care questionnaire with 65 items divided into five domains and a six-point rating scale: 1 " certainly no" to 6 "certainly yes." MEASUREMENTS AND MAIN RESULTS Back and forward translations of the EMpowerment of PArents in THe Intensive Care questionnaire between Dutch (original version) and Italian languages were deployed. Cultural adaptation of the instrument was confirmed by a consultation with a representative parent group (n = 10). Totally, 150 of 190 parents (79%) participated in the study. On item level, 12 statements scored a mean below 5.0. The Cronbach's α, measured for internal consistency, on domain level was between 0.67 and 0.96. Congruent validity was measured by correlating the five domains with four gold standard satisfaction measures and showed adequate correlations (rs, 0.41-0.71; p < 0.05). No significant differences occurred in the nondifferential validity testing between three children's characteristics and the domains; excepting parents with a child for a surgical and planned admission were more satisfied on information and organization issues. CONCLUSIONS The Italian version of the EMpowerment of PArents in THe Intensive Care questionnaire has satisfactory reliability and validity estimates and seems to be appropriate for Italian PICU setting. It is an important instrument providing benchmark data to be used in the process of quality improvement toward the development of a family-centered care philosophy within Italian PICUs.
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Tume LN, Ista E, van den Hoogen A, Wielenga J, Latour JM. A roadmap for paediatric and neonatal critical care nursing science in Europe: engage, action and impact. Nurs Crit Care 2017; 20:224-6. [PMID: 26268197 DOI: 10.1111/nicc.12175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lyvonne N Tume
- PICU and Children's Nursing Research Unit, Alder Hey Children's NHS, Liverpool L12 2AP, UK. .,University of Central Lancashire, School of Health, Preston PR1 2HE, UK.
| | - Erwin Ista
- Department of Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Agnes van den Hoogen
- Clinical Health Science Research & Education Division Woman and Baby University Medical Center Utrecht Utrecht, The Netherlans.
| | - Joke Wielenga
- Intensive Care Neonatology Emma Children's Hospital Academic Medical Centre Amsterdam, The Netherlands.
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, Devon PL4 8AA, UK. , .,School of Nursing and Midwifery, Faculty of Health Science, Curtin University, Perth 6102, Australia. ,
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Soares M, Silva UVA, Homena WS, Fernandes GC, De Moraes APP, Brauer L, Lima MF, De Marco FV, Bozza FA, Salluh JIF. Family care, visiting policies, ICU performance, and efficiency in resource use: insights from the ORCHESTRA study. Intensive Care Med 2016; 43:590-591. [PMID: 28028553 DOI: 10.1007/s00134-016-4654-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Marcio Soares
- Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil.
| | - Ulysses V A Silva
- ICU, Fundação Pio XII - Hospital de Câncer de Barretos, Barretos, Brazil
| | | | | | | | | | | | | | - Fernando A Bozza
- Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil
| | - Jorge I F Salluh
- Department of Critical Care, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30. Botafogo, Rio De Janeiro, 22281-100, Brazil
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Parental presence in Italian pediatric intensive care units: a reappraisal of current visiting policies. Intensive Care Med 2016; 43:458-459. [DOI: 10.1007/s00134-016-4628-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/26/2022]
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Pierrat V, Coquelin A, Cuttini M, Khoshnood B, Glorieux I, Claris O, Durox M, Kaminski M, Ancel PY, Arnaud C. Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study. Pediatr Crit Care Med 2016; 17:957-967. [PMID: 27518584 PMCID: PMC5049969 DOI: 10.1097/pcc.0000000000000914] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. DESIGN Prospective national cohort study of all births before 32 weeks of gestation. SETTING Twenty-five French regions. PARTICIPANTS All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p < 0.001). Individual factors associated with kangaroo care initiation were gestational age (odds ratio, 5.79; 95% CI, 4.49-7.48 for babies born at 27-31 wk compared with babies born at 23-26 wk) and, to a lesser extent, single pregnancy, birthweight above the 10th centile, and mother's employment before pregnancy. At unit level, policies and training in neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p < 0.0001). CONCLUSIONS Dissemination of neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.
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Affiliation(s)
- Veronique Pierrat
- 1Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France.2Paris Descartes University, Paris, France.3CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France.4Research Unit of Perinatal Epidemiology, Pediatric Hospital Bambino Gesù, Rome, Italy.5Department of Neonatology, Toulouse University Hospital, Toulouse, France.6Department of Neonatology, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Bron, France.7EAM 4128, Claude Bernard University Lyon 1,Villeurbanne, France.8Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hôtel-Dieu Hospital, Paris, France.9Inserm U 1027, Toulouse, France.10Paul-Sabatier University, Toulouse, France.11Purpan, Clinical epidemiology Unit, Toulouse, France
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Montenegro PA, Farias-Reyes D, Galiano-Gálvez MA, Quiroga-Toledo N. Visita restrictiva / Visita no restrictiva en una unidad de paciente crítico adulto. AQUICHAN 2016. [DOI: 10.5294/aqui.2016.16.3.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: buscar evidencia que responda a la pregunta ¿cuál es el impacto en el paciente, familia y personal de salud de visitas no restrictivas versus restrictivas? Método: revisión sistemática. Estrategia de búsqueda: 1993-2016 en Cochrane Library, Joanna Briggs, EBSCO,PubMed, CINHAL, Trip DataBase, con términos Mesh y palabras claves. Criterios de selección de artículos: revisiones sistemáticas,ensayos clínicos randomizados, no randomizados, cohortes, casos controles, estudios descriptivos correlacionales, UCI adultos, español e inglés. Recolección y análisis: selección inicial de 293 artículos, aplicando criterios de selección quedaron 13 artículos para análisis crítico.Calidad metodológica analizada con guías CASPe. Resultados: la visita no restrictiva no incrementa riesgo de infección, la ansiedad delpaciente es menor, la satisfacción de enfermeras es mayor, la presencia familiar ayuda a recuperación del paciente, la familia está más informada, satisfecha y con mejor conocimiento de situación. La frecuencia de complicaciones cardiovasculares es mayor en pacientes con visitas restrictivas. Conclusiones: las visitas no restrictivas en UCI no generan daño al paciente, por el contrario contribuyen a la recuperación de su salud física y emocional.
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Garrouste-Orgeas M, Vinatier I, Tabah A, Misset B, Timsit JF. Reappraisal of visiting policies and procedures of patient's family information in 188 French ICUs: a report of the Outcomerea Research Group. Ann Intensive Care 2016; 6:82. [PMID: 27566711 PMCID: PMC4999564 DOI: 10.1186/s13613-016-0185-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background The relatives of intensive care unit (ICU) patients must cope with both the severity of illness of their loved one and the unfamiliar and stressful ICU environment. This hardship may lead to post-intensive care syndrome. French guidelines provide recommendations on welcoming and informing families of ICU patients. We questioned whether and how they are applied 5 years after their publication. Methods We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient’s family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected. Results Among the 289 French ICUs, 188 (65 %) participated. Most ICUs have a waiting room 118/188 (62.8 %) and a dedicated room for meeting the family 152/188 (80.8 %). Of the 188 ICUs, 45 (23.9 %) were opened on a 24-h-a-day basis. In the remaining ICUs, the time period allowed for visits was 4.75 ± 1.83 h (median 5 h). In ICUs where visiting restrictions were reported, open visiting was allowed for end-of-life situations in 107/143 (74.8 %). Children are allowed to visit a patient in 164/188 (87.2 %) regardless of their age in 97/164 (59.1 %) of ICUs. Families received an information leaflet in 168/188 (89.3 %). Information was provided to families through structured meetings in 149/188 (79.2 %) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4 %) and 55/188 (29.2 %), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59 %). Participation in care was infrequent. Conclusions Although French ICUs do not follow the consensus recommendations, slow progress exists compared to previous reports. Implementation of these recommendations is largely needed to offer better welcome and information improvement. Further studies on that topic would enable evaluating remaining obstacles and increasing caregivers’ awareness, both critical for further progresses on that topic. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0185-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, UMR 1137, Sorbonne Paris Cité, Paris Diderot University, 75018, Paris, France. .,Outcomerea Research Group, 75020, Paris, France. .,Service de médecine intensive et de réanimation, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75014, Paris, France.
| | - Isabelle Vinatier
- Medical-Surgical ICU, Les Oudaries Hospital, La Roche-Sur-Yon, France
| | - Alexis Tabah
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Burns, Trauma and Critical Care Research Centre, University of Queesland, Brisbane, Australia
| | - Benoit Misset
- Medical ICU, Charles Nicolle University Hospital, Rouen, France
| | - Jean-François Timsit
- IAME, UMR 1137, Sorbonne Paris Cité, Paris Diderot University, 75018, Paris, France.,Outcomerea Research Group, 75020, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
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Palacios-Ceña D, Cachón-Pérez JM, Martínez-Piedrola R, Gueita-Rodriguez J, Perez-de-Heredia M, Fernández-de-las-Peñas C. How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups. BMJ Open 2016; 6:e009678. [PMID: 26826150 PMCID: PMC4735179 DOI: 10.1136/bmjopen-2015-009678] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management. SETTING This study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain). PARTICIPANTS Purposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years. DESIGN A qualitative study using focus groups. METHODS 7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6-10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data. RESULTS 3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care. CONCLUSIONS Patients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process of care in patients with delirium.
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Affiliation(s)
- Domingo Palacios-Ceña
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
- Grupo Excelencia Investigadora URJC-Banco Santander referencia N°30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain).
| | | | - Rosa Martínez-Piedrola
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
| | - Javier Gueita-Rodriguez
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
| | - Marta Perez-de-Heredia
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
| | - Cesar Fernández-de-las-Peñas
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon/Madrid, Spain
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Escudero D, Martín L, Viña L, Forcelledo L, García-Arias B, López-Amor L. Abrir las puertas de la UCI. Una necesidad inexcusable. Med Intensiva 2015; 39:522-3. [DOI: 10.1016/j.medin.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/07/2015] [Indexed: 11/28/2022]
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Escudero D, Martín L, Viña L, Quindós B, Espina MJ, Forcelledo L, López-Amor L, García-Arias B, del Busto C, de Cima S, Fernández-Rey E. [Visitation policy, design and comfort in Spanish intensive care units]. ACTA ACUST UNITED AC 2015; 30:243-50. [PMID: 26346582 DOI: 10.1016/j.cali.2015.06.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the design and comfort in the Intensive Care Units (ICUs), by analysing visiting hours, information, and family participation in patient care. DESIGN Descriptive, multicentre study. SETTING Spanish ICUs. METHODS A questionnaire e-mailed to members of the Spanish Society of Intensive Care Medicine, Critical and Coronary Units (SEMICYUC), subscribers of the Electronic Journal Intensive Care Medicine, and disseminated through the blog Proyecto HU-CI. RESULTS A total of 135 questionnaires from 131 hospitals were analysed. Visiting hours: 3.8% open 24h, 9.8% open daytime, and 67.7% have 2 visits a day. Information: given only by the doctor in 75.2% of the cases, doctor and nurse together in 4.5%, with a frequency of once a day in 79.7%. During weekends, information is given in 95.5% of the cases. Information given over the phone 74.4%. Family participation in patient care: hygiene 11%, feeding 80.5%, physiotherapy 17%. Personal objects allowed: mobile phone 41%, computer 55%, sound system 77%, and television 30%. Architecture and comfort: all individual cubicles 60.2%, natural light 54.9%, television 7.5%, ambient music 12%, clock in the cubicle 15.8%, environmental noise meter 3.8%, and a waiting room near the ICU 68.4%. CONCLUSIONS Visiting policy is restrictive, with a closed ICU being the predominating culture. On average, technological communication devices are not allowed. Family participation in patient care is low. The ICU design does not guarantee privacy or provide a desirable level of comfort.
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Affiliation(s)
- D Escudero
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España.
| | - L Martín
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - L Viña
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - B Quindós
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - M J Espina
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - L Forcelledo
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - L López-Amor
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - B García-Arias
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - C del Busto
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - S de Cima
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
| | - E Fernández-Rey
- Servicio de Medicina Intensiva, Hospital Universitario Central de Asturias, Oviedo, España
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Jouot T, Challan-Belval A, Floccard B, Rimmelé T. Intensive care unit staff will not go back to restricted visiting hours. Br J Anaesth 2015; 115:319-20. [DOI: 10.1093/bja/aev240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Bernardo V, Grignoli N, Marazia C, Andreotti J, Perren A, Malacrida R. Sharing intimacy in "open" intensive care units. J Crit Care 2015; 30:866-70. [PMID: 26160723 DOI: 10.1016/j.jcrc.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 04/03/2015] [Accepted: 05/16/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Opening intensive care units (ICUs) is particularly relevant because of a new Swiss law granting the relatives of patients without decision-making capability a central role in medical decisions. The main objectives of the study were to assess how the presence of relatives is viewed by patients, health care providers, and relatives themselves and to evaluate the perception of the level of intrusiveness into the personal sphere during admission. MATERIAL AND METHODS In a longitudinal and prospective design, qualitative questionnaires were submitted concomitantly to patients, relatives, and health care providers consecutively over a 6-month period. The study was conducted in the 4 ICUs of the public hospitals of Canton Ticino (Switzerland). RESULTS The questionnaires collected from patients, relatives, and health care providers were 176, 173, and 134, respectively. The analysis of the answers of 120 patient-relative pairs showed consistent results (P < .0001), whereas those of health care providers were significantly different (P < .0001), regarding both the usefulness of opening ICUs to patient relatives and what was stressful during admission. CONCLUSIONS Relatives in these "open" ICUs share a great deal of intimacy with the patients. Their presence and the deriving benefits were seen as very positive by patients and relatives themselves. Skepticism, instead, prevailed among health care providers.
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Affiliation(s)
- Valentina Di Bernardo
- Intensive Care Unit, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland; Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
| | - Nicola Grignoli
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Psychiatry Consultation Liaison Service, Organizzazione Sociopsichiatrica Cantonale, Mendrisio, Switzerland.
| | - Chantal Marazia
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland; Département d'Histoire des Sciences et de la Vie et de la Santé, University of Strasbourg, Strasbourg, France
| | - Jennifer Andreotti
- Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, Bern, Switzerland
| | - Andreas Perren
- Intensive Care Unit, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Roberto Malacrida
- Sasso Corbaro Medical Humanities Foundation, Bellinzona, Switzerland
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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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Year in review in Intensive Care Medicine 2014: II. ARDS, airway management, ventilation, adjuvants in sepsis, hepatic failure, symptoms assessment and management, palliative care and support for families, prognostication, organ donation, outcome, organisation and research methodology. Intensive Care Med 2015. [PMCID: PMC4383811 DOI: 10.1007/s00134-015-3707-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Garrouste-Orgeas M, Périer A, Mouricou P, Grégoire C, Bruel C, Brochon S, Philippart F, Max A, Misset B. Writing in and reading ICU diaries: qualitative study of families' experience in the ICU. PLoS One 2014; 9:e110146. [PMID: 25329581 PMCID: PMC4199718 DOI: 10.1371/journal.pone.0110146] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 09/16/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose Keeping an ICU patient diary has been reported to benefit the patient's recovery. Here, we investigated the families' experience with reading and writing in patient ICU diaries kept by both the family and the staff. Methods We conducted a qualitative study involving 32 semi-structured in-depth interviews of relatives of 26 patients (34% of all family members who visited patients) who met our ICU-diary criterion, i.e., ventilation for longer than 48 hours. Grounded theory was used to conceptualise the interview data via a three-step coding process (open coding, axial coding, and selective coding). Results Communicative, emotional, and humanising experiences emerged from our data. First, family members used the diaries to access, understand, and assimilate the medical information written in the diaries by staff members, and then to share this information with other family members. Second, the diaries enabled family members to maintain a connection with the patient by documenting their presence and expressing their love and affection. Additionally, families confided in the diaries to maintain hope. Finally, family members felt the diaries humanized the medical staff and patient. Conclusions Our findings indicate positive effects of diaries on family members. The diaries served as a powerful tool to deliver holistic patient- and family-centered care despite the potentially dehumanising ICU environment. The diaries made the family members aware of their valuable role in caring for the patient and enhanced their access to and comprehension of medical information. Diaries may play a major role in improving the well-being of ICU-patient families.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- IAME, UMR 1137, Paris Diderot University, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Antoine Périer
- Maison des Adolescents, University Hospital Cochin, Paris, France
- INSERM U-669, University Paris Sud and University Paris Descartes, UMR-S0669, Paris, France
| | - Philippe Mouricou
- Management department, ESSCA School of Management PRES UNAM, Boulogne- Billancourt, France
| | - Charles Grégoire
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Cédric Bruel
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Sandie Brochon
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Adeline Max
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | - Benoit Misset
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
- University Paris Descartes, Paris, France
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