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Trotta F, Petrosino F, Pucciarelli G, Alvaro R, Vellone E, Bartoli D. Reliability and validity of the training satisfaction questionnaire for family members (TSQ-FM) entering the ICU during an isolation disease outbreak. Heart Lung 2024; 66:37-45. [PMID: 38574598 DOI: 10.1016/j.hrtlng.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The presence of family members in an isolated ICU during an isolation disease outbreak is restricted by hospital policies because of the infectious risk. This can be overcome by conferring to family members the skill and the ability to safely don and doff the personal protective equipment (PPE) through a nurse-led training intervention and assess their satisfaction, to respond to the need to define a safe, effective and quality care pathway focused on Family-Centered Care (FCC) principles. OBJECTIVE the study aimed to build a valid and reliable instrument for clinical practice to assess family members' satisfaction to allow ICU nurses to restore family integrity in any case of infectious disease outbreak that requires isolation. METHODS A cross-sectional study was conducted to test the psychometric properties. The questionnaire was constructed based on a literature review on the needs of family members in the ICU. 76 family members were admitted to a COVID-ICU. Cronbach's coefficient, Geomin rotated loading, and EFA were applied to assess the reliability and validity of the instrument. RESULTS The Kaiser-Mayer-Olkin (KMO) measure was 0.662, the Bartlett sphericity test showed a significant p-value (χ²=448.33; df=45; p < 0.01), Cronbach's alpha coefficient was.896. A further CFA analysis confirmed that all fit indices were acceptable. The results showed satisfactory validity and reliability, which could be generalized and extended to any outbreak of isolation disease. CONCLUSIONS This study provides a valid and reliable instrument for clinical practice to maintain family integrity in the dyadic relationship between the patient and the family member, even during an emergency infectious disease outbreak that requires isolation.
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Affiliation(s)
- Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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2
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Zali M, Rahmani A, Powers K, Hassankhani H, Namdar-Areshtanab H, Gilani N. Nursing core competencies for postresuscitation care in Iran: a qualitative study. BMJ Open 2024; 14:e074614. [PMID: 38216202 PMCID: PMC10806684 DOI: 10.1136/bmjopen-2023-074614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE This study explored nurses' perceptions of the core competencies required for providing postresuscitation care in both in-hospital and out-of-hospital cardiac arrest. DESIGN Qualitative conventional content analysis. PARTICIPANTS 17 nurses selected with purposeful sampling method. SETTING Three educational hospitals in northwest of Iran. DATA COLLECTION AND ANALYSIS Semi-structured interviews were used for data collection and they were analysed using conventional content analysis. RESULTS Seven main categories have emerged from the data. The core competencies for nurses providing postresuscitation were identified as: quality assurance, providing evidence-based care, monitoring and presence, situation management, professionalism, positive attitude and providing family centred care. CONCLUSIONS The postresuscitation period is a unique and critical time requiring highly competent nursing care. Several core competencies for providing high-quality nursing care during postresuscitation period were identified through nurses' experience in caring for patients postresuscitation.
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Affiliation(s)
- Mahnaz Zali
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azad Rahmani
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kelly Powers
- School of Nursing, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Hadi Hassankhani
- Department of Medical-Surgical, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Neda Gilani
- Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
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3
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Pérez Lucendo A, Piñeiro Otero P, Matía Almudévar P, Alcántara Carmona S, López López E, Ramasco Rueda F. Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:509-535. [PMID: 37742996 DOI: 10.1016/j.redare.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023]
Abstract
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
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Affiliation(s)
- A Pérez Lucendo
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain.
| | - P Piñeiro Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - P Matía Almudévar
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E López López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
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Petrinec AB, Wilk C, Hughes JW, Zullo MD, George RL. Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study. Am J Crit Care 2023; 32:440-448. [PMID: 37907376 DOI: 10.4037/ajcc2023800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management. OBJECTIVE To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients. METHODS The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use. RESULTS The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app. CONCLUSIONS Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.
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Affiliation(s)
- Amy B Petrinec
- Amy B. Petrinec is an associate professor, College of Nursing, Kent State University, Kent, Ohio
| | - Cindy Wilk
- Cindy Wilk is an associate professor, College of Nursing, Kent State University, Kent, Ohio
| | - Joel W Hughes
- Joel W. Hughes is a professor, Department of Psychological Sciences, Kent State University
| | - Melissa D Zullo
- Melissa D. Zullo is a professor, College of Public Health, Kent State University
| | - Richard L George
- Richard L. George is a physician, Summa Health System, Akron, Ohio
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Lissak IA, Edlow BL, Rosenthal E, Young MJ. Ethical Considerations in Neuroprognostication Following Acute Brain Injury. Semin Neurol 2023; 43:758-767. [PMID: 37802121 DOI: 10.1055/s-0043-1775597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Neuroprognostication following acute brain injury (ABI) is a complex process that involves integrating vast amounts of information to predict a patient's likely trajectory of neurologic recovery. In this setting, critically evaluating salient ethical questions is imperative, and the implications often inform high-stakes conversations about the continuation, limitation, or withdrawal of life-sustaining therapy. While neuroprognostication is central to these clinical "life-or-death" decisions, the ethical underpinnings of neuroprognostication itself have been underexplored for patients with ABI. In this article, we discuss the ethical challenges of individualized neuroprognostication including parsing and communicating its inherent uncertainty to surrogate decision-makers. We also explore the population-based ethical considerations that arise in the context of heterogenous prognostication practices. Finally, we examine the emergence of artificial intelligence-aided neuroprognostication, proposing an ethical framework relevant to both modern and longstanding prognostic tools.
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Affiliation(s)
- India A Lissak
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Eric Rosenthal
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael J Young
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Lei Y, Zhou Q, Tao Y. Decision Aids in the ICU: a scoping review. BMJ Open 2023; 13:e075239. [PMID: 37607783 PMCID: PMC10445349 DOI: 10.1136/bmjopen-2023-075239] [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: 05/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE The purpose of this scoping review was to synthesise the effectiveness and acceptability of decision aids for critically ill patients and family members in the intensive care unit (ICU). METHODS A systematic search of four electronic databases and grey literature was undertaken to identify relevant studies on the application of decision aids in the ICU, without publication date restriction, through March 2023. The methodological framework proposed by Arksey and O'Malley was used to guide the scoping review. RESULTS Fourteen papers were ultimately included in this review. However, only nine decision aids were available, and it is noteworthy that many of these studies focused on the iterative development and testing of individual decision aids. Among the included studies, 92% (n=13) were developed in North America, with a primary focus on goals of care and life-sustaining treatments. The summary of the effect of decision aid application revealed that the most common indicators were the level of knowledge and code status, and some promising signals disappeared in randomised trials. CONCLUSIONS The complexity of treatment decisions in the ICU exceeds the current capabilities of existing decision aids. There is a clear gap in decision aids that are tailored to different cultural contexts, highlighting the need to expand the scope of their application. In addition, rigorous quality control is very important for randomised controlled trial, and indicators for assessing the effectiveness of decision aids need to be further clarified.
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Affiliation(s)
- Yuling Lei
- Department of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Qi Zhou
- Department of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yuexian Tao
- Department of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Oesch S, Verweij L, Clack L, Finch T, Riguzzi M, Naef R. Implementation of a multicomponent family support intervention in adult intensive care units: study protocol for an embedded mixed-methods multiple case study (FICUS implementation study). BMJ Open 2023; 13:e074142. [PMID: 37553195 PMCID: PMC10414125 DOI: 10.1136/bmjopen-2023-074142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The implementation of complex interventions is considered challenging, particularly in multi-site clinical trials and dynamic clinical settings. This study protocol is part of the family intensive care units (FICUS) hybrid effectiveness-implementation study. It aims to understand the integration of a multicomponent family support intervention in the real-world context of adult intensive care units (ICUs). Specifically, the study will assess implementation processes and outcomes of the study intervention, including fidelity, and will enable explanation of the clinical effectiveness outcomes of the trial. METHODS AND ANALYSIS This mixed-methods multiple case study is guided by two implementation theories, the Normalisation Process Theory and the Consolidated Framework for Implementation Research. Participants are key clinical partners and healthcare professionals of eight ICUs allocated to the intervention group of the FICUS trial in the German-speaking part of Switzerland. Data will be collected at four timepoints over the 18-month active implementation and delivery phase using qualitative (small group interviews, observation, focus group interviews) and quantitative data collection methods (surveys, logs). Descriptive statistics and parametric and non-parametric tests will be used according to data distribution to analyse within and between cluster differences, similarities and factors associated with fidelity and the level of integration over time. Qualitative data will be analysed using a pragmatic rapid analysis approach and content analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the Cantonal Ethics Committee of Zurich BASEC ID 2021-02300 (8 February 2022). Study findings will provide insights into implementation and its contribution to intervention outcomes, enabling understanding of the usefulness of applied implementation strategies and highlighting main barriers that need to be addressed for scaling the intervention to other healthcare contexts. Findings will be disseminated in peer-reviewed journals and conferences. PROTOCOL REGISTRATION NUMBER Open science framework (OSF) https://osf.io/8t2ud Registered on 21 December 2022.
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Affiliation(s)
- Saskia Oesch
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Lotte Verweij
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Lauren Clack
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Zurich, Switzerland
- Center of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Renckens SC, Pasman HR, Klop HT, du Perron C, van Zuylen L, Steegers MAH, Ten Tusscher BL, Abbink FCH, de Ruijter W, Vloet LCM, Koster SCE, Onwuteaka-Philipsen BD. Support for relatives in the intensive care unit: lessons from a cross-sectional multicentre cohort study during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:763. [PMID: 37464434 DOI: 10.1186/s12913-023-09756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Support for relatives is highly important in the intensive care unit (ICU). During the first COVID-19 wave support for relatives had to be changed considerably. The alternative support could have decreased the quality and sense of support. We aimed to evaluate how support for relatives in Dutch ICUs was organised during the first COVID-19 wave and how this was experienced by these relatives in comparison to relatives from pre-COVID-19 and the second wave. Additionally, we aimed to investigate which elements of support are associated with positive experiences. METHODS We performed a cross-sectional multicentre cohort study in six Dutch ICUs in the Netherlands. Written questionnaires were distributed among relatives of ICU patients from pre-COVID-19, the first wave and the second wave. The questionnaire included questions on demographics, the organisation of support, and the experiences and satisfaction of relatives with the support. RESULTS A total of 329 relatives completed the questionnaire (52% partner, 72% woman and 63% ICU stay of 11 days or longer). Support for relatives of ICU patients during the first COVID-19 wave differed significantly from pre-COVID-19 and the second wave. Differences were found in all categories of elements of support: who, when, how and what. Overall, relatives from the three time periods were very positive about the support. The only difference in satisfaction between the three time periods, was the higher proportion of relatives indicating that healthcare professionals had enough time for them during the first wave. Elements of support which were associated with many positive experiences and satisfaction were: fixed timeslot, receiving information (e.g. leaflets) on ≥ 2 topics, discussing > 5 topics with healthcare professionals, and being offered emotional support. CONCLUSIONS Although, support for relatives in the ICU changed considerably during the COVID-19 pandemic, relatives were still positive about this support. The altered support gave insight into avenues for improvement for future comparable situations as well as for normal daily ICU practice: e.g. daily contact at a fixed timeslot, offering video calling between patients and relatives, and offering emotional support. ICUs should consider which elements need improvement in their practice.
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Affiliation(s)
- Sophie C Renckens
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands.
| | - H Roeline Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Viaa University of Applied Sciences, Zwolle, The Netherlands
| | - Chantal du Perron
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Lia van Zuylen
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique A H Steegers
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Birkitt L Ten Tusscher
- Department of Intensive Care Medicine, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Floor C H Abbink
- Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wouter de Ruijter
- Department of Intensive Care Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Lilian C M Vloet
- Foundation Family and Patient Centered Intensive Care (FCIC), Alkmaar, The Netherlands
- Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Stephanie C E Koster
- Department of Anaesthesiology and Department of Intensive Care Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
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9
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Çınar Özbay S, Boztepe H, Kanbay Y. Nursing students' views on trauma-informed pediatric nursing care and family-centered care. Arch Psychiatr Nurs 2023; 44:107-113. [PMID: 37197854 DOI: 10.1016/j.apnu.2023.04.012] [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: 08/04/2022] [Revised: 12/30/2022] [Accepted: 04/24/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care. METHODS This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey." RESULTS Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score. CONCLUSIONS Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients. PRACTICE IMPLICATIONS Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.
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Affiliation(s)
- Sevil Çınar Özbay
- Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey.
| | - Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atilim University, Ankara, Turkey.
| | - Yalçın Kanbay
- Department of Nursing, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey.
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Jungestrand L, Holm E, Rose L, Wolf A, Ringdal M. Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study. Intensive Crit Care Nurs 2023; 75:103347. [PMID: 36470700 PMCID: PMC9637525 DOI: 10.1016/j.iccn.2022.103347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PURPOSE To explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. METHOD Qualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FINDINGS We interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme 'Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a 'distance' due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient's wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. CONCLUSION Visiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members' perceptions of distance and exclusion from the intensive care unit.
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Affiliation(s)
- Linda Jungestrand
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden
| | - Emma Holm
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Axel Wolf
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden; Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mona Ringdal
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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11
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Brauchle M, Deffner T, Nydahl P. Ten recommendations for child-friendly visiting policies in critical care. Intensive Care Med 2023; 49:341-344. [PMID: 36715706 PMCID: PMC9998315 DOI: 10.1007/s00134-022-06974-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/26/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Maria Brauchle
- Department of Anaesthesiology and Intensive Care Medicine, Hospital Landeskrankenhaus Feldkirch, Carinagasse 35, 6800, Feldkirch, Austria
| | - Teresa Deffner
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
| | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Kiel, Haus V40, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
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12
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Naef R, Filipovic M, Jeitziner MM, von Felten S, Safford J, Riguzzi M, Rufer M. A multicomponent family support intervention in intensive care units: study protocol for a multicenter cluster-randomized trial (FICUS Trial). Trials 2022; 23:533. [PMID: 35761343 PMCID: PMC9235279 DOI: 10.1186/s13063-022-06454-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/08/2022] [Indexed: 02/25/2023] Open
Abstract
Background Family members of critically ill patients face considerable uncertainty and distress during their close others’ intensive care unit (ICU) stay. About 20–60% of family members experience adverse mental health outcomes post-ICU, such as symptoms of anxiety, depression, and posttraumatic stress. Guidelines recommend structured family inclusion, communication, and support, but the existing evidence base around protocolized family support interventions is modest and requires substantiation. Methods To test the clinical effectiveness and explore the implementation of a multicomponent, nurse-led family support intervention in ICUs, we will undertake a parallel, cluster-randomized, controlled, multicenter superiority hybrid-type 1 trial. It will include eight clusters (ICUs) per study arm, with a projected total sample size of 896 family members of adult, critically ill patients treated in the German-speaking part of Switzerland. The trial targets family members of critically ill patients with an expected ICU stay of 48 h or longer. Families in the intervention arm will receive a family support intervention in addition to usual care. The intervention consists of specialist nurse support that is mapped to the patient pathway with follow-up care and includes psycho-educational and relationship-focused family interventions, and structured, interprofessional communication, and shared decision-making with families. Families in the control arm will receive usual care. The primary study endpoint is quality of family care, operationalized as family members’ satisfaction with ICU care at discharge. Secondary endpoints include quality of communication and nurse support, family management of critical illness (functioning, resilience), and family members’ mental health (well-being, psychological distress) measured at admission, discharge, and after 3, 6, and 12 months. Data of all participants, regardless of protocol adherence, will be analyzed using linear mixed-effects models, with the individual participant as the unit of inference. Discussion This trial will examine the effectiveness of the family support intervention and generate knowledge of its implementability. Both types of evidence are necessary to determine whether the intervention works as intended in clinical practice and could be scaled up to other ICUs. The study findings will make a significant contribution to the current body of knowledge on effective ICU care that promotes family participation and well-being. Trial registration ClinicalTrials.gov NCT05280691. Prospectively registered on 20 February 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06454-y.
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Affiliation(s)
- Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006, Zurich, Switzerland. .,Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Miodrag Filipovic
- Surgical Intensive Care Unit, Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Cantonal Hospital of St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern, Inselspital, University of Bern, Freiburgstrasse 16, CH10, Bern, Switzerland
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, Faculty of Medicine, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | | | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätsstrasse 84, 8006, Zurich, Switzerland.,Centre of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Center for Psychiatry and Psychotherapy, Clinic Zugersee, Triaplus AG, Widenstrasse 55, 6317, Oberwil-Zug, Switzerland
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13
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Prima A, Harahap D, Lanahdiana L, Ilyas AS, Rambu SH, Hermawan A, Andas NH, Andas AM. Prevalence Anxiety Family Members of Patients Admitted to Inpatient Hospital Room during Pandemic COVID-19. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Anxiety is confusion or worry about something that is not certain with unclear causes, causing feelings of uncertainty and powerlessness over the assessment of an object. Based on data at Izza Hospital, the number of patients who were hospitalized in July was 427 patients. The increasing number of patients in inpatient rooms during the COVID-19 pandemic caused psychological shocks to family members which caused anxiety.
AIM: The purpose of this study was to find out the description of family anxiety in the inpatient room during the COVID-19 pandemic.
METHODS: The design of this research is descriptive analytic with a cross-sectional approach. The population of this study was the entire family of patients who were treated in inpatient rooms during the COVID-19 pandemic, with a total sample of 96 respondents using a consecutive sampling technique. This study used a visual analog scale for anxiety (VAS-A) questionnaire to measure the respondents’ level of anxiety.
RESULTS: The results of this study showed that the patient’s family in the hospital inpatient room experienced mild anxiety 42 respondents (43.8%), with an average age of 40-44 years (n = 18; 0.19%), female gender (n = 51; 0.53), respondents’ education (n = 53; 0.55), work (n = 57; 0.6), nuclear family (n = 83; 0.09).
CONCLUSION: The conclusion of this study that the prevalence of anxiety in family members mostly experienced mild anxiety with a total of 42 (43.8%) respondents.
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14
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Brauchle M, Nydahl P, Pregartner G, Hoffmann M, Jeitziner MM. Practice of family-centred care in intensive care units before the COVID-19-pandemic: A cross-sectional analysis in German-speaking countries. Intensive Crit Care Nurs 2022; 68:103139. [PMID: 34750041 PMCID: PMC8421104 DOI: 10.1016/j.iccn.2021.103139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries. METHODS/DESIGN Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers. SETTING Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload. CONCLUSION The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.
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Affiliation(s)
- Maria Brauchle
- Hospital Landeskrankenhaus Feldkirch, Department of Anaesthesiology and Intensive Care Medicine, Carinagasse 35, 6800 Feldkirch, Austria
| | - Peter Nydahl
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2/9/V, 8036 Graz, Austria
| | - Magdalena Hoffmann
- Department of Internal Medicine, Medical University of Graz, Graz, Austria,Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria,Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 1/3, 8036 Graz, Austria,Corresponding author at: Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marie-Madlen Jeitziner
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland,Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
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15
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Wendlandt B, Kime M, Carson S. The impact of family visitor restrictions on healthcare workers in the ICU during the COVID-19 pandemic. Intensive Crit Care Nurs 2022; 68:103123. [PMID: 34456111 PMCID: PMC8315942 DOI: 10.1016/j.iccn.2021.103123] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession. MATERIALS AND METHODS We developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results. RESULTS Of the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient's room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension. CONCLUSION Intensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.
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Affiliation(s)
- Blair Wendlandt
- Corresponding author at: 130 Mason Farm Road CB#7020, Chapel Hill, NC 27599, United States
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16
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Schwartz AC, Dunn SE, Simon HFM, Velasquez A, Garner D, Tran DQ, Kaslow NJ. Making Family-Centered Care for Adults in the ICU a Reality. Front Psychiatry 2022; 13:837708. [PMID: 35401268 PMCID: PMC8987300 DOI: 10.3389/fpsyt.2022.837708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.
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Affiliation(s)
- Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah E Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Hannah F M Simon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alvaro Velasquez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David Garner
- Department of Nursing, Grady Health System, Atlanta, GA, United States
| | - Duc Quang Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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17
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Avcı M, Ayaz-Alkaya S. Anxiety, social support and satisfaction of patients' families in intensive care units: A descriptive-correlational study. J Clin Nurs 2021; 31:2765-2773. [PMID: 34693581 DOI: 10.1111/jocn.16094] [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: 03/02/2021] [Revised: 08/20/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
AIMS & OBJECTIVES This study was conducted with family members of patients' in the intensive care unit (ICU) to identify their anxiety level, social support and satisfaction with the ICU. BACKGROUND Admission of critical patients to the ICU usually involves the participation of family members. DESIGN A descriptive-correlational design was used and reported according to the STROBE checklist. METHODS The sample consisted of 250 family members in ICUs in a city of Turkey. Data were collected by the Multidimensional Perceived Social Support Scale, the State-Trait Anxiety Inventory and the Family Satisfaction in the Intensive Care Unit scale. RESULTS A negative correlation was found between family satisfaction of the ICU and state anxiety (r = -0.349, p < 0.001), and a negative relationship between the satisfaction of the ICU and trait anxiety of the participants (r = -0.151, p < 0.05). There was a significant relationship between the state anxiety level (Adjusted R² = 0.080, F = 8.247, p < 0.001), trait anxiety level (Adjusted R² = 0.185, F = 19.821, p < 0.001), the perceived social support (Adjusted R² = 0.094, F = 9.640, p < 0.001) and satisfaction (Adjusted R² = 0.013, F = 4.161, p < 0.001) of family members and their sociodemographic characteristics. CONCLUSIONS The study concluded that anxiety levels of relatives of the families were high, their social support and satisfaction with the intensive care unit were at a moderate level. There was a correlation between anxiety levels, satisfaction with the intensive care unit, and the perceived social support of families. RELEVANCE TO CLINICAL PRACTICE Holistic care for the psychosocial needs of families who have a member in the ICU should be planned to increase satisfaction. Nurses should observe families closely for anxiety, allow them to ask questions and include them in the care of their family member.
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Affiliation(s)
- Miyase Avcı
- Nursing Department, Aksaray University Faculty of Health Sciences, Aksaray, Turkey
| | - Sultan Ayaz-Alkaya
- Nursing Department, Gazi University Faculty of Health Sciences, Ankara, Turkey
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18
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Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives. J Multidiscip Healthc 2021; 14:2719-2730. [PMID: 34611408 PMCID: PMC8486274 DOI: 10.2147/jmdh.s240563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.
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Affiliation(s)
- Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Marino
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
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19
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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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20
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Petrinec AB, Hughes JW, Zullo MD, Wilk C, George RL. Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study. JMIR Res Protoc 2021; 10:e30813. [PMID: 34346900 PMCID: PMC8374657 DOI: 10.2196/30813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. OBJECTIVE The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. METHODS For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. RESULTS Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. CONCLUSIONS The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30813.
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Affiliation(s)
- Amy B Petrinec
- College of Nursing, Kent State University, Kent, OH, United States
| | - Joel W Hughes
- Department of Psychological Sciences, College of Arts and Sciences, Kent State University, Kent, OH, United States
| | - Melissa D Zullo
- College of Public Health, Kent State University, Kent, OH, United States
| | - Cindy Wilk
- College of Nursing, Kent State University, Kent, OH, United States
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21
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An Ethics Early Action Protocol to Promote Teamwork and Ethics Efficacy. Dimens Crit Care Nurs 2021; 40:226-236. [PMID: 34033444 DOI: 10.1097/dcc.0000000000000482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Moral dilemmas and ethical conflicts occur in critical care. Negative consequences include misunderstandings, mistrust, patient and family suffering, clinician moral distress, and patient safety concerns. Providing an opportunity for team-based ethics assessments and planning could improve communication and reduce moral distress. OBJECTIVES The aims of this study were to explore whether an early action ethics intervention affects intensive care unit (ICU) clinicians' moral distress, ethics self-efficacy, and perceptions of hospital climate and to compare nurses' and physicians' scores on moral distress, ethics self-efficacy, and ethical climate at 3 time points. METHODS Intensive care unit nurses and physicians were asked to complete surveys on moral distress, ethics self-efficacy, and ethical climate before implementing the ethics protocol in 6 ICUs. We measured responses to the same 3 surveys at 3 and 6 months after the protocol was used. RESULTS At baseline, nurses scored significantly higher than physicians in moral distress and significantly lower in ethics self-efficacy. Plot graphs revealed that nurses' and physicians' outcome scores trended toward one another. At 3 and 6 months post intervention, nurse and physician scores changed differently in moral distress and ethics self-efficacy. When examining nurse and physician scores separately over time, we found nurses' scores in moral distress and moral distress frequency decreased significantly over time and ethics self-efficacy and ethics climate increased significantly over time. Physicians' scores did not change significantly. DISCUSSION This study indicates that routine, team-based ethics assessment and planning opens a space for sharing information, which could decrease nurses' moral distress and increase their ethics self-efficacy. This, in turn, can potentially promote teamwork and reduce burnout.
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22
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Mechanism of a Flexible ICU Visiting Policy for Anxiety Symptoms Among Family Members in Brazil: A Path Mediation Analysis in a Cluster-Randomized Clinical Trial. Crit Care Med 2021; 49:1504-1512. [PMID: 33870915 DOI: 10.1097/ccm.0000000000005037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate whether the effect of a flexible ICU visiting policy that includes flexible visitation plus visitor education on anxiety symptoms of family members is mediated by satisfaction and involvement in patient care. DESIGN We embedded a multivariable path mediation analysis within a cluster-randomized crossover trial as a secondary analysis of The ICU Visits Study (ClinicalTrials.gov number: NCT02932358). SETTING Thirty-six medical-surgical ICUs in Brazil. PATIENTS Closest relatives of adult ICU patients. INTERVENTIONS Flexible visitation (12 hr/d) supported by family education or usual restricted visitation (median, 1.5 hr/d). MEASUREMENTS AND MAIN RESULTS Overall, 863 family members were assessed (mean age, 44.7 yr; women, 70.1%). Compared with the restricted visitation (n = 436), flexible visitation (n = 427) resulted in better mean anxiety scores (6.1 vs 7.8; mean difference, -1.78 [95% CI, -2.31 to -1.22]), as well as higher standardized scores of satisfaction (67% [95% CI, 55-79]) and involvement in patient care (77% [95% CI, 64-89]). The mediated effect of flexible visitation on mean anxiety scores through each incremental SD of satisfaction and involvement in patient care were -0.47 (95% CI, -0.68 to -0.24) and 0.29 (95% CI, 0.04-0.54), respectively. Upon exploratory analyses, emotional support, helping the ICU staff to understand patient needs, helping the patient to interpret ICU staff instructions, and patient reorientation were the domains of involvement in patient care associated with increased anxiety. CONCLUSIONS A flexible ICU visiting policy reduces anxiety symptoms among family members and appears to work by increasing satisfaction. However, increased participation in some activities of patient care as a result of flexible visitation was associated with higher severity of anxiety symptoms.
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Yoo HJ, Shim J. The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU. Crit Care Med 2021; 49:38-48. [PMID: 33177359 DOI: 10.1097/ccm.0000000000004694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU. DESIGN Prospective, pre- and postintervention evaluations were conducted. SETTING The cardiovascular surgery ICU was located in a tertiary hospital. PARTICIPANTS Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019. INTERVENTIONS Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an "ICU visitation kit" during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals. MEASUREMENTS AND MAIN RESULTS Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = -7.05; p < 0.001 and t = -12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626). CONCLUSIONS This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.
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Affiliation(s)
- Hye Jin Yoo
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - JaeLan Shim
- Department of Nursing Gyeongju, Dongguk University, College of Medicine, Seoul, South Korea
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Jaswal V, Kishore K, Muniraju M, Jaswal N, Kapoor R. Understanding the determinants of happiness through Gallup World Poll. J Family Med Prim Care 2020; 9:4826-4832. [PMID: 33209808 PMCID: PMC7652195 DOI: 10.4103/jfmpc.jfmpc_156_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 11/04/2022] Open
Abstract
Background The idea of happiness is as old as civilization, but breakthrough is achieved only in 20th century. Happiness can be broadly segmented into biological and behavioural component. The sufferings from illnesses hamper happiness. Happiness correlates negatively with morbidity, mortality, stress and anxiety in contrast to a positive correlation with motivation, healthy behaviours and longevity. In this article, an attempt has been made to understand the relationship between happiness and its important contributory factors. Material and Methods The current study used data from the Gallup World Poll available under license CC0. Data analysis was performed using R studio version 1.0.136. Initially, descriptive analysis in the form of mean (standard deviation), violin plot, correlation matrix, and scatter plots were reported. Subsequently, robust regression estimates along with bootstrap standard errors and confidence intervals were used to report inferential statistics. Results Norway, with a happiness score of 7.537 ranked first followed by Denmark with a score of 7.522. Burundi with a score of 2.905 is at the bottom of ranking for happiness. Freedom (CI; 0.95-2.22) and Family (CI; 0.92 - 1.57) are the strongest predictors of happiness. The trust variable does not have a significant (CI; -0.27 - 1.94) relationship with happiness. Conclusions The values and norms in society are changing at a fast pace. Therefore, the measures of happiness require consistent and innovative approaches to measure it.
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Affiliation(s)
- Vidushi Jaswal
- Department of Psychology, MCM DAV College for Women, Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Muniraju
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Jaswal
- Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Mackie BR, Mitchell M, Schults J. Application of the READY framework supports effective communication between health care providers and family members in intensive care. Aust Crit Care 2020; 34:296-299. [PMID: 33069591 PMCID: PMC7556260 DOI: 10.1016/j.aucc.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/17/2022] Open
Abstract
Effective communication between intensive care health care providers and family is crucial to support surrogate or shared decision-making and to individualise care. Despite its importance in health care standards and policy, the quality of communication with families in intensive care is regarded as suboptimal. Furthermore, an intensive care admission is an extremely stressful event for families, which may impact their understanding and subsequent decision-making. Communicating with family members is a routine practice in intensive care; however, health care providers often receive no formal communication training. To date, family-focused communication interventions in intensive care have targeted end-of-life care and are not generalisable across all types of family–health care provider communication interactions. Mugweni et al. recently reported the results of a multiprofessional training intervention involving 26 health care professionals to improve the delivery of different news to families during pregnancy and at birth. A critique of this article has been undertaken to inform routine communication with critically ill family members and optimise the delivery of care in intensive care units.
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Affiliation(s)
- Benjamin R Mackie
- Army School of Health, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Australia.
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia; Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia.
| | - Jessica Schults
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia; Department of Anaesthesia, Queensland Children's Hospital, Australia.
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Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs 2020; 61:102916. [PMID: 32807604 DOI: 10.1016/j.iccn.2020.102916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate family and health professional experience with a nurse-led family support intervention in intensive care. DESIGN Qualitative evaluation study. SETTING A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland. MAIN OUTCOME MEASURES Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies. FINDINGS Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families. CONCLUSIONS An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland; Institute of Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland.
| | - Paola Massarotto
- Institute of Intensive Medicine, University Hospital Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
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Sundberg F, Fridh I, Lindahl B, Kåreholt I. Visitor's Experiences of an Evidence-Based Designed Healthcare Environment in an Intensive Care Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:178-191. [PMID: 32734781 PMCID: PMC8079796 DOI: 10.1177/1937586720943471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objectives: The objective of the research was to study the visitors’ experiences of
different healthcare environment designs of intensive care unit (ICU)
patient rooms. Background: The healthcare environment may seem frightening and overwhelming in times
when life-threatening conditions affect a family member or close friend and
individuals visit the patient in an ICU. A two-bed patient room was
refurbished to enhance the well-being of patients and their families
according to the principles of evidence-based design (EBD). No prior
research has used the Person-centred Climate Questionnaire—Family version
(PCQ-F) or the semantic environment description (SMB) in the ICU
setting. Methods: A sample of 99 visitors to critically ill patients admitted to a
multidisciplinary ICU completed a questionnaire; 69 visited one of the two
control rooms, while 30 visited the intervention room. Results: For the dimension of everydayness in the PCQ-F, a significantly better
experience was expressed for the intervention room (p <
.030); the dimension regarding the ward climate general was also perceived
as higher in the intervention room (p < .004). The
factors of pleasantness (p < .019), and complexity
(p < 0.049), showed significant differences favoring
the intervention room in the SMB, with borderline significance on the modern
factor (p < .061). Conclusion: Designing and implementing an enriched healthcare environment in the ICU
setting increases person-centered care in relation to the patients’
visitors. This could lead to better outcomes for the visitors, for example,
decreasing post-traumatic stress disorder symptoms, but this needs further
investigations.
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Affiliation(s)
- Fredrika Sundberg
- Faculty of Caring Science, Work Life and Social Welfare, 1802University of Borås, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, 1802University of Borås, Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, 1802University of Borås, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health and Welfare, 4161Jönköping University, Sweden
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Moss KO, Douglas SL, Baum E, Daly B. Family Surrogate Decision-making in Chronic Critical Illness: A Qualitative Analysis. Crit Care Nurse 2020; 39:e18-e26. [PMID: 31154339 DOI: 10.4037/ccn2019176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Caring for an adult with chronic critical illness is a difficult undertaking. Family surrogates are tasked with decision-making on behalf of their loved one, particularly during acute-on-chronic illness episodes. Critical care nurses are well positioned and well qualified to facilitate this process. OBJECTIVES To explore family surrogate decision-making for people with chronic critical illness. METHODS In this qualitative study, interviews were conducted with family surrogates (n = 7) as part of a larger descriptive, longitudinal study (N = 264). Content analyses were guided by Miles and colleagues' methods of data analysis. RESULTS Family surrogates serving as decision makers for a spouse or another adult loved one were mostly female. Although decision-making was often described as "frustrating," most surrogates reported that they were "comfortable" with this role. Major decision-making themes were "communication as key in decision-making," "impact of past experiences," and "difficulties and coping." Advice from family and friends, health care providers (such as nurses), and faith or spirituality were significant resources for coping with decision-making challenges. CONCLUSIONS Results support recent recommendations of the National Academy of Medicine that endorsed shared decision-making. Data also support development of more effective team communication and decision support strategies, particularly addressing consistency and continuity. Critical care nurses can use their expertise to positively influence these outcomes.
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Affiliation(s)
- Karen O Moss
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center.
| | - Sara L Douglas
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
| | - Eric Baum
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
| | - Barbara Daly
- Karen O. Moss is an assistant professor in the College of Nursing at The Ohio State University, Columbus, Ohio; Sara Douglas is Arline H. & Curtis F. Garvin Professor of Nursing Excellence and Assistant Dean of Research, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Eric Baum is a certified nurse practitioner, University Hospitals Cleveland Medical Center, Cleveland, and a doctoral candidate, Frances Payne Bolton School of Nursing, Case Western Reserve University; Barbara Daly is Gertrude Perkins Oliva Professor in Oncology Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, and a clinical ethics consultant, University Hospitals Cleveland Medical Center
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Pavlish CL, Henriksen J, Brown-Saltzman K, Robinson EM, Warda US, Farra C, Chen B, Jakel P. A Team-Based Early Action Protocol to Address Ethical Concerns in the Intensive Care Unit. Am J Crit Care 2020; 29:49-61. [PMID: 31968085 DOI: 10.4037/ajcc2020915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Ethical conflicts complicate clinical practice and often compromise communication and teamwork among patients, families, and clinicians. As ethical conflicts escalate, patient and family distress and dissatisfaction with care increase and trust in clinicians erodes, reducing care quality and patient safety. OBJECTIVE To investigate the effectiveness of a proactive, team-based ethics protocol used routinely to discuss ethics-related concerns, goals of care, and additional supports for patients and families. METHODS In a pre-post intervention study in 6 intensive care units (ICUs) at 3 academic medical centers, the electronic medical records of 1649 patients representing 1712 ICU admissions were studied. Number and timing of family conferences, code discussions with the patient or surrogate, and ethics consultations; palliative care, social work, and chaplain referrals; and ICU length of stay were measured. Preintervention outcomes were compared with outcomes 3 and 6 months after the intervention via multivariate logistic regression controlled for patient variables. RESULTS The odds of receiving a family conference and a chaplain visit were significantly higher after the intervention than at baseline. The number of palliative care consultations and code discussions increased slightly at 3 and 6 months. Social work consultations increased only at 6 months. Ethics consultations increased at both postintervention time points. Length of ICU stay did not change. CONCLUSIONS When health care teams were encouraged to communicate routinely about goals of care, more patients received needed support and communication barriers were reduced.
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Affiliation(s)
| | - Joan Henriksen
- Joan Henriksen was the coordinator, Clinical Ethics Consultation Service, Mayo Clinic, Rochester, Minnesota; she is now senior staff ethicist at Children’s Minnesota in Minneapolis
| | | | - Ellen M. Robinson
- Ellen M. Robinson is a nurse ethicist, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | - Belinda Chen
- Belinda Chen is a statistician, University of California, Los Angeles, School of Nursing, Los Angeles, California
| | - Patricia Jakel
- Patricia Jakel is a clinical nurse specialist, Santa Monica Hospital, University of California, Los Angeles, Health System, Los Angeles, California
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Stressors and strains of next of kin of patients with ARDS in intensive care: A qualitative interview study using a stress-strain approach. Intensive Crit Care Nurs 2019; 57:102783. [PMID: 31882326 DOI: 10.1016/j.iccn.2019.102783] [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: 10/19/2018] [Revised: 09/16/2019] [Accepted: 11/22/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to explore and analyse the stressors and strains of next of kin of acute respiratory distress syndrome (ARDS) patients during their stay in the intensive care unit utilising the stressors and strain approach as a theoretical framework. METHODS Data collection was performed as semi-standardised qualitative interviews. 35 families of patients with ARDS were approached when visiting the intensive care unit. Participants were recruited until thematic saturation was reached; finally, 17 persons (age ranging from 26 to 71 years, nine women) took part. Systematic content analysis was conducted on the theoretical foundations of the stressors and strain approach. FINDINGS Numerous stressors were identified; they can be divided into three main categories: in relation to organising the visit, occurring during the visit and arising at home. These stressors were reported highly consistently throughout participants. However, the strains resulting from these stressors were varying in manifestation and level. CONCLUSIONS This study explores the manifold stressors and strains of next of kin of a critically ill patient. Some stressors are inherent to the life-threatening condition of a family member; others arise from the health care system and could be modified. The level of strain experienced depends on social support, individual coping skills and life circumstances.
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The state of bereavement support in adult intensive care: A systematic review and narrative synthesis. J Crit Care 2019; 50:177-187. [DOI: 10.1016/j.jcrc.2018.11.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/12/2018] [Accepted: 11/21/2018] [Indexed: 11/21/2022]
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Courtright KR, Benoit DD, Curtis JR. Focus on ethics and palliative care in the intensive care unit. Intensive Care Med 2019; 45:885-886. [PMID: 30911806 DOI: 10.1007/s00134-019-05602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Katherine R Courtright
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - J Randall Curtis
- Cambia Palliative Center of Excellence at UW Medicine, Seattle, WA, USA. .,Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.
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Kleinpell R, Heyland DK, Lipman J, Sprung CL, Levy M, Mer M, Koh Y, Davidson J, Taha A, Curtis JR. Patient and family engagement in the ICU: Report from the task force of the World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care 2018; 48:251-256. [DOI: 10.1016/j.jcrc.2018.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/15/2022]
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Sganzerla D, Teixeira C, Robinson CC, Kochhann R, Santos MMS, de Moura RM, Barbosa MG, da Silva DB, Ribeiro T, Eugênio C, Schneider D, Mariani D, Jeffman RW, Bozza F, Cavalcanti AB, Azevedo LCP, Machado FR, Salluh JI, Pellegrini JAS, Moraes RB, Damiani LP, da Silva NB, Falavigna M, Rosa RG. Statistical analysis plan for a cluster-randomized crossover trial comparing the effectiveness and safety of a flexible family visitation model for delirium prevention in adult intensive care units (the ICU Visits Study). Trials 2018; 19:636. [PMID: 30454019 PMCID: PMC6245900 DOI: 10.1186/s13063-018-3006-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most adult intensive care units (ICUs) worldwide adopt restrictive family visitation models (RFVMs). However, evidence, mostly from non-randomized studies, suggests that flexible adult ICU visiting hours are safe policies that can result in benefits such as prevention of delirium and increase in satisfaction with care. Accordingly, the ICU Visits Study was designed to compare the effectiveness and safety of a flexible family visitation model (FFVM) vs. an RFVM on delirium prevention among ICU patients, and also to analyze its potential effects on family members and ICU professionals. METHODS/DESIGN The ICU Visits Study is a cluster-randomized crossover trial which compares an FFVM (12 consecutive ICU visiting hours per day) with an RFVM (< 4.5 ICU visiting hours per day) in 40 Brazilian adult ICUs. Participant ICUs are randomly assigned to either an FFVM or RFVM in a 1:1 ratio. After enrollment and follow-up of 25 patients, each ICU is crossed over to the other visitation model, until 25 more patients per site are enrolled and followed. The primary outcome is the cumulative incidence of delirium measured by the Confusion Assessment Method for the ICU. Secondary and tertiary outcomes include relevant measures of effectiveness and safety of ICU visiting policies among patients, family members, and ICU professionals. Herein, we describe all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of this study. This pre-specified statistical analysis plan was written and submitted without knowledge of the study data. DISCUSSION This a priori statistical analysis plan aims to enhance the transparency of our study, facilitating unbiased analyses of ICU visit study data, and provide guidance for statistical analysis for groups conducting studies in the same field. TRIAL REGISTRATION ClinicalTrials.gov, NCT02932358 . Registered on 11 October 2016.
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Affiliation(s)
- Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Cassiano Teixeira
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Caroline Cabral Robinson
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Renata Kochhann
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Mariana Martins Siqueira Santos
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Rafaela Moraes de Moura
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Mirceli Goulart Barbosa
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Daiana Barbosa da Silva
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Tarissa Ribeiro
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Cláudia Eugênio
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Daniel Schneider
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Débora Mariani
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Rodrigo Wiltgen Jeffman
- Research Projects Office, Hospital Moinhos de Vento (HMV), Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Fernando Bozza
- Department of Critical Care, Instituto D'Or de Pesquisa e Ensino (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil
| | | | - Luciano Cesar Pontes Azevedo
- Intensive Care Unit, Hospital Sírio-Libanês, Rua Dona Adma Jafet, 91, Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Flávia Ribeiro Machado
- Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 737, Vila Clementino, São Paulo, SP, 04024-900, Brazil
| | - Jorge Ibrain Salluh
- HCor Research Institute, Rua Abílio Soares, 250, Paraíso, São Paulo, SP, 04005-909, Brazil
| | - José Augusto Santos Pellegrini
- Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, Santa Cecília, Porto Alegre, RS, 90035-903, Brazil
| | - Rafael Barberena Moraes
- Institute for Education and Research, HMV, Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Lucas Petri Damiani
- HCor Research Institute, Rua Abílio Soares, 250, Paraíso, São Paulo, SP, 04005-909, Brazil
| | - Nilton Brandão da Silva
- Department of Internal Medicine, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rua Sarmento Leite, 245, Centro Histórico, Porto Alegre, RS, 90050-170, Brazil
| | - Maicon Falavigna
- Institute for Education and Research, HMV, Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil
| | - Regis Goulart Rosa
- Intensive Care Unit, HMV. Rua Ramiro Barcelos, 910, Moinhos de Vento, Porto Alegre, RS, 90035-001, Brazil.
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Latour JM, Coombs M. Family-centred care in the intensive care unit: More than just flexible visiting hours. Intensive Crit Care Nurs 2018; 50:1-2. [PMID: 30348476 DOI: 10.1016/j.iccn.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, 8-11 Kirkby Place, Room 205, 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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Zupanets IA, Dobrova VY, Ratushna KL, Silchenko SO. Introduction of open visiting policy in intensive care units in Ukraine: policy analysis and the ethical perspective. Asian Bioeth Rev 2018; 10:105-121. [PMID: 33717281 PMCID: PMC7747421 DOI: 10.1007/s41649-018-0057-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/03/2018] [Indexed: 10/26/2022] Open
Abstract
Open visiting policy (OVP) in intensive care units (ICU) is considered a favorable visiting regime that may benefit patients and their family members as well as medical staff. The article examines the conditions and causes of OVP-making process in Ukraine and presents the ethical analysis of its implications with respect to the key stakeholders: ICU patients, family members, and medical staff. The OVP, established by the Ministry of Health in June, 2016, changes current approaches to the recognition of the role of families in critically ill patients' care dramatically; it does, however, have serious shortcomings. The analysis of risks and benefits showed that OVP does not adequately cater to the needs of all the key players-family members, patients, and medical staff. Moreover, there is no clear mechanism to control OVP implementation via feedback from all the key players (particularly patients and their families). These issues give rise to a concern that the implementation of OVP will die on the vine. In order to prevent this, a range of measures is required: the optimization of the ICU facilities and internal procedures, supervision of OVP implementation by policy-makers, training of medical staff, and providing family members with educational programs. Considering current shortcomings, it is crucially important to develop clear and consistent internal guidelines in hospitals that will guarantee the introduction of open ICU visiting and quality of critical care provisions.
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