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Ryan MJ, Lee L, Drisdelle S, Garros D, Seabrook JA, Curran J, Bretzler J, Slumkoski C, Walls M, Betts L, Burgess S, Foster JR. Impact of COVID-19-related restricted family presence policies on Canadian pediatric intensive care unit clinicians: a qualitative study. Can J Anaesth 2024:10.1007/s12630-024-02742-0. [PMID: 38507024 DOI: 10.1007/s12630-024-02742-0] [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: 07/21/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Pediatric intensive care units (PICUs) worldwide restricted family presence in response to the COVID-19 pandemic. We aimed to explore the experiences and impact of restricted family presence policies on Canadian PICU clinicians. METHODS We conducted a qualitative study that followed an interpretive phenomenological design. Participants were PICU clinicians providing direct patient care in Canada during periods of COVID-19-related restricted family presence. We purposively sampled for maximum variation among survey participants who consented to be contacted for further research on the same topic. In-depth interviews were conducted remotely via telephone or video-call, audio-recorded, and transcribed. Interviews were inductively coded and underwent thematic analysis. Proposed themes were member-checked by interviewees. RESULTS Sixteen PICU clinicians completed interviews. Interviewees practiced across Canada, represented a range of disciplines (eight nurses, two physicians, two respiratory therapists, two child life specialists, two social workers) and years in profession (0-34 years). We identified four themes representing the most meaningful aspects of restricted family presence for participants: 1) balancing infection control and family presence; 2) feeling disempowered by hospital and policy-making hierarchies; 3) empathizing with family trauma; and 4) navigating threats to the therapeutic relationship. CONCLUSION Pediatric intensive care unit clinicians were impacted by restricted family presence policies during the COVID-19 pandemic. These policies contributed to feelings of disempowerment and challenged clinicians' perceived ability to provide the best family-centred care possible. Frontline expertise should be incorporated into the design and implementation of policies to best support family-centred care in any context and minimize risks of moral distress for PICU clinicians.
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Affiliation(s)
- Molly J Ryan
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Sara Drisdelle
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Daniel Garros
- Stollery Children's Hospital, Edmonton, AB, Canada
- Division of Critical Care Medicine, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Corey Slumkoski
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Martha Walls
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Laura Betts
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Stacy Burgess
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Jennifer R Foster
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada.
- Department of Pediatric Critical Care, IWK Health, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
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Cardoso AF, Pires MG, Cioga E, Abalroado I, Santos D, Duque FM, Loureiro R, Felizardo H, Fernandes AM, Silva R, Ventura F, Santana E, Cardoso D, Loureiro L. Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol. JBI Evid Synth 2023; 21:2455-2464. [PMID: 37711062 DOI: 10.11124/jbies-23-00002] [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: 09/16/2023]
Abstract
OBJECTIVE The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. INTRODUCTION Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. INCLUSION CRITERIA This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. METHODS This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presented. REVIEW REGISTRATION PROSPERO CRD42022383603.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Miguel Grilo Pires
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Elisabete Cioga
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Inês Abalroado
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Diana Santos
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Filipa Margarida Duque
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Ricardo Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Helena Felizardo
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rosa Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
- Nursing School of Porto (ESEP), Porto, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Elaine Santana
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Luís Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Dijkstra BM, Felten-Barentsz KM, van der Valk MJM, van der Hoeven JG, Schoonhoven L, Vloet LCM. Exploring patients' and relatives' needs and perceptions regarding family participation in essential care in the intensive care unit: A qualitative study. Intensive Crit Care Nurs 2023; 79:103525. [PMID: 37598505 DOI: 10.1016/j.iccn.2023.103525] [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: 03/16/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To examine the needs, perceptions and influencing factors according to former adult intensive care unit patients and relatives with regard to family participation in essential care in the unit. RESEARCH DESIGN A qualitative interpretive descriptive study using inductive thematic analysis. SETTING Twelve pairs of former Dutch patients and their relatives were interviewed within two months after the patient's discharge from the unit between December 2017 and April 2018. FINDINGS Four themes emerged: the family's history, the patient's condition, supporting the patient and supporting the relative. The family's history, in particular the relationship with the patient and former experience with care, determined the level of participation in essential care. The level of participation was also influenced by the patient's condition, more specifically level of consciousness, stability of the patient's situation and length of the patient's stay. The third theme, supporting the patient, related to presence/being able to 'be there' for the patient and a mostly positive attitude towards family participation. The last theme was supporting the relative, with three subthemes associated with relatives' needs and perceptions: (dis)comfort with participation in essential care, need for invitation and support, and concern about the possible strain experienced by relatives. CONCLUSION Supporting the patient and supporting the relative are reflecting the needs and perceptions of patients and relatives regarding family participation in essential care. Both the family's history and the patient's condition influence the relative's level of participation. Intensive care unit nurses and other healthcare providers could take these themes into account when encouraging family participation in essential care. IMPLICATIONS FOR CLINICAL PRACTICE Patients' and relatives' needs and perceptions of family participation in essential care in the intensive care unit vary. Family participation in essential care is influenced by the family's history and the patient's condition. Healthcare providers could take these findings into account when implementing family participation in essential care.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Karin M Felten-Barentsz
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Margriet J M van der Valk
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands
| | | | - Lisette Schoonhoven
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Lilian C M Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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Tabah A, Elhadi M, Ballard E, Cortegiani A, Cecconi M, Unoki T, Galarza L, Rosa RG, Barbier F, Azoulay E, Laupland KB, Kai NSY, Ostermann M, Francois G, De Waele JJ, Fiest K, Spronk P, Benbenishty J, Pellegrini M, Rose L. Variation in communication and family visiting policies in intensive care within and between countries during the Covid-19 pandemic: The COVISIT international survey. J Crit Care 2022; 71:154050. [PMID: 35525226 PMCID: PMC9067300 DOI: 10.1016/j.jcrc.2022.154050] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, intensive care units (ICU) introduced restrictions to in-person family visiting to safeguard patients, healthcare personnel, and visitors. METHODS We conducted a web-based survey (March-July 2021) investigating ICU visiting practices before the pandemic, at peak COVID-19 ICU admissions, and at the time of survey response. We sought data on visiting policies and communication modes including use of virtual visiting (videoconferencing). RESULTS We obtained 667 valid responses representing ICUs in all continents. Before the pandemic, 20% (106/525) had unrestricted visiting hours; 6% (30/525) did not allow in-person visiting. At peak, 84% (558/667) did not allow in-person visiting for patients with COVID-19; 66% for patients without COVID-19. This proportion had decreased to 55% (369/667) at time of survey reporting. A government mandate to restrict hospital visiting was reported by 53% (354/646). Most ICUs (55%, 353/615) used regular telephone updates; 50% (306/667) used telephone for formal meetings and discussions regarding prognosis or end-of-life. Virtual visiting was available in 63% (418/667) at time of survey. CONCLUSIONS Highly restrictive visiting policies were introduced at the initial pandemic peaks, were subsequently liberalized, but without returning to pre-pandemic practices. Telephone became the primary communication mode in most ICUs, supplemented with virtual visits.
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Affiliation(s)
- Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Metro North Hospital and Health services, Queensland, Australia,Queensland University of Technology, Brisbane, Queensland, Australia,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,Corresponding author at: Intensive Care, Redcliffe Hospital, Anzac Av, Redcliffe, 4020, Queensland, Australia
| | | | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Italy,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Maurizio Cecconi
- Anaesthesia and Intensive Care Units, Humanitas Research Hospital, Milan, Italy,Humanitas University, Milan, Italy
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Laurą Galarza
- Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain
| | - Regis Goulart Rosa
- Intensive Care Unit, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | - Francois Barbier
- Médecine Intensive – Réanimation Hôpital de la Source - CHR Orléans, Orléans, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Kevin B. Laupland
- Queensland University of Technology, Brisbane, Queensland, Australia,Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Marlies Ostermann
- Department of Critical Care & Nephrology, King's College London, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Guy Francois
- Division of Scientific Affairs, Research, European Society of Intensive Care Medicine, Brussels, Belgium
| | - Jan J. De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium,Division of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kirsten Fiest
- Departments of Critical Care Medicine, Community Health Sciences, Psychiatry, O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Peter Spronk
- Departments of Intensive Care Medicine, Gelre Hospitals, Albert Schweitzerlaan, Apeldoorn, the Netherlands
| | | | - Mariangela Pellegrini
- Intensive Care Unit, AnOpIVA, Akademiska sjukhuset, Uppsala, Sweden,Hedenstierna Laboratory, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK,Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - the COVISIT contributorsRamananMahesh1234BaileyRachel5KronbergerIrmgard E.32CerovacAnis3334SliglWendy6PeršecJasminka78Lincango-NaranjoEddy35OsmanNermin91011TanasYousef12DeanYomna13AbbasAhmed Mohamed3652ElbahnasawyMohamed Gamal14ElshennawyEslam Mohamed37ElmandouhOmar38AhmedFatima Hamed39KoulentiDespoina15TsakiridisIoannis40GurjarMohan16CindryaniMarilaeta41MahmoodpoorAta424356AldawoodyHogir Imad Rasheed44ZuccaroFrancesco17IozzoPasquale57IppolitoMariachiara5859KatayamaYukiko60KuribaraTomoki61MiyazakiSatoko62NakayamaAsami63OuchiAkira64SakuramotoHideaki65TamotoMitsuhiro66YamadaToru67SerhanHashem Abdulaziz Abu45AlsakarnehSaqr Ghaleb Ghassab46KaligozhinZhannur18VidermanDmitriy19KaroutLina47HasanMohd Shahnaz20ZakariaAndee Dzulkarnaen55Ñamendys-SilvaSilvio A.21RaiLajpat48AbelloAntonio Thaddeus R.22PovoaPedro23TomescuDana2425DrozdovEvgeniy49GallegoAlberto Orejas26Jariod-FerrerUrsula M.53Nuñez-GarçiaBernardo54MohamedAhmed Mohamed Ibrahim50GeorgeAbram Raymon Moneer51JeitzinerMarie-Madlen27SaracogluKemal Tolga28IsikArda29AslanAbdullah Tarik30TorlinskiTomasz31Intensive Care Units, Caboolture and Prince Charles Hospitals, Queensland, AustraliaSchool of Medicine, University of Queensland, AustraliaThe George Institute for Global Health, Sydney, AustraliaUniversity of New South Wales, Sydney, AustraliaIntensive Care Outreach, Caboolture Hospital, Caboolture, QLD, AustraliaCritical Care Medicine and Infectious Diseases, Adjunct Appointment, School of Public Health, University of Alberta, CanadaClinical Department of Anesthesiology, Reanimatology and Intensive Care Medicine, University Hospital Dubrava, Zagreb, CroatiaCroatian Society of Intensive Care Medicine, CroatiaMedical Statistics, Medical Research Institute, Alexandria University, EgyptUnited Nations System Staff College Intern-UNITAR, EgyptMember of the Royal Statistical Association, EgyptAlexandria University Main Hospital, EgyptAlexandria University Main Hospital, EgyptTanta University Faculty of Medicine, Egypt2nd Critical Care Department, Attikon University Hospital, Athens, GreeceDepartment of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Rae Bareli Road, Lucknow, UP 226014, IndiaMedico Chirurgo - Anestesia e Rianimazione, Responsabile U.O.S. Coordinamento Aziendale Trapianti d'Organo E Tessuti, ItalyNational Research Center for Oncology and Transplantation, Astana, KazakhstanNazarbayev University School of Medicine, National Research Oncology Center, Department of Anesthesiology and Intensive Care, Nur-Sultan, KazakhstanUMMC, Kuala Lumpur, MalaysiaDivision of Pulmonary, Anesthesia and Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, MexicoThe Medical City Clark, Mabalacat, Pampanga, PhilippinesNOVA Medical School, New University of Lisbon, PortugalAnesthesia and Intensive Care, "Carol Davila "University of Medicine and Pharmacy, RomaniaAnesthesiology & Intensive Care Dept 3, Fundeni Clinical Institute, Sos Fundeni 258 sect 2 zip, 22328, Bucharest, ROMANIAHospital Universitario Severo Ochoa, Leganés, Madrid, SpainDepartment of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, SwitzerlandDepartment of Anesthesiology and Intensive Care, Health Sciences University, Kartal Dr Lutfi Kirdar City Hospital, Istanbul, TurkeyGeneral Surgery, Division of General Surgery,School of Medicine, Istanbul Medeniyet University, Kadıkoy/Istanbul, TurkeyDepartment of Internal Medicine, Hacettepe University School of Medicine, Ankara, TurkeyAnaesthetics - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, UKMedical University Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, Anichstrasse 35, A-6020 Innsbruck, AustriaGeneral Hospital Tešanj, Department for Gynecology and Obstetrics, Bosnia and HerzegovinaSchool of Medicine, Department for Anatomy, University of Tuzla, Bosnia and HerzegovinaHospital Vozandes Quito, Quito, EcuadorAssiut University, EgyptKafr Elshikh University Hospital, EgyptAlexandria University Hospital, EgyptFaculty of Medicine Alkasr Alainy, Cairo University, Cairo, EgyptThird Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GreeceICU IRD Sanglah, IndonesiaAnesthesiology, IranResearch Deputy of Faculty of Medicine, Tabriz University of Medical Sciences, IranKhanaqin General Hospital, IraqJordan Hospitals, JordanAl-Balqa’ Applied University, JordanAmerican University of Beirut Medical Center, LebanonDow University of Health Sciences Karachi, PakistanSiberian State Medical University, Tomsk, RussiaGadarif Teaching Hospital, SudanSoba University Hospital, SudanFaculty of Medicine, Assiut University, Assiut, EgyptMiguel Servet University Hospital, Zaragoza, SpainUniversity Hospital Parc Taulí de Sabadell, SpainSchool of Medical Sciences & Hospital, Universiti Sains, MalaysiaDirector of ICU Program, IranDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyDepartment of Surgical Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, ItalyDepartment of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, ItalyNursing Department, Sakakibara Memorial Hospital, Fuchu, JapanSchool of Nursing, Sapporo City University, Sapporo, JapanNursing Department, Tokai University Hospital, Isehara, JapanNursing Department, Dokkyo Medical University Hospital, Mibu, JapanCollege of Nursing, Ibaraki Christian University, Omika, JapanSchool of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, JapanNursing Department, University of Kyoto Hospital, Kyoto, JapanNursing Department, Toho University Omori Hospital, Tokyo, Japan
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