Flexible visiting positively impacted on patients, families and staff in an Australian Intensive Care Unit: A before-after mixed method study

In-person, virtual visiting and telephone calls in Australia and New Zealand intensive care units: A point prevalence multicentre study mapping daytime and nighttime interactions

BACKGROUND

Family presence, in-person and via virtual visiting (video calls) and the telephone, is an integral part of patient- and family-centred critical care. Previous studies focussed on visiting policies and their effects. Data mapping the frequency and timing of these interactions are not available.

OBJECTIVES

The aims of this study were to describe the prevalence of in-person visiting and the use of telephone or video conferencing in Australia and New Zealand intensive care units (ICUs).

DESIGN

A point prevalence survey was conducted to map visiting policies, hourly family presence at the bedside, telephone or video calls, and reasons for each interaction.

SETTING

The research was conducted in a 24-h study period in October 2020, corresponding to the end of the 2nd COVID-19 pandemic wave in 40 Australia and New Zealand ICUs.

MEASUREMENTS AND MAIN RESULTS

At the time of survey, 77% of ICUs had restrictions to visiting, median (interquartile range [IQR]) time of 9 (2; 24) hours with permitted visiting per day, a mean of 8 hours less than before the COVID-19 pandemic. There were 532 patients, a median (IQR) of 13 (6; 25) patients per ICU. Two patients had COVID-19. Over 24 h, 65% of patients had at least one in-person visit, median (IQR) of 1 (0; 3) hours with visitors. Telephone calls were received for 52% patients, median (IQR) of 1 (0; 2) calls. Video calls were received for 6% of the patients. In-person visits peaked between 10:00 and 12:00, with a second smaller peak between 16:00 and 17:00. Visiting continued through the evening, and 2% of the patients had visitors overnight. Telephone calls peaked at 10:00, continued through the day and evening, with few calls received overnight. In-person visits were predominantly motivated by family interactions (81%) and telephone calls by clinical updates (51%) and family interactions (47%).

CONCLUSIONS

In a low COVID-19 prevalence period, Australia and New Zealand ICUs had partially reopened to visitors. Most visits happened during the day and evening but persisted overnight. ICU resourcing and visiting policies should take these data into account to facilitate family presence at the bedside, virtual visiting, and obtaining clinical updates via telephone.

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review

BACKGROUND

The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging.

AIM

To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs.

STUDY DESIGN

We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool.

RESULTS

Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay.

CONCLUSIONS

This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions.

RELEVANCE TO CLINICAL PRACTICE

Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.

Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study

Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.

Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study

Background

The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future.

Methods

The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score.

Results

Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members.

Conclusions

The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

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.

Efficacy and safety of unrestricted visiting policy for critically ill patients: a meta-analysis

Aim

To compare the safety and effects of unrestricted visiting policies (UVPs) and restricted visiting policies (RVPs) in intensive care units (ICUs) with respect to outcomes related to delirium, infection, and mortality.

Methods

MEDLINE, Cochrane Library, Embase, Web of Science, CINAHL, CBMdisc, CNKI, Wanfang, and VIP database records generated from their inception to 22 January 2022 were searched. Randomized controlled trials and quasi-experimental studies were included. The main outcomes investigated were delirium, ICU-acquired infection, ICU mortality, and length of ICU stay. Two reviewers independently screened studies, extracted data, and assessed risks of bias. Random‑effects and fixed-effects meta‑analyses were conducted to obtain pooled estimates, due to heterogeneity. Meta-analyses were performed using RevMan 5.3 software. The results were analyzed using odds ratios (ORs), 95% confidence intervals (CIs), and standardized mean differences (SMDs).

Results

Eleven studies including a total of 3741 patients that compared UVPs and RVPs in ICUs were included in the analyses. Random effects modeling indicated that UVPs were associated with a reduced incidence of delirium (OR = 0.4, 95% CI 0.25–0.63, I² = 71%, p = 0.0005). Fixed-effects modeling indicated that UVPs did not increase the incidences of ICU-acquired infections, including ventilator-associated pneumonia (OR = 0.96, 95% CI 0.71–1.30, I² = 0%, p = 0.49), catheter-associated urinary tract infection (OR 0.97, 95% CI 0.52–1.80, I² = 0%, p = 0.55), and catheter-related blood stream infection (OR = 1.15, 95% CI 0.72–1.84, I² = 0%, p = 0.66), or ICU mortality (OR = 1.03, 95% CI 0.83–1.28, I² = 49%, p = 0.12). Forest plotting indicated that UVPs could reduce the lengths of ICU stays (SMD =  − 0.97, 95% CI − 1.61 to 0.32, p = 0.003).

Conclusion

The current meta-analysis indicates that adopting a UVP may significantly reduce the incidence of delirium in ICU patients, without increasing the risks of ICU-acquired infection or mortality. Further large-scale, multicenter studies are needed to confirm these indications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-04129-3.

Psychological distress and morbidity of family members experiencing virtual visiting in intensive care during COVID-19: an observational cohort study

Purpose

During the coronavirus disease 2019 (COVID-19) pandemic, intensive care units (ICUs) around the world introduced virtual visiting to mediate the psychological impact of in-person visiting restrictions. Our objective was to evaluate levels of distress, depression, anxiety, and stress among family members experiencing virtual visits.

Methods

Multi-centre prospective observational study recruiting adult family members of critically ill patients in the United Kingdom (UK) using a bespoke virtual visiting solution (aTouchAway). We recruited participants and administered validated questionnaires digitally via their aTouchAway account. Prior to first virtual visit, participants completed the Distress Thermometer (score range 0–10) and the Depression, Anxiety and Stress Scale (DASS)-21. Following first and subsequent virtual visits, participants repeated the Distress Thermometer and completed the Discrete Emotions Questionnaire.

Results

We recruited 2166 adult family members of ICU patients in 37 UK hospitals. Most were grown up children (33%) or spouses/partners (23%). Most (91%) were ≤ 65 years. Mean (SD) pre-virtual-visit Distress Thermometer score was 7 (2.6) with 1349/2153 (62%) reporting severe distress. Pre-visit Distress Thermometer scores were associated with relationship type (spouse/partner OR 1.65, 95% CI 1.27–2.12) but not family member age, or length of ICU stay. Mean (SD) post-visit Distress Thermometer score provided by 762 (35%) participants was 1.6 (3.2) points lower than pre-visit (P < 0.001). Of participants experiencing multiple visits, 22% continued to report severe distress. Median (IQR) pre-visit DASS-21 score was 18 (2–42) (1754 participants). Severe-to-extremely severe depression, anxiety, or stress were reported by 249 (14%), 321 (18%), and 165 (9%) participants, respectively. Participants reported a range of emotions with reassurance being the most common, anger being the least.

Conclusion

Family members exposed to COVID-19 pandemic ICU visiting restrictions experienced severe distress. One fifth of family members reported severe-to-extremely sever anxiety or depression. Distress score magnitude and prevalence of severe distress decreased after undertaking one or more virtual visits.

Contributing and Relieving Factors of Suffering in Palliative Care Cancer Patients: A Descriptive Study

To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.

The Psychological Impact on Relatives of Critically Ill Patients: The Influence of Visiting Hours

OBJECTIVES:

To identify the psychologic impact of admission to the ICU on the relatives of critically ill patients, the influence of coping, and the factors involved.

DESIGN:

We performed a cohort study with repeated measures evaluation using descriptive and comparative bivariate and multivariate analyses.

SETTINGS:

An adult ICU of a third-level complexity hospital.

PATIENTS:

The family members of patients (maximum of three per patient) staying longer than 3 days.

INTERVENTIONS:

Not applicable.

MEASUREMENTS AND MAIN RESULTS:

Psychologic impact was assessed using two subgroups of psychologic distress: anxiety (by the State-Trait Anxiety Inventory) and depression (by the Beck Depression Inventory). Satisfaction and coping were assessed by the Critical Care Family Needs Inventory and the Brief Coping Orientations to Problems Experienced Inventory, respectively. We included 104 family members; psychologic distress was high at admission (72% had anxiety, 45% had depression, and 42% had both) but decreased at discharge (34% had anxiety, 23% had depression, and 21% had both). The risk factors related to psychologic impact were severity (anxiety: Acute Physiology and Chronic Health Evaluation score ≥ 18 points: relative risk [RR], 2; 95% CI, 1–4; p = 0.03), invasive mechanical ventilation (anxiety: RR, 1.9; 95% CI, 1–3.6; p = 0.04), recent psychotropic medication use by relatives (depression: RR, 1.6; 95% CI, 1–2.9; p = 0.05), a restrictive visiting policy (anxiety: RR, 5.7; 95% CI, 2–10.4; p = 0.002), no emotion-focused coping strategy (anxiety: strategy < 11 points, RR, 6.1; 95% CI, 1.2–52; p = 0.01), and functional impairment (depression: Barthel index ≤ 60 points, RR, 7.4; 95% CI, 1.7–26.3; p = 0.01).

CONCLUSIONS:

The psychologic impact from admission to the ICU on family members is high. Visiting hours is the main modifiable factor to reduce the impact.

The family in the intensive care unit in the face of a situational crisis

OBJECTIVE

to explore the experience of family members of a relative hospitalised in the Intensive Care Unit and recognise their emotions and needs and describe the phases or milestones they go through and the strategies they use to cope with the situations that arise.

METHOD

Qualitative study developed under the grounded theory method proposed by Anselm Strauss and Juliet Corbin. During the period from July 2017 to July 2019, semi-structured interviews were conducted with 26 relatives of hospitalised patients in fifteen third-level private clinics in the city of Manizales and Medellín, Colombia. In the latter, 200 h of participant observation were performed in ICUs of two private third-level clinics. The analysis procedure consisted of a microanalysis of the data and the process of open, axial, and selective coding of the information was continued.

RESULTS

We identified that the experience of relatives when they accompany their sick relative in the Intensive Care Unit is represented in two categories: family disorganisation which is characterised by generating a change and mismatch in family dynamics and, family reorganisation in which a restoration of order is sought to cope with the situation.

CONCLUSIONS

The family in the Intensive Care Unit develops a situational crisis characterised by intense, varied, and negative emotions and needs that wear down the relatives. Faced with this, family members undertake a reorganisation process to restore the order of family dynamics to cope with the situation and overcome difficulties.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.

OBJECTIVE

To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.

METHODOLOGY

A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases.

SEARCH STRATEGY

"Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units".

INCLUSION CRITERIA

studies published between 2013-2018, population aged between 19-64 years, English and Spanish language.

RESULTS

760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n = 5), the quality of care (n = 4), and the cleanliness and environment of the units (n = 2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n = 5), inadequate communication (n = 4), and the involvement of families and patients in decision-making (n = 4). Training of professionals (n = 5), inclusion of the family during the process of hospitalization (n = 2) and redesigning the waiting room (n = 2) are some of the suggestions for improvement.

CONCLUSIONS

Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

The omission of some patterns of knowing in clinical care: A qualitative study

BACKGROUND

Providing holistic and humanistic care to patients requires a variety of factors. A care solely based on objective knowledge might be unsafe and of low quality. Using the patterns of knowing in an integrated manner and relative to the context of caring is one of the necessities for proving a holistic and efficient nursing care. This study aimed to explore the role of patterns of knowing in the formation of uncaring behaviors.

MATERIALS AND METHODS

The researchers used a qualitative research design for this study. Participants included 19 clinical nurses who attended semi-structured and in-depth interviews. In addition, theoretical and purposeful sampling methods were used in this research. Observation of caring processes in different hospital wards was another method used for collecting data. The data analysis was carried out according to conventional content analysis technique.

RESULTS

The study findings revealed five categories for the theme of "omission of some patterns of knowing" including omission of scientific principles, omission of therapeutic relationship, omission of ethics, omission of social justice, and omission of flexibility.

CONCLUSIONS

The omission of some patterns of knowing creates an ugly image of nursing and a negative outcome of caring as well.

Staff perceptions of family access and visitation policies in Australian and New Zealand intensive care units: The WELCOME-ICU survey

BACKGROUND

Family-centred critical care recognises the impact of a loved one's critical illness on his relatives. Open visiting is a strategy to improve family satisfaction and psychological outcomes by permitting unrestricted or less restricted access to visit their family member in the intensive care unit (ICU). However, increased family presence may result in increased workload and a risk of burnout for ICU staff.

OBJECTIVES

The objective of this study was to evaluate ICU staff perceptions regarding visiting hours and family access in Australian and New Zealand ICUs. Secondary outcomes included an evaluation of current visiting policies, witnessed events in ICUs, and barriers to implementing open visiting policies.

DESIGN

A web-based survey open to all healthcare workers in Australia and New Zealand ICUs was distributed through local, state-based, and national critical care networks. Open visiting was defined as ICUs open for visiting >14 h per day.

MAIN RESULTS

We received 1255 valid responses. Most respondents were nurses (n = 930, 74.1%) with a median critical care experience of 10 y. Most worked in open visiting ICUs (n = 749, 59.7%). Reported visiting hours varied greatly with a median of 20 h per day (interquartile range: 10-24 h). Open visiting was perceived as beneficial for the relatives, but less so for patients and staff (relatives: n = 845, 67.3%, patients: n = 561, 44.7%, staff: n = 257, 20.5%, p < 0.0001). Respondents from closed visiting units and nurses identified more risks from open visiting than other professional groups. Generally, staff preferred not to change from their current practice.

CONCLUSION

We report that staff perceived open visiting as beneficial for relatives, but also identified risks to themselves, including increased workload, a risk of burnout, and a risk of occupational violence. Reluctance to change highlights the importance of addressing staff perceptions when implementing an open visiting policy.

How Nurses Apply Patterns of Knowing in Clinical Practice: A Grounded Theory Study

Background

Nurses require a great deal of knowledge to provide a comprehensive and effective nursing care. A number of patterns have been put into place to help nurses acquire this knowledge. The aim of this study was to describe the core variable in the process of using patterns of knowing by nurses in clinical practice.

Methods

The study was conducted in qualitative and grounded theory approach, between April 2018 and January 2020. Semi-structured interviews were used for data collection. All the interviews were transcribed verbatim. Nineteen clinical nurses were interviewed, and eight observation sessions were conducted in different hospital departments. Participants were first selected through purposeful and then theoretical sampling. Data were analyzed and interpreted using constant comparison analysis approach.

Results

The findings of the study indicated that nurses apply the patterns of knowing in three ways in their clinical practice: “cohesion of patterns of knowing”, “domination of some patterns of knowing” and “elimination of some patterns of knowing”. The core variable of this process is cohesion of patterns of knowing in the domain of flexibility.

Conclusion

The findings of the present study indicate that application of patterns of knowing is practiced in a range of nurse flexibility in clinical settings.

Family involvement in the intensive care unit in four Nordic countries

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.

Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review

AIMS AND OBJECTIVES

To map research-based psychological distress among the family members with patients in the intensive care unit (ICU).

BACKGROUND

Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery.

DESIGN

The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist.

METHODS

A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL^® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed.

RESULTS

From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress.

CONCLUSIONS

Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members.

RELEVANCE TO CLINICAL PRACTICE

The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.

Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico

Introducción: Durante el ingreso y permanencia del paciente en la unidad de cuidado intensivo, es imperativo considerar la satisfacción de las necesidades comunicacionales e informativas de la familia del paciente. Objetivo: Integrar los resultados de investigación sobre las intervenciones llevadas a cabo para satisfacer la necesidad de información de las familias de los pacientes en la unidad de cuidado intensivo. Materiales y Métodos: Se realizó una revisión integrativa de estudios en bases de datos Sciencedirect, PubMed, Biblioteca Virtual en Salud y Scielo, con la estrategia de búsqueda [Critical care] and [Needs assessment] and [Family] con criterios de inclusión de estudios publicados entre el año 2009 y el 2019 en idioma inglés, español y portugués disponibles en texto completo Resultados: Después de la lectura analítica de 41 estudios seleccionados se organizaron en 5 temas; uso de folletos de información, sesiones educativas, llamadas telefónicas, uso de tecnologías de la información y comunicación y reuniones familiares. Conclusión: Las intervenciones de enfermería que se han utilizado en la satisfacción de la necesidad de información de la familia son muy variadas e incluyen entre otras los folletos o el uso de TICs, sin embargo la intervención que responde en mayor medida a esta necesidad son las reuniones formales con la familia. Las intervenciones reportadas en los resultados de investigación para responder a la necesidad de información son herramientas clave para que el personal de enfermería las utilice según los recursos con los cuales dispone en su entorno laboral como salas de información para la familia. Como citar este artículo: Guáqueta Parada Sandra Rocio, Henao Castaño Ángela María, Motta Robayo Claudia Lorena, Triana Restrepo Martha Cecilia, Burgos Herrera Juan David, Neira Fernández Karen Daniela, Peña Almanza Berni Alonso. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. Revista Cuidarte. 2021;12(2):e1775. http://dx.doi.org/10.15649/cuidarte.1775    

The family in the intensive care unit in the face of a situational crisis

OBJECTIVE

To explore the experience of family members of a relative hospitalized in the intensive care unit and recognize their emotions and needs and describe the phases or milestones they go through and the strategies they use to cope with the situations that arise.

METHOD

Qualitative study developed under the grounded theory method proposed by Anselm Strauss and Juliet Corbin. During the period from July 2017 to July 2019, semi-structured interviews were conducted with 26 relatives of hospitalized patients in fifteen third-level private clinics in the city of Manizales and Medellín, Colombia. In the latter, 200 hours of participant observation were performed in ICUs of two private third-level clinics. The analysis procedure consisted of a microanalysis of the data and the process of open, axial, and selective coding of the information was continued.

RESULTS

We identified that the experience of relatives when they accompany their sick relative in the intensive care unit is represented in two categories: family disorganization which is characterized by generating a change and mismatch in family dynamics and, family reorganization in which a restoration of order is sought to cope with the situation.

CONCLUSIONS

The family in the intensive care unit develops a situational crisis characterized by intense, varied, and negative emotions and needs that wear down the relatives. Faced with this, family members undertake a reorganization process to restore the order of family dynamics to cope with the situation and overcome difficulties.

The intensive care unit visiting study: A multisite survey of visitors

BACKGROUND

Being able to visit a critically ill relative provides comfort to family members and has recognised benefits to the patient. Limited research has been conducted on demographic characteristics and visiting behaviours of family members with a relative in the intensive care unit (ICU).

OBJECTIVES

The objective was to provide an overview of local ICU visitor behaviours and practices across four metropolitan units in Australia.

METHODS

A convenience sample of 440 participants from four ICUs across a metropolitan city in eastern Australia was required for the study. A descriptive 22-item self-report survey was used. Data were collected from four ICUs in a metropolitan city in eastern Australia. Sample characteristics and other variables were analysed using descriptive statistics.

RESULTS

Data collection was undertaken from April 2018 to May 2019. Four hundred sixty-two (n = 462) ICU visitors responded. There were no significant differences between visitor characteristics across the four hospitals. The mean age of the respondents was 49 years, the youngest participant being 18 years and the oldest being 93 years, with most visitors being women (n = 312, 68%). The participants were more likely to be close relatives such as spouses (n = 117, 25%), parents (n = 113, 24%), or children (n = 79, 17%). Visitors reported different methods by which they received information about visiting policies across units and indicated that they would have visited more frequently if able. Although most respondents rated their ICU visiting experience favourably, some reported being frequently asked to leave the patient's bedside impacted their experience.

CONCLUSIONS

This study has highlighted that families want to remain in close proximity when they have a relative in the ICU. Despite visiting hours being flexible, most families visit midmorning so that they can talk with staff. Data captured in this study can be used toward improving the ICU visiting experience for family members.

Perceived stress and social support needs among primary family caregivers of ICU Patients in Taiwan

BACKGROUND

Family caregivers of intensive care unit (ICU) patients may experience distress due to their care recipients' unexpected ICU hospitalization. Social support in coping with stress has been discussed from different cultural perspectives, but social support does not seem to buffer stress for Chinese people.

OBJECTIVES

The purpose of this study was to explore stress perception and social support needs and their associations among Taiwanese primary family caregivers of patients admitted to the ICU for the first time.

METHODS

This descriptive correlational study used the Perceived Stress Scale (PSS), the Impact of Events Scale-Revised (IES-R), the Norbeck Social Support Questionnaire (NSSQ), and structured interviews to explore stress perception and social support needs among Taiwanese primary family caregivers of patients admitted to the ICU.

RESULTS

The Taiwanese primary family caregivers (N = 71) perceived considerable social support, but they still experienced high stress, either daily life stress or ICU-related event stress. Most of them required extra support, such as discussion of medical conditions, disease treatment information and psychological support, even though they had social resources to assist them.

CONCLUSION

ICU health professionals should actively inquire about family caregivers' actual needs, even when family caregivers perceive considerable social support. Tailor-made interventions should be provided to assist family members in coping with stress. Further research should also explore the role of social support in stress and coping processes in Asian contexts due to cultural variance.

The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review

AIM

The aim of the study was to identify the enablers and/or barriers to children visiting their ill parent/carer in intensive care units by examining the visiting policies as practiced or perceived by nurses and experienced or perceived by parents and caregivers.

REVIEW METHOD

This is a scoping review following Joanna Briggs Institute Protocol Guidelines.

DATA SOURCES

An extensive literature search of Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsychINFO, PubMed, and Excerpta Medica dataBASE databases, using key terms, was conducted between May 2019 and July 2020; studies published between 1990 and 2020 were considered for inclusion. Double screening, extraction, and coding of the data using thematic analysis and frequency counts were used.

RESULTS

Fifteen barriers, 19 facilitators, nine situationally contingent factors, and six personal judgement considerations were identified that influenced children visiting their ill parent/carer in intensive care units. Most barriers (n = 10) were related to organisational factors including restrictive policies, nurses' level of education, age, working hours, nurses' attitudes, and lack of required skills to promote emotional resilience and/or to communicate with children. Family perception factors relating to parents' perceptions, attitudes and concerns of staff/parents, and anticipated behaviours of children were also identified as both barriers and facilitators.

CONCLUSIONS

There is a lack of consistency in the application of policies and procedures to facilitate children visiting their loved ones in an intensive care unit. Without key involvement from the nurses and healthcare team, there may have been opportunities lost to optimise family-centred care practices in critical care settings.

Satisfaction of patients and family caregivers in adult intensive care units: Literature Review

Intensive care units are hostile places, which must be conditioned to the needs of patients and families, and therefore the factors that influence their satisfaction must be known.

OBJECTIVE

To update the knowledge on the satisfaction of the patients admitted to an adult intensive care unit and that of their family caregivers as described in the scientific literature.

METHODOLOGY

A systematized literature review was carried out in PubMed, Scopus, Cinahl and WOS databases.

SEARCH STRATEGY

"Personal Satisfaction" and (patients or caregivers) and "Intensive Care Units".

INCLUSION CRITERIA

studies published between 2013-2018, population aged between 19-64 years, english and spanish language.

RESULTS

760 studies were located and 15 were selected. The factors that increased satisfaction are: good communication with professionals (n=5), the quality of care (n=4), and the cleanliness and environment of the units (n=2). The factors that produced dissatisfaction are: the infrastructure of the waiting room (n=5), inadequate communication (n=4), and the involvement of families and patients in decision-making (n=4). Training of professionals (n=5), inclusion of the family during the process of hospitalization (n=2) and redesigning the waiting room (n=2) are some of the suggestions for improvement.

CONCLUSIONS

Factors related to professionals, environment and cleanliness of the units are satisfaction-generating factors. Factors generating dissatisfaction related to poor infrastructure, a lack of involvement in decision-making and poor professional communication. Strategies to improve patient and family satisfaction relate to the organization, professionals, family members, and infrastructure and environment.

Nurse-family relationship. Beyond the opening of doors and schedules

INTRODUCTION

Care in the Intensive Care Unit involves contemplating, among other dimensions of the patient, the family. For this, it is necessary for the nurse to establish relationships with the patient's relatives.

OBJECTIVE

To identify the way in which the nurse-family relationship is established in the adult ICU, as well as the conditions, elements and factors that favour or hinder it.

METHOD

Integrative narrative review of the scientific literature. The databases consulted were Ovid, PubMed, Science Direct, Scopus, Clinical Key, Google Scholar and Scielo. Articles in English and Spanish published between 2014 and 2018 were searched. The descriptors and formulas used were selected according to the acronym Population and their problems, Exposure and Outcomes or themes- PEO. The population comprised ICU nurses and the relatives of patients in critical condition; Adult Intensive Care Unit exposure or context; the expected results, and how they are related. For the methodological evaluation, the STROBE guide was used for observational articles, PRISMA for review articles, COREQ for qualitative articles and CASPe for articles derived from projects.

RESULTS

We identified 214 articles, of which 63 were selected to be included in the review. The central themes identified were: the ICU environment and its effects on the family, empathy as an indicator of relationship, interaction as a means of relating, communication as the centre of relationships and barriers to the establishment of relationships.

CONCLUSIONS

The nurse-family relationship in the Intensive Care Unit is based on interaction and communication amidst human, physical, regulatory and administrative barriers. Improving the nurse-family relationship contributes to the humanization of Adult Intensive Care Units.

Implementation of a flexible visiting policy in intensive care unit: A randomized clinical trial

BACKGROUND

Visitation is one of the most critical needs of patients in intensive care units (ICUs). Clinicians should enable a more flexible visitation policy to prevent the adverse effects of a restricted approach.

AIM AND OBJECTIVES

This study aimed at investigating the relationship between increasing visitation time and patients' physiological parameters in intensive units. Additionally, nurses' beliefs and attitudes towards visiting is examined in this research.

DESIGN

Parallel randomized clinical trial.

METHODS

This study was conducted in four general medical ICUs in Iran. In total, 60 patients and 57 nurses participated in this study. The patients' physiological parameters were measured at particular times in both groups. Moreover, the nurses responded to the questionnaire on beliefs and attitudes towards visitation in intensive units before and after the intervention.

RESULTS

Among all the physiological parameters, systolic and diastolic blood pressure and heart rate had a significant decrease within the normal range 10 and 30 minutes after visiting in the intervention group (P < .05), and nurses' beliefs and attitudes score were at the middle of the survey scoring range (0-120). However, no significant difference was found between nurses' belief and attitude score and intervention in any groups (P > .05).

CONCLUSION

The findings indicate that increasing visitation times can lead to a positive effect on the stability and balance of patients' physiological parameters.

RELEVANCE TO CLINICAL PRACTICE

A more flexible visiting policy can provide a therapeutic environment where not only patients' physiological disorders are minimised as much as possible but also a higher level of patients' health and satisfaction are reached.

Flexible Versus Restrictive Visiting Policies in ICUs: A Systematic Review and Meta-Analysis

OBJECTIVES

To synthesize data on outcomes related to patients, family members, and ICU professionals by comparing flexible versus restrictive visiting policies in ICUs.

DATA SOURCES

Medline, Scopus, and Web of Science.

STUDY SELECTION

Observational and randomized studies comparing flexible versus restrictive visiting policies in the ICU and evaluating at least one patient-, family member-, or ICU staff-related outcome.

DATA EXTRACTION

Duplicate independent review and data abstraction.

DATA SYNTHESIS

Of 16 studies identified for inclusion, seven were meta-analyzed. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium (odds ratio, 0.39; 95% CI, 0.22-0.69; I = 0%) and lower severity of anxiety symptoms (mean difference, -2.20; 95% CI, -3.80 to -0.61; I = 71%). Flexible visiting policies were not associated with increased risk of ICU mortality (odds ratio, 0.71; 95% CI, 0.38-1.36; I = 86%), ICU-acquired infections (odds ratio, 0.98; 95% CI, 0.68-1.42; I = 11%), or longer ICU stay (mean difference, -0.26 d; 95% CI, -0.57 to 0.05; I = 54%). Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels.

CONCLUSIONS

Flexible ICU visiting hours have the potential to reduce delirium and anxiety symptoms among patients and to improve family members' satisfaction. However, they may be associated with an increased risk of burnout among ICU professionals. These conclusions are based on few studies, with small samples and moderate risk of bias.

Humanization of critical care-psychological effects on healthcare professionals and relatives: a systematic review

PURPOSE

To systematically review and evaluate the effects of humanized care of the critically ill on empathy among healthcare professionals, anxiety among relatives, and burnout and compassion fatigue in both groups.

SOURCE

MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and ProQuest Dissertations were searched from inception to 29 June 2017 for studies that investigated the effects of interventions with potential to humanize care of the critically ill on the following outcomes: empathy among critical care professionals, anxiety among relatives, and burnout and compassion fatigue in either group. We defined a humanizing intervention as one with substantial potential to increase physical or emotional proximity to the patient. Two reviewers independently selected studies, extracted data, and assessed risk of bias and data quality.

PRINCIPAL FINDINGS

Twelve studies addressing four discrete interventions (liberal visitation, diaries, family participation in basic care, and witnessed resuscitation) and one mixed intervention were included. Ten studies measured anxiety among 1,055 relatives. Two studies measured burnout in 288 critical care professionals. None addressed empathy or compassion fatigue. Eleven of the included studies had an overall high risk of bias. No pooled estimates of effect were calculated as a priori criteria for data synthesis were not met.

CONCLUSIONS

We found insufficient evidence to make any quantitative assessment of the effect of humanizing interventions on any of these psychologic outcomes. We observed a trend towards reduced anxiety among family members who participated in basic patient care, liberal visitation, and diary keeping. We found conflicting effects of liberal visitation on burnout among healthcare professionals.

A family nursing educational intervention supports nurses and families in an adult intensive care unit

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.

Visita restrictiva / Visita no restrictiva en una unidad de paciente crítico adulto

Objetivo: buscar evidencia que responda a la pregunta ¿cuál es el impacto en el paciente, familia y personal de salud de visitas no restrictivas versus restrictivas? Método: revisión sistemática. Estrategia de búsqueda: 1993-2016 en Cochrane Library, Joanna Briggs, EBSCO,PubMed, CINHAL, Trip DataBase, con términos Mesh y palabras claves. Criterios de selección de artículos: revisiones sistemáticas,ensayos clínicos randomizados, no randomizados, cohortes, casos controles, estudios descriptivos correlacionales, UCI adultos, español e inglés. Recolección y análisis: selección inicial de 293 artículos, aplicando criterios de selección quedaron 13 artículos para análisis crítico.Calidad metodológica analizada con guías CASPe. Resultados: la visita no restrictiva no incrementa riesgo de infección, la ansiedad delpaciente es menor, la satisfacción de enfermeras es mayor, la presencia familiar ayuda a recuperación del paciente, la familia está más informada, satisfecha y con mejor conocimiento de situación. La frecuencia de complicaciones cardiovasculares es mayor en pacientes con visitas restrictivas. Conclusiones: las visitas no restrictivas en UCI no generan daño al paciente, por el contrario contribuyen a la recuperación de su salud física y emocional.