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Bohart S, Nielsen AH, Sørensen JL, Andreasen AS, Waldau T, Møller AM, Thomsen T. Establishing consensus on patient- and family-centered care in adult intensive care units: A Delphi survey. J Crit Care 2024; 84:154859. [PMID: 39003924 DOI: 10.1016/j.jcrc.2024.154859] [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: 04/05/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To establish consensus between intensive care unit (ICU) experts on concrete patient- and family-centered care statements for adult patients and relatives in the ICU. MATERIALS AND METHODS We did a three-round Delphi survey with a panel of ICU health care professionals from 23 ICUs in Denmark. In round 1, participants answered 20 open-ended questions, based on existing evidence. Analysis of their responses generated close-ended statements, which participants primary rated on a five-point-Likert-scale, from very important to not important at all. In rounds 2 and 3., consensus was predefined as ≥75% of participants rating a statement important. RESULTS Sixty-nine participated: 38 nurses, 24 physicians, and four occupational and physiotherapists. In total 96%, 90% and 72% answered the first, second, and third rounds, respectively. In round 1, participants answers resulted in >3000 statements that were analyzed into 82 condensed statements. After participants rated the statements in round 2 and 3, 47 statements reached consensus as important. CONCLUSIONS The 47 statements rated to be important included interdisciplinary approaches to systematic information sharing and consultations with patients and family-members, with the aim being to accommodate patients and family-members´ individual needs throughout the ICU stay.
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Affiliation(s)
- Søs Bohart
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark.
| | - Anne Højager Nielsen
- Department of Anesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jette Led Sørensen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark; Mary Elizabeth's Hospital - Rigshospitalet for Children, Teens and Expecting Families, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tina Waldau
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Ann Merete Møller
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hayes K, Harding S, Blackwood B, Latour JM. How and when post intensive care syndrome-family is measured: A scoping review. Intensive Crit Care Nurs 2024; 84:103768. [PMID: 39079481 DOI: 10.1016/j.iccn.2024.103768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 06/22/2024] [Accepted: 07/06/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES Family members of Intensive Care Unit (ICU) patients can experience mental health difficulties. These are collectively described as Post Intensive Care Syndrome-Family (PICS-F). There are no standardised outcome measures to benchmark the impact of PICS-F. This scoping review aimed to map and characterise interventions, outcomes, and outcome instruments related to PICS-F. METHODS Eight databases were searched in June 2023: Pubmed, CINAHL, Ovid Medline, EMBASE, PsycInfo, AMED, Emcare and Cochrane. The grey literature was also searched. Studies published after 2012 related to PICS-F were included. Search strategy included: (Population) family members of adult ICU patients, (Concept) PICS-F, (Context) ICU settings. Frequency analysis of outcomes was performed, and instruments were mapped to describe the characteristics. RESULTS Of the identified 4848 records, 46 papers representing 44 unique studies met the inclusion criteria and were retained for analysis. In total, 8008 family members were represented across 15 countries in four continents worldwide. The number of studies reporting PICS-F interventions increased rapidly over the past 12 years and were performed in ICUs treating mixed conditions. Studies were randomised control trials (n = 33), before-and-after design (n = 6) and non-randomised trials (n = 5). A total of 18 outcome instruments were used measuring predominantly anxiety, with complicated grief measured only once. The identified instruments were mostly validated for clinical and disease specific populations but not validated among relatives of ICU patients. CONCLUSION There is a plethora of instruments measuring PICS-F outcomes. No core outcome set is currently available for PICS-F. To reduce heterogeneity of how PICS-F is measured, a core outcome set with validated measurements is recommended to allow benchmarking and to document the impact of PICS-F interventions. IMPLICATIONS FOR CLINICAL PRACTICE Recognising PICS-F symptoms and understanding how to assess them could help clinicians to develop interventions to improve family outcomes. Validated instruments are needed to evaluate these interventions.
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Affiliation(s)
- Kati Hayes
- Research and Development Department, North Bristol NHS Trust, Westbury On Trym, Bristol, UK.
| | - Sam Harding
- Research and Development Department, North Bristol NHS Trust, Westbury On Trym, Bristol, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University Belfast, Northern Ireland, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia; Zhongshan Hospital, Fudan University, Shanghai, China
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Allum L, Pattison N, Connolly B, Apps C, Cowan K, Flowers E, Hart N, Rose L. Codesign of a Quality Improvement Tool for Adults With Prolonged Critical Illness: A Modified Delphi Consensus Study. Crit Care Explor 2024; 6:e1146. [PMID: 39292989 PMCID: PMC11390055 DOI: 10.1097/cce.0000000000001146] [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: 09/13/2024] Open
Abstract
OBJECTIVES Increasing numbers of patients experience a prolonged stay in intensive care. Yet existing quality improvement (QI) tools used to improve safety and standardize care are not designed for their specific needs. This may result in missed opportunities for care and contribute to worse outcomes. Following an experience-based codesign process, our objective was to build consensus on the most important actionable processes of care for inclusion in a QI tool for adults with prolonged critical illness. DESIGN Items were identified from a previous systematic review and interviews with former patients, their care partners, and clinicians. Two rounds of an online modified Delphi survey were undertaken, and participants were asked to rate each item from 1 to 9 in terms of importance for effective care; where 1-3 was not important, 4-6 was important but not critical, and 7-9 was critically important for inclusion in the QI tool. A final consensus meeting was then moderated by an independent facilitator to further discuss and prioritize items. SETTING Carried out in the United Kingdom. PATIENTS/SUBJECTS Former patients who experienced a stay of over 7 days in intensive care, their family members and ICU staff. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We recruited 116 participants: 63 healthcare professionals (54%), 45 patients (39%), and eight relatives (7%), to Delphi round 1, and retained 91 (78%) in round 2. Of the 39 items initially identified, 32 were voted "critically important" for inclusion in the QI tool by more than 70% of Delphi participants. These were prioritized further in a consensus meeting with 15 ICU clinicians, four former patients and one family member, and the final QI tool contains 25 items, including promoting patient and family involvement in decisions, providing continuity of care, and structured ventilator weaning and rehabilitation. CONCLUSIONS Using experience-based codesign and rigorous consensus-building methods we identified important content for a QI tool for adults with prolonged critical illness. Work is underway to understand tool acceptability and optimum implementation strategies.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Natalie Pattison
- University of Hertfordshire, Hatfield, United Kingdom
- East & North Herts NHS Trust, Stevenage, United Kingdom
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chloe Apps
- Critical Care Research Group and Physiotherapy Department, St. Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Katherine Cowan
- Katherine Cowan Consulting Limited, East Sussex, United Kingdom
| | - Emily Flowers
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Physiotherapy Department, King's College Hospital, London, United Kingdom
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Human and Applied Physiologic Sciences, King's College London, London, United Kingdom
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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Abukari AS, Schmollgruber S. Perceived barriers of family-centred care in neonatal intensive care units: A qualitative study. Nurs Crit Care 2024; 29:905-915. [PMID: 38228405 DOI: 10.1111/nicc.13031] [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: 01/12/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Family-centered care (FCC) approach in neonatal intensive care units (NICUs) has been shown to improve family satisfaction and quality of care. However, several contextual barriers influence its use in NICUs, and these barriers are understudied in Ghana. AIM To describe FCC practice in Ghanaian NICUs in order to understand the contextual barriers. STUDY DESIGN The study employed a descriptive qualitative design. The researchers used a structured interview guide to collect the data in 24 interviews and 12 focus group discussions. We engaged families (n = 42), nurses and midwives (n = 33), and doctors (n = 9) to describe their perspectives on the barriers to FCC in two public tertiary hospital NICUs. The data were mapped, triangulated, and aggregated to inform the findings. Thematic analysis and MAXQDA qualitative software version 2020 were employed to analyse the data. This qualitative study followed the COREQ guidelines and checklist. RESULTS Perceived family barriers and perceived facility barriers to FCC were the two main themes. The perceived family barriers include family stress and anxiety, inadequate information sharing and education, culture and religion. The perceived facility barriers are inadequate space and logistics, workload and inadequate staff, restricted entry, and negative staff attitudes. CONCLUSION The findings of this study shed light on the barriers to FCC practice in neonatal care in Ghanaian NICUs. Family stress and anxiety, a lack of information sharing, cultures and religious beliefs, NICU workload and staffing shortages, restrictions on family entry into NICUs, and staff attitudes towards families are all contextual barriers to FCC practice. RELEVANCE TO CLINICAL PRACTICE Health facility managers and NICU staff may consider addressing these barriers to implement FCC in the NICU in order to enhance family satisfaction and quality neonatal care. The design of future NICUs should consider family comfort zones and subunits to accommodate families and their sick infants for optimal health care outcomes. The development of communication models and guidelines for respectful NICU care may aid in integrating families into ICUs and promoting quality health care outcomes.
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Affiliation(s)
- Alhassan Sibdow Abukari
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
- Department of General Nursing, School of Nursing, Wisconsin International University College, Accra, Ghana
| | - Shelley Schmollgruber
- Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Yoo HJ, Kim N, Park MK. Patient-centered care for mental health in patients with heart failure in the intensive care unit: A systematic review. Appl Nurs Res 2024; 78:151814. [PMID: 39053991 DOI: 10.1016/j.apnr.2024.151814] [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: 04/06/2023] [Revised: 07/30/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
AIM To assess basic data for developing appropriate interventions by examining the effects of patient-centered care (PCC) on the mental health of patients with heart failure in the intensive care unit (ICU). BACKGROUND Patients with heart failure are frequently admitted to ICUs, and ICU stays are associated with prolonged mental health problems. METHODS We conducted a systematic review using the CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and gray literature databases. Inclusion criteria were studies with participants aged ≥18 years with heart failure in the ICU who received a PCC intervention, and studies that described the outcomes for mental health problems. Data were extracted from five selected studies published after 2020 and analyzed. RESULTS PCC is classified into three areas: comprehensive nursing, multidisciplinary disease management, and targeted motivational interviewing with conventional nursing. The two specific areas of focus for PCC regarding mental health were integrated mental healthcare and specific psychological nursing. Specific psychological nursing comprised relationship building, therapeutic communication, relaxation and motivational techniques, active therapeutic cooperation, psychological status evaluation, music therapy, and environmental management. CONCLUSIONS This review provides a distinctive understanding of multidisciplinary and multicomponent PCC interventions for patients with heart failure in the ICU as an effective approach for improving their mental health. Future PCC intervention strategies aimed at patients with heart failure in the ICU should consider their preferences and family participation.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea.
| | - Min Kyung Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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Singh VK, Ahmad A, Jaiswal V. Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center. Cureus 2024; 16:e65702. [PMID: 39211660 PMCID: PMC11358507 DOI: 10.7759/cureus.65702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Family members play a crucial role in ICU patients' treatment and decision-making, despite the stress and uncertainty they may experience, ensuring high-quality medical care. Providing comfortable spaces with noise-reducing techniques can boost family satisfaction. Further research is needed to support families in intensive care units (ICU). This study aims to evaluate family satisfaction and decision-making in polytrauma patients in the ICU, identify improvement opportunities, and analyze demographic and socioeconomic factors influencing satisfaction. METHODS This cross-sectional study was conducted at King George's Medical University, Lucknow, over a period of one year. A total of 66 patients, aged between 20 and 70, their family members, and those who gave written informed consent were included. Exclusion criteria included those who died within 48 hours of ICU admission or did not give consent. Patient characteristics, such as age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and hospital stay length, were also collected. The family satisfaction in the intensive care unit (FS-ICU) questionnaire, consisting of 24 items with five Likert response options, was used to assess satisfaction levels in ICU care and decision-making. RESULTS A study of 66 patients which included 78.79% male and 21.21% female. The majority of the patients (66.67%) lived with their family members. The mean ICU stay was 13.03 days, with an APACHE score of 17.39. The results showed that families were very satisfied with a considerable portion of the ICU stay. The overall satisfaction score was 57.00. Families were less satisfied with the atmosphere in the ICU and involvement in the decision-making process. The satisfaction scores were comparable for both genders, except for the time taken to respond to questions, which was significantly higher for women. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The present study shows that the quality of treatment and communication during hospitalization is a major factor in the need for follow-up care. This underlines the need for a constant focus on communication skills in the training of nurses and doctors and in their practical training in the ICU. Participation in decision-making, especially by family members of survivors, was identified as an area for improvement. We recommend more research to be conducted in India focusing on family satisfaction with involvement in the decision-making in ICU considering the unique racial, cultural, ethnic, and linguistic differences in India.
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Affiliation(s)
- Vipin K Singh
- Anesthesiology, King George's Medical University, Lucknow, IND
| | - Azin Ahmad
- Anesthesiology, King George's Medical University, Lucknow, IND
| | - Vaibhav Jaiswal
- Trauma and Acute Care Surgery, King George's Medical University, Lucknow, IND
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Joo Y, Jang Y, Kwon OY. Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review. Nurs Crit Care 2024. [PMID: 38899600 DOI: 10.1111/nicc.13105] [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: 10/18/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
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.
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Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
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Cussen J, Mukpradab S, Tobiano G, Cooke C, Pearcy J, Marshall AP. Early mobility and family partnerships in the intensive care unit: A scoping review of reviews. Nurs Crit Care 2024; 29:597-613. [PMID: 37749618 DOI: 10.1111/nicc.12979] [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: 03/10/2023] [Revised: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. AIM In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. STUDY DESIGN In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. RESULTS Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. CONCLUSIONS There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. RELEVANCE TO CLINICAL PRACTICE Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.
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Affiliation(s)
| | - Sasithorn Mukpradab
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | - Georgia Tobiano
- Gold Coast Health, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
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He B, Mo BR, Meng SY, Yang Z, Liu WT, Wang YY, Mou XL, Chen YQ, Chen Y. Decreasing the incidence of delirium via multi-sensory stimulation in patients receiving mechanical ventilation in the intensive care unit: A protocol for a randomized feasibility study. Contemp Clin Trials Commun 2024; 38:101263. [PMID: 38304570 PMCID: PMC10831177 DOI: 10.1016/j.conctc.2024.101263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Introduction Delirium is a common acute brain dysfunction syndrome in patients admitted to intensive care units (ICUs). Family engagement strategies, based on the theory of multi-sensory stimulation to ameliorate sensory deprivation in patients, may be an effective and scalable method to reduce the burden of delirium. Methods /design: This is a assessor-blinded, randomised controlled trial of the feasibility of multi-sensory stimulation (MS) in patients with delirium. A total of 72 mechanically ventilated patients (n = 24 in each group) admitted to the ICU will be randomised to routine non-pharmacological delirium care (control), family multi-sensory stimulation and nurse multi-sensory stimulation groups. All participants except the control group will receive multi-sensory stimulation, including visual, auditory, tactile and kinesthetic stimulation, for 5 days. Our primary aim is to determine the feasibility of the study procedure (recruitment, eligibility, retention and attrition rates, appropriateness of clinical outcome measures), feasibility, acceptability and safety of the intervention (adverse events, satisfaction and other). Our secondary objective is to assess the preliminary efficacy of the MS protocol in reducing the incidence, duration and severity of delirium. Sedation levels and delirium severity will be assessed twice daily. Enrolled participants will be followed in hospital until death, discharge or up to 28 days after treatment. Ethics and dissemination The current study was approved by the Ethics Review Board of Huazhong University of Science and Technology Union Shenzhen Hospital, China (KY-2023-031-01). The results of this study will be presented at scientific conferences and submitted for publication in peer-reviewed journals. Trial registration number ChiCTR2300071457.
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Affiliation(s)
- Bin He
- Department of Intensive Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, China
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Bei-rong Mo
- Department of Intensive Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, China
| | - Si-ya Meng
- Department of Intensive Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, China
| | - Zheng Yang
- Department of Intensive Care Unit, Huazhong University of Science and Technology Union Shenzhen Hospital, China
| | - Wen-ting Liu
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Yu-ying Wang
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Xiao-Ling Mou
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Yu-Qi Chen
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Yu Chen
- School of Nursing, Southern Medical University, Guangzhou, 510515, China
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Lin L, Peng Y, Huang X, Li S, Chen L, Lin Y. A family intervention to prevent postoperative delirium in patients undergoing cardiac valve surgery: A randomized controlled study. Heart Lung 2024; 63:1-8. [PMID: 37714079 DOI: 10.1016/j.hrtlng.2023.09.002] [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: 03/28/2023] [Revised: 08/24/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Multiple guidelines recommend that families be involved in the care of ICU patients, which has been widely used in ICU delirium management in recent years. Postoperative delirium (POD) occurs frequently after cardiac surgery and is associated with poor outcomes; however, the effects of family intervention on this group are rarely studied. OBJECTIVES This study aimed to investigate the effects of family intervention on the incidence of POD and the ICU prognoses of patients undergoing cardiac valve surgery. METHODS This was a two-group, single-blind, randomized controlled trial involving 80 patients undergoing cardiac valve surgery, with 40 patients in each group. The control group received routine ICU visits, and the experimental group implemented a family intervention that instructed family caregivers to participate in delirium management during ICU visits. The occurrence of POD, ICU stay, mechanical ventilation time of patients; as well as the anxiety, depression, and satisfaction levels of family caregivers were compared between the two groups. RESULTS The incidence of POD and ICU stay of patients were significantly lower in the experimental group compared to the control group (P < 0.05). The anxiety and depression incidence of family caregivers in the experimental group was lower than those of the control group (P < 0.05), and satisfaction scores were higher than those of the control group (P < 0.05). CONCLUSIONS Family intervention has the potential to reduce the incidence of POD in patients undergoing cardiac valve surgery, shorten ICU stays, reduce the incidence of anxiety and depression in family caregivers, and improve their satisfaction. These findings suggest that family intervention could be incorporated into routine nursing practice.
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Affiliation(s)
- Lingyu Lin
- Department of Nursing, Fujian medical university, Fuzhou, Fujian, China; Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China
| | - Yanchun Peng
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China
| | - Xizhen Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China
| | - Yanjuan Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China; Heart Center of Fujian Medical University, Fuzhou, Fujian, China; Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
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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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12
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Price AM, McAndrew NS, Thaqi Q, Kirk M, Brysiewicz P, Eggenberger S, Naef R. Factors influencing critical care nurses' family engagement practices: An international perspective. Nurs Crit Care 2023; 28:1031-1044. [PMID: 35831205 DOI: 10.1111/nicc.12824] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family engagement positively impacts patient and family members' experiences of care and health outcomes. While partnering with families denotes best practice in intensive care units (ICUs), its full adoption requires improvement. A better understanding of the factors that influence the implementation of family engagement practices is necessary. AIM To investigate the factors that enable or hinder adult ICU nurse-family engagement and to explore potential international variations. STUDY DESIGN Descriptive, cross-sectional survey. Nurses from 10 countries completed the 'Questionnaire on Factors that Influence Family Engagement' (QFIFE), including five open-ended questions. We performed descriptive statistics on quantitative data and content analysis for open-ended questions, and then integrated the findings according to influencing factors and geographical patterns. This was part of a larger qualitative study where 65 nurses participated from adult intensive care units. RESULTS Sixty-one nurses completed the questionnaire, making a response rate of 94%. Overall, patient acuity (Md = 5.0) and nurses' attitudes (Md = 4.6) seemed to be the most influential facilitator, followed by nurse workflow (Md = 4.0) and ICU environment (Md = 3.1) (score 1-6 most influential). The open-ended question data showed a more nuanced picture of the complexity of family engagement in care around these four determinants. Adding a fifth determinant, namely Families are complex structures that respond uniquely to the ICU and patient, revealed that difficult family dynamics, miscommunication and family having difficulty in understanding the situation or health literacy, hindered family engagement. Exploring geographical variations, Africa/Middle East consistently differed from others on three of the four QFIFE subscales, showing lower median levels. CONCLUSIONS Some determinants are perceived to be more influential than others, becoming barriers or enablers to nurse-family engagement in adult ICU. Research that investigates contextual determinants and which compares implementation and improvement initiatives tailored to address family engagement practices barriers and enablers are needed. RELEVANCE TO CLINICAL PRACTICE Knowledge of this international study expands our understanding of enablers and barriers in family engagement that may inform family engagement practice improvement efforts around the world.
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Affiliation(s)
- Ann M Price
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
- Froedtert & the Medical College of Wisconsin, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Qendresa Thaqi
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
| | - Mary Kirk
- Faculty of Medicine, Health and Social Care, School of Nursing, Midwifery and Social Work, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Sandra Eggenberger
- College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, Mankato, Minnesota, USA
| | - Rahel Naef
- Faculty of Medicine, Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zürich, Switzerland
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13
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Dijkstra BM, Felten-Barentsz KM, van der Valk MJM, Pelgrim T, van der Hoeven JG, Schoonhoven L, Ebben RHA, Vloet LCM. Family participation in essential care activities in adult intensive care units: An integrative review of interventions and outcomes. J Clin Nurs 2023; 32:5904-5922. [PMID: 37062011 DOI: 10.1111/jocn.16714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/17/2023] [Accepted: 03/23/2023] [Indexed: 04/17/2023]
Abstract
AIMS AND OBJECTIVES To systematically review interventions and outcomes regarding family participation in essential care in adult intensive care units. BACKGROUND Patients and relatives may benefit from family participation in essential care activities. DESIGN An integrative literature review. METHODS The following databases were systematically searched from inception to January 25, 2021: PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science and reference lists of included articles. Studies were included when reporting on family participation in essential care activities in intensive care including interventions and outcomes. Quality of the studies was assessed with the Kmet Standard Quality Assessment Criteria. Interventions were assessed, using the TIDieR framework. Data were extracted and synthesised narratively. RESULTS A total of 6698 records were screened, and 322 full-text studies were assessed. Seven studies were included, describing an intervention to support family participation. Four studies had a pretest-posttest design, two were pilot feasibility studies and one was observational. The quality of the studies was poor to good, with Kmet-scores: 0.50-0.86 (possible score: 0-1, 1 being the highest). Five studies offered various essential care activities. One study provided sufficient intervention detail. Outcome measures among relatives varied from mental health symptoms to satisfaction, supportiveness, comfort level and experience. Two studies measured patient outcomes: delirium and pressure ulcers. Among ICU healthcare providers, perception, comfort level and experience were assessed. Since outcome measures varied, only narrative synthesis was possible. Family participation is associated with a reduction of anxiety and PTSD symptoms. CONCLUSION Intervention descriptions of family participation in essential care activities are generally inadequate and do not allow comparison and replication. Participation of relatives was associated with a significant reduction in mental health symptoms. Other outcome measures varied, therefore, the use of additional outcome measures with validated measurement instruments should be considered. RELEVANCE TO CLINICAL PRACTICE The review contributed further insight into interventions aiming at family participation in essential care activities in the intensive care unit and their outcomes. NO PATIENT OR PUBLIC CONTRIBUTION Neither patients nor public were involved.
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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
| | - Thomas Pelgrim
- 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
| | - Remco H A Ebben
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, School of Health Studies, Nijmegen, the Netherlands
| | - 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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McAndrew NS, Erickson J, Hetland B, Guttormson J, Patel J, Wallace L, Visotcky A, Banerjee A, Applebaum AJ. A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation. JOURNAL OF FAMILY NURSING 2023; 29:227-247. [PMID: 37191306 PMCID: PMC10330518 DOI: 10.1177/10748407231166945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA
- Froedtert & the Medical College of Wisconsin, Milwaukee, USA
| | | | - Breanna Hetland
- University of Nebraska Medical Center, Omaha, USA
- Nebraska Medicine, Omaha, USA
| | | | | | | | | | | | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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15
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Bohart S, Lamprecht C, Andreasen AS, Waldau T, Møller AM, Thomsen T. Perspectives and wishes for patient and family centred care as expressed by adult intensive care survivors and family-members: A qualitative interview study. Intensive Crit Care Nurs 2023; 75:103346. [PMID: 36470701 DOI: 10.1016/j.iccn.2022.103346] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/07/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES To explore perspectives and wishes for patient and family centred care among adult patients and family-members with recent experience of admission to an adult intensive care unit. RESEARCH DESIGN An explorative descriptive study using an inductive thematic analysis. Semi-structured interviews with adults (≥18 years) who had experienced admission ≥48 hours to an adult intensive care unit as a patient or family-member within the previous three months. Interview data were analysed used the six phases of thematic analysis, described by Braun and Clarke. Semi-structured interviews with adults (≥18 years) who had experienced admission ≥48 hours to an adult intensive care unit as a patient or family-member within the previous three months. Interview data were analysed used the six phases of thematic analysis, described by Braun and Clarke. SETTING Participants were recruited from six general (mixed surgical and medical) units in the Capital Region of Denmark. FINDINGS From fifteen interviews a total of 23 participants (8 patients and 15 family-members) described their perspectives and wishes for patient- and family-centred care. Three main themes were identified: 1) Ongoing dialogue is fundamental. Both scheduled and spontaneous information-sharing is important. 2) Humanizing. High-quality treatment was especially evident for participants when staff maintain a humanized attitude. 3) Equipping family to navigate. We found a range of specific suggestions of attention that may help patients and family-members to navigate during admission. CONCLUSIONS We found that patients' and family-members' perspectives and wishes for PFCC centred around ongoing dialogue with staff and the importance of humanizing the ICU environment. Patients and family members needed to share and have their knowledge, concerns and perspectives brought forth and acknowledged by staff. Participants emphasized the pivotal role staff have in equipping patients and family-members to cope in the unit and supporting specifically family-members in fulfilling their role as advocates and supporters of the patient.
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Affiliation(s)
- Søs Bohart
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark.
| | - Cornelia Lamprecht
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Anne Sofie Andreasen
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Tina Waldau
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Ann Merete Møller
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Thordis Thomsen
- Dep. of Anesthesiology and Herlev ACES, Herlev Anasthesia Critical and Emergency Care Science Unit, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
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16
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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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17
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Seniwati T, Rustina Y, Nurhaeni N, Wanda D. Patient and family-centered care for children: A concept analysis. BELITUNG NURSING JOURNAL 2023; 9:17-24. [PMID: 37469640 PMCID: PMC10353635 DOI: 10.33546/bnj.2350] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/02/2022] [Accepted: 01/08/2023] [Indexed: 07/21/2023] Open
Abstract
Background Family-centered care has evolved into patient and family-centered care. Although this is not a new concept; however, its application to nursing practice is very challenging among nurses due to its ambiguity. Objective This study aimed to clarify the concept of patient and family-centered care for children. Methods Walker and Avant's concept analysis method was used. A literature search was also done using the following databases: Google Scholar, ProQuest, ScienceDirect, and Scopus, for articles published from 2011 to 2021. Results The defining attributes of patient and family-centered care are partnership, communication, respect, and compassion. Antecedents include patient and family involvement, readiness to collaborate and participate, competency and desire of the care professional team, supportive environment, and policies. Consequences of the patient and family-centered care include improved child outcomes and quality of life, promotion of patient safety, increased patient and family satisfaction, enhancement of humanistic values, reduction of hospitalization cost and length of stay, and decreased stress, anxiety, and depression in family members. Conclusion Four attributes of patient and family-centered care, its antecedents, and consequences may aid researchers in better understanding the concept and its application in nursing practice. This concept can also be used to establish quality care delivery strategies and promote professional relationships between nurses, patients, and families in clinical settings.
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Affiliation(s)
- Tuti Seniwati
- Postgraduate Program, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Pediatric Nursing Department, Faculty of Nursing, Universitas Hasanuddin, Makassar, Indonesia
| | - Yeni Rustina
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Nani Nurhaeni
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dessie Wanda
- Pediatric Nursing Department, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
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18
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Charosaei F, Rostami S, Esmaeili M, Molavynejad S, Vanaki Z. Challenges in implementation of patient-centred care in cardiac care unit: A qualitative study. Nurs Open 2023; 10:838-849. [PMID: 36057965 PMCID: PMC9834141 DOI: 10.1002/nop2.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/24/2022] [Accepted: 08/22/2022] [Indexed: 01/16/2023] Open
Abstract
AIM This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. DESIGN This study was performed with a descriptive qualitative study approach. METHODS In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. RESULTS After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.
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Affiliation(s)
- Firouzeh Charosaei
- Department of Nursing, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Shahnaz Rostami
- Nursing Care Research Center in Chronic Disease, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Maryam Esmaeili
- Nursing and Midwifery Care Research Center, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Shahram Molavynejad
- Nursing Care Research Center in Chronic Disease, School of Nursing and MidwiferyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Zohreh Vanaki
- Department of Nursing, Faculty of Medical SciencesTarbiat Modares UniversityTehranIran
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19
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Best A, Harvey C, Minton C. Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature. Nurs Crit Care 2023. [DOI: 10.1111/nicc.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Amy Best
- School of Nursing Massey University Wellington New Zealand
- Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
| | - Clare Harvey
- School of Nursing Massey University Wellington New Zealand
| | - Claire Minton
- School of Nursing Massey University Palmerston North New Zealand
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20
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August D, Ullman A, Coyer F. Device related pressure injuries across the critical care lifespan. Nurs Crit Care 2023; 28:6-8. [PMID: 36715234 DOI: 10.1111/nicc.12874] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Deanne August
- Grantley Stable Neonatal Unit, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Hospital and Health Service, Children's Heath Queensland, South Brisbane, Queensland, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, University of Queensland, Saint Lucia, Queensland, Australia.,Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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21
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Alshehri HH, Wolf A, Öhlén J, Olausson S. Healthcare Professionals' Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study. Glob Qual Nurs Res 2022; 9:23333936221138077. [PMID: 36507302 PMCID: PMC9729985 DOI: 10.1177/23333936221138077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 12/12/2022] Open
Abstract
There is a growing need to integrate palliative care into intensive care units and to develop appropriate knowledge translation strategies. However, multiple challenges persist in attempts to achieve this objective. In this study, we aimed to explore intensive care professionals' perspectives on providing palliative and end-of-life care within an intensive care context. We used an interpretive description approach and interviewed 36 intensive care professionals at four hospitals in Saudi Arabia. Our findings reflect a discourse about end-of-life care driven by a do-not-resuscitate classification and challenges associated with family involvement in care goals. We provide key insights of importance for the development of strategies for the integration and knowledge translation of palliative care into intensive care contexts.
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Affiliation(s)
- Hanan Hamdan Alshehri
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Hanan Hamdan Alshehri, University of Gothenburg Sahlgrenska Academy, Box 457 405 30 Göteborg, Goteborg 405 30, Sweden. Emails: ;
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital/Östra, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- University of Gothenburg and Palliative Centre, Sahlgrenska University Hospital Region Västra Götaland, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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22
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Factors Predicting Older Patients' Family Involvement by Nursing Staff in Hospitals: The View of Hospital Nurses in Israel. Healthcare (Basel) 2022; 10:healthcare10101921. [PMID: 36292368 PMCID: PMC9602099 DOI: 10.3390/healthcare10101921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/04/2022] Open
Abstract
According to the family-centered approach, the involvement of family in the care of hospitalized older patients is a crucial element of quality care. Active involvement of family in care by the nursing staff depends on different factors, including attitudes towards the importance of family in the care and perception of the interactions with the family. This study aims to identify the factors predicting staff behavior of involving the family in the care process. A cross-sectional study was conducted among 179 nursing staff at a hospital, using a self-report questionnaire examining staff attitudes towards the importance of family in care, the perception of the interactions with the family (family behavior, communication and conflicts), and staff behavior toward family involvement. The findings point out the importance that staff attitudes have on their behavior in the active involvement of family in the care of older patients. Staff behavior of family involvement was predicted by their perceptions of the family (as conversational partners and having their own resources), less conflicts with the family, and staff academic education. Staff behavior toward family is influenced by their attitude and staff–family relationships. Educational programs should emphasize the importance of family, as well as dealing with conflicts.
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Kirkham L. Partnership working between nurses and patients' families in the critical care environment. Nurs Stand 2022; 37:45-50. [PMID: 35661163 DOI: 10.7748/ns.2022.e11669] [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] [Accepted: 02/02/2021] [Indexed: 11/09/2022]
Abstract
When an individual becomes critically ill, they may be admitted to a critical care environment, which can have significant effects on themselves and their family. There is a wealth of literature exploring the experiences and priorities of patients and their families in relation to critical care, but also a lack of research on practical interventions that can improve care delivery in this setting. This article explores partnership working between nurses and patients' families in the critical care environment and examines the barriers to, and facilitators of, family-centred care. The author draws on the literature to consider interventions that could enhance family-centred care in this setting, and makes some recommendations for practice.
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Affiliation(s)
- Lucy Kirkham
- Department of Nursing and Midwifery, Sheffield Hallam University, Sheffield, England
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Bourne RS, Jennings JK, Panagioti M, Hodkinson A, Sutton A, Ashcroft DM. Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis. BMJ Qual Saf 2022; 31:609-622. [PMID: 35042765 PMCID: PMC9304084 DOI: 10.1136/bmjqs-2021-013760] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation. METHODS The systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations. RESULTS Seventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I2=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I2=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I2=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I2=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process. CONCLUSIONS Multicomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.
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Affiliation(s)
- Richard S Bourne
- Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jennifer K Jennings
- Pharmacy and Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Maria Panagioti
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alexander Hodkinson
- National Institute for Health Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Anthea Sutton
- School of Health and Related Sciences (ScHARR), The University of Sheffield, Sheffield, Sheffield, UK
| | - Darren M Ashcroft
- National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Wong P, Gamble A, Jaspers R, Pope N, Endacott R. Experiences of health care professionals in intensive care when families participate in clinician handovers: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2048-2054. [DOI: 10.11124/jbies-21-00310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Effect of Early Low-Calorie Enteral Nutrition Support in Critically Ill Patients: A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7478373. [PMID: 35832844 PMCID: PMC9273443 DOI: 10.1155/2022/7478373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/11/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective The purpose of this research was to rigorously assess the impact of early low-fever enteral feeding supplementation in critically sick patients. Methods PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Physiotherapy Evidence Database were searched for randomized controlled trials related to enteral nutrition support of critically ill patients (retrieval time was limited to June 30, 2021); data were extracted after screening the literature, and the quality of meta-analysis was evaluated. Results When compared to adequate caloric enteral nutrition support, early low caloric enteral nutrition support reduces the incidence of intolerance to nutrition support (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13) and the insulin dose during enteral nutrition support (MD = -17.21, 95 percent CI: -19.91 to -14.51, P = 0.00001). However, it had no effect on intensive care unit (ICU) treatment duration (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), in-hospital mortality (MD = 0.60, 95 percent CI: -0.18 to 1.39, P = 0.13), or infection incidence (OR = 1.00, 95 percent CI: 0.85, 1.19, P = 0.98). Conclusion When compared to sufficient caloric enteral nutrition support, early low-calorie enteral nutrition support lowers the risk of severe illness. The rate of intolerance to nutritional assistance and the decrease in insulin dosage supplied had no effect on the length of ICU therapy, patient death, or infection incidence.
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The effect of a family-based participatory care program on anxiety in patients with acute coronary syndrome in coronary care units: A randomised controlled clinical trial. Aust Crit Care 2022:S1036-7314(22)00058-3. [PMID: 35618611 DOI: 10.1016/j.aucc.2022.04.002] [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: 10/12/2021] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Admission to the coronary care units (CCUs) and the patient's reduced interaction with family are regarded as important sources of anxiety. Family participation in care programs is pivotal to patient outcomes. OBJECTIVES The present study was conducted to determine the effect of a care program based on family participation on anxiety in patients with acute coronary syndrome. METHODS This randomised controlled trial was conducted on 90 patients in CCUs and their families. The patients were randomly assigned to one of the following three groups: routine care, control, and intervention. Routine care measures were provided to the routine care group, increased participation of the family was ensured in the control group, and a family-based participatory care program was implemented in the intervention group with the interaction of the nurse, patient, and family based on five principles, including presence, determination of needs, communication, participation in decision-making, and cooperation in care. The patients' anxiety was measured in the three groups on day 1 and 3 days after the admission to the CCU using the Spielberger State-Trait Anxiety Inventory. RESULTS The patients' mean state anxiety score before the intervention was 44.4 ± 12.7, 46.6 ± 12.4, and 45.5 ± 12.1 in the routine care, control, and intervention groups, respectively, with no significant differences between them (P = 0.81). After adjusting for anxiety before the intervention and study hospital, the mean (before-after) changes in anxiety score in the three groups showed that anxiety was significantly lower in the intervention group than in the other groups (P < 0.05). CONCLUSION Increased family presence alone has no effect on the patients' anxiety, but the family's participation and interaction with the care team can affect anxiety levels in cardiac patients in CCUs and improve the care processes. TRIAL REGISTRATION Iranian Registry of Clinical Trials, Trial No. IRCT201105146481N1.
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Li B, Yang Q. The effect of an ICU liaison nurse-led family-centred transition intervention program in an adult ICU. Nurs Crit Care 2022; 28:435-445. [PMID: 35396917 DOI: 10.1111/nicc.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND ICUs follow a restrictive companionship policy, especially after the COVID-19 outbreak. This strategy often limits the time families spend with patients, hinders their knowledge and skills in caregiving, and the sudden transfer of ICU patients to assist with disease monitoring and daily care can be very stressful for families. It is beneficial to use the transition period of transferring ICU patients to help families adjust to the role of caregiver. AIMS AND OBJECTIVES To develop and implement a patient- and family-centered transitional care intervention plan for patients transferred to the ICU. DESIGN Prospective, pretest and posttest design. METHODS The experimental group received an individualized family-centered transition plan led by the ICU liaison nurse that included 1) communication with health care professionals; distribution of a transfer booklet; 2) identification of nursing issues and communication with the ward nurse; invitation of family members to participate in the patient's rehabilitation; 3) follow-up instruction on bedside range of motion exercises; and provision of a patient rehabilitation diary. Patients in the control group received only routine care. Data were collected using the General Information Questionnaire, Family Satisfaction with ICU Patients (FS-ICU), the Family Relocation Stress Scale (FRSS), and the Stanford Acute Stress Response Questionnaire (SASRQR). RESULTS After the intervention, the total family satisfaction score of ICU patients in the experimental group was significantly higher than that of the control group (87.18 ± 8.38 vs 78.74 ± 10.63, p<0.001), and the satisfaction with the care and information provided was significantly higher in the experimental group compared to the control group (p < 0.001), with no significant difference between the two groups in terms of satisfaction with decision making (p>0.001). The level of relocation stress of patients' families was significantly lower in the experimental group compared to the control group after the intervention (p < 0.001). And there was no statistically significant difference between the two groups in terms of patients' acute stress disorder scores (p>0.001). CONCLUSION The implementation of a family-involved transition care programme significantly improved the satisfaction of ICU patients' families and reduced the stress of relocation for patients' families. RELEVANCE TO CLINICAL PRACTICE Focusing on the transition of ICU patients to ensure continuity of critical care and improve the quality of care for ICU patient transfers can be accomplished through a family-centered transition care plan led by the ICU liaison nurse.
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Affiliation(s)
- Baiyu Li
- Department of Comprehensive Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, Jiangsu, China.,Nursing College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Qin Yang
- Department of Comprehensive Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, Jiangsu, China.,Nursing College of Yangzhou University, Yangzhou, Jiangsu, China
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Dijkstra BM, Felten-Barentsz KM, van der Valk MJM, Pelgrim T, van der Hoeven HG, Schoonhoven L, Ebben RHA, Vloet LCM. Family participation in essential care activities: Needs, perceptions, preferences, and capacities of intensive care unit patients, relatives, and healthcare providers—An integrative review. Aust Crit Care 2022; 36:401-419. [PMID: 35370060 DOI: 10.1016/j.aucc.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Family participation in essential care activities may benefit both patients and relatives. OBJECTIVES In this integrative review, we aimed to identify needs, perceptions, preferences, and capacities regarding family participation in essential care in intensive care units (ICUs) from the patient's, relatives', and ICU healthcare providers' perspective. REVIEW METHOD USED An integrative review method was used. DATA SOURCES PubMed, CINAHL, EMBASE, MEDLINE, Cochrane, Web of Science, and reference lists of included articles were searched, from inception to January 25, 2021. REVIEW METHODS We included studies on family participation in essential care activities during ICU stay which reported associated needs, perceptions, preferences and capacities. Quality assessment was performed with the Kmet Standard Quality Assessment Criteria developed for evaluating primary research papers in a variety of fields, and an extensive qualitative thematic analysis was performed on the results. RESULTS Twenty-seven studies were included. Quality scores varied from 0.45 to 0.95 (range: 0-1). Patients' needs, perceptions, preferences, and capacities are largely unknown. Identified themes on needs and perceptions were relatives' desire to help the patient, a mostly positive attitude among all involved, stress regarding patient safety, perceived beneficial effects, relatives feeling in control-ICU healthcare providers' concerns about loss of control. Preferences for potential essential care activities vary. Relatives want an invitation and support from ICU healthcare providers. Themes regarding capacities were knowledge, skills, education and training, and organisational conditions. CONCLUSIONS Implementation of family participation in essential care requires education and training of relatives and ICU healthcare providers to address safety and quality of care concerns, though most studies lack further specification.
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Affiliation(s)
- Boukje M Dijkstra
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social 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, Faculty of Health and Social 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, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Thomas Pelgrim
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social 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
| | - Remco H A Ebben
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Lilian C M Vloet
- Research Department Emergency and Critical Care, HAN University of Applied Sciences, Faculty of Health and Social 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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Phiri PGMC, Chan CWH, Wong CL, Choi KC, Ng MSN. Discrepancies between nurses' current and perceived necessary practices of family-centred care for hospitalised children and their families: A cross-sectional study. J Pediatr Nurs 2022; 62:e25-e31. [PMID: 34229915 DOI: 10.1016/j.pedn.2021.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE This study investigated (1) the discrepancies between the nurses' current and perceived necessary practices of family-centred care (FCC), and (2) the nurses' demographic characteristics associated with current and perceived necessary practices of FCC for hospitalised children and their families in Malawi. DESIGN AND METHODS A cross-sectional study involving 444 nurses was conducted. The Family-Centred Care Questionnaire-Revised was used to examine the discrepancies between the nurses' current and perceived necessary practices of FCC. Univariate and multivariate statistical analyses were performed to identify the nurses' demographic characteristics associated with current and perceived necessary practices of FCC. RESULTS The total mean score of the nurses' current practices of FCC (M = 34.78, SD = 7.06) was significantly lower than that of the nurses' practices of FCC that were perceived as necessary (M = 38.63, SD = 5.60, p < 0.001). The nurses who were over 40 years of age (regression coefficient, β = 9.162, p = 0.014), had a postgraduate qualification (β = 23.314, p < 0.001), were separated or widowed (β = 9.661, p = 0.029), had a Tumbuka cultural background (β = 12.984, p < 0.001), were Seventh-day Adventist members (β = 8.863, p = 0.026), and worked in mission hospitals (β = 16.401, p = 0.021) were more likely to implement current practices of FCC. Conversely, the nurses who were members of the Moslem, Buddhist, or Hindi religious denomination (β = 6.587, p = 0.040), had a Tonga or Ngonde cultural background (β = 6.625, p = 0.046), and were nurse midwife technicians (β = -23.528, p = 0.012) were more likely to implement practices of FCC that they perceived as necessary. CONCLUSION Significant differences between the nurses' current and perceived necessary practices of FCC suggested that there were barriers to implementing necessary practices of FCC. The nurses' cultural and religious backgrounds were predictors of current practices of FCC, and this finding could direct the future development and testing of FCC interventions in Malawi. PRACTICE IMPLICATIONS Continued educational activities and research on the factors that contributed to the discrepancies between the nurses' current and perceived necessary practices of FCC and their impact on FCC in Malawi are critical.
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Affiliation(s)
- Patrick G M C Phiri
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
| | - Marques S N Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong Special Administrative Region
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Hetland BD, McAndrew NS, Kupzyk KA, Krutsinger DC, Pozehl BJ, Heusinkvelt JM, Camenzind CE. Family Caregiver Preferences and Contributions Related to Patient Care in the ICU. West J Nurs Res 2021; 44:214-226. [PMID: 34904483 DOI: 10.1177/01939459211062954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Guided by Individual and Family Self-Management Theory, the purpose of this cross-sectional study was to describe patient care activities that family caregivers endorsed and performed while visiting their family member in the ICU. We found that caregivers wanted to be involved in ICU patient care and had preferences for the care they wanted to perform with their critically ill family member. More than 80% preferred to perform tasks related to daily grooming, communication, and education. Of note, many caregivers expressed interest in holistic healing activities (i.e., music and art), and yet, less than 50% of caregivers reported participating in these activities. The discrepancy between the number of care activities that respondents desired to perform compared to the number of care activities they reported performing represents an important opportunity to shift research and practice improvement efforts toward more tailored family engagement interventions and recognition of family caregivers as essential partners in care.
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Affiliation(s)
- Breanna D Hetland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA.,Critical Care Division, Nebraska Medicine, Omaha, NE, USA
| | - Natalie S McAndrew
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dustin C Krutsinger
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bunny J Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
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Kang J, Lee M, Cho YS, Jeong JH, Choi SA, Hong J. The relationship between person-centred care and the intensive care unit experience of critically ill patients: A multicentre cross-sectional survey. Aust Crit Care 2021; 35:623-629. [PMID: 34844837 DOI: 10.1016/j.aucc.2021.10.010] [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: 04/18/2021] [Revised: 09/30/2021] [Accepted: 10/16/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Person-centred care has the potential to improve the patient experience in the intensive care unit (ICU). However, the relationship between person-centred care perceived by critically ill patients and their ICU experience has yet to be determined. OBJECTIVES The aim of this study was to investigate the relationship between person-centred care and the ICU experience of critically ill patients. METHODS This study was a multicentre, cross-sectional survey involving 19 ICUs of four university hospitals in Busan, Korea. The survey was conducted from June 2019 to July 2020, and 787 patients who had been admitted to the ICU for more than 24 hours participated. We measured person-centred care using the Person-Centered Critical Care Nursing perceived by Patient Questionnaire. Participants' ICU experience was measured by the Korean version of the Intensive Care Experience Questionnaire that consists of four subscales. We analysed the relationship between person-centred care and each area of the ICU experience using multivariate linear regression. RESULTS Person-centred care was associated with 'awareness of surroundings' (β = 0.29, p < .001), 'frightening experiences' (β = -0.31, p < .001), and 'satisfaction with care' (β = 0.54, p < .001). However, there was no significant association between person-centred care and 'recall of experience'. CONCLUSIONS We observed that person-centred care was positively related to most of the ICU experiences of critically ill patients except for recall of experience. Further studies on developing person-centred nursing interventions are needed.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Minju Lee
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Young Shin Cho
- Department of Nursing, Youngsan University, 288, Junam-ro, Yangsan-si, Gyeongsangnam-do, Republic of Korea
| | - Jin-Heon Jeong
- Department of Intensive Care Medicine & Neurology, Dong-A University Hospital, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea
| | - Sol A Choi
- Medical Intensive Care Unit, Inje University Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan, Republic of Korea
| | - Jiwon Hong
- College of Nursing, Dong-A University, 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
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Lopez-Soto C, Bates E, Anderson C, Saha S, Adams L, Aulakh A, Bowtell F, Buckel M, Emms T, Shebl M, Metaxa V. The Role of a Liaison Team in ICU Family Communication During the COVID 19 Pandemic. J Pain Symptom Manage 2021; 62:e112-e119. [PMID: 33892123 PMCID: PMC8057931 DOI: 10.1016/j.jpainsymman.2021.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT In the name of public safety, a general suspension on hospital visiting was imposed in the U.K., prohibiting family and friends to visit hospitalized patients, even if they were critically ill. OBJECTIVES we aimed to assess the impact of the FLT on the communication with patients' family and friends (PFF), especailly around end-of-life care, and their interaction with CC clinicians. METHODS A retrospective, mixed-methods analysis of a family liaison team (FLT) formed by redeployed clinicians in critical care (CC) during the first surge of the 2020 COVID 19 pandemic. RESULTS The FLT was constituted predominantly of non-ICU consultants (30/39, 77%). Following two one-hourly webinars around basic communication skills, the FLT facilitated over 12,000 video and telephone calls with 172 patients' family and friends (PFF). The majority of the PFF interviewed were mostly, very or extremely satisfied with the frequency, ease, understanding, honesty, completeness, and consistency of the information provided. Approximately 5% of the interviewees reported to be slightly or very dissatisfied in one or more of the following 3 categories: frequency, consistency, and ease of getting the information. The thematic analysis identified 3 themes: 1) being there with/ for the patient; 2) breakdown in communication; 3) disbelief at the speed of deterioration. In 14.9% of cases there was documented discrepancy between the information transmitted by the CC team and that by the FLT, particularly around the severity of the patient's illness and their imminent death. CONCLUSION The formation of a dedicated FLT was feasible and associated with high levels of satisfaction by the PFF. Friction was created when communication was not consistent and did not convey the severity of the patient's condition, to prepare the PFF for a bad outcome.
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Affiliation(s)
- Carmen Lopez-Soto
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Eleanor Bates
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Charlotte Anderson
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Sian Saha
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura Adams
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Alex Aulakh
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Francesca Bowtell
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Marie Buckel
- The National Hospital for Neurology and Neurosurgery, London, UK
| | - Thomas Emms
- Ashford & St Peter's Hospital NHS Trust, Ashford, UK
| | - Moustafa Shebl
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
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A national Position Statement on adult end-of-life care in critical care. Aust Crit Care 2021; 35:480-487. [PMID: 34384650 DOI: 10.1016/j.aucc.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Patient death in critical care is not uncommon. Rather, the provision of end-of-life care is a core feature of critical care nursing, yet not all nurses feel adequately prepared for their role in the provision of end-of-life care. For this reason, the Australian College of Critical Care Nurses (ACCCN) supported the development of a Position Statement to provide nurses with clear practice recommendations to guide the provision of end-of-life care, which reflect the most relevant evidence and information associated with end-of-life care for adult patients in Australian critical care settings. A systematic literature search was conducted between June and July, 2020 in CINAHL Complete, Medline, and EMBASE databases to locate research evidence related to key elements of end-of-life care in critical care. Preference was given to the most recent Australian or Australasian research evidence, where available. Once the practice recommendations were drafted in accordance with the research evidence, a clinical expert review panel was established. The panel comprised clinically active ACCCN members with at least 12 months of clinical experience. The clinical expert review panel participated in an eDelphi process to provide face validity for practice recommendations and a subsequent online meeting to suggest additional refinements and ensure the final practice recommendations were meaningful and practical for critical care nursing practice in Australia. ACCCN Board members also provided independent review of the Position Statement. This Position Statement is intended to provide practical guidance to critical care nurses in the provision of adult end-of-life care in Australian critical care settings.
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Khan S, Digby R, Giordano NA, Hade S, Bucknall TK. A 6-y retrospective cohort study of family satisfaction with critical care and decision-making in an Australian intensive care unit. Aust Crit Care 2021; 35:264-272. [PMID: 34384649 DOI: 10.1016/j.aucc.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Partnering with patients and families to make decisions about care needs is a safety and quality standard in Australian health services that is often not assessed systematically. OBJECTIVE The objective of this study was to retrospectively evaluate satisfaction with care and involvement in decision-making among family members of patients admitted to the intensive care unit (ICU). METHODS A retrospective cohort analysis of a satisfaction survey administered to family members of patients admitted to an ICU in an Australian metropolitan tertiary care hospital from 2014 to 2019 was conducted. The Family Satisfaction in the Intensive Care Unit questionnaire (FSICU) questionnaire was used to assess overall satisfaction, satisfaction with care, and satisfaction with decision-making on a scale from "poor" (0) to "excellent" (100). RESULTS In total, 1322 family members fully completed the survey. Respondents were typically direct relatives of ICU patients (94.2%) with an average age of 52.6 years. Most patients had an ICU length of stay <7 d (56.8%), with most patients being discharged to the ward (96.8%). The overall mean satisfaction score was high among respondents (90.26%). Similarly, mean satisfaction with care (93.06%) and decision-making (89.71%) scores were high. Satisfaction with decision-making scores remained lower than satisfaction with care scores. Multivariable modeling indicated that those younger than 50 years reported higher satisfaction scores (p = 0.006) and those with prolonged lengths of stay in the ICU were associated with lower overall satisfaction scores (p = 0.039). Despite some criticism of waiting times and noise levels, responses showed sincere gratitude for patients' treatment in the ICU and appreciation for the care, skill, and professionalism of the staff. CONCLUSION Very high satisfaction levels were reported by family members during this study. Routine, prospective evaluations of family member satisfaction with ICU experiences are feasible and can be leveraged to provide insight for clinicians and administrators seeking to improve family satisfaction with decision-making and care in ICU settings and meet national standards.
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Affiliation(s)
- Shahrukh Khan
- School of Nursing&Midwifery, Deakin University, Geelong, Australia
| | - Robin Digby
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Nicholas A Giordano
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Nursing Services, Alfred Health, Melbourne, Australia
| | - Sharon Hade
- Nursing Services, Alfred Health, Melbourne, Australia; Intensive Care Unit, Alfred Health, Australia
| | - Tracey K Bucknall
- School of Nursing&Midwifery, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Institute for Health Transformation, Deakin University, Australia; Nursing Services, Alfred Health, Melbourne, Australia.
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Thirsk LM, Vandall-Walker V, Rasiah J, Keyko K. A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study. JOURNAL OF FAMILY NURSING 2021; 27:199-211. [PMID: 33769127 PMCID: PMC8361475 DOI: 10.1177/1074840721999372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.
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Affiliation(s)
| | | | | | - Kacey Keyko
- Edmonton Southside Primary Care
Network, Alberta, Canada
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Guáqueta Parada SR, Henao-Castaño ÁM, Motta Robayo CL, Triana Restrepo MC, Burgos Herrera JD, Neira Fernández KD, Peña Almanza BA. Intervenciones de Enfermería ante la Necesidad de Información de la Familia del Paciente Crítico. REVISTA CUIDARTE 2021. [DOI: 10.15649/cuidarte.1775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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
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Naef R, Brysiewicz P, Mc Andrew NS, Beierwaltes P, Chiang V, Clisbee D, de Beer J, Honda J, Kakazu S, Nagl-Cupal M, Price AM, Richardson S, Richardson A, Tehan T, Towell-Barnard A, Eggenberger S. Intensive care nurse-family engagement from a global perspective: A qualitative multi-site exploration. Intensive Crit Care Nurs 2021; 66:103081. [PMID: 34116886 DOI: 10.1016/j.iccn.2021.103081] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Critical illness is distressing for families, and often results in negative effects on family health that influence a family's ability to support their critically ill family member. Although recent attention has been directed at improving care and outcomes for families of critically ill patients, the manner in which nurses engage with families is not fully understood. OBJECTIVES To describe nurses' perceptions and practices of family engagement in adult intensive care units from a global perspective. DESIGN A qualitative-descriptive multi-site design using content analysis. SETTINGS The study was conducted in 26 intensive care units of 12 urban, metropolitan, academic medical centers in ten countries, spanning five continents. PARTICIPANTS A total of 65 registered nurses (77% women, age of M = 39.5, SD = 11.4 years) participated. Most held intensive care certification (72%) and had worked on average 10 (SD = 9.6) years in the ICU. METHODS Semi-structured, individual interviews (M = 38.4 min, SD = 12.0) were held with ICU nurses at the hospital (94%) or their home using an interview guide. Qualitative interview data were analysed using inductive content analysis. RESULTS We found that nurse-family engagement was an ebb and flow of relational power that needed to be carefully negotiated and balanced, with nurses holding and often exerting more power than families. Constant fluctuations in nurses' practices of engagement occurred in day-to-day practice from shift-to-shift and from nurse-to-nurse. Family engagement was dependent on individual nurses' attitudes and perceptions of family, the patient's condition, and workload. Lastly, family engagement was shaped by the ICU context, with team culture, collaborative relationships, unit structures and organizational resources either enabling or limiting nurses' ability to engage with families. CONCLUSIONS This global study provides an in-depth understanding of the way nurses engage with families in ICU and reflects many different cultures and health systems. We found that nurse-family engagement was marked by a shifting, yet often unequal power distribution in the nurse-family relationship, inconsistent nurse engagement practices, both of which resulted in variable family engagement in intensive care. Our research contributes a detailed description of engagement as practiced in the everyday delivery of health care. A more concentrated team effort, based on a shared culture and defined framework of family care is needed to ensure that families of critically ill persons are fully engaged in all aspects of intensive care.
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Affiliation(s)
- Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitätstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, King George Mazisi Kunene Road, Glenwood, Durban 4041, South Africa.
| | - Natalie S Mc Andrew
- College of Nursing, University of Wisconsin-Milwaukee, Cunningham Hall, 1921 East Hartford Avenue, P.O. Box 413, Milwaukee, WI 53201-0413, USA; Froedtert & the Medical College of Wisconsin, Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Patricia Beierwaltes
- College of Allied Health and Nursing, School of Nursing, Minnesota State University, 360 Wissink Hall, Mankato, MN 56001, USA.
| | - Vico Chiang
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong.
| | - David Clisbee
- College of Science, Engineering and Technology, Computer Information Science Department, Minnesota State University, 273 Wissink Hall, Mankato, MN 56001, USA.
| | - Jennifer de Beer
- College of Nursing-Jeddah, King Saud bin Abdul Aziz University for Health Sciences-Jeddah, Makkah Highway, Al Haramain Road, Mail Code 65 65, PO Box 9515, Saudi Arabia.
| | - Junko Honda
- Child Health Nursing, College of Nursing Art and Science, University of Hyogo, 13-71, Kitaoji-cho, Akashi, Hyogo 673-8588, Japan.
| | - Shota Kakazu
- Child Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan.
| | - Martin Nagl-Cupal
- Department of Nursing Science, University of Vienna, Alser Strasse 23/12, 1080 Vienna, Austria.
| | - Ann M Price
- School of Nursing, Midwifery and Social Work, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom.
| | - Sandra Richardson
- School of Health Sciences, College of Education, Health and Human Development, University of Canterbury, 276 Antigua Street, Christchurch 8011, New Zealand; Emergency Department, Christchurch Hospital, Canterbury District Health Board, 2 Riccarton Avenue, Christchurch 8011, New Zealand.
| | - Anna Richardson
- Bachelor of Nursing Programme, Department of Health Practice, Manawa, Ara Institute of Canterbury Ltd, 276 Antigua Street, Christchurch 8140, New Zealand.
| | - Tara Tehan
- University of Massachusetts Medical School, Graduate School of Nursing, 55 Lake Ave North, Worcester, MA 01655, USA.
| | - Amanda Towell-Barnard
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Western Australia 6027, Australia; Sir Charles Gairdner Hospital, Centre for Nursing Research, Hospital Avenue, Nedlands, Western Australia 6009, Australia.
| | - Sandra Eggenberger
- College of Allied Health and Nursing, Glen Taylor Nursing Institute for Family and Society, Minnesota State University, 360 Wissink Hall and 351 7700 France, Mankato, MN 56001, USA.
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Haave RO, Bakke HH, Schröder A. Family satisfaction in the intensive care unit, a cross-sectional study from Norway. BMC Emerg Med 2021; 21:20. [PMID: 33588760 PMCID: PMC7885442 DOI: 10.1186/s12873-021-00412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. METHOD The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. RESULTS The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.
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Affiliation(s)
- Randi Olsson Haave
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Agneta Schröder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Naef R, von Felten S, Ernst J. Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model. Biopsychosoc Med 2021; 15:4. [PMID: 33588895 PMCID: PMC7885222 DOI: 10.1186/s13030-021-00206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients. METHODS We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. RESULTS A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress. CONCLUSIONS Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Stefanie von Felten
- Department of Biostatistics, Institute of Epidemiology, Biostatistics, and Prevention, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Impact of a nurse-led family support intervention on family members' satisfaction with intensive care and psychological wellbeing: A mixed-methods evaluation. Aust Crit Care 2021; 34:594-603. [DOI: 10.1016/j.aucc.2020.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022] Open
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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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Edward KL, Galletti A, Huynh M. Enhancing Communication With Family Members in the Intensive Care Unit: A Mixed-Methods Study. Crit Care Nurse 2020; 40:23-32. [DOI: 10.4037/ccn2020595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background
Nurses in the intensive care unit are central to clinical care delivery and are often the staff members most accessible to family members for communication. Family members’ ratings of satisfaction with the intensive care unit admission are affected more by communication quality than by the level of care for the patient. Family members may feel that communication in the intensive care unit is inconsistent.
Objectives
To use a shared decision-making model to deliver a communication education program for intensive care unit nurses, evaluate the confidence levels of nurses who undertook the education, and examine changes in family members’ satisfaction with communication from intensive care unit nurses after the nurses received the education.
Methods
A mixed-methods design was used. Seventeen nurses and 81 family members participated.
Results
Staff members were overall very confident with communicating with family members of critically ill patients. This finding was likely linked to staff members’ experience in the position, with 88% of nurses having more than 11 years’ experience. Family members were happy with care but dissatisfied with the environment.
Conclusions
Environmental factors can negatively affect communication with family members in the intensive care unit.
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Affiliation(s)
- Karen-leigh Edward
- Karen-leigh Edward is an adjunct professor of nursing and practice-based research, Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Swinburne University, Hawthorn, Australia
| | - Alessandra Galletti
- Alessandra Galletti is a research associate, Swinburne University of Technology
| | - Minh Huynh
- Minh Huynh is a lecturer, Sports Analytics & Data Science, School of Allied Health, Human Services & Sport, College of Science, Health and Engineering, Latrobe University, Bundoora, Melbourne, Australia
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McAndrew NS, Mark L, Butler M. Timely Family Feedback to Guide Family Engagement in the Intensive Care Unit. Crit Care Nurse 2020; 40:42-51. [PMID: 33257964 DOI: 10.4037/ccn2020644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Organizations motivated to provide high-quality care in the intensive care unit are exploring strategies to engage families in patient care. Such initiatives are based on emerging evidence that family engagement improves quality and safety of care. OBJECTIVE To gather family feedback to guide future nurse-led quality improvement efforts to engage families in the intensive care unit setting. METHODS The Critical Care Family Satisfaction Survey, which consists of 20 items rated from 1 (very dissatisfied) to 5 (very satisfied), was paired with open-ended questions and administered to families during the intensive care unit stay from March through December 2017. Content analysis was used to identify themes regarding the family experience. RESULTS Responses were collected from 178 family members. The mean (SD) score on the survey was 4.65 (0.33). Five themes emerged regarding the delivery of family care in the intensive care unit: family interactions with the interdisciplinary team, information sharing and effective communication, family navigation of the intensive care unit environment, family engagement in the intensive care unit, and quality of patient care. CONCLUSIONS This quality improvement project provided foundational information to guide family engagement efforts in the intensive care unit. Real-time solicitation of feedback is essential to improving the family experience and guiding family-centered care delivery in this practice environment.
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Affiliation(s)
- Natalie S McAndrew
- Natalie S. McAndrew is an assistant professor, College of Nursing, University of Wisconsin-Milwaukee, and a nurse-scientist, Froedtert Hospital, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Mark
- Laura Mark is a physician assistant in the cardiovascular intensive care unit, Froedtert Hospital, Froedtert & Medical College of Wisconsin
| | - Mary Butler
- Mary Butler is an assistant clinical professor, College of Nursing, University of Wisconsin-Milwaukee
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Phiri PGMC, Chan CWH, Wong CL. The Scope of Family-Centred Care Practices, and the Facilitators and Barriers to Implementation of Family-Centred Care for Hospitalised Children and their Families in Developing Countries: An Integrative Review. J Pediatr Nurs 2020; 55:10-28. [PMID: 32629368 DOI: 10.1016/j.pedn.2020.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/05/2020] [Accepted: 05/25/2020] [Indexed: 12/20/2022]
Abstract
PROBLEM Limited knowledge exists regarding the scope practices and implementation from developing countries. This integrative review aims to report research on the scope of FCC practices, facilitators and barriers to the FCC implementation for hospitalised children and their families in developing countries. ELIGIBILITY CRITERIA Qualitative, quantitative, mixed-method studies, reports, systematic reviews and integrative reviews reporting implementation, barriers and facilitators of FCC, published in English between 2008 and 2018, from developing countries were evaluated. Joanna Briggs Institute Appraisal Tools were used for methodological assessment. SAMPLE Eleven studies from developing countries met the inclusion criteria. Four studies were randomised controlled trials, five were cross-sectional, one was a quasi-experimental while one was a qualitative study. RESULTS The scope of FCC research focuses on information sharing, family participation, and respect and dignity and FCC implementation focuses on practices and perceptions, measurement and impact of FCC. Both personal and health system facilitators and barriers exist but their influence on FCC implementation is limited. Research on needs of families and hospitalised children is also limited. CONCLUSION FCC practice and research are still in infancy stage in developing countries. There is limited understanding on scope of FCC practices, the needs of parents and children, and the influence of facilitators and barriers. IMPLICATIONS The limited findings reported in this review support the need for international collaboration to FCC to critique FCC research and integrate it with other philosophies such as child and family centred care and child centred care as is the case in some developed countries.
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Affiliation(s)
- Patrick G M C Phiri
- (a)Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China.
| | - Carmen W H Chan
- (a)Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - C L Wong
- (a)Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
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McLennan M, Aggar C. Family satisfaction with care in the intensive care unit: A regional Australian perspective. Aust Crit Care 2020; 33:518-525. [DOI: 10.1016/j.aucc.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/16/2022] Open
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Naef R, Schmid-Mohler G, Ernst J. Psychometric evaluation of the German version of the instrument: Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA). Scand J Caring Sci 2020; 35:328-339. [PMID: 33128295 DOI: 10.1111/scs.12924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The involvement of families in care has long been advocated for acute and critical care settings to improve quality and safety of care. Nurses' attitudes towards families influence the way they involve and partner with families in the planning and delivery of care. Therefore, instruments with proven psychometric properties are necessary to assess the attitudes of nurses towards involving families in nursing care. AIMS To cross-culturally adapt and psychometrically test the German version of the Families' Importance in Nursing Care - Nurses' Attitudes (FINC-NA) scale with acute and critical care nurses. METHODS A cross-sectional study was carried out with 316 acute-critical care nurses, who filled in the FINC-NA between December 2016 and May 2018. Exploratory factor analysis was performed to assess structural validity. Internal consistency and homogeneity were determined using Cronbach's alpha. RESULTS The four-factor structure of the FINC-NA - family as partner in care, family as resource in nursing care, family as their own resource and family as burden - was confirmed in the German version. Due to low primary and multiple loadings, seven items were removed. Moreover, five items loaded on different factors than the original version. Cronbach's alpha of factors ranged between 0.68 and 0.86. CONCLUSION The cross-cultural adaptation and psychometric testing of the German version of the FINC-NA resulted in a 19-item scale that measure nurses' attitudes towards the importance of families in nursing care. Further testing is needed to refine the structural validity and establish construct validity of the FINC-NA German version.
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Affiliation(s)
- Rahel Naef
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland.,Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | | | - Jutta Ernst
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland
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Jakimowicz S, Perry L, Lewis J. Bowen Family Systems Theory: Mapping a framework to support critical care nurses' well-being and care quality. Nurs Philos 2020; 22:e12320. [PMID: 32835447 DOI: 10.1111/nup.12320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/16/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
Intensive care nursing is prone to episodic anxiety linked to patients' immediate needs for treatment. Balancing biomedical interventions with compassionate patient-centred nursing can be particularly anxiety provoking. These patterns of anxiety may impact compassion and patient-centred nursing. The aim of this paper is to discuss the application of Bowen Family Systems Theory to intensive care nursing, mapping a framework to support critical care nurses' well-being and, consequently, the quality of care they provide. This article is founded on research, theoretical papers and texts focused on Bowen Family Systems Theory (BFST), and findings from a constructivist study on patient-centred nursing and compassion in the intensive care unit. The goal of Bowen Family Systems Theory is to empower individuals, decreasing blame and reactivity. Bowen Family Systems Theory can be applied to the sometimes intimate relationships that develop in this environment, aiding understanding of nurses' experience of compassion satisfaction and fatigue. Where organizational factors and management styles fall short in supporting critical care nurses to meet expectations, BFST can offer a perspective on the processes that occur within the intensive care unit, impacting nurse well-being and quality of care. This paper makes plain the importance of understanding the anxiety that occurs within the intensive care unit as a system, so that individuals, such as critical care nurses, can be supported appropriately to ensure nurse well-being and quality care.
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Affiliation(s)
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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Jafarpoor H, Vasli P, Manoochehri H. How is family involved in clinical care and decision-making in intensive care units? A qualitative study. Contemp Nurse 2020; 56:215-229. [PMID: 32715979 DOI: 10.1080/10376178.2020.1801350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Involving family members in patient care is considered as a significant dimension of family-centered care in intensive care units (ICUs). Aims: To describe family members' perceptions and experiences regarding involvement in clinical care delivery and decision-making in ICUs in Iran. Design: A qualitative research method using conventional content analysis. Methods: A total number of 24 participants were selected through purposive sampling method between 2018 and 2019. Each interview also lasted between 30 and 60 min and the inductive data analysis was used. Results: The findings revealed that non-agreed involvement in clinical care delivery and family involvement in decision-making is being implemented on a continuum of paternalistic views. Conclusion: Healthcare providers, particularly nurses, and policy makers can thus exploit these findings to strengthen family involvement in this regard and consequently improve quality of care. Impact statement: A non-agreed approach and paternalistic views along with some barriers can affect family members' involvement in providing clinical care and making decisions in ICUs in Iran.
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Affiliation(s)
- Hasanali Jafarpoor
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houman Manoochehri
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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