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Hesselink G, Bins S, Bonte I, Westerhof B, Hoek N, van Strien J, Moviat M, Zegers M. Improving patient care transitions from the intensive care unit to the ward by learning from everyday practice. A multicenter qualitative study. Intensive Crit Care Nurs 2024; 85:103797. [PMID: 39226759 DOI: 10.1016/j.iccn.2024.103797] [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: 04/02/2024] [Revised: 06/27/2024] [Accepted: 08/02/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE To explore and describe the everyday practices (Work-As-Done) that hinder and facilitate patient care transitions from the intensive care unit (ICU) to the ward. RESEARCH METHOD/DESIGN Multiple qualitative case studies in the ICU and various specialized wards of three Dutch hospitals. Adult patients planned to be transferred were purposively sampled on a variety of characteristics along with their relative (if present), and the ICU and ward nurses who were involved in the transition process. Data were collected by using multiple sources (i.e., observations, semi-structured interviews and a qualitative survey) and then systematically analyzed using the thematic analysis approach until saturation was reached. FINDINGS Twenty-six cases were studied. For each case, the actual transfer was observed. Sixteen patients, five relatives and 36 nurses were interviewed. Two patients completed the survey. Fifteen themes emerged from the data, showing that the quality of transitions is influenced by the extent to which nurses anticipate to patient-specific needs (e.g., providing timely and adequate information, orientation, mental support and aftercare) and to the needs of the counterpart to continue care (e.g., by preparing handovers) besides following standard procedures. Data also show that procedures sometimes interfere with what works best in practice (e.g., communication via a liaison service instead of direct communication between ICU and ward nurses). CONCLUSIONS Subtle, non-technical nursing skills play an important role in comforting patients and in the coordination of care when patients are transferred from the ICU to the ward. IMPLICATIONS FOR CLINICAL PRACTICE These Work-As-Done findings and their underlying narratives, that are often overlooked when focusing on quality improvement, can be used as material to reflect on own practice and raise awareness for its impact on patients. They may stimulate healthcare staff in crafting interventions for optimizing the transition process.
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Affiliation(s)
- Gijs Hesselink
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands.
| | - Stan Bins
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - Ingrid Bonte
- Rijnstate Hospital, Department of Intensive Care Medicine, Arnhem, the Netherlands
| | - Brigitte Westerhof
- Rijnstate Hospital, Department of Intensive Care Medicine, Arnhem, the Netherlands
| | - Nande Hoek
- Jeroen Bosch Hospital, Department of Intensive Care Medicine, Den Bosch, the Netherlands
| | - Janneke van Strien
- Jeroen Bosch Hospital, Department of Intensive Care Medicine, Den Bosch, the Netherlands
| | - Miriam Moviat
- Jeroen Bosch Hospital, Department of Intensive Care Medicine, Den Bosch, the Netherlands
| | - Marieke Zegers
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
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Gyllander T, Näppä U, Häggström M. A journey through transitional care-family members' experiences post a life-threatening situation: A qualitative study. Scand J Caring Sci 2024. [PMID: 39317981 DOI: 10.1111/scs.13304] [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: 02/14/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Being a family member to someone who suffers from a serious illness can change one's perspectives about life. A sudden and severe illness can result in a demanding journey that involves acute admission to hospital, intensive care, post-care, and finally, returning home. AIM To describe the experience of staying beside a next of kin throughout the healthcare journey, from the onset of illness at home, to the intensive care unit, post-care, and returning home. METHODS The study employed a qualitative design, with data collected via semi-structured interviews and analysed using reflexive thematic analysis. A purposive sampling was used to recruit participants (n = 14), who had experiences of staying beside a next of kin throughout the healthcare journey from the onset of illness to discharge from the hospital. FINDINGS Family members' experiences were captured under the overarching theme Journey through an emotional turmoil and the themes Entering a new world, Continuing the journey towards something unknown, and Striving for the new normal at home. They described going through a non-linear process, characterised by transitions or changes in several aspects. The transitions included shifts in the roles that the family members played, in the various environments they found themselves in, and in the progression of the patient's illness or injury. CONCLUSION The study suggested that family members with a next of kin who experienced life-threatening situations undergo challenging transitions. The informal caregiver role placed on family members of intensive care unit-survivors significantly impacts their lives and the healthcare systems should prioritise providing high-quality support to family members throughout the entire healthcare journey. Elevating the importance of nursing care within the healthcare system can contribute to delivering holistic care and facilitating transitions. Further research should focus on understanding the support that family members perceive as necessary to facilitate their transition and enhance their well-being.
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Affiliation(s)
- Theresa Gyllander
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, Ostersund, Sweden
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Gu J, Wang H, Pei J, Meng J, Song Y. The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study. Nurs Crit Care 2024; 29:672-681. [PMID: 37922250 DOI: 10.1111/nicc.12993] [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: 03/29/2023] [Revised: 09/04/2023] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
BACKGROUND The patient's spouse, in their role as the primary caregiver, assumes responsibility for the patient's care during the recovery process and provides the most robust social support. Previous research has primarily focused on the coping experiences and thoughts of individual intensive care unit (ICU) patients or caregivers, with limited attention afforded to the relationship between patients and their spouses. AIMS This study aims to explore the dyadic coping experiences of ICU transfer patients and their spouses, with the goal of providing evidence to support the subsequent development of an individualized intervention program. STUDY DESIGN A qualitative study using a phenomenological research approach was undertaken. Purposive sampling was employed to select participants for face-to-face semi-structured in-depth interviews. The interviews took place at a tertiary general hospital in Nanjing from January 2023 to February 2023.Twelve ICU transfer patients and their twelve spouses were interviewed. The data were then summarized, and themes were derived using the Colaizzi 7-step analysis method. FINDINGS A total of four themes and eleven sub-themes emerged from the analysis. The identified themes include positive coping (actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (a lack of information, high physical and psychological stress, and significant financial burden), and needs and suggestions (strengthening transition care, fostering increased intimacy, and reducing negative emotions). CONCLUSION Both patients and spouses experience physical and psychological stress during the transfer from the ICU to the ward. Therefore, any intervention developed for caregivers should be designed in a dyadic manner. Increasing dyadic coping skills may represent an important area for future research and intervention. RELEVANCE TO CLINICAL PRACTICE This study provides valuable evidence to inform the formulation of a comprehensive dual disease management plan for ICU transfer patients and their spouses.
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Affiliation(s)
- Jiayi Gu
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - He Wang
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jiaqin Pei
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Jingyu Meng
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Yan Song
- School of Nursing, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Depatment of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medcine, Nanjing, China
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Wendlandt B, Edwards T, Hughes S, Gaynes BN, Carson SS, Hanson LC, Toles M. Novel Definitions of Wellness and Distress among Family Caregivers of Patients with Acute Cardiorespiratory Failure: A Qualitative Study. Ann Am Thorac Soc 2024; 21:782-793. [PMID: 38285875 PMCID: PMC11109912 DOI: 10.1513/annalsats.202310-904oc] [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: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Rationale: Family caregivers of patients with acute cardiorespiratory failure are at high risk for distress, which is typically defined as the presence of psychological symptoms such as anxiety, depression, or posttraumatic stress. Interventions to reduce caregiver distress and increase wellness have been largely ineffective to date. An incomplete understanding of caregiver wellness and distress may hinder efforts at developing effective support interventions. Objectives: To allow family caregivers to define their experiences of wellness and distress 6 months after patient intensive care unit (ICU) admission and to identify moderators that influence wellness and distress. Methods: Primary family caregivers of adult patients admitted to the medical ICU with acute cardiorespiratory failure were invited to participate in a semistructured interview 6 months after ICU admission as part of a larger prospective cohort study. Interview guides were used to assess caregiver perceptions of their own well-being, record caregiver descriptions of their experiences of family caregiving, and identify key stress events and moderators that influenced well-being during and after the ICU admission. This study was guided by the Chronic Traumatic Stress Framework conceptual model, and data were analyzed using the five-step framework approach. Results: Among 21 interviewees, the mean age was 58 years, 67% were female, and 76% were White. Nearly half of patients (47%) had died before the caregiver interview. At the time of the interview, 9 caregivers endorsed an overall sense of distress, 10 endorsed a sense of wellness, and 2 endorsed a mix of both. Caregivers defined their experiences of wellness and distress as multidimensional and composed of four main elements: 1) positive versus negative physical and psychological outcomes, 2) high versus low capacity for self-care, 3) thriving versus struggling in the caregiving role, and 4) a sense of normalcy versus ongoing life disruption. Postdischarge support from family, friends, and the community at large played a key role in moderating caregiver outcomes. Conclusions: Caregiver wellness and distress are multidimensional and extend beyond the absence or presence of psychological outcomes. Future intervention research should incorporate novel outcome measures that include elements of self-efficacy, preparedness, and adaptation and optimize postdischarge support for family caregivers.
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Affiliation(s)
- Blair Wendlandt
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | | | | | - Bradley N. Gaynes
- Department of Psychiatry, UNC School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health, and
| | - Shannon S. Carson
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine
| | - Laura C. Hanson
- Division of Geriatric Medicine and Palliative Care Program, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Cheng F, Yan H, Zhong J, Yang H, Nan R, Wang X, Wei Z, Dou X. Knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China: A cross-sectional study. Heliyon 2024; 10:e29318. [PMID: 38660287 PMCID: PMC11040039 DOI: 10.1016/j.heliyon.2024.e29318] [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: 08/20/2023] [Revised: 03/19/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Transfer anxiety has effect many critically ill patients in ICU around the world. Nurses must take care of the psychological adjustments that patients and families face when ICU patients transferred to general ward. During this period, basic knowledge, positive attitude, and correct practice are necessary for nurses to address the issue of transfer anxiety and seek to reduce it whenever possible. However, there were few investigations have been performed the knowledge, attitudes, and practice of registered nurses toward ICU patients' transfer anxiety. Aim The purpose of the paper is to explore the level and influencing factors of knowledge, attitude and practice of registered nurses toward ICU patients' transfer anxiety in China. Methods From February 1 to March 17, 2023, a cross-sectional study was adopted in China. An electronic questionnaire was used to collect data. Registered nurses' knowledge, attitudes and practice toward ICU patients' transfer anxiety were assessed using The Knowledge, Attitude and Practice Questionnaire for Chinese Registered nurses in ICU regarding the prevention of transfer anxiety. In the end, in this study involved 381 registered nurses from Lanzhou University Second Hospitals in China. SPSS 26.0 for mac, independent T-test, one-way ANOVA test, Scheffe's test, Pearson correlation coefficient and multiple linear regression tests were used for data analysis. Results The scores of total KAP, knowledge, attitude, and practice are 135.21 ± 24.504, 45.58 ± 13.903, 56.94 ± 10.690 and 32.87 ± 6.393 separately. Study results show that there was a statistically significant correlation among the three variables. According to the results of independent t-test or one-way ANOVA test, there is a correlation between gender(P = 0.001), highest educational attainment (P = 0.005) and knowledge; type of department(P = 0.003) and attitude; gender (P = 0.003), marital status (P = 0.002), clinical work experience (P = 0.002), type of department (P = 0.005) and practice. According to the results of linear regression analysis in this study, the variables of gender (P = 0.006), highest educational attainment (P = 0.032), scores of attitudes (P = 0.006), and scores of practice (P = 0.000) were associated with the scores of knowledge; the variables of scores of knowledge (P = 0.004), and scores of practice (P = 0.000) were associated with the scores of attitudes; the variables of scores of knowledge (P = 0.000), and scores of attitudes (P = 0.000) were associated with the scores of practice. Conclusion The findings of the study emphasize that comprehensive measures of knowledge, attitude and practice should be taken to improve nurses' knowledge, attitudes, and practices regarding transfer anxiety in intensive care unit patients in order to reduce its adverse effects on ICU patients.
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Affiliation(s)
- Feiran Cheng
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
| | - Hui Yan
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Juanping Zhong
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Hong Yang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
| | - Ruiling Nan
- Department of Critical Care Medicine, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xinglei Wang
- Department of Liver Diseases Branch, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Zhengyong Wei
- Department of Neurosurgical Intensive Care Unit, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
| | - Xinman Dou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, PR China
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, PR China
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Yau YC'C, Christensen M. Hong Kong general ward nurses' experiences of transitional care for patients discharged from the intensive care unit: An inductive thematic analysis. Intensive Crit Care Nurs 2023; 79:103479. [PMID: 37541065 DOI: 10.1016/j.iccn.2023.103479] [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: 02/13/2023] [Revised: 05/11/2023] [Accepted: 06/08/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES The aim of this study was to explore and better understand the experiences of Hong Kong general ward nurses who care for post-intensive care patients. RESEARCH METHODOLOGY/DESIGN Inductive thematic analysis and focus groups interviews were used in this study. SETTING A purposive sample of 20 ward-based registered nurses were recruited, formed five focus groups and interviewed online using video-conferencing media. FINDINGS The ward nurses in this study described the difficulties and challenges they experienced caring for the post-intensive care patient. Issues around workload and patient allocation figured highly along with a lack of education and training. Many felt scared and helpless when caring for these patients which significantly increased their anxiety. Some were compelled to spend more time with their other patients while others were so consumed with the post-ICU patient that they often neglected their other patients. The handover from the intensive care unit nurse was filled with trepidation and concern because of the level of information being handed-over was alien and complex to them so was the medications and the level of monitoring the intensive care unit nurse expected which was not often forthcoming on the ward simply because they didn't know what they were doing. CONCLUSION The findings of this study demonstrate that these ward-nurses found themselves in a difficult situation with trying to understand of the needs of the post-intensive care patient. A lack of support, a lack of education and an increased workload made this situation hard. One possible solution is the development and evaluation of a critical care outreach team to support ward-based decision-making. Combined with formal training and education around the acutely ill and /or the deteriorating patient would be a positive step forward. IMPLICATIONS FOR CLINICAL PRACTICE The post-intensive care patient poses significant challenges to ward nurses unfamiliar with the level of care they require. Unlike intensive care unit nurses whose focus is on survival and preventing deterioration, the ward nurse's attention is meeting the activities of daily living and progressing the patient's rehabilitation. One of the major obstacle experienced was at handover and the transferring of responsibility where the information conveyed was overly complex and to the ward nurse mostly irrelevant. For this, critical nurses must improve their proficiency at handover so that information is tailored to the needs of the ward environment. One way would be the development of a intensive care unit/Ward handover tool developed collaboratively so as maximise the priorities of care and improve patient outcome.
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Affiliation(s)
- Yim Ching 'Connie' Yau
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong; Interdisciplinary Centre for Qualitative Research, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Martin Christensen
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong; Interdisciplinary Centre for Qualitative Research, School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong.
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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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Gullberg A, Joelsson-Alm E, Schandl A. Patients' experiences of preparing for transfer from the intensive care unit to a hospital ward: A multicentre qualitative study. Nurs Crit Care 2023; 28:863-869. [PMID: 36325990 DOI: 10.1111/nicc.12855] [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: 05/09/2022] [Revised: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The transfer from an intensive care unit (ICU) to a regular ward often causes confusion and stress for patients and family members. However, little is known about the patients' perspective on preparing for the transfer. AIM The purpose of the study was to describe patients' experiences of preparing for transfer from an ICU to a ward. STUDY DESIGN Individual interviews with 14 former ICU patients from three urban hospitals in Stockholm, Sweden were conducted 3 months after hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting followed the consolidated criteria for reporting qualitative research checklist. RESULTS The results showed that the three categories, the discharge decision, patient involvement, and practical preparations were central to the patients' experiences of preparing for the transition from the intensive care unit to the ward. The discharge decision was associated with a sense of relief, but also worry about what would happen on the ward. The patients felt that they were not involved in the decision about the discharge or the planning of their health care. To handle the situation, patients needed information about planned care and treatment. However, the information was often sparse, delivered from a clinician's perspective, and therefore not much help in preparing for transfer. CONCLUSIONS ICU patients experienced that they were neither involved in the process of forthcoming care nor adequately prepared for the transfer to the ward. Relevant and comprehensible information and sufficient time to prepare were needed to reduce stress and promote efficient recovery. RELEVANCE TO CLINICAL PRACTICE The study suggests that current transfer strategies are not optimal, and a more person-centred discharge procedure would be beneficial to support patients and family members in the transition from the ICU to the ward.
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Affiliation(s)
- Agneta Gullberg
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
| | - Anna Schandl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Gyllander T, Näppä U, Häggström M. Relatives' experiences of care encounters in the general ward after ICU discharge: a qualitative study. BMC Nurs 2023; 22:399. [PMID: 37865767 PMCID: PMC10590035 DOI: 10.1186/s12912-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Care encounters at general wards have many reasons, and the complexity differs. Some arriving at the ward are relatives of discharged intensive care unit patients', who are usually more fragile than others due to what had happened to them. Research indicates that care encounters leave relatives dissatisfied. There is a lack of studies describing how relatives of adult patients experience the transfer from the intensive care unit. AIM The purpose of this study was to describe relatives' experiences of care encounters with nurses during their loved ones' stay in the general ward after being discharged from the intensive care unit. METHODS A qualitative descriptive design with an inductive approach was used. Semi-structured individual interviews were conducted with relatives [n = 14) of patients from different hospitals in Sweden. Data were analysed using content analysis. RESULTS Relatives expressed feeling a huge responsibility for ensuring the quality of care for their loved ones. It was essential to encounter available, committed, and compassionate nurses in the general ward after being transferred from the intensive care unit. The theme 'longing for trust and struggling to be involved in their loved one's care' was illustrated in the two subthemes of 'wanting to be seen as an important piece of the puzzle' and 'being vigilant and worrying about the quality of care'. CONCLUSION The relatives of patients experience their needs as unfulfilled in care encounters with nurses at the general ward after transfer from ICU. In order to meet the needs of relatives, nurses require well-developed non-technical skills to establish a compassionate interaction founded on trust and respect for the individual. Future research should investigate how relatives' needs can be met in practice. New nursing innovations are necessary to structure encounters with patients and relatives transitioning from the intensive care unit.
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Affiliation(s)
- Theresa Gyllander
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Nikolaisen MK, Fridh S, Olsen BF. Patient transfer from intensive care units to general wards: An exploratory qualitative study of ward nurses' experiences of patient safety. Nurs Open 2023; 10:6769-6776. [PMID: 37386753 PMCID: PMC10495723 DOI: 10.1002/nop2.1923] [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: 01/16/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023] Open
Abstract
AIM Patient transfer from intensive care units (ICUs) to general wards is a routine part of hospital care. However, if the transfer is not optimal, it can result in increased readmissions to the ICU, increased stress and discomfort for the patient and, thus, a threat to patient safety. The aim of this study was to explore how general ward nurses experience patient safety during patient transfers from ICUs to general wards. DESIGN A qualitative design based on a phenomenological approach was used. METHODS Two focus group interviews were conducted with a total of eight nurses from a medical ward and a surgical ward at one hospital in Norway. The data were analysed using systematic text condensation. RESULTS The nurses' experiences of patient safety during patient transfer had four themes: (1) the importance of preparedness; (2) the importance of the handover of information; (3) stress and a lack of resources and (4) a feeling of two different worlds. CONCLUSION In order to promote patient safety, the informants highlighted the importance of being well prepared for transfer, and to have optimal handover of information. Stress, lack of resources and a feeling of two different worlds may pose threats to patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We suggest several intervention studies testing the effect of intervention improving patient safety during the transfer process are designed, and that increased knowledge in this area is used to develop local practice recommendations. PATIENT OR PUBLIC CONTRIBUTION The participants of this study were nurses and this contribution has been explained in the Data collection section. There was no patient contribution in this study.
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Affiliation(s)
| | - Stina Fridh
- Østfold Hospital Trust, Intensive Care UnitGrålumNorway
- Faculty of Health and WelfareØstfold University CollegeHaldenNorway
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive Care UnitGrålumNorway
- Faculty of Health and WelfareØstfold University CollegeHaldenNorway
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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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12
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Mottaghi K, Hasanvand S, Goudarzi F, Heidarizadeh K, Ebrahimzadeh F. The role of the ICU liaison nurse services on anxiety in family caregivers of patients after ICU discharge during COVID-19 pandemic: a randomized controlled trial. BMC Nurs 2022; 21:253. [PMID: 36088385 PMCID: PMC9464053 DOI: 10.1186/s12912-022-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background With the onset of the COVID-19 pandemic and the need to maintain social distancing and changes in wards' structure, families no longer access the routine support they received during the hospitalization of their patients in the ICU. This study aimed to determine the effects of ICU liaison nurse services on the anxiety in patients’ family caregivers after ICU discharge during the COVID-19 pandemic. Methods This randomized controlled trial was performed in western Iran from February 2020, to March 2021. Sixty subjects were selected from the family caregivers of the patients transferred from the ICU and were randomly assigned to the control (n = 30) and the intervention groups (n = 30). The control group received routine transfer care. In the intervention group, liaison nurse services were offered in 4 dimensions: patient support, family support, training, support of the ward’s staff, and the evaluation of the destination ward. The participants’ anxiety was measured using the Spielberger State Anxiety Inventory immediately after the patient transfer and 6 h after admission to the general ward. Data analyzed with SPSS V16, descriptive and inferential statistics, including Chi-square test, Mann–Whitney test, Wilcoxon test, and Generalized Linear Model with cumulative logit link function. Results were reported at a 0.05 significance level. Results A statistically significant difference was observed in baseline anxiety levels (P = 0.035) and age group (P < 0.001) between the intervention and control groups. After moderating baseline anxiety levels, the age group, and marital status, the impact of the intervention was significant (X2 = 10.273, df = 1, P < 0.001), meaning that the intervention could reduce the relative chances of developing higher levels of anxiety by 92.1% (OR: 0.08, 95%CI: 0.017–0.373, P < 0.001). Conclusions This study confirmed the positive impact of nursing services on reducing anxiety in family caregivers during the COVID-19 pandemic. It is recommended to use these services, especially during the COVID-19 condition, to facilitate the patient transfer, support the patient's family, and reduce the health care gap between the ICU and the ward. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01034-6.
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13
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Ji J, Yang L, Yang H, Jiang Y, Tang P, Qunfeng L. Parental experience of transition from a pediatric intensive care unit to a general ward: A Qualitative Study. J Nurs Manag 2022; 30:3578-3588. [PMID: 35695173 DOI: 10.1111/jonm.13716] [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: 04/19/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore parental experience in transitioning from a pediatric intensive care unit to a general ward and to investigate parental involvement in caring for their critical illness children. BACKGROUND Parents have a major responsibility in caring for seriously ill children, but nursing staff fail to meet the expectations of parents regarding nursing care. Few studies have investigated the challenges and needs of Chinese parents during the transition from pediatric intensive care unit to general ward. METHODS Semi-structured interviews were conducted with 24 parents of children with critical illness in a pediatric hospital in Shanghai, mainland China to explore their views. Transcripts were entered into NVivo. Framework analysis was used to analyze the qualitative data. RESULTS Four themes were identified by data analysis: changes in the child during post pediatric intensive care unit periods; experiencing a wide range of emotions; factors involved in the transition; and suggestions for improving transitional care. CONCLUSIONS Due to the unmet needs of parents, a more flexible visiting policy and social media support were highly desirable. Getting accurate information, establishing family integrated care, and strengthening ward-based critical support services were also listed as important needs of parents caring for critically ill children. IMPLICATIONS FOR NURSING MANAGEMENT A profound understanding of parental experiences during the transitional period can help nursing staff to assess the effects on children and their families, improve ward-based intensive care, support parental participation, and improve visitation policies. Based on these findings, nurse managers can develop reasonable intervention programs in order to improve nursing quality and patient outcomes.
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Affiliation(s)
- Jianlin Ji
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Liling Yang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Hanlin Yang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Jiang
- Neonatal Intensive Care Unit, Children's Hospital of Shanghai, School of medicine, Shanghai Jiao Tong University
| | - Ping Tang
- Emergency Outpatient Clinic, Children's Hospital of Shanghai, School of medicine, Shanghai Jiao Tong University
| | - Lu Qunfeng
- Nursing department, Children's Hospital of Shanghai, School of medicine, Shanghai Jiao Tong University
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14
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Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, Adiban V. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022; 26:568-573. [PMID: 35719458 PMCID: PMC9160623 DOI: 10.5005/jp-journals-10071-24211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kobra Ghorbanzadeh
- Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Abbas Ebadi
- Department of Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Mohammadali Hosseini, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Phone: +09121488457, e-mail:
| | | | - Hamidreza Khankeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Department of Disaster and Emergency Medicine, Karolinska Institute, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | | | - Vahid Adiban
- Department of Anesthesiology, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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15
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Role Mismatch in Medical Decision-Making Participation Is Associated with Anxiety and Depression in Family Members of Patients in the Intensive Care Unit. J Trop Med 2022; 2022:8027422. [PMID: 35469334 PMCID: PMC9034962 DOI: 10.1155/2022/8027422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the mismatch between the preferred and actual roles in the medical decision-making of intensive care unit (ICU) patients' family members and the relationship between the role mismatch of family members' decisions and anxiety and depression syndromes. A total of 223 family members of ICU patients in the Affiliated Hospital of Jiangnan University in China were enrolled. The simple Chinese version of the Control Preference Scale was used to complete the surveys to assess the preferred and actual roles, and anxiety and depression syndromes were measured using the Generalized Anxiety Disorder-7 scale and Patient Health Questionnaire-9, respectively. For the preferred and actual roles, the active role rates were 16.1% and 8.1%, the cooperative role rates were 49.3% and 31.4%, and the passive role rates were 34.5% and 60.5%, respectively. The incidence of mismatch was 43.0% between the preferred and actual roles, and the consistency between their preferred and actual decision-making roles was poor (kappa = 0.309, P < 0.001). Family members with mismatched decision-making roles had significantly higher incidence rates of anxiety (90.6% vs. 57.5%, P < 0.001) and depression (86.5% vs. 63.0%, P < 0.001). Logistic regression analysis revealed that mismatches in decision-making roles remained independently associated with these outcomes after adjustment for family members' sociodemographic features. The results of the present study demonstrate that the preferred role of ICU patients' family members is mainly cooperative, and the actual role is mainly passive. The mismatch between the preferred and actual roles is associated with anxiety and depression among the ICU patients' family members.
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16
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Chen Y, Wang R, Yu J, Zhu L, Lu Y, Deng X. Effects of MBSR therapy on negative emotions, fatigue, and sleep quality in "post-ICU patients": A randomized controlled clinical trial protocol. Medicine (Baltimore) 2022; 101:e28331. [PMID: 35029879 PMCID: PMC8735771 DOI: 10.1097/md.0000000000028331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Survivors of intensive care unit (ICU) transfer to the common ward are often accompanied by psychological distress, negative emotions, fatigue, and sleep disturbances that affect recovery. Mindfulness-based stress reduction (MBSR) has achieved reliable results in improving physical and mental health. However, no clinical study has been conducted to evaluate the effects of MBSR on negative emotions, fatigue and sleep quality of patients who survived ICU and were transferred to general wards. METHODS This is a prospective randomized controlled trial (RCT) examining the effects of MBSR on negative emotions, fatigue, and sleep quality in inpatients transferred from ICU to general ward. Participants were randomly divided into the treatment group and the control group in a ratio of 1:1. On the basis of the same nursing plan and health education, the treatment group received MBSR therapy, while the control group received no other interventions, and all the patients were followed up for 3 months after 2 weeks of continuous treatment. The indicators included negative mood indicators [Self-rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS)], fatigue index [Fatigue Severity Scale (FSS) and Brief Fatigue Inventory (BFI)], and sleep quality index [Pittsburgh Sleep Quality Index (PSQI)]. Finally, SPSS 20.0 software was used for statistical analysis of the data. DISCUSSION This study will evaluate the effects of MBSR on negative emotions, fatigue, and sleep quality in hospitalized patients transferred from ICU to general ward. The results of this study will provide a reference for MBSR to improve psychological distress in ICU survivors transferred to general ward. TRIAL REGISTRATION This study protocol was registered in the Open Science Framework (OSF) (registration number: DOI 10.17605/OSF.IO/PD7SU).
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17
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Rosgen BK, Plotnikoff KM, Krewulak KD, Shahid A, Hernandez L, Sept BG, Morrissey J, Robertson K, Fraser N, Niven DJ, Straus SE, Leigh JP, Stelfox HT, Fiest KM. Co-development of a transitions in care bundle for patient transitions from the intensive care unit: a mixed-methods analysis of a stakeholder consensus meeting. BMC Health Serv Res 2022; 22:10. [PMID: 34974832 PMCID: PMC8722038 DOI: 10.1186/s12913-021-07392-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community). Methods We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle. Results Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle. Conclusions Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07392-2.
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Affiliation(s)
- Brianna K Rosgen
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Laura Hernandez
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Jeanna Morrissey
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Kristin Robertson
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Nancy Fraser
- Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Sharon E Straus
- Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
| | - Jeanna Parsons Leigh
- Department of Medicine, School of Health Administration, Dalhousie University, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, 10030 - 107 Street NW, Edmonton, AB, T5J 3E4, Canada.,O'Brien Institute for Public Health, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, 3260 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. .,Department of Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
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18
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Henao Castaño ÁM, Villamil Buitrago AV, Marín Ramírez S, Cogollo Hernandez CA. Características del síndrome post cuidado intensivo: revisión de alcance. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie23.csci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: identificar la evidencia disponible de las características del síndrome post unidad de cuidado intensivo en el paciente que egresa de la unidad de cuidado intensivo. Método: revisión de alcance con la metodología del Joanna Briggs Institut, en cinco bases de datos con la estrategia de búsqueda ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Se incluyeron estudios primarios publicados entre los años 2010 y 2020, disponibles en texto completo. Resultados: después del análisis de los 48 estudios primarios se extrajeron seis categorías temáticas así: aspecto cognitivo en el síndrome post UCI, osteomusculares, psicoemocionales, estrategias de prevención con modelos de sobrevivientes de UCI, síndrome post unidad cuidado intensivo en la familia y herramientas de evaluación. Conclusiones: mejorar la calidad de atención de los pacientes que presentan este síndrome, prevenir la aparición y aumentar la calidad de vida prestada a los sobrevivientes de UCI y sus familias. La evidencia reporta que entre los cuidadores se pueden desencadenar distintos trastornos que disminuyen su calidad de vida. La enfermería juega un papel crucial en la prevención de la aparición del síndrome mediante estrategias en la UCI e interdisciplinares; los planes de egreso y seguimiento a los pacientes pueden lograr que estos se rehabiliten más rápido y eviten discapacidades o secuelas a largo plazo.
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19
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Damanik SRH, Chen HM. Family needs among patients hospitalized in critical care unit: Scoping review. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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King E, Gustafson O, Judge T, Vollam S. Multidisciplinary team perception of games-based therapy in critical care: A service evaluation. Nurs Crit Care 2021. [PMID: 34783137 DOI: 10.1111/nicc.12731] [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: 06/23/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND As survivorship following critical illness improves, there is greater focus on maximizing recovery. As well as physical effects, critical illness often results in cognitive impairments such as delirium, anxiety, or disorientation. In other populations, such as delirium, non-pharmacological approaches to manage these conditions are preferred, including re-orientation and ensuring personal care needs are met. Cognitive rehabilitation is also well documented for patients with neuropsychological deficits. Treatments include memory aids, compensation strategies, and functional execution. In other hospital populations, games and activities have been utilized to optimize patient engagement, stimulation, and aid recovery, but it is considered an emerging therapy in intensive care. AIMS This service evaluation aimed to gather multidisciplinary team members' perceptions of the use of games based therapy (GBT) in critical care, including patient engagement and acceptability in clinical practice. STUDY DESIGN A UK-based single-centre qualitative service evaluation. METHODS Purposive sampling was used to identify interviewees within an adult intensive care who had experience of using a recently implemented GBT intervention. Qualitative data were collected through semi-structured interviews, which were recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS Eight staff members across the multidisciplinary team were interviewed. One overarching theme of humanizing health care was identified, with three sub-themes of enhancing recovery, non-physical components of care, and bespoke tailoring. In addition, further recommendations for development of the service were summarized. CONCLUSION GBT was well received by staff in clinical practice. It was described as a supportive adjunct to traditional care and rehabilitation, enhancing staff-patient relationships. While it was recognized it may not suit all patients, GBT has the potential to enhance cognitive and physical recovery.
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Affiliation(s)
- Elizabeth King
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Owen Gustafson
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Tom Judge
- Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Vollam
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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21
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Cuzco C, Delgado-Hito P, Marín Pérez R, Núñez Delgado A, Romero-García M, Martínez-Momblan MA, Martínez Estalella G, Carmona Delgado I, Nicolas JM, Castro P. Patients' experience while transitioning from the intensive care unit to a ward. Nurs Crit Care 2021; 27:419-428. [PMID: 34402141 DOI: 10.1111/nicc.12697] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/05/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intensive care unit (ICU) patients can experience emotional distress and post-traumatic stress disorder when they leave the ICU, also referred to as post-intensive care syndrome. A deeper understanding of what patients go through and what they need while they are transitioning from the ICU to the general ward may provide input on how to strengthen patient-centred care and, ultimately, contribute to a positive experience. AIM To describe the patients' experience while transitioning from the ICU to a general ward. DESIGN A descriptive qualitative study. METHOD Data were gathered through in-depth interviews and analysed using a qualitative content analysis. The qualitative study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. FINDINGS Forty-eight interviews were conducted. Impact on emotional well-being emerged as a main theme, comprising four categories with six subcategories. CONCLUSION Transition from the ICU can be a shock for the patient, leading to the emergence of a need for information, and an impact on emotional well-being that has to be planned for carefully and addressed prior to, during, and following transition from the ICU to the general ward. RELEVANCE TO CLINICAL PRACTICE It is essential that nurses understand patients' experiences during transfer, identifying needs and concerns to be able to develop and implement new practices such as ICU Liaison Nurse or Nurse Outreach for the follow-up of these patients, the inclusion of a consultant mental health nurse, and the application of patient empowerment during ICU discharge.
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Affiliation(s)
- Cecilia Cuzco
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,International Research Project: Proyecto HU-CI, Madrid, Spain
| | - Raquel Marín Pérez
- Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cardiology, Hospital Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Marta Romero-García
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,International Research Project: Proyecto HU-CI, Madrid, Spain
| | - María Antonia Martínez-Momblan
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Department of Fundamental and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.,Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José María Nicolas
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic, Barcelona, Spain.,Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Johanna Josepha Op't Hoog SA, Eskes AM, Johanna van Mersbergen-de Bruin MP, Pelgrim T, van der Hoeven H, Vermeulen H, Maria Vloet LC. The effects of intensive care unit-initiated transitional care interventions on elements of post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care 2021; 35:309-320. [PMID: 34120805 DOI: 10.1016/j.aucc.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness of intensive care unit (ICU)-initiated transitional care interventions for patients and families on elements of post-intensive care syndrome (PICS) and/or PICS-family (PICS--F). REVIEW METHOD USED This is a systematic review and meta-analysis SOURCES: The authors searched in biomedical bibliographic databases including PubMed, Embase (OVID), CINAHL Plus (EBSCO), Web of Science, and the Cochrane Library and included studies written in English conducted up to October 8, 2020. REVIEW METHODS We included (non)randomised controlled trials focussing on ICU-initiated transitional care interventions for patients and families. Two authors conducted selection, quality assessment, and data extraction and synthesis independently. Outcomes were described using the three elements of PICS, which were categorised into (i) physical impairments (pulmonary, neuromuscular, and physical function), (ii) cognitive impairments (executive function, memory, attention, visuo-spatial and mental processing speed), and (iii) psychological health (anxiety, depression, acute stress disorder, post-traumatic stress disorder, and depression). RESULTS From the initially identified 5052 articles, five studies were included (i.e., two randomised controlled trials and three nonrandomised controlled trials) with varied transitional care interventions. Quality among the studies differs from moderate to high risk of bias. Evidence from the studies shows no significant differences in favour of transitional care interventions on physical or psychological aspects of PICS-(F). One study with a nurse-led structured follow-up program showed a significant difference in physical function at 3 months. CONCLUSIONS Our review revealed that there is a paucity of research about the effectiveness of transitional care interventions for ICU patients with PICS. All, except one of the identified studies, failed to show a significant effect on the elements of PICS. However, these results should be interpreted with caution owing to variety and scarcity of data. PROSPERO REGISTRATION CRD42020136589 (available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020136589).
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Affiliation(s)
- Sabine Adriana Johanna Josepha Op't Hoog
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands.
| | - Anne Maria Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | | | - Thomas Pelgrim
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | | | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | - Lilian Christina Maria Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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23
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Herling SF, Brix H, Andersen L, Jensen LD, Handesten R, Knudsen H, Bove DG. A qualitative study portraying nurses' perspectives on transitional care between intensive care units and hospitals wards. Scand J Caring Sci 2021; 36:947-956. [PMID: 33908642 DOI: 10.1111/scs.12990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/04/2021] [Accepted: 03/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The transition process from the intensive care unit (ICU) to hospital ward may impact the illness trajectory and compromise the continuity of safe care for ICU survivors. ICU and ward nurses are involved with the transition and are responsible for the quality of the transitional care. AIM The aim was to explore ICU and ward nurses' views on assignments in relation to patients' transition between ICU and hospital ward. METHODS We conducted a qualitative study with 20 semi-structured interviews with ICU nurses and ward nurses and analysed data by content analysis. SETTING A university hospital with 690 beds and an 11-bed mixed medical/surgical ICU. FINDINGS The overarching themes were (1) 'Ritual of hand over' with the categories: (a) 'Ready, able and willing', (b) 'Transfer of responsibility' and (c) 'Nice to know versus need to know' and (2) 'From lifesaving care to rehabilitative care' with the categories: (a) 'Complex care needs persist', (b) 'Fight or flight mode' and (c) '"Weaning" the family'. Nurses were highly focused on the ritual of the actual handover of the patient and discussed readiness as an indicator of quality and the feeling of passing on the responsibility. Nurses had different opinions on what useful knowledge was and thus necessary to communicate during handover. Although patients' complex care needs may not have been resolved when exiting the ICU, ward nurses had to receive patients in a setting where nurses were mostly comfortable within their own specialty - this was worrying for both type of nurses. Patients could enter the ward very exhausted and weak or in 'fight mode' and demand rehabilitation at a pace the ward was not capable of delivering. ICU nurses encouraged families to be demanding after the ICU stay, and ward nurses asked them to trust them and steep back.
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Affiliation(s)
- Suzanne Forsyth Herling
- Research Unit: ACES, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark.,The Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Helene Brix
- ICU, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Lise Andersen
- ICU, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Liz Daugaard Jensen
- ICU, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Rie Handesten
- ICU, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Heidi Knudsen
- ICU, Department of Anesthesiology, Copenhagen University Hospital Herlev Gentofte, Herlev, Denmark
| | - Dorthe Gaby Bove
- Emergency Department, Copenhagen University Hospital, Hillerød, Denmark
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24
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Hengeveld B, Maaskant JM, Lindeboom R, Marshall AP, Vermeulen H, Eskes AM. Nursing competencies for family-centred care in the hospital setting: A multinational Q-methodology study. J Adv Nurs 2021; 77:1783-1799. [PMID: 33314342 PMCID: PMC8048472 DOI: 10.1111/jan.14719] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
AIM to identify: (1) nursing competencies for FCC in a hospital setting; and (2) to explore perspectives on these competencies among Dutch and Australian professionals including lecturers, researchers, Registered Nurses and policy makers. DESIGN A multinational cross-sectional study using Q-methodology. METHODS First, an integrative review was carried out to identify known competencies regarding FCC and to develop the Q-set (search up to July 2018). Second, purposive sampling was used to ensure stakeholder involvement. Third, participants sorted the Q-set using a web-based system between May and August 2019. Lastly, the data were analysed using a by-person factor analysis. The commentaries on the five highest and lowest ranked competencies were thematically analysed. RESULTS The integrative review identified 43 articles from which 72 competencies were identified. In total 69 participants completed the Q-sorting. We extracted two factors with an explained variance of 24%. The low explained variance hampered labelling. Based on a post-hoc qualitative analysis, four themes emerged from the competencies that were considered most important, namely: (a) believed preconditions for FCC; (b) promote a partnership between nurses, patients and families; (c) be a basic element of nursing; and (d) represent a necessary positive attitude and strong beliefs of the added value of FCC. Three themes appeared from the competencies that were considered least important because they: (a) were not considered a specific nursing competency; (b) demand a multidisciplinary approach; or (c) require that patients and families take own responsibility. CONCLUSIONS Among healthcare professionals, there is substantial disagreement on which nursing competencies are deemed most important for FCC. IMPACT Our set of competencies can be used to guide education and evaluate practicing nurses in hospitals. These findings are valuable to consider different views on FCC before implementation of new FCC interventions into nursing practice.
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Affiliation(s)
- Bram Hengeveld
- LivioEnschedethe Netherlands
- VilansUtrechtthe Netherlands
| | - Jolanda M. Maaskant
- Emma Children’s HospitalAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Robert Lindeboom
- Department of Clinical Epidemiology, Biostatistics and BioinformaticsAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
| | - Andrea P. Marshall
- Menzies Health Institute QueenslandSchool of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
- Gold Coast HealthSouthportQueenslandAustralia
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ healthcare)Radboud University Medical Center, Radboud Institute for Health SciencesNijmegenthe Netherlands
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Anne M. Eskes
- Menzies Health Institute QueenslandSchool of Nursing and MidwiferyGriffith UniversitySouthportQueenslandAustralia
- Department of SurgeryAmsterdam UMC, University of AmsterdamAmsterdamthe Netherlands
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25
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Ghorbanzadeh K, Ebadi A, Hosseini M, Madah SSB, Khankeh H. Challenges of the patient transition process from the intensive care unit: a qualitative study. Acute Crit Care 2021; 36:133-142. [PMID: 33508186 PMCID: PMC8182156 DOI: 10.4266/acc.2020.00626] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background The transition of patients from the intensive care unit (ICU) to the general ward is challenging. This study aimed to explain the challenges that patients face during the transition process. Methods In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation. Results The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients. Conclusions The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU care and related challenges as well as organizing a learning environment.
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Affiliation(s)
- Kobra Ghorbanzadeh
- Ph.D. Candidate in Nursing, Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Lifestyle Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Hamidreza Khankeh
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
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