The experiences of families of critically ill patients in Greece: a social constructionist grounded theory study

The family intensive care unit syndrome: A qualitative content analysis

BACKGROUND

Hospitalization of patients in an intensive care unit (ICU) is associated with a series of psychological problems for their family members called family intensive care unit syndrome (FICUS). Nonetheless, family members of patients in ICU often receive little attention from health care providers. Exploring family members' experiences of their patients' hospitalization in ICU helps health care providers focus more clearly on their problems.

AIMS AND OBJECTIVES

This study aimed to explore FICUS-related experiences among the family members of patients in ICU.

DESIGN

This was a qualitative content analysis study.

METHODS

This qualitative study was conducted in 2019. Participants were 14 family members of patients in ICU who were purposively selected from three hospitals in Tehran, Iran. Data were collected using semi-structured interviews and were analyzed using qualitative content analysis.

RESULTS

Participants' experiences of FICUS fell into four categories, that is, threat to psychological well-being (with four subcategories), threat to physical health (with three subcategories), threat to social health (with three subcategories), and change in spiritual orientation (with two subcategories). The 12 subcategories of these categories were emotional disturbances, hopelessness, changes in sleep pattern, mood changes, physical symptoms, aggravation of the existing illnesses, negligence towards personal health, alteration in social interactions, alteration in the burden of responsibility, alternation in the life process, resort to spiritual beliefs, and spiritual conflict, respectively.

CONCLUSION

FICUS symptoms are not limited to psychological problems, rather they include a wide range of psychological, physical, social, and spiritual problems, which can affect the different aspects of family members' lives. Along with care delivery to patients in ICU, health care providers should provide care and support to patients' family members.

RELEVANCE TO CLINICAL PRACTICE

FICUS is a major threat to health among the family members of patients in ICU. Careful assessment of these family members helps identify family members who are at risk for FICUS and identify FICUS effects on their decisions and health status.

Experiences and needs of families with a relative admitted to an adult intensive care unit: a systematic review of qualitative studies

OBJECTIVE

The objective of the review was to synthesize research studies that reported on the experiences and needs of families with a relative in an adult intensive care unit.

INTRODUCTION

Having a relative in an intensive care unit has been reported to be a time of turmoil, stress, and disruption to the lives of family members. Primary research studies suggest such a crisis or even a planned intensive care unit admission can have not only emotional, physical, and psychological impact, but can also affect family member roles and function. A deeper understanding of the overall experience may assist intensive care unit staff to address specific family needs.

INCLUSION CRITERIA

This review included qualitative studies of any design that described and explored the experiences and needs of family members with a relative admitted to an adult intensive care unit.

METHODS

The methods for the review followed the JBI meta-aggregation approach for synthesizing qualitative data. MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (EBSCO), Embase (Embase.com) and Web of Science Core Collection (Clarivate Analytics) databases were searched for published studies. ProQuest Dissertations and Theses database (Ovid) was searched for unpublished studies. Studies published from 2010 to November 2019 in the English language were selected for possible inclusion in the review.

RESULTS

From 7208 citations, 20 studies were agreed upon for inclusion in the review. From these studies, 112 findings were extracted and synthesized into 12 categories. Four synthesized findings were compiled by aggregating the categories. Broadly, these synthesized findings related to: psychosocial health, proximity, information needs, and the intensive care unit environment.

CONCLUSIONS

Being a relative of a patient in an intensive care unit is a complex, emotional, and individual experience that can have physical, psychological, and emotional impact. The synthesized findings from this review can be used to support family-centered care practices in adult intensive care units, particularly in regard to information provision, visiting practices, and supportive care.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016053300.

Nursing Interventions to Reduce Stress in Families of Critical Care Patients: An Integrative Review

BACKGROUND

Having a family member admitted to an intensive care unit is a stressful experience that may lead to psychological symptoms including depression, anxiety, and posttraumatic stress disorder.

OBJECTIVE

To better understand the phenomenon of stress experienced by families of intensive care unit patients and identify nursing interventions that may help reduce it.

METHODS

An integrative literature review was performed to identify principal stressors for families of patients receiving care in neonatal, pediatric, and adult intensive care units and recommended nursing interventions.

RESULTS

The principal stressors in the 3 types of intensive care units were change in parental role or family dynamics, appearance and behavior of the patient, the care setting, and communication with the health care staff. Nursing interventions should focus on valuing the role of family members in patient care, improving communication, and providing accurate information.

CLINICAL RELEVANCE

Family members of intensive care patients will benefit from nursing interventions that adequately acknowledge and address the stress they experience.

CONCLUSION

Nurses play a crucial role in helping to reduce the stress experienced by family members of intensive care unit patients.

Relationship Between the Needs of Turkish Relatives of Patients Admitted to an Intensive Care Unit and Their Coping Styles

Admission to an intensive care unit is a traumatic event for many patients' relatives. Also, the relatives may be subject to many requirements to during this process. Therefore, it is very important to determine their requirements and coping styles. This study used a descriptive, relational design. The sample of the research consisted of 247 relatives of patients staying in six intensive care units. It was found that, 65.2% of the patients' relatives were women, and their mean age was 37.25 ± 12.7 years. What they mostly needed was support, proximity, information, assurance and comfort. In that order; among the coping styles it was found that they usually used the following approaches: self-confident approach, an problem-focused coping method; was found to be used by relatives most frequently, followed by helpless approach, an emotion-focused coping style. Requirements: Assurance, information, support and comfort sub-dimension scores and problem-focused coping style; self-confident approach and social support search approach sub-dimension scores between statistically positive, significant relationship was found. Information, proximity, support and comfort sub-dimension scores and emotion-focused coping style; helpless approach and submissive sub-dimension scores between statistically positive, significant relationship was found (p<0.05). It was found that patients' relatives used the helpless approach and submissive approach to cope with stres: during this process their information needs increased and upon fulfillment of requirements, they started using self-confident approach and the social support approach, which are problem-focused coping styles.

Family Intensive Care Unit Syndrome: An Integrative Review

BACKGROUND

Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors.

MATERIALS AND METHODS

The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005-2018 with the keywords "FICUS," "intensive care unit," "family," "caregivers," "anxiety," "depression," and "post-traumatic stress disorder" in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study.

RESULTS

Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS.

CONCLUSIONS

On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term "FICUS" in the research literature. Thus, further research is needed to explore FICUS in the health field.

The process of giving information to families in intensive care units: A narrative review

AIM

Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU).

METHOD

A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018.

RESULTS

47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU.

CONCLUSIONS

Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.

Stressors and strains of next of kin of patients with ARDS in intensive care: A qualitative interview study using a stress-strain approach

OBJECTIVES

This study aims to explore and analyse the stressors and strains of next of kin of acute respiratory distress syndrome (ARDS) patients during their stay in the intensive care unit utilising the stressors and strain approach as a theoretical framework.

METHODS

Data collection was performed as semi-standardised qualitative interviews. 35 families of patients with ARDS were approached when visiting the intensive care unit. Participants were recruited until thematic saturation was reached; finally, 17 persons (age ranging from 26 to 71 years, nine women) took part. Systematic content analysis was conducted on the theoretical foundations of the stressors and strain approach.

FINDINGS

Numerous stressors were identified; they can be divided into three main categories: in relation to organising the visit, occurring during the visit and arising at home. These stressors were reported highly consistently throughout participants. However, the strains resulting from these stressors were varying in manifestation and level.

CONCLUSIONS

This study explores the manifold stressors and strains of next of kin of a critically ill patient. Some stressors are inherent to the life-threatening condition of a family member; others arise from the health care system and could be modified. The level of strain experienced depends on social support, individual coping skills and life circumstances.

Depressive and Anxiety Symptoms in Relatives of Intensive Care Unit Patients and the Perceived Need for Support

Background:

Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members.

Objectives:

This study aimed to explore the families’ psychological symptoms and their evolution over the 1^st week of patients’ ICU stay. Additional objectives were the estimation of the families’ need for support and the estimation of satisfaction regarding the information provided by ICU physicians.

Methods:

A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients’ ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients’ care; and the support of the families by medical and nursing staff.

Results:

Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives’ views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed.

Conclusions:

Over the 1^st week of ICU admission, depressive symptoms in patients’ relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients’ condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.

The lived experience of family caregivers caring for patients dependent on life-sustaining technologies

PURPOSE

The purpose of this study was to describe the meaning of the lived experience of family caregivers caring for their loved ones who were dependent upon life-sustaining technologies while in the hospital.

METHODS

This study followed van Manen's hermeneutic phenomenological approach to generate and analyze data to describe the experience of ten family caregivers who met the following inclusion criteria: a family member who participated actively in caring for the loved one who was dependent upon technologies for human care. Data were collected using individual in-depth interviews. The interview transcriptions were analyzed using van Manen's phenomenological approach, while Lincoln and Guba's criteria were used to establish trustworthiness of the study.

FINDINGS

Four thematic categories structured the meaning of the experience: Being an invisible person; supporting patients' wholeness; struggling to trust technologies for human care; and living in uncertainty. These thematic categories were reflective of Van Manen's four lived worlds of body, relation, space, and time.

CONCLUSION

Understanding the experience of family caregivers challenges nurses to express their technological competencies in caring more fully in their human care. Locsin's theory of Technological Competency as Caring in Nursing was used to explain and describe the meaning of the experiences of family caregivers caring for patients who were dependent upon technologies for human care, and foster nursing practice as caring in nursing.

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research

BACKGROUND

There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process.

METHODS

Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively.

DISCUSSION

The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.

Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.

The experience of Greek families of critically ill patients: Exploring their needs and coping strategies

OBJECTIVES

To explore the experiences, needs and coping strategies of families of patients admitted to adult intensive care units.

DESIGN AND SETTING

A descriptive qualitative research design was chosen using an inductive thematic content analysis approach. Semi-structured interviews were conducted withfourteen family members in three hospitals of Crete.

FINDINGS

Four main themes were derived from data analysis. Our results showed that family members were in turmoil having to deal with intense and alternating feelings. The protection of patient's dignity and well-being was of utmost importance mainly by maintaining proximity. Getting comprehensible information and building communication with the healthcare providers was often problematic. Three coping strategies were used: optimism, family support and spirituality.

CONCLUSION

This study is a contribution to the understanding of Greek family's experiences and psychosocial needs during critical illness. A family-inclusive framework should be promoted and implemented in intensive care recognising and supporting family's role in the patient's illness and recovery.

Barriers to families' regaining control in ICU: Disconnectedness

BACKGROUND

The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care.

AIMS

The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context.

DESIGN AND METHODS

A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia.

FINDINGS

A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope.

CONCLUSION

Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used to support patient- and family-centred care interventions in the ICU.

Patient and family involvement in adult critical and intensive care settings: a scoping review

BACKGROUND

Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings.

OBJECTIVE

This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined.

METHODS

Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis.

FINDINGS

A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care.

CONCLUSION

Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.

Family Anticipatory Grief: An Integrative Literature Review

Despite all the investment in research, uncertainty persists in anticipatory grief (AG) literature, concerning its nuclear characteristics and definition. This review aimed to synthesize recent research in order to develop further knowledge about the family experience of AG during a patient’s end of life. An integrative review was performed using standard methods of analysis and synthesis. The electronic databases Medline, Web of Knowledge, and EBSCO and relevant journals were systematically searched since 1990 to October 2015. Twenty-nine articles were selected, the majority with samples composed of caregivers of terminally ill patients with cancer. From systematic comparison of data referring to family end-of-life experience emerged 10 themes, which correspond to AG nuclear characteristics: anticipation of death, emotional distress, intrapsychic and interpersonal protection, exclusive focus on the patient care, hope, ambivalence, personal losses, relational losses, end-of-life relational tasks, and transition. For the majority of family caregivers in occidental society, AG is a highly stressful and ambivalent experience due to anticipation of death and relational losses, while the patient is physically present and needed of care, so family must be functional and inhibit grief expressions. The present study contributes to a deeper conceptualization of this term and to a more sensitive clinical practice.

Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties

OBJECTIVES

To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties.

DATA SOURCES

We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013.

STUDY SELECTION

Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility.

DATA EXTRACTION

Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies.

DATA SYNTHESIS

The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce.

CONCLUSIONS

Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.

Experiences of Turkish undergraduate nursing students in the intensive care unit

BACKGROUND

Clinical practicum provides many opportunities for nursing students to learn more about their subject and develop essential nursing skills. In contrast, nursing students often have difficulties during their clinical practicum.

AIM

This study aims to describe the clinical experiences of undergraduate nursing students in the intensive care unit.

METHODS

A descriptive qualitative approach was used in this study. The study was performed at a military medical academy between 1 March and 30 April 2008. The study was conducted with 15 fourth-year baccalaureate nursing students. Data were obtained through open-ended and in-depth audio-taped interviews, which lasted approximately 35-45 min.

FINDINGS

Themes emerged from the participants' descriptions of their experiences in the intensive care unit: anxiety, fear of doing harm, emotional connection and empathy, improving self-confidence, perceived responsibility for patients, prioritizing care of patients, preserving dignity, coping with confronting situations, and communication in the intensive care unit.

CONCLUSION

The views and expectations of nursing students regarding intensive care practice are important for the organization of the nursing education environment. The nursing curriculum must be revised and developed according to the needs of students.

The waiting process: a grounded theory study of families' experiences of waiting for patients during surgery

In this qualitative study, conducted with a grounded theory approach, 17 family members awaiting their relatives’ surgery, were interviewed. The interviews were semi-structured and the data from them was analysed using the constant comparative method suggested by Corbin and Strauss. The findings showed ‘attempt to reassure’ as the core category. The main theme of ‘assurance’, comprising patterns of ‘recourse to spirituality’, ‘communication’, ‘physical proximity’, and ‘coping’ indicated the processes used by participants to achieve their goals. These findings may help health care professionals, especially nurses, to better understand the subject and better facilitate the process of waiting whilst relatives have surgery.

Nursing students' perceptions of patient dignity

BACKGROUND

Respecting patients' dignity has been described as a fundamental part of nursing care. Many studies have focused on exploring the concept of patients' dignity from the patient and nurse perspective, but knowledge is limited regarding students' nursing perceptions and experiences.

OBJECTIVE

To explore the issue of patients' dignity from the perspective of nursing students.

RESEARCH DESIGN

A qualitative study was employed with the formation of four focus groups and the participation of nursing students. Data were analysed via a thematic content analysis of the discussions.

PARTICIPANTS AND RESEARCH CONTEXT

Thirty-four nursing students of a Cyprus University participated in the four focus groups. Each group was homogenous in terms of the year of study and heterogeneous in terms of clinical practice in various wards.

ETHICAL CONSIDERATION

The study's protocol was reviewed and approved by the Cyprus National Bioethics Committee. Ethical standards were followed throughout the study.

FINDINGS

Several factors that maintain or compromise patients' dignity emerged. These factors were grouped into five themes: (a) patients' preferences, verbal abuse and regarding a patient as a unique person; (b) privacy and confidentiality; (c) loss of autonomy and need for help; (d) discrimination and (e) attribution and reciprocity.

DISCUSSION

Different understandings of the perceived concept of dignity and the factors that maintain or compromise patient's dignity were expressed through the eyes and the feelings of nursing students. Students highlighted the importance of promoting patient dignity as an important component of nursing care.

CONCLUSION

Nurse educators can use the findings of this study in order to tailor nursing programmes to emphasise the importance of respecting patients' dignity. In addition, nurse ward managers can use the findings as means for persuading nurses to change current behaviour.

Family visitation in greek intensive care units: nurses' perspective

BACKGROUND

Policies of flexible and open visiting in intensive care units benefit both patients and patients' families. In Greek intensive care units, gaps exist between evidence and practice for family visitation, resulting in restricted visiting policies.

OBJECTIVES

To explore the beliefs of nurses in Greek intensive care units about the effects of visiting on patients, patients' families, and unit staff and nurses' attitudes toward visiting policies.

METHODS

A descriptive correlational survey was conducted in 6 public hospitals in Athens, Greece, with a sample of 143 critical care nurses. Data were collected via an anonymous questionnaire consisting of 3 validated scales to assess the nurses' beliefs about and attitudes toward visitation.

RESULTS

Generally, nurses were resistant to family visiting and open visiting, and most (94.4%) did not want an open policy in their unit. Nurses think that open visiting policies are supportive for patients and patients families, but the overall effects of visiting depend on both the nurse and the patient (91.6%). Nurses reported that open visiting created increased physical and psychological burdens for them (87.5%) and hampered nursing care (75.5%). Years of work experience, staffing level, and number of night shifts worked by nurses per 15 days were factors predictive of nurses' attitudes toward and beliefs about family visitation.

CONCLUSIONS

Nurses' beliefs about and attitudes toward visitation are important factors in the implementation of more flexible visiting policies in Greek intensive care units. Well-staffed units with experienced nurses and fewer shifts per week may affect nurses' negative attitude toward open visitation.

Health-related religious rituals of the Greek Orthodox Church: their uptake and meanings

AIM

To examine the uptake of religious rituals of the Greek Orthodox Church by relatives of patients in critical condition in Greece and to explore their symbolic representations and spiritual meanings.

BACKGROUND

Patients and their relatives want to be treated with respect and be supported for their beliefs, practices, customs and rituals. However nurses may not be ready to meet the spiritual needs of relatives of patients, while the health-related religious beliefs, practices and rituals of the Greek Orthodox Christian denomination have not been explored.

METHOD

This study was part of a large study encompassing 19 interviews with 25 informants, relatives of patients in intensive care units of three large hospitals in Athens, Greece, between 2000 and 2005. In this paper data were derived from personal accounts of religious rituals given by six participants.

RESULTS

Relatives used a series of religious rituals, namely blessed oil and holy water, use of relics of saints, holy icons, offering names for pleas and pilgrimage.

CONCLUSION

Through the rituals, relatives experience a sense of connectedness with the divine and use the sacred powers to promote healing of their patients.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers should recognize, respect and facilitate the expression of spirituality through the practice of religious rituals by patients and their relatives.

The meaning and importance of vigilant attendance for the relatives of intensive care unit patients

AIM

To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece.

BACKGROUND

A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs.

DESIGN

This qualitative study adopted the social constructionist version of grounded theory.

METHOD

Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives.

FINDINGS

Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals.

CONCLUSION

Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made.

Coping with the effects of myocardial infarction from the viewpoint of patients' spouses

The spouse of a patient who has experienced a myocardial infarction (MI) reportedly has psychological and social needs and challenges during the patient's hospitalization but there is a lack of knowledge regarding spouses' coping experiences and resources. The aim of this study was to develop a substantive theory to help explain the coping experiences of the spouse during the patient's hospitalization following an acute MI. Twenty eight spouses of patients in two Finnish hospitals participated in an open-ended interview within 2 to 5 days of the MI and included 12 husbands and 16 wives. The core category "Seeking balance" included the spouses' emotional, cognitive, and social coping experiences following an acute MI. This study adds new information about spouses' coping experiences as well as tensions and problems in interaction between the patient and the spouse. Challenges were reported in talking about serious illness concerns between the spouse and patient and also with other family members.

[Benefits of flexible visitation in the intensive care units for the family of critical patients]

AIM

To identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults.

METHOD

A review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles.

RESULTS

Fifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care.

CONCLUSION

According to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.

[Needs of the family in the intensive care units: a review of the literature]

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.

OBJECTIVE

To analyze and present the needs of the family members of the critical patient.

METHODOLOGY

A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.

RESULTS

After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.

DISCUSSION

One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.

CONCLUSIONS

This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.

Validation of the Iranian version of the Uncertainty In Illness Scale - Family form

This study aimed to evaluate the reliability and validity of the Iranian version of the Uncertainty In Illness Scale — Family form. For this purpose, the Uncertainty In Illness Scale — Family form was translated from English into Persian and tested for psychometric properties. The analyses were carried out with data from a sample of 310 patients’ family members at one general hospital in Birjand city, the center of the Southern Khorasan province. The Iranian version of the Uncertainty In Illness Scale — Family form demonstrated an acceptable level of content validity with a content validity index of 0.91. The Cronbach’s alpha of 0.83 showed that the scale had reasonable internal consistency. This preliminary validation study of the Iranian version of the Uncertainty In Illness Scale — Family form showed that it is an acceptable measure to be used with Iranian patients’ family members. Additional research is recommended for further evaluation of the psychometric properties of the scale.