1
|
Egerod I, Knudsen VE, Andersson AE, Fagerdahl A. Patient and family experience 2 years after necrotizing soft‐tissue infection: A longitudinal qualitative investigation. J Adv Nurs 2022. [DOI: 10.1111/jan.15535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 10/18/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ingrid Egerod
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Vibeke E. Knudsen
- Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Annette E. Andersson
- Institute of Health Care Sciences Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Orthopedics Sahlgrenska University Hospital/Mölndal Gothenburg Sweden
| | - Ann‐Mari Fagerdahl
- Department of Clinical Science and Education Wound Centre, Södersjukhuset Stockholm Sweden
- Karolinska Institute Stockholm Sweden
| |
Collapse
|
2
|
Coombs MA, Statton S, Endacott CV, Endacott R. Factors influencing family member perspectives on safety in the intensive care unit: a systematic review. Int J Qual Health Care 2021; 32:625-638. [PMID: 32901816 DOI: 10.1093/intqhc/mzaa106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Patient safety has developed as a strong marker for healthcare quality. Safety matters are important in the intensive care unit (ICU) where complex clinical decisions are made, intensive technology is used, and families hold a unique role. The aim of this review was to identify and describe factors that influence family member's perceptions of safety in the adult ICU. DATA SOURCES Searches were conducted between September and November 2018 and repeated in July 2020 using CINAHL, MEDLINE (EBSCO), PubMed and PsycINFO databases. STUDY SELECTION Published primary studies undertaken in adult ICUs and involving adult family member participants exploring safety or feeling safe. No date restrictions were applied. DATA EXTRACTION A data extraction form collected information about sample, study design, data collection methods and results from each paper. Methodological quality was assessed using the QualSyst tools for qualitative and quantitative studies. Narrative synthesis was undertaken. RESULTS OF DATA SYNTHESIS Twenty papers were included with 11 papers published since 2010. The majority of papers reported on qualitative studies (n = 16). Four factors were identified that influenced whether family members felt that the patient was safe in ICU: family visiting, information and communication, caring and professional competence. CONCLUSION In detailing specific practices that make families feel safe and unsafe in ICU, these review findings provide a structure for clinicians, educators and researchers to inform future work and gives opportunity for the family role in patient safety to be reconsidered.
Collapse
Affiliation(s)
- M A Coombs
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.,School of Nursing, Midwifery and Health Practice, Victoria University of Wellington, Wellington, New Zealand
| | - S Statton
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.,NIHR Exeter Clinical Research Facility, Level 2 RILD Building, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - C V Endacott
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.,Bradford Institute of Health Research, Bradford Royal Infirmary, Duckworth lane, Bradford, BD9 6RJ, UK
| | - R Endacott
- School of Nursing and Midwifery, Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, Devon, PL4 8AA, UK.,School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Building E, Peninsula Campus, 47-49 Moorooduc Highway, Frankston, Victoria, 3199, Australia
| |
Collapse
|
3
|
Egerod I, Kaldan G. Elements of chaplaincy in Danish intensive care units: key-informant interviews with hospital chaplains. J Health Care Chaplain 2021; 28:540-554. [PMID: 34284688 DOI: 10.1080/08854726.2021.1949174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Critically ill patients often require spiritual counseling. In Denmark, most hospital chaplains are provided by the State Church. More knowledge is needed regarding health care chaplaincy in this semi-agnostic non-secular welfare society. Our study aimed to explore how hospital chaplains describe their role and elements of chaplaincy in relation to patient, family and healthcare professionals in Danish intensive care units. Using a multicenter qualitative design, we performed semi-structured key-informant interviews with ten hospital chaplains. Content analysis exposed elements of chaplaincy based on spirituality, rituality, neutrality, confidentiality, advocacy, and equality. Most elements are similar in other countries; the main differences are related to educational requirements, institutional integration, research activity, and documentation practice. Chaplains fill an ambiguous role, negotiating values of church and hospital. Modern chaplaincy is propelled toward professionalism, quantification, certification and evaluation. We discuss the contemporary role of hospital chaplains and the consequences of categorizing them as part of the ICU team.
Collapse
Affiliation(s)
- Ingrid Egerod
- Intensive Care Unit, Rigshospitalet, University of Copenhagen, Copenhagen O, Denmark
| | - Gudrun Kaldan
- Research Unit Rigshospitalet 7831, Centre for Cancer and Organ Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
4
|
Affiliation(s)
- Christina Jones
- Research Manager ICU steps and Visiting Research Fellow, University of Plymouth, United Kingdom
| |
Collapse
|
5
|
Højager Nielsen A, Egerod I, Angel S. Patients' perceptions of an intensive care unit diary written by relatives: A hermeneutic phenomenological study. Intensive Crit Care Nurs 2019; 55:102751. [PMID: 31416670 DOI: 10.1016/j.iccn.2019.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/24/2019] [Accepted: 08/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore patients' perceptions of an intensive care unit diary written by relatives including pictures added by staff. DESIGN Ten patients were interviewed 3-6 and 8-16 months after discharge from the intensive care unit. Most patients were interviewed with a relative present. Interviews were analysed using Ricoeur's theory of interpretation. SETTING Interviews took place in participants' homes. FINDINGS Patients found the diary written by relatives with photos taken by staff to be valuable providing information that helped them understand their time in the intensive care unit. The diary text gave patients insight into relatives' experiences and suffering. Patients were touched by the love and care conveyed in the diary, however, the diaries could overwhelm the patients when they were confronted with the grief and agony endured by their relatives. CONCLUSION Although diaries kept by relatives confront patients with consequences beyond their own suffering, they are informative and promote understanding of what patient and family experienced during critical illness. The diaries expressed how much the relatives cared for the patient thus paving the way for mutual support and understanding. Diaries authored by relatives represent a new element to ICU diaries that have evolved from a nursing intervention toward family participation.
Collapse
Affiliation(s)
- Anne Højager Nielsen
- Department of Anaesthesiology, Regional Hospital Holstebro, Lægårdvej 12, 7500 Holstebro, Denmark.
| | - Ingrid Egerod
- University of Copenhagen, Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Intensive Care Unit 4131, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Building 1260, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| |
Collapse
|
6
|
Patient experience of necrotising soft-tissue infection from diagnosis to six months after intensive care unit stay: A qualitative content analysis. Aust Crit Care 2019; 33:187-192. [PMID: 30871854 DOI: 10.1016/j.aucc.2019.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/21/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Necrotizing soft tissue infection (NSTI) is a severe, life-threatening condition requiring immediate diagnosis and treatment to avoid widespread tissue destruction and death. Current research seeks to explain the complex interaction between patient and disease agent, whereas only few studies have addressed the patient perspective. OBJECTIVE The present study aimed to describe the patient experience of NSTI in the first six months after diagnosis. METHODS The study had a qualitative design with patient involvement. We interviewed 27 NSTI survivors at six months after diagnosis and applied content analysis to capture their experiences. Patients were recruited from two referral centers in Sweden and one in Denmark. FINDINGS We identified three categories representing chronological stages of the illness trajectory depicting pivotal patient experiences: regaining awareness in the intensive care unit, transitioning to the ward, and returning home to normal life. Fear of infection or reinfection permeated all stages of the trajectory. Each stage was characterized by ambivalence: at first the relief of being alive and distress of serious illness, then the relief of independence and distress of abandonment, and finally the relief of being home and distress of still being dependent on others. CONCLUSION Fear of infection and reinfection during and after hospitalization characterized lives of NSTI survivors and their family. This fear was potentially debilitating in daily life, working life and social life. Healthcare professionals need to be aware of these modifiable factors to help alleviate the concerns of patient and family throughout the illness trajectory.
Collapse
|
7
|
Egerod I, Kaldan G, Shaker SB, Guldin MB, Browatski A, Marsaa K, Overgaard D. Spousal bereavement after fibrotic interstitial lung disease: A qualitative study. Respir Med 2018; 146:129-136. [PMID: 30665511 DOI: 10.1016/j.rmed.2018.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Fibrotic interstitial lung disease (f-ILD) comprises a group of diseases with lung scarring and reduced life expectancy. The short time from diagnosis to death affects the patients' bereaved spouses, who risk developing prolonged grief. In Denmark palliative care is most often offered to cancer patients. AIM We aimed to investigate the experience of spouses of f-ILD patients during the final stages of illness and up to the first year after the patient's death to investigate if palliative care could ease the transition and prevent PGD. METHODS Our study had a qualitative design triangulating in-depth interviews, field notes, participant diaries and the prolonged grief questionnaire PG-13. We included 20 spouses and applied thematic analysis. Initial coding was performed deductively according to the chronological stages of before, during and after the death of the patient. We subsequently coded inductively within the stages. RESULTS During the final days the spouses experienced emotional ambivalence shifting between hope, acceptance and despair. Factors affecting the spouses during the final hours were the timing, location, and process of death. After the patient's death the spouses experienced feelings of grief and optimism as they moved toward a new life on their own. CONCLUSIONS Some of the factors affecting the spouses and potentially causing prolonged grief might be alleviated by offering palliative/supportive care and advance care planning to f-ILD patients and their family.
Collapse
Affiliation(s)
- Ingrid Egerod
- University of Copenhagen, Rigshospitalet, Intensive Care Unit, Copenhagen, Denmark.
| | - Gudrun Kaldan
- Copenhagen University Hospital, Rigshospitalet, Abdominal Centre, Copenhagen, Denmark
| | - Saher Burhan Shaker
- Department of Respiratory Medicine, Gentofte Hospital, University of Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Andrea Browatski
- Department of Pulmonary and Infectious Diseases, North Zealand University Hospital, Denmark
| | - Kristoffer Marsaa
- Palliative Unit, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Institute of Nursing and Nutrition, Copenhagen University College, Denmark
| |
Collapse
|
8
|
Erichsen Andersson A, Egerod I, Knudsen VE, Fagerdahl AM. Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study. BMC Infect Dis 2018; 18:429. [PMID: 30153808 PMCID: PMC6114743 DOI: 10.1186/s12879-018-3355-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/22/2018] [Indexed: 01/11/2023] Open
Abstract
Background Necrotizing soft tissue infection is the most serious of all soft tissue infections. The patient’s life is dependent on prompt diagnosis and aggressive treatment. Diagnostic delays are related to increased morbidity and mortality, and the risk of under- or missed diagnosis is high due to the rarity of the condition. There is a paucity of knowledge regarding early indications of disease. The aim of the study has thus been to explore patients’ and families’ experiences of early signs and symptoms and to describe their initial contact with the healthcare system. Methods A qualitative explorative design was used to gain more knowledge about the experience of early signs and symptoms. Fifty-three participants from three study sites were interviewed. The framework method was used for data analysis. Results Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. The experience of illness varied among the participants depending on the duration of antecedent signs and symptoms. Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear. Conclusion Our study adds to the understanding of the lived experience of NSTI by providing in-depth description of antecedent signs and symptoms precipitating NSTI-diagnosis. We have described diagnostic delay as patient-related, primary care related, or hospital related and recommend that patient and family narratives should be considered when diagnosing NSTI to decrease diagnostic delay.
Collapse
Affiliation(s)
- Annette Erichsen Andersson
- Institute of Health Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Göteborg, Sweden. .,Department of Orthopaedic Surgery, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden.
| | - Ingrid Egerod
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Rigshospitalet, Copenhagen University Hospital, Intensive care unit 4131, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Vibeke E Knudsen
- Rigshospitalet, Copenhagen University Hospital, Intensive care unit 4131, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Ann-Mari Fagerdahl
- Wound Centre, Södersjukhuset, Department of Clinical Science and Education, 118 83 Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Experiences of family caregivers the first six months after patient diagnosis of necrotising soft tissue infection: A thematic analysis. Intensive Crit Care Nurs 2018; 49:28-36. [PMID: 29937074 DOI: 10.1016/j.iccn.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Necrotising soft tissue infection, or necrotising fasciitis, is a rapidly progressing disease requiring immediate diagnosis and treatment consisting of antimicrobial therapy, hyperbaric oxygen, debridement surgery and treatment in the intensive care unit. The harrowing illness trajectory affects the family caregivers potentially producing long-term psychological issues. OBJECTIVES We aimed to explore the experiences and coping strategies of family caregivers during the first six months after patient diagnosis of necrotising soft tissue infection. METHODS Our study had a prospective, explorative, qualitative design using semi-structured interviews and thematic analysis to understand necrotising soft tissue infection as an intrinsic and instrumental case. Family caregivers (n = 25) were recruited at three university hospitals in Denmark and Sweden. FINDINGS We identified three chronological themes describing issues of importance to the family caregivers. In the intensive care unit: Coping with illness and intensive care; In the ward: Coping with injury and post-intensive care and At home: Coping with recovery and new home life. CONCLUSION Challenges facing family caregivers of necrotising soft tissue infections survivors are still under-recognised. Healthcare professionals need to ensure that families and stakeholders throughout the patient trajectory have access to and co-create timely information and care plans to bridge the knowledge gap across care environments and to relieve family responsibility.
Collapse
|