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Carruthers H, Derry D, Astin F. Becoming partners in rehabilitation with patients in intensive care: physiotherapists' perspectives. Disabil Rehabil 2024; 46:4194-4204. [PMID: 37818631 DOI: 10.1080/09638288.2023.2266993] [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: 06/15/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE Person-centred care is widely accepted as being central to high quality care, but little is known about how physiotherapists implement person centred rehabilitation in Intensive Care. This study explores the self-reported experiences and interpretations of physiotherapists delivering person-centred rehabilitation in this setting. METHODS A qualitative study using Interpretative Phenomenological Analysis explored the lived experiences of physiotherapists and students who have worked in Intensive Care. Three focus groups, with four participants in each, were conducted. Data were fully transcribed, analysed and managed using NVivo software. RESULTS Participants shared similar interpretations about the principles of person-centred care. Operationalising person-centred rehabilitation during early recovery was not easily achievable. As the person's clinical condition improved, participants moved away from routine physiotherapy and their practice became more person-centred through the development of a partnership. Participants connected as humans to understand the person and respond to their needs within a culture that valued person-centred care. CONCLUSIONS Physiotherapists aspire to develop a partnership with their patients by connecting on a human level with them and addressing their biopsychosocial needs. Physiotherapists with experience of developing patient partnerships influence the culture of the Intensive Care team and are role-models to facilitate collaborative person-centred activity in others.
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Affiliation(s)
- Helen Carruthers
- School of Health and Society, University of Salford, Salford, UK
| | - David Derry
- Long-Term Ventilation Unit, Wythenshawe Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Felicity Astin
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
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2
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Egelund Hansen A, Lehmkuhl L, Højager Nielsen A. Critical care nurses' perception of patient involvement in care: A qualitative focus group. Nurs Crit Care 2023; 28:878-884. [PMID: 35811495 DOI: 10.1111/nicc.12815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/15/2022] [Accepted: 06/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient involvement in care in the intensive care unit (ICU) is complex. Knowledge about the nature and extent of patient involvement in the Intensive care unit is scarce. AIM The aim of the study was to explore the critical care nursing staff's perception of patient involvement in their care in the ICU. STUDY DESIGN A phenomenological, hermeneutic research study was carried out using qualitative data. Data were collected in two focus group interviews analysed using Ricoeur's theory of interpretation. The study was conducted in a level 2 medical-surgical 8-bed ICU in a regional hospital in Southern Denmark. RESULTS Critical care nurses found it important to maintain involvement in intensive care. Depending on the patient's ability to partake in care, approaches for patient involvement ranged from (1) continually adjusting care activities according to the patient's bodily responses, (2) formation of a relationship with the patient to enable personalized care and (3) making room for self-determined care progressing with the patient's recovery. CONCLUSION Critical care nurses' perception of patient involvement depended on the patient's level of consciousness. When unconscious, patient involvement was possible but took a physical approach. However, the power inequality in the nurse-patient relationship must be expressed if patient involvement in the ICU is to take place. RELEVANCE TO CLINICAL PRACTICE Results suggest that nurses' perception of patient involvement in the ICU depends on the patient's level of consciousness. Patient involvement may be possible even when the patient is unconscious but it takes a more physical approach. It is essential that the power inequality in the nurse-patient relationship must be expressed if patient involvement in the ICU is to take place.
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Affiliation(s)
- Anja Egelund Hansen
- Department of Anaesthesiology and Intensive Care Medicine, OUH, Svendborg Hospital, Svendborg, Denmark
- Department of Urology, OUH, Odense Universitetshospital, Odense, Denmark
| | - Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care Medicine, OUH, Svendborg Hospital, Svendborg, Denmark
| | - Anne Højager Nielsen
- Department of Anaesthesiology, Gødstrup Hospital, Herning, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Cederwall CJ, Rose L, Naredi S, Olausson S, Ringdal M. Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey. Intensive Crit Care Nurs 2023; 74:103309. [PMID: 35965149 DOI: 10.1016/j.iccn.2022.103309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 07/27/2022] [Accepted: 07/31/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days. RESEARCH METHODOLOGY We conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics. RESULTS We received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units. CONCLUSION We found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.
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Affiliation(s)
- Carl-Johan Cederwall
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK; Lane Fox Respiratory Unit, St Thomas' Hospital, London, UK
| | - Silvana Naredi
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, 413 45 Gothenburg, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
| | - Mona Ringdal
- Institute of Health and Care Sciences, the Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Department of Anaesthesiology and Critical Care, Kungälvs Hospital, Kungälv, Sweden
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Salmani F, Moghimian M, Jouzi M. The effect of planned presence of the family at the time of weaning on the length of weaning from mechanical ventilation in patients with brain injury admitted to intensive care units. BMC Nurs 2022; 21:328. [PMCID: PMC9703410 DOI: 10.1186/s12912-022-01098-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Weaning the patient from mechanical ventilation (MV) is one of the common treatments in intensive care units (ICU). Among the factors that can complicate the weaning process are psychological problems caused by a lack of family visits.
Objective
This study aimed to evaluate the effect of scheduled visiting on weaning from mechanical ventilation in patients with brain injury admitted to ICUs.
Methods
This quasi-experimental study was performed on 60 patients with brain injury referred to one of the hospitals in Central Province, Iran in 2020. The selection of samples based on inclusion criteria and random allocation to the two groups of intervention and control by permuted block randomization was done. The first-degree relatives of the patients at the time of weaning in the intervention group were present at the patient’s bedside twice a day at 10:00 AM and 3:00 PM for 30–45 min and performed what they had been trained to do. Participants in the control group visited patients from the area outside the patient room. Length of weaning, length of mechanical ventilation, and length of stay in the ICU were recorded and measured using a researcher-conducted checklist. The results were analyzed using descriptive and inferential statistics and chi-square and independent t-tests in SPSS16.
Results
The study results showed that the number of patients weaned from mechanical ventilation in the intervention group was significantly higher than that of the control group (P ≤ 0.05). The mean length of weaning in the intervention and control groups was not statistically significant, but it was clinically significant in the intervention group (P > 0.05). In addition, the length of mechanical ventilation and the length of stay of the intervention group in the ICU were significantly shorter than that of the control group (P ≤ 0.05).
Conclusion
According to the study results, scheduled visiting resulted in faster weaning from mechanical ventilation. As a result, nurse managers are suggested to make arrangements for family members to be present at the patient’s bedside in order for patients to be weaned off the mechanical ventilator more easily.
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Klingshirn H, Gerken L, Hofmann K, Heuschmann PU, Haas K, Schutzmeier M, Brandstetter L, Wurmb T, Kippnich M, Reuschenbach B. Comparing the quality of care for long-term ventilated individuals at home versus in shared living communities: a convergent parallel mixed-methods study. BMC Nurs 2022; 21:224. [PMID: 35953810 PMCID: PMC9368695 DOI: 10.1186/s12912-022-00986-z] [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: 01/17/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People on home mechanical ventilation (HMV) belong to a heterogeneous population with complex care needs. In Germany, outpatient intensive care is provided in people's private home (PH) or in shared living communities (SLC). Increasing patient numbers have led to criticism of the quality of care in recent years. Since quality deficits from the perspective of those affected are largely unclear, the following research question emerged: How do interviews with ventilated individuals and family caregivers explain any differences or similarities in the quality of care between PH and SLC? METHODS This study used a mixed-methods convergent parallel design, where quantitative and qualitative components were separately collected and analysed. The quantitative component (structured interviews and online survey) included ventilation characteristics, health-related resource use, health-related quality of life (HRQL) measured with the Severe Respiratory Insufficiency Questionnaire (SRI; range 0-100; higher scores indicated higher HRQL) and the Burden Scale of the Family Caregivers short version (BSFC-s; range 0-30; higher scores indicated higher burden). The qualitative component (semi-structured interviews) focused on people's experience of person-centred care. Data were merged using a weaving method and the Picker framework of Person-Centred Care. RESULTS The quantitative component revealed that ventilated individuals living in PHs were on average 20 years younger than participants living in SLCs (n = 46; PH: 46.86 ±15.40 years vs. SLC: 65.07 ±11.78 years; p = .001). HRQL (n = 27; PH: 56.62 ±16.40 vs. SLC: 55.35 ±12.72; p > .999) and the burden of family caregivers (n = 16; PH: 13.20 ±10.18 vs. SLC: 12.64 ±8.55; p > .999) were not significantly different between living situation. The qualitative component revealed that person-centred care is possible in both care settings (ventilated individuals: n = 13; family caregivers: n = 18). CONCLUSION This study describes a care situation that is as heterogeneous as the population of people with HMV. HRQL and the burden of family caregivers are highly individual and, like person-centred care, independent of the living situation. Policy decisions that facilitate person-centred care need to recognise that quality of care is highly individual and starts with the free choice of the care setting.
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Affiliation(s)
- Hanna Klingshirn
- Catholic University of Applied Sciences Munich, Preysingstraße 95, D-81667, München, Germany.
| | - Laura Gerken
- Catholic University of Applied Sciences Munich, Preysingstraße 95, D-81667, München, Germany
| | - Katharina Hofmann
- Catholic University of Applied Sciences Munich, Preysingstraße 95, D-81667, München, Germany
| | - Peter Ulrich Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, D-97080, Würzburg, Germany.,Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Straße 2, D-97080, Würzburg, Germany.,Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
| | - Kirsten Haas
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, D-97080, Würzburg, Germany
| | - Martha Schutzmeier
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, D-97080, Würzburg, Germany
| | - Lilly Brandstetter
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilian University Würzburg, Josef-Schneider-Straße 2, D-97080, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Maximilian Kippnich
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, D-97080, Würzburg, Germany
| | - Bernd Reuschenbach
- Catholic University of Applied Sciences Munich, Preysingstraße 95, D-81667, München, Germany
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Stenman L, Högberg L, Engström Å. Critical Care Nurses' Experiences Caring for Patients When Relatives Were not Allowed in the ICUs due to COVID-19 Pandemic. SAGE Open Nurs 2022; 8:23779608221103627. [PMID: 35669888 PMCID: PMC9163743 DOI: 10.1177/23779608221103627] [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: 12/29/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Health care workers faced new challenges during the COVID-19 pandemic when physical contact with relatives more or less disappeared. Objectives The aim of this study is to describe the experiences of critical care nurses (CCNs) working in intensive care units (ICUs) under the visiting restrictions imposed as a result of COVID-19. Method This study followed a qualitative design. The purposive sample included CCNs with at least 1 year of experience working in an ICU with a visiting policy affected by the pandemic. Data collection was carried out via semi-structured interviews and analyzed through a qualitative content analysis with an inductive approach. Results The study results are presented in three categories with 10 subcategories. CCNs value the presence of patients’ relatives at the bedside and described many challenges when relatives could not be present with the patient during the pandemic. Conclusion Close relatives are able to share essential information about the patients and provide much-needed emotional support to them, the relatives’ role is of central importance and CCNs value their presence in ICUs more than any positive consequences of them not being there.
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Affiliation(s)
- Lina Stenman
- Critical Care Nurse, Skellefteå Hospital, Skellefteå, Sweden
| | - Lisa Högberg
- Critical Care Nurse, Lycksele Hospital, ICU, Lycksele, Sweden
| | - Åsa Engström
- Department of Health, Education and Technology, Division of Nursing and Medical Technology, Lulea University of Technology, Luleå, Sweden
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Andersson M, Nordin A, Engström Å. Critical care nurses' experiences of working during the first phase of the COVID-19 pandemic - Applying the Person-centred Practice Framework. Intensive Crit Care Nurs 2021; 69:103179. [PMID: 34895797 PMCID: PMC8595352 DOI: 10.1016/j.iccn.2021.103179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to deductively study person-centred care, based on critical care nurses' experiences during the first phase of the CoViD-19 pandemic. DESIGN The study used a qualitative design. METHOD Data collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach. PARTICIPANTS Six critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated. FINDINGS The findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it. CONCLUSION We need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person's needs and resources.
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Affiliation(s)
- Maria Andersson
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden
| | - Anna Nordin
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden; Karlstad University, Department of Health Science, Faculty of Health, Science, and Technology, Sweden
| | - Åsa Engström
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden.
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8
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Freeman S, Yorke J, Dark P. The multidisciplinary team perspectives on agitation management in critical care: A qualitative study. Nurs Crit Care 2021; 27:81-90. [PMID: 33576144 DOI: 10.1111/nicc.12599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/04/2021] [Accepted: 01/21/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND People who are experiencing a period of critical illness frequently experience severe agitation. The presence of agitation can pose risks to the patient, family, and clinical team. AIMS AND OBJECTIVES To capture the views and opinions of critical care multidisciplinary teams concerning the approaches in the management of agitation, and to understand and identify the perceived risks and benefits of current management strategies. DESIGN A descriptive qualitative design. METHODS Data were gathered using semi-structured interviews with multidisciplinary teams from adult critical care units from one region in the United Kingdom. FINDINGS A total of 19 participants participated between February to September 2017. There were two group interviews (GIs) (n = 12, GI 1 n = 8, GI 2 n = 4) and seven one-to-one interviews, across four hospital organisations with one participant working via an agency. The mean length (± SD) of each interview, one to one or group, was 58.86 minutes (5.81 minutes). Three major themes were generated about the complex clinical decision-making required to manage an agitated patient. These themes represented: the burden of care, continuity of clinical decision-making, and uncertainty and indecision experienced by participants. CONCLUSION Participants described caring for an agitated patient as challenging and stressful. Staff sought clarification on what level of restrictive practice is allowed. Feelings of anxiety and stress generated by the decisions made may have an impact on staff, particularly those who are more inexperienced, which in the longer term could lead to fatigue or moral distress. RELEVANCE TO CLINICAL PRACTICE The study has emphasised the challenges faced by multidisciplinary teams and how decision-making may impact on individuals within the team.
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Affiliation(s)
- Samantha Freeman
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Paul Dark
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
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Rak KJ, Ashcraft LE, Kuza CC, Fleck JC, DePaoli LC, Angus DC, Barnato AE, Castle NG, Hershey TB, Kahn JM. Effective Care Practices in Patients Receiving Prolonged Mechanical Ventilation. An Ethnographic Study. Am J Respir Crit Care Med 2020; 201:823-831. [PMID: 32023081 DOI: 10.1164/rccm.201910-2006oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rationale: Patients receiving prolonged mechanical ventilation experience low survival rates and incur high healthcare costs. However, little is known about how to optimally organize and manage their care.Objectives: To identify a set of effective care practices for patients receiving prolonged mechanical ventilation.Methods: We performed a focused ethnographic evaluation at eight long-term acute care hospitals in the United States ranking in either the lowest or highest quartile of risk-adjusted mortality in at least four of the five years between 2007 and 2011.Measurements and Main Results: We conducted 329 hours of direct observation, 196 interviews, and 39 episodes of job shadowing. Data were analyzed using thematic content analysis and a positive-negative deviance approach. We found that high- and low-performing hospitals differed substantially in their approach to care. High-performing hospitals actively promoted interdisciplinary communication and coordination using a range of organizational practices, including factors related to leadership (e.g., leaders who communicate a culture of quality improvement), staffing (e.g., lower nurse-to-patient ratios and ready availability of psychologists and spiritual care providers), care protocols (e.g., specific yet flexible respiratory therapy-driven weaning protocols), team meetings (e.g., interdisciplinary meetings that include direct care providers), and the physical plant (e.g., large workstations that allow groups to interact). These practices were believed to facilitate care that is simultaneously goal directed and responsive to individual patient needs, leading to more successful liberation from mechanical ventilation and improved survival.Conclusions: High-performing long-term acute care hospitals employ several organizational practices that may be helpful in improving care for patients receiving prolonged mechanical ventilation.
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Affiliation(s)
- Kimberly J Rak
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Laura Ellen Ashcraft
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Courtney C Kuza
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jessica C Fleck
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lisa C DePaoli
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Amber E Barnato
- Dartmouth Institute of Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; and
| | - Nicholas G Castle
- Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, West Virginia
| | - Tina B Hershey
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jeremy M Kahn
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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10
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Duque-Ortiz C, Arias-Valencia MM. Nurse-family relationship. Beyond the opening of doors and schedules. ENFERMERIA INTENSIVA 2020; 31:192-202. [PMID: 32276810 DOI: 10.1016/j.enfi.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Care in the Intensive Care Unit involves contemplating, among other dimensions of the patient, the family. For this, it is necessary for the nurse to establish relationships with the patient's relatives. OBJECTIVE To identify the way in which the nurse-family relationship is established in the adult ICU, as well as the conditions, elements and factors that favour or hinder it. METHOD Integrative narrative review of the scientific literature. The databases consulted were Ovid, PubMed, Science Direct, Scopus, Clinical Key, Google Scholar and Scielo. Articles in English and Spanish published between 2014 and 2018 were searched. The descriptors and formulas used were selected according to the acronym Population and their problems, Exposure and Outcomes or themes- PEO. The population comprised ICU nurses and the relatives of patients in critical condition; Adult Intensive Care Unit exposure or context; the expected results, and how they are related. For the methodological evaluation, the STROBE guide was used for observational articles, PRISMA for review articles, COREQ for qualitative articles and CASPe for articles derived from projects. RESULTS We identified 214 articles, of which 63 were selected to be included in the review. The central themes identified were: the ICU environment and its effects on the family, empathy as an indicator of relationship, interaction as a means of relating, communication as the centre of relationships and barriers to the establishment of relationships. CONCLUSIONS The nurse-family relationship in the Intensive Care Unit is based on interaction and communication amidst human, physical, regulatory and administrative barriers. Improving the nurse-family relationship contributes to the humanization of Adult Intensive Care Units.
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Affiliation(s)
- C Duque-Ortiz
- Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - M M Arias-Valencia
- Grupo de Investigación en Políticas y Servicios de Salud, Universidad de Antioquia, Medellín, Colombia
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Room Design-A Phenomenological-Hermeneutical Study: A Factor in Creating a Caring Environment. Crit Care Nurs Q 2019; 42:265-277. [PMID: 31135477 DOI: 10.1097/cnq.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Medical technology has progressed tremendously over the last few decades, but the same development cannot be seen in the design of these intensive care unit environments. Authors report results of a study of evidence-based room design, emphasizing the impact on conveying a caring attitude to patients. Ten nonparticipant observations were conducted in patient rooms with 2 different designs, followed by interviews. The data were analyzed using a phenomenological-hermeneutical approach. The results did not reveal that it was obvious that redesigned spaces resulted in a more caring attitude. The meanings of caring displayed during nursing activities were interpreted by interpreting gazes. Some of the nursing staff had an instrumental gaze, interpreted as caring with a task-orientated approach, while others communicated their caring with an attentive and attuned gaze, where the needs of the patients regulated the working shift. The study findings indicated that caring may not be perceived when nurses use a task-oriented approach. However, when nurses practice a person-centered approach, using an attentive and attuned gaze, caring is conveyed. Caring in intensive care contexts needs to be assisted by a supportive environment design that cultivates the caring approach.
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