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McCallum K. Overcoming the barriers to optimal end of life care in the emergency department. Emerg Nurse 2023:e2170. [PMID: 37667653 DOI: 10.7748/en.2023.e2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 09/06/2023]
Abstract
The focus of care in the emergency department (ED) is on saving or sustaining life, but some patients admitted to the ED die in the ED. Nurses whose focus is on saving lives may therefore find themselves providing end of life care to patients and their families in a stressful and distressing environment. Providing optimal end of life care involves reflecting on what a good death looks like and how patients can be supported to have a good death. This article describes the barriers to optimal end of life care in the ED and prompts nurses to think about how they can enhance their practice when caring for dying patients and their families.
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Affiliation(s)
- Kay McCallum
- acute oncology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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2
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Toy J. Family-Witnessed Cardiopulmonary Resuscitation During Emergency Department Cardiac Arrest Care: A Resident Perspective. Ann Emerg Med 2023; 82:207-215. [PMID: 36841662 DOI: 10.1016/j.annemergmed.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/10/2023] [Accepted: 01/24/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Jake Toy
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
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Bigdeli Shamloo MB, Elahi N, Zarea K. Lived Experience of Caring for Dying Muslim Patients in Emergency Room: A Phenomenological Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231153254. [PMID: 36775852 DOI: 10.1177/00302228231153254] [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: 02/14/2023]
Abstract
Death is a natural part of life, which mostly occurs in the ER. This study described the meaning of nurses' lived experience of caring for critical and dying patients in the ERs. In this qualitative study, 13 nurses who was purposefully selected. Data were collected using in-depth individual interviews. Data analysis used van Manen's hermeneutic phenomenological approach. The experiences of caring for the dying patient were divided into two parts: experiences in patients with acute and chronic problems. In patients with acute problems, four themes were extracted: fight to the death, no time for palliative and spiritual care, lacking support for the family, no privacy for peaceful death. In patients with acute problems, four themes were extracted: Facilitating a peaceful death, Allocating time for palliative and spiritual care, support for the family, Attention to privacy. Therefore, attention should be paid to the fields of care and its inadequacies.
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Affiliation(s)
- Marzieh Beigom Bigdeli Shamloo
- Clinical Research Development Unit, Ganjavian Hospital, Dezful University Medical Sciences, Dezful, Iran
- Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Elahi
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Jöbges S, Denke C, Seidlein AH. Optimierung der Zugehörigenbetreuung – angehörigenzentrierte Intensivmedizin. Med Klin Intensivmed Notfmed 2022; 117:575-583. [DOI: 10.1007/s00063-022-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
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Gradilla SM, Balakrishnan A, Silverstein DC, Pratt CL, Fletcher DJ, Wolf JM. Owner experiences with and perceptions of owner-witnessed CPR in veterinary medicine. J Vet Emerg Crit Care (San Antonio) 2022; 32:322-333. [PMID: 35043551 DOI: 10.1111/vec.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine owner experiences with and perceptions of owner-witnessed resuscitation (OWR) in veterinary medicine and to determine if previous experience with family-witnessed resuscitation (FWR) influenced perceptions. DESIGN Multicenter survey. SETTING Two academic and 2 private practice referral hospitals in the United States. SUBJECTS Four hundred and seven clients presenting their small animal or exotic pet to the emergency service, or owners of patients hospitalized in the small animal ICU, April 1 to May 15, 2019. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Anonymous, online survey. Demographic variables, familiarity with CPR, previous experience with FWR or OWR, and open-ended questions and 4-point Likert items assessing level of agreement with statements on OWR were included. Scores equal or greater than 2 represented positive agreement. An overall OWR mean score was calculated from Likert items. Seventy-nine (19.4%; 95% confidence interval [CI], 15.7%-23.7%) participants reported having been involved with FWR, and 13 (3.2%; 95% CI, 1.8%-5.5%) reported having witnessed CPR on their pet. Owners were significantly more likely to participate in OWR if they had been present for FWR (P = 0.0004). Ninety-two percent of respondents who had been present for OWR would elect to be present again (95% CI, 62.1%-99.6%). Whether present for OWR or not, owners believed there may be benefits from witnessing CPR and had overall positive feelings toward the practice (OWR mean score, 2.87, SD 0.45 and 2.68, SD 0.54, respectively). Most respondents (78.6%; 95% CI, 74.2%-82.4%) felt that owners should be offered the opportunity to witness CPR on their pets. CONCLUSIONS Owners expressed overall positive experiences with and attitudes toward OWR and believe the option for presence should be provided. As pet owners become more aware of FWR in human medicine, veterinarians may need to be prepared to entertain the possibility of OWR and owners' wishes to remain with their pet during CPR.
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Affiliation(s)
- Sarah M Gradilla
- The Emergency and Critical Care Service, Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Anusha Balakrishnan
- The Emergency and Critical Care Service, Cornell University Veterinary Specialists, Stamford, Connecticut, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chap L Pratt
- The Emergency and Critical Care Service, Wheat Ridge Animal Hospital by Ethos Veterinary Health, Wheat Ridge, Colorado, USA
| | - Daniel J Fletcher
- Clinical Programs Center, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | - Jacob M Wolf
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wicaksono RB, Ferine M, Lestari DWD, Hidayah AN, Muhaimin A. Experience of Indonesian medical students of ethical issues during their clinical clerkship in a rural setting. J Med Ethics Hist Med 2022; 14:6. [PMID: 35035794 PMCID: PMC8696554 DOI: 10.18502/jmehm.v14i6.6750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
Although ethics is an essential part of medical education, little attention has been paid to ethics education during the clerkship phase, where medical students observe how physicians make decisions regarding various ethical problems. Specific nuances and cultural contexts such as working in a rural setting can determine ethical issues raised. This phenomenology study aimed to explore ethical issues experienced by Indonesian students during clinical clerkship in a rural setting. In-depth interviews were used to explore students’ experiences. Participants were ten students, selected on gender and clerkship year variations. Data saturation was reached after eight interviews, followed by two additional interviews. Thematic analysis was used in this study, and trustworthiness was ensured through data and investigator triangulation, member checking, and audit trail. Three main themes found in this study were limited facilities and resources, healthcare financing and consent issues, as well as unprofessional behavior of healthcare providers. Many ethical issues related to substandard care were associated to limited resources and complexities within the healthcare system in the rural setting. Early exposure to recurrent ethical problems in healthcare can help students prepare for their future career as a physician in a rural setting.
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Affiliation(s)
- Raditya Bagas Wicaksono
- Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Miko Ferine
- Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Diyah Woro Dwi Lestari
- Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Arfi Nurul Hidayah
- Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Amalia Muhaimin
- Lecturer, Department of Bioethics and Humanities, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia; Researcher, Department of Ethics, Law, and Humanities, Amsterdam University Medical Centres, University of Amsterdam, The Netherlands
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7
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Schwartz AC, Dunn SE, Simon HFM, Velasquez A, Garner D, Tran DQ, Kaslow NJ. Making Family-Centered Care for Adults in the ICU a Reality. Front Psychiatry 2022; 13:837708. [PMID: 35401268 PMCID: PMC8987300 DOI: 10.3389/fpsyt.2022.837708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/29/2022] Open
Abstract
Despite the value of family-centered care (FCC) in intensive care units (ICUs), this approach is rarely a reality in this context. This article aims to increase the likelihood that ICU-based care incorporates best practices for FCC. Consistent with this goal, this article begins by overviewing FCC and its merits and challenges in ICUs. It then offers a systemic framework for conceptualizing FCC in this challenging environment, as such a model can help guide the implementation of this invaluable approach. This systemic framework combined with previous guidelines for FCC in the ICU are used to inform the series of recommended best practices for FCC in the ICU that balance the needs and realities of patients, families, and the interprofessional healthcare team. These best practices reflect an integration of the existing literature and previously published guidelines as well as our experiences as healthcare providers, family members, and patients. We encourage healthcare leaders and interprofessional ICU healthcare teams to adopt these best practices and modify them for the specific healthcare needs of the patients they serve and their families.
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Affiliation(s)
- Ann C Schwartz
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Sarah E Dunn
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Hannah F M Simon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Alvaro Velasquez
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - David Garner
- Department of Nursing, Grady Health System, Atlanta, GA, United States
| | - Duc Quang Tran
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, United States
| | - Nadine J Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
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Barreto MDS, Garcia-Vivar C, da Silva TP, Girardon-Perlini NMO, Marcon SS. A Corbin and Strauss Grounded Theory on the Experiences of Patients, Relatives, and Health Professionals About the Family Presence During Emergency Care. ANS Adv Nurs Sci 2022; 45:E1-E14. [PMID: 34267047 DOI: 10.1097/ans.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to explore the experiences of patients, relatives, and health professionals about family presence during emergency care. In this grounded theory, 42 participants were interviewed from October 2016 to February 2017 in 2 Brazilian emergency rooms. Data collection and analysis were based on the constant comparative method. Findings identified that there is a social meaning about family presence during emergency care, which is conditioned, sporadic, and variable, and health professionals are responsible for the decision. The implementation of family systems care in emergency rooms is required to meet the needs of both patients and families. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A30.
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Affiliation(s)
- Mayckel da Silva Barreto
- Department of Nursing, Federal University of Mato Grosso do Sul, Mato Grosso do Sul, Brazil (Dr Barreto); Department of Health Sciences, Public University of Navarra, Navarra, Spain (Dr Garcia-Vivar); Department of Nursing, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (Dr da Silva); Department of Nursing, Federal University of Santa Maria, Santa Maria, Brazil (Dr Girardon-Perlini); and Department of Nursing, State University of Maringá, Maringá, Brazil (Dr Marcon)
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What are the care needs of families experiencing cardiac arrest?: A survivor and family led scoping review. Resuscitation 2021; 168:119-141. [PMID: 34592400 DOI: 10.1016/j.resuscitation.2021.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/30/2021] [Accepted: 09/16/2021] [Indexed: 11/20/2022]
Abstract
AIM The sudden and unexpected cardiac arrest of a family member can be a grief-filled and life-altering event. Every year many hundreds of thousands of families experience the cardiac arrest of a family member. However, care of the family during the cardiac arrest and afteris poorly understood and incompletely described. This review has been performed with persons with lived experience of cardiac arrest to describe, "What are the needs of families experiencing cardiac arrest?" from the moment of collapse until the outcome is known. METHODS This review was guided by specific methodological framework and reporting items (PRISMA-ScR) as well as best practices in patient and public involvement in research and reporting (GRIPP2). A search strategy was developed for eight online databases and a grey literature review. Two reviewers independently assessed all articles for inclusion and extracted relevant study information. RESULTS We included 47 articles examining the experience and care needs of families experiencing cardiac arrest of a family member. Forty one articles were analysed as six represented duplicate data. Ten family care need themes were identified across five domains. The domains and themes transcended cardiac arrest setting, aetiology, family-member age and family composition. The five domains were i) focus on the family member in cardiac arrest, ii) collaboration of the resuscitation team and family, iii) consideration of family context, iv) family post-resuscitation needs, and v) dedicated policies and procedures. We propose a conceptual model of family centred cardiac arrest. CONCLUSION Our review provides a comprehensive mapping and description of the experience of families and their care needs during the cardiac arrest of a family-member. Furthermore, our review was conducted with co-investigators and collaborators with lived experience of cardiac arrest (survivors and family members of survivors and non-survivors alike). The conceptual framework of family centred cardiac arrest care presented may aid resuscitation scientists and providers in adopting greater family centeredness to their work.
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10
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Bradley C. Family Presence and Support During Resuscitation. Crit Care Nurs Clin North Am 2021; 33:333-342. [PMID: 34340794 DOI: 10.1016/j.cnc.2021.05.008] [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: 11/28/2022]
Abstract
Family presence during cardiopulmonary resuscitation (FPDR) is an evidence-based practice in the hospital setting. Members of the interdisciplinary team should adhere to ethical principles and patient and family-centered care concepts when offering interventions to support the family member during this potential end-of-life crisis. FPDR is an option for family members who are interested, screened as appropriate, and supported by a family facilitator. Essential components to guide this practice include developing an FPDR policy, educating the health care team, and creating evaluation methods.
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Affiliation(s)
- Carolyn Bradley
- Heart and Vascular Center Nursing Professional Development Specialist, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
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11
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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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Fridh I, Åkerman E. Family‐centred end‐of‐life care and bereavement services in Swedish intensive care units: A cross‐sectional study. Nurs Crit Care 2019; 25:291-298. [DOI: 10.1111/nicc.12480] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Isabell Fridh
- Faculty of Caring Science, Work Life and Social WelfareUniversity of Borås Borås Sweden
- Department of Anesthesiology and Intensive CareSahlgrenska University Hospital Gothenburg Sweden
| | - Eva Åkerman
- Intensive Care Unit, Department of Perioperative Medicine and Intensive CareKarolinska University Hospital Stockholm Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and SocietyKarolinska Institutet Stockholm Sweden
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Celik C, Celik GS, Buyukcam F. The witness of the patient’s relatives increases the anxiety of the physician, but decreases the anxiety of the relatives of the patient. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919860632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: We generally keep relatives out of the area while a critical intervention so they cannot observe the management. Recent studies recommend witnessing of the resuscitation by arguing that it supports the patient’s relatives’ beliefs that everything that could be done had been done. Objective: We investigated the influence of family witness on the anxiety of patients’ relatives and on the healthcare team. Methods: This study was planned as a prospective observational study. The critical patients who were managed in the resuscitation room with or without intubation were included in the study. The State-Trait Anxiety Inventory survey form was given to patients’ relatives. Healthcare providers were given a survey, including a visual analog scale of anxiety. Results: The mean visual analog scale score of healthcare providers was 4.37 ± 2.5. The mean visual analog scale score of allied health personnel was similar to resident doctors but lower than consultant doctors. The anxiety of healthcare providers was higher during witnessed management. In the witnessed management group, the anxiety of healthcare providers was higher in patients who received cardiopulmonary resuscitation. The mean State-Trait Anxiety Inventory anxiety score of patients’ relatives was 50.2 ± 10.3. In witnessed management, the mean anxiety score was 49.5 ± 11.3; in non-witnessed management, the score was 51.0 ± 9.3. The anxiety of patients’ relatives was not higher, but rather slightly lower during witnessed management of patients. Conclusion: In our study, the anxiety of healthcare providers was higher in family-witnessed management. It was argued that consultant physicians were more anxious because they have more responsibility about the patients. With witnessed management, the anxiety of patients’ relatives could be reduced, but it is more ominous for healthcare professionals.
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Affiliation(s)
- Caner Celik
- Department of Emergency Medicine, Bagcilar Education and Research Hospital, Istanbul, Turkey
| | - Gulden Sinem Celik
- Department of Emergency Medicine, Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Fatih Buyukcam
- Department of Emergency Medicine, Diskapi Yildirim Beyazit Education and Training Hospital, Ankara, Turkey
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Latour JM, Coombs M. Family-centred care in the intensive care unit: More than just flexible visiting hours. Intensive Crit Care Nurs 2018; 50:1-2. [PMID: 30348476 DOI: 10.1016/j.iccn.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jos M Latour
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, 8-11 Kirkby Place, Room 205, Drake Circus, Plymouth PL4 8AA, United Kingdom.
| | - Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Level 7 Clinical Services Block, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand.
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Toronto CE, LaRocco SA. Family perception of and experience with family presence during cardiopulmonary resuscitation: An integrative review. J Clin Nurs 2018; 28:32-46. [DOI: 10.1111/jocn.14649] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 07/12/2018] [Accepted: 08/11/2018] [Indexed: 01/17/2023]
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