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Onishi Y, Murai Y, Nakajima E. Framework to elicit consent from lightly sedated mechanically ventilated intensive care patients in nursing practice. Jpn J Nurs Sci 2024; 21:e12601. [PMID: 38698302 DOI: 10.1111/jjns.12601] [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: 01/04/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
AIM The study aimed to ascertain a framework of nursing practices to elicit consent from lightly sedated ventilated patients. METHODS Study participants were nurses working in intensive care and critical care wards, whose observations and semi-structured interviews were assessed using a modified grounded theory approach. RESULTS A total of 15 concepts were generated, from which three categories and three subcategories were generated. Category 1: Nurses taking the lead in providing assistance by sharing signs of change while continuing the invasive treatment, working to maintain the patient's life, alleviation of pain, promotion of awareness of the current situation, and acclimating them to the treatment environment as the basis for building a relationship between patients and nurses. Category 2: Searching for points of agreement and reaching a compromise involves the nurse drawing out the patient's thoughts, hopes, and expectations, and transforming the relationship into a patient-centered one by sharing goals with the patient in order to achieve them. Category 3: Organizing collaboration within care supported the patient's ability to move safely while maintaining the patient's pace to achieve shared goals, and guided the patient's independent actions. CONCLUSIONS Even when patients recover from an acute life-threatening situation, their physical sensations remain vague and their functional decline continues. Rather than simply eliciting consent from patients, the structure of nursing practice to elicit such response from patients involves drawing out the patient's thoughts, hopes, and expectations, as well as guiding the patient toward goals that they have created together with the nurse and utilizing the patient's strengths to achieve these goals.
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Affiliation(s)
- Yoko Onishi
- Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Yoshiko Murai
- Faculty of Nursing, Ishikawa Prefectural Nursing University (Retired), Kahoku, Japan
| | - Emiko Nakajima
- Department of Nursing, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
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Nyhagen R, Egerod I, Rustøen T, Lerdal A, Kirkevold M. Three patterns of symptom communication between patients and clinicians in the intensive care unit: A fieldwork study. J Adv Nurs 2024; 80:2540-2551. [PMID: 38050863 DOI: 10.1111/jan.16007] [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: 05/04/2023] [Revised: 11/03/2023] [Accepted: 11/19/2023] [Indexed: 12/07/2023]
Abstract
AIM To describe different patterns of communication aimed at preventing, identifying and managing symptoms between mechanically ventilated patients and clinicians in the intensive care unit. DESIGN We conducted a fieldwork study with triangulation of participant observation and individual interviews. METHODS Participant observation of nine patients and 50 clinicians: nurses, physiotherapists and physicians. Subsequent individual face-to-face interviews with nine of the clinicians, and six of the patients after they had regained their ability to speak and breathe spontaneously, were fully alert and felt well enough to sit through the interview. FINDINGS Symptom communication was found to be an integral part of patient care. We identified three communication patterns: (1) proactive symptom communication, (2) reactive symptom communication and (3) lack of symptom communication. The three patterns co-existed in the cases and the first two complemented each other. The third pattern represents inadequate management of symptom distress. CONCLUSION Recognition of symptoms in non-speaking intensive care patients is an important skill for clinicians. Our study uncovered three patterns of symptom communication, two of which promoted symptom management. The third pattern suggested that clinicians did not always acknowledge the symptom distress. IMPLICATIONS FOR PATIENT CARE Proactive and reactive symptom assessment of non-speaking patients require patient verification when possible. Improved symptom prevention, identification and management require a combination of sound clinical judgement and attentiveness towards symptoms, implementation and use of relevant assessment tools, and implementation and skill building in augmentative and alternative communication. IMPACT This study addressed the challenges of symptom communication between mechanically ventilated patients and clinicians in the intensive care unit. Our findings may have an impact on patients and clinicians concerned with symptom management in intensive care units. REPORTING METHOD We used the consolidated criteria for reporting qualitative research. PATIENT CONTRIBUTION A user representative was involved in the design of the study.
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Affiliation(s)
- Ragnhild Nyhagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Egerod
- Department of Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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Guttormson JL, Khan B, Brodsky MB, Chlan LL, Curley MAQ, Gélinas C, Happ MB, Herridge M, Hess D, Hetland B, Hopkins RO, Hosey MM, Hosie A, Lodolo AC, McAndrew NS, Mehta S, Misak C, Pisani MA, van den Boogaard M, Wang S. Symptom Assessment for Mechanically Ventilated Patients: Principles and Priorities: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:491-498. [PMID: 37000144 PMCID: PMC10112406 DOI: 10.1513/annalsats.202301-023st] [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] [Indexed: 04/01/2023] Open
Abstract
Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech-language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2) key symptom assessment principles; 3) strategies that support symptom assessment in nonvocal patients; and 4) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.
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Karlsen MMW, Holm A, Kvande ME, Dreyer P, Tate JA, Heyn LG, Happ MB. Communication with mechanically ventilated patients in intensive care units: A concept analysis. J Adv Nurs 2023; 79:563-580. [PMID: 36443915 PMCID: PMC10099624 DOI: 10.1111/jan.15501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/05/2022] [Accepted: 10/30/2022] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to perform a concept analysis of communication with mechanically ventilated patients in intensive care units and present a preliminary model for communication practice with these patients. DESIGN The Im & Meleis approach for concept analysis guided the study. SEARCH METHODS A literature search was performed in January 2022 in MEDLINE, Embase, CINAHL, psycINFO and Scopus, limited to 1998-2022. The main medical subject headings search terms used were artificial respiration, communication and critical care. The search resulted in 10,698 unique references. REVIEW METHODS After a blinded review by two authors, 108 references were included. Core concepts and terminology related to communication with mechanically ventilated patients were defined by content analytic methods. The concepts were then grouped into main categories after proposing relationships between them. As a final step, a preliminary model for communication with mechanically ventilated patients was developed. RESULTS We identified 39 different phrases to describe the mechanically ventilated patient. A total of 60 relevant concepts describing the communication with mechanically ventilated patients in intensive care were identified. The concepts were categorized into five main categories in a conceptual map. The preliminary model encompasses the unique communication practice when interacting with mechanically ventilated patients in intensive care units. CONCLUSION Highlighting different perspectives of the communication between mechanically ventilated patients and providers through concept analysis has contributed to a deeper understanding of the phenomena and the complexity of communication when the patients have limited possibilities to express themselves. IMPACT A clear definition of concepts is needed in the further development of guidelines and recommendations for patient care in intensive care, as well as in future research. The preliminary model will be tested further. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as this is a concept analysis of previous research.
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Affiliation(s)
| | - Anna Holm
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Monica Evelyn Kvande
- Department for postgraduate studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Aarhus C, Denmark.,Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Judith Ann Tate
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Lena Günterberg Heyn
- Center for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Mary Beth Happ
- Center of Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA
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Kyranou M, Cheta C, Pampoulou E. Communicating with mechanically ventilated patients who are awake. A qualitative study on the experience of critical care nurses in Cyprus during the COVID-19 pandemic. PLoS One 2022; 17:e0278195. [PMID: 36454794 PMCID: PMC9714938 DOI: 10.1371/journal.pone.0278195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Modern protocols for light sedation in combination with the increased number of COVID-19 infected patients hospitalized in Intensive Care Units (ICUs) have increased the number of patients who are mechanically ventilated and awake. Nurses require specific skills to care for this vulnerable group of patients. At the same time, nurses report feeling inadequate and frustrated when they attempt to establish communication with mechanically ventilated, conscious patients. STUDY OBJECTIVES The purpose of this study was to explore the strategies nurses use when taking care of conscious, intubated patients in the intensive care unit and the barriers they encounter in their effort to communicate. METHODS For this study, a qualitative design was employed. Data were collected using in-depth semi-structured interviews with 14 intensive care nurses working at ICUs in four different hospitals of Cyprus. The data were analyzed by applying thematic analysis. RESULTS We identified several strategies of unaided (movements-lips, hands, legs-facial expressions, gestures, touching) and aided forms of communication (pen and paper, boards, tablets, mobiles) used by nurses to communicate with patients. However, barriers to communication were reported by the participating nurses mainly pertaining to patients and nurses' characteristics as well as the ICU environment. The health protocols imposed by the pandemic added more obstacles to the communication between nurses and patients mostly related to the use of protective health equipment. CONCLUSIONS The results of this study point to the difficulties nurses in Cyprus face when trying to communicate with conscious patients during mechanical ventilation. It appears that the lack of nurses' training and of appropriate equipment to facilitate augmentative and alternative communication leave the complex communication needs of critically ill patients unaddressed. However, further research including patients' opinions, after they recover, would bring more clarity on this topic. Our study adds evidence to the communication crisis created by the protective health protocols imposed by the pandemic. As such, it highlights the need to educate nurses in augmentative and alternative ways of communication to address communication with mechanically ventilated, conscious patients during their ICU stay.
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Affiliation(s)
- Maria Kyranou
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus
- * E-mail:
| | - Chariklia Cheta
- American Medical Center/American Heart Institute, Strovolos, Cyprus
| | - Eliada Pampoulou
- Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
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Jöbges S. Kommunikation mit Patientinnen auf der Intensivstation. Med Klin Intensivmed Notfmed 2022; 117:595-599. [DOI: 10.1007/s00063-022-00957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022]
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Tarani L, Rasio D, Tarani F, Parlapiano G, Valentini D, Dylag KA, Spalice A, Paparella R, Fiore M. Pediatrics for Disability: A Comprehensive Approach to Children with Syndromic Psychomotor Delay. Curr Pediatr Rev 2022; 18:110-120. [PMID: 34844545 DOI: 10.2174/1573396317666211129093426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/30/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
Intellectual disability is the impairment of cognitive, linguistic, motor and social skills that occurs in the pediatric age and is also described by the term "mental retardation". Intellectual disability occurs in 3-28 % of the general population due to a genetic cause, including chromosome aberrations. Among people with intellectual disabilities, the cause of the disability was identified as a single gene disorder in up to 12 %, multifactorial disorders in up to 4 %, and genetic disorders in up to 8.5 %. Children affected by a malformation syndrome associated with mental retardation or intellectual disability represent a care challenge for the pediatrician. A multidisciplinary team is essential to manage the patient, thereby controlling the complications of the syndrome and promoting the correct psychophysical development. This requires continuous follow-up of these children by the pediatrician, which is essential for both the clinical management of the syndrome and facilitating the social integration of these children.
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Affiliation(s)
- Luigi Tarani
- Department of Pediatrics, Medical Faculty, Sapienza University of Rome, Rome, Italy
| | - Debora Rasio
- Department of Pediatry, Sarn Raffaele Hospital, Rome, Italy
| | - Francesca Tarani
- Department of Pediatrics, Medical Faculty, Sapienza University of Rome, Rome, Italy
| | - Giovanni Parlapiano
- Department of Pediatrics, Medical Faculty, Sapienza University of Rome, Rome, Italy
| | | | - Katarzyna Anna Dylag
- Department of Pediatric Nephrology, Jagiellonian University Medical College, Krakow, Poland.,St. Louis Children Hospital, Krakow, Poland
| | - Alberto Spalice
- Department of Pediatrics, Medical Faculty, Sapienza University of Rome, Rome, Italy
| | - Roberto Paparella
- Department of Pediatrics, Medical Faculty, Sapienza University of Rome, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
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Holm A, Nikolajsen L, Dreyer P. A multicomponent intervention to optimise nurse-patient communication in the intensive care unit: A mixed-methods acceptability and feasibility study. Aust Crit Care 2021; 35:616-622. [PMID: 34802842 DOI: 10.1016/j.aucc.2021.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Mechanically ventilated patients in intensive care units may experience communication challenges owing to intubation, which affects nurse-patient communication. Several strategies may optimise communication, but only one previous study has tested a multicomponent intervention. Implementing such an intervention can be challenging because communication strategies may be set aside by lifesaving care tasks and procedures. In a previous study, we designed a communication intervention based on pre-existing clinical methods and evidence-based approaches. The present study evaluated the intervention to determine if it was necessary to adjust its components and the implementation strategy. OBJECTIVES The objective of this study was to evaluate the feasibility and assess nurses' acceptability of a patient-centred, multicomponent communication intervention prototype in an intensive care unit. METHODS The overall frame was the Medical Research Council's framework for developing complex interventions. Indicators of feasibility and acceptability were used for the evaluation. A mixed-methods design was applied including a survey with open-ended text boxes and qualitative observations as data sources. Quantitative data were analysed descriptively, and qualitative data were explored using content analysis. Data were compiled and displayed in a side-by-side comparison. The data were collected between September 2020 and March 2021. Nurses from four intensive care units at a university hospital in Denmark participated in the study. All nurses who were on active duty during the implementation of the intervention were enrolled for the survey and participant observations. RESULTS Overall, the results provided insight into the feasibility based on fidelity and context as well as nurses' acceptability based on adherence, appropriateness, convenience, and effectiveness. Qualitative and quantitative results yielded partially contrasting findings but highlighted how the intervention may be optimised to enhance fit with clinical practice and overcome implementation challenges. CONCLUSION The intervention was feasible and acceptable. However, implementation needs to be repeated to allow nurses to fully understand and use the intervention.
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Affiliation(s)
- Anna Holm
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lone Nikolajsen
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Pia Dreyer
- Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Public Health, Section of Nursing Science, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Alrek Helseklynge, Blokk D, Årstadveien 17, NO-5020, Bergen, Norway.
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Ull C, Hamsen U, Weckwerth C, Schildhauer TA, Gaschler R, Waydhas C, Jansen O. Approach to the basic needs in patients on invasive ventilation using eye-tracking devices for non-verbal communication. Artif Organs 2021; 46:439-450. [PMID: 34637156 DOI: 10.1111/aor.14082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the feasibility of eye-tracking (ET) devices as a communicative approach to the basic needs (BN) of intensive care unit (ICU) and invasively ventilated nonverbal patients. METHODS Prospective, monocentric, and observational study including all patients without delirium, with an endotracheal tube or tracheostomy tube, with a history of invasive ventilation for more than 48 h, and inadequate nonverbal communication skills. The investigation was performed with commercially available ET devices (Tobii Dynavox I-15+) to express BN of ICU patients following a standardized 30-item yes-or-no questionnaire. RESULTS A total of 64 patients with a mean age of 58.6 years were included. The main diagnoses for ICU admission were major trauma (43.6%), sepsis (21.8%), and acute abdomen (15.6%). Pain during repositioning (69%), thirst (69%), sleep disorders (66%), fatigue (64%), and anxiety regarding the lifelong need for assistance (64%) were the main problems reported by the patients. However, most of the patients described expectations of health improvement (78%), good family support (66%), and an improvement in quality of life due to the use of ET devices (67%). CONCLUSION The use of ET in selected ICU patients with impaired communication is feasible, allowing them to express their BN. Apart from knowing the patients' individual BN, the results of our BN questionnaire may provide guidance for improvement measures in the care of patients in the ICU who are unable to speak. We believe that ET is useful for inquiring about and expressing BN and, therefore, may be capable of improving patient-medical team interactions and patient satisfaction.
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Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | | | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
| | - Robert Gaschler
- Faculty of Psychology, FernUniversität of Hagen, Hagen, Germany
| | - Christian Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.,Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany
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Koszalinski RS, McCarthy JM. Patient communication in the intensive care unit: Background and future possibilities. Intensive Crit Care Nurs 2020; 63:102955. [PMID: 33139166 DOI: 10.1016/j.iccn.2020.102955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rebecca S Koszalinski
- University of Oklahoma Health Sciences Center, Fran and Earl Ziegler College of Nursing, Oklahoma City, OK 73117, United States.
| | - Jillian M McCarthy
- University of Tennessee Health Sciences Center, Audiology and Speech Pathology, Knoxville, TN 37996, United States.
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