The core of patient-participation in the Intensive Care Unit: The patient's views

Translation and psychometric validation of the Patient Participation Culture Tool for healthcare workers in Chinese nursing context

BACKGROUND

Promoting patient participation stands as a global priority in nursing care. Currently, there is a lack of a standardized tool to assess the culture of patient participation from the perspective of nurses in China.

AIMS

To translate and examine the validity and reliability of the Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards in Chinese nursing context.

METHODS

A cross-sectional research study was conducted among 812 nurses. Brislin's recommendations were adhered to during the translation of the scale. Validity was assessed using construct validity, content validity, and face validity. Split-half reliability, test-retest reliability, and internal consistency reliability were used to evaluate dependability. The study was guided and reported following the STROBE checklist and recommendations for reporting the results of studies of instrument and scale development and testing.

RESULTS

The Chinese version of PaCT-HCW (the PaCT-HCW-C) exhibits good face validity and content validity. A rigorous exploratory factor analyse verified a six-factor (competence, support, perceived lack of time, information sharing and dialogue, response to questions and acceptance of a new role) scale structure with a cumulative variance contribution of the factors with 44 items of 68.840%. With a Cronbach's α coefficient of 0.962, split-half reliability of 0.866, and intraclass correlation coefficients of 0.989, the instrument demonstrates great reliability. Confirmatory factor analysis results validated the consistency of the six factors with the structure of the PaCT-HCW-C scale.

CONCLUSIONS

The 44-item PaCT-HCW-C is a valid and reliable instrument with satisfactory psychometric properties. It could serve as a tool for assessing the effectiveness of international programs aimed at fostering patient participation from the perspective of nurses, while also providing insights from China's practical experiences.

Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study

BACKGROUND

Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients.

OBJECTIVE

The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit.

METHODS

A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis.

RESULTS

Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences).

DISCUSSION

Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.

The diverse invitations to participate in early rehabilitation - A qualitative study of nurse-patient interactions in the intensive care unit

OBJECTIVES

To gain insight into the interaction between nurses and patients in early rehabilitation and the role of patient participation in this context.

RESEARCH DESIGN AND SETTING

A qualitative study with a phenomenological-hermeneutic approach was conducted in two units/hospitals from January 2022 to January 2023, utilizing observations and video recordings of eight nurse/patient dyads combined with post observation interviews with the nurses. The study was analysed by systematic text condensation and video analysis, informed by interaction theory.

FINDINGS

Two contrasting categories emerged: 1) Absent invitations: the nurse performed procedures without involving the patient; in other situations, the nurse informed the patient without requesting participation. Simultaneously, spontaneous patient movements were not acknowledged by the nurse. The nurses explained that this practice occurred due to time pressure, oversights, a lack of belief regarding patients' capacities, the unit's culture and little training. 2) Invitations that strengthened participation: the nurse verbally requested activity that often resulted in an inadequate response, or bodily extended invitations that sometimes led to joint active movement. Patients were the most active participants when nurses combined verbal prompts, eye contact, physical handling, and dialogue. In the interviews, the nurses emphasized giving patients enough time to participate and repeatedly encouraged participation because the patient's condition and capacity constantly fluctuated.

CONCLUSION

Interactions that combine verbal and bodily invitations appear crucial for patient participation in early rehabilitation in the intensive care unit, emphasizing the importance of integrated tailored bodily communication. The nurses' lack of insight into and attention to the patient's bodily potential for active movement combined with a paternalistic approach to the patient's situation may hinder patients' active participation.

IMPLICATIONS FOR CLINICAL PRACTICE

Integrated forms of interaction that explore patients' capacity and potential for participation should be employed in line with verbal communication. Developing competence in early rehabilitation should be emphasized in critical care nurses' education and training.

Integrating Patient Involvement Interventions within Clinical Practice: A Mixed-Methods Study of Health Care Professional Reasoning

Background. Patient involvement interventions are complex interventions that improve patient involvement in treatment and care in health care systems. Studies report several benefits of patient involvement interventions and that health care professionals are positive about using them. However, they have not been explored as a collected group of interventions throughout the continuum of care and treatment. In addition, the relationship between patient involvement interventions and the clinical reasoning process of health care professionals has not been thoroughly studied. Design. This mixed-methods study was conducted at Aarhus University Hospital in Denmark between April and November 2022 using interview data from 12 health care professionals and survey data from 420 health care professionals. Informants were medical doctors, nurses, midwives, dietitians, physiotherapists, and occupational therapists who had direct contact with patients during their daily care and treatment. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed via inductive and deductive content analysis. Results. Communication and interaction were seen as overarching aspects of patient involvement, with patient involvement interventions being defined as concrete tools and methods to enhance health care professionals' explicit clinical reasoning process. Limitations. It is unclear if results are representative of all health care professionals at the hospital or only those with a positive view of patient involvement interventions. Conclusions. Patient involvement interventions are viewed as beneficial for patients and fit with the clinical reasoning of health care professionals. Clinical reasoning may be an active ingredient in the development and implementation of patient involvement interventions. Implications. In practice, health care professionals need training in person-centered communication and the ability to articulate their clinical reasoning explicitly. In research, a more in-depth understanding of the interrelations between patient involvement interventions and clinical reasoning is needed.

Highlights

Communication and interaction are the fundamental goals of patient involvement in practice, regardless of which patient involvement intervention is being used.Clinical reasoning is often an unconscious process using tacit knowledge, but the use of patient involvement interventions may be a way for health care professionals (at both individual and group levels) to become more explicit about and aware of their reflections.Clinical reasoning can be viewed as a mechanism of change in the development and implementation of patient involvement interventions.