Determination of patients’ family members’ needs and related factors in the intensive care unit with visiting restrictions during the COVID-19 pandemic

Translation, cultural debugging, and validation of the Chinese version of the Sour Seven Questionnaire: a cross-sectional study

Introduction

Intensive care unit delirium (ICUD) is an acute cerebral dysfunction accompanied by a change of level of consciousness, disorientation, and cognitive dysfunction, typically occurring over a short duration ranging from hours to days and resulting from underlying medical causes. Family members may sometimes detect changes in consciousness earlier than medical staff. The Sour Seven Questionnaire is a tool to assist family members in screening for delirium, but there is currently no Chinese version. This study aimed to translate and cross-culturally debug the Sour Seven Questionnaire and test the effectiveness of the Chinese version in screening for ICUD by family members.

Methods

To create the Chinese version of the questionnaire, the questionnaire was first translated and then culturally debugged through expert consultation and cognitive interviews. Patients and their family members admitted to three ICUs in a Chinese hospital were selected to test the Chinese version of the Sour Seven Questionnaire and the results were compared with those of the validated and recommended Confusion Assessment Method for the intensive care unit (CAM-ICU) assessment.

Results

A total of 190 ICU patients and their families were included in this study. Results of the CAM-ICU assessment showed that 73 (38.4%) patients developed ICUD compared to the 66 (34.7%) using the Chinese version of the Sour Seven Questionnaire, which had a Cohen's kappa coefficient of 0.853, a sensitivity of 0.863, and a specificity of 0.974. The positive predictive value was 0.954 and the negative predictive value was 0.919.

Discussion

The Chinese version of the Sour Seven Questionnaire is a valid assessment tool for helping families screen for ICUD, and it is effective in identifying altered consciousness in patients even during online visits.

Communication strategies for expressing empathy during family-clinician conversations in the intensive care unit: A mixed methods study

OBJECTIVES

To explore communication strategies intensive care clinicians and patients' family members prefer for expressing empathy during family-clinician conversations.

RESEARCH METHODOLOGY/DESIGN

Mixed-methods survey study.

SETTING

Two medical ICUs of a German academic tertiary care hospital.

MAIN OUTCOME MEASURES

Using a self-developed online survey with closed and open-ended questions with free-text options, the participants' preferences of communication strategies for expressing empathy were investigated. Quantifiable similarities and differences were determined by statistical analysis. Qualitative themes were derived at by directed content analysis.

FINDINGS

The responses of 94 family members, 42 nurses, and 28 physicians were analysed (response rate: 45.3 %). Four communication strategies were deduced: (1) reassuring the families that the intensive care unit team will not abandon neither them nor the patient, (2) acknowledging emotions and offering support, (3) saying that the families are welcome and cared for in the intensive care unit, (4) providing understandable information. In comparison, the families considered an expression of nonabandonment as more empathic than the physicians did (p =.031,r = 0.240), and those expressions focussing solely on the family members' well-being (p =.012,r = 0.228) or comprising evaluative wording ("good", "normal") (p =.017,r = 0.242) as less empathic than the nurses did. Unanimously advocated nonverbal communication strategies included to listen attentively and to avoid interrupting as well as being approachable and honest.

CONCLUSION

The participants' preferences supported expert recommendations and highlighted that it is not only important what the clinicians say but also how they say it. Further research is needed to elucidate ways of successfully expressing empathy during family-clinician conversations in the intensive care unit.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care unit clinicians are encouraged to practice active listening and to express their caring and nonabandonment. It is further suggested to reflect on and adjust pertinent nonverbal behaviours and relational aspects of their communication, as applicable.

Family members' experiences of COVID-19 visiting restrictions in the intensive care unit-A qualitative study

OBJECTIVE

To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden.

BACKGROUND

In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated.

DESIGN

This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist.

RESULTS

Two categories-dealing with uncertainty and being involved at a distance-described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact.

CONCLUSIONS

Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home.

RELEVANCE TO CLINICAL PRACTICE

This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU.

PATIENT AND PUBLIC CONTRIBUTION

None in the conceptualisation or design of the study.

Experiences and Needs of Patients, Caregivers and Nurses during the COVID-19 Pandemic: Study Protocol for a Mixed-Methods Multicentre Study

The COVID-19 pandemic is a major public health problem with millions of confirmed cases and deaths described. Nurses are among the health care professionals most involved at the front line, caring for those affected by COVID-19. Patients and families have been subjected to a high emotional burden of fear, anxiety, and uncertainty. The COVID-19 pandemic has had a significant impact on the approach to patients, the organisation of care, and communication with patients and their families, all requiring considerable adaptation on the part of nurses and health care professionals. The overall aim of this research was to find out the needs of patients with COVID-19, the nursing interventions provided and their outcomes, and to explore the experiences of the nurses, patients, and caregivers. A mixed method study will be performed with a convergent design. The study was divided into three phases. Quantitative methods involved nurses and patients affected by COVID-19 with a questionnaire. Qualitative methods involved nurses, patients, and caregivers with interviews and finally a quantitative analysis of the nursing documentation of the interviewed patients. We hope that this study will help us to understand and identify the main nursing and support needs expressed by patients and their families at different stages of their illness.