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Istanboulian L, Dale C, Terblanche E, Rose L. Clinician-perceived barriers and facilitators for the provision of actionable processes of care important for persistent or chronic critical illness. J Adv Nurs 2024; 80:1619-1629. [PMID: 37902117 DOI: 10.1111/jan.15924] [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: 09/09/2023] [Revised: 10/06/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
AIM To explore clinician-perceived barriers to and facilitators for the provision of actionable processes of care important for patients with persistent or chronic critical illness. DESIGN Qualitative descriptive interview study. METHODS Secondary analysis of semi-structured telephone interviews (December 2018 - February 2019) with professionally diverse clinicians working with adults experiencing persistent or chronic critical illness in Canadian intensive care units. We used deductive content analysis informed by the Social-Ecological Model. RESULTS We recruited 31 participants from intensive care units across nine Canadian provinces. Reported intrapersonal level barriers to the provision of actionable processes of care included lack of training, negative emotions and challenges prioritizing these patients. Facilitators included establishment of positive relations and trust with patients and family. Interpersonal barriers included communication difficulties, limited access to physicians and conflict. Facilitators included communication support, time spent with the patient/family and conflict management. Institutional barriers comprised inappropriate care processes, inadequate resources and disruptive environmental conditions. Facilitators were regular team rounds, appropriate staffing and employment of a primary care (nurse and/or physician) model. Community-level barriers included inappropriate care location and insufficient transition support. Facilitators were accessed to alternate care sites/teams and to formalized transition support. Public policy-level barriers included inadequacy of formal education programs for the care of these patients; knowledge implementation for patient management was identified as a facilitator. CONCLUSION Our results highlighted multilevel barriers and facilitators to the delivery of actionable processes important for quality care for patient/family experiencing persistent or chronic critical illness. IMPACT Using the Social-Ecological Model, the results of this study provide intra and interpersonal, institutional, community and policy-level barriers to address and facilitators to harness to improve the care of patients/family experiencing persistent or chronic critical illness. REPORTING METHOD Consolidated criteria for reporting qualitative studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Laura Istanboulian
- Michael Garron Hospital, Toronto, Canada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing and Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ella Terblanche
- Department of Critical Care, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Gunnels MS, Thompson SL, Jenifer Y. Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review. Crit Care Nurse 2024; 44:31-40. [PMID: 38555969 DOI: 10.4037/ccn2024942] [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: 04/02/2024]
Abstract
BACKGROUND Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes. OBJECTIVE To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication? METHODS An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both. RESULTS Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention. CONCLUSIONS Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.
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Affiliation(s)
- Marshall S Gunnels
- Marshall S. Gunnels is a nurse in the neuroscience intensive care unit at Mayo Clinic, Rochester, Minnesota
| | - Susan L Thompson
- Susan L. Thompson is a clinical nurse specialist in the multispecialty intensive care unit at Mayo Clinic
| | - Yvette Jenifer
- Yvette Jenifer is a clinical nurse specialist at Johns Hopkins Bayview Medical Center and the Doctor of Nursing Practice Advanced Practice project coordinator at Johns Hopkins School of Nursing, Baltimore, Maryland
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Allum L, Terblanche E, Pattison N, Connolly B, Rose L. Clinician views on actionable processes of care for prolonged stay intensive care patients and families: A descriptive qualitative study. Intensive Crit Care Nurs 2024; 80:103535. [PMID: 37801854 DOI: 10.1016/j.iccn.2023.103535] [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: 04/04/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To explore clinician perspectives on key actionable processes of care that may improve outcomes and experience of patients experiencing a prolonged (over 7 days) intensive care unit stay, and their family members. RESEARCH METHODOLOGY A descriptive qualitative interview study in the United Kingdom. We conducted online semi-structured interviews using video conferencing software (October 2020-August 2022). We used purposive sampling ensuring participation from a broad range of professions representing the interprofessional team in the United Kingdom. We used Framework Analysis methods to group actionable processes into the six themes of person-centred care. Analyses were informed by our previous scoping review and previous interviews with former patients and family members. FINDINGS We interviewed 24 staff participants and identified 36 actionable processes of care under six themes of person-centred care. Processes relating to communication (both establishing an effective communication method for the patient and staff communication with the patient and family), continuity of staff and care plans, and personalising the environment and routines, and allowing flexible family visiting were most frequently articulated. These processes were perceived as having a multifaceted impact on patient and family wellbeing, for example family visiting helping patient and family emotional wellbeing and staff communication with family; and establishing an effective communication method for patients reduced their anxiety, enhanced their involvement in their care and allowed staff to include them in ward rounds more efficiently. CONCLUSION We identified 36 actionable processes of care from interviews with intensive care staff, with an emphasis on enhancing patient autonomy through optimising communication and involvement in decision-making, participation of family, and continuity of staff and care plans. IMPLICATIONS FOR CLINICAL PRACTICE These 36 actionable processes of care will contribute to future development of quality improvement tools, which will be used to standardise the care of prolonged-stay intensive care patients and their families.
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Affiliation(s)
- Laura Allum
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
| | - Ella Terblanche
- Nutrition and Dietetic Department, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH, London.
| | - Natalie Pattison
- University of Hertfordshire, College Lane, Hatfield AL109AB, UK; East & North Herts NHS Trust, Coreys Mill Lane, Stevenage SG14AB, UK.
| | - Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Centre for Human and Applied Physiological Sciences, King's College London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, SE1 8WA London, UK; Department of Critical Care and Lane Fox Clinical Respiratory Physiology Research Centre, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
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Erikson EJ, Edelman DA, Brewster FM, Marshall SD, Turner MC, Sarode VV, Brewster DJ. The use of checklists in the intensive care unit: a scoping review. Crit Care 2023; 27:468. [PMID: 38037056 PMCID: PMC10691022 DOI: 10.1186/s13054-023-04758-2] [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: 10/05/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Despite the extensive volume of research published on checklists in the intensive care unit (ICU), no review has been published on the broader role of checklists within the intensive care unit, their implementation and validation, and the recommended clinical context for their use. Accordingly, a scoping review was necessary to map the current literature and to guide future research on intensive care checklists. This review focuses on what checklists are currently used, how they are used, process of checklist development and implementation, and outcomes associated with checklist use. METHODS A systematic search of MEDLINE (Ovid), Embase, Scopus, and Google Scholar databases was conducted, followed by a grey literature search. The abstracts of the identified studies were screened. Full texts of relevant articles were reviewed, and the references of included studies were subsequently screened for additional relevant articles. Details of the study characteristics, study design, checklist intervention, and outcomes were extracted. RESULTS Our search yielded 2046 studies, of which 167 were selected for further analysis. Checklists identified in these studies were categorised into the following types: rounding checklists; delirium screening checklists; transfer and handover checklists; central line-associated bloodstream infection (CLABSI) prevention checklists; airway management checklists; and other. Of 72 significant clinical outcomes reported, 65 were positive, five were negative, and two were mixed. Of 122 significant process of care outcomes reported, 114 were positive and eight were negative. CONCLUSIONS Checklists are commonly used in the intensive care unit and appear in many clinical guidelines. Delirium screening checklists and rounding checklists are well implemented and validated in the literature. Clinical and process of care outcomes associated with checklist use are predominantly positive. Future research on checklists in the intensive care unit should focus on establishing clinical guidelines for checklist types and processes for ongoing modification and improvements using post-intervention data.
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Affiliation(s)
- Ethan J Erikson
- Intensive Care Unit, Cabrini Hospital, Malvern, Melbourne, Australia
| | - Daniel A Edelman
- Department of Critical Care, Alfred Health, Melbourne, Australia
| | - Fiona M Brewster
- Department of Anaesthesia, The Royal Women's Hospital, Parkville, Melbourne, Australia
| | - Stuart D Marshall
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Anaesthesia, Peninsula Health, Melbourne, Australia
| | - Maryann C Turner
- Department of Critical Care, University of Melbourne, Melbourne, Australia
- Department of Anaesthesia, The Royal Children's Hospital, Melbourne, Australia
| | - Vineet V Sarode
- Intensive Care Unit, Cabrini Hospital, Malvern, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - David J Brewster
- Intensive Care Unit, Cabrini Hospital, Malvern, Melbourne, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Rose L, Istanboulian L, Amaral ACKB, Burry L, Cox CE, Cuthbertson BH, Iwashyna TJ, Dale CM, Fraser I. Co-designed and consensus based development of a quality improvement checklist of patient and family-centered actionable processes of care for adults with persistent critical illness. J Crit Care 2022; 72:154153. [PMID: 36174432 DOI: 10.1016/j.jcrc.2022.154153] [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: 06/14/2022] [Revised: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Few quality improvement tools specific to patients with persistent or chronic critical illness exist to aid delivery of high-quality care. Using experience-based co-design methods, we sought consensus from key stakeholders on the most important actionable processes of care for inclusion in a quality improvement checklist. METHODS Item generation methods: systematic review, semi-structured interviews (ICU survivors and family) members, touchpoint video creation, and semi-structured interviews (ICU clinicians). Consensus methods: modified online Delphi and a virtual meeting using nominal group technique methods. RESULTS We enrolled 138 ICU interprofessional team, patients, and family members. We obtained consensus on a quality improvement checklist comprising 11 core domains: patient and family involvement in decision-making; patient communication; physical comfort and complication prevention; promoting self-care and normalcy; ventilator weaning; physical therapy; swallowing; pharmacotherapy; psychological issues; delirium; and appropriate referrals. An additional 27 actionable processes are contained within 6 core domains that provide more specific direction on the actionable process to be targeted. CONCLUSIONS Using a highly collaborative and methodologically rigorous process, we generated a quality improvement checklist of actionable processes to improve patient and family-centred care considered important by key stakeholders. Future research is needed to understand optimal implementation strategies and impact on outcomes and experience.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
| | - Laura Istanboulian
- Provincial Centre of Weaning Excellence, Michael Garron Hospital, Toronto, Toronto East Health Network, Canada
| | - Andre Carlos Kajdacsy-Balla Amaral
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada
| | - Lisa Burry
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Mount Sinai Hospital, Sinai Health System, Toronto, ON, Canada
| | | | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Sunnybrook Research Institute, Toronto, Canada; University Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - Theodore J Iwashyna
- University of Michigan, Ann Arbor, VA Health System, United States of America
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ian Fraser
- Provincial Centre of Weaning Excellence, Michael Garron Hospital, Toronto East Health Network, Toronto, Canada
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