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Brooks LA, Manias E, Rasmussen B, Bloomer MJ. Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi study. Intensive Crit Care Nurs 2024; 86:103814. [PMID: 39357320 DOI: 10.1016/j.iccn.2024.103814] [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: 07/10/2024] [Accepted: 08/23/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs. AIM The aim was to develop and evaluate practice recommendations for culturally sensitive communication at the end of life. METHOD Modified two-round eDelphi study. An Australian national sample of 58 expert ICU clinicians of nursing and medical backgrounds participated in an online survey to rate the relevance of 13 practice recommendations. Ten clinicians participated in a subsequent expert panel interview to provide face validity and comprehensive details about the practical context of the recommendations. Survey data were analysed using descriptive statistics, interview data using deductive content analysis. RESULTS All 13 practice recommendations achieved item content validity index (I-CVI) above 0.8, and scale content validity index (S-CVI) of 0.95, indicating sufficient consensus. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus. CONCLUSION These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds. IMPLICATIONS FOR CLINICAL PRACTICE Clinicians want practice recommendations that are understandable and broadly applicable across diverse ICU contexts. The high consensus scores confirm these practice recommendations are relevant and feasible to clinicians who provide end-of-life care for patients and their family members. The recommendations also provide clear guidance for ICU leaders, managers and organisational policy makers.
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Affiliation(s)
- Laura A Brooks
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, VIC, Australia.
| | - Elizabeth Manias
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, VIC, Australia; Sector of Health Services Research, Department of Public Health, University of Copenhagen, Denmark; Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, VIC, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Cypress B, Gharzeddine R, Rosemary Fu M, Ransom M, Villarente F, Pitman C. Healthcare professionals perspective of the facilitators and barriers to family engagement during patient-and-family-centered-care interdisciplinary rounds in intensive care unit: A qualitative exploratory study. Intensive Crit Care Nurs 2024; 82:103636. [PMID: 38301418 DOI: 10.1016/j.iccn.2024.103636] [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: 08/25/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES Family engagement in care for critically ill patients remains an inconsistent practice and an understudied area of nursing science. Rounds for this study is an interdisciplinary activity conducted at the bedside in partnership with patients, their families, and the health care professionals involved in providing the care. We sought to explore and describe the facilitators and barriers to family engagement during patient and family-centered interdisciplinary rounds in the intensive care unit. RESEARCH METHODOLOGY/DESIGN This qualitative exploratory study is part of a multisite experimental study (#Pro2020001614; NCT05449990). We analyzed the narrative data from the qualitative questions added in the survey from 52 healthcare professionals involved in a multisite experimental study using Braun and Clarke's (2006) constructionist, contextualist approach to thematic analysis. SETTING The study was conducted in the intensive care unit of two medical centers. MAIN OUTCOME MEASURES The findings presented are themes illuminated from thematic analysis namely communication gaps, family's lack of resources, familial and healthcare providers' characteristics, lack of leadership, interprofessional support, policy, and guidelines. FINDINGS Family engagement in critical care during interdisciplinary rounds occurred within the intersectionality among families, healthcare professionals' practice, and organizational factors. The facilitators for family engagement include supported, championed, and advocated-for family adaptation, teams, and professional practice, and organizational receptivity, and support. Communication and leadership are the precursors to family engagement. CONCLUSIONS The findings added new knowledge for exploring the nature and scope of family engagement in critical care. Family engagement must be incorporated into the organizational vision and mission, and healthcare delivery systems. IMPLICATIONS FOR CLINICAL PRACTICE There is a need to further investigate the resources, organizational support mechanisms, and systems that affect patients, families, and healthcare professionals, and the establishment of policies that will aid in reducing barriers to family engagement in the intensive care unit.
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Freudiger K, Verweij L, Naef R. Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study. JOURNAL OF FAMILY NURSING 2024; 30:114-126. [PMID: 38622871 DOI: 10.1177/10748407241234262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.
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Affiliation(s)
| | - Lotte Verweij
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
| | - Rahel Naef
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
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Kelly S, Garner J, Treadway V, Sadera G. Knowledge mobilization in critical care and the evolving communication role of nurses. Nurs Crit Care 2023; 28:913-922. [PMID: 35794068 DOI: 10.1111/nicc.12821] [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: 11/05/2021] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes. AIMS The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members. STUDY DESIGN A qualitative approach was used, consisting of semi-structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach. RESULTS Data collected prior to the COVID-19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend. CONCLUSIONS It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout. RELEVANCE TO CLINICAL PRACTICE These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all.
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Affiliation(s)
- Sioban Kelly
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Jayne Garner
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Victoria Treadway
- Library and Knowledge Service, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
- NHS England, Leeds, UK
| | - Girendra Sadera
- Department of Critical Care and Anaesthesia, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK
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Maputle MS, Mbedzi T, Maluleke M, Netshikweta ML, Ramathuba DU, Raliphaswa NS, Luhalima TR, Mulondo SA, Malwela T, Tshililo AR, Mafumo JL, Shilubane NH, Ndou ND, Netshisaulu KG. Perceived Consequences of COVID-19 Restrictive Visitation Policy on Family Members at Rural Hospitals in Vhembe District: A Qualitative Study. NURSING REPORTS 2023; 13:1399-1409. [PMID: 37873824 PMCID: PMC10594422 DOI: 10.3390/nursrep13040117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 10/25/2023] Open
Abstract
From a public health standpoint, a stringent visitation policy was necessary during the COVID-19 pandemic, but it had unforeseen communicative and emotional health consequences for family members. This study explored family members' experiences regarding implementing a restricted visitation policy when a patient was admitted with COVID-19 at public hospitals in the Vhembe district. Researchers used an exploratory, descriptive, and contextual qualitative technique. Twelve family members made up the population. Unstructured telephone interviews were used to obtain the data, and open coding was used to analyse data. Ethics were consistently followed. Before taking part, participants provided verbal informed consent, acknowledging that they could withdraw from the study if necessary. Three themes emerged: inadequate measures for temporary communication channels and techniques, the mental health effects of COVID-19 admission, and poor/lack of standardised visitation policy during the COVID 19-pandemic. There was a need to balance safety from contracting COVID-19 infection and promoting family-centred care. Virtual visits through telecommunication solutions could reduce fear and anxiety as the family could be updated on the progress of the hospitalised relative. Alternatively, hospital managers must allocate a dedicated person in the unit to update families when they call and enquire about the conditions.
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Affiliation(s)
- Maria Sonto Maputle
- Department of Advanced Nursing, University of Venda, Private Bag X5050, Thohoyandou 0950, South Africa; (T.M.); (M.M.); (D.U.R.); (N.S.R.); (T.R.L.); (S.A.M.); (T.M.); (A.R.T.); (J.L.M.); (N.H.S.); (N.D.N.); (K.G.N.)
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Jin J, Son YJ, Tate JA, Choi J. Challenges and Learning Needs of Nurse-Patients' Family Communication: Focus Group Interviews With Intensive Care Unit Nurses in South Korea. Eval Health Prof 2022; 45:411-419. [PMID: 35337208 PMCID: PMC9630962 DOI: 10.1177/01632787221076911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intensive care unit (ICU) nurses are expected to facilitate effective day-to-day communication with patients and family members at the bedside. To date, communication training for ICU health care professionals has targeted mainly intensivists-in-training, but there is limited data on communication experience and needs to be evaluated among ICU nurses. This qualitative study used focus group interviews to explore daily communication experiences with patients' families and communication training needs and preferences among ICU nurses in South Korea. Five focus group interviews were conducted with 27 ICU nurses (4-6 nurses per group). The results of inductive qualitative content analysis highlighted four main categories: "Perceived difficulties during communication," "burden from working conditions," "endeavors to promote communication skills," and "strategies for cultivating effective communication." Regarding suggestions for future communication training, nurses preferred interactive learning with peer-support over traditional methods (e.g., lectures). Nurses also suggested that communication training for ICU nurses should include learning skills appropriate for difficult situations (e.g., angry family members). Findings from this study can serve as a framework for stakeholders in ICU care and healthcare education (e.g., hospital and nursing administrators, nurse educators) when designing communication training to support ICU nurses with their practical knowledge and communication skills.
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Affiliation(s)
- Juhye Jin
- Department of Nursing, College of
Health and Life Science, Korea National University of
Transportation, Jeungpyeong, South Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Judith A. Tate
- The Ohio State University, College of
Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Mo-Im Kim Nursing Research
Institute, Yonsei University College of
Nursing, Seoul, South Korea,JiYeon Choi, Yonsei University College of
Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
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Bernal OA, Roberts B, Wu DS. Interprofessional Interventions to Improve Serious Illness Communication in the Intensive Care Unit: A Scoping Review. Am J Hosp Palliat Care 2022:10499091221130755. [PMID: 36189871 DOI: 10.1177/10499091221130755] [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: 11/15/2022] Open
Abstract
Serious illness communication is fundamental to the provision of quality care for patients in the intensive care unit (ICU). Evidence suggests that including interprofessional team members in such communication is beneficial. This scoping review--conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines-maps existing evidence regarding interprofessional interventions to improve serious illness communication in the ICU. The review yielded 14 studies for inclusion, which were organized by 3 thematic categories of strategies implemented: training curriculum, scheduled meetings, and liaison role. Most used a combination of intervention strategies. Outcome measures varied across the studies but could be broadly categorized as patient/family-focused, provider-focused, or systems-focused. Great heterogeneity between studies exists. More research is needed.
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Affiliation(s)
- Olivia A Bernal
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Roberts
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA.,Palliative Care Program, 23238Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - David S Wu
- Department of Medicine, School of Medicine, 23238Johns Hopkins University, Baltimore, MD, USA.,Palliative Care Program, 23238Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Thyagarajan S, Ramachandra G, Jamalpuri V, Calhoun AW, Nadkarni V, Deutsch ES. Simulathon 2020: Integrating Simulation Period Prevalence Methodology Into the COVID-19 Disaster Management Cycle in India. Simul Healthc 2022; 17:183-191. [PMID: 34405824 PMCID: PMC9169606 DOI: 10.1097/sih.0000000000000601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SUMMARY STATEMENT The disaster management cycle is an accepted model that encompasses preparation for and recovery from large-scale disasters. Over the past decade, India's Pediatric Simulation Training and Research Society has developed a national-scale simulation delivery platform, termed the Simulathon , with a period prevalence methodology that integrates with core aspects of this model. As an exemplar of the effectiveness of this approach, we describe the development, implementation, and outcomes of the 2020 Simulathon, conducted from April 20 to May 20 in response to the nascent COVID-19 pandemic disaster. We conclude by discussing how aspects of the COVID-19 Simulathon enabled us to address key aspects of the disaster management cycle, as well as challenges that we encountered. We present a roadmap by which other simulation programs in low- and middle-income countries could enact a similar process.
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Affiliation(s)
- Sujatha Thyagarajan
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Geethanjali Ramachandra
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vijayanand Jamalpuri
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Aaron W. Calhoun
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Vinay Nadkarni
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ellen S. Deutsch
- From the Aster RV Hospital (S.T.), Bangalore; PediSTARS (S.T.); Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad; Pediatric Simulation Training and Research Society (G.R.); Rainbow Children's Hospital (V.J.), Hyderabad, India; Department of Pediatrics (A.W.C.), Norton Children's Hospital, University of Louisville, Louisville, KC; and Departments of Anesthesiology (V.N., E.S.D.), Critical Care (V.N.), and Pediatrics (V.N.), Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Moss SJ, Rosgen BK, Lucini F, Krewulak KD, Soo A, Doig CJ, Patten SB, Stelfox HT, Fiest KM. Psychiatric Outcomes in ICU Patients With Family Visitation: A Population-Based Retrospective Cohort Study. Chest 2022; 162:578-587. [PMID: 35271840 DOI: 10.1016/j.chest.2022.02.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Lack of family visitation in the ICU can have long-term consequences on patients in the ICU after discharge. The effect of family visitation on the incidence of patient psychiatric disorders is unknown. RESEARCH QUESTION What is the association between family visitation in the ICU and incidence of psychiatric outcomes in patients in the ICU 1 year after hospital discharge? STUDY DESIGN AND METHODS This study assessed a population-based retrospective cohort of adult patients admitted to the ICU from January 1, 2014, through May 30, 2017, surviving to hospital discharge with ICU length of stay of ≥ 3 days. To be eligible, patients needed to have minimum of 5 years of administrative data before ICU admission and a minimum of 1 year of follow-up data after hospital discharge. An internally validated algorithm that interpreted natural language in health records determined patients with or without in-person family (ie, relatives, friends) visitation during ICU stay. The primary outcome was risk of an incidence of psychiatric disorder (composite outcome), including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders, identified using coding algorithms for administrative databases. Propensity scores were used in inverse probability weighted logistic regression models, and average treatment effects were converted to risk ratios (RRs) with 95% CIs. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder. RESULTS We included 14,344 patients with (96% [n = 13,771]) and without (4.0% [n = 573]) in-person family visitation who survived hospital discharge. More than one-third of patients received a diagnosis of any psychiatric disorder within 1 year after discharge (34.9%; 95% CI, 34.1%-35.6%). Patients most often received diagnoses of anxiety disorders (17.5%; 95% CI, 16.9%-18.1%) and depressive disorders (17.2%; 95% CI, 16.6%-17.9%). After inverse probability weighting of 13,731 patients, in-person family visitation was associated with a lower risk of received a diagnosis of any incident psychiatric disorder within 1 year after discharge (RR, 0.79; 95% CI, 0.68-0.92). INTERPRETATION ICU family visitation is associated with a decreased risk of psychiatric disorders in critically ill patients up to 1 year after hospital discharge.
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Affiliation(s)
- Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Filipe Lucini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Wendlandt B, Kime M, Carson S. The impact of family visitor restrictions on healthcare workers in the ICU during the COVID-19 pandemic. Intensive Crit Care Nurs 2022; 68:103123. [PMID: 34456111 PMCID: PMC8315942 DOI: 10.1016/j.iccn.2021.103123] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/05/2021] [Accepted: 07/17/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To obtain information on how family visitor restriction during the COVID-19 pandemic has impacted the workplace experience of physicians and nurses in the medical intensive care unit, and to assess differences by profession. MATERIALS AND METHODS We developed a survey containing closed- and open-ended questions, applying both quantitative and qualitative analyses to our results. RESULTS Of the 74 respondents, 29 (38%) were nurses and 45 (62%) were physicians. Nurses reported positive changes to daily workflow and the ability to provide medical care, while physicians reported negative changes in these areas. Both groups reported decreased comprehension and increased distress among families, and decreased ability to provide end-of-life care. For the qualitative analysis, eight themes were identified: the patient's room as space, creation of a new space through virtual communication, time, increased complexity of care, challenges around the use of technology, adjustments to team roles and responsibilities, desire for families to return, and internal tension. CONCLUSION Intensive care physicians and nurses reported both positive and negative effects of family visitor restriction during the COVID-19 pandemic, with significant differences based on profession. Both groups expressed concern for an overall negative impact of visitor restriction on healthcare workers, patients, and their families.
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Affiliation(s)
- Blair Wendlandt
- Corresponding author at: 130 Mason Farm Road CB#7020, Chapel Hill, NC 27599, United States
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11
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Chen C, Sullivan SS, Lorenz RA, Wittenberg E, Li CS, Chang YP. COMFORT communication in the ICU: Pilot test of a nurse-led communication intervention for surrogates. J Clin Nurs 2021; 31:3076-3088. [PMID: 34811825 DOI: 10.1111/jocn.16132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 12/28/2022]
Abstract
AIM This study was designed to investigate the feasibility, acceptability, and preliminary efficacy of a nurse-led communication intervention among surrogates in the intensive care unit (ICU) guided by the COMFORT (Connect; Options; Making meaning; Family caregivers; Openings; Relating; Team) communication model. BACKGROUND As frontline communicators, nurses experience communication difficulties with surrogates who face complex informational and emotional barriers when making decisions for critically ill patients in the ICU. However, research on effective nurse communication focusing on both curative and end-of-life (EOL) care is lacking in the literature. DESIGN A single-centre two-group pretest-posttest quasi-experiment. METHOD The total sample included 41 surrogates of adult ventilated patients. Twenty participants were allocated to the intervention group who received a daily 20-min telephone call with content based on the COMFORT communication model. Twenty-one participants comprised the control group who received usual care. Participants completed a questionnaire before and after the study measuring satisfaction, anxiety and depression, decisional conflict, and quality of communication. The Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist was followed for nonrandomised controlled trials. RESULT The intervention was feasible, with 19 of 20 surrogates completing the follow-up surveys, and 48 telephone conversations completed (48% of the planned phone calls). Surrogates' satisfaction was higher in the intervention group than in the control group after adjusting for the selected covariates (25.43 and 24.15, respectively; p = .512). Preliminary efficacy outcomes favouring the intervention included quality of communication with healthcare providers, but not surrogates' perceived depression/anxiety and decisional conflicts. CONCLUSION Implementation of the intervention is feasible, acceptable, and favourable among surrogates to improve quality of communication with healthcare providers in the ICU. Further research is needed to determine whether the intervention could be implemented by nurses to improve surrogates' outcomes in other ICUs.
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Affiliation(s)
- Chiahui Chen
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Rebecca A Lorenz
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Elaine Wittenberg
- Department of Communication Studies, California State University Los Angeles, Los Angeles, California, USA
| | - Chin-Shang Li
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
| | - Yu-Ping Chang
- School of Nursing, University at Buffalo - The State University of New York, Buffalo, New York, USA
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12
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Au SS, Roze des Ordons AL, Blades KG, Stelfox HT. Best practices toolkit for family participation in ICU rounds. J Eval Clin Pract 2021; 27:1066-1075. [PMID: 33230927 DOI: 10.1111/jep.13517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Guidelines recommend inviting family members of intensive care unit (ICU) patients to rounds. We aimed to create a toolkit to support family participation in ICU bedside rounds, based upon evidence from research and in collaboration with ICU family member representatives and healthcare providers. METHODS Ethnographic observations of rounds and interviews and focus groups with family members and ICU healthcare providers were analyzed for key themes, barriers and facilitators of participation, and suggestions. A full day workshop with family representatives and providers (physicians, nurses, social workers, and unit managers) from a diverse range of adult ICUs in Western Canada, including several community ICUs and a majority of large, urban ICUs enabled the collaborative development of key toolkit elements. RESULTS We have developed an evidence-informed approach to patient-and-family-centered rounds that highlights the importance of six key elements foundational to patient and family centered rounds: Invitation, Orientation, Engagement, Summary, Questions, and Communication Follow-Up. We describe strategies, techniques, and templates to optimize these elements and interactions so that communication is more meaningful, and to facilitate the ability of family members to adopt a meaningful role as contributing members of the care team. CONCLUSION There is consensus on general strategies for facilitating family participation in rounds and meaningful communication between family and the healthcare team during rounds as an important element of the continuum of communication in the ICU. The incorporation of these elements should be standardized, though tailored to user needs.
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Affiliation(s)
- Selena S Au
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Oncology, Division of Palliative Care, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth G Blades
- Ward of the 21st Century Research & Innovation Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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13
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Rose L, Yu L, Casey J, Cook A, Metaxa V, Pattison N, Rafferty AM, Ramsay P, Saha S, Xyrichis A, Meyer J. Communication and Virtual Visiting for Families of Patients in Intensive Care during the COVID-19 Pandemic: A UK National Survey. Ann Am Thorac Soc 2021; 18:1685-1692. [PMID: 33617747 PMCID: PMC8522289 DOI: 10.1513/annalsats.202012-1500oc] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Rationale: Restriction or prohibition of family visiting intensive care units (ICUs) during the coronavirus disease (COVID-19) pandemic poses substantial barriers to communication and family- and patient-centered care. Objectives: To understand how communication among families, patients, and the ICU team was enabled during the pandemic. The secondary objectives were to understand strategies used to facilitate virtual visiting and associated benefits and barriers. Methods: A multicenter, cross-sectional, and self-administered electronic survey was sent (June 2020) to all 217 UK hospitals with at least one ICU. Results: The survey response rate was 54%; 117 of 217 hospitals (182 ICUs) responded. All hospitals imposed visiting restrictions, with visits not permitted under any circumstance in 16% of hospitals (28 ICUs); 63% (112 ICUs) of hospitals permitted family presence at the end of life. The responsibility for communicating with families shifted with decreased bedside nurse involvement. A dedicated ICU family-liaison team was established in 50% (106 ICUs) of hospitals. All but three hospitals instituted virtual visiting, although there was substantial heterogeneity in the videoconferencing platform used. Unconscious or sedated ICU patients were deemed ineligible for virtual visits in 23% of ICUs. Patients at the end of life were deemed ineligible for virtual visits in 7% of ICUs. Commonly reported benefits of virtual visiting were reducing patient psychological distress (78%), improving staff morale (68%), and reorientation of patients with delirium (47%). Common barriers to virtual visiting were related to insufficient staff time, rapid implementation of videoconferencing technology, and challenges associated with family members' ability to use videoconferencing technology or access a device. Conclusions: Virtual visiting and dedicated communication teams were common COVID-19 pandemic innovations addressing the restrictions to family ICU visiting, and they resulted in valuable benefits in terms of patient recovery and staff morale. Enhancing access and developing a more consistent approach to family virtual ICU visits could improve the quality of care, both during and outside of pandemic conditions.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Lisa Yu
- King’s Health Partners, London, United Kingdom
| | | | - Amelia Cook
- Cicely Saunders Institute, King’s College London, London,United Kingdom
| | | | - Natalie Pattison
- East and North Hertfordshire National Health Service Trust, Hertfordshire, United Kingdom
- University of Hertfordshire, Hertfordshire, United Kingdom
| | | | - Pam Ramsay
- University of Dundee, Dundee, United Kingdom; and
| | - Sian Saha
- King's College Hospital, London, United Kingdom
| | - Andreas Xyrichis
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, and
| | - Joel Meyer
- Guy’s and St. Thomas’ National Health Service Foundation Trust, London, United Kingdom
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14
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Lucini FR, Krewulak KD, Fiest KM, Bagshaw SM, Zuege DJ, Lee J, Stelfox HT. Natural language processing to measure the frequency and mode of communication between healthcare professionals and family members of critically ill patients. J Am Med Inform Assoc 2021; 28:541-548. [PMID: 33201981 DOI: 10.1093/jamia/ocaa263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To apply natural language processing (NLP) techniques to identify individual events and modes of communication between healthcare professionals and families of critically ill patients from electronic medical records (EMR). MATERIALS AND METHODS Retrospective cohort study of 280 randomly selected adult patients admitted to 1 of 15 intensive care units (ICU) in Alberta, Canada from June 19, 2012 to June 11, 2018. Individual events and modes of communication were independently abstracted using NLP and manual chart review (reference standard). Preprocessing techniques and 2 NLP approaches (rule-based and machine learning) were evaluated using sensitivity, specificity, and area under the receiver operating characteristic curves (AUROC). RESULTS Over 2700 combinations of NLP methods and hyperparameters were evaluated for each mode of communication using a holdout subset. The rule-based approach had the highest AUROC in 65 datasets compared to the machine learning approach in 21 datasets. Both approaches had similar performance in 17 datasets. The rule-based AUROC for the grouped categories of patient documented to have family or friends (0.972, 95% CI 0.934-1.000), visit by family/friend (0.882 95% CI 0.820-0.943) and phone call with family/friend (0.975, 95% CI: 0.952-0.998) were high. DISCUSSION We report an automated method to quantify communication between healthcare professionals and family members of adult patients from free-text EMRs. A rule-based NLP approach had better overall operating characteristics than a machine learning approach. CONCLUSION NLP can automatically and accurately measure frequency and mode of documented family visitation and communication from unstructured free-text EMRs, to support patient- and family-centered care initiatives.
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Affiliation(s)
- Filipe R Lucini
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Alberta, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Joon Lee
- Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Parsons Leigh J, Krewulak KD, Zepeda N, Farrier CE, Spence KL, Davidson JE, Stelfox HT, Fiest KM. Patients, family members and providers perceive family-administered delirium detection tools in the adult ICU as feasible and of value to patient care and family member coping: a qualitative focus group study. Can J Anaesth 2021; 68:358-366. [PMID: 33210217 PMCID: PMC7902561 DOI: 10.1007/s12630-020-01866-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE While studies report on perceptions of family participation in delirium prevention, little is known about the use of family-administered delirium detection tools in the care of critically ill patients. This study sought the perspectives of patients, their family members, and healthcare providers on the use of family-administered delirium detection tools to detect delirium in critically ill patients and barriers and facilitators to using family-administered delirium detection tools in patient care. METHODS In this qualitative study, critical care providers (five physicians, six registered nurses) and participants from the Family ICU Delirium Detection Study (seven past patients and family members) took part in four focus groups at one hospital in Calgary, Alberta. RESULTS Key themes identified following thematic analysis from 18 participants included: 1) perceptions of acceptability of family-administered delirium detection (e.g., family feels valued, intensive care unit (ICU) care team may not use a family member's results, intensification of work load), 2) considerations regarding feasibility (e.g., insufficient knowledge, healthcare team buy-in), and 3) overarching strategies to support implementation into routine patient care (e.g., value of family-administered delirium detection for patients and families is well understood in the clinical context, regular communication between the family and ICU providers, an electronic version of the tool). CONCLUSIONS Patients, family members and healthcare providers who participated in the focus groups perceived family participation in delirium detection and the use of family-administered delirium detection tools at the bedside as feasible and of value to patient care and family member coping. TRIAL REGISTRATION www.ClinicalTrials.gov (NCT03379129); registered 15 December 2017.
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Affiliation(s)
- Jeanna Parsons Leigh
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Nubia Zepeda
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Christian E Farrier
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
| | - Judy E Davidson
- Department of Education, Development and Research, University of California, San Diego Health, San Diego, CA, USA
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Critical Care Medicine, Alberta Health Services and University of Calgary, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
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16
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Bernild C, Missel M, Berg S. COVID-19: Lessons Learned About Communication Between Family Members and Healthcare Professionals-A Qualitative Study on How Close Family Members of Patients Hospitalized in Intensive Care Unit With COVID-19 Experienced Communication and Collaboration With Healthcare Professionals. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060005. [PMID: 34839721 PMCID: PMC8640332 DOI: 10.1177/00469580211060005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Family members to patients admitted to intensive care units in general experience a psychological crisis with elevated levels of needs in support, information, assurance, and proximity. During COVID-19, this has been made more difficult as visiting restrictions prevent proximity and cause less access to communication with healthcare professionals. This study aims to explore and understand how communication with healthcare professionals was experienced by family members to patients admitted to intensive care units with COVID-19. To gain knowledge about this, 12 qualitative interviews with family members of patients hospitalized with COVID-19 were conducted. Adopting Reflexive Methodology, the interpretation is carried out following 4 levels, where the empirically grounded themes are analyzed and discussed using Habermas's theoretical concept of communication. The analysis brought forward 2 interconnected themes about how family members experienced the communication with the healthcare professionals during their loved one's hospitalization with COVID-19: The Structure and Form of the Communication and The Contents of the Communication. The study concludes that the family members experienced large variation in the ways that healthcare professionals communicated with them. This variation in communication goes for the when, how, what, and who-all adding to the level of uncertainty. The analyses show that the family members need more fixed patterns for the communication, more continuity in terms of who they speak to, and that they wish that the communication be conducted in a way that is true, right, and truthful.
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Affiliation(s)
- Camilla Bernild
- The Heart Centre, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Malene Missel
- The Heart Centre, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Selina Berg
- The Heart Centre, 53146Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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17
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Cook M, Zonies D, Brasel K. Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient. CURRENT TRAUMA REPORTS 2020; 6:183-193. [PMID: 33145148 PMCID: PMC7595000 DOI: 10.1007/s40719-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
Purpose of Review Communication skills in the ICU are an essential part of the care of trauma patients. The goal of this review is to summarize key aspects of our understanding of communication with injured patients in the ICU. Recent Findings The need to communicate effectively and empathetically with patients and identify primary goals of care is an essential part of trauma care in the ICU. The optimal design to support complex communication in the ICU will be dependent on institutional experience and resources. The best/worst/most likely model provides a structural model for communication. Summary We have an imperative to improve the communication for all patients, not just those at the end of their life. A structured approach is important as is involving family at all stages of care. Communication skills can and should be taught to trainees.
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Affiliation(s)
- Mackenzie Cook
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - David Zonies
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
| | - Karen Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Mail Code L611, 3181 SW Sam Jackson Park Rd, Portland, OR 97230 USA
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18
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Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs 2020; 61:102916. [PMID: 32807604 DOI: 10.1016/j.iccn.2020.102916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate family and health professional experience with a nurse-led family support intervention in intensive care. DESIGN Qualitative evaluation study. SETTING A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland. MAIN OUTCOME MEASURES Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies. FINDINGS Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families. CONCLUSIONS An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland; Institute of Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland.
| | - Paola Massarotto
- Institute of Intensive Medicine, University Hospital Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
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