Impacto de los familiares del paciente crítico Ante una acogida protocolizada

Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research

BACKGROUND

There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process.

METHODS

Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively.

DISCUSSION

The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.

[Satisfaction of relatives of the patients admitted to an intensive careunit: Perceptions of relatives and professionals]

OBJECTIVES

To estimate the satisfaction of relatives of critical care patients with regard to the environment, relationship with professionals and visitation and compare it to the perception of professionals.

METHODOLOGY

A descriptive study in two phases. In the first phase validated telephone survey within 15 days of discharge to the relatives of the patients was performed. In the second phase, the same modified questionnaire was self-administered to the professionals. The same variables were studied in both populations.

RESULTS

We interviewed 78 family members and 44 professionals. 95% of professionals vs 67% of the families claimed not to know the name of the nurses (P < .001). Over 70% of professionals and families agreed that the visit protocol is correct and that the information was adequate income. 70% of professionals felt that the information received at admission is not understood by the family although 97% of households claimed to have understood themselves. Statistically significant differences were observed in relation to the location of the unit assessment, the waiting, the aspects of information and comfort, always being the professionals who felt greater dissatisfaction (P < .05).

CONCLUSIONS

The perceptions of relatives and professionals were mostly uneven, making it necessary to continue exploring the differences through qualitative and participatory methodologies.

Humanização da fisioterapia em Unidade de Terapia Intensiva Adulto: estudo transversal

RESUMO Para promover qualidade de vida aos pacientes internados na unidade de terapia intensiva (UTI), há a necessidade e obrigação de humanizar o atendimento, em que somos comprometidos a prevenir, cuidar, proteger e recuperar, ou seja, promover saúde. O fisioterapeuta exerce um papel fundamental na reabilitação dos pacientes internados em UTI, e, além de qualidade técnica, deve prezar pela qualidade relacional de sua assistência, a fim de transmitir confiança e de estar atento às necessidades dos pacientes. O objetivo do estudo foi verificar se a assistência fisioterapêutica em unidade de terapia intensiva é realizada de forma humanizada. Trata-se de um estudo de corte transversal, mediante entrevistas com questionário avaliativo no quarto dos pacientes, incluindo 60 indivíduos maiores de 18 anos que receberam alta da UTI adulta. Os pacientes entrevistados aprovaram as condutas utilizadas pelos fisioterapeutas, destacando o cuidado destes ao realizar os procedimentos, a modo de evitar maior desconforto dos pacientes. Eles também apresentaram satisfação nas dimensões de atendimento, sendo que dignidade, comunicação, confiabilidade, aspectos interpessoais e receptividade alcançaram 100% de respostas positivas, garantia 98,3%, empatia 96,7%, os aspectos autonomia e eficácia emplacaram 95% das respostas favoráveis à humanização. Os pacientes demonstraram alto grau de aprazimento nos vários aspectos analisados quanto à assistência oferecida pelos fisioterapeutas, que devem prezar pela humanização em sua conduta profissional. Chegou-se à conclusão de que o atendimento fisioterapêutico disponibilizado na UTI foi caracterizado como humanizado pelos pacientes. Os fisioterapeutas demonstraram sua assistência com respeito e ética, possibilitando uma assistência de qualidade.

[Meaning of family confrontation for nurses of intensive care units for adult people - Medellín 2013]

OBJECTIVE

To comprehend the meaning nurses give to family confrontation, from their experiences while patients are in adult intensive care units in Medellin 2013.

METHOD

A qualitative research study was carried out using a phenomenological approach and theoretical convenience sampling of subjects was used. Interviews with open questions were conducted with nurses that worked in different intensive care units in the city of Medellin, with more than one year of experience in these units. The information was coded and categorised to perform the analysis, and some concept maps were created for the final report.

RESULTS

This study showed that nurses focus their care on the critical patient and not on the patient's family. They considered that there is family confrontation when its members comprehend the processes that are carried out in the intensive care unit, and can contribute to the patient's care, while if families do not have confrontations, it is because they do not understand the process, or feel desperate or are absent. The interventions that nurses consider must be done to help in the family confrontation are: information, interdisciplinary support, visits, and companionship.

CONCLUSION

For the nurses, family confrontation means that family members understand, comprehend, accept, know, bear and go on with the situation; therefore, they can make good decisions regarding the patient's care in the adult intensive care units.

Ability to Cope and Adapt in Relatives of Adult Patients Hospitalized at an Intensive Care Unit

Objetivo: identificar la capacidad de afrontamiento y adaptación de los familiares del paciente adulto hospitalizado en la unidad de cuidado intensivo de la Clínica Universidad de La Sabana, en Chía, Colombia. Materiales y métodos: estudio de tipo cuantitativodescriptivo desarrollado en el segundo semestre del 2010, que incluyó 61 familiares. Para la recolección de la información se utilizó el instrumento Escala de Medición del Proceso de Afrontamiento y Adaptación de Callista Roy. Para el análisis de datos se utilizaron medidas de tendencia central, test estadísticos de Mann-Whitney y KrusKal-Wallis. Los rangos de edad de los participantes oscilaron entre 18 y 65 años, con una participación mayoritaria del género femenino (67,2 %) sobre el masculino (32,8 %). Resultados: se consideró que la capacidad de afrontamiento y adaptación fue alta al obtener un puntaje del 85,2 % y baja con puntaje del 14,8 %. Se observó que en una gama de estrategias de afrontamiento y adaptación las utilizadas con mayor frecuencia por los familiares fueron: las de factor físico yenfocado (factor 2, relacionado con bajo afrontamiento), y factores combinados recursivo y centrado (factores 1 y 3, relacionados con alta capacidad de afrontamiento). Conclusiones: las estrategias de afrontamiento utilizadas por los familiares fueron las dirigidas a la solución del problema, caracterizándose por hacer frente a la situación desde un principio, planeando actividades dirigidas a modificar la conducta y desarrollar objetivos específicos que contribuyan con la solución del mismo.

[Benefits of flexible visitation in the intensive care units for the family of critical patients]

AIM

To identify, analyze and summarize the main effects that may be related to flexible visitation policies for the relatives of critically ill adults.

METHOD

A review of the literature was conducted in the following databases: PubMed, CINAHL, PsycINFO, Cochrane Library and CUIDEN. Thematic content analysis was used to evaluate selected articles.

RESULTS

Fifteen articles were included in this review. Four main themes emerged from the thematic content analysis. Themes included the main effects of flexible visitation policies for the family of the critical patients such as: improvement of satisfaction, reduction of anxiety and stress, satisfaction regarding their own family needs, and the role of the family in the patient's care.

CONCLUSION

According to the existing evidence, flexible visitation policies appear to be both beneficial and decisive. It seems to be necessary to favor the participation of the family in the care of the intensive patient as well as the acquisition of a more prominent role the visitation context and in their relationship with the patient.

[Needs of the family in the intensive care units: a review of the literature]

Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting.

OBJECTIVE

To analyze and present the needs of the family members of the critical patient.

METHODOLOGY

A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed.

RESULTS

After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical.

DISCUSSION

One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed.

CONCLUSIONS

This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.

Expectativas de familiares de clientes em UTI sobre o atendimento em saúde: estudo sociopoético

Considerando a política de humanização no atendimento de saúde, tem-se como o problema de pesquisa: quais são as expectativas dos familiares de clientes internados em Unidade de Terapia Intensiva (UTI) quanto à humanização no atendimento pela enfermagem atuante neste setor? Objetivo: analisar a dimensão imaginativa dos familiares de clientes hospitalizados em UTI, identificando suas expectativas sobre o atendimento de suas necessidades humanas pela equipe de enfermagem. Pesquisa sociopoética realizada em 2008 em um Hospital do Rio de Janeiro, Brasil. Grupo Pesquisador: 11 familiares. Resultados com as categorias analíticas: Superando sentimentos de ansiedade; Refletindo sobre as informações de saúde e Fontes de superação da internação do familiar em UTI. Concluiu-se que os familiares expressaram expectativas positivas em relação à internação do cliente, por meio do acolhimento e das informações recebidas. Como contribuição do estudo, acredita-se que, com a orientação e o acolhimento da enfermagem, eles poderão ultrapassar suas expectativas, possibilitando seu crescimento individual e maior aquisição de habilidades em qualidades humanas.

[Analysis of the literature on the relatives of the critical patient: research in effective care needs to be performed]

AIM

To explore the nature of studies on families and the Intensive Care Unit context and the issues they deal with.

DESIGN AND METHODS

This is a qualitative, methodological study that makes a documental analysis of 24 articles (between 1993-2004) located by descriptors in journals and databases. A double analysis was conducted: quality assessment and content analysis.

RESULTS

The articles analyzed were mainly descriptive and reviews of the literature. Six categories were found: environment hostility, family needs, design of interventions, nursing care, experience of the families, and decision making autonomy.

CONCLUSIONS

The nursing staff wants to establish care aimed at the patient's family. To do so, they need to be trained in psychological aspects such as handling of emotional stress, strategies and skills for coping and communication strategies and skills. Research should change its focus from being description to proposing and evaluating intervention strategies. Research findings should translate into recommendations for this change.

[What is important for the family of patients in the intensive care unit?]

The abundant bibliography shows us that the family plays a fundamental paper in the recovery of the hospitalized patients, and the patients in the intensive care units (ICU) are no exception. Several authors have demonstrated that a stress-free and calm setting helps in the care process. Thus, the family needs must be considered to improve their well-being. In this way, their attitude will help in the patient's recovery. Health care personnel must be aware of these needs and make up for their deficit as far as possible. The first study that evaluated this question used the CCFNI questionnaire (Critical Care Family Needs Inventory) that measures the degree of importance given by the relatives to the needs of safety, support, information, comfort and proximity. This study has aimed to detect the degree of importance given by the relatives of the patients in the ICU of the Hospital Dr. Josep Trueta of Girona, using the CCFNI questionnaire. All the relatives of the patients in said unit during the autumn of the year 2003 were interviewed and the needs considered to be most important were compared with the sociodemographic variables of the relatives. The total sample was made up of the 132 people interviewed. The need considered to be most important was safety with 50.3% followed by need for support with 47.2%. In the results, some differences were observed depending according to age and studies of those surveyed and according to the diagnosis and the origin of the hospitalization. The collected data did not differ with the reviewed bibliography. All the study was very valuable for the health care professionals of the unit and was taken into account to improve the deficiencies of the ICU of the hospital of Girona.

The process of giving information to families of critically ill patients: a field of tension

We conducted research to study nurses' views on factors that influence their relationship with patients' relatives in intensive care units in three hospitals in Mallorca (Balearic Islands, Spain). This article focuses on the findings related to the process of giving information to the family. We used a post-structuralist theoretical framework and data were collected through observations and interviews. The analysis revealed that nurses thought information eases relatives' worries, but they felt that in order to avoid conflicts with physicians they should restrain themselves from providing it. We propose that the existing power relationships in intensive care units should be challenged if we expect health care professionals to offer patients' relatives a planned information process.