A Typology of ICU Patients and Families from the Clinician Perspective: Toward Improving Communication

Professionals' narratives of interactions with patients' families in intensive care

Background: ICU patients' family members are in a new, uncertain, and vulnerable situation due to the patient's critical illness and complete dependence on the ICU nurses and physicians. Family members' feeling of being cared for is closely linked to clinicians' attitudes and behavior.Aim: To explore ICU nurses' and physicians' bedside interaction with critically ill ICU patients´ families and discuss this in light of the ethics of care.Research design: A qualitative study using participant observation, focus groups, and thematic narrative analysis.Participants and research context: Data were gathered from July 2017 to August 2019, in four ICUs in Norway through 270 h of fieldwork and seven focus groups with ICU nurses and physicians.Ethical considerations: The Regional Committee for Medical and Health Research Ethics and the Norwegian Centre for Research Data approved the study. Findings: Quality of ICU family care depends on nurses' and physicians' attitudes, behavior, and personality traits. Three main themes were identified: being attentive, an active approach, and degree of tolerance.Discussion: The findings are discussed in light of the ethics of care and empirical research from the intensive care environment.Conclusions: This study shows that attentive, active, and tolerant clinicians represent a culture of ethical care that gives families greater freedom of action and active participation in patient care. Clinicians must not bear sole responsibility for this culture; it must have a firm basis in the hospital and ICU and be established through training, interprofessional reflection, and support of clinicians.

A scheduling-based methodology for improving patient perceptions of quality of care in intensive care units

Research has found that hospitals with better scores on patient experience of care surveys have better patient safety records and outcomes. Therefore, targeting ways of improving patient experience of care is becoming relevant for hospitals not only for the patient health outcomes but also for the financial implications. Therefore, the goal of this paper is to develop new operation management strategies for improving patient experience of care in intensive care units (ICUs). A new scheduling-based methodology is developed that considers two of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey dimensions, doctor communication and discharge information. Two hypotheses are studied. The first hypothesis postulates that to improve doctor communication with the patient, a nurse must be present in the patient room when the doctor performs ward rounds. The second hypotheses states that to improve the patient-doctor communication of discharge information aspect, doctors must see the patient expected to be discharged early in the day. A computational study is performed to gather insights and to measure the performance of the scheduling-based methodology on a case study from an intensive care unit located in a hospital in central Texas. The results show hospital improvement in the studied dimensions of the HCAHPS survey after 1 year of the hospital adoption of the study recommendations.

Creating Middle Stage: Finding a New Space for Reflection within a Residency Program

While communication is essential to effective clinical outcomes, training programs that employ synchronous feedback systems are expensive and time consuming. Using a secure web blog as an asynchronous alternative for enhancing communication skills, we created a unique middle stage learning opportunity within a residency training program. Each resident was recorded interacting with a patient and that digital record was posted to a secure blog. By the end of year three, the residents (N = 6) interacted with 20 patients and wrote a blog post discussing each interaction. The other residents watched these interactions and responded to their peers' digitized interactions in the form of a blog post (N = 95). Transcripts were created and analyzed using the constant comparative method and yielded five categories of resident message types. They were: Narrative of the visit, visit issues, communication strategies, social support, and reflections on the experience and provided a unique opportunity to examine interaction among the residents.

Variation in health literacy among family caregiver communication types

OBJECTIVE

Previously, four caregiver types have been identified as a result of communication patterns between patient and caregiver, revealing unique caregiver information needs and preferences. The purpose of this study was to explore variation in health literacy among the four family caregiver communication types: manager, partner, carrier, and lone caregivers.

METHODS

The sample consisted of 115 cancer caregivers. Participants completed the Family Caregiver Communication Tool and the Health Literacy of Caregivers Scale-Cancer.

RESULTS

A significant difference in health literacy domains was found between caregiver types for cancer-related communication with the care recipient (P = .038) and understanding of the health care system (P = .003). Of the health literacy domains, mean scores were highest on understanding the health care system for both lone and carrier caregivers. Manager and partner caregivers were highest on the social support domain. The self-care domain was lowest for the carrier, lone, and manager caregivers.

CONCLUSIONS

There was a variation across health literacy domains among caregiver communication types, further validating the Family Caregiver Communication Typology. Findings showed a need for educational programs for cancer caregivers to strengthen their health literacy skills. As cancer caregivers have a prominent role in the delivery and quality of cancer care, it is pivotal for health care centers to provide caregiver communication training and support.

"It's better to have three brains working instead of one": a qualitative study of building therapeutic alliance with family members of critically ill patients

Background

Studies in the intensive care unit (ICU) suggest that better communication between families of critically ill patients and healthcare providers is needed; however, most randomized trials targeting interventions to improve communication have failed to achieve family-centered outcomes. We aim to offer a novel analysis of the complexities involved in building positive family-provider relationships in the ICU through the consideration of not only communication but other important aspects of family-provider interactions, including family integration, collaboration, and empowerment. Our goal is to explore family members’ perspectives on the enablers and challenges to establishing therapeutic alliance with ICU physicians and nurses.

Methods

We used the concept of therapeutic alliance as an organizational and analytic tool to conduct an interview-based qualitative study in a 20-bed adult medical-surgical ICU in an academic hospital in Toronto, Canada. Nineteen family members of critically ill patients who acted as substitute decision-makers and/or regularly interacted with ICU providers were interviewed. Participants were sampled purposefully to ensure maximum variation along predetermined criteria. A hybrid inductive-deductive approach to analysis was used.

Results

Participating family members highlighted the complementary roles and practices of ICU nurses and physicians in building therapeutic alliance. They reported how both provider groups had profession specific and shared contributions to foster family communication, integration, and collaboration, while physicians played a key role in family empowerment. Families’ lack of familiarity with ICU personnel and processes, physicians’ sporadic availability and use of medical jargon during rounds, however, reinforced long established power differences between lay families and expert physicians and challenged family integration. Family members also identified informal interactions as missed opportunities for relationship-building with physicians. While informal interactions with nurses at the bedside facilitated therapeutic alliance, inconsistent and ad-hoc interactions related to routine decision-making hindered family empowerment.

Conclusions

Multiple opportunities exist to improve family-provider relationships in the ICU.

The four dimensions of therapeutic alliance prove analytically useful to highlight those aspects that work well and need improvement, such as in the areas of family integration and empowerment.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3341-1) contains supplementary material, which is available to authorized users.

The communicative role of companion pets in patient-centered critical care

OBJECTIVE

This study examines a personal pet hospital visitation program dedicated to preserving the human-animal bond during chronic, critical, or terminal illness to understand the novel ways companion pets facilitate meaningful communication between patients, providers, and families in hospital settings.

METHODS

I thematically analyzed data collected through a variety of qualitative methods, including participant observation, informal and semi-structured interviews, and a review of organizational materials.

RESULTS

The presence of a patient's personal pet prompted stories and behaviors characterized by (1) compassion, (2) connection, and (3) response between patients, providers, and family members.

CONCLUSION

Personal pet hospital visits facilitate storied conversations, foster healing relationships, and offer alternative ways of knowing that can promote greater understandings of the patient's psychosocial context for more personalized care and improved well-being.

PRACTICE IMPLICATIONS

Patient-centered critical care requires meaningful consideration of a patient's health, well-being, and comfort. When appropriate, the therapeutic benefits of companion animals and the deep personal bonds between patients and their pets should be acknowledged and provided as part of this care.