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Wubben N, van den Boogaard M, van der Hoeven JG, Zegers M. Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study. BMJ Open 2021; 11:e050134. [PMID: 34380728 PMCID: PMC8359489 DOI: 10.1136/bmjopen-2021-050134] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members. DESIGN Qualitative study. SETTING Two Dutch tertiary centres. PARTICIPANTS 19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay. RESULTS Three themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family. CONCLUSIONS Interviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients' values and needs in the decision-making process.
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Affiliation(s)
- Nina Wubben
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | | | - Marieke Zegers
- Intensive care, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Silva MCFCRD, Borba RIHD, Onishi JYT, Horta ALDM, Ribeiro CA. Interação do técnico em enfermagem com a família do paciente hospitalizado. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar as interações observadas entre o técnico em enfermagem e a família do paciente hospitalizado, à luz dos pressupostos do Cuidado Centrado no Paciente e na Família e do Código de Ética dos Profissionais de Enfermagem. Métodos Estudo qualitativo, cujos referenciais teóricos foram os pressupostos do Cuidado Centrado no Paciente e na Família e o Código de Ética dos Profissionais de Enfermagem. Participaram nove técnicos em enfermagem das unidades de clínica médica de dois hospitais públicos do Estado de São Paulo. Os dados foram coletados por observação participante e analisados pela Análise Qualitativa de Conteúdo Convencional. Resultados As interações entre o técnico em enfermagem e os familiares foram limitadas no que se referiu à utilização dos pressupostos do Cuidado Centrado no Paciente e na Família e no cumprimento do que era preconizado pelo o Código de Ética dos Profissionais de Enfermagem, conforme revelaram as categorias: Não tratando os familiares com respeito e dignidade; Não compartilhando informação com os familiares; Não negociando a forma de participação e colaboração na prestação do cuidado. Conclusão É imprescindível a incorporação dos pressupostos do Cuidado Centrado no Paciente e na Família e de aspectos éticos relacionados à família preconizados pelo Código de Ética dos Profissionais de Enfermagem na formação e na vivência profissional do técnico em enfermagem, contribuindo para um cuidado de qualidade, ético e solidário.
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van Mol MMC, Boeter TGW, Verharen L, Kompanje EJO, Bakker J, Nijkamp MD. Patient- and family-centred care in the intensive care unit: a challenge in the daily practice of healthcare professionals. J Clin Nurs 2017; 26:3212-3223. [DOI: 10.1111/jocn.13669] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Margo MC van Mol
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Trudi GW Boeter
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | | | - Erwin JO Kompanje
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
| | - Jan Bakker
- Department of Intensive Care Adults; Erasmus MC University Medical Center Rotterdam; Rotterdam the Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine; Department of Medicine; Columbia University Medical Center; New York NY USA
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences; Open University of the Netherlands; Heerlen the Netherlands
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Rensen A, van Mol MM, Menheere I, Nijkamp MD, Verhoogt E, Maris B, Manders W, Vloet L, Verharen L. Quality of care in the intensive care unit from the perspective of patient's relatives: development and psychometric evaluation of the consumer quality index 'R-ICU'. BMC Health Serv Res 2017; 17:77. [PMID: 28118840 PMCID: PMC5260020 DOI: 10.1186/s12913-016-1975-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 12/31/2016] [Indexed: 11/11/2022] Open
Abstract
Background The quality standards of the Dutch Society of Intensive Care require monitoring of the satisfaction of patient’s relatives with respect to care. Currently, no suitable instrument is available in the Netherlands to measure this. This study describes the development and psychometric evaluation of the questionnaire-based Consumer Quality Index ‘Relatives in Intensive Care Unit’ (CQI ‘R-ICU’). The CQI ‘R-ICU’ measures the perceived quality of care from the perspective of patients’ relatives, and identifies aspects of care that need improvement. Methods The CQI ‘R-ICU’ was developed using a mixed method design. Items were based on quality of care aspects from earlier studies and from focus group interviews with patients’ relatives. The time period for the data collection of the psychometric evaluation was from October 2011 until July 2012. Relatives of adult intensive care patients in one university hospital and five general hospitals in the Netherlands were approached to participate. Psychometric evaluation included item analysis, inter-item analysis, and factor analysis. Results Twelve aspects were noted as being indicators of quality of care, and were subsequently selected for the questionnaire’s vocabulary. The response rate of patients’ relatives was 81% (n = 455). Quality of care was represented by two clusters, each showing a high reliability: ‘Communication’ (α = .80) and ‘Participation’ (α = .84). Relatives ranked the following aspects for quality of care as most important: no conflicting information, information from doctors and nurses is comprehensive, and health professionals take patients’ relatives seriously. The least important care aspects were: need for contact with peers, nuisance, and contact with a spiritual counsellor. Aspects that needed the most urgent improvement (highest quality improvement scores) were: information about how relatives can contribute to the care of the patient, information about the use of meal-facilities in the hospital, and involvement in decision-making on the medical treatment of the patient. Conclusions The CQI ‘R-ICU’ evaluates quality of care from the perspective of relatives of intensive care patients and provides practical information for quality assurance and improvement programs. The development and psychometric evaluation of the CQI ‘R-ICU’ led to a draft questionnaire, sufficient to justify further research into the reliability, validity, and the discriminative power of the questionnaire. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1975-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ans Rensen
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.
| | - Margo M van Mol
- Department of Intensive Care, Erasmus MC, University Medical Center's, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilse Menheere
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
| | - Marjan D Nijkamp
- Faculty of Psychology and Educational Sciences-Open University of the Netherlands, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands
| | - Ellen Verhoogt
- Medical Center Spaarne Gasthuis, Vondelweg 999, 2026 BW, Haarlem, Netherlands
| | - Bea Maris
- Medical Center Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - Willeke Manders
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
| | - Lilian Vloet
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands.,IQ scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisbeth Verharen
- Department of Emergency and Critical care, Faculty of Health, Behavior and Society, HAN University of Applied Sciences, Postbox 6960, 6503, GL, Nijmegen, The Netherlands
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