Families dealing with advanced heart failure: a challenge and an opportunity

Caring for the invisible and forgotten: a qualitative document analysis and experience-based co-design project to improve the care of families experiencing out-of-hospital cardiac arrest

OBJECTIVES

The objectives of this project were to collect and analyze clinical governance documents related to family-centred care and cardiac arrest care in Canadian EMS organizations; and to improve the family-centredness of out-of-hospital cardiac arrest care through experience-based co-design.

METHODS

We conducted qualitative document analysis of Canadian EMS clinical governance documents related to family-centred and cardiac arrest care, combining elements of content and thematic analysis methods. We then used experience-based co-design to develop a family-centred out-of-hospital cardiac arrest care policy and procedure template.

RESULTS

Thirty-five Canadian EMS organizations responded to our requests, representing service area coverage for 80% of the Canadian population. Twenty documents were obtained for review and six overarching themes were identified: addressing family in event of in-home death, importance of family, family member escort, provider discretion and family presence discouraged. Informed by our qualitative analysis we then co-designed a policy and procedure template was created that prioritizes patient care while promotes family-centredness.

CONCLUSIONS

There were few directives to support family-centred care by Canadian EMS organizations. A family-centred out-of-hospital cardiac arrest care policy and procedure template was developed using experience-based co-design to assist EMS organizations improve the family-centredness of out-of-hospital cardiac arrest care.

What are the care needs of families experiencing cardiac arrest?: A survivor and family led scoping review

AIM

The sudden and unexpected cardiac arrest of a family member can be a grief-filled and life-altering event. Every year many hundreds of thousands of families experience the cardiac arrest of a family member. However, care of the family during the cardiac arrest and afteris poorly understood and incompletely described. This review has been performed with persons with lived experience of cardiac arrest to describe, "What are the needs of families experiencing cardiac arrest?" from the moment of collapse until the outcome is known.

METHODS

This review was guided by specific methodological framework and reporting items (PRISMA-ScR) as well as best practices in patient and public involvement in research and reporting (GRIPP2). A search strategy was developed for eight online databases and a grey literature review. Two reviewers independently assessed all articles for inclusion and extracted relevant study information.

RESULTS

We included 47 articles examining the experience and care needs of families experiencing cardiac arrest of a family member. Forty one articles were analysed as six represented duplicate data. Ten family care need themes were identified across five domains. The domains and themes transcended cardiac arrest setting, aetiology, family-member age and family composition. The five domains were i) focus on the family member in cardiac arrest, ii) collaboration of the resuscitation team and family, iii) consideration of family context, iv) family post-resuscitation needs, and v) dedicated policies and procedures. We propose a conceptual model of family centred cardiac arrest.

CONCLUSION

Our review provides a comprehensive mapping and description of the experience of families and their care needs during the cardiac arrest of a family-member. Furthermore, our review was conducted with co-investigators and collaborators with lived experience of cardiac arrest (survivors and family members of survivors and non-survivors alike). The conceptual framework of family centred cardiac arrest care presented may aid resuscitation scientists and providers in adopting greater family centeredness to their work.

Towards a universal model of family centered care: a scoping review

Background

Families play an important role meeting the care needs of individuals who require assistance due to illness and/or disability. Yet, without adequate support their own health and wellbeing can be compromised. The literature highlights the need for a move to family-centered care to improve the well-being of those with illness and/or disability and their family caregivers. The objective of this paper was to explore existing models of family-centered care to determine the key components of existing models and to identify gaps in the literature.

Methods

A scoping review guided by Arksey & O’Malley (2005) examined family-centered care models for diverse illness and age populations. We searched MEDLINE, PsycINFO, CINAHL and EMBASE for research published between 1990 to August 1, 2018. Articles describing the development of a family-centered model in any patient population and/or healthcare field or on the development and evaluation of a family-centered service delivery intervention were included.

Results

The search identified 14,393 papers of which 55 met our criteria and were included. Family-centered care models are most commonly available for pediatric patient populations (n = 40). Across all family-centered care models, the consistent goal is to develop and implement patient care plans within the context of families. Key components to facilitate family-centered care include: 1) collaboration between family members and health care providers, 2) consideration of family contexts, 3) policies and procedures, and 4) patient, family, and health care professional education. Some of these aspects are universal and some of these are illness specific.

Conclusions

The review identified core aspects of family-centred care models (e.g., development of a care plan in the context of families) that can be applied to all populations and care contexts and some aspects that are illness specific (e.g., illness-specific education). This review identified areas in need of further research specifically related to the relationship between care plan decision making and privacy over medical records within models of family centred care. Few studies have evaluated the impact of the various models on patient, family, or health system outcomes. Findings can inform movement towards a universal model of family-centered care for all populations and care contexts.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4394-5) contains supplementary material, which is available to authorized users.

The role of stress, depression, and violence on unintended pregnancy among young urban women

BACKGROUND

Unintended pregnancy (UP) is common, particularly among women exposed to violence, and it is linked to adverse maternal and child outcomes. This study investigated the potential role of current depressive symptoms, social support, and psychosocial stress in moderating the association between violence exposure and UP.

METHODS

Pregnant women, being treated at an urban Emergency Room, completed a self-reported baseline interview where pregnancy intention as well as depression symptoms, perceived stress, past and current violence, and demographic factors were evaluated.

RESULTS

Pregnant women were identified among women aged 14-40 years presenting to an urban emergency department. Women reporting sadness or planning to terminate the pregnancy were classified as having an UP. A higher number of women reported an UP if they had at least one episode of childhood sexual assault (CSA) (odds ration [OR]=1.39, 95% confidence interval [CI]: 1.03-1.87), but this association disappeared after adjusting for socioeconomic factors. Relative to women reporting an intended pregnancy, women reporting sadness or wanting to abort the pregnancy reported lower social support (mean number of friends 2.5 vs. 3.0, p=0.005), had a higher prevalence of current depressive symptoms (67% vs. 49%, OR=2.14, 95% CI: 1.72-2.66), and had higher mean levels of current perceived stress (6.9 vs. 5.6, p<0.001). At least one episode of CSA and current depressive symptoms was positively associated with the report of sadness or wanting to abort the pregnancy relative to women with no depressive symptoms and no history of CSA. In addition, high level of stress positively moderated the role of CSA and reporting sadness or wanting to abort the pregnancy.

CONCLUSION

Ongoing screening for depressive symptoms and stress among female survivors of CSA may be important in reducing the high rates of unintended pregnancy in urban communities.

Achieving medical stability: Wives' experiences with heart failure

The incidence of heart failure continues to rise as innovative treatments are developed. Despite life-prolonging interventions, morbidity and mortality in patients younger than 65 remain high. Few studies have focused on this younger cohort and/or their family caregivers as they navigate the complex illness trajectories manifested in heart failure. Instrumental case studies were employed to present exemplars for each of the five identified heart failure trajectories. Culling data from a longitudinal study of female spousal caregivers, each case study represents a wife's discussion of caring for a husband (<65 years) in response to the husband's changing heart failure trajectory. The goal of medical stability and the notion of uncertainty permeate throughout the case studies. Suggestions for supporting these wives are presented.

Psychological, social and spiritual distress at the end of life in heart failure patients

PURPOSE OF REVIEW

Chronic heart failure patients have palliative care needs that include psychosocial and spiritual support, particularly towards the end of life, when breathlessness and resultant immobility become increasingly severe. This review informs clinicians of the importance of understanding, assessing and managing patients' psychosocial and spiritual needs.

RECENT FINDINGS

The high prevalence of depression (9-77.5%) among chronic heart failure patients is well documented. Clinical assessment and treatment of depression and anxiety are key to good patient care, although no model for assessment has been agreed. Evidence suggests that social support and spiritual belief are important coping resources, but there is a dearth of research into social and spiritual distress in chronic heart failure. Patients rarely access social services support, and family carers experience considerable burden. Little is known about how psychosocial and spiritual variables influence each other, and the impact of social and spiritual distress on outcomes such as quality of life.

SUMMARY

We hope this review will inform cardiac and palliative care staff about the prevalence of psychosocial and spiritual distress in advanced chronic heart failure, and highlight the importance of their assessment and management. There is an urgent need for research in this field, including the rigorous development and evaluation of service models and nonpharmacological interventions.

Living kidney organ donation: experiences of spousal support of donors

AIM

The purpose of this study was to explore the process of living kidney donation as experienced by husbands of donors to aid nurses and all members of the health care team in promoting informed consent for those considering living donation and to promote the well being of spouses of living donors, donors and their families.

BACKGROUND

The attitudes of husbands of living kidney donors may affect their decision to donate and satisfaction with recovery from donation surgery, thus it is critical to know how husbands of living kidney donors view kidney donation.

METHODS

Eleven male spouses of living kidney donors were interviewed three months following their wife's donation. Grounded theory methodology was used to inaugurate a substantive theory that describes living kidney donation and its impact on the spousal relationship and family, as experienced by the husband of a donor.

RESULTS

The result of the data analysis was a substantive theory pertaining strictly to the husbands' experiences as the spouse of the living kidney donor. The process commenced with scheduling of the living donation followed by the postoperative time frame, including bringing the donor wife home. The core variable, 'Fulfilling Your Vows', described attitudes, behaviours and actions that guided husbands in successfully and generously caring for their wives, their families, the recipients and themselves throughout the living kidney donation process and continuing 'to this day'.

RELEVANCE TO CLINICAL PRACTICE

The substantive theory of 'Fulfilling Your Vows' will guide nurses and other transplant specialists in helping to improve fully informed consent of potential donors before surgery and in developing supportive strategies to maximize spouse, donor and family outcomes throughout the transplantation process.

Palliative care and hospice in advanced heart failure

This paper provides an evidence-based review of the principles underlying palliative care for heart failure (HF), including its pathogenesis, staging, assessment, prognosis, and treatment. Approaches to advanced care planning, symptom management, hospice eligibility, home inotropic infusions, device management and improving the continuum of care in HF are discussed. The reader will be able to recognize advanced HF, use important elements of physical assessment, utilize Web-based prognostic and risk-stratification models, facilitate advance care planning, ensure optimal treatment, manage common symptoms and comorbid conditions, determine hospice eligibility, and consider issues related to withholding or withdrawal of inotropic infusions and devices used in HF refractory to standard treatment. The ultimate goal of palliative care for heart failure is to integrate knowledge of treatment advances and comfort measures and to provide them concurrently in a seamless continuum to patients with late-stage disease.

A Qualitative Evaluation of a Family Nursing Intervention

Congestive heart failure is a major source of anxiety for both patients and their family. This article presents the results of a qualitative case study aimed at evaluating family nursing interventions from the perspective of the family members and a clinical nurse specialist (CNS). A CNS applied a family nursing intervention program with 4 couples. Data were obtained through semistructured interviews preintervention and postintervention for the couples and postintervention for the CNS. The transcripts of the interviews were submitted for content analysis. For the couples, results show both spouses subject to a high level of suffering, which can be alleviated through a family nursing meeting that allows them to obtain a better understanding of each other's experience. For the CNS, family interventions were considered a privilege since they helped relieve suffering and her own feelings of powerlessness. These results have the potential to improve family nursing interventions and enhance CNS practice.

Evidence on Spouse Responses to Illness as a Guide to Understanding and Studying Spouse Responses to Living Organ Donation

Although living kidney donors receive praise from friends and coworkers for their selflessness, recent studies report that members of the immediate family may not be as supportive. Reports of conflict surrounding living organ donation include divorce between the donor and the donor's spouse. The purpose of this review of the literature is to (1) discuss the spousal role when confronted with a partner's illness, (2) explore the current research describing the spouses of patients with heart disease and cancer, various transplant recipients, and living organ donors, and (3) identify the need for future research to explore the experiences and needs of the spouses of living kidney donors. Because the attitudes of donor family members, especially spouses, may affect the decision to donate and the satisfaction with recovery from donation surgery, it is critical to know how the spouses of living kidney donors view kidney donation. This knowledge may be instrumental in promoting family harmony and donor recovery and wellness.

Evidenced-based Factors in Readmission of Patients with Heart Failure

The purpose of this project was to organize the variables associated with the hospital readmission of patients with heart failure (HF) into a usable framework to inform clinical practice and facilitate administrative decision making. An integrated, systematic review of the literature was used as the research approach. A content analysis of the sample (31 research reports from the years 1986-2004) yielded multiple factors associated with the hospital readmission of HF patients. Factors and their definitions were extracted, grouped into like categories, and eventually classified into 5 domains-demographic, physiologic, psychosocial, patient functioning, and resource utilization. The resulting framework has clinical, research, and administrative implications in the delivery of care to HF patients.

Depression and Anxiety in Heart Failure

BACKGROUND

Although common among patients with heart failure, depression and anxiety have been relatively neglected by researchers and practitioners. Both depression and anxiety have been implicated in contributing independently to the poor outcomes seen in patients with heart failure. Emphasis in the literature is on physical symptom recognition and management, in contrast to the patient's perspective of the effects of heart failure on his or her daily life.

METHODS AND RESULTS

This review summarizes and integrates research findings on anxiety and depression and translates these findings to clinical practice. Depression and anxiety are prevalent among patients with heart failure and require assessment and intervention. Short-term nonpharmacologic approaches, in conjunction with drug therapy, hold promise for successful management of patients who are depressed or anxious.

CONCLUSION

Carefully designed clinical trials that are tailored to individual needs, yet are embedded within a systemic framework, are needed to inform clinicians regarding optimal practices for the treatment of patients with heart failure who suffer from depression or anxiety.