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Karachi F, van Nes MB, Gosselink R, Hanekom S. Patient perceptions of ICU physiotherapy: 'Your body needs to go somewhere to be recharged … '. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:e1092. [PMID: 38357692 PMCID: PMC10866209 DOI: 10.7196/sajcc.2023.v39i3.1092] [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] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes. Objectives As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit. Methods A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed. Results Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy). Conclusion While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes. Contribution of the study The study highlights the feasibility and importance of the use of patient-reported outcomes to measure physiotherapy interventions and informs the development of patient reported outcomes and the importance of patient centred physiotherapy care in the ICU setting.
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Affiliation(s)
- F Karachi
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - M B van Nes
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R Gosselink
- Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium; and Department of Physiotherapy, Stellenbosch University,
Tygerberg, South Africa
| | - S Hanekom
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
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Cardona M, Anstey M, Lewis ET, Shanmugam S, Hillman K, Psirides A. Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic. Breathe (Sheff) 2020; 16:200062. [PMID: 33304408 PMCID: PMC7714540 DOI: 10.1183/20734735.0062-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
The patient and family perspective on the appropriateness of intensive care unit (ICU) treatments involves preferences, values and social constructs beyond medical criteria. The clinician's perception of inappropriateness is more reliant on clinical judgment. Earlier consultation with families before ICU admission and patient education on the outcomes of life-sustaining therapies may help reconcile these provider-patient disagreements. However, global emergencies like COVID-19 change the usual paradigm of end-of-life care, as it is a new disease with only scarce predictive information about it. Pandemics can also bring about the burdensome predicament of doctors having to make unwanted choices of rationing access to the ICU when demand for otherwise life-saving resources exceeds supply. Evidence-based prognostic checklists may guide treatment triage but the principles of shared decision-making are unchanged. Yet, they need to be altered with respect to COVID-19, defining likely outcomes and likelihood of benefit for the patient, and clarifying their willingness to take on the risks inherent to being in an ICU for 2 weeks for those eligible. For patients who are admitted during the prodrome of COVID-19 disease, or those who deteriorate in the second week, clinicians have some lead time in hospital to have appropriate discussions about ceilings of treatments offered based on severity. KEY POINTS The patient and family perspective on inappropriateness of intensive care at the end of life often differs from the clinician's opinion due to the nonmedical frame of mind.To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction is a good start to reconcile differences between physician and health service users' viewpoints.During pandemics, where health systems may collapse, different admission criteria driven by the need to ration services may be warranted. EDUCATIONAL AIMS To explore the extent to which older patients and their families are involved in decisions about appropriateness of intensive care admission or treatmentsTo understand how patients or their families define inappropriate intensive care admission or treatmentsTo reflect on the implications of decision to admit or not to admit to the intensive care unit in the face of acute resource shortages during a pandemic.
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Affiliation(s)
- Magnolia Cardona
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
- Gold Coast Hospital and Health Service, Southport, Australia
| | - Matthew Anstey
- Intensive Care Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Ebony T. Lewis
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, Australia
| | | | - Ken Hillman
- Intensive Care Unit, Liverpool Hospital, Liverpool, Australia
| | - Alex Psirides
- Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand
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Uveges MK, Milliken A, Alfred A. Role of the Critical Care Nurse in Disclosing Difficult News. AACN Adv Crit Care 2020; 30:287-293. [PMID: 31462527 DOI: 10.4037/aacnacc2019436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Melissa Kurtz Uveges
- Melissa Kurtz Uveges is Postdoctoral Research Fellow, Center for Bioethics at Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 . Aimee Milliken is Wiese Postdoctoral Fellow in Clinical Ethics, Brigham and Women's Hospital, Brighton, Massachusetts. Afi Alfred is Clinical Operations Manager, Bowdoin Street Health Center, Boston, Massachusetts
| | - Aimee Milliken
- Melissa Kurtz Uveges is Postdoctoral Research Fellow, Center for Bioethics at Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 . Aimee Milliken is Wiese Postdoctoral Fellow in Clinical Ethics, Brigham and Women's Hospital, Brighton, Massachusetts. Afi Alfred is Clinical Operations Manager, Bowdoin Street Health Center, Boston, Massachusetts
| | - Afi Alfred
- Melissa Kurtz Uveges is Postdoctoral Research Fellow, Center for Bioethics at Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 . Aimee Milliken is Wiese Postdoctoral Fellow in Clinical Ethics, Brigham and Women's Hospital, Brighton, Massachusetts. Afi Alfred is Clinical Operations Manager, Bowdoin Street Health Center, Boston, Massachusetts
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Deem MJ, Stokes F. Culture and Consent in Clinical Care: A Critical Review of Nursing and Nursing Ethics Literature. ANNUAL REVIEW OF NURSING RESEARCH 2019; 37:223-259. [PMID: 30692159 DOI: 10.1891/0739-6686.37.1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jongerden IP, Slooter AJ, Peelen LM, Wessels H, Ram CM, Kesecioglu J, Schneider MM, van Dijk D. Effect of intensive care environment on family and patient satisfaction: a before–after study. Intensive Care Med 2013; 39:1626-34. [DOI: 10.1007/s00134-013-2966-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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Olufowote JO. A dialectical perspective on informed consent to treatment: an examination of radiologists' dilemmas and negotiations. QUALITATIVE HEALTH RESEARCH 2011; 21:839-852. [PMID: 21403091 DOI: 10.1177/1049732311402097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Informed consent to treatment (ICT), designed to honor patient autonomy, has been an important subject of inquiry in many disciplines. To foreground the dynamic and dilemmatic tendencies of ICT practice implied by previous inquiries, I advanced relational dialectics theory into the realm of physicians' experiences with ICT. On performing a dialectical analysis of transcripts from focus group discussions with radiologists, I found them experiencing four primary tensions: (a) between simple and complex ICT; (b) between radiologist and patient control; (c) between standardized and idiosyncratic practice (involving struggles between documentation and conversational process, and between vague and detailed language use); and (d) between withholding and disclosing alternatives. Moreover, I drew on concepts from relational dialectics theory to capture the various ways radiologists negotiate these dialectics. I conclude with practical applications for physician and patient training and interprofessional coordination.
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Olufowote JO. Informed consent to treatment's sociohistorical discourse of traditionalism: a structurational analysis of radiology residents' accounts. HEALTH COMMUNICATION 2010; 25:22-31. [PMID: 20390668 DOI: 10.1080/10410230903473508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Informed consent to treatment (IC) is designed to protect patient autonomy and control through disclosures and shared decisions. However, many malpractice claims suggest patients perceive problems with its handling (e.g., information withholding). Moreover, previous studies of IC lack the nuance of discursive perspectives, theoretical grounding, and recognition of IC's sociohistorical context. Drawing on a structurational perspective, which conceives of IC as constituted by contradictory sociohistorical structures (discourse formations) representing different groups' interests in controlling IC, this study examines how the structure representing physicians' interests is (re)produced in practice. Focus group accounts reveal how radiologists-drawing upon interpretive schemes of patients as fearful, ignorant, and easily controlled-discursively and skillfully manipulate IC language and information in engineering patients' decisions.
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Stuke L, Jennings A, Gunst M, Tyner T, Friese R, O'Keeffe T, Frankel H. Universal consent practice in academic intensive care units (ICUs). J Intensive Care Med 2009; 25:46-52. [PMID: 20034952 DOI: 10.1177/0885066609350982] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs. METHODS A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied. RESULTS Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients. CONCLUSION There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.
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Affiliation(s)
- Lance Stuke
- LSU Health Science Center, New Orleans, LA, USA
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Wittmann-Price RA, Fliszar R, Bhattacharya A. Elective Cesarean births: are women making emancipated decisions? Appl Nurs Res 2009; 24:147-52. [PMID: 21777789 DOI: 10.1016/j.apnr.2009.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/12/2009] [Accepted: 08/16/2009] [Indexed: 11/29/2022]
Abstract
This mixed method study investigated the extent to which women used emancipated decision making when selecting a birth method, whether they perceived they had a choice, and if they were satisfied with their decision. Findings suggest that vaginal birth is still the preferred method of delivery for these study participants.
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Affiliation(s)
- Ruth A Wittmann-Price
- Drexel University College of Nursing and Health Professions, Philadelphia, PA 19102, USA.
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Olumide Olufowote J. A structurational analysis of informed consent to treatment: (re)productions of contradictory sociohistorical structures in practitioners' interpretive schemes. QUALITATIVE HEALTH RESEARCH 2009; 19:802-814. [PMID: 19365100 DOI: 10.1177/1049732309335605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Informed consent (IC) to treatment honors patient autonomy and bodily integrity. Yet, it is a leading reason for patient litigation, it has not been examined from discursive or theoretical perspectives, and its sociohistorical context is ignored. In a previous analysis of American IC law and the IC literature, structuration theory guided a reconceptualization of IC as unfolding amid contradictory sociohistorical structures or discursive formations-traditionalism, liability, and decision making-representing interests favoring a group's (physicians, states and administrative entities, and patients, respectively) control of IC. This study's focus groups with radiologists found them (re)producing these structures in their interpretive schemes of patients' reactions to IC, IC as protective paperwork, and IC as a patient- and relationship-centered process.
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Abstract
As critical care nurses, we all participate in the informed consent process, whether for a routine procedure or surgery or for a research study or clinical trial. This first article of a 2-part series discusses the critical care nurse's role concerning informed consent for surgery or other invasive procedures, including nursing procedures. Part 2 will discuss the critical care nurse's role concerning informed consent for clinical trials.
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Verheijde JL, Rady MY, McGregor JL. Defining the scope of implied consent in the emergency department: shortchanging patients' right to self determination. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2007; 7:51-W4. [PMID: 18098026 DOI: 10.1080/15265160701710352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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