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Ryan MJ, Lee L, Drisdelle S, Garros D, Seabrook JA, Curran J, Bretzler J, Slumkoski C, Walls M, Betts L, Burgess S, Foster JR. Impact of COVID-19-related restricted family presence policies on Canadian pediatric intensive care unit clinicians: a qualitative study. Can J Anaesth 2024:10.1007/s12630-024-02742-0. [PMID: 38507024 DOI: 10.1007/s12630-024-02742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 03/22/2024] Open
Abstract
PURPOSE Pediatric intensive care units (PICUs) worldwide restricted family presence in response to the COVID-19 pandemic. We aimed to explore the experiences and impact of restricted family presence policies on Canadian PICU clinicians. METHODS We conducted a qualitative study that followed an interpretive phenomenological design. Participants were PICU clinicians providing direct patient care in Canada during periods of COVID-19-related restricted family presence. We purposively sampled for maximum variation among survey participants who consented to be contacted for further research on the same topic. In-depth interviews were conducted remotely via telephone or video-call, audio-recorded, and transcribed. Interviews were inductively coded and underwent thematic analysis. Proposed themes were member-checked by interviewees. RESULTS Sixteen PICU clinicians completed interviews. Interviewees practiced across Canada, represented a range of disciplines (eight nurses, two physicians, two respiratory therapists, two child life specialists, two social workers) and years in profession (0-34 years). We identified four themes representing the most meaningful aspects of restricted family presence for participants: 1) balancing infection control and family presence; 2) feeling disempowered by hospital and policy-making hierarchies; 3) empathizing with family trauma; and 4) navigating threats to the therapeutic relationship. CONCLUSION Pediatric intensive care unit clinicians were impacted by restricted family presence policies during the COVID-19 pandemic. These policies contributed to feelings of disempowerment and challenged clinicians' perceived ability to provide the best family-centred care possible. Frontline expertise should be incorporated into the design and implementation of policies to best support family-centred care in any context and minimize risks of moral distress for PICU clinicians.
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Affiliation(s)
- Molly J Ryan
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Laurie Lee
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Sara Drisdelle
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Daniel Garros
- Stollery Children's Hospital, Edmonton, AB, Canada
- Division of Critical Care Medicine, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
- Department of Pediatrics, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Janet Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Corey Slumkoski
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Martha Walls
- Patient Partner, Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Laura Betts
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Stacy Burgess
- Department of Pediatric Critical Care, IWK Health, Halifax, NS, Canada
| | - Jennifer R Foster
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada.
- Department of Pediatric Critical Care, IWK Health, 5850/5980 University Avenue, Halifax, NS, B3K 6R8, Canada.
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Cardoso AF, Pires MG, Cioga E, Abalroado I, Santos D, Duque FM, Loureiro R, Felizardo H, Fernandes AM, Silva R, Ventura F, Santana E, Cardoso D, Loureiro L. Experiences with remote communication in adult intensive care units during the COVID-19 pandemic: a systematic review protocol. JBI Evid Synth 2023; 21:2455-2464. [PMID: 37711062 DOI: 10.11124/jbies-23-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE The objective of this review is to explore the lived experiences of critically ill adults, their families, or health care professionals with remote communication in intensive care units (ICUs) during the COVID-19 pandemic. INTRODUCTION Family visiting restrictions in ICUs during the COVID-19 pandemic imposed significant challenges to communication between critically ill adults, their families, and the health care team. Evidence shows that several communication strategies were developed and implemented in ICUs during the COVID-19 pandemic to promote family engagement; however, the experiences of critically ill adults, their families, and health care professionals with these strategies are scattered across primary qualitative studies. INCLUSION CRITERIA This review will consider qualitative studies that include critically ill adults, their families, or health care professionals, focusing on their experiences with remote communication strategies in ICUs during the COVID-19 pandemic. METHODS This review will be conducted in accordance with JBI methodology. The search strategy will aim to locate both published and unpublished qualitative studies in English, Spanish, and Portuguese. Studies published after January 2020 will be included. Study selection, critical appraisal, and data extraction will be performed independently by 2 reviewers. Data will be presented in narrative format and synthesized using the JBI meta-aggregation process. A ConQual Summary of Findings will be presented. REVIEW REGISTRATION PROSPERO CRD42022383603.
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Affiliation(s)
- Ana Filipa Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Miguel Grilo Pires
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Elisabete Cioga
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Inês Abalroado
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Diana Santos
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
| | - Filipa Margarida Duque
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Ricardo Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Helena Felizardo
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - António Manuel Fernandes
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rosa Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
- Nursing School of Porto (ESEP), Porto, Portugal
| | - Filipa Ventura
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Elaine Santana
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
| | - Daniela Cardoso
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Luís Loureiro
- Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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Quach S, Veitch A, Zaccagnini M, West A, Nonoyama ML. Underrepresentation of Respiratory Therapists as Experts in Delphi Studies on Respiratory Practices and Research Priorities. Respir Care 2022; 67:1609-1632. [PMID: 36442987 PMCID: PMC9994035 DOI: 10.4187/respcare.10012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Delphi survey techniques are a common consensus method used to collect feedback from an expert panel to inform practices, establish guidelines, and identify research priorities. Collecting respiratory therapists' (RT) expertise and experiences as part of consensus-building methodologies is one way to ensure that they align with RT practices and to better influence respiratory care practice. This narrative review aimed to report the RT representation in expert panels of Delphi studies focused on respiratory therapy practices and research priorities. The research question that guided this review is: to what extent are RTs included as expert participants among published Delphi studies relate to respiratory therapy and research topics? We conducted a structured search of the literature and identified 23 papers that reported Delphi studies related to respiratory care practices and 15 that reported on respiratory-related research priorities. Delphi studies that focused on reporting consensus on respiratory care practices included the following: (1) mechanical ventilation, (2) high-flow nasal cannula therapy, (3) COVID-19 respiratory management, (4) home oxygen therapy, (5) cardiopulmonary monitoring, and (6) disease-specific guidelines. Delphi studies that focused on establishing respiratory research priorities included the following: (1) theory and practice-orientated knowledge gaps, and (2) priority research topics for empirical investigation. The results of this review suggest that RTs were rarely included as expert participants and, when involved, were minimally represented (5% to 33%). Given RTs' diverse and relevant experience in respiratory care, incorporating their perspectives to inform future education, respiratory care practices, and research priorities would allow evidence to better align with knowledge gaps deemed important for the respiratory therapy profession.
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Affiliation(s)
- Shirley Quach
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
| | - Alanna Veitch
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada
- Department Respiratory Therapy, McGill University Health Centre, Montréal, Quebec, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, New Brunswick, Canada
| | - Mika L Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.
- Respiratory Therapy Department, Hospital of Sick Children, Toronto, Ontario, Canada
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Fiest KM, Krewulak KD, Hernández LC, Jaworska N, Makuk K, Schalm E, Bagshaw SM, Bernet X, Burns KEA, Couillard P, Doig CJ, Fowler R, Kho ME, Kupsch S, Lauzier F, Niven DJ, Oggy T, Rewa OG, Rochwerg B, Spence S, West A, Stelfox HT, Parsons Leigh J. Evidence-informed consensus statements to guide COVID-19 patient visitation policies: results from a national stakeholder meeting. Can J Anaesth 2022; 69:868-879. [PMID: 35359262 PMCID: PMC8970637 DOI: 10.1007/s12630-022-02235-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Hospital policies forbidding or limiting families from visiting relatives on the intensive care unit (ICU) has affected patients, families, healthcare professionals, and patient- and family-centered care (PFCC). We sought to refine evidence-informed consensus statements to guide the creation of ICU visitation policies during the current COVID-19 pandemic and future pandemics and to identify barriers and facilitators to their implementation and sustained uptake in Canadian ICUs. METHODS We created consensus statements from 36 evidence-informed experiences (i.e., impacts on patients, families, healthcare professionals, and PFCC) and 63 evidence-informed strategies (i.e., ways to improve restricted visitation) identified during a modified Delphi process (described elsewhere). Over two half-day virtual meetings on 7 and 8 April 2021, 45 stakeholders (patients, families, researchers, clinicians, decision-makers) discussed and refined these consensus statements. Through qualitative descriptive content analysis, we evaluated the following points for 99 consensus statements: 1) their importance for improving restricted visitation policies; 2) suggested modifications to make them more applicable; and 3) facilitators and barriers to implementing these statements when creating ICU visitation policies. RESULTS Through discussion, participants identified three areas for improvement: 1) clarity, 2) accessibility, and 3) feasibility. Stakeholders identified several implementation facilitators (clear, flexible, succinct, and prioritized statements available in multiple modes), barriers (perceived lack of flexibility, lack of partnership between government and hospital, change fatigue), and ways to measure and monitor their use (e.g., family satisfaction, qualitative interviews). CONCLUSIONS Existing guidance on policies that disallowed or restricted visitation in intensive care units were confusing, hard to operationalize, and often lacked supporting evidence. Prioritized, succinct, and clear consensus statements allowing for local adaptability are necessary to guide the creation of ICU visitation policies and to optimize PFCC.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute of Public Health, Calgary, AB, Canada.
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Laura C Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Emma Schalm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Xavier Bernet
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Physiotherapy, Hôpital du Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Robert Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - François Lauzier
- Departments of Medicine and Anesthesiology & Critical Care, Université Laval, Québec City, QC, Canada
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Taryn Oggy
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Ground Floor, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB, T2N 5A1, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute of Public Health, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
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