1
|
Franck LS, Magaña J, Bisgaard R, Lothe B, Sun Y, Morton CH. Mobile-enhanced Family Integrated Care for preterm infants: A qualitative study of parents' views. PEC INNOVATION 2024; 4:100284. [PMID: 38737891 PMCID: PMC11087992 DOI: 10.1016/j.pecinn.2024.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Objective The Family Integrated Care (FICare) model improves outcomes for preterm infants and parents compared with family-centered care (FCC). FICare with mobile technology (mFICare) may improve uptake and impact. Research on FICare in the United States (US) is scarce and little is known about parents' experience. Methods We conducted qualitative interviews with nine parents, exploring their NICU experiences, participation in and perceptions of the mFICare program. A directed content analysis approach was used, and common themes were derived from the data. Results Overall, parents had positive NICU experiences and found mFICare helpful in meeting three common parenting priorities: actively caring for their infant, learning how to care for their infant, and learning about the clinical status of their infant. They described alignment and misalignment with mFICare components relative to their personal parenting priorities and offered suggestions for improvement. Nurses were noted to play key roles in providing or facilitating parent support and encouragement to participate in mFICare and parenting activities. Conclusion The mFICare program showed potential for parental acceptance and participation in US NICUs. Innovation The mFICare model is an innovation in neonatal care that can advance the consistent delivery of NICU family-centered care planning and caregiving.Clinical Trial Registration:NCT03418870 01/02/2018.
Collapse
Affiliation(s)
- Linda S. Franck
- Department of Family Health Care Nursing, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Jazzelle Magaña
- Department of Pediatrics, Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Robin Bisgaard
- Intensive Care Nursery, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | | | - Yao Sun
- Division of Neonatology, University of California San Francisco, San Francisco, CA, USA
| | - Christine H. Morton
- Department of Pediatrics, Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
2
|
Duong J, Wang G, Lean G, Slobod D, Goldfarb M. Family-centered interventions and patient outcomes in the adult intensive care unit: A systematic review of randomized controlled trials. J Crit Care 2024; 83:154829. [PMID: 38759579 DOI: 10.1016/j.jcrc.2024.154829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/19/2024] [Accepted: 05/05/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE There is a need to understand how family engagement in the intensive care unit (ICU) impacts patient outcomes. We reviewed the literature for randomized family-centered interventions with patient-related outcomes in the adult ICU. DATA SOURCES The MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases were searched from inception until July 3, 2023. STUDY SELECTION Articles involving randomized controlled trials (RCTs) in the adult critical care setting evaluating family-centered interventions and reporting patient-related outcomes. DATA EXTRACTION Author, publication year, setting, number of participants, intervention category, intervention, and patient-related outcomes (patient-reported, physiological, clinical) were extracted. DATA SYNTHESIS There were 28 RCTs (12,174 participants) included. The most common intervention types were receiving care and meeting needs (N = 10) and family presence (N = 7). 16 RCTs (57%) reported ≥1 positive outcome from the intervention; no studies reported worse outcomes. Studies reported improvements in patient-reported outcomes such as anxiety, satisfaction, post-traumatic stress symptoms, depression, and health-related quality of life. RCTs reported improvements in physiological indices, adverse events, mechanical ventilation duration, analgesia use, ICU length of stay, delirium, and time to withdrawal of life-sustaining treatments. CONCLUSIONS Nearly two-thirds of RCTs evaluating family-centered interventions in the adult ICU reported positive patient-related outcomes. KEYPOINTS Question: Do family-centered interventions improve patient outcomes in the adult intensive care unit (ICU)? FINDINGS The systematic review found that nearly two-thirds of randomized clinical trials of family-centered interventions in the adult ICU improved patient outcomes. Studies found improvements in patient mental health, care satisfaction, physiological indices, and clinical outcomes. There were no studies reporting worse patient outcomes. Meaning: Many family-centered interventions can improve patient outcomes.
Collapse
Affiliation(s)
- Julia Duong
- McGill Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Gary Wang
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Graham Lean
- McGill Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada
| | - Douglas Slobod
- Department of Critical Care Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|
3
|
Potter KM, Pun BT, Maya K, Young B, Williams S, Schiffman M, Hosie A, Boehm LM. Delirium and Coronavirus Disease 2019: Looking Back, Moving Forward. Crit Care Nurs Clin North Am 2024; 36:415-426. [PMID: 39069360 PMCID: PMC11284274 DOI: 10.1016/j.cnc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
During the coronavirus disease 2019 pandemic, crisis changes in clinical care increased rates of delirium in the intensive care unit (ICU). Deep sedation, unfamiliar environments with visitor restrictions, and such factors due to high workload and health system strain contributed to the occurrence of delirium doubling in the ICU. As the pandemic wanes, health care systems and ICU leadership must emphasize post-pandemic recovery, integrating lessons learned about delirium management, evidence-based care, and family involvement. Strategies to empower clinicians, creatively deliver care, and integrate families pave the way forward for a more holistic approach to patient care in the post-pandemic era.
Collapse
Affiliation(s)
- Kelly M Potter
- Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Brenda T Pun
- Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri Maya
- Sutter Health System, Sacramento, CA, USA
| | - Bethany Young
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey Williams
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Annmarie Hosie
- School of Nursing & Midwifery Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia; Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Sydney, New South Wales, Australia; IMPACCT- Improving Palliative, Aged and Chronic Care Through Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
4
|
Li X, Lin Y, Huang L, Lin H, Cheng X, Li S, Hu R, Liao J. Effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit: A randomized controlled trial. Intensive Crit Care Nurs 2024; 83:103697. [PMID: 38583413 DOI: 10.1016/j.iccn.2024.103697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To examine the effects of web neonatal intensive care unit diaries on the mental health, quality of life, sleep quality, care ability, and hormone levels of parents of preterm infants in the neonatal intensive care unit. DESIGN Prospective randomized controlled parallel-group clinical trial. SETTING Maternal and Child Health Hospital, Fujian, China. METHODS The control group received routine neonatal intensive care unit care, while the intervention group received a web neonatal intensive care unit diary based on routine care. Outcomes, including anxiety, depression, and post-traumatic stress disorder symptoms, quality of life, sleep quality, care ability, and cortisol and melatonin levels, were evaluated at T1 (Time 1, before the intervention), T2 (Time 2, immediately after the intervention), and T3 (Time 3, 1 month after the intervention). RESULTS Seventy pairs of parents of preterm infants in the neonatal intensive care unit were randomly allocated to two groups: intervention (n = 35) and control (n = 35). The anxiety scores in the intervention group were significantly lower at T2 and T3 than those in the control group (P < 0.001). The care ability scores in the intervention group were significantly higher at T2 and T3 (P < 0.001). The prevalence of post-traumatic stress disorder at T3 was significantly different between the groups (P = 0.040). No significant differences were observed in the quality of life or sleep quality between the groups at T2 and T3 (P > 0.05). No significant differences were observed in cortisol and melatonin levels between the groups (P > 0.05). CONCLUSIONS Web neonatal intensive care unit diaries effectively relieved anxiety symptoms, reduced the prevalence of post-traumatic stress disorder, and enhanced the care abilities of parents of preterm infants in the neonatal intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE Web neonatal intensive care unit diary can be considered in clinical practice as a convenient psychological intervention method, especially among parents of preterm infants in the neonatal intensive care unit.
Collapse
Affiliation(s)
- Xiaoting Li
- The School of Nursing, Fujian Medical University, Fuzhou, China; Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ying Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Long Huang
- Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai, China
| | - Huimin Lin
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiao Cheng
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Sijia Li
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou, China.
| | - Jinhua Liao
- The School of Nursing, Fujian Medical University, Fuzhou, China; The Nursing National Experimental Learning Demonstration Center, Fujian Medical University, Fuzhou, China.
| |
Collapse
|
5
|
Yoo HJ, Kim N, Park MK. Patient-centered care for mental health in patients with heart failure in the intensive care unit: A systematic review. Appl Nurs Res 2024; 78:151814. [PMID: 39053991 DOI: 10.1016/j.apnr.2024.151814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/30/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
AIM To assess basic data for developing appropriate interventions by examining the effects of patient-centered care (PCC) on the mental health of patients with heart failure in the intensive care unit (ICU). BACKGROUND Patients with heart failure are frequently admitted to ICUs, and ICU stays are associated with prolonged mental health problems. METHODS We conducted a systematic review using the CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and gray literature databases. Inclusion criteria were studies with participants aged ≥18 years with heart failure in the ICU who received a PCC intervention, and studies that described the outcomes for mental health problems. Data were extracted from five selected studies published after 2020 and analyzed. RESULTS PCC is classified into three areas: comprehensive nursing, multidisciplinary disease management, and targeted motivational interviewing with conventional nursing. The two specific areas of focus for PCC regarding mental health were integrated mental healthcare and specific psychological nursing. Specific psychological nursing comprised relationship building, therapeutic communication, relaxation and motivational techniques, active therapeutic cooperation, psychological status evaluation, music therapy, and environmental management. CONCLUSIONS This review provides a distinctive understanding of multidisciplinary and multicomponent PCC interventions for patients with heart failure in the ICU as an effective approach for improving their mental health. Future PCC intervention strategies aimed at patients with heart failure in the ICU should consider their preferences and family participation.
Collapse
Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Cheonan, Republic of Korea
| | - Namhee Kim
- Wonju College of Nursing, Yonsei University, Wonju, Republic of Korea.
| | - Min Kyung Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Meiers S, de Goumoëns V, Thirsk L, Abbott-Anderson K, Brysiewicz P, Eggenberger S, Heitschmidt M, Kiszio B, Mcandrew NS, Morman A, Richardson S. Nursing strategies to mitigate separation between hospitalized acute and critical care patients and families: A scoping review. Intensive Crit Care Nurs 2024; 84:103773. [PMID: 39067380 DOI: 10.1016/j.iccn.2024.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To describe the nursing strategies used to mitigate the impact of forced separation between hospitalized acute and critical care patients and their families during the COVID-19 pandemic. RESEARCH METHODOLOGY/DESIGN A scoping review was performed in accordance with JBI methodology. SETTINGS Those acute and critical care areas in which sudden, often unexpected, emergent episodes of illness or injury were treated. MAIN OUTCOME MEASURES Articles written in English and French between March 2020 and September 2023 in Medline, CINAHL Complete, APA PsycInfo, Embase and the Cochrane COVID-19 study register databases that met our inclusion criteria were included. Gray literature included dissertations, theses and Base Bielefeld Academic Search Engines. RESULTS Among the 1,357 articles screened, 46 met the criteria for inclusion. Most of the articles were published in North America. Adult critical care units were the most frequently reported settings, followed by neonatal intensive care units. The most frequently reported strategies were virtual telephone or video communications. A majority of the innovative strategies involved interprofessional collaboration at the unit level. Core components included the provision of relational nursing practices, virtual visits, tailored information, fostering relationships between family members, palliative care support regarding end of life, and general information about hospitalization and COVID-19. Pediatric care settings were more likely than adult care settings to accommodate physical visitation. CONCLUSION Nurses used synchronous, episodic, and structured virtual interactions, either alone or as part of an interprofessional team, to mitigate separation between patients and families during the COVID-19 pandemic in acute and critical care settings. IMPLICATIONS FOR CLINICAL PRACTICE Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings.
Collapse
Affiliation(s)
- Sonja Meiers
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA; Department of Graduate Nursing, Winona State University, 400 South Broadway, Suite 204, Rochester, MN 55904, USA.
| | - Véronique de Goumoëns
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne, Switzerland; Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Avenue Alexandra Vinet 30 - 1004, Lausanne, Switzerland.
| | - Lorraine Thirsk
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada.
| | - Kristen Abbott-Anderson
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA.
| | - Petra Brysiewicz
- School of Nursing & Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban 4041, South Africa.
| | - Sandra Eggenberger
- Glen Taylor Nursing Institute for Family and Society, Minnesota State University, 360 Wissink Hall (WH 360), Mankato, Mankato, MN, USA.
| | - Mary Heitschmidt
- RUSH System for Health, Center for Clinical Research and Scholarship, 600 South Paulina, Suite 1080 AAC, Chicago, IL 60612, USA; Rush College of Nursing, 600 South Paulina, Suite 1080 AAC, Chicago, IL 60612, USA.
| | - Blanche Kiszio
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Av. Vinet 30, Lausanne, Switzerland; Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST) a JBI Center of Excellence, Avenue Alexandra Vinet 30 - 1004, Lausanne, Switzerland.
| | - Natalie S Mcandrew
- School of Nursing, College of Health Professions & Sciences, University of Wisconsin-Milwaukee, 1921 East Hartford Avenue, Milwaukee, WI 53211, USA; Department of Patient Care Research, Froedtert & the Medical College of Wisconsin, Froedtert Hospital, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
| | - Aspen Morman
- College of Nursing, University of Wisconsin-Eau Claire, 105 Garfield Ave, P.O. Box 4004, Eau Claire, WI 54702-4004, USA.
| | - Sandra Richardson
- Emergency Department, Christchurch Hospital, Canterbury - Te Waipounamu - Waitaha, Health New Zealand - Te Whatu Ora, New Zealand.
| |
Collapse
|
7
|
Şeren H, Altun Uğraş G, Çam Yanik T. Determining the needs of relatives of patients with a COVID-19 diagnosis in the intensive care unit. Aust Crit Care 2024:S1036-7314(24)00121-8. [PMID: 39054203 DOI: 10.1016/j.aucc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2024] [Accepted: 06/14/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The precautions taken in the intensive care unit (ICU) during the COVID-19 pandemic have caused a change in the needs of relatives of patients. OBJECTIVE This research was conducted to determine the needs of relatives of ICU patients diagnosed with COVID-19. METHODS The sample of this cross-sectional study consisted of 68 relatives of patients treated with COVID-19 in the ICU. Data were collected with a "Patient Relatives Information Form", a "Factors Affecting the Needs of the Relatives of Patients in the Intensive Care Unit Form", and the Critical Care Family Needs Inventory (CCFNI). A multivariate and univariate general linear model was used to determine the factors affecting the CCFNI total and subscale scores. Higher CCFNI scores are indicative of higher family need. RESULTS The assurance (3.5 ± 0.4), information (3.4 ± 0.5), proximity (3.0 ± 0.6), comfort (2.8 ± 0.6), and support (2.7 ± 0.5) dimensions were important needs of relatives of patients hospitalised in the ICU. There was a weak negative correlation between participants' ages and CCFNI scores (p = 0.041). According to the univariate general linear model, significant difference was found between the total CCFNI scores (p = 0.032; 95% confidence interval [CI]: 2.68-3.03), based on multivariate general linear model proximity scores (p = 0.000; 95% CI: 2.49-2.91), and support scores (p = 0.029; 95% CI: 2.26-2.68) and the effect of ICU visit restrictions on relatives' anxiety. Additionally, based on the multivariate general linear model, significant difference was found between the assurance scores and the presence of people who provided support to avoid disruption of responsibilities at home (p = 0.025; 95% CI: 3.30-3.54) and between the proximity scores and the expectations of intensive care nurses (p = 0.028; 95% CI: 2.83-3.59). CONCLUSION This study showed that relatives of ICU patients had high levels of needs. Relatives had high needs for assurance and information, whereas their needs for comfort and support were low. As the age of patients' relatives increased, their levels of needs decreased. Relatives of the patients who received support to help with their obligations at home had increased assurance needs, and those who had anxiety about the ICU visit restrictions had increased proximity and support needs.
Collapse
Affiliation(s)
- Hasan Şeren
- Mersin University, Institute of Health Sciences PhD Student, Turkey.
| | - Gülay Altun Uğraş
- Mersin University, Faculty of Nursing, Department of Surgical Nursing, Ciftlikkoy Campus, 33343, Yenisehir, Mersin, Turkey.
| | - Tuğba Çam Yanik
- Mersin University, Faculty of Nursing, Department of Surgical Nursing, Ciftlikkoy Campus, 33343, Yenisehir, Mersin, Turkey.
| |
Collapse
|
8
|
Zhuang C, Dexter F, Hadler RA. Poor Concordance Between Intensive Care Unit Patients' and Family Members' Patient Dignity Inventory Scores Despite Communication of Dignity-Related Distress. Anesth Analg 2024:00000539-990000000-00864. [PMID: 39008425 DOI: 10.1213/ane.0000000000006907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
BACKGROUND Promptly assessing and treating the distress of intensive care unit (ICU) patients may improve long-term psychological outcomes. One holistic approach to reduce patient distress is through dignity-centered care, traditionally used in palliative care. The 25-item Patient Dignity Inventory has construct validity and reliability for measuring dignity-related distress among ICU patients. Because family members often serve as ICU patients' surrogates and play an integral role in patients' dignity, we examined whether family members reliably recognized ICU patients' sources of distress. METHODS Two single-center observational studies of adult ICU patients were performed from May to June 2022. Inclusion criteria were ICU length-of-stay >48 hours, awake and alert, intact cognition, and no delirium. Study #1 evaluated concordance between patient and family for dignity-related distress. Both completed the Patient Dignity Inventory independently. The next Study #2 measured how many distressing items that the patient reported discussing with family members. RESULTS Study #1 of concordance had 33 patient-family dyads complete the Patient Dignity Inventory. The concordance correlation coefficient was small, 0.20 (99% confidence interval -0.21 to 0.55) and less than the inventory's test-retest reliability (r = .85). Study #2 examined sharing of Patient Dignity Inventory-related items between patients and family members. There were 12 of 19 patients who had severe distress based on an average Patient Dignity Inventory item score ≥1.92. The median patient shared multiple items of distress with their family (median 12, 99% 2-sided exact Hodges-Lehmann interval 4.0-17.5). CONCLUSIONS Although ICU patients often report sharing sources of distress with their loved ones, family members cannot accurately or reliably assess the extent to which patients experience psychosocial, existential, and symptom-related distress during critical illness. Treatments of distress should not be delayed by the absence of family members.
Collapse
Affiliation(s)
- Caywin Zhuang
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Rachel A Hadler
- Department of Anesthesiology
- Department of Family and Preventive Medicine, Emory Critical Care Center, Emory University, Atlanta, Georgia
| |
Collapse
|
9
|
Li M, Shi T, Chen J, Ding J, Gao X, Zeng Q, Zhang J, Ma Q, Liu X, Yu H, Lu G, Li Y. The facilitators and barriers to implementing virtual visits in intensive care units: A mixed-methods systematic review. J Eval Clin Pract 2024. [PMID: 38993019 DOI: 10.1111/jep.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/10/2024] [Accepted: 05/25/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Visitation has a positive effect on patients and families, yet, it can disrupt intensive care unit (ICU) care and increase the risk of patient infections, which previously favoured face-to-face visits. The coronavirus disease 2019 (COVID-19) pandemic has raised the importance of virtual visits and led to their widespread adoption globally, there are still many implementation barriers that need to be improved. Therefore, this review aimed to explore the use of ICU virtual visit technology during the COVID-19 pandemic and the barriers and facilitators of virtual visits to improve virtual visits in ICUs. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six databases (CINAHL, China National Knowledge Infrastructure [CNKI], PubMed, Cochrane, VIP and Wang Fang databases) were searched for empirical studies published between 1 January 2020 and 22 October 2023. Studies that investigated and reported barriers to and facilitators of implementing virtual visits in ICUs during the COVID-19 pandemic were included. Evidence from the included studies was identified and thematically analysed using Thomas and Harden's three-step approach. Study quality was appraised with the Mixed-Methods Appraisal Tool. RESULTS A total of 6770 references were screened, of which 35 studies met the inclusion criteria after a full-text review. Eight main barriers to virtual visits use were identified: technical difficulties; insufficient resources; lack of physical presence and nonverbal information; low technical literacy; differences in families' perceptions of visual cues; privacy and ethics issues; inequitable access and use of virtual visit technology; and lack of advance preparation. Four facilitating factors of virtual visit use were identified: providing multidimensional professional support; strengthening coordination services; understanding the preferences of patients and their families; and enhancing privacy and security protection. In the quality appraisal of 35 studies, 12 studies were rated as low, five as medium and 18 as high methodological quality. CONCLUSION This review identified key facilitating factors and barriers to ICU virtual visits, which can foster the development of infrastructure, virtual visiting workflows, guidelines, policies and visiting systems to improve ICU virtual visiting services. Further studies are necessary to identify potential solutions to the identified barriers.
Collapse
Affiliation(s)
- Mengyao Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Tian Shi
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Juan Chen
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jiali Ding
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xianru Gao
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qingping Zeng
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Jingyue Zhang
- School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Hailong Yu
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| | - Guangyu Lu
- School of Public Health, Medical College of Yangzhou University, Yangzhou University, China
| | - Yuping Li
- Neuro-Intensive Care Unit, Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China
| |
Collapse
|
10
|
Maurer C, Exl MT, Gander HP, Bertschi D, Fischbacher I, Barbezat I, Eissler C, Jeitziner MM. Consequences of a stay in the intensive care unit and outpatient follow-up care for chronic critically ill patients: A retrospective data analysis. Aust Crit Care 2024:S1036-7314(24)00098-5. [PMID: 38971649 DOI: 10.1016/j.aucc.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/22/2024] [Accepted: 05/20/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Patients with chronic critical illness (CCI) represent a particularly vulnerable patient population with significant quality-of-life consequences and a need for follow-up care. Existing research on their quality-of-life trajectory and outpatient follow-up care is limited. OBJECTIVES The aim of this study was to (i) describe a quality improvement project focussing on patients with CCI in the Swiss setting; (ii) explain the consequences of an intensive care unit (ICU) stay for patients with CCI; and (iii) evaluate outpatient follow-up care for patients with CCI. METHODS This retrospective descriptive mixed-methods longitudinal study used routine data from outpatient follow-up care between October 2018 and June 2022. The pre-ICU data were collected retrospectively for the week before ICU admission (baseline); prospectively at 3, 6, and 12 months after ICU discharge; and during an outpatient follow-up care at 6 months. Its main outcomes were health-related quality of life (HRQOL). Patients with CCI were defined as those having a ICU stay longer than 7 days. RESULTS This study enrolled 227 patients with outpatient follow-up care, but only 77 were analysed at all four timepoints. Their EuroQol five-dimension five-level questionnaire-Visual Analogue Scale scores ranged from 0 to 100, with a median of 85 (interquartile range = 0-100) and a mean of 77.2 (standard deviation ± 23.52) before their ICU stay. Their scores had almost returned to the baseline 12 months after their ICU stay. While some reported existing restrictions in the individual HRQOL dimensions before their ICU stay, patients and their families appreciated the outpatient follow-up care including an ICU visit. CONCLUSION Patients with CCI have different HRQOL trajectories over time. Patients with CCI can have a good HRQOL despite their impairments; however, the HRQOL trajectories of many patients remain unclear. The focus must be on identifying the illness trajectories and on measuring and maintaining their long-term HRQOL.
Collapse
Affiliation(s)
- Carol Maurer
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Hans-Peter Gander
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Daniela Bertschi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Irene Fischbacher
- Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland; Health Department of St.Gallen, Service for Care and Development, Oberer Graben 32, 9001 St.Gallen, Switzerland.
| | - Isabelle Barbezat
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland; Clinical Practice Development, Department of Nursing, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Christian Eissler
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| |
Collapse
|
11
|
Maleki M, Abbasi S, Esmaeili M, Mardani A. Mothers' experiences of privacy in neonatal intensive care units: A qualitative study. Nurs Crit Care 2024. [PMID: 38961666 DOI: 10.1111/nicc.13110] [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: 01/16/2024] [Revised: 05/01/2024] [Accepted: 05/28/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Examining the privacy experiences of mothers in neonatal intensive care units (NICUs) can play a crucial role in bolstering patient privacy safeguards and elevating the overall quality of health care. However, our understanding of mothers' experiences regarding privacy issues they may face after their infants' hospitalization in the NICU is limited. AIM This study aimed to investigate the experiences of mothers concerning privacy within NICUs to contribute valuable insights for improving infant care and privacy protection. DESIGN A qualitative content analysis using a conventional approach was conducted. A total of 18 participants, with diverse sociodemographic backgrounds, were interviewed using open-ended questions. Qualitative content analysis was undertaken for data analysis. SETTING The study was conducted in the NICU of an urban teaching hospital in Iran. RESULTS The study identified four main themes: 'understanding of privacy', 'fluctuating respect for privacy', 'efforts to maintain privacy' and 'privacy barriers'. Participants viewed privacy as multidimensional, influenced by cultural and religious factors. Respect for privacy varied, with instances of both adherence and violation. Mothers employed strategies to preserve privacy, emphasizing the importance of their infants' privacy. Privacy barriers included hospital attire, the physical space of the NICU, inhomogeneous human resources and insufficient supervision and training. CONCLUSION This study, the first of its kind in the NICU context, provides valuable insights into maternal experiences of privacy. Integrating these insights into practice and future research can contribute to creating more empathetic and privacy-respecting NICU environments. RELEVANCE TO CLINICAL PRACTICE Health care providers can use these findings to enhance support for mothers, potentially reshaping physical spaces and communication practices within NICUs.
Collapse
Affiliation(s)
- Maryam Maleki
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheila Abbasi
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Esmaeili
- Nursing and Midwifery Care Research Center, Department of Critical Care, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
12
|
Andersen SK, Chang CCH, Arnold RM, Pidro C, Darby JM, Angus DC, White DB. Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment. Ann Intensive Care 2024; 14:103. [PMID: 38954149 PMCID: PMC11219699 DOI: 10.1186/s13613-024-01344-9] [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: 04/01/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Patients with advanced critical illness often receive more intensive treatment than they would choose for themselves, which contributes to high health care costs near the end of life. The purpose of this study was to determine whether a family support intervention delivered by the interprofessional ICU team decreases hospitalization costs and hospital readmissions among critically ill patients at high risk of death or severe functional impairment. RESULTS We examined index hospitalization costs as well as post-discharge utilization of acute care hospitals, rehabilitation and skilled nursing facilities, and hospice services for the PARTNER trial, a multicenter, stepped-wedge, cluster randomized trial of an interprofessional ICU family support intervention. We determined patients' total controllable and direct variable costs using a computerized accounting system. We determined post-discharge resource utilization (as defined above) by structured telephone interview at 6-month follow-up. We used multiple variable regression modelling to compare outcomes between groups. Compared to usual care, the PARTNER intervention resulted in significantly lower total controllable costs (geometric mean: $26,529 vs $32,105; log-linear coefficient: - 0.30; 95% CI - 0.49, - 0.11) and direct variable costs ($3912 vs $6034; - 0.33; 95% CI - 0.56, - 0.10). A larger cost reduction occurred for decedents ($20,304 vs. $26,610; - 0.66; 95% CI - 1.01, - 0.31) compared to survivors ($31,353 vs. $35,015; - 0.15; 95% CI - 0.35,0.05). A lower proportion in the intervention arm were re-admitted to an acute care hospital (34.9% vs 45.1%; 0.66; 95% CI 0.56, 0.77) or skilled nursing facility (25.3% vs 31.6%; 0.63; 95% CI 0.47, 0.84). CONCLUSIONS A family support intervention delivered by the interprofessional ICU team significantly decreased index hospitalization costs and readmission rates over 6-month follow-up. Trial registration Trial registration number: NCT01844492.
Collapse
Affiliation(s)
- Sarah K Andersen
- Program on Ethics and Decision Making, Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, 3550 Terrace St, Scaife Hall, Room 608, Pittsburgh, PA, 15261, USA
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chung-Chou H Chang
- Department of Critical Care Medicine, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert M Arnold
- Section of Palliative Care and Medical Ethics, Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Palliative and Supportive Institute, UPMC Health System, Pittsburgh, PA, USA
| | - Caroline Pidro
- Department of Critical Care Medicine, The CRISMA Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph M Darby
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Douglas B White
- Program on Ethics and Decision Making, Department of Critical Care Medicine, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, University of Pittsburgh School of Medicine, 3550 Terrace St, Scaife Hall, Room 608, Pittsburgh, PA, 15261, USA.
| |
Collapse
|
13
|
Burlar A, Conroy S. An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults. J Christ Nurs 2024; 41:E40-E46. [PMID: 38853326 DOI: 10.1097/cnj.0000000000001182] [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: 06/11/2024] Open
Abstract
ABSTRACT Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.
Collapse
|
14
|
Alqarawi N, Alhalal E. Nurses' practices of children and family-centered care for chronically ill children: A cross-sectional study. J Pediatr Nurs 2024; 77:172-179. [PMID: 38522211 DOI: 10.1016/j.pedn.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE There is limited evidence of children and family-centered care (CFCC) practice in different cultural contexts, particularly regarding the factors that predict it among nurses providing care to chronically ill children. Also, the CFCC's impact on the quality of care has not been well studied. This study aimed to test a hypothesized model in which nurses' attributes and care environments predict CFCC, thereby increasing the quality of nursing care. DESIGN AND METHODS A multicenter cross-sectional study recruited a convenience sample of 405 nurses caring for chronically ill children in Saudi Arabia for an online survey between February 2023 and August 2023. Structural Equation Modeling evaluated the hypothesized model. RESULTS The hypothesized model fits the data based on the fit indices. Care environment affected CFCC (β = 0.831, p = .000), while nursing attributes only indirectly affected CFCC practices through the mediating effect of the work environment (β = 0.553, p = .000). The CFCC practices positively affect the quality of nursing care (β = 0.636, p = .000). CONCLUSIONS Nursing attributes impact the work environment, which affects the practice of CFCC and enhances the quality of care for chronically ill children. Investing in nurses' attributes and a positive work environment is crucial for nursing leaders to enhance CFCC practice and the quality of care. PRACTICAL IMPLICATIONS The findings of this study can be used to shape policies and develop interventions to improve nursing CFCC practices and promote better quality of care for chronically ill children.
Collapse
Affiliation(s)
- Nada Alqarawi
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia; College of Nursing, King Saud University, Riyadh, Saudi Arabia.
| | - Eman Alhalal
- Community and mental health nursing, Nursing college, King Saud University Riyadh, Saudi Arabia
| |
Collapse
|
15
|
Wen FH, Chou WC, Huang CC, Hu TH, Chuang LP, Tang ST. Factors Associated With Quality-of-Dying-and-Death Classes Among Critically Ill Patients. JAMA Netw Open 2024; 7:e2420388. [PMID: 38949808 PMCID: PMC11217872 DOI: 10.1001/jamanetworkopen.2024.20388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/05/2024] [Indexed: 07/02/2024] Open
Abstract
Importance Improving end-of-life care in the intensive care unit (ICU) is a priority, but clinically modifiable factors of quality of dying and death (QODD) are seldom identified. Objectives To comprehensively identify factors associated with QODD classes of dying ICU patients, emphasizing clinically modifiable factors based on the integrative framework of factors associated with for bereavement outcomes. Design, Setting, and Participants This observational cohort study was conducted at medical ICUs of 2 Taiwanese medical centers from January 2018 to March 2020 with follow-up through December 2022. Eligible participants included primary family surrogates responsible for decision making for critically ill ICU patients at high risk of death (Acute Physiology and Chronic Health Evaluation II score >20) but who survived more than 3 days after ICU admission. Data analysis was conducted from July to September 2023. Main Outcomes and Measures QODD was measured by the 23-item ICU-QODD questionnaire. Factors associated with patient membership in 4 previously determined QODD classes (high, moderate, poor to uncertain, and worst) were examined using a 3-step approach for latent class modeling with the high QODD class as the reference category. Results A total of 309 family surrogates (mean [SD] age, 49.83 [12.55] years; 184 women [59.5%] and 125 men [40.5%]) were included in the study. Of all surrogates, 91 (29.4%) were the patients' spouse and 66 (53.7%) were the patients' adult child. Patient demographics were not associated with QODD class. Two family demographics (age and gender), relationship with the patient (spousal or adult-child), and length of ICU stay were associated with QODD classes. Patients of surrogates perceiving greater social support were less likely to be in the poor to uncertain (adjusted odds ratio [aOR], 0.89; 95% CI, 0.83-0.94) and worst (aOR, 0.92; 95% CI, 0.87-0.96) QODD classes. Family meetings were associated with the poor to uncertain QODD class (aOR, 8.61; 95% CI, 2.49-29.74) and worst QODD class (aOR, 7.28; 95% CI, 1.37-38.71). Death with cardiopulmonary resuscitation was associated with the worst QODD class (aOR, 7.51; 95% CI, 1.12-50.25). Family presence at patient death was uniformly negatively associated with the moderate QODD class (aOR, 0.16; 95% CI, 0.05-0.54), poor to uncertain QODD class (aOR, 0.21; 95% CI, 0.05-0.82), and worst QODD class (aOR, 0.08; 95% CI, 0.02-0.38). Higher family satisfaction with ICU care was negatively associated with the poor to uncertain QODD class (aOR, 0.93; 95% CI, 0.87-0.98) and worst QODD class (aOR, 0.86; 95% CI, 0.81-0.92). Conclusions and Relevance In this cohort study of critically ill patients and their family surrogates, modifiable end-of-life ICU-care characteristics played a more significant role in associations with patient QODD class than did immutable family demographics, preexisting family health conditions, patient demographics, and patient clinical characteristics, thereby illuminating actionable opportunities to improve end-of-life ICU care.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taiwan, R.O.C
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R.O.C
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R.O.C
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, R.O.C
- School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, R.O.C
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C
| |
Collapse
|
16
|
Barnes S, Macdonald I, Rahmaty Z, de Goumoëns V, Grandjean C, Jaques C, Ramelet AS. Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review. JBI Evid Synth 2024; 22:1208-1261. [PMID: 38505961 PMCID: PMC11230661 DOI: 10.11124/jbies-23-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units. INTRODUCTION Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve families' outcomes and experiences. INCLUSION CRITERIA This review considered studies that focused on effectiveness or family experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. For the quantitative component of the review, the type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. For the qualitative component, the phenomenon of interest was family experiences of interventions that included collaboration and partnering with the health care team in the pediatric or neonatal intensive care unit. Quantitative, qualitative, and mixed methods studies, published from 2000 to August 2022 in English or French, were eligible for inclusion. METHODS The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched in December 2019 and again in August 2022. Study selection, critical appraisal, and data extraction were performed by 2 reviewers independently. Findings of quantitative studies were statistically pooled through meta-analysis and those that could not be pooled were reported narratively. Qualitative studies were pooled through meta-synthesis. RESULTS This review included 6 qualitative and 42 quantitative studies. The methodological quality varied, and all studies were included regardless of methodological quality. Meta-analyses showed improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families." Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration. CONCLUSIONS Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements reported in stress, anxiety, and satisfaction with family-centered care. REVIEW REGISTRATION PROSPERO CRD42019137834. SUPPLEMENTAL DIGITAL CONTENT A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A50 . A French-language version of the abstract of this review is available at http://links.lww.com/SRX/A51 .
Collapse
Affiliation(s)
- Shannon Barnes
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Ibo Macdonald
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Zahra Rahmaty
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Véronique de Goumoëns
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- La Source School of Nursing, HES-SO, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Chantal Grandjean
- Pediatric Intensive Care Unit, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Cécile Jaques
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- Medical Library, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d’Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| |
Collapse
|
17
|
Franco Fuenmayor ME, Fawcett A, Schwartz KE, Horner S, Balasundaram M, Burke BL, Bean KA, Russell LN, Simonton E, Machut KZ, Fry JT. Understanding family-centered care in the NICU: a scoping review protocol. JBI Evid Synth 2024; 22:1379-1386. [PMID: 38385497 DOI: 10.11124/jbies-23-00252] [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: 02/23/2024]
Abstract
OBJECTIVE This scoping review will aim to identify and categorize the definitions of neonatal intensive care unit (NICU) family-centered care (FCC) and its associated concepts. It also aims to identify and categorize the practices and interventions that comprise NICU FCC, and catalog the metrics used to evaluate NICU FCC. INTRODUCTION FCC has been identified as an important element of care for neonates and infants admitted to the NICU, and there is clear evidence that the incorporation of families in care improves clinical outcomes. However, FCC has been linked to numerous associated terms and concepts and lacks a unifying definition or framework, thus limiting the ability to categorize, prioritize, and identify practices and interventions to optimize both institutional approaches for individual centers and for the field at large. INCLUSION CRITERIA Studies that include or apply at least one FCC concept or its associated terms will be considered eligible for inclusion. Studies not related exclusively to the NICU will be excluded. METHODS The review will follow the JBI methodology for scoping reviews and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Several electronic databases and sources of gray literature will be searched from 1992 to the present day. The review will include only full-text studies in English and will be independently screened by a minimum of 2 authors. Data will be extracted using a modified JBI data extraction tool and presented using narrative summaries; concept mapping; and categorization of practices, interventions, and metrics.
Collapse
Affiliation(s)
- Maria E Franco Fuenmayor
- Department of Pediatrics, Division of Neonatology, John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrea Fawcett
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Clinical and Organizational Development, Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine E Schwartz
- Division of Neonatal-Perinatal Medicine, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Susan Horner
- Lurie Children's Pediatric Research and Evidence Synthesis Centre (PRECIISE): A JBI Affiliated Group, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Malathi Balasundaram
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Barbara Lawlor Burke
- Patient Family Experience Department, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Katherine A Bean
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Laura N Russell
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Kerri Z Machut
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jessica T Fry
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| |
Collapse
|
18
|
Norton T, Chechel L, Sanchez C, Terterian G. A Qualitative Study to Explore the Nurses' Experience of Writing Caring Notes in Diaries for Extracorporeal Oxygenation Membrane (ECMO) Patients: Explore the nurse's experience. Crit Care Nurs Q 2024; 47:184-192. [PMID: 38860948 DOI: 10.1097/cnq.0000000000000511] [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: 06/12/2024]
Abstract
The use of diaries is known to reduce post-intensive care syndrome in the intensive care unit (ICU) for survivors and families. Studies are needed to explore nurses' experience with diaries. Although the diaries are written for the patient, the diary entries may be helpful for the nurse as well. Research has shown that ICU diaries fill in significant memory gaps and aid in the resolution of delusional memories. However, there is a shortage of knowledge about the nurses' experience of writing caring notes in diaries. The purpose of this research was to explore the extracorporeal membrane oxygenation (ECMO) nurses' experience of writing caring notes in diaries during the patients' ICU stay. This is a descriptive phenomenological qualitative research study using semi-structured interviews. A one-on-one interview was performed, audiotaped, and transcribed. Three investigators analyzed the data for themes, subcategories, and indicators. A purposive sample of 15 specialty-trained ECMO nurses participated in the study. Three themes emerged from the study relating to the nurse, family, and patient, including positive and negative aspects of writing in the diary and barriers. The vast majority (88%) of 340 comments answered during the interviews were positive. Overall, nurses found the diaries to be beneficial to the nurse, family, and patient. Diary writing may help nurses get back to the core of why we do what they do. Understanding the nurses' experience may help to improve communication and family satisfaction while optimizing dairy programs.
Collapse
Affiliation(s)
- Tamara Norton
- Author Affiliation: Department of Cardiovascular Intensive Care (Norton); Department of Education Development and Research (Chechel); Department of Psychiatry, University of California San Diego Health, La Jolla, California (Sanchez); Department of Nursing, Cedars-Sinai Tarzana Medical Center, Tarzana, California (Terterian)
| | | | | | | |
Collapse
|
19
|
Urbina T, Balasundaram M, Coughlin M, Sorrells K, Toney-Noland C, Day C. The Why and How of Family-Centered Care. Neoreviews 2024; 25:e393-e400. [PMID: 38945966 DOI: 10.1542/neo.25-7-e393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 07/02/2024]
Abstract
Although the Accreditation Council for Graduate Medical Education states that neonatal-perinatal medicine fellows must demonstrate an understanding of the emotional impact of admission to the NICU on a family, few curricula are in place to teach this important competency. Family-centered care (FCC) in the NICU is an approach to health care that focuses on decreasing mental and emotional trauma for families while empowering them to reclaim their role as caregivers. FCC is deeply rooted in trauma-informed care and is crucial during transition periods throughout the NICU admission. In this article, we provide a review of FCC and trauma-informed care and how to use these approaches at different stages during an infant's hospitalization. We also discuss parent support networks and how to integrate FCC into an existing NICU practice.
Collapse
Affiliation(s)
- Theresa Urbina
- Department of Pediatrics, Uniformed Services University of Health Services, Bethesda, MD
| | - Malathi Balasundaram
- Division of Neonatology, Department of Pediatrics, Stanford Medicine Children's Health, Standford, CA
| | | | | | | | - Colby Day
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| |
Collapse
|
20
|
Jennerich AL. An Approach to Caring for Patients and Family of Patients Dying in the ICU. Chest 2024; 166:127-135. [PMID: 38354905 DOI: 10.1016/j.chest.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024] Open
Abstract
TOPIC IMPORTANCE Death is common in the ICU and often occurs after a decision to withhold or withdraw life-sustaining therapies. Care of the dying is a core skill for ICU clinicians, requiring expert communication, primarily with family of critically ill patients. REVIEW FINDINGS Limited high-quality evidence supports specific practices related to the care of dying patients in the ICU; thus, many of the recommendations that exist are based on expert opinion. Value exists in sharing a practical approach to caring for patients during the dying process, including topics to be addressed with family members, rationales for recommended care, and strategies for implementing comfort measures only. Through dedicated preparation and planning, clinicians can help family members navigate this intense experience. SUMMARY After a decision had been made to discontinue life-sustaining therapies, family members need to be given a clear description of comfort measures only and provided with additional detail about what it entails, including therapies or interventions to be discontinued, monitoring during the dying process, and common features of the dying process. Order sets can be a valuable resource for ensuring that adequate analgesia and sedation are available and the care plan is enacted properly. To achieve a good death for patients, a collaborative effort among members of the care team is essential.
Collapse
Affiliation(s)
- Ann L Jennerich
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, and the Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA.
| |
Collapse
|
21
|
Lee JJ, Mathur S, Gerhart J, Glover CM, Ritz E, Basapur S, Greenberg JA. Written communication and the ICU team experience (WRITE): A pre-post intervention study. Intensive Crit Care Nurs 2024; 84:103753. [PMID: 38924848 DOI: 10.1016/j.iccn.2024.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Families of critically ill patients may benefit from receiving a written update of patient care each day. Our objective was to develop a system to facilitate care provider creation of written updates and to determine the effect of implementing this process on the care provider experience. DESIGN The experiences of ICU care providers (nurses, advanced practice providers, and physicians) were measured monthly during a 3-month pre-intervention and a 3-month intervention period. During the intervention period, written updates were sent to families each day and posted in the electronic medical record. Study investigators assisted by editing and distributing the written communication to families. SETTING An urban academic medical center in the United States. MAIN OUTCOME MEASURES Nurse-Physician Collaboration Scale (NPCS) and Maslach Burnout Inventory (MBI). RESULTS Over the 3-month intervention period, care providers created written communication for families of 152 patients (average 5 ICU days per family). NPCS scores among the 65 participating care providers were significantly lower, indicating greater collaboration during the intervention vs. pre-intervention period: 49.9 (95 % CI 46.4-53.6) vs. 55.4 (95 % CI 51.5-59.3), p = 0.002. MBI scores were similar during the intervention vs. pre-intervention periods. A subset of care providers participated in individual interviews. Care providers reported that the process of creating written communication was acceptable and had clear benefits for both families and the medical team. CONCLUSIONS Use of written communication as a supplement to verbal communication improves collaboration among ICU care providers without affecting symptoms of burnout. IMPLICATIONS FOR PRACTICE We created a system to facilitate written communication with ICU families that was acceptable to care providers and improved aspects of their experience. In the future, use of written communication can be enhanced with refinements to the process that reduce the time spent creating written updates while highlighting the benefits to families and care providers.
Collapse
Affiliation(s)
| | - Shubha Mathur
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Crystal M Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA; Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Ethan Ritz
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL, USA
| | - Santosh Basapur
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jared A Greenberg
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
22
|
Joo Y, Jang Y, Kwon OY. Contents and effectiveness of patient- and family-centred care interventions in adult intensive care units: A systematic review. Nurs Crit Care 2024. [PMID: 38899600 DOI: 10.1111/nicc.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/16/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The need and values of patient- and family-centred care (PFCC) have been globally increasing in the health care landscape. However, the concept of PFCC and the components in adult intensive care units (ICUs) remain wide-ranging. AIM To elucidate the core concepts of PFCC interventions and evaluate the effects of the interventions in adult ICUs. STUDY DESIGN We searched electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, PsycINFO, RISS, KMbase and KoreaMed) from inception to 20 June 2022, for all studies on PFCC interventions. Three authors independently conducted data screening and extraction. The core concepts and the effects of PFCC interventions in adult ICUs were examined. The effects of patient- and family-centred care interventions in adult ICUs were examined. The quality of the included studies was evaluated using the Mixed Methods Appraisal Tool. RESULTS Overall, 3507 records were identified, and 14 full-text articles were assessed. Participants in the included studies were patients and/or their family members in adult ICUs. The main concepts of the studies were participation and information-sharing. Only two studies used collaboration as the main concept of intervention. PFCC interventions have shown positive outcomes for patients, including increased satisfaction, improvement of patient health status and reduced incidence of complications. They have also been beneficial for families, leading to higher satisfaction levels and decreased anxiety. Additionally, these interventions have positively impacted health care providers by enhancing satisfaction and improving rounding efficiency. Moreover, they have influenced health care utilization by decreasing hospital costs and length of stay. CONCLUSIONS This review highlights the advantages of PFCC interventions for patients, families and health care providers in adult ICUs. Future research should focus on developing strategies to incorporate collaboration more comprehensively as a core concept in the implementation of PFCC interventions. RELEVANCE TO CLINICAL PRACTICE Future research endeavours must prioritize collaborative efforts involving health care providers, patients and their families by deploying an array of strategies within the intensive care unit setting.
Collapse
Affiliation(s)
- Youngshin Joo
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Oh Young Kwon
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
23
|
Bansal S, Molloy EJ, Rogers E, Bidegain M, Pilon B, Hurley T, Lemmon ME. Families as partners in neonatal neuro-critical care programs. Pediatr Res 2024:10.1038/s41390-024-03257-6. [PMID: 38886506 DOI: 10.1038/s41390-024-03257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 06/20/2024]
Abstract
Parents of neonates with neurologic conditions face a specific breadth of emotional, logistical, and social challenges, including difficulties coping with prognostic uncertainty, the need to make complex medical decisions, and navigating new hopes and fears. These challenges place parents in a vulnerable position and at risk of developing mental health issues, which can interfere with bonding and caring for their neonate, as well as compromise their neonate's long-term neurodevelopment. To optimize neurologic and developmental outcomes, emerging neonatal neuro-critical care (NNCC) programs must concurrently attend to the unique needs of the developing newborn brain and of his/her parents. This can only be accomplished by embracing a family-centered care environment-one which prioritizes effective parent-clinician communication, longitudinal parent support, and parents as equitable partners in clinical care. NNCC programs offer a multifaceted approach to critical care for neonates at-risk for neurodevelopmental impairments, integrating expertise in neonatology and neurology. This review highlights evidence-based strategies to guide NNCC programs in developing a family-partnered approach to care, including primary staffing models; staff communication, implicit bias, and cultural competency trainings; comprehensive and tailored caregiver training; single-family rooms; flexible visitation policies; colocalized neonatal and maternal care; uniform mental health screenings; follow-up care referrals; and connections to peer support. IMPACT: Parents of neonates with neurologic conditions are at high-risk for experiencing mental health issues, which can adversely impact the parent-neonate relationship and long-term neurodevelopmental outcomes of their neonates. While guidelines to promote families as partners in the neonatal intensive care unit (NICU) have been developed, no protocols integrate the unique needs of parents in neonatal neurologic populations. A holistic approach that makes families true partners in the care of their neonate with a neurologic condition in the NICU has the potential to improve mental and physical well-being for both parents and neonates.
Collapse
Affiliation(s)
- Simran Bansal
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Eleanor J Molloy
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
- Trinity Research in Childhood Centre (TriCC), Children's Health Ireland & Coombe Hospital, Dublin, Ireland
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | | | - Tim Hurley
- Paediatric Research Laboratory, Trinity Translational Medicine Institute (TTMI), St. James' Hospital, Dublin, Ireland
- Discipline of Paediatrics, Dublin Trinity College, The University of Dublin, Dublin, Ireland
| | - Monica E Lemmon
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
24
|
Wiencek C. Palliative Care in the Intensive Care Unit: The Standard of Care. AACN Adv Crit Care 2024; 35:112-124. [PMID: 38848570 DOI: 10.4037/aacnacc2024525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Intensive care unit-based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. Although all critically ill patients inherently have palliative care needs, the path was not linear but rather filled with the challenges of blending the intensive care unit goals of aggressive treatment and cure with the palliative care goals of symptom management and quality of life. Today, palliative care is considered an essential component of high-quality critical care and a core competency of all critical care nurses, advanced practice nurses, and other intensive care unit clinicians. This article provides an overview of the current state of intensive care unit-based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes.
Collapse
Affiliation(s)
- Clareen Wiencek
- Clareen Wiencek is Professor of Nursing, University of Virginia School of Nursing, 202 Jeanette Lancaster Way, Charlottesville, VA 22908
| |
Collapse
|
25
|
Basso B, Fogolin S, Danielis M, Mattiussi E. The Experiences of Family Members of Patients Discharged from Intensive Care Unit: A Systematic Review of Qualitative Studies. NURSING REPORTS 2024; 14:1504-1516. [PMID: 38921723 PMCID: PMC11206407 DOI: 10.3390/nursrep14020113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Improving the understanding of the post-discharge experiences of family members after their loved ones leave the Intensive Care Unit (ICU) is essential for developing effective follow-up strategies. These strategies are crucial for mitigating potential negative outcomes for both patients and their families. The aim of this study was to explore the lived experiences of family members after the discharge of their loved ones from the ICU. METHODS In September 2023, we conducted a systematic search of qualitative studies across the following databases: CINAHL, MEDLINE, Scopus and Web of Science. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review. RESULTS Eight articles met the inclusion criteria. Four themes were identified following evidence synthesis: (1) grappling with a weighty burden; (2) recognizing and confronting adversities along the way; (3) seeking support beyond one's own resources; and (4) addressing comprehensive care requirements. CONCLUSIONS Family members face significant psychological and physical challenges while caring for their loved ones recovering from an ICU stay. Adequate formal and informal help is imperative to provide support both during hospitalization and after discharge. A refined understanding of the distinct requirements and experiences of family members can serve as a strategic framework for informing educational interventions and follow-up programs during the transition from hospital settings to community-based care. This study was not registered.
Collapse
Affiliation(s)
- Benedetta Basso
- School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (B.B.); (S.F.); (E.M.)
| | - Sebastiano Fogolin
- School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (B.B.); (S.F.); (E.M.)
| | - Matteo Danielis
- Laboratory of Studies and Evidence Based Nursing, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131 Padova, Italy
| | - Elisa Mattiussi
- School of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy; (B.B.); (S.F.); (E.M.)
| |
Collapse
|
26
|
Wang LY, Tsai HM, Chen YW, Jhang JY, Wu PJ, Huang YT, Lee MY, Chen LC, Yu WP, Chiang MC. A preliminary study of the effectiveness of video visitation on depression and stress in mothers with preterm infants during the pandemic. Pediatr Neonatol 2024:S1875-9572(24)00092-5. [PMID: 38910078 DOI: 10.1016/j.pedneo.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/26/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND AND PURPOSE Parents of preterm infants experience anxiety and stress in the neonatal intensive care unit (NICU). Visitation restrictions due to COVID-19 have increased maternal pressure and limited bonding opportunities. Little research exists in Taiwan on using video conferencing as a solution. This study investigates depression and stress levels in mothers of preterm infants and evaluates the effectiveness of video visitation during NICU restrictions. METHODS This study adopts a cross-sectional design and a qualitative survey. Mothers of premature infants were recruited and they participated in the study. Interventions for video visits were scheduled on the third day of admission to the NICU (T1) and during the second week of the study (T2). After each video visit, participants completed an online survey. The study's online survey used structured questionnaires including demographics, the Edinburgh Postnatal Depression Scale (EPDS) and the Parental Stress Scale (PSS): Infant Hospitalization (IH). RESULTS A total of 51 mothers of preterm infants participated in the study. During the T1 and T2 periods, single mothers with lower educational levels and those aged below 30 experienced depression and high levels of stress. Lower birth weight and gestational age were associated with maternal depression. Video visitation intervention led to a significant decrease in depression scores (EPDS, T1: 11.3 ± 5.5 vs. T2: 10.1 ± 5.2, p = 0.039). Positive correlations were observed between EPDS and PSS: IH scores (p < 0 .005). CONCLUSION Video visitation intervention can reduce maternal depression in mothers with preterm infants. Since it is practical, video visitation may be applied even after the pandemic.
Collapse
Affiliation(s)
- Ling-Ying Wang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; MSc Program in Innovation for Smart Medicine, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Min Tsai
- College of Nursing, Hungkuang University, Taichung, Taiwan
| | - Yi-Wen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jing-Yi Jhang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Pei-Jhen Wu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Ting Huang
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ming-Ying Lee
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chen Chen
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wen-Pin Yu
- Department of Nursing, Chang Gung Memorial Hospital, Linkou, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
27
|
Hriberšek M, Eibensteiner F, Bukowski N, Yeung AWK, Atanasov AG, Schaden E. Research areas and trends in family-centered care in the 21st century: a bibliometric review. Front Med (Lausanne) 2024; 11:1401577. [PMID: 38933103 PMCID: PMC11201138 DOI: 10.3389/fmed.2024.1401577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Family-centered care (FCC) is a model of care provision that sees a patient's loved ones as essential partners to the health care team and positively influences the psychological safety of patients and loved ones. Objectives This review aims to present an overview of impactful publications, authors, institutions, journals, countries, fields of application and trends of FCC in the 21st century as well as suggestions on further research. Methods The Web of Science Database was searched for publications on FCC between January 2000 and Dezember 2023. After screening for duplicates, VOS Viewer and CiteSpace were used to analyze and visualize the data. Results Scientific interest in FCC has grown and resulted in the scientific output of 4,836 publications originating from 103 different countries. Based on the frequent author keywords, FCC was of greatest interest in neonatology and pediatrics, nursing, critical and intensive care, end-of-life and palliative care, and patient-related outcomes. The recent research hotspots are "patient engagement," "qualitative study," and "health literacy." Conclusion FCC has gained recognition and spread from the pediatric to the adult palliative, intensive, end-of-life and geriatric care settings. This is a very reassuring development since adults, especially when older, want and need the assistance of their social support systems. Recent research directions include the involvement of patients in the development of FCC strategies, health literacy interventions and the uptake of telemedicine solutions.
Collapse
Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Clinical Department of Pediatric Nephrology and Gastroenterology, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Nils Bukowski
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Andy Wai Kan Yeung
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Institute of Genetics and Animal Biotechnology, Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety (LBG), Vienna, Austria
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
28
|
Shadi D, Jabraeili M, Hassankhani H, Alhani F, Bostanabad MA. Development and validation of a supportive programme for family caregivers of children suffering from cystic fibrosis: protocol for a sequential exploratory mixed-methods study. BMJ Open 2024; 14:e081560. [PMID: 38830739 PMCID: PMC11149150 DOI: 10.1136/bmjopen-2023-081560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 05/09/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Families with children who have cystic fibrosis (CF) face a multitude of challenges. They require complex and time-consuming daily care, various forms of knowledge and intricate care responsibilities. One of the most critical challenges that Iranian families of children with CF face is the lack of adequate support from health teams in the early stages of diagnosis, frequent hospitalisation and the postdischarge process. Unfortunately, limited studies have been conducted in this field, and the Iranian society lacks a comprehensive support programme for these families after leaving treatment centres or home care teams. Therefore, it is necessary to identify and redefine the needs of these families for better care and support in Iran. METHODS AND ANALYSIS A mixed-method research design with an exploratory sequential approach will be used in this study. The study consists of three stages: stage (1) the qualitative phase (conventional content analysis and scoping review); stage (2) the programme design phase (development of a support programme) and stage (3) the quantitative phase (validation of the programme through the Delphi method). In the first stage, data will be collected through interviews. Key concepts, evidence and gaps in research will also be identified, collected and analysed through a scoping review. In the second stage, a support programme will be designed based on the results of the content analysis of interviews and the findings from the scoping review. In the final phase, the study will aim to validate the designed programme through a Delphi study. ETHICS AND DISSEMINATION This study formed part of a Ph.D. degree and was approved by the ethics committee of Tabriz University of Medical Sciences (IR.TBZMED.REC.1402.395). Informed consent will be obtained from all study participants. Findings will be published in a peer-reviewed journal.
Collapse
Affiliation(s)
- Danial Shadi
- Department of Pediatric Nursing, Nursing and Midwifery faculty,Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mahnaz Jabraeili
- Department of Pediatric Nursing, Nursing and Midwifery faculty,Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Hadi Hassankhani
- Department of Medical Surgical Nursing, Nursing and Midwifery faculty,Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Fatemeh Alhani
- Tarbiat Modares University, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Arshadi Bostanabad
- Department of Pediatric Nursing, Nursing and Midwifery faculty,Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| |
Collapse
|
29
|
Forte K, Larkin D. Applying Lessons From Ars Moriendi to Foster Dying Well in Acute Care Settings. J Hosp Palliat Nurs 2024; 26:172-177. [PMID: 38478852 DOI: 10.1097/njh.0000000000001024] [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: 05/08/2024]
Abstract
Medical and technological advances have made it possible to keep people alive well beyond what was once possible, leading health care providers to focus on life-sustaining measures rather than questioning the futility of such measures and considering quality of life. In the midst of the struggle to foster dying well in a medicalized environment, acute care nurses may be challenged with shifting the focus to providing optimal end-of-life care because of lack of training, time, and resources. A remedy for the current western societal approach to medicalized dying is to look back in history to a time during the late Middle Ages, when death was an accepted part of medieval life. A literary genre called Ars Moriendi (translated "the art of dying") was written and illustrated to provide instruction on how to die well and how to care for the dying. Nurses can apply lessons from this text to fulfill the ethical obligation to practice with dignity and provide compassionate end-of-life care. These lessons include helping patients and families identify goals of care and accept finitude, encouraging the participation of loved ones at the bedside, and fostering reconciliation at the end of life.
Collapse
|
30
|
Trotta F, Petrosino F, Pucciarelli G, Alvaro R, Vellone E, Bartoli D. Reliability and validity of the training satisfaction questionnaire for family members (TSQ-FM) entering the ICU during an isolation disease outbreak. Heart Lung 2024; 66:37-45. [PMID: 38574598 DOI: 10.1016/j.hrtlng.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The presence of family members in an isolated ICU during an isolation disease outbreak is restricted by hospital policies because of the infectious risk. This can be overcome by conferring to family members the skill and the ability to safely don and doff the personal protective equipment (PPE) through a nurse-led training intervention and assess their satisfaction, to respond to the need to define a safe, effective and quality care pathway focused on Family-Centered Care (FCC) principles. OBJECTIVE the study aimed to build a valid and reliable instrument for clinical practice to assess family members' satisfaction to allow ICU nurses to restore family integrity in any case of infectious disease outbreak that requires isolation. METHODS A cross-sectional study was conducted to test the psychometric properties. The questionnaire was constructed based on a literature review on the needs of family members in the ICU. 76 family members were admitted to a COVID-ICU. Cronbach's coefficient, Geomin rotated loading, and EFA were applied to assess the reliability and validity of the instrument. RESULTS The Kaiser-Mayer-Olkin (KMO) measure was 0.662, the Bartlett sphericity test showed a significant p-value (χ²=448.33; df=45; p < 0.01), Cronbach's alpha coefficient was.896. A further CFA analysis confirmed that all fit indices were acceptable. The results showed satisfactory validity and reliability, which could be generalized and extended to any outbreak of isolation disease. CONCLUSIONS This study provides a valid and reliable instrument for clinical practice to maintain family integrity in the dyadic relationship between the patient and the family member, even during an emergency infectious disease outbreak that requires isolation.
Collapse
Affiliation(s)
- Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Francesco Petrosino
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Bartoli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
31
|
Bryan AF, Reich AJ, Norton AC, Campbell ML, Schwartzstein RM, Cooper Z, White DB, Mitchell SL, Fehnel CR. Process of Withdrawal of Mechanical Ventilation at End of Life in the ICU: Clinician Perceptions. CHEST CRITICAL CARE 2024; 2:100051. [PMID: 38957855 PMCID: PMC11218830 DOI: 10.1016/j.chstcc.2024.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Nearly one-quarter of all Americans die in the ICU. Many of their deaths are anticipated and occur following the withdrawal of mechanical ventilation (WMV). However, there are few data on which to base best practices for interdisciplinary ICU teams to conduct WMV. RESEARCH QUESTION What are the perceptions of current WMV practices among ICU clinicians, and what are their opinions of processes that might improve the practice of WMV at end of life in the ICU? STUDY DESIGN AND METHODS This prospective two-center observational study conducted in Boston, Massachusetts, the Observational Study of the Withdrawal of Mechanical Ventilation (OBSERVE-WMV) was designed to better understand the perspectives of clinicians and experience of patients undergoing WMV. This report focuses on analyses of qualitative data obtained from in-person surveys administered to the ICU clinicians (nurses, respiratory therapists, and physicians) caring for these patients. Surveys assessed a broad range of clinician perspectives on planning, as well as the key processes required for WMV. This analysis used independent open, inductive coding of responses to open-ended questions. Initial codes were reconciled iteratively and then organized and interpreted using a thematic analysis approach. Opinions were assessed on how WMV could be improved for individual patients and the ICU as a whole. RESULTS Among 456 eligible clinicians, 312 in-person surveys were completed by clinicians caring for 152 patients who underwent WMV. Qualitative analyses identified two main themes characterizing high-quality WMV processes: (1) good communication (eg, mutual understanding of family preferences) between the ICU team and family; and (2) medical management (eg, planning, availability of ICU team) that minimizes patient distress. Team member support was identified as an essential process component in both themes. INTERPRETATION Clinician perceptions of the appropriateness or success of WMV prioritize the quality of team and family communication and patient symptom management. Both are modifiable targets of interventions aimed at optimizing overall WMV.
Collapse
Affiliation(s)
- Ava Ferguson Bryan
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Amanda J Reich
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Andrea C Norton
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Margaret L Campbell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Richard M Schwartzstein
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Zara Cooper
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Douglas B White
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Susan L Mitchell
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| | - Corey R Fehnel
- Department of Surgery (A. F. B.), The University of Chicago, Chicago, IL; Center for Surgery and Public Health, Brigham & Women's Hospital (A. F. B. and A. J. R.), Boston, MA; Beth Israel Deaconess Medical Center/Harvard Medical School (A. C. N., R. M. S., S. L. M., and C. R. F.), Boston, MA; Wayne State University (M. L. C.), Detroit, MI; Brigham and Women's Hospital/Harvard Medical School (Z. C.), Boston, MA; University of Pittsburgh School of Medicine (D. B. W.), Pittsburgh, PA; and the Marcus Institute for Aging Research (S. L. M. and C. R. F.), Hebrew Senior Life, Boston, MA
| |
Collapse
|
32
|
Wen FH, Prigerson HG, Hu TH, Huang CC, Chou WC, Chuang LP, Chiang MC, Tang ST. Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents. Crit Care Med 2024; 52:900-909. [PMID: 38299933 PMCID: PMC11093430 DOI: 10.1097/ccm.0000000000006199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst). DESIGN Prospective, longitudinal, observational study. SETTING Medical ICUs at two academically affiliated medical centers in Taiwan. PATIENTS/PARTICIPANTS Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class. CONCLUSIONS The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | | | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| |
Collapse
|
33
|
Peschel E, Krotsetis S, Seidlein AH, Nydahl P. Opening Pandora's box by generating ICU diaries through artificial intelligence: A hypothetical study protocol. Intensive Crit Care Nurs 2024; 82:103661. [PMID: 38394982 DOI: 10.1016/j.iccn.2024.103661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Patients and families on Intensive Care Units (ICU) benefit from ICU diaries, enhancing their coping and understanding of their experiences. Staff shortages and a limited amount of time severely restrict the application of ICU diaries. To counteract this limitation, generating diary entries from medical and nursing records using an artificial intelligence (AI) might be a solution. DESIGN AND PURPOSE Protocol for a hypothetical multi-center, mixed method study to identify the usability and impact of AI-generated ICU diaries, compared with hand-written diaries. METHOD A hand-written ICU diary will be written for patients with expected length of stay ≥ 72 h by trained nursing staff and families. Additionally at discharge, the medical and nursing records are analyzed by an AI software, transformed into understandable, empathic diary entries, and printed as diary. Based on an appointment with patients within 3 months, diaries are read in randomized order by trained clinicians with the patients and families. Patients and families will be interviewed about their experiences of reading both diaries. In addition, usability of diaries will be evaluated by a questionnaire. EXPECTED FINDINGS AND RESULTS Patients and families describe the similarities and differences of language and the content of the different diaries. In addition, concerns can be expressed about the generation and data processing by AI. IMPLICATIONS FOR PRACTICE Professional nursing involves empathic communication, patient-centered care, and evidence-based interventions. Diaries, beneficial for ICU patients and families, could potentially be generated by Artificial Intelligence, raising ethical and professional considerations about AI's role in complementing or substituting nurses in diary writing. CONCLUSIONS Generating AI-based entries for ICU diaries is feasible, but raises serious questions about nursing ethics, empathy, data protection, and values of professional nurses. Researchers and developers shall discuss these questions in detail, before starting such projects and opening Pandora's box, that can never be closed afterwards.
Collapse
Affiliation(s)
- Ella Peschel
- University Hospital of Schleswig-Holstein, Kiel, Germany
| | | | | | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Nursing Research and Development, Kiel, Germany; Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
| |
Collapse
|
34
|
Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [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: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
Collapse
Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
35
|
Olson LM, Perry GN, Yang S, Galyean PO, Zickmund SL, Sorenson S, Pinto NP, Maddux AB, Watson RS, Fink EL. Parents' Experiences Caring for a Child after a Critical Illness: A Qualitative Study. J Pediatr Intensive Care 2024; 13:127-133. [PMID: 38919699 PMCID: PMC11196146 DOI: 10.1055/s-0041-1740450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022] Open
Abstract
Objectives This article described parents' experience and identifies outcomes important to parents following their child's critical illness. Methods Semistructured interviews with 22 female and 4 male parents representing 26 critically ill children with predominately neurologic and respiratory diagnoses. Most children were younger than 5 years at discharge with a median (interquartile range) of 2 (2.0-3.0) years from discharge to interview. Results Many children returned home with life-altering physical and cognitive disabilities requiring months to years of rehabilitation. Parents remembered feeling unprepared and facing an intense, chaotic time when the child first returned home. They described how they suddenly had to center their daily activities around the child's needs amidst competing needs of siblings and partners, and in some cases, the medicalization of the home. They recounted negotiating adjustments almost daily with insurance agencies, medical doctors and therapists, employers, the child, and other family members to keep the family functioning. In the long term, families developed a new norm, choosing to focus on what the child could still do rather than what they could not. Even if the child returned to baseline, parents remembered the adjustments made to keep the child alive and the family functioning. Conclusion Heightened awareness of family experiences after pediatric critical illness will allow health care providers to improve family preparedness for the transition from hospital to home.
Collapse
Affiliation(s)
- Lenora M. Olson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Grace N. Perry
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Serena Yang
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Patrick O'Roke Galyean
- Qualitative Research Core, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, United States
| | - Samuel Sorenson
- Department of Pediatrics, Division of Critical Care, University of Utah, Salt Lake City, Utah, United States
| | - Neethi P. Pinto
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Aline B. Maddux
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado, United States
| | - R. Scott Watson
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Washington School of Medicine, Seattle, Washington, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Ericka L. Fink
- Division of Pediatric Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
| |
Collapse
|
36
|
Lisanti AJ, Min J, Golfenshtein N, Marino BS, Curley MAQ, Medoff-Cooper B. Perceived family-centered care and post-traumatic stress in parents of infants cared for in the paediatric cardiac intensive care unit. Nurs Crit Care 2024. [PMID: 38816199 DOI: 10.1111/nicc.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Family-centred care (FCC), while a core value of paediatric hospitals, has not been well-studied in the paediatric cardiac intensive care unit (PCICU). AIMS To describe parents' perceptions of FCC provided by nurses in the PCICU during their infant's recovery from neonatal cardiac surgery and explore associations of perceptions of FCC on parent post-traumatic stress (PTS) 4 months post-discharge. STUDY DESIGN Data obtained from a previously conducted randomized clinical trial (RCT) on telehealth home monitoring after neonatal cardiac surgery at three free-standing paediatric hospitals were analysed from a subset of 164 parents who completed the FCC Scale at hospital discharge, which measures a parent's experience of nursing care that embodies core principles of FCC. The RCT intervention was provided after hospital discharge, having no influence on parent's perception of FCC. The intervention also had no effect on PTS. RESULTS Perceived FCC was lowest for items 'nurses helped me feel welcomed' and 'nurses helped me feel important in my child's care'. Having 12%-19% points lower perception of FCC at hospital discharge was associated with parent experience of six or more PTS symptoms, at least moderate PTS symptom severity, or PTS disorder diagnosis at 4-month follow-up. Every 10% increase in parental perceptions of FCC was associated with less PTS symptoms (β = -0.29, SE = 0.12; p = .02) and lower PTS symptom cluster scores of arousal (β = -0.18, SE = 0.08; p = .02). CONCLUSIONS Parents who perceived lower FCC during their infants' hospitalization were at increased risk for the development of PTS symptoms, more PTS symptom severity and PTS disorder diagnosis 4-months post-discharge. RELEVANCE TO CLINICAL PRACTICE Nurses have a prominent role to support the implementation of FCC for infants with cardiac defects and their parents. FCC may positively influence overall parent mental health and well-being, reducing the trauma and distress of the PCICU experience.
Collapse
Affiliation(s)
- Amy J Lisanti
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jungwon Min
- Department of Biomedical and Health Informatics, Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Barbara Medoff-Cooper
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
37
|
Azoulay É, Kentish-Barnes N, Boulanger C, Mistraletti G, van Mol M, Heras-La Calle G, Estenssoro E, van Heerden PV, Delgado MCM, Perner A, Arabi YM, Myatra SN, Laake JH, De Waele JJ, Darmon M, Cecconi M. Family centeredness of care: a cross-sectional study in intensive care units part of the European society of intensive care medicine. Ann Intensive Care 2024; 14:77. [PMID: 38771395 PMCID: PMC11109056 DOI: 10.1186/s13613-024-01307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/05/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To identify key components and variations in family-centered care practices. METHODS A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making. The primary outcome, self-rated family-centeredness, was assessed using a visual analog scale. Additionally, respondents completed the Maslach Burnout Inventory and the Ethical Decision Making Climate Questionnaire to capture burnout dimensions and assess the ethical decision-making climate. RESULTS The response rate was 53% (respondents from 359/683 invited ICUs who actually open the email); participating healthcare professionals (HCPs) were from Europe (62%), Asia (9%), South America (6%), North America (5%), Middle East (4%), and Australia/New Zealand (4%). The importance of family-centeredness was ranked high, median 7 (IQR 6-8) of 10 on VAS. Significant differences were observed across quartiles of family centeredness, including in visitation policies availability of a waiting rooms, family rooms, family information leaflet, visiting hours, night visits, sleep in the ICU, and in team-family interactions, including daily information, routine day-3 conference, and willingness to empower nurses and relatives. Higher family centeredness correlated with family involvement in rounds, participation in patient care and end-of-life practices. Burnout symptoms (41% of respondents) were negatively associated with family-centeredness. Ethical climate and willingness to empower nurses were independent predictors of family centeredness. CONCLUSIONS This study emphasizes the need to prioritize healthcare providers' mental health for enhanced family-centered care. Further research is warranted to assess the impact of improving the ethical climate on family-centeredness.
Collapse
Affiliation(s)
- Élie Azoulay
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France.
| | - Nancy Kentish-Barnes
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Carole Boulanger
- Royal Devon University NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Giovanni Mistraletti
- Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti. A.S.S.T. Ovest Milanese, Università degli Studi di Milano, Ospedale Civile di Legnano, Legnano, MI, Italy
| | | | - Gabriel Heras-La Calle
- International Research Project for the Humanisation of Intensive Care Units, Proyecto HU-CI, Madrid, Spain
- Humanizing Healthcare Foundation. Intensive Care Unit, Hospital Universitario de Jaén, Jaén, Spain
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, La Plata, Buenos Aires, Argentina
| | - Peter Vernon van Heerden
- Department of Anesthesiology, Critical Care and Pain medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maria-Cruz Martin Delgado
- Department Intensive Care Medicine Hospital 12 de Octubre, Madrid, Spain
- Research Institute "Hospital 12 de Octubre (imas12)", Universidad Complutense de Madrid, Madrid, Spain
| | - Anders Perner
- Department of Intensive Care, Department of Clinical Medicine, Copenhagen University Hospital - Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yaseen M Arabi
- Intensive Care Department, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health - Affairs, and College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sheila Nainan Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai, Mumbai, India
| | - Jon Henrik Laake
- Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care and Emergencies, Rikshopitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Michael Darmon
- Médecine Intensive et Réanimation, APHP, Hôpital Saint-Louis, Paris-Cité University, 1 avenue Claude Vellefaux, Paris, 75010, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Levi Montalcini, Pieve Emanuele, MI, Italy
- 2IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| |
Collapse
|
38
|
Goldfarb MJ, Saylor MA, Bozkurt B, Code J, Di Palo KE, Durante A, Flanary K, Masterson Creber R, Ogunniyi MO, Rodriguez F, Gulati M. Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1176-e1188. [PMID: 38602110 DOI: 10.1161/cir.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Patient-centered care is gaining widespread acceptance by the medical and lay communities and is increasingly recognized as a goal of high-quality health care delivery. Patient-centered care is based on ethical principles and aims at establishing a partnership between the health care team and patient, family member, or both in the care planning and decision-making process. Patient-centered care involves providing respectful care by tailoring management decisions to patients' beliefs, preferences, and values. A collaborative care approach can enhance patient engagement, foster shared decision-making that aligns with patient values and goals, promote more personalized and effective cardiovascular care, and potentially improve patient outcomes. The objective of this scientific statement is to inform health care professionals and stakeholders about the role and impact of patient-centered care in adult cardiovascular medicine. This scientific statement describes the background and rationale for patient-centered care in cardiovascular medicine, provides insight into patient-oriented medication management and patient-reported outcome measures, highlights opportunities and strategies to overcome challenges in patient-centered care, and outlines knowledge gaps and future directions.
Collapse
|
39
|
Avgeri K, Mantzarlis K, Gerovasileiou E, Deskata K, Chatzi M, Fotakopoulos G, Sgantzos M, Tsolaki V, Zakynthinos E, Makris D. Quality of Life, Family Support, Spirometry, and 6-Minute Walking Distance Differences between COVID-19 and Non-COVID-19 Intensive Care Unit Patients in One Year Following Hospital Discharge. Healthcare (Basel) 2024; 12:996. [PMID: 38786407 PMCID: PMC11121675 DOI: 10.3390/healthcare12100996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Critically ill patients after Intensive Care Unit (ICU) discharge may present disability in their cognitive and physical functions. OBJECTIVES To investigate the quality of life (QoL) of both COVID-19 and non-COVID-19 patients following ICU discharge, lung function, and physical performance of participants. METHODS This study was prospective and conducted between 2020 and 2021 in the "X" hospital. If patients were Mechanically-Ventilated (MV) > 48 h, they were included. RESULTS Fifty COVID-19 and seventy-two non-COVID-19 participants were included in this study. The mean (SD) of the total SF-36 scores at COVID-19 patients at hospital discharge and 3 and 12 months were 46.5 (14.5), 68.6 (17.8), and 82.3 (8.9) (p < 0.05), while non-COVID-19 participants were 48.5 (12.1), 72.2 (9.9), and 82.7 (5.4) (p < 0.05). The forced expiratory volume in one second (FEV1) and 6-minute walking distance (6MWD) were assessed at 3 and 12 months and significantly improved over 12 months. CONCLUSION The QoL of COVID-19 patients improved significantly over time as FEV1 and 6MWD.
Collapse
Affiliation(s)
| | - Konstantinos Mantzarlis
- Medical Deparment, University of Thessaly, 41336 Larissa, Greece; (K.A.); (E.G.); (K.D.); (M.C.); (G.F.); (M.S.); (V.T.); (E.Z.); (D.M.)
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Walter J, Hill DL, Cetin A, DeWitt A, Kellom K, Quarshie W, Griffis H, Shults J, Arnold R, Tjia J, Puopolo K, Curley MAQ, Feudtner C. A Pediatric Interprofessional Cardiac Intensive Care Unit Intervention: CICU Teams and Loved Ones Communicating (CICU TALC) is Feasible, Acceptable, and Improves Clinician Communication Behaviors in Family Meetings. Pediatr Cardiol 2024:10.1007/s00246-024-03497-7. [PMID: 38700711 DOI: 10.1007/s00246-024-03497-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/11/2024] [Indexed: 07/17/2024]
Abstract
Parents of children in the pediatric cardiac intensive care unit (CICU) are often unprepared for family meetings (FM). Clinicians often do not follow best practices for communicating with families, adding to distress. An interprofessional team intervention for FM is feasible, acceptable, and positively impacts family preparation and conduct of FM in the CICU. We implemented a family- and team-support intervention for conducting FM and conducted a pretest-posttest study with parents of patients selected for a FM and clinicians. We measured feasibility, fidelity to intervention protocol, and parent acceptability via questionnaire and semi-structured interviews. Clinician behavior in meetings was assessed through semantic content analyses of meeting transcripts tracking elicitation of parental concerns, questions asked of parents, and responses to parental empathic opportunities. Logistic and ordinal logistic regression assessed intervention impact on clinician communication behaviors in meetings comparing pre- and post-intervention data. Sixty parents (95% of approached) were enrolled, with collection of 97% FM and 98% questionnaire data. We accomplished > 85% fidelity to intervention protocol. Most parents (80%) said the preparation worksheet had the right amount of information and felt positive about families receiving this worksheet. Clinicians were more likely to elicit parental concerns (adjusted odds ratio = 3.42; 95%CI [1.13, 11.0]) in post-intervention FM. There were no significant differences in remaining measures. Implementing an interprofessional team intervention to improve family preparation and conduct of FM is locally feasible, acceptable, and changes clinician behaviors. Future research should assess broader impact of training on clinicians, patients, and families.
Collapse
Affiliation(s)
- Jennifer Walter
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Douglas L Hill
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arzu Cetin
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aaron DeWitt
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katie Kellom
- Policy Lab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Qualitative Research Core, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - William Quarshie
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justine Shults
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Arnold
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Karen Puopolo
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Chris Feudtner
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Justin Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
41
|
Freudiger K, Verweij L, Naef R. Translation and Psychometric Validation of the German Version of the Iceland-Family Perceived Support Questionnaire (ICE-FPSQ): A Cross-Sectional Study. JOURNAL OF FAMILY NURSING 2024; 30:114-126. [PMID: 38622871 DOI: 10.1177/10748407241234262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Supporting families experiencing critical illness through family interventions is essential to ease illness burden, enable family management, and reduce their risk for adverse health. Thus far, there is no validated German instrument to measure the perceived support families receive from nurses. We translated the 14-item Iceland-Family Perceived Support Questionnaire (ICE-FPSQ) and tested its psychometric properties with 77 family members of intensive care patients. Compared with the original instrument, the construct validity of the German ICE-FPSQ (FPSQ-G) showed unstable results with a partially divergent structure, most likely caused by the limited sample size. The first two principal components explained 61% of the overall variance and a good internal consistency with a Cronbach's alpha of .92. The FPSQ-G is a promising instrument to measure family members' perceptions of the support they received from nurses in the acute critical care setting but requires further validation.
Collapse
Affiliation(s)
| | - Lotte Verweij
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
| | - Rahel Naef
- University of Zurich, Switzerland
- University Hospital Zurich, Switzerland
| |
Collapse
|
42
|
Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
Collapse
Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
| |
Collapse
|
43
|
Kentish-Barnes N, Azoulay E, Reignier J, Cariou A, Lafarge A, Huet O, Gargadennec T, Renault A, Souppart V, Clavier P, Dilosquer F, Leroux L, Légé S, Renet A, Brumback LC, Engelberg RA, Pochard F, Resche-Rigon M, Curtis JR. A randomised controlled trial of a nurse facilitator to promote communication for family members of critically ill patients. Intensive Care Med 2024; 50:712-724. [PMID: 38573403 DOI: 10.1007/s00134-024-07390-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Suboptimal communication with clinicians, fragmented care and failure to align with patients' preferences are determinants of post intensive care unit (ICU) burden in family members. Our aim was to evaluate the impact of a nurse facilitator on family psychological burden. METHODS We carried out a randomised controlled trial in five ICUs in France comparing standard communication by ICU clinicians to additional communication and support by nurse facilitators. We included patients > 18 years, with expected ICU length of stay > 2 days, chronic life-limiting illness, and their family members. Facilitators were trained to help families to secure care in line with patient's goals, beginning in ICU and continuing for 3 months. Assessments were made at baseline and 1, 3 and 6 months post-randomisation. Primary outcome was the evolution of family symptoms of depression over 6 months using a linear mixed effects model on the depression subscale of the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes included HADS-Anxiety, Impact of Event Scale-6, goal-concordant care and experience of serious illness (QUAL-E). RESULTS 385 patients and family members were enrolled. Follow-up at 1-, 3- and 6-month was completed by 284 (74%), 264 (68.6%) and 260 (67.5%) family members respectively. The intervention was associated with significantly more formal meetings between the ICU team and the family (1 [1-3] vs 2 [1-4]; p < 0.001). There was no significant difference between the intervention and control groups in evolution of symptoms of depression over 6 months (p = 0.91), nor in symptoms of depression at 6 months [0.53 95% CI (- 0.48; 1.55)]. There were no significant differences in secondary outcomes. CONCLUSION This study does not support the use of facilitators for family members of ICU patients.
Collapse
Affiliation(s)
- Nancy Kentish-Barnes
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France.
| | - Elie Azoulay
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
- Paris Cité University, Paris, France
| | - Jean Reignier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
- Université de Nantes, Nantes, France
| | - Alain Cariou
- Paris Cité University, Paris, France
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Antoine Lafarge
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Olivier Huet
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
- Université de Brest, Brest, France
| | - Thomas Gargadennec
- Anaesthesia and Intensive Care Unit, Brest University Hospital, Brest, France
| | - Anne Renault
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Virginie Souppart
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Pamela Clavier
- Medical Intensive Care Unit, CHU de Nantes, Nantes, France
| | | | - Ludivine Leroux
- Medical Intensive Care Unit, Brest University Hospital, Brest, France
| | - Sébastien Légé
- Medical Intensive Care Unit, APHP, Cochin University Hospital, Paris, France
| | - Anne Renet
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Lyndia C Brumback
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Ruth A Engelberg
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| | - Frédéric Pochard
- Medical Intensive Care Unit, Famiréa Research Group, APHP, Saint Louis University Hospital, Paris, France
| | - Matthieu Resche-Rigon
- Paris Cité University, Paris, France
- Clinical Research Unit, APHP, Saint Louis University Hospital, Paris, France
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, USA
| |
Collapse
|
44
|
Bradford JY, Camarda A, Gilmore L, Horigan AE, Kaiser J, MacPherson-Dias R, Perry A, Slifko A, Slivinski A, Van Dusen K, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Family Presence During Resuscitation and Invasive Procedures. J Emerg Nurs 2024; 50:463-468. [PMID: 38705706 DOI: 10.1016/j.jen.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 05/07/2024]
|
45
|
Çimke S, Yıldırım Gürkan D, Polat S. Research on Family-Centered Care in pediatric patients: A Bibliometric Analysis. J Pediatr Nurs 2024; 76:199-206. [PMID: 38479074 DOI: 10.1016/j.pedn.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/01/2024] [Accepted: 02/19/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE This study is conducted as a bibliometric analysis to determine the trends in studies related to family-centered care in children. MATERIALS AND METHODS The Web of Science database was used to collect study data. A search was conducted on Web of Science using the keywords "family-centered care", "family centered care", "family-centred care", "family centred care", "family-integrated care", "family integrated care", "patient and family centered care", "patient- and family-centered care" and "child" or "pediatric" or "pediatrics" or "child" or "newborn" or "neonatal" or "adolescent" together. The VOSviewer program was used for data analysis and visualization. The analysis included the number of publications by year, distribution by journals, most cited studies, countries with the highest publication output, most frequently used keywords, and co-authorship dimensions, presented with visual maps. RESULTS A total of 2525 studies conducted from 1980 onwards were analyzed. The analysis revealed that the initial publications related to the subject emerged in 1980, and the United States was identified as the country with the highest number of publications, based on the Web of Science database. The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) was determined as the journal with the highest number of publications, while the journal receiving the most citations was PEDIATRICS. CONCLUSION The study found an increasing importance given to the Family-Centered Care Approach since the 1980s, with a majority of studies being descriptive in nature. It was determined that the studies were concentrated in the USA indicating a lack of global interest in the Family-Centered. PRACTICAL IMPLICATIONS Nursing researchers can build upon this study in the field of family-centered care by conducting more specific and in-depth investigations. This contributes to adding new information to the nursing literature and filling gaps in this area.
Collapse
Affiliation(s)
- Sevim Çimke
- Faculty of Health Sciences, Yozgat Bozok University, Turkey.
| | | | - Sevinç Polat
- Faculty of Health Sciences, Yozgat Bozok University, Turkey
| |
Collapse
|
46
|
Razdan S, Hedli LC, Sigurdson K, Profit J, Morton CH. Disparity drivers, potential solutions, and the role of a health equity dashboard in the neonatal intensive care unit: a qualitative study. J Perinatol 2024; 44:659-664. [PMID: 38155228 DOI: 10.1038/s41372-023-01856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/02/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Racial/ethnic disparities are well-described in the neonatal intensive care unit (NICU). We explored expert opinion on their etiology, potential solutions, and the ability of health equity dashboards to meaningfully capture NICU disparities. STUDY DESIGN We conducted 12 qualitative semi-structured interviews, purposively selecting a diverse group of neonatal experts. We used grounded theory to develop codes, shape interviews, and conduct analysis. RESULT We identified three sources of disparity: interpersonal bias, care process and institutional barriers, and social determinants of health, particularly as they affect parental engagement in the NICU. Proposed solutions included racial/cultural concordance, bolstering hospital-based resources, and policy interventions. Health equity dashboards were viewed as useful but limited, because clinical metrics do not account for many of the aforementioned sources of disparities. CONCLUSION Equity dashboards serve as a motivational starting point for quality improvement; future iterations may require novel, qualitative data sources to identify underlying etiologies of NICU disparities.
Collapse
Affiliation(s)
- Sheila Razdan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Laura C Hedli
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Krista Sigurdson
- School of Journalism, Writing, and Media, University of British Columbia, Kelowna, BC, Canada
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Christine H Morton
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| |
Collapse
|
47
|
Nyhagen R, Egerod I, Rustøen T, Lerdal A, Kirkevold M. Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study. Dimens Crit Care Nurs 2024; 43:111-122. [PMID: 38564453 DOI: 10.1097/dcc.0000000000000637] [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: 04/04/2024] Open
Abstract
BACKGROUND Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients. OBJECTIVE The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit. METHODS A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis. RESULTS Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences). DISCUSSION Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.
Collapse
|
48
|
Ghavi A, Hassankhani H, Meert KL. Parental supporter in pediatric resuscitation: A mixed-method study with Delphi and analytic hierarchy process. J Nurs Scholarsh 2024; 56:392-404. [PMID: 38031298 DOI: 10.1111/jnu.12947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Providing support to parents is an evidence-based practice and a crucial part of family-centered nursing care. However, it is not clear who and how to provide the best support to parents during and after their child's resuscitation attempts. PURPOSE This study was conducted to explore the characteristics and roles of parental supporters responsible for caring for parents during and after their child's resuscitation. METHODS This is a mixed-method study combining the Delphi technique and the Analytic Hierarchy Process. A list of potentially important items describing the characteristics and roles of parental supporters caring for parents during and after pediatric resuscitation was developed through qualitative interviews with parents and members of the resuscitation team, and a thorough literature search. Then, the Delphi round was conducted with key experts. In the final step, the Analytic Hierarchy Process was used for ranking items in the order of their importance. RESULTS A list with 69 items describing the characteristics and roles of parental supporters was developed. 15 items (21.74%) were related to the "Characteristics of parental supporter" category; 8 items (11.59%) were related to the "Roles of a parental supporter during resuscitation" category; 13 items (18.84%) were related to the "Roles of a parental supporter after successful resuscitation" category; 23 items (33.34%) were related to the "Roles of a parental supporter after unsuccessful resuscitation" category; and 10 items (14.49%) were related to the "Roles of a parental supporter after unsuccessful resuscitation with help of other staff of the hospital" category. CONCLUSION The findings of this study can be used to develop guidelines that include parental supporter characteristics and roles to support parents during and after their child's resuscitation according to family-centered care practices in pediatric settings. CLINICAL RELEVANCE Study findings indicate the need for the presence of a parental supporter during and after pediatric resuscitation, whether witnessed by the parents or not. Knowledge regarding the characteristics and roles of parental supporters can be used in practice to uphold family-centered nursing care during critical situations.
Collapse
Affiliation(s)
- Arezoo Ghavi
- Department of Pediatric Nursing, Ferdows Branch, Islamic Azad University, Ferdows, Iran
| | - Hadi Hassankhani
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Central Michigan University, Mt. Pleasant, Michigan, USA
| |
Collapse
|
49
|
Ramirez P, Mueller A, Shelton K, Dudzinski DM, Colbert A, Jacobsen J, Greenwald JL, Ludmir J. Family Perceptions of Virtual Family-Centered Rounds in a Quaternary Cardiac Intensive Care Unit. J Intensive Care Med 2024; 39:499-504. [PMID: 38374623 DOI: 10.1177/08850666241233495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background: Family-centered rounds (FCR) reduce the risk of psychological comorbidities of family members and improve the quality of communication between providers and families. Materials and methods: We conducted a pilot quality improvement study analyzing family perceptions of virtual FCR. Family members of previously admitted cardiac ICU patients who participated in at least one session of virtual FCR between April 2020 and June 2021 at Massachusetts General Hospital were surveyed post-ICU discharge. Results: During the study, 82 family members enrolled and participated in virtual FCR with 29 completing the post-admission telephone survey. Many cardiac ICU patients were male (n = 53), and a majority were discharged home (43%) with the patient's wives being the most common respondents to the questionnaire (n = 18). Across all questions in the survey, more than 75% of the respondents perceived the highest level of care in trust, communication, relationship, and compassion with their provider. Participants perceived the highest level of care in trust (96%), explanation (88%), as well as care and understanding (89%). Conclusions: Family members of cardiac ICU patients positively rated the quality of communication and perceived a high level of trust and communication between their providers on the virtual format.
Collapse
Affiliation(s)
- Paolo Ramirez
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ken Shelton
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David M Dudzinski
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Annie Colbert
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Juliet Jacobsen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jonathan Ludmir
- Cardiology Division, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
50
|
Willmeroth T. Nurses' and Parents' View on Neonatal Intensive Care Unit Diaries: A Qualitative Study and Framework Conceptualization. Am J Perinatol 2024; 41:e1800-e1812. [PMID: 37207660 DOI: 10.1055/s-0043-1768959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE The birth of a premature or critically ill newborn can be a traumatic event for the entire family. In these situations, the neonatal intensive care unit (NICU) diary is a relevant coping intervention to support family members. However, a profound theoretical concept is lacking, and there is little evidence about how it is applied by nurses in clinical practice. Therefore, this study aims to investigate how NICU diaries are used by nurses to support family members cope with their experiences and to develop an evidence-guided and theory-based framework for conceptualizing diary usage in the NICU. STUDY DESIGN A qualitative study design containing 12 narrative interviews with nurses from six different hospitals and two focus group interviews with nine parents from two different hospitals was chosen. The qualitative data were analyzed via content analysis inductively and separately and brought together via graphical coding in a second step. RESULTS Four main categories emerged from the analyzed data to describe the NICU diary in nursing practice. Regarding diary (1) "usage," three different types of NICU diaries were identified, which seem to be established largely intuitive. The (2) "content" is constituted by the diary's title, introduction, textual, and nontextual components. Taking into account the diary (3) "function" for the parental coping process, three subcategories emerge: (a) strengthening the parental role, (b) supporting understanding of events, and (c) bringing joy and normality to the situation. (4) "Challenges" address an appropriate writing style, the reading of parental entries by nurses and limited resources. Based on these results and taking into account relevant literature, a framework for conceptualizing NICU diaries was developed. CONCLUSION NICU diaries show great potential to support the parental coping process. Nevertheless, diary conceptualization should be based on a theoretical framework to clarify its usage for nurses and parents. KEY POINTS · NICU diaries are an established intervention used by nurses to support parental coping.. · In nursing practice, different types of NICU diaries emerge.. · Writing styles, content, and reading of entries are reported heterogeneously.. · A conceptualizing framework for NICU diaries is needed..
Collapse
Affiliation(s)
- Tabea Willmeroth
- Fachbereich Gesundheit, FH Münster, University of Applied Sciences, Witten, Germany
| |
Collapse
|