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Palmryd L, Rejnö Å, Alvariza A, Godskesen T. Critical care nurses' experiences of ethical challenges in end-of-life care. Nurs Ethics 2024:9697330241252975. [PMID: 38775348 DOI: 10.1177/09697330241252975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. AIM To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. RESEARCH DESIGN The study used a qualitative approach with an interpretive descriptive design. RESEARCH CONTEXT AND PARTICIPANTS Twenty critical care nurses from eight intensive care units in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. ETHICAL CONSIDERATIONS This study was approved by The Swedish Ethics Review Authority. FINDINGS Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients' deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. CONCLUSION Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context.
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Affiliation(s)
- Lena Palmryd
- Marie Cederschiöld University
- Karolinska University Hospital
| | - Åsa Rejnö
- University West
- Skaraborg Hospital Skövde
- Skaraborg institute for Research and Development
| | | | - Tove Godskesen
- Nord University
- Uppsala University
- Marie Cederschiöld University
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van Dieën MSH, Paans W, Mariani MA, Dieperink W, Blokzijl F. A qualitative study of the experiences and perceptions of older patients and relatives prior to cardiac surgery. Heart Lung 2024; 65:40-46. [PMID: 38395007 DOI: 10.1016/j.hrtlng.2024.02.001] [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: 07/14/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Shared decision-making plays an important role in ensuring value-based healthcare in cardiac surgery. However, the personal situations of patients in cardiac care have not been widely explored, and thus, little is known about the decision-making experiences of patients and their relatives before surgery. OBJECTIVE To explore the perceptions of patients indicated for cardiac surgery and their relatives during the decision-making process, as well as their experiences of a conversation aimed at achieving shared decision-making in the treatment trajectory. METHODS The data were collected through semi-structured in-depth interviews with patients aged ≥70 years who were indicated for cardiac surgery and their relatives until theme saturation. Both inductive and deductive analysis were conducted based on the principles of reflexive thematic analysis. RESULTS Interviews with 16 patients and 10 relatives provided in-depth insights into the experiences of patients and their relatives in terms of a shared decision-making process prior to surgery. Overall, 15 subthemes were identified, and these were divided into three themes. In general, the patients' experiences and perceptions were influenced by their (1) general daily functioning. The relatives were more concerned about (2) social expectations and (3) existential uncertainty. CONCLUSIONS Patients eligible for cardiac surgery and their families have unique experiences and perceptions during the process of shared decision-making. The subthemes emerging from this study, such as the overestimation of potential medical outcomes by patients and their relatives, who experience fear about the current health situation of their loved one, require careful attention from healthcare professionals during decision-making conversations.
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Affiliation(s)
- Milou S H van Dieën
- Hanze University of Applied Sciences, School of Nursing, Research Group Nursing Diagnostics, Petrus Driessenstraat 3 9714 CA Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Hanzeplein 1 9713 GZ Groningen, The Netherlands.
| | - Wolter Paans
- Hanze University of Applied Sciences, School of Nursing, Research Group Nursing Diagnostics, Petrus Driessenstraat 3 9714 CA Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Critical Care, Hanzeplein 1 9713 GZ Groningen, The Netherlands
| | - Massimo A Mariani
- University of Groningen, University Medical Center Groningen, Department of Cardiothoracic Surgery, Hanzeplein 1 9713 GZ Groningen, The Netherlands
| | - Willem Dieperink
- Hanze University of Applied Sciences, School of Nursing, Research Group Nursing Diagnostics, Petrus Driessenstraat 3 9714 CA Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Critical Care, Hanzeplein 1 9713 GZ Groningen, The Netherlands
| | - Fredrike Blokzijl
- Hanze University of Applied Sciences, School of Nursing, Research Group Nursing Diagnostics, Petrus Driessenstraat 3 9714 CA Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Critical Care, Hanzeplein 1 9713 GZ Groningen, The Netherlands
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Belser T, Exl MT, Nydahl P, Zumstein-Shaha M, Jeitziner MM. Experiences of parents visiting an adult family member in the intensive care unit accompanied by their underaged children: A qualitative study. Aust Crit Care 2024:S1036-7314(24)00033-X. [PMID: 38631938 DOI: 10.1016/j.aucc.2024.02.004] [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: 11/06/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The objective of this study was to explore experiences and needs of parents visiting critically ill family members in intensive care units (ICUs) accompanied by their underaged children (<18 years). METHODS Six semistructured interviews with parents were conducted in a qualitative design. Data analysis and synthesis were performed using Braun and Clarke's thematic analysis. This study was conducted in five adult ICUs in Switzerland. FINDINGS Parents opted for early and truthful involvement of their children, and the majority initiated the visits themselves. Five themes were identified: feeling of shock by the entire family; crying in front of the children; feeling welcome with the children; knowing that the children can cope with it; and holding the family together. Parents felt only partially welcomed in the ICU when accompanied by their children. In one case, the parents withdrew the child from the visit. CONCLUSIONS Parents experienced the visit to a critically ill family member in the ICU with their underaged children as challenging. They were emotionally vulnerable and yet took the initiative to keep the family together. Parents had to mediate between their children, the critically ill family member, and the treatment team. Awareness of the needs of the parents visiting with underaged children is important in clinical practice. There is a need for family-centred structures and processes, including adequate visiting times and rooms suitable for children with books, pictures, and toys.
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Affiliation(s)
- Tanja Belser
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany; Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria.
| | - Maya Zumstein-Shaha
- Bern University of Applied Sciences Health, Murtenstrasse 10, 3008 Bern, Switzerland; University of Witten/Herdecke, Department of Nursing, Alfred-Herrhausen-Strasse 50, 58448 Witten, Germany.
| | - 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.
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Yuan C, Xiao Y, Wang F, Wang Y, Wang Y, Lin F. The effect of video visitation on intensive care unit patients and family members outcomes during the COVID-19 pandemic: A randomised controlled trial. Intensive Crit Care Nurs 2023; 76:103394. [PMID: 36731263 PMCID: PMC9852363 DOI: 10.1016/j.iccn.2023.103394] [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: 09/13/2021] [Revised: 12/19/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the effect of video visitation on intensive care patients' and family members' outcomes during the COVID-19 pandemic. DESIGN This is a randomised controlled trial. SETTING An adult intensive care unit in a tertiary hospital in Beijing, China. METHODS A total of 121 adults, who were >18 years of age, conscious, able to communicate verbally, and admitted to the intensive care unit for over 24 hours were randomised into the intervention (video visitation) (n = 65) and control (n = 56) Groups. A total of 98 family members participated. Patient primary outcomes included anxiety and depression, measured using the Hospital Anxiety and Depression Scale. Secondary outcomes included patient delirium and family anxiety assessed using the Confusion Assessment Method scale and Self-Rating Anxiety Scale, respectively; and patient and family satisfaction, measured using a questionnaire routinely used in the hospital. RESULTS There were no statistically significant differences between the groups in patients' anxiety (t = 1.328, p = 0.187) and depression scores (t = 1.569, p = 0.119); and no statistically significant differences in delirium incidence between the groups (7.7 % vs 7.1 %, p > 0.05). There were no significant differences in changes in family members' anxiety scores (t = 0.496, p = 0.621). A statistically significant difference in satisfaction was found between the two group patients (86.1 % vs 57.2 % of patients were satisfied with using video visitation, p < 0.05), and the result of family members' satisfaction was also statistically significant (88 % vs 62.5 % of family members were satisfied with using video visitation, p < 0.05). CONCLUSION Video visitation did not seem to influence anxiety, but the use of video visitation can improve the patient and their family members' satisfaction. Future research is needed to determine the feasibility of embedding video visitation into routine practice, and the optimal frequency and length of video visitation in relation to patients' and family members' outcomes. IMPLICATIONS FOR CLINICAL PRACTICE Video visitation improved patient and family members' satisfaction. Therefore, clinicians should consider using video visitation when face to face visit is restricted. Video visVitation did not reduce patient anxiety significantly in this study maybe because the average length of intensive care stay was too short. Future research is needed on its effect on long term intensive care patients.
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Affiliation(s)
- Cui Yuan
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China,Corresponding authors
| | - Yanyan Xiao
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yi Wang
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Yaqing Wang
- Department of Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Frances Lin
- School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia,Corresponding authors
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[Ways of supporting relatives in intensive care units : Overview and update]. Med Klin Intensivmed Notfmed 2022; 117:349-357. [PMID: 35394164 PMCID: PMC8992398 DOI: 10.1007/s00063-022-00915-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022]
Abstract
Hintergrund Angehörige von kritisch Kranken auf der Intensivstation („intensive care unit“, ICU) sind in einer herausfordernden Situation: Sie befinden sich häufig in einer existenziellen Krise mit einer großen emotionalen Belastung, gleichzeitig sind sie oftmals aktiv in therapeutische Entscheidungen mit eingebunden. Die Besuchsrestriktionen während der Pandemie aufgrund der Coronaviruserkrankung 2019 (COVID-19) haben viele Rahmenbedingungen für die Angehörigenbegleitung geändert und so die Betreuung von Angehörigen schwieriger gemacht. Ziel Ziel der Publikation ist die Darstellung der aktuellen und neuen Entwicklungen in der Angehörigenbegleitung von kritisch Kranken auf Intensivstationen im Rahmen einer narrativen Übersichtsarbeit. Ergebnisse In den letzten Jahren wurden zahlreiche Maßnahmen und Projekte zur Angehörigenbegleitung entwickelt, die sich den folgenden 6 Bereichen zuordnen lassen: 1) Anwesenheit der Angehörigen, 2) proaktive Einbindung in die Betreuung, 3) strukturierte Kommunikation und Information sowie Onlineangebote, 4) multidisziplinäre Zusammenarbeit, 5) Aufgaben der Organisationsleitung und 6) Follow-up-Angebote. Die Evidenz und der derzeitige Implementierungsstand der Maßnahmen sind international und national sehr heterogen. Schlussfolgerungen Maßnahmen zur Angehörigenbetreuung sind vielfältig und können zum Teil auch unter Besuchsrestriktionen umgesetzt werden. Neuere Entwicklungen im digitalen Bereich ermöglichen zunehmend auch virtuelle Besuche und einen ergänzenden Informationsaustausch zwischen dem Team der ICU und den Angehörigen.
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Laurent A, Nguyen S, Leclerc P, Capellier G. L’enfant visiteur en réanimation adulte : vécu psychologique de la visite et dispositifs d’accompagnement. PRAT PSYCHOL 2021. [DOI: 10.1016/j.prps.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lamiani G, Bonazza F, Del Negro S, Meyer EC. The impact of visiting the Intensive Care Unit on children's and adolescents' psychological well-being: A systematic review. Intensive Crit Care Nurs 2021; 65:103036. [PMID: 33775551 DOI: 10.1016/j.iccn.2021.103036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The visits of children/adolescents in adult intensive care units are increasingly more common. However, few studies examine the psychological impact of visiting. This systematic review aims to summarise the psychological effects that visiting family members has on children/adolescents. RESEARCH METHODOLOGY A systematic review of research articles published from 1990 to January 2021 was conducted using PsycInfo, PubMed, and CINAHL. Inclusion/exclusion criteria were applied. Those studies included were evaluated using the Joanna Briggs Institute Critical Appraisal tools. A narrative synthesis of the results was conducted. SETTING Adult intensive care unit. RESULTS The review identified five studies (three of which qualitative), involving 141 children/adolescents. Although the experience of visiting was potentially traumatic, it enabled children/adolescents to better understand the reality and to preserve their relationships with family members. The impact of visiting was influenced by individual characteristics (e.g., age, past traumatic experiences) and by organisational characteristics (e.g., facilitated visit or not). Regardless of visitation, most children/adolescents presented anxiety and depression symptoms that need to be addressed. CONCLUSIONS Child/adolescent visitation seems to have positive effects, provided there is preparation and facilitation. Clinicians should pay attention to individual characteristics and optimise organisational factors (e.g., environment) in order to minimise potentially trauma-inducing aspects.
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Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Via Di Rudinì 8, 20142 Milan, Italy.
| | - Federica Bonazza
- Department of Health Sciences, University of Milan, Via Di Rudinì 8, 20142 Milan, Italy
| | - Silvia Del Negro
- ASST Santi Paolo e Carlo, San Carlo Hospital, Via Pio II 3, 20153 Milan, Italy
| | - Elaine C Meyer
- Department of Psychiatry, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA; Center for Bioethics, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
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Ewens B, Collyer D, Kemp V, Arabiat D. The enablers and barriers to children visiting their ill parent/carer in intensive care units: A scoping review. Aust Crit Care 2021; 34:604-619. [PMID: 33736910 DOI: 10.1016/j.aucc.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022] Open
Abstract
AIM The aim of the study was to identify the enablers and/or barriers to children visiting their ill parent/carer in intensive care units by examining the visiting policies as practiced or perceived by nurses and experienced or perceived by parents and caregivers. REVIEW METHOD This is a scoping review following Joanna Briggs Institute Protocol Guidelines. DATA SOURCES An extensive literature search of Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, PsychINFO, PubMed, and Excerpta Medica dataBASE databases, using key terms, was conducted between May 2019 and July 2020; studies published between 1990 and 2020 were considered for inclusion. Double screening, extraction, and coding of the data using thematic analysis and frequency counts were used. RESULTS Fifteen barriers, 19 facilitators, nine situationally contingent factors, and six personal judgement considerations were identified that influenced children visiting their ill parent/carer in intensive care units. Most barriers (n = 10) were related to organisational factors including restrictive policies, nurses' level of education, age, working hours, nurses' attitudes, and lack of required skills to promote emotional resilience and/or to communicate with children. Family perception factors relating to parents' perceptions, attitudes and concerns of staff/parents, and anticipated behaviours of children were also identified as both barriers and facilitators. CONCLUSIONS There is a lack of consistency in the application of policies and procedures to facilitate children visiting their loved ones in an intensive care unit. Without key involvement from the nurses and healthcare team, there may have been opportunities lost to optimise family-centred care practices in critical care settings.
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Affiliation(s)
- Beverley Ewens
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Doreen Collyer
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; School of Nursing and Midwifery, Edith Cowan University, Australia
| | - Vivien Kemp
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia
| | - Diana Arabiat
- School of Nursing & Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Maternal and Child Nursing Department, School of Nursing, The University of Jordan, Amman, 11942, Jordan
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Abstract
The psychological impact of critical illness is far reaching, affecting patients and their loved ones. Family members face a multitude of stressors, ranging from concerns about death or permanent disability to stress over health care costs and lost wages. Patients are at risk for developing post-intensive care syndrome. Professional groups and patient safety organizations have crafted family-centered care (FCC) models that support hospitalized patients and their families. There is a paucity of data on use of FCC in cardiothoracic intensive care units. This article discusses FCC models and why they are beneficial to the needs of families of postoperative cardiothoracic surgery patients.
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Fergé JL, Banydeen R, Le Terrier C, Fize H, Miguel M, Kentish-Barnes N, Jehel L, Moroy A, Valentino R, Mehdaoui H. Mental Health of Adolescent Relatives of Intensive Care Patients: Benefits of an Open Visitation Policy. Am J Crit Care 2021; 30:72-76. [PMID: 33385205 DOI: 10.4037/ajcc2021799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Symptoms of anxiety and depression are common in adolescents with a loved one in an intensive care unit (ICU) and are known precursors of posttraumatic stress disorder (PTSD). OBJECTIVES To assess the prevalence of PTSD and associated factors in adolescent (age 12-17 years) relatives of patients in an ICU with an open visitation policy. METHODS One year after the patient was discharged from the ICU, eligible adolescent relatives completed a satisfaction survey, anxiety history questionnaire, and psychometric evaluations (Hospital Anxiety and Depression Scale and 8-item Children's Revised Impact of Event Scale). RESULTS Thirty-two patients intubated for >2 days and with a Simplified Acute Physiology Score II >30 were included. Forty-six adolescents with first- to third-degree relationships to the patient, and in regular contact (≥monthly) with the patient before hospitalization, were enrolled. The prevalence of PTSD among the adolescents was 33%. Adolescents who visited the ICU were less likely to report feelings of regret than those who did not visit the ICU (2% vs 9%, P = .01). A past sense of threat (odds ratio [95% CI], 19.4 [1.9-201.2]; P = .01) and anxiety and depression symptoms (odds ratio [95% CI], 9.6 [1.4-63.7]; P = .02) were independent factors associated with probable PTSD. CONCLUSIONS A cautiously prepared open visiting policy should be maintained for adolescents with a relative in the ICU, because it could prevent feelings of regret and subsequent PTSD. Adolescents with risk factors should be screened and followed up.
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Affiliation(s)
- Jean-Louis Fergé
- Jean-Louis Fergé is an anesthesiologist-intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Rishika Banydeen
- Rishika Banydeen is an epidemiologist-research methodologist, Clinical Research Department, CHU Martinique
| | - Christophe Le Terrier
- Christophe Le Terrier is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hélène Fize
- Helene Fize is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Mathurina Miguel
- Mathurina Miguel is a general practitioner, Regional Union of Liberal Doctors of Martinique, Fort-de-France, France
| | - Nancy Kentish-Barnes
- Nancy Kentish-Barnes is a sociologist, Famiréa Research Group, Saint-Louis University Hospital, Paris, France
| | - Louis Jehel
- Louis Jehel is a psychiatrist, Psychiatric Unit, CHU Martinique
| | - Anne Moroy
- Anne Moroy is a psychiatrist, Psychiatric Unit, National Resource and Resilience Center, Lille, France
| | - Ruddy Valentino
- Ruddy Valentino is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
| | - Hossein Mehdaoui
- Hossein Mehdaoui is an intensivist, Intensive Care Unit, CHU Martinique (Centre Hospitalier Universitaire de Martinique), Fort-de-France, France
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Imanipour M, Kiwanuka F. Family nursing practice and family importance in care – Attitudes of nurses working in intensive care units. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Mistraletti G, Mezzetti A, Anania S, Ionescu Maddalena A, Del Negro S, Giusti GD, Gili A, Iacobone E, Pulitanò SM, Conti G, Bocci MG. Improving communication toward ICU families to facilitate understanding and reduce stress. Protocol for a multicenter randomized and controlled Italian study. Contemp Clin Trials 2019; 86:105847. [PMID: 31525488 DOI: 10.1016/j.cct.2019.105847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Families of ICU patients have a pressing need for information: they find themselves suddenly in a complex technical environment often because of a life-threatening illness of a loved one. Some evidence suggests that specific communication tools (like websites or brochures) could improve the experience of ICU families. DESIGN Randomized, multicenter, stepped wedge trial for large-scale assessment of the effectiveness of a multitasking intervention to improve communication with families of critically ill patients. MAIN OUTCOME correct understanding of the prognosis. SECONDARY OUTCOMES correct understanding of medical treatments, prevalence of anxiety, depression and post-traumatic stress symptoms in the first ICU week. Prevalence of PTSD 6 months from ICU discharge. Empathy and burnout among ICU staff. Prevalence of refusals for tissues/organ donation, and medical claims. SUBJECTS 2100 ICU relatives of critically ill patients. INTERVENTIONS The intervention employs specific tools especially designed to raise the correctness of information and to improve the quality of communication: a website presenting the ICU world and justifying the relatives' emotions, with a webpage specifically dedicated to each participating ICU; a standard brochure; eight posters for the families' waiting room and a signboard for the ICU door. MEASUREMENTS AND MAIN RESULTS The study plans to assess these materials in up to 300 Italian ICUs that will participate, according to a five waves program, each one with randomized starting order. This way the effect of the intervention will be evaluated simultaneously. CONCLUSION This is an educational study, aiming to spread good medical practices, while also verifying their real effectiveness in a large number of ICUs. TRIAL REGISTRATION NUMBER NCT03438175.
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Affiliation(s)
- Giovanni Mistraletti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Italy; SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy.
| | - Andrea Mezzetti
- AUSL Toscana Centro, SOS 118 Emergenza Territoriale, Empoli, Italy
| | - Stefania Anania
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | - Alessandra Ionescu Maddalena
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Silvia Del Negro
- SC Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy
| | | | - Alessio Gili
- Dipartimento di Medicina Sperimentale, Università degli Studi di Perugia, Italy
| | - Emanuele Iacobone
- SAR, Dipartimento Emergenza-Urgenza, AV3 Ospedale di Macerata, ASUR Marche, Italy
| | - Silvia Maria Pulitanò
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Giorgio Conti
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Maria Grazia Bocci
- Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Roma, Italy; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Laurent A, Leclerc P, Nguyen S, Capellier G. The effect visiting relatives in the adult ICU has on children. Intensive Care Med 2019; 45:1490-1492. [DOI: 10.1007/s00134-019-05690-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
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Imanipour M, Kiwanuka F, Akhavan Rad S, Masaba R, Alemayehu YH. Family members' experiences in adult intensive care units: a systematic review. Scand J Caring Sci 2019; 33:569-581. [PMID: 30866085 DOI: 10.1111/scs.12675] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission to Intensive Care Units (ICU) exposures family members to a new environment, advanced monitoring systems and aggressive treatments. This is coupled with the critical condition of the patient being admitted in ICU. In such times of stress and crisis, families have varying experiences as they navigate the ICU journey. These happen more or less in chronological phases. AIM This review sought to describe the experiences of family members of patients admitted in adult ICUs. DATA SOURCES Four electronic databases (PubMed, Embase, Scopus and Web of Science) were searched, using keywords and free-text words. METHODS Curation of the review question involved problem identification, a scoping search, developing a search strategy, evaluation, data analysis, and reporting. Freehand search in reference lists of eligible articles was also done to obtain potentially eligible articles published in English language between 2007 and 2018. Studies were included if they reported on family members' experiences in adult ICUs. This review conforms to the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). RESULTS Upon completion of the screening process, 28 studies were included. Most studies were conducted in the United States while no study was identified from Africa. We report on 717 family members. Family members' experience of the ICU journey falls into three main themes: (i) Floating, (ii) Probing and (iii) Continuity or Closure. CONCLUSION As healthcare technology advances, the ICU environment consequently needs to evolve. As such, healthcare providers will need to adjust their practice, support and consider the patients' family as the other part of the patient and members of the care team in order to meet their expectations. Further research highlighting family members' experience of the ICU journey in Africa is needed.
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Affiliation(s)
- Masoomeh Imanipour
- Nursing and Midwifery Care Research Center.,Department of Critical Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Frank Kiwanuka
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran
| | | | - Ronald Masaba
- School of Nursing, Clarke International University, Kampala, Uganda
| | - Yisak Hagos Alemayehu
- Department of critical care nursing, School of nursing and midwifery, International Campus, Tehran University of Medical Sciences (IC-TUMS), Tehran, Iran.,Ayder Comprehensive Specialized Hospital, Mekelle University College of Health Sciences, Mekelle, Ethiopia
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