1
|
Daltveit S, Kleppe L, Petterteig MO, Moi AL. Photographs in burn patient diaries: A qualitative study of patients' and nurses' experiences. Intensive Crit Care Nurs 2024; 82:103619. [PMID: 38185023 DOI: 10.1016/j.iccn.2023.103619] [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: 07/25/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To explore burn patients' and burn intensive care nurses' experiences of the photos in patient diaries. DESIGN A qualitative inductive study using thematic analysis was performed. We conducted individual interviews with six former burn patients (age range 20-77 years; four women), and two focus groups with 11 burn intensive care nurses (age range 38-61 years; all women). Data from patients and nurses were analysed together, and the findings reported according to the consolidated criteria for reporting qualitative research (COREQ). SETTING A Norwegian burn centre where the writing of diaries including text and photos has been practiced for approximately two decades. FINDINGS Three main themes were derived from the combined analysis of the two data sets: hesitating when facing photos; visualising others care; and visualising the trajectory from burn trauma to recovery. Although the patients worried beforehand about what they would see in the photos and the nurses feared to select frightening photos, the photos were welcome, and several patients said they would have liked even more. The photos filled in gaps of memory, told more than words, and did not lie. Photos of family, friends or staff demonstrated shared actions that supported memories and recovery. CONCLUSION Both the burn patients and the burn intensive care nurses considered photos to be an essential part of the diary that gave context and provided a factual presentation of the patients' pathway of treatment, care and recovery. IMPLICATION FOR CLINICAL PRACTICE Tailored information about photo content should be offered to patients before a diary is handed over to them. Nurses should attempt to include photos covering the patients' entire stay at the burn centre, as well as photos of family, friends and staff. Individual nurses should be supported in their practical selection of photos for the diary.
Collapse
Affiliation(s)
- Siri Daltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway.
| | - Lena Kleppe
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Marie Opsanger Petterteig
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway
| | - Asgjerd Litleré Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway; Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, PO Box 1400, 5021 Bergen, Norway; Faculty of Health Sciences, VID Specialized University, Ulriksdal 10, 5009 Bergen, Norway
| |
Collapse
|
2
|
Calzari S, Villa M, Mauro S, Mirto V, Bulloni P, Zini P, Deelen P, Grassellini PR, Bernasconi S, Cassina T. The intensive care unit diary as a valuable care tool: A qualitative study of patients' experiences. Intensive Crit Care Nurs 2024; 80:103558. [PMID: 37826962 DOI: 10.1016/j.iccn.2023.103558] [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: 05/25/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES The aim is to learn about patients' experience of reading the diary, assess attributed meaning and explore patients' experience and memories during their stay in the intensive care unit. SETTING Eleven patients who received the diary after a stay in a nine-bed cardiac intensive care unit in Southern Switzerland, from November 2019 to October 2021. MAIN OUTCOME MEASURES Descriptive qualitative research was performed using semi-structured interviews, followed by thematic analysis. Three research nurses conducted individual telephone or face-to-face interviews. FINDINGS Fifteen sub-themes emerged from the data interviews and were grouped into five main categories: a) the experience in the intensive care unit; b) Post Intensive Care Syndrome symptoms; c) the patient diary; d) new meaning of life; and e) sharing. Patients showed difficulties in remembering and understanding what happened during the hospitalization period. Reading the diary enabled them to understand the impact that the illness had on their daily experience. For some of them, reading the diary was helpful in reacting positively during moments of discouragement. CONCLUSION Qualitative approach allowed us to assess how patients perceive the diary in the intensive care unit in a cultural context of Central and Southern Europe, which is still poorly investigated. The diary responded to the person's need to know what happened during a period that they had no memory of. Its use demonstrated important benefits, allowing people to understand the impact that the illness had on everyday life. It allowed them to relate to the difficulties encountered during the healing process. Thus, the diary played an important role during the healing process. IMPLICATIONS FOR CLINICAL PRACTICE The diary was appreciated by patients during all stages of recovery from severe and acute illness. Gaps within the narration were avoided, in order to provide patients with a better timeline of the events occurred during the time they were unconscious.
Collapse
Affiliation(s)
- Sergio Calzari
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Michele Villa
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland.
| | - Stefania Mauro
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Valentina Mirto
- Urgent Care Department, Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Patrizia Bulloni
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Piergiorgio Zini
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paula Deelen
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Paola Rusca Grassellini
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Stefano Bernasconi
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Department of Intensive Care, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| |
Collapse
|
3
|
Renner C, Jeitziner MM, Albert M, Brinkmann S, Diserens K, Dzialowski I, Heidler MD, Lück M, Nusser-Müller-Busch R, Sandor PS, Schäfer A, Scheffler B, Wallesch C, Zimmermann G, Nydahl P. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care 2023; 27:301. [PMID: 37525219 PMCID: PMC10392009 DOI: 10.1186/s13054-023-04569-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS. METHODS A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as "strong recommendation", "recommendation" or "therapy option", based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified. RESULTS The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS. RECOMMENDATIONS early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS. CONCLUSIONS PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments.
Collapse
Affiliation(s)
- Caroline Renner
- Department of Neurology and Neuro-Rehabilitation, Herz-Kreislauf-Zentrum, Klinikum Hersfeld-Rotenburg GmbH, Rotenburg a. F., University of Leipzig, Leipzig, Germany
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Monika Albert
- Department of Neurology, Rehabilitation ZURZACH Care, Baden, Switzerland
| | | | - Karin Diserens
- Department of Clinical Neurosciences, University Hospital, Lausanne, Switzerland
| | - Imanuel Dzialowski
- ELBLAND Neuro-Rehabilitation Center Grossenhain, Academic Teaching Hospital Technical University Dresden, Dresden, Germany
| | | | | | | | - Peter S Sandor
- Department Neurology and Psych. ZURZACH Care, Bad Zurzach, Switzerland
| | - Andreas Schäfer
- Asklepios Center for Further Education in Intensive Care - and Anaesthesia Nursing North Hesse, Frankfurt, Germany
| | - Bettina Scheffler
- Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Claus Wallesch
- BDH-Hospital Elzach - Center for Neurorehabilitation and Intensive Care, Elzach, Germany
| | - Gudrun Zimmermann
- IB University of Health and Applied Social Science Berlin, Hamburg, Cologne, Stuttgart, Munich, Germany
| | - 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.
| |
Collapse
|
4
|
Nishimura M, Toyama M, Mori H, Sano M, Imura H, Kuriyama A, Nakayama T. Providing End-of-Life Care for Patients Dying of COVID-19 and Their Families in Isolated Death During the Pandemic in Japan: The Providing End-of-life Care for COVID-19 Project. Chest 2023; 163:383-395. [PMID: 36257473 PMCID: PMC9576251 DOI: 10.1016/j.chest.2022.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Death resulting from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many health care providers (HCPs) have struggled with end-of-life (EOL) care for these patients, the various strategies across hospitals are not well known. RESEARCH QUESTION What EOL care did HCPs give patients dying of COVID-19 and their families in hospitals during the COVID-19 pandemic? What were the key themes in care? STUDY DESIGN AND METHODS This qualitative study used individual, semistructured, internet, and face-to-face interviews. We recruited HCPs who provided EOL care to patients with COVID-19 dying in hospitals and their families. Purposive sampling was used through the academic networks at the School of Public Health, Kyoto University. Anonymized verbatim transcripts were analyzed thematically. RESULTS Fifteen doctors and 18 nurses from 23 hospitals in 13 regions across Japan participated; 16 participants (48%) were women, with an age range of 20 to 59 years (most were 30-39 years of age). Participants described 51 strategies, including providing physical and psychological-spiritual care, making connections, providing death care, and arranging care environments and bereavement care for patients and their families. Four themes emerged as prominent efforts in COVID-19 EOL care: maintaining relationships with isolated patients, connecting patients and families, sharing decision-making in isolation, and creating humanistic episodes. INTERPRETATION Proper application and awareness of the four themes may help HCPs to implement better EOL care. To compensate for limited memories resulting from isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. EOL education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for EOL care.
Collapse
Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University.
| | - Mayumi Toyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Hiroko Mori
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Section of Epidemiology, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Makiko Sano
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Nursing, School of Health Sciences, Bukkyo University
| | - Haruki Imura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University,Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto
| | - Akira Kuriyama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| | - Takeo Nakayama
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University
| |
Collapse
|