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Yu H. Improving pressure ulcer care in intensive care units: Evaluating the impact of bundled care and silver nanoparticle dressings. World J Clin Cases 2024; 12:3873-3881. [PMID: 38994315 PMCID: PMC11235428 DOI: 10.12998/wjcc.v12.i19.3873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/28/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Pressure ulcer (PU) are prevalent among critically ill trauma patients, posing substantial risks. Bundled care strategies and silver nanoparticle dressings offer potential solutions, yet their combined effectiveness and impact on patient satisfaction remain insufficiently investigated. AIM To assess the impact of bundled care along with silver nanoparticle dressing on PUs management and family satisfaction in critically ill trauma patients. METHODS A total of 98 critically ill trauma patients with PUs in intensive care unit (ICU) were included in this study. Patients were randomly assigned to either the control group (conventional care with silver nanoparticle dressing, n = 49) or the intervention group (bundled care with silver nanoparticle dressing, n = 49). The PU Scale for Healing (PUSH) tool was used to monitor changes in status of pressure injuries over time. Assessments were conducted at various time points: Baseline (day 0) and subsequent assessments on day 3, day 6, day 9, and day 12. Family satisfaction was assessed using the Family Satisfaction ICU 24 questionnaire. RESULTS No significant differences in baseline characteristics were observed between the two groups. In the intervention group, there were significant reductions in total PUSH scores over the assessment period. Specifically, surface area, exudate, and tissue type parameters all showed significant improvements compared to the control group. Family satisfaction with care and decision-making was notably higher in the intervention group. Overall family satisfaction was significantly better in the intervention group. CONCLUSION Bundled care in combination with silver nanoparticle dressings effectively alleviated PUs and enhances family satisfaction in critically ill trauma patients. This approach holds promise for improving PUs management in the ICU, benefiting both patients and their families.
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Affiliation(s)
- Hong Yu
- Department of Intensive Care Unit, The First People's Hospital of Ziyang, Ziyang 641300, Sichuan Province, China
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2
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Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, Divatia JV, Kumar A, Iyer SK, Deodhar J, Bhat RS, Salins N, Thota RS, Mathur R, Iyer RK, Gupta S, Kulkarni P, Murugan S, Nasa P, Myatra SN. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024; 28:200-250. [PMID: 38477011 PMCID: PMC10926026 DOI: 10.5005/jp-journals-10071-24661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine-Indian Association of Palliative Care (ISCCM-IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al. Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200-250.
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Affiliation(s)
- Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Kaushambi, Uttar Pradesh, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Savita Butola
- Department of Palliative Care, Border Security Force Sector Hospital, Panisagar, Tripura, India
| | - Roop Gursahani
- Department of Neurology, P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Dhvani Mehta
- Division of Health, Vidhi Centre for Legal Policy, New Delhi, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | - Jigeeshu V Divatia
- Department of Anaesthesia, Critical Care, and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arun Kumar
- Department of Intensive Care, Medical Intensive Care Unit, Fortis Healthcare Ltd, Mohali, Punjab, India
| | - Shiva K Iyer
- Department of Critical Care, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
| | - Jayita Deodhar
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajani S Bhat
- Department of Interventional Pulmonology and Palliative Medicine, SPARSH Hospitals, Bengaluru, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghu S Thota
- Department Palliative Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Roli Mathur
- Department of Bioethics, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Rajam K Iyer
- Department of Palliative Care, Bhatia Hospital; P. D. Hinduja National Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Sangeetha Murugan
- Department of Education and Research, Karunashraya, Bengaluru, Karnataka, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Sheila N Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Giannitrapani KF, Yefimova M, McCaa MD, Goebel JR, Kutney-Lee A, Gray C, Shreve ST, Lorenz KA. Using Family Narrative Reports to Identify Practices for Improving End-of-Life Care Quality. J Pain Symptom Manage 2022; 64:349-358. [PMID: 35803554 DOI: 10.1016/j.jpainsymman.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/07/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT Patient experiences should be considered by healthcare systems when implementing care practices to improve quality of end-of-life care. Families and caregivers of recent in-patient decedents may be best positioned to recommend practices for quality improvement. OBJECTIVES To identify actionable practices that bereaved families highlight as contributing to high quality end-of-life care. METHODS We conducted qualitative content analysis of narrative responses to the Bereaved Family Surveys Veterans Health Administration inpatient decedents. Out of 5964 completed surveys in 2017, 4604 (77%) contained at least one word in response to the open-ended questions. For feasibility, 1500/4604 responses were randomly selected for analysis. An additional 300 randomly selected responses were analyzed to confirm saturation. RESULTS Over 23% percent (355/1500) of the initially analyzed narrative responses contained actionable practices. By synthesizing narrative responses to the BFS in a national healthcare system, we identified 98 actionable practices reported by the bereaved families that have potential for implementation in QI efforts. Specifically, we identified 67 end-of-life practices and 31 practices in patient-centered care domains of physical environment, food, staffing, coordination, technology and transportation. The 67 cluster into domains including respectful care and communication, emotional and spiritual support, death benefits, symptom management. Sorting these practices by target levels for organizational change illuminated opportunities for implementation. CONCLUSION Narrative responses from bereaved family members can yield approaches for systematic quality improvement. These approaches can serve as a menu in diverse contexts looking for approaches to improve patient quality of death in in-patient settings.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, Stanford, CA, USA.
| | - Maria Yefimova
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Office of Research (M.Y.), Patient Care Services, Stanford Healthcare, Stanford, CA, USA
| | - Matthew D McCaa
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Joy R Goebel
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; School of Nursing California State University Long Beach (J.R.G.), Long Beach CA, USA
| | - Ann Kutney-Lee
- Veteran Experience Center (A.K.L.), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; University of Pennsylvania School of Nursing (A.K.L.), Philadelphia, PA, USA
| | - Caroline Gray
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Scott T Shreve
- Hospice and Palliative Care Program (S.T.S.), US Department of Veteran Affairs, Hospice and Palliative Care Unit, Lebanon VA Medical Center, Lebanon, PA, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation (K.F.G., M.Y., M.D.M., J.R.G., C.G., K.A.L.), VA Palo Alto Health Care System, Menlo Park, CA, USA; Division of Primary Care and Population Health (K.F.G., K.A.L.), Stanford University School of Medicine, Stanford, CA, USA
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Rahul, Kumar A, Verma A, Sanjeev OP, Singh RK, Ghatak T, Nath A. A questionnaire-based study on quality and adequacy of clinical communication between physician and family members of admitted Covid-19 patients. PATIENT EDUCATION AND COUNSELING 2022; 105:304-310. [PMID: 34625320 PMCID: PMC8445776 DOI: 10.1016/j.pec.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 03/30/2024]
Abstract
OBJECTIVE To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients' family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic. METHODS Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient's relatives (Group-1) and treating physicians (Group-2), through Google Forms. RESULTS Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5-10 min) and designating one responsible person from the family for daily appraisal. CONCLUSION Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority. PRACTICE IMPLICATIONS Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient's health condition changes), either by voice or video calls for 5-10 min.
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Affiliation(s)
- Rahul
- Department of Surgical Gastroenterology, C, Block, SGPGI (MS), Lucknow 226014, India.
| | - Anup Kumar
- Department of Biostatistics and Health Informatics, H, Block, SGPGI (MS), Lucknow 226014, India.
| | - Alka Verma
- Department of Emergency Medicine, SGPGI (MS), Lucknow 226014, India.
| | - Om Prakash Sanjeev
- Department of Emergency Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, India.
| | | | - Tanmoy Ghatak
- Department of Emergency Medicine, SGPGI (MS), Lucknow 226014, India.
| | - Alok Nath
- Department of Pulmonology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, PMSSY Block, SGPGI, Lucknow 226014, India
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Yoosefi Lebni J, Irandoost SF, Safari H, Xosravi T, Ahmadi S, Soofizad G, Ebadi Fard Azar F, Hoseini AS, Mehedi N. Lived Experiences and Challenges of the Families of COVID-19 Victims: A Qualitative Phenomenological Study in Tehran, Iran. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221081405. [PMID: 35225048 PMCID: PMC8886310 DOI: 10.1177/00469580221081405] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Being COVID-19 positive and then dying causes a slew of personal, familial, and social issues for family members. Therefore, the current study was carried out to analyze the lived experiences and issues of COVID-19 victims' families in Tehran, Iran. The phenomenological approach was used in the qualitative analysis of 21 first-degree relatives of COVID-19 victims. From August 22 to October 21, 2020, data was gathered by phone (4 people) and in-person (17 people) using semi-structured interviews. The subjects were chosen through purposeful and snowball sampling. The MAXQDA-2018 program was used to organize the data, and the Colaizzi analytical technique was used to analyze it. Guba and Lincoln's criteria were also used to assess the findings' quality. After analyzing the data, 2 main categories and 14 subcategories were extracted, including (1) challenges in caring for a COVID-19 patient (being rejected, limited access to medical facilities, dissatisfaction with the behavior of medical staff, disruption of family life, the challenge of managing family members' behavior with the patient, and living with doubts and worries (2) challenges after a COVID-19 patient's death (incomplete farewell to the corpse, unbelievability of the death, ambiguity and tension in the burial process, lonely burial, the twinge of conscience, worry about not respecting the deceased, incomplete condolences, and abandonment). The troubles of victims' families can be ameliorated by developing the skills of caring for COVID-19 patients at home, providing medical and psychological services to families before and after the patient's death, appropriately informing the families to guarantee them about dignity and respect and respect of the deceased at the interment, and developing a culture of virtual condolence to provide emotional support to survivors.
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Affiliation(s)
- Javad Yoosefi Lebni
- Health Promotion Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Fahim Irandoost
- Social Determinants of Health Research Center, Clinical Research Institute, 37555Urmia University of Medical Sciences, Urmia, Iran
| | - Hossein Safari
- Health Promotion Research Center, 440827Iran University of Medical Sciences, Tehran, Iran.,School of Nursing and Midwifery, 113106Qazvin University of Medical Sciences, Qazvin, Iran
| | - Tareq Xosravi
- 201574Islamic Azad University Sanandaj Branch, Sanandaj, Iran
| | - Sina Ahmadi
- Social Welfare Management Research Centre, Department of Social Welfare Management, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Goli Soofizad
- School of Public Health and Safety, 556492Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farbod Ebadi Fard Azar
- Health Promotion Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Ava Sadat Hoseini
- Department of Health Education and Health Promotion, School of Health, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Nafiul Mehedi
- Department of Social Work, 113074Shahjalal University of Science and Technology, Sylhet, Bangladesh
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6
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Developing a Decision-Making Framework to Improve Healthcare Service Quality during a Pandemic. APPLIED SYSTEM INNOVATION 2021. [DOI: 10.3390/asi5010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The COVID-19 pandemic has significantly impacted almost every sector. This impact has been especially felt in the healthcare sector, as the pandemic has affected its stability, which has highlighted the need for improvements in service. As such, we propose a collaborative decision-making framework that is capable of accounting for the goals of multiple stakeholders, which consequently enables an optimal, consensus decision to be identified. The proposed framework utilizes the best–worst method (BWM) and the Multi-Actor Multi-Criteria Analysis (MAMCA) methodology to capture and rank each stakeholder’s preferences, followed by the application of a Multi-Objective Linear Programming (MOLP) model to identify the consensus solution. To demonstrate the applicability of the framework, two hypothetical scenarios involving improving patient care in an intensive care unit (ICU) are considered. Scenario 1 reflects all selected criteria under each stakeholder, whereas in Scenario 2, every stakeholder identifies their preferred set of criteria based on their experience and work background. The results for both scenarios indicate that hiring part-time physicians and medical staff can be the effective solution for improving service quality in the ICU. The developed integrated framework will help the decision makers to identify optimal courses of action in real-time and to select sustainable and effective strategies for improving service quality in the healthcare sector.
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7
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Carletto S, Corezzi M, Furmenti MF, Olivero E, Rapicavoli P, Rossello P, Stanizzo MR, Bovero A. Interprofessional Communication Team for Caregivers of Patients Hospitalized in the COVID-19 Wards: Results From an Italian Experience. Front Med (Lausanne) 2021; 8:621725. [PMID: 34589497 PMCID: PMC8473685 DOI: 10.3389/fmed.2021.621725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: During the COVID-19 pandemic, emergency restrictions did not allow clinician family meetings and relatives' visits. In Molinette Hospital, a new communication model between healthcare providers and families of COVID-19 affected patients was developed by a team of physicians and psychologists. The study's aims were to investigate caregivers' distress and to analyse their satisfaction with the communications provided. Methods: A cross-sectional study was conducted among caregivers of patients of Molinette Hospital COVID wards. Between April and June 2020, all caregivers were contacted 2 weeks after the patient's discharge/death to assess their satisfaction with the communications received through an online survey. Results: A total of 155 caregivers completed the survey. Caregivers' distress level was found to be higher in women than men (p = 0.048) and in caregivers whose relative died compared to the caregivers whose relative was discharged (p < 0.001). More than 85% of caregivers defined communication "excellent"/"very good"; being male was associated with higher satisfaction levels than women (β = -0.165, p = 0.046). Besides daily communication, 63 caregivers (40.6%) received additional support from a psychologist of the team. Conclusions: To our knowledge, this is the first study presenting, in an emergency, a new model of communication provided by a team of physicians and psychologists, and analyzing satisfaction with it. This model was highly appreciated by caregivers and it limited the discomfort caused by the restrictions on relatives' visits. It would be interesting to further evaluate the possibility of extending a communication model that includes doctors and psychologists in routine clinical practice.
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Affiliation(s)
- Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy.,Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Michele Corezzi
- Department of Public Health Sciences, University of Torino, Turin, Italy.,Department of Quality and Safety Healthcare, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maria Francesca Furmenti
- Department of Public Health Sciences, University of Torino, Turin, Italy.,Department of Quality and Safety Healthcare, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Elena Olivero
- Department of Public Health Sciences, University of Torino, Turin, Italy.,Department of Quality and Safety Healthcare, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Paola Rapicavoli
- Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Paola Rossello
- Department of Public Health Sciences, University of Torino, Turin, Italy.,Department of Quality and Safety Healthcare, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Maria Rosa Stanizzo
- Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
| | - Andrea Bovero
- Clinical Psychology Unit, University Hospital "Città della Salute e della Scienza di Torino", Turin, Italy
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8
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Padilla Fortunatti C, De Santis JP, Munro CL. Family Satisfaction in the Adult Intensive Care Unit: A Concept Analysis. ANS Adv Nurs Sci 2021; 44:291-305. [PMID: 33624988 DOI: 10.1097/ans.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Admission of patients to an intensive care unit is often a stressful event for family members. In the context of patient- and family-centered care, family satisfaction is recognized as a quality indicator of intensive care unit care. However, family satisfaction has not been consistently used or conceptualized in the literature. A modified version of Walker and Avant's method for concept analysis was utilized to examine the concept of family satisfaction in the adult intensive care unit. Antecedents, attributes, consequences, and empirical referents of family satisfaction are presented and implications for practice, research, and policy.
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Affiliation(s)
- Cristobal Padilla Fortunatti
- University of Miami, School of Nursing & Health Studies, Coral Gables, Florida (Ms Padilla Fortunatti and Drs De Santis and Munro); and Department of the Adult and the Senescent, Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile (Ms Padilla Fortunatti)
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9
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Padilla Fortunatti C, Munro CL. Factors associated with family satisfaction in the adult intensive care unit: A literature review. Aust Crit Care 2021; 35:604-611. [PMID: 34535370 DOI: 10.1016/j.aucc.2021.07.006] [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: 04/12/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The objective of this study was to identify and summarise factors associated with family satisfaction among family members of adult intensive care unit (ICU) patients. REVIEW METHODS/DATA SOURCES A search was conducted from inception to October 2020 in the following databases: PubMed, Scopus, EMBASE, CINAHL Plus, ProQuest Health Management, PsycINFO, LILACS, and SciELO. Studies reporting the questionnaire's items or dimensions as family satisfaction factors, studies dichotomising family satisfaction outcome, and those involving family members of neonatal, paediatric, palliative, and end-of-life patients were excluded. Quality of the studies was examined through a modified approach to the Consolidated Standards for Reporting Trials (CONSORT). Reported factors were classified as family member, patient, or provider/organisation related. RESULTS The search yielded 26 articles reporting factors associated with family satisfaction in the ICU. Regarding study quality, 19.2% were classified as high-quality studies. Family member-related variables such as educational level, gender, and kinship to the patient showed divergent associations with family satisfaction. Within patient-related variables, the severity of illness was positively associated with family satisfaction. Factors related to healthcare providers and organisations were reported only in 26.9% of the studies. CONCLUSIONS A broad number of factors associated with family satisfaction in the ICU were found in this review. However, few nonmodifiable factors related to the family members and the patient showed a significant and consistent association with family satisfaction. Evidence on factors related to healthcare providers was scarce. Gaps in knowledge regarding family satisfaction in the ICU, including methodological issues that impair the validity of the findings, were identified. Future studies should address these limitations to accurately identify factors that impact family satisfaction in the ICU.
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Affiliation(s)
- Cristóbal Padilla Fortunatti
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA; Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile.
| | - Cindy L Munro
- University of Miami, School of Nursing and Health Studies, Coral Gables, USA
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10
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Rasheed AM, Mhawish HA, Asa'Ad DS, Almuabbadi B, Amirah MF, Alshammari B, Aldamaeen A, Alharthy A. Enhancing family-centered care in the ICU during the COVID-19 pandemic. Nurs Manag (Harrow) 2021; 52:34-38. [PMID: 34397670 DOI: 10.1097/01.numa.0000758684.16364.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Akram M Rasheed
- At King Saud Medical City, Critical Care Department, in Riyadh, Saudi Arabia, Akram M. Rasheed is a senior nurse specialist; Huda A. Mhawish , Dao'od S. Asa'ad , and Basel Almuabbadi are nurse managers; Mohammad F. Amirah is a senior nurse specialist; Batla Alshammari is the assistant CNO; Abdullah Aldamaeen is the CNO; and Abdulrhman Alharthy is a consultant
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11
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Burlakov N, Rozani V, Bluvstein I, Kagan I. The Association Between Quality and Safety Climate of a Hospital Ward, Family Members' Empowerment, and Satisfaction With Provided Care. J Nurs Scholarsh 2021; 53:727-736. [PMID: 34048128 DOI: 10.1111/jnu.12682] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study was designed to examine the perceptions of ward quality and safety held by family members and nurses, and investigate its impact on family members' empowerment, and satisfaction with patient hospitalization. DESIGN A cross-sectional study on two study groups was conducted at a large public hospital in Israel. The first group comprised 86 family members of patients hospitalized for more than 72 hours in acute critical condition in intensive care units (ICU) or general wards (GW). The second group included 101 registered nurses who treated the patients in the ICU or GW. METHODS Data were collected by a validated self-administered structured questionnaire. All participants voluntarily signed an informed consent and answered questions related to their demographic characteristics, perceptions, and attitudes toward quality and safety climate, empowerment, and satisfaction with the patients' hospitalization. Pearson correlations coefficient, t-test for independent samples, and a multiple regression model were performed to analyze the data. FINDINGS The mean age of family members was 51.4 ± 14.1 years and of nurses was 40.9 ± 9.9 years. A significant positive association was found between ward quality and safety climate and empowerment of the family member (r = .716; p < .001); empowerment of the family member and family members' satisfaction with the patients' hospitalization (r = .695; p < .001); and ward safety and quality climate and family members' satisfaction with the patients' hospitalization (r = .763; p <.001). Family members ranked ward quality and safety climate (M = 4.20 ± 0.60 vs. M = 3.61 ± 0.40), and their satisfaction with the patients' hospitalization (M = 4.49 ± 0.69 vs. M = 4.07± 0.54), which were significantly (p < .001) higher than the nurses' estimate. The significant predictors for family members' satisfaction with patients' hospitalization were commitment to quality leadership (b = .210; p = .027); implementing a quality improvement (b = .547; p < .001); and hand-off communication (b = .299; p = .001). CONCLUSIONS Positive relationships between quality and safety climate, empowerment, and satisfaction with patients' hospitalization suggest that by improving the ward quality and safety climate, and family empowerment, we may also improve family satisfaction. Although family members reported being satisfied with hospitalization in the ICU and GW, quality leadership and implementing a quality improvement among the nurses and hand-off communication between nurses and patients' families, will be targeted to improve family satisfaction with the patients' hospitalization. CLINICAL RELEVANCE Nurses who provide care for patients in a critical condition should maintain high levels of safety and quality care in order to improve the patients' family empowerment and satisfaction. Specifically, their efforts should target a commitment to quality leadership, implementing quality improvement, and hand-off communication.
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Affiliation(s)
- Nataly Burlakov
- Senior Nurse, Intensive Care Unit, Bnei Zion Medical Center, Haifa, Israel
| | - Violetta Rozani
- Lecture, Department of Nursing, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, Israel
| | - Irit Bluvstein
- Teacher, Department of Nursing, The Stanley Steyer School of Health Professions; School of Psychological Sciences and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Senior Lecturer, Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Haave RO, Bakke HH, Schröder A. Family satisfaction in the intensive care unit, a cross-sectional study from Norway. BMC Emerg Med 2021; 21:20. [PMID: 33588760 PMCID: PMC7885442 DOI: 10.1186/s12873-021-00412-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient's closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family's level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. METHOD The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. RESULTS The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables - relation to the patient and patient survival - significantly affected family satisfaction. CONCLUSION Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses' knowledge when meeting the family of the intensive care patient.
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Affiliation(s)
- Randi Olsson Haave
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Agneta Schröder
- Department of Health Sciences in Gjøvik, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Gjøvik, Norway
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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13
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Martin K, Nanu L, Kwon WS, Martin D. Small Garden, Big Impact: Emotional and Behavioral Responses of Visitors to a Rooftop Atrium in a Major Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:274-287. [PMID: 33576250 DOI: 10.1177/1937586721992799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To measure hospital visitors' satisfaction with a rooftop atrium and its resultant impact on the visitors' behavioral intentions toward the healing garden, the hospital, and overall satisfaction with the hospital. BACKGROUND There is a significant lack of empirical research that links the emotional and behavioral responses toward healing gardens and the hospitals providing them. METHODS A purposeful sample of 96 visitors to the healing garden in the rooftop atrium of a surgery building in a major hospital in the Southeastern United States completed a survey based on Roger Ulrich's Theory of Supportive Gardens and the Stimulus, Organism, Response (S-O-R) paradigm. RESULTS Findings of this study suggest visitors' experience with the healing garden can lead to overall satisfaction with the hospital and behavioral intentions toward the hospital. Visitors' satisfaction with the healing garden significantly predicted their satisfaction with the hospital, their intend to revisit the hospital, and their intend to recommend it. CONCLUSIONS This study demonstrates that a small healing garden can be a powerful enough space to impact visitors' overall satisfaction with the hospital and their intentions regarding their future behavior toward the hospital, such as revisiting or recommending the hospital.
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Affiliation(s)
- Kelly Martin
- Department of Consumer and Design Sciences, 1383Auburn University, AL, USA
| | - Luana Nanu
- Department of Nutrition, Dietetics, & Hospitality Management, 1383Auburn University, AL, USA
| | - Wi-Suk Kwon
- Department of Consumer and Design Sciences, 1383Auburn University, AL, USA
| | - David Martin
- Department of Nutrition, Dietetics, & Hospitality Management, 1383Auburn University, AL, USA
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14
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Liang Y, Li J, Pan W. Family satisfaction in the intensive care unit: The influence of disease severity, care relationship, patient anxiety and patient pain. Intensive Crit Care Nurs 2020; 63:102995. [PMID: 33349481 DOI: 10.1016/j.iccn.2020.102995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 11/15/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is little empirical evidence that can be used to identify factors associated with family satisfaction in the context of the intensive care unit, especially from the perspectives of the patient and patient-family member interactions. OBJECTIVES To explore the influence of disease severity, care relationship, anxiety, and pain of patients on family satisfaction in the intensive care unit. STUDY DESIGN A cross-sectional descriptive and exploratory study was conducted in the Surgical unit in the Zhongshan Hospital Fudan University, Shanghai, China. METHODS A total of 227 patients and their family member dyads were included and surveyed. The dependent variable family satisfaction was measured by the Chinese version of the critical care family satisfaction survey. The independent variables included patient characteristics, care relationship, disease severity, patient anxiety, and patient pain. Disease severity was assessed by The Acute Physiology and Chronic Health Evaluation II. Patient anxiety was measured using the Self-Rating Anxiety Scale. Patient pain was measured with Numeric rating scale. RESULTS Patients with higher self-rating anxiety scores (OR 0.92, 95% CI 0.87-0.97) were less likely to have higher family satisfaction for their family member dyad. However, those with mild perceived pain (OR 5.21, 95% CI 1.97-13.80) were more likely to have higher family satisfaction for their family member dyad. Disease severity and care relationship showed no significant associations with family satisfaction. CONCLUSIONS Future interventions may include open communication with family members giving explanations regarding the physical and psychological condition of the patient, care delivered and interventions received.
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Affiliation(s)
- Yan Liang
- School of Nursing, Fudan University, China
| | | | - Wenyan Pan
- Zhongshan Hospital, Fudan University, China.
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15
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Edward KL, Galletti A, Huynh M. Enhancing Communication With Family Members in the Intensive Care Unit: A Mixed-Methods Study. Crit Care Nurse 2020; 40:23-32. [DOI: 10.4037/ccn2020595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background
Nurses in the intensive care unit are central to clinical care delivery and are often the staff members most accessible to family members for communication. Family members’ ratings of satisfaction with the intensive care unit admission are affected more by communication quality than by the level of care for the patient. Family members may feel that communication in the intensive care unit is inconsistent.
Objectives
To use a shared decision-making model to deliver a communication education program for intensive care unit nurses, evaluate the confidence levels of nurses who undertook the education, and examine changes in family members’ satisfaction with communication from intensive care unit nurses after the nurses received the education.
Methods
A mixed-methods design was used. Seventeen nurses and 81 family members participated.
Results
Staff members were overall very confident with communicating with family members of critically ill patients. This finding was likely linked to staff members’ experience in the position, with 88% of nurses having more than 11 years’ experience. Family members were happy with care but dissatisfied with the environment.
Conclusions
Environmental factors can negatively affect communication with family members in the intensive care unit.
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Affiliation(s)
- Karen-leigh Edward
- Karen-leigh Edward is an adjunct professor of nursing and practice-based research, Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Swinburne University, Hawthorn, Australia
| | - Alessandra Galletti
- Alessandra Galletti is a research associate, Swinburne University of Technology
| | - Minh Huynh
- Minh Huynh is a lecturer, Sports Analytics & Data Science, School of Allied Health, Human Services & Sport, College of Science, Health and Engineering, Latrobe University, Bundoora, Melbourne, Australia
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16
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Negro A, Mucci M, Beccaria P, Borghi G, Capocasa T, Cardinali M, Pasculli N, Ranzani R, Villa G, Zangrillo A. Introducing the Video call to facilitate the communication between health care providers and families of patients in the intensive care unit during COVID-19 pandemia. Intensive Crit Care Nurs 2020; 60:102893. [PMID: 32576488 PMCID: PMC7247985 DOI: 10.1016/j.iccn.2020.102893] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 12/02/2022]
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17
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Abraham TH, Deen TL, Hamilton M, True G, O'Neil MT, Blanchard J, Uddo M. Analyzing free-text survey responses: An accessible strategy for developing patient-centered programs and program evaluation. EVALUATION AND PROGRAM PLANNING 2020; 78:101733. [PMID: 31675509 DOI: 10.1016/j.evalprogplan.2019.101733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/11/2019] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
Despite widespread availability of yoga in the Veterans Health Administration (VA), it remains unclear how to best evaluate yoga programs. This is particularly problematic for programs aimed at veterans with mental health concerns, as evaluation typically focuses narrowly upon mental health symptom severity, even though program participants may have other health-related priorities. We analyzed responses to free-text questions on 237 surveys completed by veterans with mental health concerns enrolled in a yoga program at six VA clinics in Louisiana to characterize veteran participants' experiences with yoga. Qualitative analysis resulted in 15 domains reflecting veterans' individual health-related values and priorities. We use results to illustrate the potential for analysis of free-text responses to reveal valuable insights into patient experiences, demonstrating how these data can inform patient-centered program evaluation. The approach we present is more accessible to those responsible for decision-making about local programs than conventional methods of analyzing qualitive evaluation data.
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Affiliation(s)
- Traci H Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, 2200 Fort Roots Drive, Building 58, North Little Rock, AR 72114-1706, United States; Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, United States; VA South Central Mental Illness Research, Education and Clinical Center, 2200 Fort Roots Drive, Building 58, North Little Rock, AR 72114-1706, United States.
| | - Tisha L Deen
- Central Arkansas Veterans Healthcare System, Eugene J. Towbin Healthcare Center, 2200 Fort Roots Drive, North Little Rock, AR 72114-1706, United States
| | - Michelle Hamilton
- Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119, United States
| | - Gala True
- South Central Mental Illness Research, Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119, United States; Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, United States
| | | | | | - Madeline Uddo
- South Central Mental Illness Research, Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal Street, New Orleans, LA 70119, United States
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18
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Stephens AL, Bruce CR, Childress A, Malek J. Why Families Get Angry: Practical Strategies for Clinical Ethics Consultants to Rebuild Trust Between Angry Families and Clinicians in the Critical Care Environment. HEC Forum 2020; 31:201-217. [PMID: 30820819 DOI: 10.1007/s10730-019-09370-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: (1) perceived or actual medical error, (2) concerns about the medical team's competence, (3) miscommunication, (4) perceived conflict of interest or commitment, or (5) loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship.
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Affiliation(s)
| | - Courtenay R Bruce
- The Methodist Hospital System, System Quality and Patient Safety, Houston, TX, USA
| | - Andrew Childress
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA
| | - Janet Malek
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA.
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Lyes S, Richards-Belle A, Connolly B, Rowan KM, Hinton L, Locock L. Can the UK 24-item family satisfaction in the intensive care unit questionnaire be used to evaluate quality improvement strategies aimed at improving family satisfaction with the ICU? A qualitative study. J Intensive Care Soc 2019; 21:312-319. [PMID: 34093733 DOI: 10.1177/1751143719883563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The experiences and satisfaction of family members of patients are important indicators of healthcare quality in the intensive care unit. The family satisfaction in the intensive care unit (FS-ICU-24) questionnaire, developed in Canada and now validated in the UK, is becoming the gold standard measure to evaluate family members' satisfaction with the intensive care unit. To inform future use of the UK FS-ICU-24 to evaluate quality improvement strategies aimed at improving family satisfaction with the intensive care unit, we set out to explore the extent to which the 24-scored items and domains of the UK FS-ICU-24 reflect common suggestions and priorities for quality improvement self-reported as important to family members in the UK. Methods Two data sources were thematically analysed - (1) open-text responses from family members who completed the UK FS-ICU-24 in a large observational cohort study; (2) a set of quality improvement activities generated by patients, family members and staff through experience-based co-design in a mixed-methods' intensive care unit quality improvement study. Summarised themes were then mapped to the 24-scored items and domains of the UK FS-ICU-24 to assess coverage by the UK FS-ICU-24. Results We found a good degree of coverage between the topics and themes identified as important to family members with the 24-scored items and domains of the UK FS-ICU-24. Conclusion Our study confirms the face validity of the UK FS-ICU-24 and indicates that its inclusion as an outcome measure for evaluating quality improvement strategies aimed at improving family satisfaction with the intensive care unit is appropriate.
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Affiliation(s)
- Susannah Lyes
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alvin Richards-Belle
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Bronwen Connolly
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Kathryn M Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK
| | - Lisa Hinton
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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20
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Scott P, Thomson P, Shepherd A. Families of patients in ICU: A Scoping review of their needs and satisfaction with care. Nurs Open 2019; 6:698-712. [PMID: 31367391 PMCID: PMC6650754 DOI: 10.1002/nop2.287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To describe published literature on the needs and experiences of family members of adults admitted to intensive care and interventions to improve family satisfaction and psychological well-being and health. DESIGN Scoping review. METHODS Several selective databases were searched. English-language articles were retrieved, and data extracted on study design, sample size, sample characteristics and outcomes measured. RESULTS From 469 references, 43 studies were identified for inclusion. Four key themes were identified: (a) Different perspectives on meeting family needs; (b) Family satisfaction with care in intensive care; (c) Factors having an impact on family health and well-being and their capacity to cope; and (d) Psychosocial interventions. Unmet informational and assurance needs have an impact on family satisfaction and mental health. Structured written and oral information shows some effect in improving satisfaction and reducing psychological burden. Future research might include family in the design of interventions, provide details of the implementation process and have clearly identified outcomes.
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Affiliation(s)
- Pamela Scott
- Intensive Care UnitForth Valley Royal HospitalLarbertUK
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21
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Björk K, Lindahl B, Fridh I. Family members' experiences of waiting in intensive care: a concept analysis. Scand J Caring Sci 2019; 33:522-539. [PMID: 30866083 DOI: 10.1111/scs.12660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore the meaning of family members' experience of waiting in an intensive care context using Rodgers' evolutionary method of concept analysis. METHOD Systematic searches in CINAHL and PubMed retrieved 38 articles which illustrated the waiting experienced by family members in an intensive care context. Rodgers' evolutionary method of concept analysis was applied to the data. FINDINGS In total, five elements of the concept were identified in the analysis. These were as follows: living in limbo; feeling helpless and powerless; hoping; enduring; and fearing the worst. Family members' vigilance regarding their relative proved to be a related concept, but vigilance does not share the same set of attributes. The consequences of waiting were often negative for the relatives and caused them suffering. The references show that the concept was manifested in different situations and in intensive care units (ICUs) with various types of specialties. CONCLUSIONS The application of concept analysis has brought a deeper understanding and meaning to the experience of waiting among family members in an intensive care context. This may provide professionals with an awareness of how to take care of family members in this situation. The waiting is inevitable, but improved communication between the ICU staff and family members is necessary to reduce stress and alleviate the suffering of family members. It is important to acknowledge that waiting cannot be eliminated but family-centred care, including a friendly and welcoming hospital environment, can ease the burden of family members with a loved one in an ICU.
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Affiliation(s)
- Kristofer Björk
- Department of Intensive Care, Northern Älvsborgs County Hospital, Trollhättan, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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22
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Jerng JS, Huang SF, Yu HY, Chan YC, Liang HJ, Liang HW, Sun JS. Comparison of complaints to the intensive care units and those to the general wards: an analysis using the Healthcare Complaint Analysis Tool in an academic medical center in Taiwan. Crit Care 2018; 22:335. [PMID: 30522508 PMCID: PMC6282256 DOI: 10.1186/s13054-018-2271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 11/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background The management of complaints in the setting of intensive care may provide opportunities to understand patient and family experiences and needs. However, there are limited reports on the structured application of complaint analysis tools and comparisons between healthcare complaints in the critical care setting and other settings. Methods From the complaint management database of a university-affiliated medical center in Taiwan, we retrospectively identified the records of healthcare complaints to the intensive care units (ICUs) from 2008 to 2016. Complaints to the general wards in the same period were randomly selected from the database with twice the number of that of the ICU complaints. We coded, typed, and compared the complaints from the two settings according to the Healthcare Complaint Analysis Tool. Results We identified 343 complaints to the ICUs and randomly selected 686 complaints to the general wards during the 9-year study period. Most (94.7%) of the complaints to the ICUs came from the family members, whereas more complaints to the general wards came from the patients (44.2%). A total of 1529 problems (441 from ICU and 818 from general wards) were identified. Compared with the general ward complaints, in the ICU there were more complaints with multiple problems (25.1% vs. 16.9%, p = 0.002), complaints were referred more frequently to the nurses (28.1% vs. 17.5%, p < 0.001), and they focused more commonly on the care on the ICU/ward (60.5% vs. 54.2%, p = 0.029). The proportions of the three domains (clinical, management, and relationship) of complaints were similar between the ICU and general ward complaints (p = 0.121). However, in the management domain, the problems from ICU complaints focused more on the environment than on the institutional processes (90.9% vs. 74.5%, p < 0.001), whereas in the relationship domain, the problems focused more on communication (17.9% vs. 8.0%) and less on listening (34.6% vs. 46.5%) (p = 0.002) than the general ward complaints. Conclusions A structured typing and systematic analysis of the healthcare complaints to the ICUs may provide valuable insights into the improvement of care quality, especially to the perceptions of the ICU environment and communications of the patients and their families. Electronic supplementary material The online version of this article (10.1186/s13054-018-2271-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Szu-Fen Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsin-Yu Yu
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chan
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huang-Ju Liang
- Center for Quality Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Huey-Wen Liang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, No. 7, Zhongshan South Road, Taipei, 100, Taiwan.
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23
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Cody SE, Sullivan-Bolyai S, Reid-Ponte P. Making a Connection: Family Experiences With Bedside Rounds in the Intensive Care Unit. Crit Care Nurse 2018; 38:18-26. [PMID: 29858192 DOI: 10.4037/ccn2018128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The hospitalization of a family member in an intensive care unit can be stressful for the family. Family bedside rounds is a way for the care team to inform family members, answer questions, and involve them in care decisions. The experiences of family members with intensive care unit bedside rounds have been examined in few studies. OBJECTIVES To describe (1) the experiences of family members of patients in the intensive care unit who participated in family bedside rounds (ie, view of the illness, role in future management, and long-term consequences on individual and family functioning) and (2) the experiences of families who chose not to participate in family bedside rounds and their perspectives regarding its value, their illness view, and future involvement in care. METHODS A qualitative descriptive study was done, undergirded by the Family Management Style Framework, examining families that participated and those that did not. RESULTS Most families that participated (80%) found the process helpful. One overarching theme, Making a Connection: Comfort and Confidence, emerged from participating families. Two major factors influenced how that connection was made: consistency and preparing families for the future. Three types of consistency were identified: consistency in information being shared, in when rounds were being held, and in informing families of rounding delays. In terms of preparing families for the future, families appeared to feel comfortable with the situation when a connection was present. When any of the factors were missing, families described feelings of anger, frustration, and fear. Family members who did not participate described similar feelings and fear of the unknown because of not having participated. CONCLUSION What health care providers say to patients' families matters. Families may need to be included in decision-making with honest, consistent, easy-to-understand information.
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Affiliation(s)
- Shawn E Cody
- Shawn E. Cody was the Associate Chief Nursing Officer for critical care at UMass Memorial Medical Center, Worcester, Massachusetts, when this article was written. .,Susan Sullivan-Bolyai is a professor of Nursing at the University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts. .,Patricia Reid-Ponte is a clinical associate professor at Boston College Connell School of Nursing, Chestnut Hill, Massachusetts.
| | - Susan Sullivan-Bolyai
- Shawn E. Cody was the Associate Chief Nursing Officer for critical care at UMass Memorial Medical Center, Worcester, Massachusetts, when this article was written.,Susan Sullivan-Bolyai is a professor of Nursing at the University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts.,Patricia Reid-Ponte is a clinical associate professor at Boston College Connell School of Nursing, Chestnut Hill, Massachusetts
| | - Patricia Reid-Ponte
- Shawn E. Cody was the Associate Chief Nursing Officer for critical care at UMass Memorial Medical Center, Worcester, Massachusetts, when this article was written.,Susan Sullivan-Bolyai is a professor of Nursing at the University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts.,Patricia Reid-Ponte is a clinical associate professor at Boston College Connell School of Nursing, Chestnut Hill, Massachusetts
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Dale B, Frivold G. Psychometric testing of the Norwegian version of the questionnaire Family Satisfaction in the Intensive Care Unit (FS-ICU-24). J Multidiscip Healthc 2018; 11:653-659. [PMID: 30510429 PMCID: PMC6231505 DOI: 10.2147/jmdh.s184003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The questionnaire, Family Satisfaction in the Intensive Care Unit (FS-ICU-24), was developed to assess relatives' satisfaction with care and involvement in decision-making processes when a close family member stays in the ICU. AIM This study was aimed at describing the translation and exploring the psychometric properties of the Norwegian version of the questionnaire. METHODS The study design was a cross-sectional survey. After translating the questionnaire according to recommended procedures, 123 close relatives of patients, recently treated in ICU, responded to a mailed questionnaire including the FS-ICU-24-No. Item-to-total correlations and Cronbach's alpha coefficient were assessed for estimating reliability and construct validity was assessed by the "known groups" technique and explorative factor analysis. RESULTS The Cronbach's alpha coefficient of 0.96 and significant item-to-total correlations supported the homogeneity of the instrument. The construct validity was reflected in significant differences in median scores on the total scale and subscales between the group reporting lower degrees of satisfaction and the group reporting higher degrees of satisfaction. Two fixed factors with an eigenvalue >1, and an explained variance of 62.5%, emerged from the factor analysis. CONCLUSION The FS-ICU-24-No showed promising psychometric properties regarding reliability in this study group, which may indicate that the instrument is suitable for assessing family members' satisfaction with care and decision making in Norwegian ICU.
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Affiliation(s)
- Bjørg Dale
- Centre for Caring Research, Southern Norway, University of Agder, Faculty of Health and Sport Sciences, Grimstad, Norway,
| | - Gro Frivold
- University of Agder, Faculty of Health and Sport Sciences, Grimstad, Norway
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Development and initial validation of the Swedish Family Satisfaction Intensive Care Questionnaire (SFS-ICQ). Intensive Crit Care Nurs 2018; 50:118-124. [PMID: 29935980 DOI: 10.1016/j.iccn.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/27/2018] [Accepted: 05/02/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Measuring patients satisfaction is an important part of continuous quality improvement in health care. In intensive care, family satisfaction is often used as a proxy for patient experience. At present, no suitable instrument to measure this has been fully validated in Sweden. The purpose of this study was to develop and validate a questionnaire intended to evaluate families' satisfaction of quality of care in Swedish intensive care units. METHODS Based on literature and the modification of pertinent items in two existing North American questionnaires, a Swedish questionnaire was developed. Content validity was assessed by experts, and the cognitive method Think Aloud was used with twelve family members of intensive care patients in two different intensive care units. Data was analysed using qualitative content analysis. FINDINGS Seven items in the questionnaire were identified as problematic, causing eight problems concerning questioning of content and 23 concerning misunderstanding. Six of these items were changed in order to be understood the way they were intended, and one item was removed. CONCLUSION A family satisfaction questionnaire applicable in Swedish intensive care units has been developed and validated for respondents' understanding of the questions being asked. However, further psychometric testing should be performed when more data are available.
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Neves JDL, Schwartz E, Guanilo MEE, Amestoy SC, Mendieta MDC, Lise F. AVALIAÇÃO DA SATISFAÇÃO DE FAMILIARES DE PACIENTES ATENDIDOS EM UNIDADES DE TERAPIA INTENSIVA: REVISÃO INTEGRATIVA. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-070720180001800016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
RESUMO Objetivo: analisar a produção científica relacionada às evidências acerca da satisfação de familiares de pacientes de UTI e os instrumentos utilizados para sua avaliação. Metodo: revisão integrativa na qual foram analisados artigos publicados entre 2005 e 2015, em inglês, português ou espanhol, nas bases de dados PUBMED/MEDLINE e LILACS e a biblioteca SciELO. Utilizou-se como estratégia de busca: personal satisfactional OR satisfaction AND family. Para coleta de dados dos artigos elaborou-se um instrumento com informações como: título, autores, ano de publicação e revista, objetivo do estudo, delineamento, participantes, local da pesquisa, temática principal e resultados. Resultados: atenderam aos critérios de inclusão 27 produções. Foram identificados quatro instrumentos utilizados para avaliar a satisfação de familiares de pacientes na UTI o Critical Care Family Satisfaction Survey, Family Satisfaction in the Intensive Care Unit, Critical Care Family Needs Inventory e o Quality of Dying and Death. Os estudos abordaram a satisfação dos familiares em relação às suas necessidades e tomadas de decisão, satisfação quanto a cuidados paliativos, evidenciou-se, ainda, estudos de adaptação transcultural e validação de instrumentos. Quanto ao nível de evidência, os estudos se concentram nos níveis II a VI. Conclusão: a análise da produção científica sobre a satisfação de familiares de pacientes de UTI permitiu evidenciar que o fator que mais contribui na promoção da satisfação da família foi a qualidade do atendimento.
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Provided information and parents' comprehension at the time of admission of their child in pediatric intensive care unit. Eur J Pediatr 2018; 177:395-402. [PMID: 29270825 DOI: 10.1007/s00431-017-3075-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/10/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED This study evaluated the first interaction (FI) between parents and health care providers at the time of admission of a child in pediatric intensive care unit (PICU), and explored the extent to which parents understood the medical information. This prospective study took place in three French university-affiliated PICUs. Forty-two parents of 30 children were interviewed. The physician and nurse who took care of the child completed a questionnaire. We evaluated parents' comprehension (excellent, fair, or poor) by comparing parents' and physicians' responses to six items: diagnosis, affected organ, reason for hospitalization, prognosis, treatments, and further investigations. Parent-physician FI occurred within 24 h of child's admission. Two thirds of the parents were dissatisfied to wait before receiving information. Most of the parents had an excellent comprehension of the affected organ (n = 25/28, 89.3%) and prognosis (n = 26/30, 86.7%). Two thirds of the parents understood the reason for hospitalization (n = 18/28, 64.3%) and diagnosis (n = 19/30, 63.3%). Less than half the parents understood child's treatments (n = 10/30, 33.3%) and further investigations (n = 8/21, 38.1%). When a nurse delivered information on treatment, parental comprehension improved (p = 0.053). CONCLUSION Parents complained of their wait time before receiving information. Most of them had an excellent comprehension. An improved communication between nurses and physicians is mandatory, and the active participation of nurses to give information to the parents should be encouraged. What is known: • In pediatric intensive care unit, health care providers deliver information to parents on their child's condition, which fosters the trust between them to build a partnership. • Various guidelines exist to help health care providers communicate with parents in PICU, but never mention the specific time of admission. What is new: • Even though parents could wait before entering the unit, they all received information on their child's condition within 24 hours after admission. • Parents understood the information well, and nurses improved the parental comprehension of the treatments by reformulating.
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Clark K, Milner KA, Beck M, Mason V. Measuring Family Satisfaction With Care Delivered in the Intensive Care Unit. Crit Care Nurse 2018; 36:e8-e14. [PMID: 27908955 DOI: 10.4037/ccn2016276] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND In our competitive health care environment, measuring the experience of family members of patients in the intensive care unit to ensure that health care providers are meeting families' needs is critical. Surveys from Press Ganey and the Centers for Medicare and Medicaid Services are unable to capture families' satisfaction with care in this setting. OBJECTIVE To implement a sustainable measure for family satisfaction in a 12-bed medical and surgical intensive care unit. To assess the feasibility of the selected tool for measuring family satisfaction and to make recommendations that are based on the results. METHOD A descriptive survey design using the Family Satisfaction in the Intensive Care Unit 24-item questionnaire to measure satisfaction with care and decision-making. RESULTS Forty family members completed the survey. Overall, the mean score for families' satisfaction with care was 72.24% (SD, 14.87%) and the mean score for families' satisfaction with decision-making was 72.03% (SD, 16.61%). Families reported that nurses put them at ease and provided understandable explanations. Collaboration, inclusion of families in clinical discussions, and timely information regarding changes in the patient's condition were the most common points brought up in free-text responses from family members. Written communication, including directions and expectations, would have improved the families' experience. CONCLUSION Although patients' family members reported being satisfied with their experience in the intensive care unit, there is room for improvement. Effective communication among the health care team, patients' families, and patients will be targeted for quality improvement initiatives.
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Affiliation(s)
- Kathleen Clark
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Kerry A Milner
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts. .,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing. .,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing. .,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts.
| | - Marlene Beck
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Virginia Mason
- Kathleen Clark is an adjunct professor at Sacred Heart University College of Nursing, Fairfield, Connecticut, and a critical care nurse at Newton Wellesley Hospital, Newton, Massachusetts.,Kerry A. Milner is an associate professor at Sacred Heart University College of Nursing.,Marlene Beck is a clinical assistant professor and director of the MSN and DNP online programs at Sacred Heart University College of Nursing.,Virginia Mason is a coordinator and critical care/intensive care unit nurse education specialist at UMASS Memorial Medical Center, Worcester, Massachusetts
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Kynoch K, Cabilan CJ, McArdle A. Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2018; 14:83-90. [PMID: 27941513 DOI: 10.11124/jbisrir-2016-003193] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.
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Affiliation(s)
- Kate Kynoch
- Nursing Research Centre and the Queensland Centre for Evidence-Based Nursing and Midwifery: a Joanna Briggs Institute Centre of Excellence, Mater Misericordiae Limited, Brisbane, Australia
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Nurhaeni N. Reliability and validity of the family satisfaction instrument in families of children with pneumonia. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence. Int J Nurs Stud 2018; 77:15-26. [DOI: 10.1016/j.ijnurstu.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022]
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Frivold G, Slettebø Å, Heyland DK, Dale B. Family members' satisfaction with care and decision-making in intensive care units and post-stay follow-up needs-a cross-sectional survey study. Nurs Open 2017; 5:6-14. [PMID: 29344389 PMCID: PMC5762765 DOI: 10.1002/nop2.97] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/22/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore family members' satisfaction with care and decision‐making during the intensive care units stay and their follow‐up needs after the patient's discharge or death. Design A cross‐sectional survey study was conducted. Methods Family members of patients recently treated in an ICU were participating. The questionnaire contented of background variables, the instrument Family Satisfaction in ICU (FS‐ICU 24) and questions about follow‐up needs. Descriptive and non‐parametric statistics and a multiple linear regression were used in the analysis. Results A total of 123 (47%) relatives returned the questionnaire. Satisfaction with care was higher scored than satisfaction with decision‐making. Follow‐ up needs after the ICU stay was reported by 19 (17%) of the participants. Gender and length of the ICU stay were shown as factors identified to predict follow‐up needs.
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Affiliation(s)
- Gro Frivold
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Åshild Slettebø
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway
| | - Daren K Heyland
- Clinical Evaluation Research Unit Kingston General Hospital Kingston ON Canada.,The Canadian Researchers at the End of Life Network Kingston ON Canada.,Critical Care Nutrition Department of Critical Care Medicine Queen's University Kingston ON Canada
| | - Bjørg Dale
- University of Agder Faculty of Health and Sport Sciences Grimstad Norway.,Centre for Caring Research Southern Norway Grimstad Norway
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Bruce CR, Newell AD, Brewer JH, Timme DO, Cherry E, Moore J, Carrettin J, Landeck E, Axline R, Millette A, Taylor R, Downey A, Uddin F, Gotur D, Masud F, Zhukovsky DS. Developing and testing a comprehensive tool to assess family meetings: Empirical distinctions between high- and low-quality meetings. J Crit Care 2017; 42:223-230. [PMID: 28780489 DOI: 10.1016/j.jcrc.2017.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The heterogeneity with regard to findings on family meetings (or conferences) suggests a need to better understand factors that influence family meetings. While earlier studies have explored frequency or timing of family meetings, little is known about how factors (such as what is said during meetings, how it is said, and by whom) influence family meeting quality. OBJECTIVES (1) To develop an evaluation tool to assess family meetings (Phase 1); (2) to identify factors that influence meeting quality by evaluating 34 family meetings (Phase 2). MATERIALS AND METHODS For Phase 1, methods included developing a framework, cognitive testing, and finalizing the evaluation tool. The tool consisted of Facilitator Characteristics (i.e., gender, experience, and specialty of the person leading the meeting), and 22 items across 6 Meeting Elements (i.e., Introductions, Information Exchanges, Decisions, Closings, Communication Styles, and Emotional Support) and sub-elements. For Phase 2, methods included training evaluators, assessing family meetings, and analyzing data. We used Spearman's rank-order correlations to calculate meeting quality. Qualitative techniques were used to analyze free-text. RESULTS No Facilitator Characteristic had a significant correlation with meeting quality. Sub-elements related to communication style and emotional support most strongly correlated with high-quality family meetings, as well as whether "next steps" were outlined (89.66%) and whether "family understanding" was elicited (86.21%). We also found a significant and strong positive association between overall proportion scores and evaluators' ratings (rs=0.731, p<0.001). CONCLUSIONS We filled a gap by developing an evaluation tool to assess family meetings, and we identified how what is said during meetings impacts quality.
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Affiliation(s)
- Courtenay R Bruce
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA; Houston Methodist System, Bioethics Program, Houston, TX, USA.
| | - Alana D Newell
- Center for Educational Outreach, Baylor College of Medicine, Houston, TX, USA
| | | | - Divina O Timme
- Texas A&M University, College of Medicine, Bryan, TX, USA
| | - Evan Cherry
- Texas A&M University, College of Medicine, Bryan, TX, USA
| | - Justine Moore
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Jennifer Carrettin
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Emily Landeck
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Rebecca Axline
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Allison Millette
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Ruth Taylor
- Department of Social Work and Case Management, Houston Methodist Hospital, Houston, TX, USA
| | - Andrea Downey
- Division of Supportive and Palliative Care, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Uddin
- Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Deepa Gotur
- Weill Cornell Medical College, New York, NY, USA; Critical Care Division, Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Faisal Masud
- Weill Cornell Medical College, New York, NY, USA; Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, TX, USA
| | - Donna S Zhukovsky
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Abstract
BACKGROUND Patient- and family-centered care permeates critical care where there are often multiple teams involved in management. A method of facilitating information sharing to support shared decision making is essential in appropriately rendering care.This study sought to determine whether incorporating family members on rounds in the intensive care unit (ICU) improves patient and family knowledge and whether doing so improves team time management and satisfaction with the process. METHODS A nonrandomized comparative before-and-after trial of incorporating family members on rounds (July to December 2009 vs January to July 2010) in a single quarternary center's surgical ICU assessed (1) family members' knowledge, (2) nurse's and physician's satisfaction with the intervention, (3) frequency and timing of family meetings, and (4) physician's workflow. RESULTS Intensive care unit demographics and use were similar between time frames. Presurvey (n = 412 family members; 49 nurses) and postsurvey (n = 427 family members; 47 nurses) were coupled with presurvey (n = 5) and postsurvey (n = 6) physicians' informal feedback. Family knowledge of the clinical course and plans increased from 146 (35.4%) of 412 to 374 (87.6%) of 427 (p < 0.0001). Nurses were nearly uniformly satisfied with planned family interaction on rounds (presurvey: 9/49 [18.4%] vs postsurvey: 46/47 [97.9%]; p < 0.0001). Family meetings per week outside of rounds substantially decreased from a mean of 5.3 ± 2.7 to 0.3 ± 0.9; p < 0.001). Goals of therapy including end-of-life care became an element frequently discussed on rounds with families (presurvey: 9.4% ± 4.7% vs postsurvey: 82.5% ± 14.8%; p < 0.0001). One intensivist was dissatisfied with the process. CONCLUSION Incorporating family members on rounds in the ICU improves communication and satisfaction and shifts the team's time away from family communication events outside of rounds, condensing most of those activities within the rounding structure. Critical care nurses and intensivists were principally satisfied with the process. LEVEL OF EVIDENCE Therapeutic, level III.
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Kim Y, Min J, Lim G, Lee JK, Lee H, Lee J, Kim KS, Park JS, Cho YJ, Jo YH, Rhu H, Kim KS, Lee SM, Lee YJ. Transcultural Adaptation and Validation of the Family Satisfaction in the Intensive Care Unit Questionnaire in a Korean Sample. Korean J Crit Care Med 2017; 32:60-69. [PMID: 31723617 PMCID: PMC6786738 DOI: 10.4266/kjccm.2016.00962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022] Open
Abstract
Background A number of questionnaires designed for analyzing family members’ inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. Methods The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). Results In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman’s r = 0.84, p < 0.001). Cronbach’s αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). Conclusions The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members’ satisfaction about ICU care.
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Affiliation(s)
- Youlim Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jinsoo Min
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gajin Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jinwoo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Jae Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hogeol Rhu
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Seok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeon Joo Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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The Impact of Resident Training on Communication with Families in the Intensive Care Unit. Resident and Family Outcomes. Ann Am Thorac Soc 2017; 13:512-21. [PMID: 26989925 DOI: 10.1513/annalsats.201508-495oc] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE In high-acuity settings such as intensive care units (ICUs), the quality of communication with patients' families is a particularly important component of care. Evidence shows that ICU communication is often inadequate and can negatively impact family outcomes. OBJECTIVES To assess the impact of a communication training program on resident skills in communicating with families in an ICU and on family outcomes. METHODS We conducted a prospective, single-site educational intervention study. The intervention featured a weekly required communication training program (4 h total) during the ICU rotation, which included interactive discussion, and role play with immediate feedback from simulated family members. All internal medicine residents on ICU rotation between July 2012 and July 2014 were invited to participate in the study. Family members who had a meeting with an enrolled resident were approached for a survey or interview. The primary outcome was family ratings of how well residents met their informational and emotional needs. MEASUREMENTS AND MAIN RESULTS The response rate for the resident baseline survey was 93% (n = 149 of 160), and it was 90% at postcourse and 84% at 3-month follow-up. Of 303 family members approached, 237 were enrolled. Enrolled family members who had a confirmed meeting with a resident were eligible to complete a survey or interview. The completion rate was 86% (n = 82 of 95). Family members were more likely to describe residents as having "fully met" (average rating of 10/10 on 0-10 scale) their informational and emotional needs when the resident had completed two or three course sessions (84% of family members said conversation with these residents "fully met" their needs), as compared with residents who had taken one session or no sessions (25% of family members said needs were "fully met") (P < 0.0001). Residents described improvements across all domains. All differences are statistically significant, most with large effect sizes. CONCLUSIONS At our institution, an on-site communication training program designed for integration into medical residency programs was associated with strongly positive family member outcomes and significant improvements in residents' perceived skills. This intervention may serve to prepare residents for optimal communications with patients and family members in ICUs and elsewhere.
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Efstathiou N, Ives J. Compassionate care during withdrawal of treatment: A secondary analysis of ICU nurses' experiences. Nurs Ethics 2017; 25:1075-1086. [PMID: 28116962 DOI: 10.1177/0969733016687159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND: Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units. OBJECTIVES: The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal. DESIGN: The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care. ETHICAL CONSIDERATIONS: The primary study was approved by the local Research Ethics Committee and the hospital's Research and Development services. FINDINGS: Compassionate care was mostly directed to the patient's family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient's dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus. CONCLUSION: This study's findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians' roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.
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Satisfaction Domains Differ between the Patient and Their Family in Adult Intensive Care Units. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9025643. [PMID: 28044138 PMCID: PMC5156795 DOI: 10.1155/2016/9025643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/26/2016] [Accepted: 10/12/2016] [Indexed: 11/18/2022]
Abstract
Background. Patients' and family's satisfaction data from the Asian intensive care units (ICUs) is lacking. Objective. Domains between patient and family satisfaction and contribution of each domain to the general satisfaction were studied. Method. Over 3 months, adult patients across 4 ICUs staying for more than 48 hours with abbreviated mental test score of 7 or above and able to understand English and immediate family members were surveyed by separate validated satisfaction questionnaires. Results. Two hundred patients and 194 families were included in the final analysis. Significant difference in the satisfaction scores was observed between the ICUs. Patients were most and least satisfied in the communication (4.2 out of 5) and decision-making (2.9 out of 5) domains, respectively. Families were most and least satisfied in the relationship with doctors (3.9 out of 5) and family's involvement domains (3.3 out of 5), respectively. Domains contributing most to the general satisfaction were the illness management domain for patients (β coefficient = 0.44) and characteristics of doctors and nurses domain for family (β coefficient = 0.45). Discussion. In an Asian ICU community, patients and families differ in their expectations and valuations of health care processes. Health care providers have difficult tasks in attending to these different domains.
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Pagnamenta A, Bruno R, Gemperli A, Chiesa A, Previsdomini M, Corti F, Merlani P, Cottini S, Llamas M, Rothen HU. Impact of a communication strategy on family satisfaction in the intensive care unit. Acta Anaesthesiol Scand 2016; 60:800-9. [PMID: 26823125 DOI: 10.1111/aas.12692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/28/2015] [Accepted: 12/29/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Family satisfaction of critically ill patients has gained increased interest as important indicator to evaluate the quality of care in the intensive care unit (ICU). The family satisfaction in the ICU questionnaire (FS-ICU 24) is a well-established tool to assess satisfaction in such settings. We tested the hypothesis that an intervention, aiming at improved communication between health professionals and patients' next of kin in the ICU improves family satisfaction, as assessed by FS-ICU 24. METHODS Using a multicenter before-and-after study design, we evaluated medium-term effectiveness of VALUE, a recently proposed strategy aiming at improved communication. Satisfaction was assessed using the FS-ICU 24 questionnaire. Performance-importance plots were generated in order to identify items highly correlated with overall satisfaction but with low individual score. RESULTS A total of 163 completed family questionnaires in the pre-intervention and 118 in the post-intervention period were analyzed. Following the intervention, we observed: (1) a non-significant increase in family satisfaction summary score and sub-scores; (2) no decline in any individual family satisfaction item, and (3) improvement in items with high overall impact on satisfaction but quoted with low degree of satisfaction. CONCLUSION No significant improvement in family satisfaction of critically ill adult patients could be found after implementing the VALUE strategy. Whether these results are due to insufficient training of the new strategy or a missing effect of the strategy in our socio-economic environment remains to be shown.
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Affiliation(s)
- Alberto Pagnamenta
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Unit of Clinical Epidemiology of EOC; Bellinzona Switzerland
| | - Roberta Bruno
- Swiss Association of Counselling; Zurich Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy; Lucerne University; Lucerne Switzerland
- Swiss Paraplegic Research; Nottwil Switzerland
| | - Alessandro Chiesa
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Surgical Intensive Care Medicine; University Hospital Zurich; Zurich Switzerland
| | - Marco Previsdomini
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Fabio Corti
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Paolo Merlani
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Department of Anesthesiology; Pharmacology and Intensive Care; University Hospital Geneva; Geneva Switzerland
| | - Silvia Cottini
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
- Surgical Intensive Care Medicine; University Hospital Zurich; Zurich Switzerland
| | - Michael Llamas
- Department of Intensive Care Medicine of the Ente Ospedaliero Cantonale (EOC); Intensive Care Units of Regional Hospital of Mendrisio; Bellinzona Lugano and Locarno Switzerland
| | - Hans Ulrich Rothen
- Department of Intensive Care Medicine; Bern University Hospital (Inselspital); Bern Switzerland
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Akroute AR, Bondas T. Critical care nurses and relatives of elderly patients in intensive care unit–Ambivalent interaction. Intensive Crit Care Nurs 2016; 34:59-72. [DOI: 10.1016/j.iccn.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 07/19/2015] [Accepted: 08/07/2015] [Indexed: 12/31/2022]
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Higginson IJ, Rumble C, Shipman C, Koffman J, Sleeman KE, Morgan M, Hopkins P, Noble J, Bernal W, Leonard S, Dampier O, Prentice W, Burman R, Costantini M. The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories. BMC Anesthesiol 2016; 16:11. [PMID: 26860461 PMCID: PMC4746769 DOI: 10.1186/s12871-016-0177-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With increasingly intensive treatments and population ageing, more people face complex treatment and care decisions. We explored patterns of the decision-making processes during critical care, and sources of conflict and resolution. METHODS Ethnographic study in two Intensive Care Units (ICUs) in an inner city hospital comprising: non-participant observation of general care and decisions, followed by case studies where treatment limitation decisions, comfort care and/or end of life discussions were occurring. These involved: semi-structured interviews with consenting families, where possible, patients; direct observations of care; and review of medical records. RESULTS Initial non-participant observation included daytime, evenings, nights and weekends. The cases were 16 patients with varied diagnoses, aged 19-87 years; 19 family members were interviewed, aged 30-73 years. Cases were observed for <1 to 156 days (median 22), depending on length of ICU admission. Decisions were made serially over the whole trajectory, usually several days or weeks. We identified four trajectories with distinct patterns: curative care from admission; oscillating curative and comfort care; shift to comfort care; comfort care from admission. Some families considered decision-making a negative concept and preferred uncertainty. Conflict occurred most commonly in the trajectories with oscillating curative and comfort care. Conflict also occurred inside clinical teams. Families were most often involved in decision-making regarding care outcomes and seemed to find it easier when patients switched definitively from curative to comfort care. We found eight categories of decision-making; three related to the care outcomes (aim, place, response to needs) and five to the care processes (resuscitation, decision support, medications/fluids, monitoring/interventions, other specialty involvement). CONCLUSIONS Decision-making in critical illness involves a web of discussions regarding the potential outcomes and processes of care, across the whole disease trajectory. When measures oscillate between curative and comfort there is greatest conflict. This suggests a need to support early communication, especially around values and preferred care outcomes, from which other decisions follow, including DNAR. Offering further support, possibly with expert palliative care, communication, and discussion of 'trial of treatment' may be beneficial at this time, rather than waiting until the 'end of life'.
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Affiliation(s)
- I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
| | - C Rumble
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - C Shipman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - J Koffman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - K E Sleeman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - M Morgan
- King's College London, Department of Primary Care and Public Health Sciences, Capital House, London Bridge, London, UK
| | - P Hopkins
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - J Noble
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - W Bernal
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - S Leonard
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - O Dampier
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - W Prentice
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - R Burman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - M Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Family experience survey in the surgical intensive care unit. Appl Nurs Res 2015; 28:281-4. [DOI: 10.1016/j.apnr.2015.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 11/19/2022]
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Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties. Crit Care Med 2015; 43:1731-44. [PMID: 25821917 DOI: 10.1097/ccm.0000000000000980] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties. DATA SOURCES We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013. STUDY SELECTION Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility. DATA EXTRACTION Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies. DATA SYNTHESIS The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce. CONCLUSIONS Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.
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Paul RG, Finney SJ. Family satisfaction with care on the ICU: essential lessons for all doctors. Br J Hosp Med (Lond) 2015; 76:504-9. [DOI: 10.12968/hmed.2015.76.9.504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Richard G Paul
- NIHR Clinical Research Fellow in Adult Intensive Care, Royal Brompton Hospital, London SW3 6NP
| | - Simon J Finney
- Consultant in Adult Intensive Care in the Adult Intensive Care Unit, Royal Brompton Hospital, London SW3 6NP
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Pelazza BB, Simoni RCM, Freitas EGB, Silva BRD, Silva MJPD. Visita de Enfermagem e dúvidas manifestadas pela família em unidade de terapia intensiva. ACTA PAUL ENFERM 2015. [DOI: 10.1590/1982-0194201500011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo : Conhecer as dúvidas dos familiares de pacientes internados na unidade de terapia intensiva, há mais de 24 horas, e manifestadas durante as visitas de enfermagem. Métodos : Estudo transversal prospectivo que incluiu 115 famíliares de pacientes internados há mais de 24 horas em unidade de terapia intensiva. O instrumento de pesquisa foi um questionário aplicado em três visitas de enfermagem. Resultados : A dúvida mais apresentada foi sobre o estado clínico e a diferença média entre as dúvidas da primeira e segunda visita foi estatisticamente significante (p=0,047). A média de dúvidas da primeira visita foi significante, quando comparada com a terceira (p<0,001). Conclusão : As dúvidas manifestadas por familiares foram sobre o estado de saúde, condições clínicas e sobre o cuidado realizado. O número médio de dúvidas foi menor na terceira visita de enfermagem.
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Medicaid managed care: Issues for beneficiaries with disabilities. Disabil Health J 2015; 8:130-5. [DOI: 10.1016/j.dhjo.2014.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/16/2014] [Accepted: 08/19/2014] [Indexed: 11/18/2022]
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Takahashi K, Sasanuma N, Itani Y, Tanaka T, Domen K, Masuyama T, Ohyanagi M, Suzuki K. Impact of early interventions by a cardiac rehabilitation team on the social rehabilitation of patients resuscitated from cardiogenic out-of-hospital cardiopulmonary arrest. Intern Med 2015; 54:133-9. [PMID: 25743003 DOI: 10.2169/internalmedicine.54.2825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We examined the effects of intervention performed by a multidisciplinary cardiac rehabilitation (CR) team on the social rehabilitation of patients with cardiogenic out-of-hospital cardiopulmonary arrest (OHCA) in the acute phase. METHODS This study included 122 patients who were resuscitated after cardiogenic OHCA during a 10-year period. They were divided into two groups: including a non-CR group of patients (n=58) who were admitted before the CR team started performing systematic intervention and a CR group (n=64) who were admitted after the intervention was initiated. The following items were examined for each group: treatment condition at onset, contents of treatment, primary disease, presence or absence of underlying disease, presence or absence of complications, general physical and neurological outcome, duration of hospital stay, and status of social rehabilitation. RESULTS Although the number of patients with cardiogenic OHCA did not markedly change, the number of bystanders participating in cardiopulmonary resuscitation (CPR) was significantly higher in the CR group versus the non-CR group (p<0.01). The effect of bystanders participating in CPR also significantly reduced the mortality outcome (p<0.05 versus the group without CPR), and patients in the CR group were more likely to achieve social rehabilitation (p<0.05 versus the group without CPR). Moreover, the number of patients who returned to society one year later was increased in the CR group versus the non-CR group (p<0.05). The incidence of respiratory complications was also significantly lower in the CR group versus the non-CR group (p<0.05). CONCLUSION Along with the usefulness of rapid pre-hospital aid, our results suggest that systemic intervention performed by the CR team administered while the patient was in the acute phase may have promoted social rehabilitation of patients resuscitated after cardiogenic OHCA.
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Affiliation(s)
- Keiko Takahashi
- Medical Education Center, Hyogo College of Medicine; Cardiovascular Division, Department of Internal Medicine Hyogo College of Medicine, Japan
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Alonso-Ovies A, Álvarez J, Velayos C, García MM, Luengo MJ. [Expectations of relatives of critically ill patients regarding medical information. Qualitative research study]. ACTA ACUST UNITED AC 2014; 29:325-33. [PMID: 25534566 DOI: 10.1016/j.cali.2014.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/07/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine and analyse the expectations, needs and experiences of relatives of critically ill patients as regards medical information and the level of their understanding. To find keys for improving communication and to draw up best practices in clinical information. MATERIAL AND METHODS Qualitative research study through semi-structured interviews carried out in a polyvalent adult intensive care unit (ICU) in a University Hospital. PARTICIPANTS relatives of patients who were admitted to the ICU and who were discharged alive from the Unit. Ten interviews were performed taking into account diversification variables such as, type of family relationship with patients, patient age, length of ICU stay, origin, and location at the time of the interview. RESULTS The results of the analysis of 10 interviews focused on: the subjective position of the family in the ICU (the agonizing wait), what the ICU represents for the family (surveillance and monitoring of a situation between life and death), perceived care (complete delegation of care), and medical information (what and how they expect and what and how they receive it), as much in the first information (sincerity, hope, delicacy) as in the successive. CONCLUSIONS There is divergence between what families expect and what they get as regards medical information. To know the expectations of the families will help to provide higher quality care and more humane treatment in the ICU.
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Affiliation(s)
- A Alonso-Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | - J Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - C Velayos
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - M M García
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - M J Luengo
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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