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Zhuang C, Dexter F, Hadler RA. Poor Concordance Between Intensive Care Unit Patients' and Family Members' Patient Dignity Inventory Scores Despite Communication of Dignity-Related Distress. Anesth Analg 2024:00000539-990000000-00864. [PMID: 39008425 DOI: 10.1213/ane.0000000000006907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
BACKGROUND Promptly assessing and treating the distress of intensive care unit (ICU) patients may improve long-term psychological outcomes. One holistic approach to reduce patient distress is through dignity-centered care, traditionally used in palliative care. The 25-item Patient Dignity Inventory has construct validity and reliability for measuring dignity-related distress among ICU patients. Because family members often serve as ICU patients' surrogates and play an integral role in patients' dignity, we examined whether family members reliably recognized ICU patients' sources of distress. METHODS Two single-center observational studies of adult ICU patients were performed from May to June 2022. Inclusion criteria were ICU length-of-stay >48 hours, awake and alert, intact cognition, and no delirium. Study #1 evaluated concordance between patient and family for dignity-related distress. Both completed the Patient Dignity Inventory independently. The next Study #2 measured how many distressing items that the patient reported discussing with family members. RESULTS Study #1 of concordance had 33 patient-family dyads complete the Patient Dignity Inventory. The concordance correlation coefficient was small, 0.20 (99% confidence interval -0.21 to 0.55) and less than the inventory's test-retest reliability (r = .85). Study #2 examined sharing of Patient Dignity Inventory-related items between patients and family members. There were 12 of 19 patients who had severe distress based on an average Patient Dignity Inventory item score ≥1.92. The median patient shared multiple items of distress with their family (median 12, 99% 2-sided exact Hodges-Lehmann interval 4.0-17.5). CONCLUSIONS Although ICU patients often report sharing sources of distress with their loved ones, family members cannot accurately or reliably assess the extent to which patients experience psychosocial, existential, and symptom-related distress during critical illness. Treatments of distress should not be delayed by the absence of family members.
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Affiliation(s)
- Caywin Zhuang
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Rachel A Hadler
- Department of Anesthesiology
- Department of Family and Preventive Medicine, Emory Critical Care Center, Emory University, Atlanta, Georgia
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Hadler RA, Dexter F, Mergler BD. Lack of Useful Predictors of Dignity-Related Distress Among the Critically Ill as Assessed With the Patient Dignity Inventory. Anesth Analg 2023; 137:676-681. [PMID: 36827204 DOI: 10.1213/ane.0000000000006405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Many intensive care unit patients are awake (ie, alert and engaging in conversation), actively experiencing many facets of their critical care. The Patient Dignity Inventory can be used to elicit sources of distress in these patients. We examined the administrative question as to which awake intensive care unit patients should be evaluated and potentially treated (eg, through palliative care consultation) for distress. Should the decision to screen for distress be based on patient demographics or treatment conditions? METHODS This was a retrospective cohort study of 155 adult patients from 5 intensive care units of one hospital from 2019 to 2020. Each patient had ≥48 hours without delirium, dementia, or sedation. The Patient Dignity Inventory has 25 items to which patients responded on a 1 (not a problem) to 5 (an overwhelming problem) scale. Multiple complete, stepwise forward, and stepwise backward logistic regression models were created among patient and treatment variables for predicting thresholds of the mean among the 25 items. RESULTS There were 50% (78/155; 95% confidence interval [CI], 42-58) of patients with significant dignity-related distress (mean score ≥1.60). There were 34% (52/155; CI, 26-42) of patients with severe dignity-related distress (mean score ≥1.92; previously associated with often feeling like wanting to die). Models including combinations of vasopressor medication (protective of distress), tracheostomy (greater risk of distress), and female gender (greater risk of distress) had some predictive value. However, all combinations of potential predictors had misclassification rates significantly >20%. CONCLUSIONS Identification of subsets of patients with little potential benefit to screening for dignity-related distress would have a reduced workload of palliative care team members (eg, nurses or social workers). Our results show that this is impractical. Given that approximately one-third of critical care patients who are alert and without delirium demonstrate severe dignity-related distress, all such patients with prolonged intensive care unit length of stay should probably be evaluated for distress.
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Affiliation(s)
- Rachel A Hadler
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Franklin Dexter
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Blake D Mergler
- Department of Anesthesiology, University of Pennsylvania, Philadephia, Pennsylvania
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Cox CE, Gu J, Ashana DC, Pratt EH, Haines K, Ma J, Olsen MK, Parish A, Casarett D, Al-Hegelan MS, Naglee C, Katz JN, O'Keefe YA, Harrison RW, Riley IL, Bermejo S, Dempsey K, Johnson KS, Docherty SL. Trajectories of Palliative Care Needs in the ICU and Long-Term Psychological Distress Symptoms. Crit Care Med 2023; 51:13-24. [PMID: 36326263 PMCID: PMC10191149 DOI: 10.1097/ccm.0000000000005701] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES While palliative care needs are assumed to improve during ICU care, few empiric data exist on need trajectories or their impact on long-term outcomes. We aimed to describe trajectories of palliative care needs during ICU care and to determine if changes in needs over 1 week was associated with similar changes in psychological distress symptoms at 3 months. DESIGN Prospective cohort study. SETTING Six adult medical and surgical ICUs. PARTICIPANTS Patients receiving mechanical ventilation for greater than or equal to 2 days and their family members. MEASUREMENTS AND MAIN RESULTS The primary outcome was the 13-item Needs at the End-of-Life Screening Tool (NEST; total score range 0-130) completed by family members at baseline, 3, and 7 days. The Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Post-Traumatic Stress Scale (PTSS) were completed at baseline and 3 months. General linear models were used to estimate differences in distress symptoms by change in need (NEST improvement ≥ 10 points or not). One-hundred fifty-nine family members participated (median age, 54.0 yr [interquartile range (IQR), 44.0-63.0 yr], 125 [78.6%] female, 54 [34.0%] African American). At 7 days, 53 (33%) a serious level of overall need and 35 (22%) ranked greater than or equal to 1 individual need at the highest severity level. NEST scores improved greater than or equal to 10 points in only 47 (30%). Median NEST scores were 22 (IQR, 12-40) at baseline and 19 (IQR, 9-37) at 7 days (change, -2.0; IQR, -11.0 to 5.0; p = 0.12). There were no differences in PHQ-9, GAD-7, or PTSS change scores by change in NEST score (all p > 0.15). CONCLUSIONS Serious palliative care needs were common and persistent among families during ICU care. Improvement in needs was not associated with less psychological distress at 3 months. Serious needs may be commonly underrecognized in current practice.
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Affiliation(s)
- Christopher E Cox
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Jessie Gu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Deepshikha Charan Ashana
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Elias H Pratt
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Krista Haines
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
- Department of Surgery, Division of Trauma and Critical Care and Acute Care Surgery, Duke University, Durham, NC
| | - Jessica Ma
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, Durham, NC
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - David Casarett
- Department of Medicine, Section of Palliative Care and Hospice Medicine, Duke University, Durham, NC
| | - Mashael S Al-Hegelan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Colleen Naglee
- Department of Anesthesiology, Duke University, Durham, NC
- Department of Neurology, Division of Neurocritical Care, Duke University, Durham, NC
| | - Jason N Katz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Yasmin Ali O'Keefe
- Department of Neurology, Division of Neurocritical Care, Duke University, Durham, NC
| | - Robert W Harrison
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Isaretta L Riley
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Santos Bermejo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Katelyn Dempsey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC
- Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC
| | - Kimberly S Johnson
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System, Durham, NC
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
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Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, Wunderlich MM, Lütz A, Balzer F, Weiss B, Spies CD. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10:jcm10173928. [PMID: 34501376 PMCID: PMC8432195 DOI: 10.3390/jcm10173928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Jakob Gülden
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Vivian-Marie Mauersberger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Lukas Ehlen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | | | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Alawi Lütz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Correspondence: ; Tel.: +49-30-450-551-102
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Thank you letters from patients in an intensive care unit: From the expression of gratitude to an applied ethic of care. Intensive Crit Care Nurs 2017; 43:47-54. [PMID: 28668642 DOI: 10.1016/j.iccn.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Patients' perception of an intensive care unit stay can lead to a better understanding of the expectations and needs of patients hospitalised in intensive care so that care for critically ill patients can be adapted and improved. Thank you letters are sources of original information which come directly and spontaneously from patients. OBJECTIVE The objective of this study was to analyse the thank you letters from patients who required intensive care treatment and to identify messages that could be intended for the intensive care unit team. DESIGN We conducted a qualitative study according to a thematic analysis. The body of research consisted of 17 letters from patients hospitalised in intensive care unit. SETTING The study took place in the medical-surgical intensive care unit of a French general hospital. The intensive care unit is made up of 16 resuscitation beds and four continuous monitoring beds. FINDINGS Two main themes emerged: (i) expression of gratitude through a description of the caregivers' behaviour (humanity and professionalism) and recognition for surviving (ii) the narrative of the intensive care unit experience. CONCLUSION Thank you letters give a rich insight into how the patients perceived their stay in intensive care unit. Letters from patients give direct feedback on the quality of care provided, contribute to give meaning to work and raise the question of what the core values of care should be for all concerned in the healthcare providers-patients relationship.
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Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and family involvement in adult critical and intensive care settings: a scoping review. Health Expect 2016; 19:1183-1202. [PMID: 27878937 PMCID: PMC5139045 DOI: 10.1111/hex.12402] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite international bodies calling for increased patient and family involvement, these concepts remain poorly defined within literature on critical and intensive care settings. OBJECTIVE This scoping review investigates the extent and range of literature on patient and family involvement in critical and intensive care settings. Methodological and empirical gaps are identified, and a future agenda for research into optimizing patient and family involvement is outlined. METHODS Searches of MEDLINE, CINAHL, Social Work Abstracts and PsycINFO were conducted. English-language articles published between 2003 and 2014 were retrieved. Articles were included if the studies were undertaken in an intensive care or critical care setting, addressed the topic of patient and family involvement, included a sample of adult critical care patients, their families and/or critical care providers. Two reviewers extracted and charted data and analysed findings using qualitative content analysis. FINDINGS A total of 892 articles were screened, 124 were eligible for analysis, including 61 quantitative, 61 qualitative and 2 mixed-methods studies. There was a significant gap in research on patient involvement in the intensive care unit. The analysis identified five different components of family and patient involvement: (i) presence, (ii) having needs met/being supported, (iii) communication, (iv) decision making and (v) contributing to care. CONCLUSION Three research gaps were identified that require addressing: (i) the scope, extent and nature of patient involvement in intensive care settings; (ii) the broader socio-cultural processes that shape patient and family involvement; and (iii) the bidirectional implications between patient/family involvement and interprofessional teamwork.
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Affiliation(s)
- Michelle Olding
- British Columbia Centre for Excellence in HIV/AIDSVancouverBCCanada
| | - Sarah E. McMillan
- Collaborative Academic PracticeUniversity Health NetworkTorontoONCanada
| | - Scott Reeves
- Centre for Health and Social Care ResearchKingston University and St. George's University of LondonLondonUK
| | | | | | - Simon Kitto
- Department of Innovation in Medical EducationFaculty of MedicineUniversity of OttawaOttawaONCanada
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Karnatovskaia LV, Johnson MM, Dockter TJ, Gajic O. Perspectives of physicians and nurses on identifying and treating psychological distress of the critically ill. J Crit Care 2016; 37:106-111. [PMID: 27676170 DOI: 10.1016/j.jcrc.2016.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/22/2016] [Accepted: 09/09/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Survivors of critical illness are frequently unable to return to their premorbid level of psychocognitive functioning following discharge. Therefore, we aimed to evaluate the burden of psychological trauma experienced by patients in the intensive care unit (ICU) as perceived by clinicians to assess factors that can impede its recognition and treatment in the ICU. MATERIALS AND METHODS Two distinct role-specific Web-based surveys were administered to critical care physicians and nurses in medical and surgical ICUs of 2 academic medical centers. Responses were analyzed in the domains of psychological trauma, exacerbating/mitigating factors, and provider-patient communication. RESULTS A survey was completed by 43 physicians and 55 nurses with a response rate of 62% and 37%, respectively. Among physicians, 65% consistently consider the psychological state of the patient in decision making; 77% think it is important to introduce a system to document psychological state of ICU patients; 56% would like to have more time to communicate with patients; 77% consistently spend extra time at bedside besides rounds and often hold patient's hand/reassure them. Notably, for the question about the average level of psychological stress experienced by a patient in the ICU (with 0=no stress and 100=worst stress imaginable) during initial treatment stage and by the end of the ICU stay, median assessment by both physicians and nurses was 80 for the initial stress level and 68 for the stress level by the end of the ICU stay. Among nurses, 69% always try to minimize noise and 73% actively promote patient's rest. Physicians and nurses provided multiple specific suggestions for improving ICU environment and communication. CONCLUSIONS Both physicians and nurses acknowledge that they perceive that critically ill patients experience a high level of psychological stress that persists throughout their period of illness. Improved understanding of this phenomenon is needed to design effective therapeutic interventions. Although the lack of time is identified as significant barrier to ameliorating patient's psychological stress, the majority of clinicians indicate that they attempt to provide interventions to achieve this goal.
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Affiliation(s)
- Lioudmila V Karnatovskaia
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Margaret M Johnson
- Division of Pulmonary and Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224
| | - Travis J Dockter
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
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Wassenaar A, van den Boogaard M, van der Hooft T, Pickkers P, Schoonhoven L. 'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the intensive care unit. J Clin Nurs 2015; 24:3233-44. [PMID: 26374345 DOI: 10.1111/jocn.12995] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe and understand intensive care unit (ICU) nurses' views regarding their role in ICU patients' perception of safety. BACKGROUND Feeling safe is an important issue for ICU patients. Not feeling safe may result in adverse effects including traumatic experiences, having nightmares and feeling depressed. Nursing care plays a major role in patients' perception of safety. However, it is unknown whether ICU nurses are aware of this role. DESIGN A grounded theory approach following Corbin and Strauss. METHODS A total of 13 participants were included in the study following maximum variation sampling, by selecting ICU nurses who differed in gender, age, work experience as registered ICU nurse, and were employed in different IC units. In-depth interviews were performed using open-ended questions guided by a topic list with broad question areas. Data collection and analysis were executed during an iterative process. RESULTS The core category, building a bond of trust to provide good and comfortable care, arose from four main categories: explaining and informing ICU patients, using patients' family bond, ICU nurses' attitudes and expertise, and creating physical safety. CONCLUSION The ICU nurses stated that they were not explicitly aware of ICU patients' perception of safety, but that they strived to provide good and comfortable care, through building a bond of trust with their patients. According to the nurses, a bond of trust is essential for patients to feel safe in the ICU. RELEVANCE TO CLINICAL PRACTICE The importance of feeling safe in ICU patients should be addressed within the education and clinical practice of ICU nurses, to ensure that they become aware of ICU patients' perception of safety.
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Affiliation(s)
- Annelies Wassenaar
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Truus van der Hooft
- Clinical Health Sciences, Faculty of Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette Schoonhoven
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health Sciences, University of Southampton, Southampton, UK
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