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Khatib WE, Fawaz M, Al-Shloul MN, Rayan A, ALBashtawy M, Al-Amer RM, Abdalrahim A, Khatatbeh M. Critical Care Nurses' Experiences During the Illness of Family Members: A Qualitative Study. SAGE Open Nurs 2022; 8:23779608221132169. [PMID: 36245848 PMCID: PMC9561664 DOI: 10.1177/23779608221132169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/09/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction A loved one's hospitalization in a critical care unit is a traumatic experience for families. However, because of their status and professional competence, a family member who is also a critical care nurse has additional obstacles and often long-term consequences. Objectives To describe the experiences of critical care nurse-family members when a loved one is admitted to a critical care unit at the Hotel-Dieu de France hospital. Methods A qualitative path based on van Manen's hermeneutic phenomenology combining both descriptive and interpretive models were adopted. Results The lived experience of critical care nurses in providing care for their family members admitted into the same critical care were summarized in five themes. Nurses were torn between roles, consisting of confounding roles, their registered nurse status, and watchfulness. The lived experience of critical care nurses in providing care for their family members admitted into the same critical care was summarized into specialized knowledge that included a double-edged sword of seeking information and difficulty delivering the information. Critical nurses compete for expectations, including those placed on self and family members, resulting in emotional and personal sacrifice while gaining insight into the experiences. Conclusions Critical care nurse-family members have a unique experience compared to the rest of the family, necessitating specialized care and attention. Increased awareness among healthcare providers could be a start in the right direction.
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Affiliation(s)
| | - Mirna Fawaz
- Faculty of Health Sciences, Beirut Arab
University, Beirut, Lebanon
| | - Mohammad N. Al-Shloul
- Faculty of Nursing, Irbid National University, Irbid, Jordan,Mohammad N. Al-Shloul, RN, MPH, DrNSc,
Faculty of Nursing, Irbid National University, Irbid, Jordan.
| | - Ahmad Rayan
- Faculty of Nursing, Zarqa University,
Zarqa, Jordan
| | - Mohammed ALBashtawy
- Department of Community and Mental Health, Princess Salma Faculty of
Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Rasmieh M. Al-Amer
- Department of Psychiatric Health Nursing, Faculty of Nursing,
Isra
University, Amman, Jordan,Western Sydney University, School of Nursing and Midwifery, Sydney,
NSW, Australia
| | - Asem Abdalrahim
- Department of Community and Mental Health, Princess Salma Faculty of
Nursing, AL Al-Bayt University, Mafraq, Jordan
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Norouzadeh R, Heidari MR, Rahimi F, Kazemnejad A. Psychometric Properties of the "ICU Nurses" Perceptions Questionnaire of Self-Performance with Families of Critically Ill Patients (Persian Version). J Nurs Meas 2021; 30:135-147. [PMID: 34518435 DOI: 10.1891/jnm-d-20-00069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Nurses' self-perception of their performance toward family members of patients is one of the most important issues in predicting family adaptive behaviors. This study analyze the psychometric properties of the Persian version of ICU nurses' perceptions questionnaire of self-performance with families of critically ill patients. METHODS Among 135 intensive care nurses, to determine face validity, 10 nurses were asked to comment on, comprehensibility, grammar, and writing of items. Exploratory factor analysis was used to assess construct validity. RESULTS The intra-cluster correlation coefficient (ICC) was 0.82 and Cronbach's alpha was 0.74. Exploratory factor analysis showed the first nine related factors have 65.22% variance. CONCLUSION Persian version of "ICU nurses' perceptions of self-performance with families of critically ill patients" had good reliability and validity.
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Naef R, Massarotto P, Petry H. Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study. Intensive Crit Care Nurs 2020; 61:102916. [PMID: 32807604 DOI: 10.1016/j.iccn.2020.102916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate family and health professional experience with a nurse-led family support intervention in intensive care. DESIGN Qualitative evaluation study. SETTING A twelve-bed surgical intensive care unit in a 900-bed University Hospital in Switzerland. MAIN OUTCOME MEASURES Data were collected through 16 semi-structured interviews with families (n = 19 family members) and three focus group interviews with critical care staff (n = 19) and analysed using content analysis strategies. FINDINGS Four themes related to the new family support intervention were identified. First, families and staff described it as a valuable and essential part of ICU care. Second, it facilitated staff-family interaction and communication. Third, from staff perspective, it promoted the quality of family care. Fourth, staff believed that the family support intervention enabled them to better care for families through increased capacity for developing and sustaining relationships with families. CONCLUSIONS An advanced practice family nursing role coupled with a family support pathway is an acceptable, appreciated and beneficial model of care delivery in the inttensive care unit from the perspective of families and critical care staff. Further research is needed to investigate the intervention's effectiveness in the intensive care unit.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland; Institute of Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Switzerland.
| | - Paola Massarotto
- Institute of Intensive Medicine, University Hospital Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Switzerland
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New Graduate Nurse Transition Into the Intensive Care Unit: Qualitative Insights From a Longitudinal Study-Part 1. Res Theory Nurs Pract 2020; 33:428-444. [PMID: 31666397 DOI: 10.1891/1541-6577.33.4.428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years. METHODS This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed. RESULTS Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.
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Ghaedi F, Ashouri E, Soheili M, Sahragerd M. Nurses' Empathy in Different Wards: A Cross-Sectional Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2020; 25:117-121. [PMID: 32195156 PMCID: PMC7055183 DOI: 10.4103/ijnmr.ijnmr_84_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/23/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022]
Abstract
Background: Empathy is an important component of the nurse-client relationship and nursing care. The current study aimed to compare nurses' level of empathy with patients in critical care units, psychiatric, and emergency wards. Materials and Methods: The present cross-sectional study was conducted on 112 nurses selected by convenience sampling in three educational hospitals affiliated with Isfahan University of Medical Sciences, Iran from June to September 2017. Data collection tool was a two-part questionnaire consisting of sociodemographic data (such as age, gender, and work experience) and Jefferson Scale of Empathy (JSE) containing 20 items, scored according to Likert scale from totally agree (7 points) to totally disagree (1 point). In total, the maximum score was 140 and the minimum score was 20. Data were analyzed using SPSS version 16 as well as descriptive and analytical statistical tests (multiple regression). Results: The mean (SD) empathy score of nurses working in critical care units, emergency, and psychiatric wards was 87.51 (6.65), 87.59 (4.90), and 90.71 (7.12), respectively. Regarding the regression models, it was observed that only the work experience was a significant predictor for empathy (β = 0.19, p = 0.04). This model predicted 3.50% of variances in the nurses' empathy. Conclusions: Nurses' level of empathy in this study was above average with equal scores in different wards. Therefore, increasing the nurses' level of empathy is essential in interventional studies.
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Affiliation(s)
- Fatemeh Ghaedi
- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elaheh Ashouri
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhgan Soheili
- PhD Student of Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Sahragerd
- Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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6
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Lamiani G, Dordoni P, Vegni E, Barajon I. Caring for Critically Ill Patients: Clinicians' Empathy Promotes Job Satisfaction and Does Not Predict Moral Distress. Front Psychol 2020; 10:2902. [PMID: 31969851 PMCID: PMC6960200 DOI: 10.3389/fpsyg.2019.02902] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 12/06/2019] [Indexed: 12/30/2022] Open
Abstract
Background Several studies have highlighted the benefits of empathy in healthcare settings. A correlation between clinicians' empathy and patients' adherence and satisfaction, as well as the ability for the clinician to accurately assess family members' needs, has been found. However, empathy is often seen by clinicians as a risk factor for their wellbeing. This study aims to assess whether the level of empathy of clinicians working in critical care settings may expose them to moral distress, poor job satisfaction, and intention to quit their job. Methods Italian clinicians who attended the 2016 "Smart Meeting Anesthesia Resuscitation in Intensive Care" completed the Empathy Quotient questionnaire, the Moral Distress Scale-Revised, and two questions assessing job satisfaction and intention to quit the job. Multiple linear and logistic regressions were performed to determine if clinicians' empathy influences moral distress, job satisfaction, and intention to quit. Age, gender, and profession were used as control variables. Results Out of 927 questionnaires distributed, 216 were returned (23% response rate) and 210 were used in the analyses. Respondents were 56% physicians, 24% nurses, and 20% residents. Over half of the clinicians (58%) were female. Empathy resulted the only significant predictor of job satisfaction (β = 0.193; p < 0.05). None of the variables included in the model predicted moral distress. Conclusion Empathy determined neither moral distress nor intention to quit. Findings suggest that empathy is not a risk factor for critical care clinicians in developing moral distress and the intention to quit their job. On the contrary, empathy was found to enhance clinicians' job satisfaction.
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Affiliation(s)
- Giulia Lamiani
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Paola Dordoni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Isabella Barajon
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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7
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Facing the unfamiliar: Nurses’ transcultural care in intensive care – A focus group study. Intensive Crit Care Nurs 2019; 55:102752. [DOI: 10.1016/j.iccn.2019.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 11/21/2022]
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8
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Affiliation(s)
- Wendy Walker
- Reader in Acute and Critical Care Nursing, Institute of Health, University of Wolverhampton, UK. Editorial Intern, Nursing in Critical Care
| | - Josef Trapani
- Lecturer in Nursing, Faculty of Health Sciences, University of Malta. Editorial Intern, Nursing in Critical Care
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9
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Rodríguez-Huerta MD, Álvarez-Pol M, Fernández-Catalán ML, Fernández-Vadillo R, Martín-Rodríguez M, Quicios-Dorado B, Díez-Fernández A. An informative nursing intervention for families of patients admitted to the intensive care unit regarding the satisfaction of their needs: The INFOUCI study. Intensive Crit Care Nurs 2019; 55:102755. [PMID: 31515006 DOI: 10.1016/j.iccn.2019.102755] [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: 02/25/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Abstract
AIM To evaluate whether an informative intervention by nursing professionals through Short Message Service (SMS) improved patients' family members' satisfaction with the intensive care experience. METHODS/DESIGN This was an exploratory, two-armed, randomised, non-pharmacological, prospective study. The intervention consisted of providing information to the contact persons of patients admitted to the ICU of the University Hospital La Princesa (Madrid, Spain) through SMS based on the patient's nursing assessment. Nursing diagnoses established by NANDA and based on the Virginia Henderson model were used as a reference. The main result was the satisfaction levels of the contacts of patients admitted to the intensive care unit, which was evaluated with the Critical Care Family Needs Inventory. RESULTS The total score on the Critical Care Family Needs Inventory was significantly better in the intervention group (16.6 ± 3.3 vs. 19.1 ± 4.7; p = 0.012) compared with the control group. All participants included in the intervention considered it useful to some degree. Even when the contact person received negative information, there was no demand for information outside established hours, which was included as a possible adverse effect of the intervention. CONCLUSION Support in the form of additional nursing information implied an increase in the satisfaction of the needs perceived by the contact persons of patients admitted to the intensive care unit, together with a better perception of the quality of intensive care unit care and a reassuring and beneficial effect.
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Affiliation(s)
| | | | | | | | | | | | - Ana Díez-Fernández
- Universidad de Castilla-La Mancha, Faculty of Nursing, Cuenca, Spain; Universidad de Castilla-La Mancha, Social and Health Care Research Center, Cuenca, Spain.
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10
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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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11
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Page P, Simpson A, Reynolds L. Bearing witness and being bounded: The experiences of nurses in adult critical care in relation to the survivorship needs of patients and families. J Clin Nurs 2019; 28:3210-3221. [PMID: 31017337 DOI: 10.1111/jocn.14887] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
AIM To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. BACKGROUND The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. DESIGN A constructivist grounded theory approach with constant comparative analysis. METHODS As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. CONCLUSION The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.
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Affiliation(s)
- Pamela Page
- Faculty of Health Social Care & Education, School of Nursing & Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - Alan Simpson
- School of Health Sciences, Centre for Mental Health Research, City, University of London, London, UK
| | - Lisa Reynolds
- Nursing Division, School of Health Sciences, City, University of London, London, UK
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12
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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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13
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Hasandoost F, Momeni M, Dehghankar L, Norouzi Parashkouh N, Rezaei Looyeh H, Emamgholian F. Family Needs of Patients Admitted to the Intensive Care Units. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2018. [DOI: 10.15171/ijer.2018.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background and aims: Organizational support of family members of the patients admitted to intensive care units (ICUs) potentially reduces mental stresses and enables them to better comply with and support the patients. The current study aimed at evaluating the needs of families of the patients admitted to ICUs in teaching hospitals of Iran. Methods: This cross-sectional study was conducted in 2015 using convenience sampling method. The Critical Care Family Needs Inventory (CCFNI) in 5 factors was used as a main data collection tool. The study population included 235 family members of the patients. Results: Total score of CCFNI was 132.32±18.46. Needs of family members of ICU patients decreased 0.428 times following the increase of length of stay in ICU (P<0.001). Moreover, the need for supportive cares was significantly 9.273 times lower among illiterate families, compared with the ones with higher education level (P<0.018). Conclusion: Considering that the highest need was in the area of support and the predictors of the family needs of the patients were the duration of hospitalization and the educational status of their families, the main focus of nurses should be on the support of family members of the patients admitted to the ICU and supporting and paying attention to their needs, who experience stressful conditions, to satisfy them and even to encourage them to give better care to the patient and help health care staff.
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Affiliation(s)
- Fateme Hasandoost
- Nursing Department, Medical Sciences Faculty,Tarbiat Modares University, Tehran, Iran
- Department of Nursing, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Momeni
- Department of Nursing, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Leila Dehghankar
- Department of Nursing, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Haydeh Rezaei Looyeh
- MSc (medical-surgical), Sevom Shaban Hospital of Damavand, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fateme Emamgholian
- Nursing Student, Student Research Committee, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
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14
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Alshahrani S, Magarey J, Kitson A. Relatives' involvement in the care of patients in acute medical wards in two different countries-An ethnographic study. J Clin Nurs 2018. [PMID: 29514398 DOI: 10.1111/jocn.14337] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the nature of relatives' involvement in the care of patients in acute medical settings in Australia and Saudi Arabia and to explore the perceptions, attitudes and experiences of nurses. BACKGROUND There is little known about how relatives respond to being involved in patient care and the impact this has on the quality of care. Equally, little is known about how nurses enable such involvement. Previous studies have focused on settings such as critical care and paediatrics where relatives' involvement as advocates is mostly acknowledged and accepted. DESIGN The study used a qualitative ethnographic approach based on an interpretive paradigm. METHODS Data collection was carried out in medical settings in two major hospitals: one in Australia and another in Saudi Arabia. Data were collected by observations and interviews over a 6-month period, with 3 months spent in each setting. RESULTS In both fields, relatives and nurses faced ongoing ambiguity about the role relatives should play in the hospital environment. Nurses were challenged by the unpredictability of relatives' participation in patient care. The nurses' fear of taking responsibility and uncertainty about the relatives' role led them to take varied and individualised approaches to the involvement of relatives in patient care. Relatives were unclear about how to behave in the role; what the needs of patients were; and whether they were contributing positively to care and this resulted in frustration. CONCLUSION The results show that ambiguity regarding the role of relatives led to problems in patient care such as safety concerns and conflict with nurses. RELEVANCE TO CLINICAL PRACTICE This study identified the need for patients' relatives and nursing staff to more actively engage in negotiating and managing their respective roles in acute medical areas. This could be supported by the development and use of a set of principles or guidelines for nurses, relatives and patients regarding relatives' involvement in hospital care settings to reduce ambiguity for all involved.
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Affiliation(s)
| | - Judy Magarey
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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15
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de-la-Cueva-Ariza L, Delgado-Hito P, Martínez-Estalella G, Via-Clavero G, Lluch-Canut T, Romero-García M. Implementation of the evidence for the improvement of nursing care to the critical patient's family: a Participatory Action Research. BMC Health Serv Res 2018; 18:357. [PMID: 29747635 PMCID: PMC5946428 DOI: 10.1186/s12913-018-3177-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 05/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process. METHODS Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively. DISCUSSION The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality.
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Affiliation(s)
- Laura de-la-Cueva-Ariza
- Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain.
| | - Gemma Martínez-Estalella
- Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain.,Hospital Clínic, Barcelona, Spain
| | - Gemma Via-Clavero
- Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain.,Intensive Care Unit. Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Teresa Lluch-Canut
- Public Health, Mental Health and MCH Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain
| | - Marta Romero-García
- Fundamental and Medical-Surgical Nursing Department, Nursing School (Faculty of Medicine and Health Sciences), University of Barcelona, Barcelona, Spain
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Affiliation(s)
- Julie Benbenishty
- General Intensive Care Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Wong P, Liamputtong P, Koch S, Rawson H. Barriers to families' regaining control in ICU: Disconnectedness. Nurs Crit Care 2017; 23:95-101. [PMID: 28849608 DOI: 10.1111/nicc.12310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The nature of interactions between health care professionals and families may have a significant impact on families' experience and outcomes of critical illness. The value of encouraging positive relationships with families is well documented; however, it is argued that the lack of theoretical frameworks to guide practice in this area may be a barrier to improving patient- and family-centred care. AIMS The study on which this paper is based aimed to understand families' experiences of their interactions when a relative is admitted unexpectedly to an Australian intensive care unit and to generate a substantive theory that represents families' interactions that can be used to guide critical care nursing practice when caring for patients' families in this context. DESIGN AND METHODS A grounded theory methodology was adopted for the study. Data were collected between 2009 and 2013 using in-depth interviews with 25 family members of 21 critically ill patients admitted to a metropolitan, tertiary-level intensive care unit (ICU) in Australia. FINDINGS A core category of regaining control has been generated from our study. This paper focuses on Disconnectedness, which leads to increased emotional vulnerability and is also a barrier to families' regaining control. Families feel disconnected when staff emotionally and physically disengage from them, when staff interact insensitively and in a manner that offers families limited hope. CONCLUSION Our findings offer an in-depth understanding of staff engagement with families and its impact on the families' ability to regain control. Although some themes have been previously identified in the literature in isolation, the interrelationships of the categories within a theoretical framework to represent family resilience in the context of an ICU situated in the Australian health care system are a novel finding. RELEVANCE TO CLINICAL PRACTICE The findings can be used to support patient- and family-centred care interventions in the ICU.
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Affiliation(s)
- Pauline Wong
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Australia
| | - Pranee Liamputtong
- School of Science and Health, Western Sydney University, Campbelltown Campus, Penrith, Australia
| | - Susan Koch
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,University of Sydney Medical School, Hornsby Ku-ring-gai Hospital, Hornsby, Australia
| | - Helen Rawson
- School of Nursing & Midwifery, Faculty of Health, Deakin University, Geelong, Australia
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Warnock C, Buchanan J, Tod AM. The difficulties experienced by nurses and healthcare staff involved in the process of breaking bad news. J Adv Nurs 2017; 73:1632-1645. [PMID: 28072478 DOI: 10.1111/jan.13252] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
Abstract
AIMS The aim of this study was to explore the difficulties experienced by nurses and healthcare professionals when engaging in the process of breaking bad news. BACKGROUND The challenges faced by staff when breaking bad news have previously been researched in relation to particular settings or participants. This study involved staff from diverse settings and roles to develop broader insights into the range of difficulties experienced in clinical practice. DESIGN The study used a descriptive survey design involving self-reported written accounts and framework analysis. METHODS Data were collected using a structured questionnaire containing a free text section that asked participants to describe a difficult experience they had encountered when involved in the process of breaking bad news. Data were collected from healthcare staff from hospital, community, hospice and care home settings attending training days on breaking bad news between April 2011 and April 2014. FINDINGS Multiple inter-related factors presented challenges to staff engaging in activities associated with breaking bad news. Traditional subjects such as diagnostic and treatment information were described but additional topics were identified such as the impact of illness and care at the end of life. A descriptive framework was developed that summarizes the factors that contribute to creating difficult experiences for staff when breaking bad news. CONCLUSION The framework provides insights into the scope of the challenges faced by staff when they engage in the process of breaking bad news. This provides the foundation for developing interventions to support staff that more closely matches their experiences in clinical practice.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jean Buchanan
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Mary Tod
- School of Nursing and Midwifery, The University of Sheffield, UK
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Hosieni F, Ravari A, Akbari A. The Effect of Communicating with Patients Using Peplau Model on Patients’ Satisfaction with the Provided Nursing Cares at the Cardiac Intensive Care Unit. ACTA ACUST UNITED AC 2017. [DOI: 10.29252/ijn.29.104.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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20
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Kirshbaum-Moriah D, Harel C, Benbenishty J. Family members' experience of intensive care unit support group: qualitative analysis of intervention. Nurs Crit Care 2016; 23:256-262. [PMID: 28008695 DOI: 10.1111/nicc.12272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/20/2016] [Accepted: 10/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Family members of intensive care unit patients develop anxiety, depression and/or symptoms suggestive of risk for post-traumatic stress. Nurse-led support groups have been recommended and used in a variety of settings as a mechanism to help meet family needs and overcome challenges. These groups have been reported to increase the members' understanding of complex medical issues involved in their situations and to be helpful in identifying practical coping mechanisms. AIM To investigate the experiences of family members participating in a nurse-social worker led support group in the intensive care unit. METHOD Study design: prospective collection of family narratives during support group meetings. A qualitative analysis was done of the narratives of weekly routine nurse-social worker led support group for family members of intensive care unit patients. The meeting contents are documented and related in the nursing notes. SETTING level 1 trauma centre, at a university hospital, with 13-bed intensive care unit. During the past 3 years this family support group has been providing routine intervention with the purpose of calming the families of intensive care unit patients during crisis situations by utilizing nurse, social worker and group dynamics. RESULTS A qualitative analysis was performed on the content of support group dynamics. The principal themes found were Behavioural, Perceptual, Emotional and Supportive. CONCLUSIONS The family support group provides the participants with a 'tool box' of coping mechanisms, which they can choose from in this current unfamiliar crisis event. The group provides a supportive environment, mutuality, a sense of belonging, needs of community, unconditional acceptance and information provision for the participants in the group. RELEVANCE TO CLINICAL PRACTICE In order to provide support for several families, nurses can use the family support group intervention as an effective technique in reaching as many families as possible. Narratives from family members during group meetings may be a good information source providing insights for nursing guidance and patient/family education.
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Affiliation(s)
| | - Chaya Harel
- Department of Social Work Services Hadassah Hebrew University Medical center, Jerusalem, Israel
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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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Rafii F, Nikbakht Nasrabadi A, Karim MA. End-of-life care provision: experiences of intensive care nurses in Iraq. Nurs Crit Care 2015; 21:105-12. [PMID: 26487503 DOI: 10.1111/nicc.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurses play a key role in providing care for the critically ill in the intensive care unit (ICU). The physical, psychological, emotional and spiritual intimate care given by Kurdish nurses allows them to develop a therapeutic relationship with terminally ill patients in the ICU. AIMS This study sought to explore the meaning of caring for terminally ill patients from the perspective of Kurdish ICU nurses. DESIGN Van Manen's (1990) hermeneutic phenomenological design was adopted. METHOD The data were collected through in-depth semi-structured interviews with a purposive sample of 10 nurses working in ICUs. Interviews were transcribed and finally analysed according to Van Manen's method. RESULTS Four major themes including emotional labour, death as a positive dimension, optimistic rather than futile care and working within constraints emerged. CONCLUSIONS Kurdish nurses in their caring encounters with terminally ill patients experienced a range of feelings from emotional strain to being optimistic while working within limited resources in the ICU. Further research is needed to explore the experiences of nurses with other cultures of caring for terminally ill patients in ICUs. RELEVANCE TO PRACTICE End-of-life care in ICU is emotionally challenging, therefore, nurses in this setting require psychological and spiritual support to ensure optimal care provision.
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Affiliation(s)
- Forough Rafii
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, International Campus (IUMS-IC), Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | - Muaf Abdulla Karim
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
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Abstract
BACKGROUND In the 21st century, we are starting to discover and understand the longer term sequelae of critical illness from both patient's and family members' perspectives. The consequential effects on physical and psychological function and the social landscape are being slowing realized. We are beginning to understand the long-term legacy of critical care, with survivorship possibly the greatest challenge within the critical care setting. AIM To draw together research that has appraised the experience of surviving critical illness from the holistic, triadic perspectives of survivor, relative and critical care nurse. In doing so, knowledge of the complexities of the critical care trajectory is enhanced. SEARCH STRATEGY Using Medline; Assia; CINAHL Plus; SCOPUS; Web of knowledge searches from 2000 to 2015 were conducted utilizing the terms 'critical care'; 'intensive care', ITU; patient*; relative*; family member*; experience*; nurse*, and trajectory. Relevant exclusion criteria were applied to provide a generalist adult critical care perspective. RESULTS Following a process of constant comparative analysis of the literature and thematic synthesis, seven themes were highlighted. Facing mortality, critical junctures, physiological sequelae, psychological sequelae, family presence, beyond meeting the needs of family members and technology versus humanity were all emergent themes. CONCLUSION As humans, we do not live an isolated life; we are interdependent upon each other. This inclusive review of literature has highlighted the lacunae and areas of dissonance both in the literature and in clinical practice in relation to the critical care trajectory as experienced by survivors of critical illness and their families. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can and should play a role in preparing and supporting patients and families beyond the critical care unit. In turn, Registered Nurses needed to be supported to fulfil this important role in enabling the process of moving patients and their families from surviving to thriving (survivorship).
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25
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Giles TM, Williamson V. Torn between dual roles: the experiences of nurse-family members when a loved one is hospitalised in a critical condition. J Clin Nurs 2015. [PMID: 26215438 DOI: 10.1111/jocn.12900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To understand and interpret the experiences of nurse-family members when a family member or loved one is hospitalised in a critical condition. BACKGROUND Having a family member hospitalised with a critical illness is a traumatic stressor, often with long-term sequelae. Providing holistic care for family members who are also nurses makes the provision of care more complex because of their professional expertise; yet few studies have explored this issue. DESIGN In this descriptive study, qualitative data were collected using a questionnaire and analysed using van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) six-step approach. METHODS Twenty nurse-family members completed an online questionnaire in June 2013. Qualitative findings from 19 participants were included in the analysis. The phenomenological analysis approach described by van Manen (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy, 1990, State University of New York Press, London, ON) was used to describe and interpret nurse-family member experiences. RESULTS Nurse-family members experience significant dual role conflicts between their personal and professional personas due to their specialised knowledge, need for watchfulness and competing expectations. Our findings describe how dual role conflicts developed and were managed, and reveal the resultant emotional toll and psychological distress as nurse-family members struggled to resolve these conflicts. CONCLUSIONS Nurse-family members require a different type of care than general public family members, yet their unique needs are often unmet, leading to increased anxiety and distress that could potentially be minimised. An increased awareness and emphasis on the nurse-family member experience can ensure health care professionals are better placed to provide appropriate and targeted care to minimise distressing dual role conflicts. RELEVANCE TO CLINICAL PRACTICE There is a need for targeted and specialised communication appropriate to each nurse-family members' needs and level of understanding, and to clarify expectations to ensure nurse-family members' professional knowledge and skills are recognised and respected without being exploited.
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Affiliation(s)
- Tracey M Giles
- School of Nursing & Midwifery, Flinders University, Adelaide, SA, Australia
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26
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Aliberch Raurell A, Miquel Aymar I. Necesidad de rol en los familiares del paciente en la unidad de cuidados intensivos. ENFERMERIA INTENSIVA 2015; 26:101-11. [DOI: 10.1016/j.enfi.2015.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 01/31/2015] [Accepted: 02/21/2015] [Indexed: 11/25/2022]
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Cravinho CRM, Cunha ACBD. Enfrentamento da morte fetal pela enfermagem na abordagem disposicional e na Teoria Motivacional do Coping. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2015. [DOI: 10.1590/0103-166x2015000200014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O enfrentamento (coping) tem sido entendido como uma ação autorregulatória de ajuste ao desequilíbrio provocado pelo estressor, sempre com função adaptativa, ainda que a estratégia de enfrentamento não seja resolutiva. Duas abordagens têm esta definição em comum - a Abordagem Disposicional e a Teoria Motivacional do Coping. Visando a estudar o copingda morte fetal, 36 profissionais de enfermagem de dois hospitais públicos responderam, individualmente, o Inventário COPE com 60 itens e uma Entrevista de Coping Motivacional, com 12 categorias de coping. Esses profissionais lidam com a morte fetal utilizando preferencialmente as seguintes estratégias de enfrentamento: Negociação, Busca de Informação, Autoconfiança e Busca de Suporte (Entrevista), e pela Religiosidade, Reinterpretação positiva e Planejamento (COPE). Discute-se a possibilidade de estudar o coping com base em enfoque multiteórico, a fim de ampliar a compreensão do processo de enfrentamento de condições adversas, como a morte fetal.
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Li L, Ruan H, Yuan WJ. The relationship between social support and burnout among ICU nurses in Shanghai: A cross-sectional study. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cnre.2015.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Durso FT, Ferguson AN, Kazi S, Cunningham C, Ryan C. Strategic threat management: an exploration of nursing strategies in the pediatric intensive care unit. APPLIED ERGONOMICS 2015; 47:345-354. [PMID: 25287275 DOI: 10.1016/j.apergo.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 08/20/2014] [Accepted: 09/08/2014] [Indexed: 06/03/2023]
Abstract
Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management.
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Affiliation(s)
- Francis T Durso
- School of Psychology, Georgia Institute of Technology, 654 Cherry Street, Atlanta, GA 30332, USA.
| | - Ashley N Ferguson
- School of Psychology, Georgia Institute of Technology, 654 Cherry Street, Atlanta, GA 30332, USA
| | - Sadaf Kazi
- School of Psychology, Georgia Institute of Technology, 654 Cherry Street, Atlanta, GA 30332, USA
| | - Charlene Cunningham
- Nursing Research and Evidence-Based Practice, Children's Healthcare of Atlanta, GA 30329, USA
| | - Christina Ryan
- Nursing Research and Evidence-Based Practice, Children's Healthcare of Atlanta, GA 30329, USA
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McConnell B, Moroney T. Involving relatives in ICU patient care: critical care nursing challenges. J Clin Nurs 2015; 24:991-8. [PMID: 25597494 DOI: 10.1111/jocn.12755] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the barriers critical care nurses experience to relative involvement in intensive care unit patient care. BACKGROUND Previous studies have discussed the experiences of relatives visiting an intensive care unit, the needs of relatives in the intensive care environment, critical care nurse and relative interaction, intensive care unit visiting policies and the benefits of including relatives in patient care. The barriers that critical care nurses experience to relative involvement in patient care have received minimal exploration. DESIGN Critical care nurses were recruited for a mixed methods study. An explanatory mixed method design was used, with two phases. Phase 1 was Quantitative and Phase 2 was Qualitative. METHODS Data collection occurred over five months in 2012-2013. Phase 1 used an online questionnaire (n = 70), and semi-structured interviews (n = 6) were conducted in Phase 2. Phase 1 participants were 70 critical care nurses working in Australian intensive care units and six critical care nurses were recruited from a single Sydney intensive care unit for Phase 2. Through sequential data collection, Phase 1 results formed the development of Phase 2 interview questions. RESULTS Participants reported various barriers to relative involvement in critically ill patient care. Factors related to the intensive care unit patient, the intensive care unit relative, the critical care nurse and the intensive care environment contributed to difficulties encompassing relative involvement. CONCLUSIONS This study has identified that when considering relative involvement in patient care, critical care nurses take on a paternalistic role. The barriers experienced to relative involvement result in the individual critical care nurse deciding to include or exclude relatives from patient care. RELEVANCE TO CLINICAL PRACTICE Knowledge of the barriers to relative involvement in critically ill patient care may provide a basis for improving discussion on this topic and may assist intensive care units to implement strategies to reduce barriers.
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Adams AMN, Mannix T, Harrington A. Nurses' communication with families in the intensive care unit - a literature review. Nurs Crit Care 2015; 22:70-80. [DOI: 10.1111/nicc.12141] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 08/13/2014] [Accepted: 09/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- AMN Adams
- MNg; University Hospital of Northern Norway, Intensiv avdeling; 9038 Tromsø Norway
| | - T Mannix
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
| | - A Harrington
- School of Nursing and Midwifery; Flinders University, Adelaide; GPO Box 2100 Adelaide South Australia Australia
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Efstathiou N, Walker W. Intensive care nurses' experiences of providing end-of-life care after treatment withdrawal: a qualitative study. J Clin Nurs 2014; 23:3188-96. [DOI: 10.1111/jocn.12565] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nikolaos Efstathiou
- School of Health and Population Sciences (Nursing); College of Medical and Dental Sciences; University of Birmingham; Birmingham UK
| | - Wendy Walker
- Centre for Health and Social Care Improvement; School of Health and Wellbeing; University of Wolverhampton; Wolverhampton UK
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Arbour RB, Wiegand DL. Self-described nursing roles experienced during care of dying patients and their families: a phenomenological study. Intensive Crit Care Nurs 2014; 30:211-8. [PMID: 24560634 DOI: 10.1016/j.iccn.2013.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 11/08/2013] [Accepted: 12/16/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Critical care nurses frequently care for dying patients and their families. Little is known about the roles experienced and perceived by bedside nurses as they care for dying patients and their families. OBJECTIVES The purpose of this study was to understand the experiences of critical care nurses and to understand their perceptions of activities and roles that they performed while caring for patients and families during the transition from aggressive life-saving care to palliative and end-of-life care. METHODS A descriptive, phenomenological study was conducted and a purposive sampling strategy was used to recruit 19 critical care nurses with experience caring for dying patients and their families. Individual interviews were conducted and audio-recorded. Coliazzi's method of data analysis was utilised to inductively determine themes, clusters and categories. Data saturation was achieved and methodological rigour was established. RESULTS Categories that evolved from the data included educating the family, advocating for the patient, encouraging and supporting family presence, managing symptoms, protecting families and creating positive memories and family support. Participants also identified the importance of teaching and mentoring novice clinicians. CONCLUSIONS The results of this study have important implications for clinical practice, education and research for optimal preparation in providing end-of-life care.
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Affiliation(s)
- Richard B Arbour
- In-Patient Liver Transplant Coordinator, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Debra L Wiegand
- University of Maryland School of Nursing, Baltimore, MD, USA
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Santiago C, Lazar L, Jiang D, Burns KE. A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit. Intensive Crit Care Nurs 2014; 30:13-21. [DOI: 10.1016/j.iccn.2013.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 03/21/2013] [Accepted: 06/17/2013] [Indexed: 11/16/2022]
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Malliarou M, Gerogianni G, Babatsikou F, Kotrotsiou E, Zyga S. Family Perceptions of Intensive Care Unit Nurses' Roles: A Greek Perspective. Health Psychol Res 2014; 2:994. [PMID: 26973925 PMCID: PMC4768562 DOI: 10.4081/hpr.2014.994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/27/2013] [Accepted: 02/27/2013] [Indexed: 11/22/2022] Open
Abstract
This study was done in order to examine the role of the nurse in families with critically ill patients as perceived by family members. A descriptive design was conducted with 93 family members aged 18-53 years from a 6-bed intensive care unit in a Greek Hospital. An anonymous self-completed questionnaire recording demographic data and the questionnaire Family members perception of nurses behavioral role expectation/enactment scale of Hickey and Lewandowski was used. Parametric statistic tests were used to examine the research questions. Intensive care unit (ICU) patients’ family members expect nurses to make them feel they can ask whatever they want whenever they want, placing great emphasis on communicating with one another and on participating in decision making to the progress of patient care. The age seems to correlate with the expectation from nurse to meet the role of training on how to handle the patient. Nurses did well with regard to meeting family members’ expectations. Most family members assessed positively the role of ICU nurse confirming the need for communication, and clear support of families.
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Affiliation(s)
- Maria Malliarou
- Department of Nursing, Technological Educational Institute of Larisa , Greece
| | - Georgia Gerogianni
- Department of Nursing A, Laboratory of Community Heath Nursing, Technological Educational Institute of Athens , Greece
| | - Fotoula Babatsikou
- Department of Nursing A, Laboratory of Community Heath Nursing, Technological Educational Institute of Athens , Greece
| | | | - Sofia Zyga
- Department of Nursing, Faculty of Human Movement and Quality of Life Sciences, University of Peloponnese , Sparta Lakonias, Greece
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Konstanti Z, Gouva M, Nakos G, Koulouras V. Heart-focused anxiety in critically ill patients' relatives. Crit Care 2014. [PMCID: PMC4068394 DOI: 10.1186/cc13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Giles TM, Hall KL. Qualitative systematic review: the unique experiences of the nurse-family member when a loved one is admitted with a critical illness. J Adv Nurs 2013; 70:1451-64. [PMID: 24308440 DOI: 10.1111/jan.12331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 11/28/2022]
Abstract
AIM To interpret and synthesize nurse-family member experiences when a critically ill loved one is admitted to hospital. BACKGROUND Having a family member hospitalized in a critical condition is an important stressor. When the family member is also a nurse, the provision of care is more complex, yet little research exists on this issue. DESIGN Systematic review using Thomas and Harden's approach to thematic synthesis of qualitative research. DATA SOURCES Primary studies were located by searching CINAHL, Proquest, Journals@Ovid, SCOPUS, Cochrane Library and Google Scholar. No date restrictions were applied due to a lack of relevant literature. All studies that met inclusion criteria were retrieved (n = 1717) and seven met the review aim. REVIEW METHODS Following critical appraisal, seven studies from 1999-2011 describing the nurse-family member's experience were reviewed and synthesized. RESULTS Six characteristics of the nurse-family member experience were identified: specialized knowledge; dual-role conflicts; competing expectations; building relationships; being 'let in'; and healthcare setting. CONCLUSION Nurse-family members experience important stressors that can negatively affect their psychological health and experience as a healthcare consumer. Nurse-family members want a different type of care than other healthcare consumers. Acknowledging nurse-family members' specialized knowledge and dual role, keeping them fully informed and allowing them to be with the patient and feel in control can reduce their fear and anxiety. Further research is needed to develop a deeper understanding of the unique experiences, challenges and needs of nurse-family members to provide them with an enhanced level of care.
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Affiliation(s)
- Tracey M Giles
- Flinders University School of Nursing and Midwifery, Adelaide, South Australia, Australia
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Plakas S, Taket A, Cant B, Fouka G, Vardaki Z. The meaning and importance of vigilant attendance for the relatives of intensive care unit patients. Nurs Crit Care 2013; 19:243-54. [PMID: 24131580 DOI: 10.1111/nicc.12054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To explore the meaning of vigilant attendance for relatives of critically ill patients in Greece. BACKGROUND A plethora of international research has identified proximity to the patient to be a major concern for relatives of critically ill patients. Greece however follows a strict visiting policy in intensive care units (ICUs) so Greek relatives spend great amounts of time just outside the ICUs. DESIGN This qualitative study adopted the social constructionist version of grounded theory. METHOD Data were collected from three ICUs in Athens through in depth interviews with 25 informants and approximately 10 h of observations outside the ICUs on 159 relatives. FINDINGS Vigilant attendance was one of the main coping mechanisms identified for relatives. Four subcategories were found to comprise vigilant attendance: (1) being as close as possible to feel relief, (2) being there to find out what is going on, (3) monitoring changes in the loved one and making own diagnosis and (4) interacting with the ICU professionals. CONCLUSION Vigilant attendance describes the way in which relatives in Greece stayed outside the ICUs. Relatives felt satisfaction from being close as the best alternative for not actually being inside the ICU and they tried to learn what was going on by alternative methods. By seeing the patients, relatives were also able to make their own diagnoses and could therefore avoid relying solely on information given to them. However, a prerequisite for successful vigilant attendance was to get on well with doctors and nurses. RECOMMENDATIONS FOR CLINICAL PRACTICE Changes in visiting policies in Greece are needed to meet the needs of relatives adequately. Recommendations for changes with minimal investment of time and funding are made.
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Affiliation(s)
- Sotirios Plakas
- S Plakas, RN, MSc, PhD, Lecturer, Nursing B' Department, School of Health and Welfare, Technological Educational Institution (TEI) of Athens, Egaleo, Greece
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Kean S, Mitchell M. How do intensive care nurses perceive families in intensive care? Insights from the United Kingdom and Australia. J Clin Nurs 2013; 23:663-72. [PMID: 23889320 DOI: 10.1111/jocn.12195] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To compare how intensive care nurses in the UK and Australia (AU) perceive families in intensive care units (ICUs). BACKGROUND International healthcare research and practice is often based on an underlying assumption of a person- or family-centred ideology. While nurses in ICUs acknowledge the importance of patients' families, a true integration of families as units of care is often not realised. DESIGN Data from ICU nurses from two international studies: (1) a constructivist grounded theory study in the UK and (2) a quasi-experimental non-equivalent clinical study in AU. Data were collected in tertiary adult ICUs in the UK and AU. Nurse-to-patient ratio for high-acuity patients was 1:1 in both units. PARTICIPANTS Twenty ICU nurses in five focus groups (UK study) and 197 surveys were sent out to ICU nurses in AU (response rate 26%). RESULTS Evidence from both studies makes visible the contribution of family care in adult ICUs. Nurses remaining in control and initiating family member care involvement are less likely to perceive families as a burden. The AU study indicated that when nurses partner with families to deliver care, there was a minimal effect on their workload. The nurses concluded that inviting family members to be a part of the patient's care should be usual practice in ICUs. CONCLUSION Nurses should promote, facilitate and invite the integration of families in care in today's healthcare system. This is mandatory as families are the caring resource for these patients during an often prolonged recovery trajectory. RELEVANCE TO CLINICAL PRACTICE Families are more likely to be successfully integrated into a more active involvement with ICU patients when they are not perceived as a burden. Inviting and supporting family members is not necessarily time-consuming and starts the journey of supporting ICU survivors' recovery journey.
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Affiliation(s)
- Susanne Kean
- School of Health in Social Science, Nursing Studies, The University of Edinburgh, Edinburgh, UK
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Improving communication and cost-effectiveness in the intensive care unit through palliative care: a review of literature. Dimens Crit Care Nurs 2011; 30:133-8. [PMID: 21478705 DOI: 10.1097/dcc.0b013e31820d2114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Approximately 20% of deaths in the United States each year occur in the intensive care unit. This article reviews the literature on this important topic to critical-care nurses.
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Efstathiou N, Clifford C. The critical care nurse's role in end-of-life care: issues and challenges. Nurs Crit Care 2011; 16:116-23. [PMID: 21481113 DOI: 10.1111/j.1478-5153.2010.00438.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The purpose of this article is to discuss the challenges critical care nurses face when looking after patients needing End-of-Life (EoL) care in critical care environments. BACKGROUND Critical care nurses frequently provide care to patients who fail to respond to treatments offered to support and prolong life. The dying phase for individuals in critical care settings, commonly after withholding/withdrawing treatment, is very short posing great demands on critical care nurses to provide physical and emotional support to both patients and their families. Despite the existence of recognized care planning frameworks that may help nurses in providing EoL care, these are not used by all units and many nurses rely on experience to inform practice. A number of aspects such as communication, patient/family-centred decision-making, continuity of care, emotional/spiritual support and support for health professionals have been indicated as contributing factors towards the provision of effective EoL care. These are considered from the perspective of critical care nursing. CONCLUSION Skills development in key aspects of care provision may improve the provision of EoL care for critical care patients and their families. RELEVANCE TO CLINICAL PRACTICE Critical care nurses have an essential role in the provision of effective EoL care; however, this dimension of their role needs further exploration. It is noted that educational opportunities need to be provided for critical care nurses to increase the knowledge on planning and delivering EoL care. To inform this evaluation of current EoL care provision in critical care is necessary to address a knowledge deficit of the needs of nurses who seek to support patients and their families at a critical time.
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Affiliation(s)
- Nikolaos Efstathiou
- University of Birmingham, College of Medical and Dental Sciences, School of Health and Population Sciences, Nursing and Physiotherapy, Birmingham, UK.
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Pardavila Belio MI, Vivar CG. [Needs of the family in the intensive care units: a review of the literature]. ENFERMERIA INTENSIVA 2011; 23:51-67. [PMID: 21775182 DOI: 10.1016/j.enfi.2011.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 06/06/2011] [Indexed: 11/17/2022]
Abstract
UNLABELLED Admission to the Intensive Care Units (ICU) is perceived by both patients and their family as a stressful experience. This situation can cause shock, skepticism and anxiety in the patient's setting. OBJECTIVE To analyze and present the needs of the family members of the critical patient. METHODOLOGY A review was made of the literature in the following data bases: Pubmed, CINAHL, Cuiden and Cochrane Library. Furthermore, three journals specialized in Intensive Cares were reviewed. RESULTS After including the articles that met the screening criteria, 30 articles were finally selected. Of these, 11 were reviews of the literature, 7 qualitative studies and 12 more were quantitative investigations. Four groups of needs in the families were identified after the analysis of these articles, these being cognitive, emotional, social and practical. DISCUSSION One of the main needs of the family is to receive better information from the professionals followed by the need for closeness with the ill family member. This review proposes that, in order to cover these needs, the information should be protocolized and the visiting hours should be made flexible. Furthermore, incorporation of two familial evaluation tools, the genogram and ecomap, is proposed. CONCLUSIONS This work has revealed the importance of having the Intensive Care nurses identify the needs of the family during the admission of the patient in the ICU in order to be able to provide help, support and counseling care that relieves the suffering of the families.
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Affiliation(s)
- M I Pardavila Belio
- Departamento de Cuidados Intensivos, Clínica Universidad de Navarra, Facultad de Enfermería, Universidad de Navarra, España.
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Reid M, McDowell J, Hoskins R. Communicating news of a patient's death to relatives. ACTA ACUST UNITED AC 2011; 20:737-40, 742. [DOI: 10.12968/bjon.2011.20.12.737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Megan Reid
- Intensive Care Unit, Royal Alexandra Hospital, Paisley
| | - Joan McDowell
- Nursing and Healthcare, Faculty of Medicine, University of Glasgow
| | - Robert Hoskins
- Nursing and Healthcare, Faculty of Medicine, University of Glasgow
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Trepidation: a family member's response to shift change in the intensive care unit. Dimens Crit Care Nurs 2011; 29:288-92. [PMID: 20940584 DOI: 10.1097/dcc.0b013e3181f0c1b5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Every shift change in the intensive care unit presents an opportunity for uncertainty among family members regarding rules and information exchange. High levels of uncertainty maintain a presence in the intensive care unit environment, and feelings of trepidation can increase with uncertainty. Critical care nurses in the intensive care unit play a pivotal role in mediating family members' feelings of trepidation by what they do or do not do. Further research into family members' responses to shift change and into inconsistencies in nursing decisions regarding rules and information exchange in the intensive care unit is needed to better understand the feelings that family members experience in the intensive care unit environment and to motivate meaningful changes that will contribute to a clearer sense of purpose for family and their loved ones.
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Engström B, Uusitalo A, Engström A. Relatives' involvement in nursing care: a qualitative study describing critical care nurses' experiences. Intensive Crit Care Nurs 2010; 27:1-9. [PMID: 21146991 DOI: 10.1016/j.iccn.2010.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 11/13/2010] [Accepted: 11/16/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES When patients become critically ill it also affects their relatives. The aim of this study was to describe critical care nurses' experience of relatives' involvement in the nursing care of patients in an intensive care unit. METHOD Semi-structured personal interviews with eight critical care nurses in an intensive care unit in the northern part of Sweden were conducted during 2010. The interview texts were subjected to qualitative content analysis which resulted in the formulation of two main categories and five sub-categories. FINDINGS The findings showed that relatives' involvement was appreciated and seen as great resource for both patients and critical care nurses. Protecting the integrity of patients was one reason for limiting their involvement. The environment and lack of time were experienced as other obstacles to the involvement of relatives. CONCLUSION Aligning the needs of the relatives to be involved in the care with the needs of the patient and the work situation of the nurses requires open communication between all three parties.
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Nelms TP, Eggenberger SK. The essence of the family critical illness experience and nurse-family meetings. JOURNAL OF FAMILY NURSING 2010; 16:462-486. [PMID: 21051759 DOI: 10.1177/1074840710386608] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Nursing care of families is essential to strong family support and maintenance of family health during a critical illness. Secondary data analysis of interviews conducted with 11 families with a family member in the intensive care unit revealed two essences: the family critical illness experience and the family vision for the kind of care families required and desired from nurses. The purpose of this article was to explicate the essence of these phenomena and their implications for family nursing practice. Findings affirm the need for a family intervention described in the literature, that of regularly scheduled nurse-family meetings. Although developed for work with families experiencing a chronic illness, bringing families together and inviting meaningful conversation about their experiences is appropriate for families experiencing critical illness. Nurse-family meetings acknowledge suffering and vulnerability of families when a loved one is critically ill and afford families an opportunity for honest sensitive communication with nurses.
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Affiliation(s)
- Tommie P Nelms
- WellStar School of Nursing, Kennesaw State University, Kennesaw, Georgia 30144, USA.
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Eggenberger SK, Regan M. Expanding Simulation to Teach Family Nursing. J Nurs Educ 2010; 49:550-8. [DOI: 10.3928/01484834-20100630-01] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/10/2010] [Indexed: 01/10/2023]
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Oliveira LMDAC, Medeiros M, Barbosa MA, Siqueira KM, Oliveira PMC, Munari DB. [Support group as embracement strategy for relatives of patients in intensive care unit]. Rev Esc Enferm USP 2010; 44:429-36. [PMID: 20642057 DOI: 10.1590/s0080-62342010000200027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Admissions to the Intensive Care Unit (ICU) generate needs among relatives, which sometimes do not receive appropriate care. This study aimed at describing a support group (SG) that embraces the relatives of patients admitted to ICU and to evaluate its effectiveness in meeting their needs of information and emotional support. This descriptive study was performed in 2006 in a Hospital of Goiânia/GO, by means sessions of the Support Group for Families (SGF). The sessions were recorded and registered in a field-diary for further analysis of the group process. In addition, individual interviews were performed to evaluate if the needs for information and support were met. The SGF permitted to see to the needs of families, helping them cope with the hospitalization of their relative in the ICU. In conclusion, SGF helps to promote humanized care practice and to overcome care that is historically focused on patient and disease. Nurses should consider reorganizing their practice and the possibility of including the SGF as a strategy to meet the needs of the families.
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Abstract
AIM This paper is a report a study of critical care nurses' experiences of grief and their coping mechanisms when a patient dies. BACKGROUND The goal of patients entering critical care is survival and recovery. However, despite application of advanced technologies and intensive nursing care, many patients do not survive their critical illness. Nurses experience death in their everyday work, exposing them to the emotional and physical repercussions of grief. METHOD This study adopted a Heideggerian phenomenological approach, interviewing eight critical care nurses. Data collection occurred in 2007/8. Interviews were transcribed verbatim and themes generated through Colaizzi's framework. FINDINGS Participants reported feelings of grief for patients they had cared for. The death of a patient was reported as being less traumatic if the participant had perceived the death to be a 'good death', incorporating expectedness and good nursing care. They described how a patient's death was more significant if it 'struck a chord', or if they had developed 'meaningful engagement' with the patient and relatives. They denied accessing formal support: however, informal conversations with colleagues were described as a means of coping. Participants exhibited signs of normalizing death and described how they disassociated themselves emotionally from dying patients. CONCLUSION There are many predisposing factors and circumstantial occurrences that shape both the nature of care of the dying and subsequent grief. Repeated exposure to death and grief may lead to occupational stress, and ultimately burn out. Emotional disengagement from caring for the dying may have an impact on the quality of care for both the dying patient and their family.
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Warnock C, Tod A, Foster J, Soreny C. Breaking bad news in inpatient clinical settings: role of the nurse. J Adv Nurs 2010; 66:1543-55. [PMID: 20492016 DOI: 10.1111/j.1365-2648.2010.05325.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of an exploration of the role of the nurse in the process of breaking bad news in the inpatient clinical setting and the provision of education and support for nurses carrying out this role. BACKGROUND The term 'breaking bad news' is mostly associated with the moment when negative medical information is shared with a patient or relative. However, it can also be seen as a process of interactions that take place before, during and after bad news is broken. Little research has been conducted exploring the role of the nurse in the process of breaking bad news in the inpatient clinical setting. METHODS A questionnaire was developed using Likert scales and open text questions. Data collection took place in 2007. Fifty-nine inpatient areas took part in the study; 335 questionnaires were distributed in total and 236 were completed (response rate 70%). RESULTS Nurses engaged in diverse breaking bad news activities at many points in care pathways. Relationships with patients and relatives and uncontrolled and unplanned events shaped the context in which they provided this care. Little formal education or support for this work had been received. CONCLUSION Guidance for breaking bad news should encompass the whole process of doing this and acknowledge the challenges nurses face in the inpatient clinical area. Developments in education and support are required that reflect the challenges that nurses encounter in the inpatient care setting.
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Affiliation(s)
- Clare Warnock
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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