A meta-synthesis of qualitative research into needs and experiences of significant others to critically ill or injured patients

Family experiences and perceptions of intensive care unit care and communication during the COVID-19 pandemic

INTRODUCTION

In 2020, during the first wave of the COVID-19 pandemic in Melbourne, visitor access to acute hospitals including intensive care units (ICUs) was initially barred, followed by a limit of one person per patient for one hour per day. This study explores the care and communication experienced by family members of ICU patients during this time.

METHODS

This qualitative descriptive study was conducted at an Australian quaternary hospital. Semistructured phone interviews were conducted using an aide-memoire designed to understand participants' experiences as family of a patient during this time. Interviews were recorded, transcribed, and thematically analysed.

FINDINGS

Twenty family members of patients in the ICU participated. Three major themes were identified: 'impact of restricting visiting procedures', 'family experiences of communication', and 'care and support'. Inflexible visiting restrictions had a momentous impact on families. Participants objected to having to nominate only two people to visit during the admission and the short visiting time limit. Some family members suffered extreme stress and anxiety during their absence from the bedside. Additional challenges were experienced by rural families, visitors with disabilities, and the young children of patients who were excluded. Communication with clinicians varied. Telehealth was valued by some but not universally embraced. The relationship between staff members and families and involvement in decision-making were unaffected.

CONCLUSION

Families experienced significant psychological distress from being separated from their critically ill relatives. Patient care and involvement in decision-making appeared to be unchanged, but communication with staff felt to be lacking. Better alternatives to face-to-face communication must be sought to limit the impact of family separation on mental health. Families are a key link between the patient and clinicians and often play a major role in patient support and recovery after discharge. There is an urgent need to support them and facilitate meaningful engagement despite the obstacles.

Family members' perceptions of counselling during visits to loved ones in an adult ICU

AIMS

The study's aims were to (1) assess family members' perceptions of the quality of the counselling they received while visiting a loved one in an adult ICU and (2) identify factors that influence family members' perceptions of counselling quality.

DESIGN

A cross-sectional survey of visiting family members of adult ICU patients.

METHODS

Family members (n = 55) at eight ICUs across five Finnish university hospitals completed a cross-sectional survey.

RESULTS

Family members assessed the quality of counselling in adult ICUs to be good. Factors associated with the quality of counselling were knowledge, family-centred counselling, and interaction. Family members' ability to live normally was associated with understanding of the loved one's situation (ρ = 0.715, p < 0.001). Interaction was associated with understanding (ρ = 0.715, p < 0.001). Family members felt that intensive care professionals did not adequately ensure that they understood counselling-related issues and that they lacked opportunities to give feedback, in 29% of cases, staff asked the family members whether they understood the counselling and 43% of family members had opportunities to offer feedback. However, the family members felt that the counselling they received during ICU visits was beneficial.

Interprofessional Interventions to Improve Serious Illness Communication in the Intensive Care Unit: A Scoping Review

Serious illness communication is fundamental to the provision of quality care for patients in the intensive care unit (ICU). Evidence suggests that including interprofessional team members in such communication is beneficial. This scoping review--conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines-maps existing evidence regarding interprofessional interventions to improve serious illness communication in the ICU. The review yielded 14 studies for inclusion, which were organized by 3 thematic categories of strategies implemented: training curriculum, scheduled meetings, and liaison role. Most used a combination of intervention strategies. Outcome measures varied across the studies but could be broadly categorized as patient/family-focused, provider-focused, or systems-focused. Great heterogeneity between studies exists. More research is needed.

Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey

Background

The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene.

Methods

The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others.

Results

A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information.

Conclusions

Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses’ interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved.

Conditions and strategies to meet the challenges imposed by the COVID-19-related visiting restrictions in the intensive care unit: A Scandinavian cross-sectional study

OBJECTIVES

To examine conditions and strategies to meet the challenges imposed by the coronavirus disease 2019 (COVID-19)-related visiting restrictions in Scandinavian intensive care units.

RESEARCH METHODOLOGY/DESIGN

A cross-sectional survey.

SETTING

Adult intensive care units in Denmark, Norway and Sweden.

MAIN OUTCOME MEASURES

Likert scale responses and free-text comments within six areas: capacity and staffing, visiting policies and access to the unit, information and conferences with relatives, written information, children as relatives and follow-up initiatives.

RESULTS

The overall response rate was 53% (74/140 participating units). All intensive care units had planned for capacity extensions; the majority ranging between 11 and 30 extra beds. From March-June 2020, units had a mean maximum of 9.4 COVID-19 patients simultaneously. Allowing restricted visiting was more common in Denmark (52%) and Norway (61%) than in Sweden where visiting was mostly denied except for dying patients (68%), due to a particular increased number of COVID-19 patients. The restrictions forced nurses to compromise on their usual standards of family care. Numerous models for maintaining contact between relatives and patients were described.

CONCLUSION

Visitation restrictions compromised the quality of family care and entailed dilemmas for healthcare professionals but also spurred initiatives to developing new ways of providing family care.

Family involvement in the intensive care unit in four Nordic countries

BACKGROUND

Relevance to clinical practice The findings from the study highlighting family involvement, high-quality communication and flexible visiting policy as central aspects of family care may inspire clinicians to identify aspects of everyday family care in their ICUs calling for further improvement.

AIMS AND OBJECTIVES

To describe family involvement, communication practices and visiting policies in adult ICUs.

DESIGN

A cross-sectional survey.

METHOD

A questionnaire consisting of 11 sections was developed, pilot tested and e-mailed to 196 ICUs. The participants were intensive care nurses in adult ICUs in four Nordic countries.

RESULTS

The survey was conducted in October to December 2019. The response rate was 81% (158/196) of the invited ICUs. Most of the units had fewer than 11 beds. Family participation in patient care, including involvement in ward rounds and presence during cardiopulmonary resuscitation, varied between the countries, whereas most families in all countries were involved in decision-making. Family conferences were generally initiated by staff or family members. Children under 18 did not always receive information directly from the staff, and parents were not advised about how to inform their children. Although most respondents described open visiting, restrictions were also mentioned in free-text comments.

CONCLUSIONS

The level of family care in ICUs in the four Nordic countries is generally based on nurses' discretion. Although most Nordic ICUs report having an open or flexible visiting policy, a wide range of potential restrictions still exists. Children and young relatives are not routinely followed up. Family members are included in communication and decision-making, whereas family involvement in daily care, ward rounds and family-witnessed resuscitation seem to be areas with a potential for improvement.

Experiences and needs of families with a relative admitted to an adult intensive care unit: a systematic review of qualitative studies

OBJECTIVE

The objective of the review was to synthesize research studies that reported on the experiences and needs of families with a relative in an adult intensive care unit.

INTRODUCTION

Having a relative in an intensive care unit has been reported to be a time of turmoil, stress, and disruption to the lives of family members. Primary research studies suggest such a crisis or even a planned intensive care unit admission can have not only emotional, physical, and psychological impact, but can also affect family member roles and function. A deeper understanding of the overall experience may assist intensive care unit staff to address specific family needs.

INCLUSION CRITERIA

This review included qualitative studies of any design that described and explored the experiences and needs of family members with a relative admitted to an adult intensive care unit.

METHODS

The methods for the review followed the JBI meta-aggregation approach for synthesizing qualitative data. MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (EBSCO), Embase (Embase.com) and Web of Science Core Collection (Clarivate Analytics) databases were searched for published studies. ProQuest Dissertations and Theses database (Ovid) was searched for unpublished studies. Studies published from 2010 to November 2019 in the English language were selected for possible inclusion in the review.

RESULTS

From 7208 citations, 20 studies were agreed upon for inclusion in the review. From these studies, 112 findings were extracted and synthesized into 12 categories. Four synthesized findings were compiled by aggregating the categories. Broadly, these synthesized findings related to: psychosocial health, proximity, information needs, and the intensive care unit environment.

CONCLUSIONS

Being a relative of a patient in an intensive care unit is a complex, emotional, and individual experience that can have physical, psychological, and emotional impact. The synthesized findings from this review can be used to support family-centered care practices in adult intensive care units, particularly in regard to information provision, visiting practices, and supportive care.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016053300.

Practice Recommendations for End-of-Life Care in the Intensive Care Unit

TOPIC

A substantial number of patients die in the intensive care unit, so high-quality end-of-life care is an important part of intensive care unit work. However, end-of-life care varies because of lack of knowledge of best practices.

CLINICAL RELEVANCE

Research shows that high-quality end-of-life care is possible in an intensive care unit. This article encourages nurses to be imaginative and take an individual approach to provide the best possible end-of-life care for patients and their family members.

PURPOSE OF PAPER

To provide recommendations for high-quality end-of-life care for patients and family members.

CONTENT COVERED

This article touches on the following domains: end-of-life decision-making, place to die, patient comfort, family presence in the intensive care unit, visiting children, family needs, preparing the family, staff presence, when the patient dies, after-death care of the family, and caring for staff.

Positive Appraisal of Caregiving for Intensive Care Unit Survivors: A Qualitative Secondary Analysis

BACKGROUND

More than half of intensive care unit survivors require assistance from family caregivers after discharge. Caregiving is associated with negative consequences including poor health-related quality of life, psychosocial distress, and burden. Little is known about how family caregivers find satisfaction and meaning in their experience.

OBJECTIVES

To explore positive descriptions of the experiences of family caregivers of critically ill patients and to describe factors that family caregivers view as important to a positive caregiving experience from hospitalization to 4 months after discharge.

METHODS

Qualitative secondary analysis was performed on data from semistructured interviews conducted as part of a longitudinal study that examined physical and psychological responses to stress in a convenience sample of family caregivers of adult intensive care unit patients who underwent prolonged mechanical ventilation (≥ 4 days). Interviews were conducted at 4 time points: during the hospitalization and within 2 weeks, 2 months, and 4 months after discharge.

RESULTS

Participants (n = 41) reported factors that helped them positively appraise their caregiving experience in 113 interviews conducted face to face or via telephone. During patients' hospitalization, caregivers described changes in their role, with their primary responsibility being to advocate for the patient. They described how this experience fulfilled their identity and strengthened their relationship with the patient. Most family caregivers mentioned the importance of social support and prayer.

CONCLUSIONS

Family caregivers of intensive care unit patients can identify positive aspects of caregiving during the experience. Interventions to reframe the caregiving experience in a positive light are warranted.

Family and health professional experience with a nurse-led family support intervention in ICU: A qualitative evaluation study

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.

Family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer: A phenomenological hermeneutical study

AIMS AND OBJECTIVES

To reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer.

BACKGROUND

Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units (ICUs). These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for.

DESIGN

A qualitative design based on phenomenological hermeneutics.

METHODS

The study was conducted at two Swedish general ICUs. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research principles were applied in the conduct and reporting of this study.

RESULTS

Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close.

CONCLUSIONS

The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning.

RELEVANCE TO CLINICAL PRACTICE

The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.

Sheltering under a shield of love-A phenomenological-hermeneutic study of relatives' experiences in an acute neurological ward

Aim

To investigate the lived experience of being a relative to a patient admitted to an acute neurological ward to bring knowledge of what is essential to them.

Design

The study takes a phenomenological-hermeneutic approach.

Methods

Data were gathered through six individual semi-structured interviews with relatives from an acute neurological ward. A three-levelled analysis and interpretation inspired by Paul Ricoeur's philosophy was applied.

Results

Two main themes were identified: To make yourself strong while feeling vulnerable inside and To live in a changed everyday life. Within these themes, the connection between the relatives and the patients appeared to be a relationship of love. In this relationship, the relatives experience existential vulnerability. The lives of relatives undergo a difficult upheaval, which is challenged by deep emotional feelings. However, to be able to be there for their loved ones they are sheltering under a shield of love.

Family ratings of ICU care. Is there concordance within families?

PURPOSE

To examine heterogeneity of quality-of-care ratings within families and to examine possible predictors of concordance.

MATERIALS AND METHODS

We examined two aspects of agreement within families: response similarity and the amount of exact concordance in responses in a cohort of Danish ICU family members participating in a questionnaire survey (the European Quality Questionnaire: euroQ2).

RESULTS

Two hundred seventy-four family respondents representing 122 patients were included in the study. Identical ratings between family members occurred in 28%-59% of families, depending upon the specific survey item. In a smaller sample of 28 families whose patients died, between 39% and 86% gave identical responses to items rating end-of-life care. There was more response variance within than between families, yielding low estimates of intrafamily correlation. Statistics correcting for chance agreement also suggested modest within-family agreement.

CONCLUSIONS

The finding that variance is higher within than between families suggests the value of including multiple participants within a family in order to capture varying points of view.

Experiences of long-distance visitors to intensive care units at a regional major trauma centre in the United Kingdom: A cross-sectional survey

OBJECTIVES

This study aimed to investigate the experiences of long-distance visitors of major trauma patients admitted to intensive care units at a regional major trauma centre.

RESEARCH METHODOLOGY/DESIGN

Postal survey.

SETTING

Survey participants (n = 103) at a regional major trauma centre in England, United Kingdom, were identified from hospital records. Included were adult visitors (next of kin) of major trauma patients admitted to intensive care at the study site between January 2016 and July 2018, with ordinary residence located more than one hour's drive from the major trauma centre.

FINDINGS

Response rate was 45.6%. Median (range) driving distance between respondents' residence and the major trauma centre was 57.8 km (28.8-331.5). Median (range) number of days respondents visited at the major trauma centre was 18 (1-200). The quality of care at the centre was rated highly. Visitors described their often-challenging circumstances, negotiating the emotional, psychological, physical and financial impact of the situation. Suggested areas for improvement included car parking, signposting on and around the site, information provision, waiting areas and accommodation at or nearby the major trauma centre.

CONCLUSIONS

This study has described experiences of long-distance visitors at one regional major trauma centre in England and identified opportunities to ameliorate visitors' stress points locally. Replication at other regional centres may be warranted.

The experience of being a couple during an intensive care unit admission

BACKGROUND

In critical care nursing, a trend has been seen towards growing attention to the family experience of critical illness. Despite trends moving towards care of the family as a unit, previous research has focused on individual family members' experience of critical illness. Exploring the life world of the family, especially that of spouses and their interaction, is essential to providing family-centred critical care and has not previously been described.

AIM

To explore the lived experience of being a couple during admission to an intensive care unit.

DESIGN

Data were collected through dyadic semi-structured interviews with four couples who had experienced admission to an intensive care unit. Interviews were audio-taped and transcribed verbatim.

METHOD

Grounded in the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, using a method described by Dreyer and Pedersen.

RESULTS

By way of analysis, the life world of being a couple during admission to an intensive care unit was disclosed and divided into themes: For better and for worse; The meaningful proximity; and Being a couple.

CONCLUSION

Although critical illness brings a sudden disruption of a couple's twosomeness, the need to remain, act as and be seen and cared for as a couple persists during admission to an intensive care unit. Therefore, couples need to be cared for as individuals and as a unit, underlining the need to follow trends towards family-centred critical care.

Challenges of caring for victims of violence and their family members in the emergency department

INTRODUCTION

Interpersonal violence causes illness and suffering for victims and their family members. Emergency nurses are often given responsibility for forensic patients and their family members, but there is limited knowledge of their experiences regarding this task. This study aimed to describe nurses' experiences when caring for victims of violence and their family members in the emergency department.

METHODS

Individual interviews were conducted with twelve nurses from seven emergency departments. Data were analyzed using qualitative content analysis.

RESULTS

The analysis resulted in the theme: a challenge to create a caring encounter. Hindering factors comprising this challenge are described under four categories: struggling to intervene and talk about violence; contradictions when caring for family members; being helped by forensic guidelines but needing more knowledge; and dealing with one's own strong emotions towards violence.

DISCUSSION

Creating a caring encounter is perceived as a prerequisite to providing forensic care. Nurses often felt hindered to act and forensic issues were left unaddressed. Family members are offered little or no support in the aftermath of violence. The hindering factors must be overcome to ensure forensic care for victims of all types of violence.

Identifying improvement opportunities for patient- and family-centered care in the ICU: Using qualitative methods to understand family perspectives

PURPOSE

The purposes of the study were to provide richer context for families' quantitative assessments of the quality of ICU care, and to describe further quality areas of importance for family members.

MATERIALS AND METHODS

Free-text comments from 1077 family members of 920 patients focusing on family evaluation of ICU quality of care were analyzed using content analysis. Twenty-one Danish and Dutch ICUs participated from October 2014 to June 2015.

RESULTS

Four themes emerged as important to families: information, clinician skills, ICU environment, and discharge from the ICU. Families highlighted the importance of receiving information that was accessible, understandable and honest. They indicated that quality care was ensured by having clinicians who were both technically and interpersonally competent. The ICU environment and the circumstances of the transfer out of the ICU were described as contributing to quality of care. The comments identified room for improvement within all themes.

CONCLUSIONS

The study highlights the importance of including both technical and emotional care for patients and families and the consequent need to focus on clinicians' mastery of interpersonal skills.

Health-promoting conversations-A novel approach to families experiencing critical illness in the ICU environment

AIMS AND OBJECTIVES

To identify and describe the outcomes of a nurse-led intervention, "Health-promoting conversations with families," regarding family functioning and well-being in families with a member who was critically ill.

BACKGROUND

Families who have a critically ill family member in an intensive care unit face a demanding situation, threatening the normal functioning of the family. Yet, there is a knowledge gap regarding family members' well-being during and after critical illness.

DESIGN

The study used a qualitative inductive-descriptive design.

METHODS

Eight families participated in health-promoting conversations aimed to create a context for change related to the families' identified problems and resources. Fifteen qualitative interviews were conducted with 18 adults who participated in health-promoting conversations about a critical illness in the family. Eight participants were patients (six men, two women) and 10 were family members (two male partners, five female partners, one mother, one daughter, one female grandchild). The interviews were analysed by conventional content analysis.

RESULTS

Family members experienced strengthened togetherness, a caring attitude and confirmation through health-promoting conversations. The caring and calming conversations were appreciated despite the reappearance of exhausting feelings. Working through the experience and being confirmed promoted family well-being.

CONCLUSION

Health-promoting conversations were considered to be healing, as the family members take part in sharing each other's feelings, thoughts and experiences with the critical illness.

RELEVANCE TO CLINICAL PRACTICE

Health-promoting conversations could be a simple and effective nursing intervention for former intensive care patients and their families in any cultural context.

The health promoting conversations intervention for families with a critically ill relative: A pilot study

BACKGROUND

After intensive care unit treatment, patients often have prolonged impairments that affect their physical, cognitive and mental health. Family members can face overwhelming and emotionally challenging situations and their concerns and needs must be addressed.

OBJECTIVE

We investigated the outcomes of pilot randomised control trial, a nurse-led family intervention, Health Promoting Conversations, which focused on family functioning and wellbeing in families with a critically ill member.

STUDY DESIGN

This randomised controlled pilot study used a pre-test, post-test design with intervention and control groups to investigate the outcomes of the nurse-led intervention in 17 families.

OUTCOME MEASURES

The Health Promoting Conversations intervention was evaluated using validated instruments that measure family functioning and family wellbeing: the General Functioning sub-scale from the McMaster Family Assessment Device; the Family Sense of Coherence, the Herth Hope Index, and the Medical Outcome Short-Form Health Survey. Descriptive and analytical statistical methods were used to analyse the data.

RESULTS

After 12 months, the intervention group reported better family functioning than the control group. The intervention group also had better social functioning and mental health after 12 months.

CONCLUSION

This intervention may improve family wellbeing by improving family function, reducing stress, and promoting better mental health.

Experiences and needs of families with a relative admitted to an adult intensive care unit: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of the proposed review is to determine the best available qualitative evidence to guide healthcare workers when providing care and support for families of relatives in an adult intensive care unit (ICU). The specific objective is to explore the experiences and needs of families with a relative in an adult ICU.

Satisfaction with quality of ICU care for patients and families: the euroQ2 project

Background

Families’ perspectives are of great importance in evaluating quality of care in the intensive care unit (ICU). This Danish-Dutch study tested a European adaptation of the “Family Satisfaction in the ICU” (euroFS-ICU). The aim of the study was to examine assessments of satisfaction with care in a large cohort of Danish and Dutch family members and to examine the measurement characteristics of the euroFS-ICU.

Methods

Data were from 11 Danish and 10 Dutch ICUs and included family members of patients admitted to the ICU for 48 hours or more. Surveys were mailed 3 weeks after patient discharge from the ICU. Selected patient characteristics were retrieved from hospital records.

Results

A total of 1077 family members of 920 ICU patients participated. The response rate among family members who were approached was 72%. “Excellent” or “Very good” ratings on all items ranged from 58% to 96%. Items with the highest ratings were concern toward patients, ICU atmosphere, opportunities to be present at the bedside, and ease of getting information. Items with room for improvement were management of patient agitation, emotional support of the family, consistency of information, and inclusion in and support during decision-making processes. Exploratory factor analysis suggested four underlying factors, but confirmatory factor analysis failed to yield a multi-factor model with between-country measurement invariance. A hypothesis that this failure was due to misspecification of causal indicators as reflective indicators was supported by analysis of a factor representing satisfaction with communication, measured with a combination of causal and reflective indicators.

Conclusions

Most family members were moderately or very satisfied with patient care, family care, information and decision-making, but areas with room for improvement were also identified. Psychometric assessments suggest that composite scores constructed from these items as representations of either overall satisfaction or satisfaction with specific sub-domains do not meet rigorous measurement standards. The euroFS-ICU and other similar instruments may benefit from adding reflective indicators.

Electronic supplementary material

The online version of this article (doi:10.1186/s13054-017-1826-7) contains supplementary material, which is available to authorized users.

Experiences of healthcare professionals of having their significant other admitted to an acute care facility: a qualitative systematic review

BACKGROUND

Most healthcare professionals at some time will experience having a significant other admitted to an acute care hospital. The knowledge and understanding that these individuals possess because of their professional practice can potentially alter this experience. Expectations of staff and other family members (FMs) can potentially increase the burden on these health professionals. All FMs of patients should have their needs and expectations considered; however, this review specifically addresses what may be unique for healthcare professionals.

OBJECTIVES

To synthesize the qualitative evidence on the experiences of healthcare professionals when their significant others are admitted to an acute care hospital.

INCLUSION CRITERIA TYPES OF PARTICIPANTS

The current review considered studies reporting the experiences of healthcare professionals, specifically registered nurses (RNs) and physicians.

PHENOMENA OF INTEREST

The experiences of RNs and physicians when a significant other is admitted to an acute care facility.

TYPES OF STUDIES

Qualitative studies that have examined the phenomenon of interest including, but not limited to, designs such as phenomenology and grounded theory.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies with no date restrictions. Only studies published in English were considered for inclusion in this review.

METHODOLOGICAL QUALITY

Qualitative papers selected for retrieval were assessed using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI).

DATA EXTRACTION

Data were extracted from the seven included papers using the standardized data extraction tool from JBI-QARI.

DATA SYNTHESIS

The data were synthesized using the JBI approach to meta-synthesis by meta-aggregation using the JBI-QARI software and methods.

RESULTS

Seven studies of moderate quality were included in the review. Forty findings were extracted and aggregated to create 10 categories, from which five synthesized findings were derived: CONCLUSION: In contrast to "lay" FMs, health professionals possess additional knowledge and understanding that alter their perceptions and expectations, and the expectations others have of them. This knowledge and understanding can be an advantage in navigating a complex health system but may also result in an additional burden such as role conflict.

Patient-centred care of patients with ventricular arrhythmias and risk of sudden cardiac death: What do the 2015 European Society of Cardiology guidelines add?

Nurses and allied professionals are at the forefront of care delivery in patients with arrythmogenic risk and have a responsibility to deliver care that is focused on their individual needs. The 2015 European Society of Cardiology guideline on prevention of ventricular arrhythmia and sudden cardiac death heralds a step-change in patient and family focus and interdisciplinary involvement. This development reflects a recognition within the European Society of Cardiology that chronic care of patients with cardiovascular conditions can be improved by involving all stakeholders, making use of multidisciplinary interventions, and placing the patient at the centre of the care process. In this article, taskforce contributors discuss the latest evidence and highlight some of the most pertinent issues for nurses involved in patient-centred care of patients and families with ventricular arrhythmias and/or risk of sudden death.

Understanding Uncertainty Among Critically Ill Patients in the Intensive Care Unit Using Mishel's Theory of Uncertainty of Illness

BACKGROUND

The concept uncertainty has been explored in critical care but only among patients with myocardial infarction and post-cardiac catheterization using the Uncertainty in Illness Theory. Uncertainty is also a finding of numerous studies conducted in intensive care units (ICUs) that included only family members as participants of the research.

OBJECTIVES

The purpose of this article is to explore, describe, and understand the concept of uncertainty among patients and family members during critical illness in the ICU from the perspective of a phenomenological study with support from other studies published in the literature using Mishel's Theory of Uncertainty in Illness.

METHODS

The concept "uncertainty" as the topic for this article is one of the specific themes illuminated from a qualitative phenomenological study conducted in the ICU in 2010. Five from each category of patients, family members, and nurses were interviewed until data saturation was achieved. The data were analyzed using van Manen's wholistic, selective, and detailed line-by-line approach until themes were illuminated.

RESULTS

Uncertainty is a patient-specific theme illuminated in this qualitative phenomenological study not noted among the family members. The patients perceived that they "do not know what is going to happen," "if they are progressing or not," or "if they will make it or not."

DISCUSSION

Uncertainty among patients related to critical illness should be further explored. Patients with different critical care diagnosis should be included as participants.

The needs of families accompanying injured patients into the emergency department in a tertiary hospital in Gauteng

BACKGROUND

Families are not prepared for traumatic injuries of loved ones. Emergency nurses have the important role of caring for patients and families in this time of crisis. Family needs in the critical care setting have been explored using the Critical Care Family Needs Inventory (CCFNI), however little is known about family needs in the emergency department.

OBJECTIVES

This study sought to determine the needs of family members accompanying injured patients into the emergency department, and if these needs were met.

METHODS

A quantitative, descriptive, study was conducted in a level 1 trauma facility in Johannesburg, South Africa. The population included families of patients admitted to the emergency department, sampling 100 participants. The instrument, based on the CCFNI, was validated in a pilot study in Melbourne, Australia and re-evaluated using the Cronbach Alpha validity test to ensure internal consistency.Five themes were explored: 'meaning', 'proximity', 'communication', 'comfort' and 'support' and data were analysed using descriptive statistics. Responses to open-ended questions were analysed using content analysis. Permission from the Human Research Ethics Committee was granted and participants were ensured confidentiality and the option for counselling if required.

RESULTS

Themes ranked highly important were 'meaning' and 'communication'. Satisfaction was highest for 'meaning'. Low satisfaction levels for 'communication' were found. Issues regarding prolonged time spent in the emergency department and discrimination were raised.

CONCLUSION

These findings have a negative impact on the family's satisfaction with care and it is recommended that the nurse's role in family care be further explored and emphasised.

The meaning of significant others’ encounter with the ambulance clinicians in a non-emergency care context

The ambulance service is often summoned by a significant other. Therefore the ambulance clinician is expected to establish a trusting relationship with her/him and not focus solely on the patient. The aim of this study was to illuminate the meaning of significant others’ encounter with ambulance clinicians in a non-emergency ambulance care context, where patients were triaged to a level of care below that of the Accident and Emergency Department. The design was inductive. We used the phenomenological hermeneutic method developed by Lindseth and Norberg. Eleven significant others were interviewed using an open-ended method. A structural analysis resulted in a total of seven themes, covering the meaning of being de-burdened or the absence of de-burdening. When de-burdened, the significant other was empowered, irrespective of the outcome of the medical assessment and triage process. In the absence of de-burdening, the significant other felt inferior, petty, de-powered and not taken seriously by the ambulance clinicians. The majority of ambulance assignments are considered non-emergency care. The ambulance clinicians are the first to encounter significant others in these situations and therefore have a huge obligation to understand and handle their basic needs.

Families' experiences of intensive care unit quality of care: Development and validation of a European questionnaire (euroQ2)

PURPOSE

The purpose of the study is to adapt and provide preliminary validation for questionnaires evaluating families' experiences of quality of care for critically ill patients in the intensive care unit (ICU).

MATERIALS AND METHODS

This study took place in 2 European ICUs. Based on literature and qualitative interviews, we adapted 2 previously validated North American questionnaires: "Family Satisfaction with the ICU" and "Quality of Dying and Death." Family members were asked to assess relevance and understandability of each question. Validation also included test-retest reliability and construct validity.

RESULTS

A total of 110 family members participated. Response rate was 87%. For all questions, a median of 97% (94%-99%) was assessed as relevant, and a median of 98% (97%-100%), as understandable. Median ceiling effect was 41% (30%-47%). There was a median of 0% missing data (0%-1%). Test-retest reliability showed a median weighted κ of 0.69 (0.53-0.83). Validation showed significant correlation between total scores and key questions.

CONCLUSIONS

The questions were assessed as relevant and understandable, providing high face and content validity. Ceiling effects were comparable to similar instruments; missing data, low; and test-retest reliability, acceptable. These measures are promising for use in research, but further validation is needed before they can be recommended for routine clinical use.

The acute psychobiological impact of the intensive care experience on relatives

There is a growing awareness amongst critical care practitioners that the impact of intensive care medicine extends beyond the patient to include the psychological impact on close family members. Several studies have addressed the needs of relatives within the intensive care context but the psychobiological impact of the experience has largely been ignored. Such impact is important in respect to health and well-being of the relative, with potential to influence patient recovery. The current feasibility study aimed to examine the acute psychobiological impact of the intensive care experience on relatives. Using a mixed methods approach, quantitative and qualitative data were collected simultaneously. Six relatives of patients admitted to the intensive care unit (ICU) of a District General Hospital, were assessed within 48 h of admission. Qualitative data were provided from semi-structured interviews analysed using interpretative phenomenological analysis. Quantitative data were collected using a range of standardised self-report questionnaires measuring coping responses, emotion, trauma symptoms and social support, and through sampling of diurnal salivary cortisol as a biomarker of stress. Four themes were identified from interview: the ICU environment, emotional responses, family relationships and support. Questionnaires identified high levels of anxiety, depression and trauma symptoms; the most commonly utilised coping techniques were acceptance, seeking support through advice and information, and substance use. Social support emerged as a key factor with focused inner circle support relating to family and ICU staff. Depressed mood and avoidance were linked to greater mean cortisol levels across the day. Greater social network and coping via self-distraction were related to lower evening cortisol, indicating them as protective factors in the ICU context. The experience of ICU has a psychological and physiological impact on relatives, suggesting the importance of identifying cost-effective interventions with evaluations of health benefits to both relatives and patients.

The impacts of injury at the individual, community and societal levels: a systematic meta-review

OBJECTIVES

Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those individuals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology.

STUDY DESIGN

Systematic meta-review.

METHODS

To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review.

RESULTS

Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts.

CONCLUSIONS

In summary, the meta-review identified a substantial body of knowledge at the individual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury.

The dignity of the nursing profession

Background:

Nursing continues to gain legitimation epistemologically and ontologically as a scientific discipline throughout the world. If a profession gains respect as a true autonomous scientific profession, then this recognition has to be put in practice in all environments and geographical areas. Nursing professional dignity, as a self-regarding concept, does not have a clear definition in the literature, and it has only begun to be analyzed in the last 10 years.

Objectives:

The purpose of this meta-synthesis was to determine the various factors that constitute the notion of nursing professional dignity. The target was to create a tentative model of the concept.

Research design:

The research design was a meta-synthesis (N = 15 original articles) of nursing professional dignity described in the literature, based on the guidelines by Noblit and Hare.

Method and findings:

Original studies were sought out from electronic databases and manual searches. The selection of literature was conducted on stages based on titles (n = 2595), abstracts (n = 70), and full-texts (n = 15) according to the inclusion and exclusion criteria. From this analysis, a clear definition of nursing professional dignity emerged that underscored two main macro-dimensions constituting this intertwined, multidimensional, and complex notion: characteristics of the human beings and workplace elements.

Conclusion:

The recognition of nursing professional dignity could have a positive impact on patients because the results clearly showed that nurses are more prone to foster patients’ dignity, patients’ safety, and a better quality of care if their own dignity is respected. If nurses are uncomfortable, humiliated, or not seen in their professional role, it is difficult to give to others good care, good support, or good relationships.

Voices of family members and significant others in the tele-intensive care unit

BACKGROUND

Research suggests that tele-intensive care units (tele-ICUs) are associated with decreases in mortality rates, length of stay, and health care costs. However, little is known about the awareness and perceptions of the tele-ICU among patients' significant others.

OBJECTIVES

To assess whether patients' significant others were informed about the tele-ICU, what their preferences are regarding source and type of information about the tele-ICU, and what their perceptions are of the impact of the tele-ICU on patient care.

METHODS

A survey was conducted with a nonprobability, convenience sample of patients' significant others at 3 health systems.

RESULTS

Two-thirds of patients' significant others reported that they were uninformed about the tele-ICU and identified staff as the preferred source for this information. The 3 most important topics of information were patients' physical privacy, impact on patient care, and the technology. Most expressed favorable perceptions of the tele-ICU.

CONCLUSIONS

This pilot study demonstrated significant gaps in communication about the tele-ICU between staff and patients' significant others and revealed a preference to be informed about the tele-ICU by staff. Study findings will help define goals, objectives, and methods for further research to improve communication with patients' significant others about the tele-ICU.

Understanding of advance care planning by family members of persons undergoing hemodialysis

The purpose of this qualitative descriptive study was to explore hemodialysis patients' family members' understanding of end-of-life decision-making processes. The project aimed to address (a) family members' constructions of advance care planning (ACP), including their roles and responsibilities, and (b) family members' perceptions of health care providers' roles and responsibilities in ACP. Eighteen family members of persons undergoing hemodialysis were recruited primarily from outpatient dialysis facilities and interviewed individually. Confirmed transcript data were analyzed, coded, and compared, and categories were established. Interpretations were validated throughout the interviews and peer debriefing sessions were used at a later stage in the analysis. The overarching construct identified was one of Protection. Family members protect patients by (a) Sharing Burdens, (b) Normalizing Life, and (c) Personalizing Care. Recommendations for future research include the need to explore ACP of persons undergoing hemodialysis who do not have a family support system.

Needs and experiences of intensive care patients' families: a Saudi qualitative study

AIM

To identify the perceived needs of Saudi families of patients in Intensive Care in relation to their culture and religion.

BACKGROUND

Admission of a family member to an intensive care unit (ICU) is a deeply distressing and often unexpected life event to the family. Families of critically ill patients have needs that should be acknowledged and met by the ICU team. Literature is virtually silent on the issue of recognizing the ICU family needs in relation to the influence of their cultural values and religious beliefs.

DESIGN

A descriptive exploratory qualitative study.

METHOD

Individual, semi-structured interviews of a purposive sample of 12 family members were carried out between November 2011 and February 2012. The closest family members were recruited to participate in the interviews with a mean age of 44·25 years in eight mixed medical-surgical ICUs of eight major trauma hospitals in Saudi Arabia.

RESULTS

The family needs and experiences are described via six major themes: looking for information, maintaining reassurance, spiritual healing, maintaining close proximity, involvement in care and support not being facilitated. The results indicated that family members sought to access information readily to diminish their anxiety. They also needed to be reassured that the best care was being delivered to their loved one and to feel supported during this critical time. Saudi families have cultural and spiritual healing beliefs and practices including faith in God and that God is the ultimate healer, reading of the Qur'an, prayer and charity. These lessen their stress and connect them to hold on to hope. In addition, maintaining proximity to their ill family member was considered of the greatest importance to the families.

CONCLUSION

The study provided an in-depth understanding of the family members' experience of having a relative in Intensive Care and focussed on a range of unmet needs, particularly those related to culture and religion. The ICU team need to work collaboratively with family members to improve their experience.

RELEVANCE TO PRACTICE

The recognition of family needs, experiences and situations can enhance the care provided by the critical care team to patients and families.

A qualitative study of new fathers' experiences of care in relation to complicated childbirth

OBJECTIVES

The objective of the study was to describe new fathers' experiences with care related to complicated childbirth.

METHODS

A qualitative approach consisting of individual interviews using a semi-structured interview guide with open-ended questions was applied. A purposive sample of eight fathers participated. The interview text was subjected to qualitative thematic content analysis.

RESULTS

Analysis revealed the following three categories: (1) feeling scared and uncared for during acute situations; (2) appreciating the opportunity to participate in care and becoming a family; and (3) needing continued care. Based on these three categories, a recurring theme was identified: struggling to be recognized by care staff as a partner in the family was revealed.

CONCLUSION

Although fathers lack support and understanding from care staff, they strive to fulfill their roles as fathers by guarding their families and keeping them together. Caregivers involved in the childbirth process should realize that by acknowledging and encouraging fathers in these roles, they in turn support the entire family unit. Interventions developed for fathers and family care requires further development. Additional research concerning how midwives and critical care nurses (CCNs) view the presence of fathers in the emergency situations that may accompany childbirth is also needed.

Critical care nurses' experiences of nursing mothers in an ICU after complicated childbirth

BACKGROUND

Providing nursing care for a critically ill obstetric patient or a patient who has just become a mother after a complicated birth can be a challenging experience for critical care nurses (CCNs). These patients have special needs because of the significant alterations in their physiology and anatomy together with the need to consider such specifics as breastfeeding and mother-child bonding.

AIM

The aim with this study was to describe CCNs' experience of nursing the new mother and her family after a complicated childbirth.

METHOD

The design of the study was qualitative. Data collection was carried out through focus group discussions with 13 CCNs in three focus groups during spring 2012. The data were subjected to qualitative content analysis.

FINDINGS

The analysis resulted in the formulation of four categories: the mother and her vital functions are prioritized; not being responsible for the child and the father; an environment unsuited to the new family and collaboration with staff in neonatal and maternity delivery wards.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

When nursing a mother after a complicated birth the CCNs give her and her vital signs high priority. The fathers of the children or partners of the mothers are expected to take on the responsibility of caring for the newborn child and of being the link with the neonatal ward. It is suggested that education about the needs of new families for nursing care would improve the situation and have clinical implications. Whether the intensive care unit is always the best place in which to provide care for mothers and new families is debatable.

How older female spouses cope with partners' coronary artery bypass graft surgery

This research sought to better understand how older female spouses cope with a partner's coronary artery bypass graft surgery and to explore coping's relationships with life-change stress, cognitive appraisal, resilience, social support, and aspects of spouse's surgery. A sample of 96 women, aged from 55 to 81 years, completed surveys after their partner's surgery. Folkman and Lazarus' ways of coping (WCQ) scales yielded two factors in this sample—reactive coping and adaptive coping. Reactive coping, including more emotion-focused ways of coping from the WCQ, was associated only with more time spent anticipating spouses' surgeries. Women described the greatest use of ways of coping labeled adaptive, which in turn had significant relationships with greater resilience, social support, and positive appraisal of the surgical experience. Stepwise multiple regression found greater resilience, more frequent religious participation, and fewer children to be distinct predictors of adaptive coping. Nursing staff are encouraged to accept and normalize reactive coping, while facilitating adaptive coping with surgical stresses.