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Wang L, Zhang Q. Effect of the postoperative pain management model on the psychological status and quality of life of patients in the advanced intensive care unit. BMC Nurs 2024; 23:496. [PMID: 39030616 PMCID: PMC11264701 DOI: 10.1186/s12912-024-02144-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/01/2024] [Indexed: 07/21/2024] Open
Abstract
OBJECTIVE it was to explore the influence of the postoperative pain management mode on the psychological state, quality of life (QOL), and nursing satisfaction of late patients in the intensive care unit (ICU) and improve the nursing effect of late patients in the ICU. METHODS seventy patients who were admitted to the postoperative ICU for gastric cancer and received treatment in our hospital from March 2021 to May 2022 were selected. The patients were assigned into a research group and a control (Ctrl) group according to a random number table, with 70 cases in each group. The Ctrl group received routine nursing intervention, while research group received nursing intervention based on routine nursing intervention with postoperative pain management mode and received psychological care. Good communication was established with the patients, and the postoperative pain assessment was well conducted. The general information, state-trait anxiety (STAI) score, World Health Organization's Quality of Life Instrument (WHO QOL-BREF) score, and care satisfaction were compared. RESULTS the general information differed slightly, such as sex, age, and ward type, between groups, with comparability (P > 0.05). S-AI scores (13.15 ± 1.53 vs. 16.23 ± 1.24) and T-AI scores (14.73 ± 3.12 vs. 18.73 ± 3.16) in research group were inferior to those in Ctrl group (P < 0.05). The scores of patients in research group in the physiological field (78.9 ± 6.1 points vs. 72.3 ± 5.6 points), social relationship field (76.9 ± 4.5 points vs. 71.3 ± 4.8 points), psychological field (78.6 ± 6.2 points vs. 72.4 ± 5.3 points), environmental field (78.6 ± 6.7 points vs. 73.5 ± 6.4 points), and total QOL (79.5 ± 7.4 points vs. 71.6 ± 5.4 points) were higher than those in Ctrl group (P < 0.05). The total satisfaction rate with nursing care in research group (82.85%) was dramatically superior to that in Ctrl group (62.85%) (P < 0.05). CONCLUSION the adoption of a postoperative pain management model in postoperative nursing interventions for patients in advanced ICUs can alleviate anxiety and depression, improve patients' QOL and nursing satisfaction, and have clinical promotion value.
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Affiliation(s)
- Lijuan Wang
- Department of Rehabilitation Medicine, Pingyi County Hospital of Traditional Chinese Medicine, Linyi, Shandong, 273300, China
| | - Qiang Zhang
- Department of Critical Care Medicine, Zibo Central Hospital, Zibo, Shandong, 255000, China.
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Xie P, Liu Z, Chen H, Wu Y, Xie P, Liu H, Ying W. Exploring the barriers and facilitators of palliative care in the adult intensive care unit from nurses' perspectives in China: A qualitative study. Nurs Crit Care 2024; 29:756-764. [PMID: 38311989 DOI: 10.1111/nicc.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/11/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Intensive care units (ICUs) in China primarily focus on active rescue efforts, and it is not common to provide palliative care services within the ICU. As nurses play a primary role as caregivers for end-of-life patients in the ICU, it is necessary to explore the factors that impede or facilitate palliative care from their perspective. AIM To explore the barriers and facilitators associated with implementing palliative care in Chinese adult ICUs from nurses' perspectives. STUDY DESIGN This study utilized a descriptive phenomenological research approach and purposive sampling to conduct face-to-face semi-structured interviews with nurses working in adult ICUs from three comprehensive hospitals in China during the period between February and May 2023. A total of 17 nurses were interviewed, and the collected data were transcribed, coded, and synthesized thematically. RESULTS Two themes of barriers and facilitators of palliative care in the Chinese adult ICU were extracted. The three sub-themes of hindering factors are as follows: (1) The influence of Chinese traditional culture. (2) The specificity of the ICU context. (3) Lacking sufficient attention in the ICU. The three sub-themes of the promoting factors are as follows: (1) Government and society value palliative care. (2) Patients and their families have palliative care needs. (3) Nurses view palliative care positively. CONCLUSION Currently, integrating palliative care into the ICU may face challenges such as cultural factors, the specificity of the ICU context, and insufficient attention. However, it is worth noting that as the government and society place more emphasis on palliative care, more and more people are gradually paying attention to the palliative care needs of critically ill patients and their families. RELEVANCE TO CLINICAL PRACTICE This study serves as a reference for exploring an ICU palliative care service model that is suitable for China's national conditions, such as education and training, resource allocation, service processes, and the palliative care environment, among others.
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Affiliation(s)
- Peiying Xie
- School of Nursing, Shantou University Medical College, Shantou, People's Republic of China
| | - Zhili Liu
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Huiyao Chen
- Intensive Care Unit, The First Peoples Hospital of Foshan, Foshan, People's Republic of China
| | - Yanchun Wu
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Peijie Xie
- Urology Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Hui Liu
- Orthopaedic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, People's Republic of China
| | - Wenjuan Ying
- Department of Nursing Research, The First Affiliated Hospital of Shantou University Medical College, Shantou, People's Republic of China
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Kawase Y, Takahashi S, Okayasu M, Hirai Y, Matsumoto I. Effectiveness of a Simulation-Based Education Program to Improve Novice Nurses' Clinical Judgment Skills. Cureus 2024; 16:e61685. [PMID: 38975451 PMCID: PMC11223944 DOI: 10.7759/cureus.61685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION We assessed the effectiveness of a simulation-based education program to improve novice nurses' clinical judgment skills. METHODS A simulation education program was implemented for 21 novice nurses. Surveys were conducted on program satisfaction, learning, and clinical judgment skills before, immediately after, and two months after the program. RESULTS Novice nurses were highly satisfied with the simulation education program. The following nine categories were identified as learnings: provide psychological care for patients, conduct sufficient observation, conduct assessment and make judgment based on observational findings, consult and report appropriately to senior nurses, take response action calmly, collect necessary information, acquire knowledge, predict patients' conditions, and make environmental arrangements. The subscale score for theoretical and practical reasoning was significantly higher immediately after and two months after the program than before it. In addition, the subscale for grasping the condition by observation was significantly higher two months after the program than before and immediately after it. CONCLUSION The novice nurses learned to sufficiently observe, obtain necessary information, and prospectively assess patients' conditions by taking part in the simulation education program. The subscale score for grasping the condition by observation was significantly higher two months after the program than before and immediately after it. After the simulation program, novice nurses were likely actively practicing nursing; therefore, this program may not be directly responsible for the improvement of these new nurses' clinical judgment. Nevertheless, we found that the completion of the simulation program was correlated with enhanced clinical judgment.
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Affiliation(s)
- Yoshiko Kawase
- Faculty of Nursing and Nutrition, University of Shimane, Izumo, JPN
| | - Shoko Takahashi
- Faculty of Nursing and Nutrition, University of Shimane, Izumo, JPN
| | - Masako Okayasu
- Faculty of Nursing and Nutrition, University of Shimane, Izumo, JPN
| | - Yuka Hirai
- Faculty of Nursing and Nutrition, University of Shimane, Izumo, JPN
| | - Ichie Matsumoto
- Faculty of Nursing and Nutrition, University of Shimane, Izumo, JPN
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McNall A, Breda KL, Hinderer KA. Simulation, Storytelling, and Pediatric End-of-Life Care: A Continuing Professional Development Approach for Nurse Residents. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:220-228. [PMID: 38523331 DOI: 10.1177/27527530231194596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Background: Providing end-of-life (EOL) care to pediatric patients and their families is challenging. Newly licensed nurses, especially those working with the hematology/oncology population, have little to no experience providing the specialized care needed for the dying child. An evidence-based continuing professional development activity provided a novel approach to improve the knowledge, attitudes, and comfort levels of nurse residents related to pediatric EOL care. Method: A high-fidelity simulation module of a pediatric oncology patient at the EOL was embedded into a 12-month nurse residency program. The module employed several teaching strategies including a storytelling approach. Results: Thirteen pediatric nurse residents participated in the program. While the evidence-based intervention increased participants' EOL care knowledge, their overall attitudes, and comfort levels remained unchanged. Discussion: EOL simulation with a storytelling approach is a highly valuable method of teaching new nurses how to care for a dying patient. Additional studies are needed to explore how to increase the comfort levels of new nurses in the delicate population of pediatric hematology/oncology.
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Affiliation(s)
- Avery McNall
- Connecticut Children's, Hartford, CT, USA
- Department of Nursing, University of Hartford, West Hartford, CT, USA
| | - Karen Lucas Breda
- Department of Nursing, University of Hartford, West Hartford, CT, USA
| | - Katherine A Hinderer
- Institute for Nursing Research and Evidence-Based Practice, Connecticut Children's, Hartford, CT, USA
- School of Medicine Department of Pediatrics, University of Connecticut, Farmington, CT, USA
- School of Nursing, University of Connecticut, Storrs, CT, USA
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Moliterno NV, Paravidino VB, Robaina JR, Lima-Setta F, da Cunha AJLA, Prata-Barbosa A, de Magalhães-Barbosa MC. High-fidelity simulation versus case-based discussion for training undergraduate medical students in pediatric emergencies: a quasi-experimental study. J Pediatr (Rio J) 2024:S0021-7557(24)00038-X. [PMID: 38608720 DOI: 10.1016/j.jped.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/21/2024] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To evaluate the effect of high-fidelity simulation of pediatric emergencies compared to case-based discussion on the development of self-confidence, theoretical knowledge, clinical reasoning, communication, attitude, and leadership in undergraduate medical students. METHODS 33 medical students were allocated to two teaching methods: high-fidelity simulation (HFS, n = 18) or case-based discussion (CBD, n = 15). Self-confidence and knowledge tests were applied before and after the interventions and the effect of HFS on both outcomes was estimated with mixed-effect models. An Objective Structured Clinical Examination activity was conducted after the interventions, while two independent raters used specific simulation checklists to assess clinical reasoning, communication, attitude, and leadership. The effect of HFS on these outcomes was estimated with linear and logistic regressions. The effect size was estimated with the Hedge's g. RESULTS Both groups had an increase in self-confidence (HFS 59.1 × 93.6, p < 0.001; CDB 50.5 × 88.2, p < 0.001) and knowledge scores over time (HFS 45.1 × 63.2, p = 0.001; CDB 43.5 × 56.7, p-value < 0.01), but no difference was observed between groups (group*time effect in the mixed effect models adjusted for the student ranking) for both tests (p = 0.6565 and p = 0.3331, respectively). The simulation checklist scores of the HFS group were higher than those of the CBD group, with large effect sizes in all domains (Hedges g 1.15 to 2.20). CONCLUSION HFS performed better than CBD in developing clinical reasoning, communication, attitude, and leadership in undergraduate medical students in pediatric emergency care, but no significant difference was observed in self-confidence and theoretical knowledge.
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Affiliation(s)
- Nathalia Veiga Moliterno
- Instituto D'Or de Pesquisa e Educação (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Faculdade de Medicina de Petrópolis, Departamento de Pediatria, Petrópolis, RJ, Brazil.
| | - Vitor Barreto Paravidino
- Universidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Departamento de Epidemiologia, Rio de Janeiro, RJ, Brazil; Academia Naval, Marinha do Brasil, Departamento de Educação Física e Desportos, Rio de Janeiro, RJ, Brazil
| | | | - Fernanda Lima-Setta
- Instituto D'Or de Pesquisa e Educação (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Fundação Oswaldo Cruz, Instituto Fernandes Figueira, Unidade de Terapia Intensiva Pediátrica, Rio de Janeiro, RJ, Brazil
| | - Antônio José Ledo Alves da Cunha
- Instituto D'Or de Pesquisa e Educação (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
| | - Arnaldo Prata-Barbosa
- Instituto D'Or de Pesquisa e Educação (IDOR), Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil
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Solstad K, Kamrath H, Meiers S, Goloff N, Scheurer JM. Pediatric End-of-Life Simulation Workshop to Clinical Care: Lasting Implications on Clinical Practice. Palliat Med Rep 2024; 5:136-141. [PMID: 38560746 PMCID: PMC10979662 DOI: 10.1089/pmr.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 04/04/2024] Open
Abstract
Background Simulations are an important modality for practicing high-acuity, low-frequency events. We implemented a deliberate practice simulation-based workshop to improve pediatric end-of-life care skills (PECS) competence. Purpose To understand pediatric subspecialty fellows' perceptions about influences of a simulation-based workshop on PECS provided at the bedside several months following participation. Methods Pediatric subspecialty fellows were recruited to voluntary focus groups during regular educational sessions six months following PECS workshop participation with aims to identify perceptions about their workshop participation and any implication on their clinical practice. Inductive qualitative content analysis of focus group interview data was performed adhering to the Standards for Reporting Qualitative Research. Results Ten fellows participated in one of three focus groups. Researchers identified three major themes of fellow experience: burden, safe practice space, and self-efficacy. Fellows described practice implications from workshop participation, including incorporation of specific practices, improved anticipatory guidance, and increased team leader confidence. Conclusions Targeted, deliberate simulation-based practice of PECS can help close the gap from learning to practice, contributing to provider self-efficacy and potentially improving clinical care for pediatric patients and families at end of life.
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Affiliation(s)
- Kayla Solstad
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Heidi Kamrath
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Neonatology, Children's Minnesota, Saint Paul, Minnesota, USA
| | - Sonja Meiers
- Department of Nursing, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Naomi Goloff
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Johannah M. Scheurer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Weismantel I, Zhang N, Burston A. Exploring intensive care nurses' perception of simulation-based learning: A systematic review and meta-synthesis. J Clin Nurs 2024; 33:1195-1208. [PMID: 38258507 DOI: 10.1111/jocn.17016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
AIM(S) To explore intensive care nurses' (ICN) perceptions of simulation-based learning (SBL). DESIGN A systematic review and meta-synthesis. METHODS The review followed the PRISMA guidelines for reporting a systematic review. A systematic search strategy was developed using a modified PICo framework. A comprehensive search was conducted in July 2023 in CINAHL, OVID Embase, Medline complete, Web of Science, ERIC and Scopus databases for articles published in English between 2013 and 2023. Data were extracted using the Joanna Briggs Institute QARI Data Extraction, with data synthesis guided by Braun and Clark's thematic analysis approach. Quality appraisal was assessed using the CASP tool. RESULTS Eleven studies providing qualitative data were included for analysis. Analysis and meta-synthesis led to the construction of two themes: The learning experience and professional growth through collaboration. CONCLUSION The review highlights the balance needed in finding the appropriate simulation approach, with the right level of fidelity, conducted at appropriately regular intervals, incorporating the correct makeup of professional team members, conducted in the right environment and facilitated by a skilled facilitator, to ensure best outcomes and return on investment for ICN's education. IMPLICATIONS FOR PRACTICE These findings are a valuable resource for educators and organisations considering simulation-based learning initiatives in the intensive care setting. NO PATIENT OR PUBLIC CONTRIBUTION This review involved analysis of existing literature and as such no unique patient or public involvement occurred. REPORTING METHOD The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) reporting guidelines.
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Affiliation(s)
- Isabella Weismantel
- School of Nursing, Midwifery and Paramedicine (Melbourne), Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Nancy Zhang
- School of Nursing, Midwifery and Paramedicine (Melbourne), Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Adam Burston
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, Queensland, Australia
- School of Nursing, Midwifery and Paramedicine (Brisbane), Faculty of Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia
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Abstract
Communication skills training is a core competency for neonatal-perinatal medicine (NPM) fellows, yet many neonatology fellowship programs do not have formal communication skills curricula. Since the late 1990s, experiential learning that includes role-play and simulation has become the standard for communication training. NPM fellows who receive simulation-based communication skills training report greater comfort with difficult conversations in the NICU. Most communication skills studies in neonatology focus on antenatal counseling, with some studies regarding family meetings and end of life conversations. Published examples for simulation-based communication skills curricula exist, with ideas for adapting them to meet the needs of local resources.
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Affiliation(s)
- Sara Munoz-Blanco
- Department of Pediatrics, Division of Neonatology and Pediatric Palliative Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Renee Boss
- Department of Pediatrics, Division of Neonatology and Pediatric Palliative Medicine, Berman Institute of Bioethics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Stanich J, Sunga K, Loprinzi-Brauer C, Ginsburg A, Ingram C, Bellolio F, Cabrera D. Teaching Palliative Care to Emergency Medicine Residents Using Gamified Deliberate Practice-Based Simulation: Palliative Gaming Simulation Study. JMIR MEDICAL EDUCATION 2023; 9:e43710. [PMID: 37585258 PMCID: PMC10468704 DOI: 10.2196/43710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Emergency departments (EDs) care for many patients nearing the end of life with advanced serious illnesses. Simulation training offers an opportunity to teach physicians the interpersonal skills required to manage end-of-life care. OBJECTIVE We hypothesized a gaming simulation of an imminently dying patient using the LIVE. DIE. REPEAT (LDR) format, would be perceived as an effective method to teach end-of-life communication and palliative care management skills. METHODS This was a gaming simulation replicating the experience of caring for a dying patient with advanced serious illness in the ED. The scenario involved a patient with pancreatic cancer presenting with sepsis and respiratory distress, with a previously established goal of comfort care. The gaming simulation game was divided into 4 stages, and at each level, learners were tasked with completing 1 critical action. The gaming simulation was designed using the LDR serious game scheme in which learners are allowed infinite opportunities to progress through defined stages depicting a single patient scenario. If learners successfully complete the predetermined critical actions of each stage, the game is paused, and there is a debriefing to reinforce knowledge or skills before progressing to the next stage of the gaming simulation. Conversely, if learners do not achieve the critical actions, the game is over, and learners undergo debriefing before repeating the failed stage with an immediate transition into the next. We used the Simulation Effectiveness Tool-Modified survey to evaluate perceived effectiveness in teaching end-of-life management. RESULTS Eighty percent (16/20) of residents completed the Simulation Effectiveness Tool-Modified survey, and nearly 100% (20/20) either strongly or somewhat agreed that the gaming simulation improved their skills and confidence at the end of life in the following dimensions: (1) better prepared to respond to changes in condition, (2) more confident in assessment skills, (3) teaching patients, (4) reporting to the health care team, (5) empowered to make clinical decisions, and (6) able to prioritize care and interventions. All residents felt the debriefing contributed to learning and provided opportunities to self-reflect. All strongly or somewhat agree that they felt better prepared to respond to changes in the patient's condition, had a better understanding of pathophysiology, were more confident on their assessment skills, and had a better understanding of the medications and therapies after the gaming simulation. A total of 88% (14/16) of them feel more empowered to make clinical decisions. After completing the gaming simulation, 88% (14/16) of residents strongly agreed that they would feel more confident communicating with a patient and prioritizing care interventions in this context. CONCLUSIONS This palliative gaming simulation using the LDR format was perceived by resident physicians to improve confidence in end-of-life communication and palliative care management.
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Affiliation(s)
- Jessica Stanich
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kharmene Sunga
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | | | - Alexander Ginsburg
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Cory Ingram
- Division of Palliative, Department of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, United States
| | - Daniel Cabrera
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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Anguis Carreño M, Marín Yago A, Jurado Bellón J, Baeza-Mirete M, Muñoz-Rubio GM, Rojo Rojo A. An Exploratory Study of ICU Pediatric Nurses' Feelings and Coping Strategies after Experiencing Children Death. Healthcare (Basel) 2023; 11:healthcare11101460. [PMID: 37239746 DOI: 10.3390/healthcare11101460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND This study aims to explore the feelings and experiences of nursing staff when faced with the death of a pediatric patient in the ICU. METHODOLOGY A qualitative study based on hermeneutic phenomenology was conducted through semi-structured interviews. Ten nurses (30% of staff) from the Pediatric Intensive Care Unit of a referral hospital were interviewed in April 2022. Text transcripts were analysed using latent content analysis. RESULTS Content analysis indicated that the interviewees had feelings of sadness and grief; they had a misconception of empathy. They had no structured coping strategies, and those they practiced were learned through personal experience, not by specific training; they reported coping strategies such as peer support, physical exercise, or strengthening ties with close family members, especially their children. The lack of skills to cope with the death and the absence of support from personnel management departments were acknowledged. This can lead to the presence of compassion fatigue. CONCLUSIONS The feelings that PICU nurses have when a child they care for die are negative feelings and sadness, and they possess coping strategies focused on emotions learned from their own experience and without institutional training support. This situation should not be underestimated as they are a source of compassion fatigue and burnout.
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Affiliation(s)
| | - Ana Marín Yago
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Healthcare System, 30120 Murcia, Spain
| | - Juan Jurado Bellón
- Pediatric Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Healthcare System, 30120 Murcia, Spain
| | - Manuel Baeza-Mirete
- Faculty of Nursing, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
| | - Gloria María Muñoz-Rubio
- Intensive Care Unit, Hospital Universitario Virgen de la Arrixaca, Public Murcian Health System, 30120 Murcia, Spain
| | - Andrés Rojo Rojo
- Faculty of Nursing, Catholic University of Murcia (UCAM), 30107 Murcia, Spain
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McSherry ML, Rissman L, Mitchell R, Ali-Thompson S, Madrigal VN, Lobner K, Kudchadkar SR. Prognostic and Goals-of-Care Communication in the PICU: A Systematic Review. Pediatr Crit Care Med 2023; 24:e28-e43. [PMID: 36066595 DOI: 10.1097/pcc.0000000000003062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Admission to the PICU may result in substantial short- and long-term morbidity for survivors and their families. Engaging caregivers in discussion of prognosis is challenging for PICU clinicians. We sought to summarize the literature on prognostic, goals-of-care conversations (PGOCCs) in the PICU in order to establish current evidence-based practice, highlight knowledge gaps, and identify future directions. DATA SOURCES PubMed (MEDLINE and PubMed Central), EMBASE, CINAHL, PsycINFO, and Scopus. STUDY SELECTION We reviewed published articles (2001-2022) that examined six themes within PGOCC contextualized to the PICU: 1) caregiver perspectives, 2) clinician perspectives, 3) documentation patterns, 4) communication skills training for clinicians, 5) family conferences, and 6) prospective interventions to improve caregiver-clinician communication. DATA EXTRACTION Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology. DATA SYNTHESIS Of 1,420 publications screened, 65 met criteria for inclusion with several key themes identified. Parent and clinician perspectives highlighted the need for clear, timely, and empathetic prognostic communication. Communication skills training programs are evaluated by a participant's self-perceived improvement. Caregiver and clinician views on quality of family meetings may be discordant. Documentation of PGOCCs is inconsistent and most likely to occur shortly before death. Only two prospective interventions to improve caregiver-clinician communication in the PICU have been reported. The currently available studies reflect an overrepresentation of bereaved White, English-speaking caregivers of children with known chronic conditions. CONCLUSIONS Future research should identify evidence-based communication practices that enhance caregiver-clinician PGOCC in the PICU and address: 1) caregiver and clinician perspectives of underserved and limited English proficiency populations, 2) inclusion of caregivers who are not physically present at the bedside, 3) standardized communication training programs with broader multidisciplinary staff inclusion, 4) improved design of patient and caregiver educational materials, 5) the development of pediatric decision aids, and 6) inclusion of long-term post-PICU outcomes as a measure for PGOCC interventions.
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Affiliation(s)
- Megan L McSherry
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD
| | - Lauren Rissman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Riley Mitchell
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Sherlissa Ali-Thompson
- Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Vanessa N Madrigal
- Division of Critical Care Medicine, Department of Pediatrics, George Washington University, Washington, DC
- Pediatric Ethics Program, Children's National Hospital, Washington, DC
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins University, Baltimore, MD
| | - Sapna R Kudchadkar
- Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD
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