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

The moderating effects of nurses' background characteristics on the relationship between family-centred care perception and practice for hospitalized children and their families in Malawi

PURPOSE

Globally, limited information is available on the relationship between the perception and practice of family-centered care (FCC), and the moderating effects of nurses' background characteristics on this relationship. This study investigated the relationship between FCC perception and FCC practice and the moderating effects of the nurses' background characteristics on this relationship.

DESIGN AND METHODS

A cross-sectional study was conducted using a two-stage stratified sampling method. Data were collected from 444 nurses using the Family Centered Care Questionnaire-Revised and analyzed using IBM SPSS Version 25. The Hayes PROCESS macro model, version 3, was integrated into SPSS to examine the moderating effects at a significance level of 0.05.

RESULTS

The response rate was 98%, and a statistically significant positive association was found between FCC perception and FCC practice (r = 0.353, p < .001). Gender of a nurse (ΔR2 = 0.0206, p < .002), having children (ΔR2 = 0.0231, p < .001), experience (ΔR2 = 0.0107, p = .028), and working in a medical-surgical ward (ΔR2 = 0.0208, p = .008) had a statistically significant moderating effect on the relationship between FCC perception and FCC practice.

CONCLUSION

These findings provide minimal evidence of the existence of non-modifiable moderators of FCC. Future studies with modifiable moderators are therefore needed.

PRACTICE IMPLICATIONS

Understanding the moderating effects of nurses' background characteristics on the relationship between FCC perception and FCC practice may facilitate the development of FCC interventions that favor these background characteristics and facilitate the integration of FCC into routine policies and practices.

The needs and experiences of critically ill patients and family members in intensive care unit of a tertiary hospital in Malaysia: a qualitative study

BACKGROUND

Admission to an intensive care unit (ICU) is a stressful experience for patients and their family members. While the focus of management is primarily on medical care, there can be other areas which are overlooked. The purpose of this study was to investigate the needs and experiences of ICU patients and family members.

METHOD

This qualitative study involved four trained researchers conducting in-depth interviews (IDI) based on a semi-structured interview guide. The participants were ICU patients and family members. All IDIs were audio-recorded and transcribed verbatim. Four researchers independently analyzed the data via thematic analysis with the aid of QDA Miner Lite®. The themes and subthemes were generated and confirmed by literature and expert opinion.

RESULTS

Six IDIs were conducted with three patients and three family members, whose ages ranged from 31 to 64 years old. One pair of participants consisted of a patient and his respective family member, while the other four participants did not have a familial relationship with each other. Three main themes emerged from the analysis: (I) critical care services; (II) physical spaces; and (III) monitoring technology. Medical, psychological, physical, and social needs for critical care services were expressed by both patients and family members. Patients' needs in clinical spaces were highlighted as a conducive ICU environment with ambient temperature and controlled noise levels. In non-clinical spaces, family members expressed a need for more chairs in the waiting area. Participants expressed the need for call bells as well as patients' negative perceptions of medical equipment alarms in the ICU when it pertained to monitoring technology.

CONCLUSION

This study provides an in-depth view at the needs and experiences of ICU patients and family members who have a variety of unmet needs. This understanding is critical for guiding ICU personnel and stakeholders in their efforts to humanize ICU care.

Family attendance during critical illness episodes: Reflection on practices in Arabic and Muslim contexts

It is common practice in healthcare systems in the Arabic region to exclude relatives when patients receive treatment for critical emergent incidents or illnesses. This exclusion is despite family members' wishes for proximity and cultural and religious values that mean being with unwell people is considered a form of worship or religious act. The marked lack of implementation of relatives' wishes in this regard is coupled with a paucity of relevant policies, guidelines, and research, despite patient populations in these countries being traditional in nature, religious, and having strong connections within their families and extended social units. The present authors reflected on this concern and advocated for increased attention to the needs and rights of critically ill patients and their families to support better quality, holistic care, especially during critical illness incidents. Healthcare professionals should consider allowing families to be present with their patients in such circumstances and appreciate the importance of family presence, despite the acknowledged challenges. The recommendations presented in this reflection may support the implementation of effective, holistic healthcare services in these countries. This reflection is also relevant to any context where care for Arabic or Muslim patients is provided.

Improving Post-Injury Care: Key Family Caregiver Perspectives of Critical Illness After Injury

There is little research about how caregiver experiences evolve from ICU admission to patient recovery, especially among caregivers for patients who have traumatic injuries. In this study, we characterize diverse caregiver experiences during and after ICU admission for injury.

An integrative review of the use of the concept of reassurance in clinical practice

Aim

To synthesize evidence on the concept of reassurance in nursing practice.

Design

Integrative review.

Review Method

PubMed, OVID MEDLINE, CINAHL and PsycINFO were searched from their inception to the 30 May 2020. The search results were screened. We assessed the quality of primary studies using the Mixed Method Appraisal Tool. Included studies were analysed using narrative synthesis. The review protocol was pre‐registered (PROSPERO‐CRD42020186962).

Results

Thirty‐two papers out of the 2,771 search results met our inclusion criteria. The synthesis of evidence generated three intricate themes, namely “antecedents of reassurance,” “defining attributes of reassurance” and “outcomes of reassurance.” Emotional distress was the main antecedent of reassurance. The three sub‐themes identified under defining attributes of reassurance include self‐awareness, emotional connectedness and verbal and non‐verbal techniques. Ultimately, reposing the confidence of patients and their families in healthcare professionals and the care delivery process to enable them to overcome their challenges constitutes the outcomes of reassurance.

The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review

BACKGROUND

The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients.

OBJECTIVE

To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings.

DESIGN

A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist.

DATA SOURCES

The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020.

METHODS

Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools.

FINDINGS

A total of 15 studies - two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies (n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes.

CONCLUSION

The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings.

Jordanian Patients' Family Members Need Perceptions in the Critical Care Settings: Nurses' Perspectives versus Family Members' Perspectives in the Context of Health Informatics

Background

An unexpected hospitalization in any of the Critical Care Units (CCUs) is a stressful condition, not only for patients but also for other family members. Research in this field in Jordan is not available. The main objective of this study was to identify the most important needs as perceived by these family members in the light of this stressful event and compare them with the nurses' perceptions of the importance of these needs and also to determine the perception of the needs' importance with the sociodemographic characteristics of both family members and caring nurses.

Methods

This was a cross-sectional study conducted in the period between February and August 2020 among adult family members of patients admitted to the CCUs in hospitals of Jordan from all sectors (public, private, and teaching). The "Critical Care Family Needs Inventory (CCFNI)" questionnaire was administered to 82 family members and 99 CCU nurses to determine the importance of the needs on the inventory. The data were analyzed using descriptive statistics.

Results

The most important need identified by the family members was relevant to the need for proximity (3.64 ± 0.45), followed by information (3.57 ± 0.58), assurance (3.44 ± 0.43), support (3.31 ± 0.62), and comfort (3.21 ± 0.56). Nurses identified the needs for assurance as the highest, followed by information, comfort, and support, whereas proximity was the least need perceived as very important. The top 10 important needs for both family members and nurses were identified. Family members and nurses were only common in 2 of the need statements on the scale. There was no significant association between the sociodemographic characteristics of the sample and the perception of the needs' importance (p=0.05).

Conclusion

This study has shown that nurses and family members of patients admitted to CCUs have different perspectives relevant to needs' importance. This should warn nurses to set the needs viewed by family members as a priority. Implications. In the CCU settings, in the context of advancing health informatics, families of patients in the ICUs have different needs other than those viewed by nurses. Their needs must be identified and considered.

Explaining the Process of Spiritual healing of Critically-ill Patients: A Grounded Theory Study

Background

Spiritual healing is one of the most intriguing category of alternative and complementary medicine. The aim of this study was to explain the process of spiritual healing in patients with refractory diseases in Iran.

Methods

This grounded theory study was conducted in Iran from 2018 to 2019. The participants were 14 patients with refractory diseases and 4 healers whom were first selected through purposeful and then theoretical sampling. Semi-structured interviews were used to collect data on patients and healers. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories and analyzed using the Strauss and Corbin's approach (2008).

Results

Four main categories emerged from data analysis including: I) frustration to initial acceptance II) disbelief to trust III) evaluation to action and IV) doubt to certainty.

Conclusion

The results of our study provide context-specific factors affecting the complex and multifactorial nature of spiritual healing process in patients with refractory diseases. Health care professional can use these findings in designing and implementing appropriate interventions to integrate spiritual healing into their holistic practices of care.

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.

Family participation during physical activity in the intensive care unit: A longitudinal qualitative study

PURPOSE

Family-centered care has been implemented in the ICU to meet relatives' needs concerning information, support, participation and shared decision making. This study explores the needs, beliefs, feelings and behaviors of relatives of patients admitted to the ICU regarding participation during physical activity.

METHODS

Longitudinal qualitative study design following a grounded theory approach. Relatives were interviewed at 4, 8 and 12 days after the patient's ICU-admission. Data were analyzed using constant comparison.

RESULTS

Twenty-five interviews were conducted in ten relatives. Relatives believed that physical activity in the ICU improves recovery. Participating in physical activity decreased their feelings of powerlessness and uselessness. Relatives mentioned that they would be stimulated to participate if they were invited, guided and informed by healthcare providers. The perceived reticence of healthcare providers, patient's health-changing capacity and the inability to communicate led to a more passive attitude towards participation.

CONCLUSIONS

The conceptual model shows how family participation during physical activity changes from a passive role, with negative beliefs and feelings of uselessness and powerlessness, to a more proactive participatory role. Relatives felt more useful and like they were part of the team. Providing relatives with additional information might be a viable strategy to help and stimulate participation.

The influence of spirituality and religion on critical care nursing: An integrative review

BACKGROUND

Spiritual care could help family members and critically ill patients to cope with anxiety, stress and depression. However, health care professionals are poorly prepared and health managers are not allocating all the resources needed.

AIMS AND OBJECTIVES

To critically review the empirical evidence concerning the influence of spirituality and religion (S-R) on critical care nursing.

METHODS

An integrative review of the literature published in the last 10 years (2010-2019) was conducted in PubMed, Scopus, CINHAL, PsycINFO, Web of Science, Cochrane and LILACS. In addition, searches were performed in the System for Information on Grey Literature in Europe and the Grey Literature Report. Quantitative and/or qualitative studies, assessing S-R and including health care professionals caring for critically ill patients (i.e. adults or children), were included.

RESULTS

Forty articles were included in the final analysis (20 qualitative, 19 quantitative and 1 with a mixed methodology). The studies embraced the following themes: S-R importance and the use of coping among critical care patients and families; spiritual needs of patients and families; health care professionals' awareness of spiritual needs; ways to address spiritual care in the intensive care unit (ICU); definition of S-R by health care professionals; perceptions and barriers of addressing spiritual needs; and influence of S-R on health care professionals' outcomes and decisions. Our results indicate that patients and their families use S-R coping strategies to alleviate stressful situations in the ICU and that respecting patients' spiritual beliefs is an essential component of critical care. Although nurses consider spiritual care to be very important, they do not feel prepared to address S-R and report lack of time as the main barrier.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Critical care professionals should be aware about the needs of their patients and should be trained to handle S-R in clinical practice. Nurses are encouraged to increase their knowledge and awareness towards spiritual issues.

Family satisfaction in Egyptian adult intensive care units: A mixed-method study

OBJECTIVES

To examine family members' satisfaction in adult intensive care units.

METHODOLOGY

This is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion.

SETTINGS

Six adult intensive care units in university hospitals in Egypt.

MAIN OUTCOME MEASURES

Family satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews.

RESULTS

The mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members' satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (-2.41 [-3.23 to -1.59]), low economic status (-1.57 [-2.47 to -0.67]), and perceiving patient condition to be deteriorating (-0.99 [-1.93 to -0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment.

CONCLUSIONS

In Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.

Needs of family members of patients admitted to a university hospital critical care unit, Izmir Turkey: comparison of nurse and family perceptions

Purpose:

This study aims to compare the perceptions of nurses and families on the needs of the relatives of the patients in Intensive Care Unit (ICU).

Methods

This cross-sectional study was conducted in the ICU of a university hospital. The study comprised 213 critical care patients’ relatives and 54 nurses working in the same ICU. Data were collected using the Turkish version of Critical Care Family Needs Inventory (CCFNI) and a questionnaire on the characteristics of the participants. The difference between the perceptions of families and nurses was analyzed using Student t-test. Results: CCFNI’s assurance/proximity subscale mean scores ranked first among bothpatients and nurses. The item “To be assured the best care possible is being given to the patient” was the top priority for both groups. Mean assurance/proximity and information dimensions of relatives were significantly higher compared to nurses (p < 0.001). No significant difference was found between the perception of patient relatives and nurses related to support and comfort dimensions (p < 0.05).

Conclusion

The needs of the relatives of patients are underestimated by nurses. This inhibited the performance of ICU nurses in line with the holistic care approach. Educational objectives that include the needs of ICU patients’ relatives should be incorporated into the undergraduate and in-service training of nurses. Policies should be established to create space and time for effective relative-nurse communication.

Holistic nursing care among operating room nurses: Strengthening the standard of practice in Saudi Arabia

BACKGROUND

Holistic practices have been found beneficial for patients as well as nurses. They increase both the nurses and the patients' health-promoting behaviors, spirituality, and interpersonal relationships.

OBJECTIVE

This study aimed to determine holistic nursing care and compare its differences based on individual characteristics.

METHODS

This study employed a quantitative-cross sectional approach. It was conducted at the hospitals of Hail region, Kingdom of Saudi Arabia, from February 2020 to March 2020. Selected through convenience sampling, 154 operating room nurses participated in the study. Frequency and percentages were used to analyze the demographic information, and t-tests and analysis of variance were used to test for differences.

RESULTS

Holistic nursing dimensions such as physiological (4.72 ± 0.40), socio-cultural (4.53 ± 0.45), psychological (4.66 ± 0.32), and spiritual aspects (4.22 ± 0.73) were consistently carried out in the operating room. On the physiological dimension, no significant differences were found in years of experience [(t) -0.073; p > 0.942], gender [(t) -1.113; p > 0.27], or age [(F) 0.558; p > 0.57), but there was a significant difference with nationality [(t) -3.328; p < 0.001]. On the socio-cultural dimension, the length of experience [(t) 0.599; p > 0.550], gender, [(t) -1.420; p > 0.158], and age [(F) 0.148; p > 0.862] were not significant, but a significant difference was found with nationality [(t) -7.516; p < 0.001]. Regarding the psychological dimension, the length of experience [(t) -1.101; p > 0.276], gender [(t) -1.545; p > 0.129], and age [(F) 1.259; p > 0.287] were not significant, but there was a significant difference with nationality [(t) -5.492; p < 0.001]. Finally, with the spiritual dimension, no significant difference was found on length of experience [(t) -1.101; p > 0.276] or age [(F) 0.584; p > 0.559], but there were significant differences on gender [(t) -3.890; p < 0.001] and nationality [(t) -3.653; p < 0.001].

CONCLUSION

Nationality is a causal factor to physiological, socio-cultural, psychological, and spiritual dimensions, while gender is significant to spiritual aspect. Regardless of nationality or gender, nurses must be knowledgeable regarding the significance of adopting holistic care to improve the quality of their care to their patients.

Informational Needs of the Families of Patients Discharged From Intensive Care Units: A Case of Iran

BACKGROUND

thousands of patients are admitted to intensive care units annually, which is a stressful event. Many of these patients still require particular care after discharge. In many countries, families play an essential role in taking care of these patients after discharge. This study aimed to determine the informational needs of families of patients discharged from Intensive Care Units (ICU), Kerman, southeast Iran.

METHODS

this study had a cross-sectional design. Families were selected using the information extracted from patients' medical records. One hundred forty family members of the ICU discharged patients participated in the survey using convenience sampling. Data collection tools were a validated researcher-made questionnaire about informational needs and a demographic characteristics form.

RESULTS

the mean score of family informational needs was 31.18 ± 3.97 out of 40. Most families required a high level of information in all dimensions. However, the maximum need was associated with self-care subscale (4.89 out of 5), and the minimum need was associated with defecation (3.13 out of 5).

CONCLUSION

the families of patients discharged from intensive care units required much information about different areas of care particularly self-care. Health care providers, especially nurses, should be aware of the informational needs of the ICU patients' families post-discharge to provide better care.

Relationship Between the Needs of Turkish Relatives of Patients Admitted to an Intensive Care Unit and Their Coping Styles

Admission to an intensive care unit is a traumatic event for many patients' relatives. Also, the relatives may be subject to many requirements to during this process. Therefore, it is very important to determine their requirements and coping styles. This study used a descriptive, relational design. The sample of the research consisted of 247 relatives of patients staying in six intensive care units. It was found that, 65.2% of the patients' relatives were women, and their mean age was 37.25 ± 12.7 years. What they mostly needed was support, proximity, information, assurance and comfort. In that order; among the coping styles it was found that they usually used the following approaches: self-confident approach, an problem-focused coping method; was found to be used by relatives most frequently, followed by helpless approach, an emotion-focused coping style. Requirements: Assurance, information, support and comfort sub-dimension scores and problem-focused coping style; self-confident approach and social support search approach sub-dimension scores between statistically positive, significant relationship was found. Information, proximity, support and comfort sub-dimension scores and emotion-focused coping style; helpless approach and submissive sub-dimension scores between statistically positive, significant relationship was found (p<0.05). It was found that patients' relatives used the helpless approach and submissive approach to cope with stres: during this process their information needs increased and upon fulfillment of requirements, they started using self-confident approach and the social support approach, which are problem-focused coping styles.

The process of giving information to families in intensive care units: A narrative review

AIM

Information is one of the most important needs of families of critical patients. Healthcare professionals also identify the great value of communication with families to reduce their anxiety and stress. Despite this, families may feel inadequately informed, causing added suffering. The purpose of this study is to provide an understanding of both families' and healthcare professionals' perspectives on information giving within intensive care units (ICU).

METHOD

A narrative review was conducted using MEDLINE, CINAHL, PsycINFO databases and the Cochrane Library to identify studies published in either English or Spanish from 2002 to 2018.

RESULTS

47 studies were included, and five categories were identified: 1)"the need to know"; 2)family satisfaction with the information received; 3)impact of information on families' experiences in the ICU; 4)nurses and physicians' perceptions of information transmission, and 5)information process in the ICU.

CONCLUSIONS

Providing honest and truthful information to the families of critical patients is essential to reduce family anxiety and increase family control, although this often appears to be inadequately accomplished by staff. Interdisciplinary involvement in information giving may be beneficial for both families and ICU professionals. This review brings new understanding about the process of information to families of ICU patients and it can be used to improve the quality and humanization of care in the ICUs.

Family's Supportive Behaviors in the Care of the Patient Admitted to the Cardiac Care Unit: A Qualitative Study

Introduction: A life-threatening illness can cause the involvement of family members and the imposition of psychological and physical stress on them. Certainly, the family is a very valuable resource in patient care and plays an important role in maintaining the emotional support and patient’s recovery. The aim of this study was to explain the family members’ supporting behaviors of the patient admitted to the cardiac special units.

Methods: This qualitative study was performed in the cardiac special units in Isfahan. The number of participants was 20, including 5 nurses, 8 family members, and 7 patients. The data were collected through interview and observation by purposive sampling. Then, the data were analyzed by Graneheim and Lundman’s qualitative content analysis method. The study lasted 12 months.

Results: Data analysis showed that family’s support can be classified into three levels, including support by the therapeutic alliance (attempts to console and reassure, restoration of selfesteem, diminishing patient’s insensitivity, commitment to the patient, and visiting the patient ), participatory information (obtaining reliable information from the nurse, active role in providing meaningful information about the patient’s prognosis), practical and instrumental support (searching for economic support resources, providing the patient with the necessary equipment, trying to do the right care taking into account the family culture).

Conclusion: Understanding family’s supportive behaviors can help improve counseling and planning for quality care of patients admitted to the cardiac care units (CCUs).

Comfort and religious-spiritual coping of intensive care patients' relatives

OBJECTIVES

To identify the level of comfort and religious-spiritual coping of family members of intensive care unit patients and to analyse the sociodemographic/clinical variables that influence this association.

METHODS

Cross-sectional study on the adult and paediatric intensive care units of two public hospitals in the state of São Paulo, between January and September 2016. Participants were divided into two groups: adult (n = 96) and paediatric (n = 70). We used the religious-spiritual coping brief (RSC-Brief) and the comfort scale for relatives of people in critical states of health (ECONF).

RESULTS

Comfort was low in both groups and the family members used limited strategies in the RSC-Brief. The multiple linear regression analysis indicated that the variable length of hospitalization (β = 0.69; p < 0.01) influenced comfort and was also associated with the RSC-Brief (β = -0.18; p < 0.01).

CONCLUSION

Family members' comfort was low in both groups. It increased with the hospitalisation time of the patients' relative and tended to decrease with the severity of the disease.

Experiences of partners of intensive care survivors and their need for support after intensive care

BACKGROUND

When a relative with a critical illness is admitted to an intensive care unit (ICU), it can be a life-changing event for the partner. There is a lack of studies that focus on the partners' experiences of the time after intensive care.

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences of partners of intensive care survivors and their need for support after intensive care.

DESIGN

A qualitative descriptive design was used.

METHODS

Six semi-structured interviews was conducted in Sweden and analysed using inductive content analysis with inspiration from Graneheim and Lundman.

RESULTS

Three categories emerged from the data: Being in chaos when a partner needs intensive care, Being the one who everyone depends on, and Life goes on after intensive care. The findings indicate that life goes on after intensive care even if recovery takes time, and during that time, the partners need comforting support from people around them.

CONCLUSION

Partners need extensive and continuous support from health care staff and others during and after intensive care. Intensive care leads, on the one hand, to a sense of chaos for the partner, but on the other hand, if the family relations are strengthened and the partner receives the right kind of comforting support, it can relieve the chaos and facilitate a smoother recovery path to help them view the future more positively.

RELEVANCE TO CLINICAL PRACTICE

This study can contribute knowledge that guides nurses in the ICU and at the ICU follow-up service and could also help nurses in other areas of care in communication with relatives.

Do consumers who identify as Muslim experience culturally safe care (CSC) in the Emergency Department (ED)? A scoping review

Lack of awareness about cultural and religious values and beliefs of patients presenting to Emergency Departments (ED) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade. The changing face of the Australian population requires that Australian health care carefully consider the dominant Western cultural paradigm currently influencing health care delivery. This predominance is particularly critical in the ED, as it is a common gateway into health care services. This scoping review explores the evidence of key components and impacts of culturally safe care (CSC) in the ED for staff and care consumers who identify as Muslim. A systematic search using electronic (five databases) and heading searching methods for primary research was undertaken; followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, and the subsequent content was grouped, synthesized and tested for clinical salience using the six stages of the Arksey and O'Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature. Three studies were included in the analysis. Religious beliefs and practices are common among the individuals who identify as Muslim. Such beliefs and practices could influence patients' understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. These ideals could also impact on a patient's care seeking behaviors and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in the ED locally and internationally. While many EDs may have procedure documents or staff care guidelines, it is unclear as to how these guides were derived, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers.

The Experiences of Muslim Family Members of Critically Ill Patients During End-of-Life Care in Saudi Arabia: A Qualitative Phenomenological Study

The aim of this study was to identify the needs, beliefs, and practices of Muslim family members during the end-of-life care for a family member in the intensive care unit (ICU) in Saudi Arabia. This was a phenomenological study using in-depth individual interviews to gather data. Ten family members of adult ICU patients receiving end-of-life care were interviewed. The experiences of family members during end-of-life care were reflected in four major themes: (a) the spirituality of death, (b) family’s need for information, (c) being there, and (d) the ICU environment. Participants placed high value on religious practices such as prayer, and appreciated when these practices could be accommodated in the ICU. Family participants also detailed their need for frequent communication and opportunities to ask questions about the care of their critically ill loved one. Being able to spend as much time as desired in close proximity to the critically ill patient particularly as the end of life approaches was also important, with participants suggesting that visitation times should be waived. Finally, family participant suggested that changes were needed to the ICU environment to make accommodating large families easier and more comfortable particularly when they wish to spend significant time at the bedside of their loved one. Family should be prioritized as an extension of the care provided to critically ill ICU patients, particularly those approaching end of life. A model of care should be introduced to deliver supportive and holistic care during the end-of-life care journey, supported by appropriate education regarding family care at the end of life.

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

Patients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians' practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians' practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS).The majority of participants practice in governmental non-for-profit dialysis units (79%), and think they are well prepared to make decision with patients and family on issues of dialysis withdrawal and withholding (69%). If a chronic dialysis patient became permanently unconscious only few respondents (17%) indicated probability of stopping dialysis. On the other hand, more respondents (48%) reported that dialysis is likely to be withheld in PVS patients who develop kidney failure. In high risk or poor prognosis ESKD patients and given how likely they would consider each option independently, respondents reported they are likely to consider time-limited dialysis in 78% of the time followed by stopping (46%) or forgoing (27%) dialysis. Majority of the participants perceived that their decisions in providing renal care for PVS patients in UAE were influenced by the family sociocultural beliefs (76% of participants), the current hospital policies (72% of participants), and by Islamic beliefs (66% of participants). Only few perceived access to palliative care (30%) and treatment cost (17%) to have an impact on their decision making.Decisions of initiation and continuation of dialysis treatment to ESKD patients in PVS are prevalent among nephrology practices in UAE. Development of local guidelines based on the societal values along with early integration of palliative kidney failure management care would be required to improve the quality of provision of end-of-life renal care in UAE.

ABBREVIATIONS

ESKD: stage kidney disease; UAE: United Arab Emirates; PVS: persistent vegetative state; RPA: Renal Physicians Association; ASN: American Society of Nephrology; EMAN: Emirates Medical Association Nephrology Society; CPR: cardiopulmonary resuscitation.

Awareness of holistic care practices by intensive care nurses in north-western Saudi Arabia

Objectives:

To examine awareness of holistic patient care by staff nurses in the intensive care units of hospitals in the city of Hail, Saudi Arabia.

Methods:

A quantitative correlational study design was used to investigate relationships between intensive care nurse’s awareness of holistic practices and nurses’ latest performance review. Intensive care staff nurses (n=99) from 4 public sector hospitals in Hail were surveyed on their awareness of variables across 5 holistic domains: physiological, sociocultural, psychological, developmental, and spiritual. Data were collected between October and December 2015 using written survey, and performance evaluations obtained from the hospital administrations. Results were statistically analyzed and compared (numerical, percentage, Pearson’s correlation, Chronbach’s alpha).

Results:

The ICU staff nurses in Hail City were aware of the secular aspects of holistic care, and the majority had very good performance evaluations. There were no demographic trends regarding holistic awareness and nurse performance. Further, awareness of holistic care was not associated with nurse performance.

Conclusion:

A caring-enhancement workshop and a mentoring program for non-Saudi nurses may increase holistic care awareness and enhance its practice in the ICUs.

Nurse perceptions of family nursing during acute hospitalizations of older adult patients

AIMS

The purpose of this study was to describe nurses' critical appraisal of their family nursing practice and experience of interaction and reciprocity in the nurse-family relationship.

BACKGROUND

Nursing practice that is inclusive of family during hospitalizations of older adults with chronic illnesses benefits patients and families, as well as nurses. There is, however, a limited amount of research that has focused on nurses' perceptions of caring for older adult patients and their families who are managing chronic illness.

DESIGN

The Calgary Family Intervention Model guided this descriptive mixed-methods study.

METHODS

Registered nurses working on four medical-surgical units completed the Family Nursing Practice Scale (n = 60), which includes a quantitative scale and three open-ended questions.

RESULTS

The results showed positive perceptions from nurse participants overall with significant variation across study units in nurses' perceptions of interactions in the nurse-family relationship. Additionally qualitative results revealed several themes concerning the advantages and disadvantages of working with families, in addition to how nurses are currently including families in their practice.

CONCLUSIONS

This study provides details concerning the advantages and disadvantages of working with families and how nurses currently strive to include families in their nursing practice. Although nurses in this study did espouse the importance of family nursing practice, they did point out a number of disadvantages. It is essential to understand the problems that can arise when working with families so that nurses are better able to manage these issues.

The experience of Greek families of critically ill patients: Exploring their needs and coping strategies

OBJECTIVES

To explore the experiences, needs and coping strategies of families of patients admitted to adult intensive care units.

DESIGN AND SETTING

A descriptive qualitative research design was chosen using an inductive thematic content analysis approach. Semi-structured interviews were conducted withfourteen family members in three hospitals of Crete.

FINDINGS

Four main themes were derived from data analysis. Our results showed that family members were in turmoil having to deal with intense and alternating feelings. The protection of patient's dignity and well-being was of utmost importance mainly by maintaining proximity. Getting comprehensible information and building communication with the healthcare providers was often problematic. Three coping strategies were used: optimism, family support and spirituality.

CONCLUSION

This study is a contribution to the understanding of Greek family's experiences and psychosocial needs during critical illness. A family-inclusive framework should be promoted and implemented in intensive care recognising and supporting family's role in the patient's illness and recovery.

A survey of next of kin needs of trauma patients admitted to Intensive Care Units in South Africa

AIM

To conduct a cross-sectional survey of next of kin needs of critically injured trauma patients admitted to Intensive Care Units in South Africa.

METHODS

The needs of next of kin of trauma patients (in public and private hospitals) who were critically injured and required admission to Intensive Care Units were surveyed at two points: on admission within first 24hours and on Day 3/day of transfer if earlier.

RESULTS

A total of 162 next of kin participated (114 from state and 48 from private) and Critical Care Family Needs Inventory subscale scores obtained at admission and at Day 3/day of transfer if earlier indicated a trend toward reporting increased needs. In all the needs ratings, the top domains were those of Assurance and Information.

CONCLUSION

The next of kin have a great number of needs that are currently not being met (both in the state and the private hospital and these needs actually increase over time. This study can help nurses understand the needs of next of kin in the Intensive Care Unit and that these needs change over the hospitalization period.

A generalized resistance resource: faith. A nursing view

Based on Aaron Antonovsky's salutogenic model, the authors of this article aim to analyze the term Faith as a Generalized Resistance Resource (GRR) of people's health and to delve the relevance of this construct to clinical practice in Nursing. The authors consider that, in order for nurses to intervene in the promotion of faith so as to bring health benefits to people, a solid educational training in this subject area is required by nursing students.

Nurses’ care practices at the end of life in intensive care units in Bahrain

Background:

The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought.

Objectives:

This study explored nurses’ care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity.

Research Design and context:

Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated.

Ethical Considerations:

Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals.

Findings:

A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting.

Discussion:

Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members.

Conclusion:

Despite the avoidance of death talk and nurses’ lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

Questionnaires on Family Satisfaction in the Adult ICU: A Systematic Review Including Psychometric Properties

OBJECTIVES

To perform a systematic review of the literature to determine which questionnaires are currently available to measure family satisfaction with care on the ICU and to provide an overview of their quality by evaluating their psychometric properties.

DATA SOURCES

We searched PubMed, Embase, The Cochrane Library, Web of Science, PsycINFO, and CINAHL from inception to October 30, 2013.

STUDY SELECTION

Experimental and observational research articles reporting on questionnaires on family satisfaction and/or needs in the ICU were included. Two reviewers determined eligibility.

DATA EXTRACTION

Design, application mode, language, and the number of studies of the tools were registered. With this information, the tools were globally categorized according to validity and reliability: level I (well-established quality), II (approaching well-established quality), III (promising quality), or IV (unconfirmed quality). The quality of the highest level (I) tools was assessed by further examination of the psychometric properties and sample size of the studies.

DATA SYNTHESIS

The search detected 3,655 references, from which 135 articles were included. We found 27 different tools that assessed overall or circumscribed aspects of family satisfaction with ICU care. Only four questionnaires were categorized as level I: the Critical Care Family Needs Inventory, the Society of Critical Care Medicine Family Needs Assessment, the Critical Care Family Satisfaction Survey, and the Family Satisfaction in the Intensive Care Unit. Studies on these questionnaires were of good sample size (n ≥ 100) and showed adequate data on face/content validity and internal consistency. Studies on the Critical Care Family Needs Inventory, the Family Satisfaction in the Intensive Care Unit also contained sufficient data on inter-rater/test-retest reliability, responsiveness, and feasibility. In general, data on measures of central tendency and sensitivity to change were scarce.

CONCLUSIONS

Of all the questionnaires found, the Critical Care Family Needs Inventory and the Family Satisfaction in the Intensive Care Unit were the most reliable and valid in relation to their psychometric properties. However, a universal "best questionnaire" is indefinable because it depends on the specific goal, context, and population used in the inquiry.