Barbara's story: a thematic analysis of a relative's reflection of being in the intensive care unit

Investigation of Hope and Spiritual Well-Being Levels among Relatives of Intensive Care Patients in Turkey

This study was conducted to determine the levels of hope and spiritual well-being among relatives of intensive care patients. The data were collected using the Patient Descriptive Information Form, Trait Hope Scale, and Spiritual Well-Being Scale. The mean total scores on the Trait Hope Scale and the Spiritual Well-Being Scale were 48.24 ± 8.37 and 104.99 ± 8.06, respectively. The mean scores on the Trait Hope Scale differed significantly according to the employment status, income status, and the reaction of the patient's relatives during the visit (p < 0.05). A significant difference was found between the mean scores of patient relatives on the Spiritual Well-Being Scale according to the level of education, income, and the intensive care unit where the patient was hospitalized (p < 0.05). A significant positive correlation was found between the Trait Hope Scale and the Spiritual Well-Being Scale (p < 0.05). This study found that patient relatives had good hope and spiritual well-being levels, and spiritual well-being increased the level of hope among patient relatives.

The role of intensive care unit diaries in the grieving process: A monocentric qualitative study

BACKGROUND

The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated.

AIM

To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit.

STUDY DESIGN

Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis.

SETTING

Italian general intensive care unit.

FINDINGS

Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process.

CONCLUSIONS

The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process.

RELEVANCE TO CLINICAL PRACTICE

The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

Critical care: A concept analysis

Objective

The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care.

Method

Walker and Avant's eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022.

Results

Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome.

Conclusion

Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.

Intensive care unit diaries to help bereaved family members in their grieving process: a systematic review

BACKGROUND

Intensive care unit diaries are often used to support patients during their psychological recovery. The intensive care unit stay can be upsetting, disturbing and traumatic for both patients and their families especially when the patient does not survive.

AIM

To investigate the connection between intensive care unit diaries and the grieving process experienced by family members of adult patients deceased in the intensive care unit.

METHODS

Systematic literature review according to PRISMA guidelines: PubMed, CINAHL and Cochrane Library were consulted. The Caldwell's framework was used for the quality appraisal.

RESULTS

Only six studies examine this topic. The potential benefits of intensive care unit diaries in family members' bereavement process may be an aid to realise how extremely ill their loved one was, may provide comfort and may help relatives to cope with their loss.

CONCLUSION

The use of intensive care unit diaries to help family members' bereavement process may be a useful tool but further research is necessary to better understand their role and benefits.

Stakeholders' perceptions of family-centred care in the intensive care unit: An associative group analysis

AIM

To explore different stakeholders' including nurses, health care professionals and family member's perceptions of ideal family-centred care in an intensive care unit.

RESEARCH DESIGN AND METHODS

We used a mixed method approach to identify perceptions of family-centred care with 60 stakeholders of equal numbers who voluntarily participated in the study. Data were collected over one month using an associative group analysis method. The responses were ranked, scored, thematically themed and weighted.

SETTING

A 23 bed adult intensive care unit in an urban private hospital in South Africa.

FINDINGS

According to the stakeholders' responses, ideal family-centred care should be built around communication based on expectations and engagement. In addition, the physical environment should allow for overall comfort and spiritual care must be incorporated.

CONCLUSION

Stakeholders had similar perceptions on the main themes however; nuances of different perspectives were identified showing some of the complexities related to family-centred care. Spiritual care was highlighted by the family members, revealing the need to broaden the care perspectives of healthcare providers.

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.

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person-centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.

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.

The significance of hope as experienced by the next of kin to critically ill patients in the intensive care unit

AIM

To examine and increase understanding of diverse aspects of hope as experienced by the next of kin when someone close to them is critically ill in intensive care unit (ICU).

DESIGN

A qualitative study with a phenomenological approach.

METHOD

The data were collected through five in-depth interviews with next of kin at the ICU in Central Norway. Data were interpreted to gain a deeper understanding on hope in an acute and critical context.

RESULTS

The analysis presents five main themes: (i) hope for survival, (ii) hope is fostered by signs of improvement, (iii) hope keeps fear for the worst at bay, (iv) hope that things will turn out well and (v) hope for the return to a normal life. Hope kept next of kin going during a difficult time and was strengthened when they saw their close family member responding positively to treatment provided by the ICU.

Prevention, recognition and management of delirium in patients who are critically ill

Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures.

A family information brochure and dedicated website to improve the ICU experience for patients' relatives: an Italian multicenter before-and-after study

PURPOSE

Good communication between ICU staff and patients' relatives may reduce the occurrence of post-traumatic stress disorder, anxiety or depression, and dissatisfaction with clinicians. An information brochure and website to meet relatives' needs were designed to explain in technical yet simple terms what happens during and after an ICU stay, to legitimize emotions such as fear, apprehension, and suffering, and to improve cooperation with relatives without increasing staff workload. The main outcomes were improved understanding of prognosis and procedures, and decrease of relatives' anxiety, depression, and stress symptoms.

METHODS

In this prospective multicenter before-and-after study, a self-administered questionnaire was used to investigate relatives' understanding of prognosis, treatments, and organ dysfunction, families' satisfaction, and symptoms of anxiety, depression, and post-traumatic stress.

RESULTS

A total of 551 relatives received questionnaires in nine Italian ICUs; 332 (60%) responded, 144 before and 179 after implementation of the brochure and website. Of the 179 relatives who responded after, 131 (73%) stated they had read the brochure and 34 (19%) reported viewing the website. The intervention was associated with increased correct understanding of the prognosis (from 69 to 84%, p = 0.04) and the therapeutic procedures (from 17 to 28%, p = 0.03). Multivariable analysis, together with non-modifiable factors (relative's gender, education level, relationship to patient, and patient status at ICU discharge), showed the intervention to be significantly associated with a lower incidence of post-traumatic stress symptoms (Poisson coefficient = -0.29, 95% CI -0.52/-0.07). The intervention had no effect on the prevalence of symptoms of anxiety and depression.

CONCLUSION

An information brochure and website designed to meet relatives' needs improved family members' comprehension and reduced their prevalence of stress symptoms.