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Xie XM, Huang D, Chun S, Bai DX, Lu XY, Li Y, Hou CM, Ji WT, Gao J. Factors influencing thirst in ICU patients: A mixed methods systematic review. Intensive Crit Care Nurs 2024; 86:103811. [PMID: 39213788 DOI: 10.1016/j.iccn.2024.103811] [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: 01/19/2024] [Revised: 08/17/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To systematically review the factors influencing thirst in ICU patients, providing a reference for effective management of thirst in ICU patients and the formulation of intervention measures. METHODS A total of 12 electronic databases were searched from inception to July 2023. The synthesis method of JBI mixed methods research systematic review was used. The quantitative studies were analyzed by Stata17.0 and RevMan 5.3 software, and the qualitative studies by meta-aggregation. RESULTS A total of 13 studies were included, including 2 qualitative studies and 11 quantitative studies. The quantitative study was carried out by meta-aggregation, extracting seven categories to form two synthesized findings. Quantitative meta-analysis revealed that 11 factors, including marital status, whether to use mechanical ventilation for the first time, air leakage, mechanical ventilation mode, simplified acute physiology score, respiratory rate, mask comfort, serum sodium concentration, breathing pattern, diuretics, and vasoactive drugs, were all associated with the occurrence of thirst in ICU patients. The qualitative and quantitative results were integrated into 5 categories, namely personal characteristics and lifestyle, disease factors, treatment factors, psychological factors, and nurse factors. CONCLUSIONS Thirst is a prevalent and severe issue among ICU patients, and effective interventions are required to address it. Considering its various causes, managing thirst in ICU patients should involve multiple levels of intervention. Treatment-related factors contribute significantly to thirst, and these factors should be taken into consideration when developing a thirst management strategy. Personal characteristics and lifestyle, psychological factors, drug-related factors, and nursing factors should be identified and optimized as soon as possible. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals should pay attention to thirst symptoms in ICU patients and promptly take effective preventive or intervention measures based on the influencing factors.
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Affiliation(s)
- Xue-Mei Xie
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dan Huang
- Fifth People's Hospital Affiliated to Chengdu University of Chinese Medicine, Chengdu, China
| | - Shuang Chun
- Chengdu First People's Hospital, Chengdu, China
| | - Ding-Xi Bai
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xian-Ying Lu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yue Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chao-Ming Hou
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wen-Ting Ji
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| | - Jing Gao
- Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Knutsen K, Solbakken R, Gallagher S, Müller RT, Normann B. Patients' experiences with early rehabilitation in intensive care units: A qualitative study about aspects that influence their participation. J Adv Nurs 2024; 80:1984-1996. [PMID: 37962126 DOI: 10.1111/jan.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
AIM To explore patients' experiences with early rehabilitation in the intensive care unit and what they perceive to influence their participation. DESIGN A qualitative design anchored in phenomenological and hermeneutical traditions utilizing in-depth interviews. METHODS Thirteen patients were interviewed from 5 to 29 weeks following discharge from three units, in January-December 2022. Analysed using systematic text condensation and the pattern theory of self. Reporting adhered to consolidated criteria for reporting qualitative research. RESULTS Interviews described four main categories: (1) A foreign body, how the participants experienced their dysfunctional and different looking bodies. (2) From crisis to reorientation, the transformation the participants experienced from a state of crisis to acceptance and the ability to look forwards, indicating how bodily dysfunctions are interlinked to breakdowns of the patients' selves and the reorganization process. (3) Diverse expectations regarding activity: ambiguous expectations communicated by the nurses. (4) Nurse-patient: a powerful interaction, highlighting the essential significance of positive expectations and tailored bodily and verbal interaction for rebuilding the patient's outwards orientation. CONCLUSION Outwards orientation and reorganization of the self through a reduction in bodily dysfunctions, strengthening the patients' acceptance of the situation, providing tailored expectations and hands-on and verbal interaction appear to be fundamental aspects of patient participation in early rehabilitation. IMPLICATIONS Insights into patients' perceptions show how dysfunctional bodies cloud individuals' perceptual fields, causing inwards orientation and negative thoughts concerning themselves, their capabilities, environment and future. This knowledge can improve nurses' ability to tailor care to promote optimal recovery for patients. PATIENT OR PUBLIC CONTRIBUTION User representative contributed to the design of the study.
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Affiliation(s)
- Karina Knutsen
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Rita Solbakken
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
- Faculties of Law, School of Liberal Arts, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital, Bodø, Norway
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Okeny PK, Pittalis C, Monaghan CF, Brugha R, Gajewski J. Dimensions of patient-centred care from the perspective of patients and healthcare workers in hospital settings in sub-Saharan Africa: A qualitative evidence synthesis. PLoS One 2024; 19:e0299627. [PMID: 38626224 PMCID: PMC11020865 DOI: 10.1371/journal.pone.0299627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/14/2024] [Indexed: 04/18/2024] Open
Abstract
INTRODUCTION The United States Institute of Medicine defines patient centred care (PCC), a core element of healthcare quality, as care that is holistic and responsive to individual needs. PCC is associated with better patient satisfaction and improved clinical outcomes. Current conceptualizations of PCC are mainly from Europe and North America. This systematic review summarises the perceived dimensions of PCC among patients and healthcare workers within hospitals in sub-Saharan Africa (SSA). METHODS Without date restrictions, searches were done on databases of the Web of Science, Cochrane Library, PubMed, Embase, Global Health, and grey literature, from their inception up to 11th August 2022. Only qualitative studies exploring dimensions or perceptions of PCC among patients, doctors and/or nurses in hospitals in (SSA) were included. Review articles and editorials were excluded. Two independent reviewers screened titles and abstracts, and conducted full-text reviews with conflicts resolved by a third reviewer. The CASP (critical appraisal skills program) checklist was utilised to assess the quality of included studies. The framework synthesis method was employed for data synthesis. RESULTS 5507 articles were retrieved. Thirty-eight studies met the inclusion criteria, of which 17 were in the specialty of obstetrics, while the rest were spread across different fields. The perceived dimensions reported in the studies included privacy and confidentiality, communication, shared decision making, dignity and respect, continuity of care, access to care, adequate infrastructure and empowerment. Separate analysis of patients' and providers' perspective revealed a difference in the practical understanding of shared-decision making. These dimensions were summarised into a framework consisting of patient-as-person, access to care, and integrated care. CONCLUSION The conceptualization of PCC within SSA was largely similar to findings from other parts of the world, although with a stronger emphasis on access to care. In SSA, both relational and structural aspects of care were significant elements of PCC. Healthcare providers mostly perceived structural aspects such as infrastructure as key dimensions of PCC. TRIAL REGISTRATION PROSPERO Registration number CRD42021238411.
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Affiliation(s)
- Paul K. Okeny
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Surgery, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Ruairi Brugha
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Alcalá-Jiménez I, Delgado-Hito P, Benito-Aracil L, Martínez-Momblan MA, Muñóz-Rey P, Otero-García I, Sánchez-Pamplona C, Romero-García M. National validation of the nursing Intensive-Care satisfaction scale: Research protocol. Nurs Open 2023. [PMID: 37157228 DOI: 10.1002/nop2.1777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/19/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023] Open
Abstract
AIM Validate the Nursing Intensive-Care Satisfaction Scale in ICUs throughout Spain. Identify the improvement strategies recommended by the patients and professionals. DESIGN Quantitative psychometric methodology and a cross-sectional descriptive correlational design. METHODS The study population will be all patients discharged from 19 participating ICUs in Spain. Consecutive sampling (n = 564). Once discharged from the ICUs, they will receive the questionnaire and then, after 48 hours it will be given to them again to analyse the temporal stability. To validate the questionnaire, the internal consistency (Cronbach's Alpha) and temporal stability (test-retest) will be analysed. RESULTS Improve the quality of nursing care by modifying, changing or strengthening behaviours, skills, attitudes or areas for improvement involved in the process.
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Affiliation(s)
- Isidro Alcalá-Jiménez
- Hospital Vall d'Hebrón, Barcelona, Spain
- Intensive Care Unit, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Pilar Delgado-Hito
- Fundamental Care and Medical-Surgical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain
- International Research Project: Proyecto HU-CI, Madrid, Spain
| | - Llúcia Benito-Aracil
- Fundamental Care and Medical-Surgical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - María Antonia Martínez-Momblan
- Fundamental Care and Medical-Surgical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- Center for Biomedical Research in Mental Health Network (CIBERSAM), Madrid, Spain
| | - Pilar Muñóz-Rey
- Intensive Care Unit, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Irene Otero-García
- Hospital Vall d'Hebrón, Barcelona, Spain
- Intensive Care Unit, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Cristina Sánchez-Pamplona
- Hospital Vall d'Hebrón, Barcelona, Spain
- Intensive Care Unit, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Marta Romero-García
- Fundamental Care and Medical-Surgical Nursing Department, Faculty of Nursing, University of Barcelona, Barcelona, Spain
- IDIBELL, Bellvitge Biomedical Research Institute, Barcelona, Spain
- International Research Project: Proyecto HU-CI, Madrid, Spain
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Demir G, Seki Öz H. Psychological Experiences of Elderly Patients With Covid-19 Diagnosis in Intensive Care: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221126212. [PMID: 36069594 DOI: 10.1177/00302228221126212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In the study, it was aimed to determine the experiences of elderly COVID-19 patients hospitalized in intensive care units. The study was conducted based on the phenomenological design, one of the qualitative research methods. In-depth interviews were conducted using a semi-structured interview form with 15 participants, who were determined by the homogeneous and criterion sampling methods, two of the purposive sampling methods. Data were analyzed using Colaizzi's seven-step method. After the interviews, four themes were determined: intensive care experiences, importance of nursing care, intensive care environment and coping mechanisms related to COVID-19 disease, and post-intensive care realizations. In addition, 13 sub-themes were determined. This study provided a better understanding of the psychological experiences of elderly individuals during the disease, who have been hospitalized in intensive care unit and survived COVID-19.
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Affiliation(s)
- Gökçe Demir
- Faculty of Health Sciences, Department of Nursing, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hilal Seki Öz
- Faculty of Health Sciences, Department of Nursing, Kırşehir Ahi Evran University, Kırşehir, Turkey
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Lu KK, Zhang MM, Zhu YL, Ye C, Li M. Improving the Quality of Emergency Intrahospital Transport for Critically Ill Patients by Using Toyota Production System Methods. J Multidiscip Healthc 2022; 15:1111-1120. [PMID: 35607363 PMCID: PMC9123905 DOI: 10.2147/jmdh.s360261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ke-Ke Lu
- Emergency Department, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Miao-Miao Zhang
- Emergency Department, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yue-Li Zhu
- Department of Nursing, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
- Correspondence: Yue-Li Zhu, Department of Nursing, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China, Email
| | - Chen Ye
- Emergency Department, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Min Li
- Department of Infectious Diseases, Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
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Michael Robie E, Cole S, Suwal A, Coustasse A. Tele-ICU in the Unites States: Is a cost-effective model? INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2040877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- E. Michael Robie
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Stephanie Cole
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Archana Suwal
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
| | - Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, WV 25303 USA
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Agyei FB, Bayuo J, Baffour PK, Laari C. "Surviving to thriving": a meta-ethnography of the experiences of healthcare staff caring for persons with COVID-19. BMC Health Serv Res 2021; 21:1131. [PMID: 34670562 PMCID: PMC8528651 DOI: 10.1186/s12913-021-07112-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/17/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The emergence of the Coronavirus disease has heightened the experience of emotional burden among healthcare staff. To guide the development of support programmes, this review sought to aggregate and synthesise qualitative studies to establish a comparative understanding of the experiences of healthcare staff caring for persons with the disease. DESIGN A meta-ethnography approach was used to aggregate and synthesise primary qualitative studies. Database search was undertaken from January to November 2020. A standardised tool was used to extract data from the identified primary studies. The studies were translated into each other to formulate overarching concepts/ metaphors which formed the basis of undertaking a narrative synthesis. RESULTS Eight qualitative studies met the inclusion criteria. Two overarching metaphors/ concepts were formulated from the primary studies: 1) surviving to thriving in an evolving space and 2) support amid the new normal. The initial phase of entering the space of caring during the outbreak was filled with psychological chaos as healthcare staff struggled to survive within the context of an illness which was not fully understood. Gradually, healthcare staff may transition to a thriving phase characterised by resilience but still experienced heavy workload and physical/ emotional exhaustion predisposing them to burnout and compassion fatigue. Fear persisted throughout their experiences: fear of contracting the disease or infecting one's family members/ loved ones remained a key concern among healthcare staff despite infection precaution measures. Healthcare staff who contracted the disease felt isolated with additional fears of dying alone. The sources of support were varied with a strong emphasis on peer support. CONCLUSIONS Healthcare staff caring for persons infected with the Coronavirus disease are at risk of burnout and compassion fatigue and require ongoing mental health support commensurate to their needs. Staff who contract the disease may require additional support to navigate through the illness and recovery. Policies and concerted efforts are needed to strengthen support systems and build resilience among healthcare staff.
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Affiliation(s)
| | - Jonathan Bayuo
- Department of Nursing, Presbyterian University College, Agogo, Ghana.
| | | | - Cletus Laari
- Department of General Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
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Krampe H, Denke C, Gülden J, Mauersberger VM, Ehlen L, Schönthaler E, Wunderlich MM, Lütz A, Balzer F, Weiss B, Spies CD. Perceived Severity of Stressors in the Intensive Care Unit: A Systematic Review and Semi-Quantitative Analysis of the Literature on the Perspectives of Patients, Health Care Providers and Relatives. J Clin Med 2021; 10:jcm10173928. [PMID: 34501376 PMCID: PMC8432195 DOI: 10.3390/jcm10173928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to synthesize quantitative research that identified ranking lists of the most severe stressors of patients in the intensive care unit, as perceived by patients, relatives, and health care professionals (HCP). We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, PsycInfo, CINAHL, and Cochrane Library from 1989 to 15 May 2020. Data were analyzed with descriptive and semi-quantitative methods to yield summarizing ranking lists of the most severe stressors. We synthesized the results of 42 prospective cross-sectional observational studies from different international regions. All investigations had assessed patient ratings. Thirteen studies also measured HCP ratings, and four studies included ratings of relatives. Data indicated that patients rate the severity of stressors lower than HCPs and relatives do. Out of all ranking lists, we extracted 137 stressor items that were most frequently ranked among the most severe stressors. After allocation to four domains, a group of clinical ICU experts sorted these stressors with good to excellent agreement according to their stress levels. Our results may contribute to improve HCPs' and relatives' understanding of patients' perceptions of stressors in the ICU. The synthesized stressor rankings can be used for the development of new assessment instruments of stressors.
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Affiliation(s)
- Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Jakob Gülden
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Vivian-Marie Mauersberger
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Lukas Ehlen
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | | | - Maximilian Markus Wunderlich
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Alawi Lütz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Department of Healthcare Management, Technische Universität Berlin, 10623 Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany; (M.M.W.); (F.B.)
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
| | - Claudia D. Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (H.K.); (C.D.); (J.G.); (V.-M.M.); (L.E.); (A.L.); (B.W.)
- Correspondence: ; Tel.: +49-30-450-551-102
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Badanta B, Rivilla-García E, Lucchetti G, de Diego-Cordero R. The influence of spirituality and religion on critical care nursing: An integrative review. Nurs Crit Care 2021; 27:348-366. [PMID: 33966310 DOI: 10.1111/nicc.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/21/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Bárbara Badanta
- Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes", Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain
| | | | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, Brazil
| | - Rocío de Diego-Cordero
- Research Group CTS 969 "Innovation in HealthCare and Social Determinants of Health", School of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Jöbges S, Biller-Andorno N. [Use of coercive measures in the intensive care unit]. Med Klin Intensivmed Notfmed 2021; 116:205-209. [PMID: 33660019 PMCID: PMC8016755 DOI: 10.1007/s00063-021-00800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022]
Abstract
Zwangsbehandlungen in der Medizin umfassen Maßnahmen, die gegen eine aktuelle oder frühere Willensäußerung der betroffenen Person durchgeführt werden. Hierunter fällt auch die Überwindung manifestierter Widerstände z. B. bei nicht einwilligungsfähigen Patienten. Zwang gibt es nicht nur in der Psychiatrie, sondern kann auch auf der Intensivstation ausgeübt werden. Im Spannungsfeld zwischen intensivmedizinischer Behandlung, Fürsorge und Patientenwille besteht ein hohes Risiko für Zwangsbehandlungen sowie freiheitseinschränkende Maßnahmen. Häufig ist dem Team dieses moralische Spannungsfeld nur zum Teil bewusst. Vom Patienten wird Zwang als Kontrollverlust beschrieben und kann als traumatisierend, entwürdigend und stressauslösend wahrgenommen werden. Die Herausforderung für das Team einer hochspezialisierten Intensivstation besteht darin, den Patienten in seiner Individualität zu sehen und so weit wie möglich einzubinden. Um Zwang auf Intensivstation zu vermeiden und dem individuellen Patienten gerecht zu werden, muss die Problematik zuallererst wahrgenommen werden. Hilfreich zur Vermeidung von Zwang auf einer Intensivstation können Ausbildungskonzepte, eine ethische Reflexion im Team (Teamkultur), Supervision und psychologische Begleitung für Patienten und das Team sowie klinikinternen Standards sein. Diese Arbeit beschreibt Ursachen, verschiedene Formen und Häufigkeiten von Zwangsbehandlungen auf der Intensivstation sowie juristische Vorgaben. Es wird eine Annäherung versucht, welche intensivmedizinischen Maßnahmen mit der Ausübung von Zwang einhergehen können und wie Zwang von Patienten und dem Team wahrgenommen wird.
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Affiliation(s)
- S Jöbges
- Institut für Biomedizinische Ethik und Medizingeschichte (IBME), Universität Zürich, Winterthurerstrasse 30, 8006, Zürich, Schweiz.
| | - N Biller-Andorno
- Institut für Biomedizinische Ethik und Medizingeschichte (IBME), Universität Zürich, Winterthurerstrasse 30, 8006, Zürich, Schweiz
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Palmryd L, Rejnö Å, Godskesen TE. Integrity at end of life in the intensive care unit: a qualitative study of nurses' views. Ann Intensive Care 2021; 11:23. [PMID: 33544309 PMCID: PMC7865031 DOI: 10.1186/s13613-021-00802-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrity is a core value for delivering ethical health care. However, there is a lack of precision in defining what integrity is and how nurses understand it. In the setting of nurses caring for critically ill and dying patients in intensive care units (ICUs), integrity has not received much attention. Therefore, the aim of this study was to explore how nurses perceive and maintain the integrity of patients during end-of-life care in the ICU setting. METHODS This study had a qualitative descriptive design. Data were collected using individual semi-structured interviews with 16 intensive care nurses working at ICUs in four Swedish hospitals. The data were analysed by applying qualitative content analysis. RESULTS Five overall categories were explored: seeing the unique individual; sensitive to patient vulnerability; observant of patients' physical and mental sphere; perceptive of patients' religion and culture; and being respectful during patient encounters. Many nurses found it difficult to define integrity and to explain what respecting integrity entails in the daily care of dying patients. They often used notions associated with respect and patient-centred attitudes, such as listening and being sensitive or by trying to describe good care. Integrity was nonetheless seen as a central value for their clinical work and a precondition for ethical nursing practice. Some nurses were concerned about patient integrity, which is at risk of being "wiped out" due to the patient's illness/injury, unfamiliarity with the ICU environment and utter dependence on others for care. Protecting patients from harm and reducing patient vulnerability were also seen as important and a way to maintain the integrity of patients. CONCLUSIONS The study results show that even though integrity is a fundamental ethical concept and a core value in nursing, ethical codes and guidelines are not always helpful in clinical situations in the end-of-life care of ICU patients. Hence, opportunities must regularly be made available for ICU nurses to reflect on and discuss ethical issues in terms of their decision-making and behaviour.
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Affiliation(s)
- Lena Palmryd
- Perioperative Medicine and Intensive Care Function, Karolinska University Hospital, 171 76 SolnaStockholm, Sweden
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Box 11189, 100 61 Stockholm, Sweden
| | - Åsa Rejnö
- Department of Health Sciences, University West, 461 86 Trollhättan, Sweden
- Department of Medicine, Skaraborg Hospital Skövde, 541 85 Skövde, Sweden
| | - Tove E. Godskesen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Box 11189, 100 61 Stockholm, Sweden
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, BMC, Box 564, SE-751 22 Uppsala, Sweden
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Albarran J, Scholes J. What's in this issue. Nurs Crit Care 2020; 24:337-339. [PMID: 31755178 DOI: 10.1111/nicc.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Danielis M, Povoli A, Mattiussi E, Palese A. Understanding patients' experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta-synthesis and meta-summary. J Clin Nurs 2020; 29:2107-2124. [PMID: 32243007 DOI: 10.1111/jocn.15259] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/02/2020] [Accepted: 03/14/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). BACKGROUND Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. DESIGN A systematic review of qualitative studies followed by a meta-synthesis and a meta-summary was performed. METHODS Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. RESULTS A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) "The effect of the intense stress on the body's systems," (b) "The induced negative emotional situations," (c) "The feeling of being cared for in a hospital setting" and (d) "The perceived support from the family and loved ones." Furthermore, the most frequent codes across studies were "Being afraid," "Feeling supervised," "Feeling comforted," "Failing to communicate," and "Experiencing difficulties in breathing," with an intensity of 66.6%. CONCLUSION Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. RELEVANCE TO CLINICAL PRACTICE Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator-tolerant patient.
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Affiliation(s)
- Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Arianna Povoli
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Elisa Mattiussi
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
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Frick E, Büssing A, Rodrigues Recchia D, Härtl K, Beivers A, Wapler C, Dodt C. [Spiritual needs of patients in an emergency room]. Med Klin Intensivmed Notfmed 2020; 116:245-253. [PMID: 32034431 PMCID: PMC8016754 DOI: 10.1007/s00063-020-00653-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/08/2019] [Indexed: 11/26/2022]
Abstract
Hintergrund Spirituelle Bedürfnisse (spB) sind von einer religiösen Gebundenheit prinzipiell unabhängige wichtige Elemente des menschlichen Wesens. Sie können in Belastungssituationen, die z. B. durch das akute Auftreten einer Erkrankung ausgelöst werden, eine Ressource zur Bewältigung der Situation sein. Notaufnahmen sind Bereiche des Krankenhauses mit hoher medizinischer Leistungsdichte, was für Notfallpatienten eine besondere Unsicherheit hervorruft. Die vorliegende Studie untersucht erstmals das Vorliegen spiritueller Bedürfnisse eines Kollektivs von Patienten eines Notfallzentrums. Methoden Insgesamt 383 von 479 kontaktierten Patienten füllten die deutschsprachige Version des Spiritual Needs Questionnaire (SpNQ-20) aus und stimmten der Erhebung demographischer und klinischer Daten zu. Die Auswertung umfasste deskriptive Statistiken, Korrelationsanalysen, univariate sowie multiple Varianzanalysen. Ergebnisse Bedürfnisse nach innerem Frieden und generative Bedürfnisse (etwas weitergeben, etwas für andere tun) waren stärker ausgeprägt als religiöse (rB) und existenzielle (eB) Bedürfnisse. Es fanden sich keine Zusammenhänge zwischen spB einerseits und Grund der Konsultation, Schweregrad und Anzahl der Komorbiditäten andererseits. Das Alter spielte keine ausschlaggebende Rolle; vielmehr waren die vorhandenen Bedürfnisse, insbesondere die rB, bei Frauen signifikant stärker ausgeprägt als bei Männern. Schlussfolgerung Auch in einer Notfallsituation sind Menschen bereit, ihre spirituellen Bedürfnisse zu äußern. Die frühzeitige Erhebung in einer Notaufnahme erfasst auch nichtmedizinische wichtige Aspekte des kranken Menschen und erlaubt die Berücksichtigung der erfassten Bedürfnisse. Ob das auf den weiteren Behandlungsverlauf und das Wohlbefinden der Patienten einen Einfluss hat, müssen weitere Studien klären.
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Affiliation(s)
- E Frick
- Forschungsstelle Spiritual Care, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, Langerstr. 3, 81675, München, Deutschland.
| | - A Büssing
- Professur Lebensqualität, Spiritualität und Coping, Universität Witten/Herdecke, Witten, Deutschland
| | - D Rodrigues Recchia
- Professur Lebensqualität, Spiritualität und Coping, Universität Witten/Herdecke, Witten, Deutschland
| | - K Härtl
- Hochschule Fresenius München, München, Deutschland
| | - A Beivers
- Hochschule Fresenius München, München, Deutschland
| | - C Wapler
- Forschungsstelle Spiritual Care, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, Langerstr. 3, 81675, München, Deutschland
| | - C Dodt
- Klinik für Notfallmedizin, München Klinik Bogenhausen, München, Deutschland
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