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Mathews E, McNeill L, Cooper M, Briley A. Lost in transition: Perspectives from women and their families living in rural Australia on relocation for specialist maternal and neonatal care. Women Birth 2024; 37:101637. [PMID: 38959593 DOI: 10.1016/j.wombi.2024.101637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
PROBLEM Families living in rural communities need to relocate, be transferred or travel long distances to access specialist maternal and neonatal care, leading to isolation from their support networks. BACKGROUND High-risk maternal and neonatal complexities in rural maternity units results in more transfers and retrievals to metropolitan services. There is limited understanding of the physical and psychological impacts for women and their families when they are transferred or displaced from their rural communities during pregnancy. AIM To investigate the lived experience of relocation for specialist pregnancy, birthing, postnatal and neonatal care on women and families. METHODS Women (n=5) and partners (n=4) from rural South Australia, participated in semi-structured interviews on their experiences of transfer from local maternity providers. Couples interviewed together, interactions were recorded, transcribed verbatim and thematically analysed to identify overarching and sub-themes. FINDINGS The overarching theme was 'mismatched expectations', with three identified sub-themes: 'communication', 'compassion' and 'safety'. Discrepancies between expectations and realities during relocation left participants feeling isolated, alone and needing to self-advocate during this vulnerable period. Despite receiving specialist care, women and partners encountered unique hardships when separated from their rural community. Their social needs were poorly understood and seldom addressed in specialist units, resulting in poor experiences. DISCUSSION Consideration regarding the impact of attending specialist maternity services for women and partners from rural areas is required. The 'one size fits all' approach for maternity care is unrealistic and research is needed to improve the experiences for those uprooted from rural communities for higher levels of care.
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Affiliation(s)
- Emily Mathews
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, South Australia Health, South Australia, Australia.
| | - Liz McNeill
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Megan Cooper
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Annette Briley
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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2
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Burns M, Montelpare W, Leÿenaar M. Supporting rural families during interhospital patient transfers for critical illness events: An exploration of an acceptable communication process. Intensive Crit Care Nurs 2024; 83:103689. [PMID: 38613939 DOI: 10.1016/j.iccn.2024.103689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 04/15/2024]
Abstract
Critically ill patients in rural areas at times require an interhospital transfer from their local hospital to an urban tertiary care centre for advanced critical care services not available locally. Family members have described this transfer window as a communication blackout and one of the most stressful times of their relative's critical illness event. OBJECTIVE To explore what communication process would be most acceptable between family members and transfer team members (consisting of critical care nurses, paramedics, and physicians) during interhospital transfers of critically ill patients. RESEARCH METHODOLOGY Using a qualitative descriptive approach of critical thematic analysis, data were collected in September and November 2022, from focus groups of five family members and four transfer team members who experienced this phenomenon. SETTING Rural Canada where speciality services such as interventional cardiology and neurosurgery are unavailable, and a tertiary care hospital is more than 160 km away. FINDINGS Within themes of unequal power relations and status-based hierarchies, family members described how communication during interhospital transfers supports connection and coping, challenges experienced in accessing information, an overwhelming unknown, and practical challenges of the transfer. Transfer team members described a context of power relations and status-based hierarchies in which themes of transfer team burden, role confusion or connection, protection and management of family members, and complexities of information sharing during interhospital transfers were identified. CONCLUSION In critical illness, communication linkages are created between healthcare providers and family members but are broken during an interhospital transfer resulting in increased stress for family members. Acceptable communication elements described by transfer team members and family members may maintain these linkages during the transfer window. IMPLICATIONS FOR CLINICAL PRACTICE These findings provide the foundation for critical care nurses and their professional colleagues to take family care to the next level with an explicit communication strategy during interhospital transfers.
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Affiliation(s)
- Margie Burns
- Faculty of Nursing, University of Prince Edward Island, Canada.
| | - William Montelpare
- The Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science and Faculty of Nursing, University of Prince Edward Island, Canada
| | - Matthew Leÿenaar
- Emergency Health Services, Department of Health and Wellness, Prince Edward Island, Canada
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3
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Karasik D, Cabrera CI, Shammassian B, Wright JM, Bambakidis N, D'Anza B. Benefits of Neurosurgical Teleconsults in the Management of Intracerebral Hemorrhage: Transfers and Transportation Cost Reduction. World Neurosurg 2024:S1878-8750(24)01058-1. [PMID: 38936617 DOI: 10.1016/j.wneu.2024.06.099] [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: 06/12/2024] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Our study explores the efficacy and economic benefits of neurosurgical teleconsultations in managing intracerebral hemorrhage (ICH), focusing on reducing unnecessary patient transfers and associated costs. METHODS We conducted a cost-savings analysis at our institution of a previously published pilot study involving a cohort of patients with ICH who were potential candidates for airlift to our tertiary care center but instead received neurosurgical consultation via teleconsultation to avoid the transfer. Data on patient demographics, distances, and costs were collected and analyzed to assess the economic impact of teleconsultations. RESULTS The cohort comprised 14 patients; we noted significant cost savings from avoiding interhospital transfers, ranging from $84,346.52 to $120,495.03 per patient. Teleconsultations facilitated immediate, collaborative decision-making between healthcare providers at community hospitals and a tertiary care center, reducing the need for expensive air transportation and unnecessary hospital transfers. CONCLUSIONS Neurosurgical teleconsultations offer a cost-effective alternative to traditional patient transfer methods for ICH management, providing substantial economic benefits while maintaining high physician and patient-family satisfaction levels. This study underscores the potential of our teleneurosurgery program to significantly reduce costs by reducing unnecessary financial burdens on patients' families and healthcare systems.
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Affiliation(s)
- Daniel Karasik
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Berje Shammassian
- Department of Neurological Surgery, Louisiana State University Health Sciences New Orleans, Louisiana, USA
| | - James M Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Nicholas Bambakidis
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Brian D'Anza
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Brian.D'
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Vázquez-Sánchez MÁ, Casals-Vázquez A, López-Leiva I, Sánchez-Ojeda MA, Río-Urenda SD, Navarro-Prado S, García-Gámez M, Casals C. Cultural adaptation and validation of the Family Nursing Practice Scale (FNPS) for use with Spanish-speaking Nursing Degree students. Nurse Educ Pract 2023; 72:103756. [PMID: 37625362 DOI: 10.1016/j.nepr.2023.103756] [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: 05/30/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023]
Abstract
AIM The task proposed was to conduct a cultural adaptation of the Family Nursing Practice Scale and to assess the psychometric properties of the resulting instrument. BACKGROUND Nursing students must obtain sufficient personal competence and confidence to act with patients and their families. For this purpose, an assessment scale is needed to inform teachers of the student's progress and to determine whether further training or changes in teaching methods are required. DESIGN A cross-sectional study design was used. METHODS The researchers conducted this study with 202 students of nursing at two Spanish universities. In the cultural adaptation, the following steps were followed: definition of concepts, translation, back translation, expert group review and implementation by a pilot group with a subsequent cognitive interview. Internal consistency was determined by Cronbach's alpha. Reliability was verified by an initial application of the scale, followed by a repetition after seven days, analysing the results obtained in terms of the intraclass correlation coefficient, the construct validity (by Spearman's non-parametric correlation test) and confirmatory factor analysis (using JASP 0.16.4 statistical software). RESULTS Cronbach's alpha resulted in 0.95. Spearman's correlation coefficient Family Nursing Practice Scale total with the course year was -0.26 < 0.001. The intraclass correlation coefficient for the total score of the scale was 0.91. The confirmatory factor analysis was performed on a model in which the total score for the scale was considered in relation to the two subscales, and each subscale in relation to its constituent items. The p-value associated with the chi-square was 0.550. The root mean square error of approximation and comparative fit indices presented values of <0.001 (90 % C.I. <0.001-0.048) and 1.000, respectively. CONCLUSIONS These results indicate that the Spanish version presents good internal consistency, construct validity and reliability. Moreover, the confirmatory factor analysis confirms that it presents a good fit to the model initially proposed for this scale for Nursing Degree students.
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Affiliation(s)
| | | | - Inmaculada López-Leiva
- Faculty of Health Sciences, Department of Nursing, University of Málaga, Malaga, Andalucía 29071, Spain
| | | | - Susana Del Río-Urenda
- Faculty of Health Sciences, Department of Nursing, University of Málaga, Malaga, Andalucía 29071, Spain
| | - Silvia Navarro-Prado
- Faculty of Health Sciences, Department of Nursing, Melilla Campus, University of Granada, Melilla 52005, Spain
| | - Marina García-Gámez
- Faculty of Health Sciences, Department of Nursing, University of Málaga, Malaga, Andalucía 29071, Spain
| | - Cristina Casals
- ExPhy Research Group, Department of Physical Education, Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Universidad de Cádiz, Puerto Real 11519, Spain
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Burns M, Bally J, Burles M, Peacock S. Critically Ill Patients: Family Experiences of Interfacility Transfers From Rural to Urban Centers and Impact on Family Relationships. JOURNAL OF FAMILY NURSING 2023; 29:74-88. [PMID: 36172740 PMCID: PMC9850375 DOI: 10.1177/10748407221124254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A critical illness event is intensely stressful for family members and can lead to negative psychological, emotional, social and financial consequences. In geographically rural areas, critically ill patients may require an interfacility transfer to an urban centre for advanced critical care services. In this context, research suggests that these family members from rural areas experience additional burdens, yet little is known about these experiences. An interpretive phenomenological approach was used to explore lived experiences of family members from rural areas whose critically ill relative undergoes an interfacility transfer to an urban centre for advanced critical care services. Participants described feelings of vulnerability in the urban centre, the need to protect the critically ill patient and other relatives, maintaining responsibilities at home, navigating family relationships, and a loss of connection during the transfer window. These findings may better position nurses to address family members' stress and anxiety during this experience.
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Affiliation(s)
- Margie Burns
- University of Prince Edward Island,
Charlottetown, Canada
| | - Jill Bally
- University of Saskatchewan, Saskatoon,
Canada
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Robson B, McAnulty G, Secombe P. Critical care resource use associated with tourism in Central Australia. Aust J Rural Health 2021; 29:408-416. [PMID: 34085730 DOI: 10.1111/ajr.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/16/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Tourism to regional and remote Australia is increasing. Its impact on regional critical care services is incompletely understood. We describe tourist admissions and their impact on critical care resources relative to the local population. DESIGN Single-centre retrospective study using prospectively collected data from January 2009 to December 2018. SETTING Australian regional intensive care unit. PARTICIPANTS All critical care admissions for patients aged over 18 years for whom postcode data were available were included. OUTCOME MEASURES Primary outcome was hospital mortality. Secondary outcomes examined resource use (intensive care unit and hospital length of stay, mechanical ventilation, interhospital transfer) and admission diagnosis. RESULTS Tourists comprise 6.1% of critical care admissions, occupying 5.7% of intensive care unit bed days. They were less likely to be Indigenous (6.3% vs 72.7%), but older (61.5 vs 49.2 years) and male (65.4% vs 52.6%). They were more frequently admitted following acute myocardial infarction (14.2% vs 8.9%) or trauma (20.0% vs 5.0%). There was no difference in hospital mortality (2.9% vs 4.0%) or intensive care unit mortality (2.4% vs 1.8%); however, tourists were more than twice as likely to require interhospital transfer (31.7% vs 14.0%). These findings persisted after adjustment for illness severity. CONCLUSION Tourists are an appreciable caseload of this regional intensive care unit and are more likely to require interhospital transfer. There was no difference in mortality. Further research is required across regional and rural Australia to better understand the epidemiology and impact of tourism on critical care resources, and the economic implications of becoming unwell in a regional area.
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Affiliation(s)
- Briony Robson
- Intensive Care Unit, St Vincent's Private Hospital Northside, Brisbane, Qld, Australia.,Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Clinical Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Greg McAnulty
- Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Medicine, Flinders University, Bedford Park, SA, Australia
| | - Paul Secombe
- Intensive Care Unit Alice Springs Hospital, Alice Springs, NT, Australia.,School of Medicine, Flinders University, Bedford Park, SA, Australia.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell, Vic., Australia
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Kerlin MP, Costa DK, Kahn JM. The Society of Critical Care Medicine at 50 Years: ICU Organization and Management. Crit Care Med 2021; 49:391-405. [PMID: 33555776 DOI: 10.1097/ccm.0000000000004830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Meeta Prasad Kerlin
- Division of Pulmonary, Allergy, and Critical Care Medicine and Palliative and Advanced Illness Research Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA
| | - Deena Kelly Costa
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Institute for Healthcare Innovation & Policy, University of Michigan, Ann Arbor, MI
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA
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Karlsson J, Eriksson T, Lindahl B, Fridh I. Family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer: A phenomenological hermeneutical study. J Clin Nurs 2020; 29:3721-3730. [PMID: 32644235 DOI: 10.1111/jocn.15402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/23/2020] [Accepted: 06/21/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To reveal meanings of family members' lived experiences when a loved one undergoes an interhospital intensive care unit-to-unit transfer. BACKGROUND Interhospital intensive care unit-to-unit transfers take place between different hospitals and their respective intensive care units (ICUs). These types of transfers are an increasing phenomenon but are sparsely studied from the family members' perspective. Indeed, the patient's critical illness and care can have a major impact on family members. During the transfer process, there is a demand for the involved intensive care health personnel to make family members feel safe and cared for. DESIGN A qualitative design based on phenomenological hermeneutics. METHODS The study was conducted at two Swedish general ICUs. Data were generated through individual in-depth interviews with seven family members and analysed using a phenomenological hermeneutical approach. The Criteria for Reporting Qualitative Research principles were applied in the conduct and reporting of this study. RESULTS Four themes that reveal meanings of family members' lived experiences were developed: losing your safe haven, dealing with uncertainty, carrying your own and others' burdens and a wish to be close. CONCLUSIONS The study reveals that an interhospital intensive care unit-to-unit transfer affects the whole family and is characterised by family members experiencing many negative feelings. The findings also illustrate that being a family member when a loved one is transferred means being exposed to the core existential elements of being human, such as loneliness and searching for meaning. RELEVANCE TO CLINICAL PRACTICE The study highlights the importance of maintaining a family-centred approach during the transfer process. Our findings can provide deeper knowledge for intensive care health personnel, better preparing them for the delicate task of providing family-centred care during the interhospital intensive care unit-to-unit transfer process.
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Affiliation(s)
- Jonas Karlsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Thomas Eriksson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Berit Lindahl
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Isabell Fridh
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tume LN, Trapani J. What's in this issue. Nurs Crit Care 2020. [DOI: 10.1111/nicc.12506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lyvonne N. Tume
- School of Health & SocietyUniversity of Salford Manchester UK
| | - Josef Trapani
- Faculty of Health SciencesUniversity of Malta L‐Imsida Malta
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