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Jensen HI, Rasmussen CK, Haberlandt TN, Jensen SS. End-of-life issues experienced by the nurse-led rapid response team: An analysis of extent and experiences. Intensive Crit Care Nurs 2023; 76:103411. [PMID: 36796162 DOI: 10.1016/j.iccn.2023.103411] [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: 12/13/2022] [Revised: 01/05/2023] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To examine the frequency, clinical characteristics and nurse-led rapid response team experiences of calls that involve end-of-life issues. RESEARCH METHODOLOGY AND DESIGN The study consisted of two parts: 1) a retrospective journal audit of registered rapid response team calls for 2011-2019 that involved end-of-life issues, and 2) interviews with intensive care rapid response team nurses. The quantitative data were analysed with descriptive statistics and the qualitative data with content analysis. SETTING The study was conducted at a Danish university hospital. RESULTS Twelve percent (269/2,319) of the rapid response team calls involved end-of-life issues. "No indication for intensive care therapy" and "Do not resuscitate" were the main medical end-of-life orders. The patients had a mean age of 80 years, and the main reason for the calls was a respiratory problem. Ten rapid response team nurses were interviewed, and four themes evolved from the analysis: "Uncertain roles for the rapid response team nurses", "Solidarity with ward nurses", "Lack of information" and "Timing of decision-making". CONCLUSION Twelve percent of the rapid response team calls involved end-of-life issues. The main reason for these calls was a respiratory problem, and the rapid response team nurses often found their role uncertain and experienced lack of information and sub-optimal timing of decision-making. IMPLICATIONS FOR CLINICAL PRACTICE Intensive care nurses working in a rapid response team often face end-of-life issues during calls. Therefore, end-of-life care should be included in training for rapid response team nurses. Furthermore, advanced care planning is recommended to secure high-quality end-of-life care and to decrease uncertainty in acute medical situations.
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Affiliation(s)
- Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J. B. Winsløwsvej 19.3, 5000 Odense C, Denmark.
| | - Christina Kirkegaard Rasmussen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Trine Nørskov Haberlandt
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
| | - Sabrina Schøler Jensen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
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Muehlensiepen F, Knitza J, Marquardt W, May S, Krusche M, Hueber A, Schwarz J, Vuillerme N, Heinze M, Welcker M. Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413127. [PMID: 34948737 PMCID: PMC8701397 DOI: 10.3390/ijerph182413127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.
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Affiliation(s)
- Felix Muehlensiepen
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Correspondence:
| | - Johannes Knitza
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Wenke Marquardt
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
| | - Susann May
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
| | - Martin Krusche
- Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Axel Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, 90419 Nürnberg, Germany;
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Institut Universitaire de France, 75006 Paris, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38400 Grenoble, France
| | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, 82152 Planegg, Germany;
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Mühlensiepen F, Kurkowski S, Krusche M, Mucke J, Prill R, Heinze M, Welcker M, Schulze-Koops H, Vuillerme N, Schett G, Knitza J. Digital Health Transition in Rheumatology: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052636. [PMID: 33807952 PMCID: PMC7967307 DOI: 10.3390/ijerph18052636] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022]
Abstract
The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.
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Affiliation(s)
- Felix Mühlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf, Germany;
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14476 Potsdam, Germany;
- Correspondence:
| | - Sandra Kurkowski
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany;
| | - Martin Krusche
- Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University, 40225 Duesseldorf, Germany;
| | - Robert Prill
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14476 Potsdam, Germany;
- Department of Orthopaedics and Trauma Surgery, Brandenburg Medical School Theodor Fontane, Municipal Clinic Brandenburg, 14770 Brandenburg, Germany
| | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf, Germany;
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, 82152 Planegg, Germany;
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität München, 80336 Munich, Germany;
| | - Nicolas Vuillerme
- AGEIS, Faculty of Medicine, Université Grenoble Alpes, 38706 Grenoble, France; (N.V.); (J.K.)
- Institut Universitaire de France, 75006 Paris, France
- LabCom Telecom4Health, Université Grenoble Alpes & Orange Labs, 38400 Grenoble, France
| | - Georg Schett
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Johannes Knitza
- AGEIS, Faculty of Medicine, Université Grenoble Alpes, 38706 Grenoble, France; (N.V.); (J.K.)
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany;
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
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