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Krupp AE, Tan A, Vasilevskis EE, Mion LC, Pun BT, Brockman A, Hetland B, Ely EW, Balas MC. Patient, Practice, and Organizational Factors Associated With Early Mobility Performance in Critically Ill Adults. Am J Crit Care 2024; 33:324-333. [PMID: 39217113 DOI: 10.4037/ajcc2024939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied. OBJECTIVES To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance. METHODS A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated. RESULTS In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01-1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59-1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14-2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04-2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30-1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39-0.49), delirium (AOR, 0.63; 95% CI, 0.59-0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79-0.92), physical restraints (AOR, 0.74; 95% CI, 0.68-0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68-0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance. CONCLUSIONS Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance.
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Affiliation(s)
- Anna E Krupp
- Anna E. Krupp is an assistant professor, College of Nursing, University of Iowa, Iowa City
| | - Alai Tan
- Alai Tan is a research professor, Center for Research and Health Analytics, The Ohio State University College of Nursing, Columbus
| | - Eduard E Vasilevskis
- Eduard E. Vasilevskis is a professor and chief of the Division of Hospital Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lorraine C Mion
- Lorraine C. Mion is a research professor, Center for Healthy Aging, Self-Management and Complex Care, The Ohio State University College of Nursing
| | - Brenda T Pun
- Brenda T. Pun is director of data quality, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Audrey Brockman
- Audrey Brockman is a graduate research assistant, The Ohio State University College of Nursing
| | - Breanna Hetland
- Breanna Hetland is an assistant professor, College of Nursing, University of Nebraska Medical Center, Omaha, and a critical care nurse scientist, Nebraska Medicine, Omaha
| | - E Wesley Ely
- E. Wesley Ely is a professor, Department of Medicine and the Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, and associate director of medicine and research, Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Michele C Balas
- Michele C. Balas is professor and associate dean of research, College of Nursing, University of Nebraska Medical Center
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Potter KM, Pun BT, Maya K, Young B, Williams S, Schiffman M, Hosie A, Boehm LM. Delirium and Coronavirus Disease 2019: Looking Back, Moving Forward. Crit Care Nurs Clin North Am 2024; 36:415-426. [PMID: 39069360 PMCID: PMC11284274 DOI: 10.1016/j.cnc.2023.12.003] [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] [Indexed: 07/30/2024]
Abstract
During the coronavirus disease 2019 pandemic, crisis changes in clinical care increased rates of delirium in the intensive care unit (ICU). Deep sedation, unfamiliar environments with visitor restrictions, and such factors due to high workload and health system strain contributed to the occurrence of delirium doubling in the ICU. As the pandemic wanes, health care systems and ICU leadership must emphasize post-pandemic recovery, integrating lessons learned about delirium management, evidence-based care, and family involvement. Strategies to empower clinicians, creatively deliver care, and integrate families pave the way forward for a more holistic approach to patient care in the post-pandemic era.
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Affiliation(s)
- Kelly M Potter
- Department of Critical Care Medicine, CRISMA Center, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Brenda T Pun
- Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kerri Maya
- Sutter Health System, Sacramento, CA, USA
| | - Bethany Young
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stacey Williams
- Monroe Carrell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | - Annmarie Hosie
- School of Nursing & Midwifery Sydney, University of Notre Dame Australia, Sydney, New South Wales, Australia; Cunningham Centre for Palliative Care, St Vincent's Health Network Sydney, Sydney, New South Wales, Australia; IMPACCT- Improving Palliative, Aged and Chronic Care Through Research and Translation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
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Cussen J, Mukpradab S, Tobiano G, Haines KJ, O'Connor L, Marshall AP. Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study. Aust Crit Care 2024:S1036-7314(24)00120-6. [PMID: 39107155 DOI: 10.1016/j.aucc.2024.06.007] [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: 11/29/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.
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Affiliation(s)
- Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Sasithorn Mukpradab
- Griffith University, Southport, Queensland, Australia; Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand.
| | - Georgia Tobiano
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia.
| | - Lauren O'Connor
- Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Nyhagen R, Egerod I, Rustøen T, Lerdal A, Kirkevold M. Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit: A Qualitative Study. Dimens Crit Care Nurs 2024; 43:111-122. [PMID: 38564453 DOI: 10.1097/dcc.0000000000000637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients. OBJECTIVE The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit. METHODS A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis. RESULTS Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences). DISCUSSION Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.
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Papautsky EL, Abdulbaseer U. Capturing the Work of Patients' Family Members in the Medical Intensive Care Unit Using Naturalistic Observations. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:84-91. [PMID: 37553816 DOI: 10.1177/19375867231190620] [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] [Indexed: 08/10/2023]
Abstract
BACKGROUND The contributions of cognitive and behavioral work of patients' family members in intensive care units remain largely unrecognized. OBJECTIVE The objective of this study was to develop a framework of outwardly observable family work, with specific focus on describing the physical space. METHODS We conducted approximately 50 hrs of naturalistic observations of family activities on a medical intensive care unit (MICU) at a large, Midwestern teaching hospital. RESULTS We created a framework of activities that include requesting, receiving, or delivering either information or action, along with examples. Further, we identified clinician and staff roles with whom families interact and characterized the physical spaces in which interactions take place. CONCLUSIONS Knowledge contribution is a proposed framework of family activities in the MICU. It has the potential to guide and be further described by future research and to inform development of human-centered family-facing interventions to support cognitive and behavioral cognitive and behavioral work.
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Dayton K, Hudson M, Lindroth H. Stopping Delirium Using the Awake-and-Walking Intensive Care Unit Approach: True Mastery of Critical Thinking and the ABCDEF Bundle. AACN Adv Crit Care 2023; 34:359-366. [PMID: 38033207 PMCID: PMC11019856 DOI: 10.4037/aacnacc2023159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Kali Dayton
- Kali Dayton is ICU Sedation and Mobility Consultant, Dayton ICU Consulting, Washington
| | - Mark Hudson
- Mark Hudson is an ICU survivor and patient advocate for improved ICU care; podcaster of the ICU Life and Recovery podcast; and a student at the School of Psychology and Counselling, The Open University, Milton Keynes, United Kingdom
| | - Heidi Lindroth
- Heidi Lindroth is a clinician-nurse scientist, Department of Nursing, Mayo Clinic, 200 1st St SW, Mayo Clinic, Rochester, MN, 55902 ; and an affiliate scientist, Center for Innovation and Implementation Science and the Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, Indiana
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McAndrew NS, Erickson J, Hetland B, Guttormson J, Patel J, Wallace L, Visotcky A, Banerjee A, Applebaum AJ. A Mixed-Methods Feasibility Study: Eliciting ICU Experiences and Measuring Outcomes of Family Caregivers of Patients Who Have Undergone Hematopoietic Stem Cell Transplantation. JOURNAL OF FAMILY NURSING 2023; 29:227-247. [PMID: 37191306 PMCID: PMC10330518 DOI: 10.1177/10748407231166945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The impact of an intensive care unit (ICU) admission on family caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT) has not been well described. Aims of this study were to determine the feasibility of conducting research with family caregivers of HSCT patients during an ICU admission and generate preliminary data about their experiences and engagement in care. Using a mixed-methods, repeated measures design, we collected data from family caregivers after 48 hr in the ICU (T1) and at 48 hr after transferring out of ICU (T2). Enrolling HSCT caregivers in research while in the ICU was feasible (10/13 consented; 9/10 completed data collection at T1); however, data collection at T2 was not possible for most caregivers. Caregiver distress levels were high, and engagement in care was moderate. The three themes that emerged from interviews (n = 5) highlighted that although HSCT family caregivers faced many challenges and received limited support during their ICU experience, they were able to access their own personal resources and demonstrated resilience.
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Affiliation(s)
- Natalie S McAndrew
- University of Wisconsin-Milwaukee, USA
- Froedtert & the Medical College of Wisconsin, Milwaukee, USA
| | | | - Breanna Hetland
- University of Nebraska Medical Center, Omaha, USA
- Nebraska Medicine, Omaha, USA
| | | | | | | | | | | | - Allison J Applebaum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medicine, New York, NY, USA
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Watland S, Solberg Nes L, Hanson E, Ekstedt M, Stenberg U, Børøsund E. The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study. JMIR Form Res 2023; 7:e46299. [PMID: 37097744 PMCID: PMC10170368 DOI: 10.2196/46299] [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: 02/09/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. OBJECTIVE This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. METHODS The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). RESULTS The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. CONCLUSIONS This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.
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Affiliation(s)
- Solbjørg Watland
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Medicine Intensive Care Unit, Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lise Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry and Psychology, College of Medicine and Science, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth Hanson
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Swedish Family Care Competence Centre, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Una Stenberg
- Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway
- Frambu Resource Center for Rare Disorders, Ski, Norway
| | - Elin Børøsund
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Dunn H, Balas MC, Hetland B, Krupp A. Post-intensive care syndrome: A review for the primary care NP. Nurse Pract 2022; 47:15-22. [PMID: 36287731 DOI: 10.1097/01.npr.0000884864.28090.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT Post-intensive care syndrome is a costly and complicated collection of physical, cognitive, and mental health problems experienced by survivors of critical illness. The primary care NP is uniquely positioned to assess, monitor, manage, and treat patients with this syndrome following hospital discharge.
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Bakas T, Miller EL. Family Caregiving across the Lifespan and Conditions: Special Issue on Family Caregiving. West J Nurs Res 2021; 44:203-204. [PMID: 34873985 DOI: 10.1177/01939459211064029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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