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Meiring-Noordstra A, van der Meulen IC, Onrust M, Hafsteinsdóttir TB, Luttik ML. Relatives' experiences of the transition from intensive care to home for acutely admitted intensive care patients-A qualitative study. Nurs Crit Care 2024; 29:117-124. [PMID: 37154290 DOI: 10.1111/nicc.12918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Acute admission to an intensive care unit (ICU) can negatively affect quality of life for patients and their relatives. Relatives play an important caregiving role after the patient's admission. More knowledge and understanding of their needs are necessary as the patient transitions home. AIM This study aims to explore relatives' experiences of acutely admitted ICU patients' transition from the ICU to a general ward and then home. STUDY DESIGN A qualitative study with a phenomenological approach was conducted. Interviews were in-depth and featured open-ended questions. The interviews took place after the patients transitioned from ICU to home and were conducted online by videoconference. Data were analysed using Colaizzi's seven-step method. RESULTS Twelve relatives of acutely admitted ICU patients were interviewed. Five main themes emerged: (1) mixed feelings, (2) sense of not being involved, (3) limited information provision, (4) lack of acknowledgement as a caregiver, and (5) an uncertain future perspective. Relatives experience major uncertainties during transitions and prefer to be actively involved in care and care decisions. CONCLUSIONS This study indicates that relatives of ICU patients experience a lack of guidance during the transitions from the ICU to a general ward and to home, or a follow-up facility. More focus is needed on the themes of mixed feelings, the sense of not being involved, limited information provision, lack of acknowledgement as a caregiver, and an uncertain future perspective. This increased focus might improve the guidance during these transitions. RELEVANCE TO CLINICAL PRACTICE The insights from this study may help to improve the care of patients and their relatives during the transitions.
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Affiliation(s)
- Aaltje Meiring-Noordstra
- Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ingeborg C van der Meulen
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, The Netherlands
| | - Marisa Onrust
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thóra B Hafsteinsdóttir
- Nursing Science, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
- Nursing Science Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie Louise Luttik
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Family Care, University of Applied Sciences Hanzehogeschool, lectorate in Nursing Diagnostics, Groningen, The Netherlands
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Mottaghi K, Hasanvand S, Goudarzi F, Heidarizadeh K, Ebrahimzadeh F. The role of the ICU liaison nurse services on anxiety in family caregivers of patients after ICU discharge during COVID-19 pandemic: a randomized controlled trial. BMC Nurs 2022; 21:253. [PMID: 36088385 PMCID: PMC9464053 DOI: 10.1186/s12912-022-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background With the onset of the COVID-19 pandemic and the need to maintain social distancing and changes in wards' structure, families no longer access the routine support they received during the hospitalization of their patients in the ICU. This study aimed to determine the effects of ICU liaison nurse services on the anxiety in patients’ family caregivers after ICU discharge during the COVID-19 pandemic. Methods This randomized controlled trial was performed in western Iran from February 2020, to March 2021. Sixty subjects were selected from the family caregivers of the patients transferred from the ICU and were randomly assigned to the control (n = 30) and the intervention groups (n = 30). The control group received routine transfer care. In the intervention group, liaison nurse services were offered in 4 dimensions: patient support, family support, training, support of the ward’s staff, and the evaluation of the destination ward. The participants’ anxiety was measured using the Spielberger State Anxiety Inventory immediately after the patient transfer and 6 h after admission to the general ward. Data analyzed with SPSS V16, descriptive and inferential statistics, including Chi-square test, Mann–Whitney test, Wilcoxon test, and Generalized Linear Model with cumulative logit link function. Results were reported at a 0.05 significance level. Results A statistically significant difference was observed in baseline anxiety levels (P = 0.035) and age group (P < 0.001) between the intervention and control groups. After moderating baseline anxiety levels, the age group, and marital status, the impact of the intervention was significant (X2 = 10.273, df = 1, P < 0.001), meaning that the intervention could reduce the relative chances of developing higher levels of anxiety by 92.1% (OR: 0.08, 95%CI: 0.017–0.373, P < 0.001). Conclusions This study confirmed the positive impact of nursing services on reducing anxiety in family caregivers during the COVID-19 pandemic. It is recommended to use these services, especially during the COVID-19 condition, to facilitate the patient transfer, support the patient's family, and reduce the health care gap between the ICU and the ward. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01034-6.
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Li B, Yang Q. The effect of an ICU liaison nurse-led family-centred transition intervention program in an adult ICU. Nurs Crit Care 2022; 28:435-445. [PMID: 35396917 DOI: 10.1111/nicc.12764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND ICUs follow a restrictive companionship policy, especially after the COVID-19 outbreak. This strategy often limits the time families spend with patients, hinders their knowledge and skills in caregiving, and the sudden transfer of ICU patients to assist with disease monitoring and daily care can be very stressful for families. It is beneficial to use the transition period of transferring ICU patients to help families adjust to the role of caregiver. AIMS AND OBJECTIVES To develop and implement a patient- and family-centered transitional care intervention plan for patients transferred to the ICU. DESIGN Prospective, pretest and posttest design. METHODS The experimental group received an individualized family-centered transition plan led by the ICU liaison nurse that included 1) communication with health care professionals; distribution of a transfer booklet; 2) identification of nursing issues and communication with the ward nurse; invitation of family members to participate in the patient's rehabilitation; 3) follow-up instruction on bedside range of motion exercises; and provision of a patient rehabilitation diary. Patients in the control group received only routine care. Data were collected using the General Information Questionnaire, Family Satisfaction with ICU Patients (FS-ICU), the Family Relocation Stress Scale (FRSS), and the Stanford Acute Stress Response Questionnaire (SASRQR). RESULTS After the intervention, the total family satisfaction score of ICU patients in the experimental group was significantly higher than that of the control group (87.18 ± 8.38 vs 78.74 ± 10.63, p<0.001), and the satisfaction with the care and information provided was significantly higher in the experimental group compared to the control group (p < 0.001), with no significant difference between the two groups in terms of satisfaction with decision making (p>0.001). The level of relocation stress of patients' families was significantly lower in the experimental group compared to the control group after the intervention (p < 0.001). And there was no statistically significant difference between the two groups in terms of patients' acute stress disorder scores (p>0.001). CONCLUSION The implementation of a family-involved transition care programme significantly improved the satisfaction of ICU patients' families and reduced the stress of relocation for patients' families. RELEVANCE TO CLINICAL PRACTICE Focusing on the transition of ICU patients to ensure continuity of critical care and improve the quality of care for ICU patient transfers can be accomplished through a family-centered transition care plan led by the ICU liaison nurse.
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Affiliation(s)
- Baiyu Li
- Department of Comprehensive Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, Jiangsu, China.,Nursing College of Yangzhou University, Yangzhou, Jiangsu, China
| | - Qin Yang
- Department of Comprehensive Intensive Care Unit, Affiliated Hospital of Yangzhou University, Yangzhou First People's Hospital, Yangzhou, Jiangsu, China.,Nursing College of Yangzhou University, Yangzhou, Jiangsu, China
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The experiences and needs of relatives of intensive care unit patients during the transition from the intensive care unit to a general ward: A qualitative study. Aust Crit Care 2020; 33:526-532. [DOI: 10.1016/j.aucc.2020.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/06/2020] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
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Hervé MEW, Zucatti PB, Lima MADDS. Transition of care at discharge from the Intensive Care Unit: a scoping review. Rev Lat Am Enfermagem 2020; 28:e3325. [PMID: 32696919 PMCID: PMC7365613 DOI: 10.1590/1518-8345.4008.3325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/07/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to map the available evidence on the components of the transition of care, practices, strategies, and tools used in the discharge from the Intensive Care Unit (ICU) to the Inpatient Unit (IU) and its impact on the outcomes of adult patients. METHOD a scoping review using search strategies in six relevant health databases. RESULTS 37 articles were included, in which 30 practices, strategies or tools were identified for organizing and executing the transfer process, with positive or negative impacts, related to factors intrinsic to the Intensive Care Unit and the Inpatient Unit and cross-sectional factors regarding the staff. The analysis of hospital readmission and mortality outcomes was prevalent in the included studies, in which trends and potential protective actions for a successful care transition are found; however, they still lack more robust evidence and consensus in the literature. CONCLUSION transition of care components and practices were identified, in addition to factors intrinsic to the patient, associated with worse outcomes after discharge from the Intensive Care Unit. Discharges at night or on weekends were associated with increased rates of readmission and mortality; however, the association of other practices with the patient's outcome is still inconclusive.
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Min J, Kim Y, Lee JK, Lee H, Lee J, Kim KS, Cho YJ, Jo YH, Ryu HG, Kim K, Lee SM, Lee YJ. Survey of family satisfaction with intensive care units: A prospective multicenter study. Medicine (Baltimore) 2018; 97:e11809. [PMID: 30095649 PMCID: PMC6133602 DOI: 10.1097/md.0000000000011809] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022] Open
Abstract
Although family satisfaction is an important indicator for quality improvement of intensive care units (ICUs), few studies have translated family satisfaction data into quality improvement in Asia. A prospective multicenter study was conducted to evaluate family satisfaction regarding the care of patients and their family.The family satisfaction in the ICU (FS-ICU) questionnaire was administered from January 2015 to February 2016 at ICUs of 3 tertiary teaching hospitals in South Korea. Family members of adult patients, staying at an ICU for ≥48 hours, were included. Key factors affecting satisfaction were identified using quantitative and qualitative analyses.In total, 200 family members participated in this survey. The mean score for overall family satisfaction (FS-ICU/total) was 75.4 ± 17.7. The mean score for satisfaction with information/decision-making was greater than that for satisfaction with care (78.2 ± 18.2 vs 73.5 ± 19.4; P ≤ .001). Family members who agreed to not resuscitate and whose patient died at the ICU had lower FS-ICU/total scores. When compared with hospital A, hospital C was an independent predictor with an FS-ICU/total score of <75. Families reported the least satisfaction for the atmosphere of the ICU, including the waiting room atmosphere and management of agitation.We evaluated family satisfaction regarding ICUs for the first time in Asia using a validated tool. The decision to not resuscitate, ICU mortality, and ICU culture were associated with family satisfaction with critical care. Efforts should be targeted for improving factors that cause low family satisfaction when planning quality improvement interventions for ICUs in Asia.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon
| | - Youlim Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center
| | | | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | | | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
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Shafipour V, Moosazadeh M, Jannati Y, Shoushi F. The effect of education on the anxiety of a family with a patient in critical care unit: a systematic review and meta-analysis. Electron Physician 2017; 9:3918-3924. [PMID: 28461865 PMCID: PMC5407223 DOI: 10.19082/3918] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Studies have shown that family members of patients in intensive care units experience high levels of anxiety. Contradictions in the results of the studies conducted regarding the effect of training on the anxiety level of such families, emphasize the necessity of employing other research methods to eliminate these ambiguities. OBJECTIVE This study applied meta-analysis to determine the effect of training on the anxiety level of families with patients in the intensive care unit. METHODS In order to find electronically published studies from 1990 to 2016, the articles published in journals indexed in the following databases were used: Elsevier, Scopus, ProQuest, ISI, Web of Science, PubMed, Google scholar and Cochrane. For data analysis Stata Software version 11 was used and the heterogeneity index of studies was determined through Cochran (Q) and I2. Due to the heterogeneity, the random effect model was used to estimate the difference between the standardized mean of anxiety. RESULTS In this meta-analysis and systematic review article, eight articles were found to be eligible. The number of samples in the initial studies into a meta-analysis included 387 patients in the intervention group and 393 people in the control group. Standardized difference of the mean anxiety score in the intervention group was -0.329 (CI 95%: -0.756-0.099) units less than that of the control group, indicating that this effect was not statistically significant. CONCLUSIONS The results of this meta-analysis show that training will decline the anxiety level of a family with patients hospitalized in the intensive care unit, although the impact is not considerable.
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Affiliation(s)
- Vida Shafipour
- Ph.D., Assistant Professor, Department of Medical-Surgical Nursing, Nasibeh Nursing & Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Ph.D., Assistant Professor, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yadollah Jannati
- Ph.D., Assistant Professor, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fariba Shoushi
- MSc student of Nursing and Midwifery Faculty & Student's Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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