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Moreines LT, Brody AA, Murali KP. An Evolutionary Concept Analysis of the "Fighter" in the Intensive Care Unit. J Hosp Palliat Nurs 2024; 26:158-165. [PMID: 38345365 DOI: 10.1097/njh.0000000000001017] [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: 05/08/2024]
Abstract
The purpose of this article was to analyze the concept of "the fighter in the intensive care unit (ICU)" per the scientific literature and the impact this mentality has on care administered in the ICU. A literature review and a concept analysis based on Rodger's evolutionary method were performed to identify surrogate terms, antecedents, attributes, and consequences pertaining to the "fighter" in the ICU. Thirteen articles with a focus on "the fighter" were included in this analysis. There is a strong desire to remain optimistic and maintain high spirits as a coping mechanism in the face of extreme prognostic uncertainty. Themes that emerged from the literature were the need to find inner strength and persist in the face of adversity. The concept of "the fighter in the ICU" can serve as either adaptive or maladaptive coping, depending on the larger clinical picture. Patient experiences in the ICU are fraught with physical and psychological distress. How the patient and family unit cope during this anxiety-provoking time is based on the individual. Maintaining optimism and identifying as a fighter can be healthy ways to adapt to the circumstances. This concept analysis highlights the importance of holistic care and instilling hope particularly as patients may be nearing the end of life.
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Schwartz NH, Teed DN, Glover CM, Basapur S, Blodgett C, Giesing C, Lawm G, Podzimek G, Reeter R, Schorfheide L, Swiderski S, Greenberg JA. Clinician-initiated written communication for families of patients at a long-term acute care hospital. PEC INNOVATION 2023; 3:100179. [PMID: 38213760 PMCID: PMC10782111 DOI: 10.1016/j.pecinn.2023.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 01/13/2024]
Abstract
Objective To assess the experience of families and clinicians at a long term acute care hospital (LTACH) after implementing a written communication intervention. Methods Written communication templates were developed for six clinical disciplines. LTACH clinicians used templates to describe the condition of 30 mechanically ventilated patients at up to three time points. Completed templates were the basis for written summaries that were sent to families. Impressions of the intervention among families (n = 21) and clinicians (n = 17) were assessed using a descriptive correlational design. Interviews were analyzed using thematic content analysis. Results We identified four themes during interviews with families: Written summaries 1) facilitated communication with LTACH staff, 2) reduced stress related to COVID-19 visitor restrictions, 3) facilitated understanding of the patient condition, prognosis, and goals and 4) facilitated communication among family members. Although clinicians understood why families would appreciate written material, they did not feel that the intervention addressed their main challenge - overly optimistic expectations for patient recovery among families. Conclusion Written communication positively affected the experience of families of LTACH patients, but was less useful for clinicians. Innovation Use of written patient care updates helps LTACH clinicians initiate communication with families.
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Affiliation(s)
| | - Don N. Teed
- West Suburban Medical Center, Oak Park, United States
| | - Crystal M. Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, United States
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, United States
| | - Santosh Basapur
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, United States
| | | | | | - Gerald Lawm
- RML Specialty Hospital, Chicago, United States
| | | | | | | | | | - Jared A. Greenberg
- Department of Internal Medicine, Rush University Medical Center, Chicago, United States
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Howard AF, Crowe S, Choroszewski L, Kovatch J, Kelly M, Haljan G. When chronic critical illness is a family affair: A multi-perspective qualitative study of family involvement in long-term care. Chronic Illn 2023; 19:804-816. [PMID: 36426509 PMCID: PMC10655697 DOI: 10.1177/17423953221141134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 11/05/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Those with chronic critical illness (CCI) remain dependent on life-sustaining treatments and increasingly reside in long-term care facilities equipped to meet their needs. The nature of family involvement in care remains undetermined thwarting approaches to mitigate poor family outcomes. The research objective was to explicate family involvement in the care of an individual with CCI who resides in long-term care. METHODS In this qualitative research, we used thematic analysis and constant comparative techniques to analyze data from interviews with 38 participants: 11 family members, 6 residents with CCI, and 21 healthcare providers. RESULTS Involvement in care entailed family: (1) reorienting their life despite the stress and emotional toll; (2) assuming responsibility for meaningful activities and management of practical matters, yet struggling alone; (3) advocating for care by being present, reminding and pushing, and picking their battles; and (4) figuring out how to contribute to nursing care, but with unclear expectations. DISCUSSION The burden of family caregiving was substantial, contrasting the assumption that family are relieved of their caregiver responsibilities when the patient with CCI is in a care facility. Research to address unmet family needs specific to their roles and responsibilities could potentially improve family outcomes and is warranted.
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Affiliation(s)
- A Fuchsia Howard
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Crowe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Critical Care, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Laura Choroszewski
- Department of Critical Care, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Joe Kovatch
- Department of Critical Care, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Mary Kelly
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregory Haljan
- Department of Critical Care, Fraser Health Authority, Surrey, British Columbia, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Hill DL, Boyden JY, Feudtner C. Hope in the context of life-threatening illness and the end of life. Curr Opin Psychol 2023; 49:101513. [PMID: 36481600 DOI: 10.1016/j.copsyc.2022.101513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Recent research shows the importance of hope in the context of life-threatening illness and the end of life for patients and their families. While some patients and family members continue to hope for a cure or extending life, others may develop more complex hopes related to quality of life and making the most of the time left. Clinicians often worry about taking hope away with bad news about the patient's prognosis, but patients and family members often appreciate honesty without losing hope. Clinicians should recognize that hopes in the context of serious, progressive illness may be complex, contradictory, culturally based, and evolve over time. Recent interventions have been developed to support hope for these patients, caregivers, and parents.
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Affiliation(s)
- Douglas L Hill
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Jackelyn Y Boyden
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Feudtner
- Justin Ingerman Center for Palliative Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of General Pediatrics, Department of Pediatrics, Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Leung KM, McCoy TH, Rubin EB. Changes in Orders for Life-Sustaining Treatment in Patients Requiring Prolonged Mechanical Ventilation. J Palliat Med 2022; 25:1850-1856. [PMID: 36201303 DOI: 10.1089/jpm.2022.0194] [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: 01/04/2023] Open
Abstract
Background: Growing numbers of acute critical illness survivors experience chronic critical illness (CCI) marked by prolonged dependence on life support, delirium, and/or disability. There is minimal recent data on treatment limitations in CCI. Objectives: To evaluate the natural history of changes in orders for life-sustaining treatment (OLST) in patients requiring prolonged mechanical ventilation. Design: Retrospective cohort study of 410 patients who received tracheostomy in an intensive care unit for prolonged respiratory failure. Results: Three hundred twenty-four patients had one OLST throughout the admission, with no limitations on prearrest life-sustaining treatment or cardiopulmonary resuscitation. The 86 patients who underwent at least one change in OLST were older, had longer admissions, were more likely to be deceased at hospital discharge, and were more likely to have received specialty palliative care. Thirty percent of OLST changes occurred in the last week of admission. Conclusions: OLST occur infrequently and late in patients with CCI.
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Affiliation(s)
- Krystle M Leung
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas H McCoy
- Division of Clinical Research, Center for Quantitative Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily B Rubin
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Dammann M, Staudacher S, Simon M, Jeitziner MM. Insights into the challenges faced by chronically critically ill patients, their families and healthcare providers: An interpretive description. Intensive Crit Care Nurs 2021; 68:103135. [PMID: 34736830 DOI: 10.1016/j.iccn.2021.103135] [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: 01/27/2021] [Revised: 08/03/2021] [Accepted: 08/15/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To describe and understand the challenges of patients with chronic critical illness (CCI), their families and healthcare providers during the disease trajectory. METHODOLOGY/DESIGN This qualitative study follows Thorne's methodology of interpretive description and was guided by the ethnographic method of observation and participation. Five cases, each comprising one patient with chronic critical illness their family members and several healthcare providers, were followed from the intensive care unit of a university hospital in Switzerland across different settings. In total, five patients with chronic critical illness, 12 family members and 92 healthcare providers (nurses, nursing students, care assistants, physiotherapists and occupational therapists and physicians) were observed. FINDINGS Regardless of the medical diagnoses and disease trajectories of the patients with chronic critical illness, all cases faced three main challenges: 1. Dealing with the unpredictability of the disease trajectory beyond the underlying disease. 2. Coping with the complexity of care. 3. Perceiving communication challenges despite all involved parties' dependency on it. CONCLUSION Unpredictability is not only a unique characteristic of the prolonged disease trajectory of patients with chronic critical illness, but also one of the main challenges of the participants. Therefore, the way unpredictability is handled is dependent on changes in the complexity of care and communication, highlighting the need for participation, information, empathy, clarity and honesty among all participants.
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Affiliation(s)
- Maria Dammann
- Department of Nephrology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Sandra Staudacher
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Michael Simon
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Nursing Research Unit, Department of Nursing, University Hospital Bern (Inselspital), Freiburgstrasse 4, 3010 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.
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Howard F, Crowe S, Beck S, Haljan G. Attending to Methodological Challenges in Qualitative Research to Foster Participation of Individuals with Chronic Critical Illness and Communication Impairments. Glob Qual Nurs Res 2021; 8:23333936211000044. [PMID: 33954226 PMCID: PMC8058801 DOI: 10.1177/23333936211000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Individuals with chronic critical illness experience multiple complex physiological disturbances including ongoing respiratory failure, requiring prolonged mechanical ventilation, and thus communication impairments. In conducting a qualitative interpretive description study, we sought to ensure that individuals with chronic critical illness themselves were included as participants. Our commitment to recruiting these individuals to the study and ensuring their data meaningfully informed the analysis and findings required us to reconsider and challenge some of the traditional notions of high-quality qualitative research and develop appropriate practical strategies. These strategies included: (1) centering participant abilities and preferences, (2) adopting a flexible approach to conducting interviews, (3) engaging in a therapeutic relationship, and (4) valuing "thin" data. In this article, we extend existing literature describing the complexities of conducting research with individuals with communication impairments and strategies to consider in the hopes of informing future research with other populations historically excluded from study participation.
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Affiliation(s)
| | - Sarah Crowe
- The University of British Columbia, Vancouver, Canada.,Fraser Health, Surrey, BC, Canada
| | - Scott Beck
- The University of British Columbia, Vancouver, Canada
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